Objective
To study the diagnostic value of hysteroscopy in abnormal uterine bleeding.
Methods
254 patients with abnormal uterine bleeding clearly diagnosed by the pathology department in this hospital were selected for the study, and the hysteroscopic findings were compared with the pathological diagnostic findings to evaluate the diagnostic value of hysteroscopy in abnormal uterine bleeding and also to analyze the common causes of abnormal uterine bleeding. Results The diagnostic hysteroscopic findings and pathological diagnostic findings in submucosal fibroids, endometrial polyps, uterine adhesions, cervical polyps, displaced IUDs, uterine malformations, and endometrial tuberculosis had a diagnostic compliance rate of 100.00%, and in dysfunctional uterine bleeding, postmenopausal bleeding, endometrial cancer cervical cancer, endometritis, and endometrial atypical hyperplasia, the compliance rates were 92.86%, 83.33%, 84.21%, 81.25%, and 50.00%, respectively. The overall compliance rate for hysteroscopic diagnostic findings was 91.34%. The common causes of bleeding in 254 patients in this study were endometrial polyps 16.93% (43/254), endometritis 11.02% (28/254), submucosal myoma 10.24% (26/254), endometrial cancer 8.27% (21/254), endometrial hyperplasia 7.09% (18/254), abnormal ring placement 7.09% (18/ 254), intrauterine residuals 15.75% (40/254), and the remaining patients were caused by birth control device breakage, displacement, and incomplete intrauterine cleaning.
Conclusion
The causes of abnormal uterine bleeding mainly include endometrial polyps, endometrial hyperplasia, endometrial cancer, and submucosal myoma, and the hysteroscopic diagnosis has a high rate of compliance with pathological diagnosis, which has a high clinical application value.
With the continuous maturation of hysteroscopic technology, its application in gynecological clinics has become more widespread. As an important branch of endoscopic surgery, the application of hysteroscopy in intrauterine lesions has important clinical value. Abnormal uterine bleeding is a common clinical disease in gynecology, with complex causative factors, mainly endometrial diseases, such as submucosal fibroids, endometrial polyps, endometritis, endometrial cancer, etc. At the same time, some female patients may bleed due to endocrine disorders and misplaced birth control devices. The clinical manifestations of abnormal uterine bleeding are diverse, and some patients have obvious pathological features, so the diagnosis is less difficult, but some patients cannot be clearly diagnosed by gynecologic ultrasound, pelvic MRI and other routine examinations. If the etiology is not clear before the diagnostic curettage, it can be classified as dysfunctional uterine bleeding, but the clinical diagnosis may still be different from the pathological diagnosis of curettage [1]. In contrast, with the help of hysteroscopy, not only can we understand the appearance and location of the lesion in the hysteroscope, but we can also complete the extraction with direct vision, thus improving the accuracy of the diagnosis [2]. In cases of abnormal uterine bleeding due to endometrial polyps and submucosal fibroids, hysteroscopic electrodesiccation to remove the lesion instead of hysterectomy can alleviate the surgical pain as well as the high cost of surgery. This study was conducted around the diagnosis of hysteroscopy in abnormal uterine bleeding during February 2011-January 2014 and is reported below.
1.Data and methods
1.1 General information
254 patients with abnormal uterine bleeding confirmed by the closed pathology department from February 2011 to January 2014 in this hospital, aged 22 to 85 years, with an average of (54.37±5.10) years, were selected for the study. Clinical manifestations included abnormal uterine bleeding, excessive menstrual flow, and severe secondary amenorrhea. Preoperatively, patients underwent routine ultrasound examination, with 142 cases of intrauterine occupying lesions, 70 cases of endometrial thickening, and 42 cases without abnormalities. Patients with bleeding due to internal diseases, hematologic diseases, acute genital infections, and contraindications to hysteroscopy were excluded. The vagina was cleaned using vaginal anti-inflammatory pessary 3-7 d after menstruation without history of intercourse, and patients with bleeding were given hemostatic treatment to relieve the symptoms of vaginal bleeding before hysteroscopy, and misoprostol tablets were placed into the vaginal opening in patients with tight cervical opening. The above patients were divided into postmenopausal bleeding group (107 cases), irregular menstruation group (85 cases), and pregnancy-related group (62 cases).
1.2 Methods
The electronic hysteroscope was manufactured by Nordoff, Germany, with 5% glucose injection as the dilatation medium at a pressure of 10-20 kPa. Hysteroscopy was started 3-7 d after menstrual cleansing, the bladder was emptied, the truncal position was taken, and the cervix was clamped through the cervical forceps to understand the depth and direction of the cervix with a probe. After evacuating the gas in the irrigation tube, the expansion fluid is injected into the uterine cavity, after which the hysteroscope is slowly inserted, the blood is flushed out of the hysteroscope, the fluid flow is adjusted so that the pressure in the uterine cavity meets the standard, the cervical canal and the uterine cavity can be observed after extending the uterine cavity, a biopsy specimen is taken from the suspicious area and sent for examination, after which a diagnostic scraping procedure is performed and the scraped specimen is sent to the pathology department for examination, the average operation time is about 15 min, and some Patients can directly rely on hysteroscopic guidance for treatment.
2. Results
2.1 Comparison of the conformity of hysteroscopic and pathological examination results
[Abstract] Objective To study the diagnostic value of hysteroscopy in abnormal uterine bleeding. Methods 254 patients who were clearly diagnosed with abnormal uterine bleeding by the pathology department in this hospital were selected for the study, and the hysteroscopic findings were compared with the pathological diagnostic findings to evaluate the diagnostic value of hysteroscopy in abnormal uterine bleeding and also to analyze the common causes of abnormal uterine bleeding. Results The diagnostic hysteroscopic findings and pathological diagnostic findings in submucosal fibroids, endometrial polyps, uterine adhesions, cervical polyps, displaced IUDs, uterine malformations, and endometrial tuberculosis had a diagnostic compliance rate of 100.00%, and in dysfunctional uterine bleeding, postmenopausal bleeding, endometrial cancer cervical cancer, endometritis, and endometrial atypical hyperplasia, the compliance rates were 92.86%, 83.33%, 84.21%, 81.25%, and 50.00%, respectively. The overall compliance rate for hysteroscopic diagnostic findings was 91.34%. The common causes of bleeding in 254 patients in this study were endometrial polyps 16.93% (43/254), endometritis 11.02% (28/254), submucosal myoma 10.24% (26/254), endometrial cancer 8.27% (21/254), endometrial hyperplasia 7.09% (18/254), abnormal IUD placement 7.09% (18/ 254), intrauterine residue 15.75% (40/254), and the remaining patients were caused by birth control device rupture, displacement, and incomplete intrauterine cleaning. Conclusion The causes of abnormal uterine bleeding mainly include endometrial polyps, endometrial hyperplasia, endometrial cancer, and submucosal myoma, and the hysteroscopic diagnosis has a high compliance rate with pathological diagnosis, which has a high clinical application value.
3.Discussion
Abnormal uterine bleeding refers to excessive duration of menstruation, excessive amount of menstruation or meeting both of the above conditions, non-menstrual and intermenstrual bleeding, postmenopausal bleeding (bleeding condition in which the last normal menstruation at the time of menopause is higher than 6 months), mainly including excessive menstruation, too short menstrual interval, too long late menstrual interval, reduced menstrual blood volume, irregular uterine bleeding, and bleeding after menopause. The most common benign clinical diseases of postmenopausal bleeding are atrophic vaginitis, atrophic endometrium, endometrial polyps and hyperplasia of the endometrium. ].
At present, clinical examination of abnormal uterine bleeding is mainly performed by curettage, ultrasound and hysteroscopy, etc. Diagnostic curettage is mainly based on the technique and experience of the operating physician, which is not objective enough and prone to leakage, especially in soft and localized lesions. ultrasound is easy to operate but lacks specificity [4]. In contrast, hysteroscopy is advanced and can directly observe the uterine cavity and endometrial lesions, grasp the number, nature, location and other relevant information at the lesion, and thus make a comprehensive and accurate diagnosis. It reduces hysterectomy due to unexplained uterine bleeding and prevents blind treatment. The hysteroscopic field of view is clearer, and there are corresponding hysteroscopic images for different intrauterine lesions, so it has a high specificity and accuracy. Some studies have shown that its sensitivity for microscopic intrauterine lesions can be as high as 98%, and the diagnostic compliance rate in this study was 91.34% [5], which is slightly lower than the results of the above-mentioned study, considering that it may be due to the limited sample size, but it is basically consistent. Some studies have shown that older patients are more likely to have abnormal uterine bleeding [6], considering that the diagnosis may be missed due to internal diagnosis, imaging blood diagnosis, and histological examination, while simple curettage can only examine 70% to 80% of the uterine cavity [7], which may still be missed, whereas hysteroscopy enables direct visualization of the uterine cavity and simultaneous biopsy, making its diagnostic advantage more significant.
Hysteroscopy enables selective biopsy and diagnosis of intrauterine cavity lesions, and the compliance rate between hysteroscopic views and hysteroscopic selective biopsy pathology can reach 87%, which is higher than that of the purely diagnostic scraping procedure [8]. It is particularly suitable for postmenopausal patients with abnormal uterine bleeding. Several studies have shown a high concordance between hysteroscopic examination and pathological findings [9-10]. Microscopic biopsy should be taken when ultrasound images show abnormalities that cannot identify intrauterine lesions, or when ultrasound images show normal but the patient still has clinical symptoms, so as to get an accurate picture of the pathology.
Abnormal postmenopausal uterine bleeding is mainly caused by inflammatory lesions such as vaginitis, endometrial polyps, endometritis, and malignant tumors, and the longer a woman has been menopausal, the more severe her genital atrophy becomes, making it more difficult to obtain an IUD and more prone to infection. Therefore, patients who have difficulty in obtaining an IUD should avoid repeated operations and have the IUD removed under ultrasound guidance. Patients with irregular menstruation under the constant effect of medical abortion do not have timely ultrasound review after abortion, which leads to the inability to dispose of intrauterine residues in a timely manner [11]. Overall, older age, endometrial polyps, submucosal fibroids, endometrial cancer, and endometrial hyperplasia are all important factors for abnormal uterine bleeding and require clinical attention.
In addition, although hysteroscopy is more specific than vaginal ultrasound and has many advantages, it still has certain limitations, i.e., it cannot observe lesions outside the uterine cavity, for which auxiliary diagnostic methods such as X-ray uterus, vaginal ultrasound and laparoscopy are still needed to avoid the occurrence of missed diagnosis and misdiagnosis in a combined diagnostic way.
In conclusion, there are many causes of abnormal uterine bleeding, and a comprehensive clinical examination should be done for high-risk patients. Hysteroscopy has high accuracy and specificity in the diagnosis of abnormal uterine bleeding, and has a high clinical promotion value.