Endometrial disease is ruled out by a homogenously light stained endometrium on chromohysteroscopy

Dr Indira Prasad; Dr S S Trivedi; Dr Kiran Aggarwal; Dr Kiran Agarwal; Dr (Lt Col) Urmila Prasad

Volume : VI, Issue : XII, December - 2017

Endometrial disease is ruled out by a homogenously light stained endometrium on chromohysteroscopy

Dr Indira Prasad, Dr S S Trivedi, Dr Kiran Aggarwal, Dr Kiran Agarwal, Dr Lt Col Urmila Prasad

Abstract :

Aim: To study the differential staining of endometrium in different uterine pathologies in patients of abnormal uterine bleeding on chromohysteroscopy. Study Methods: A prospective study was conducted in 100 perimenopausal women with abnormal uterine bleeding over three years. All women underwent transvaginal sonography, hysteroscopy and chromohysteroscopy followed by the guided biopsy of the endometrial tissue which underwent histopathological examination by a clinical pathologist who was blinded regarding hysteroscopic findings. Results: Mean age of the study group was 43.49 yrs, mean parity was 3 and mean BMI was 25.41. 40% cases presented with menorrhagia, 38% with polymenorhagia, 9% with metrorrhagia and 4% with postmenopausal bleeding. On TVS, mean size of the uterus was 8.2 cm and the endometrial thickness (ET) varied between 2 to 30 mm with mean ET of 10.21 mm. Conventional Hysteroscopy revealed normal endometrium in 83 cases while diffuse endometrial disease was suspected in 17 cases (hyperplastic in 13 cases and polypoidal in 4 cases; intracavitary lesions were detected in 26 cases (submucous fioids in 14, endometrial polyps in 11, and growth with areas of necrosis in one case), synechiae in 2 cases. On Chromohysteroscopy, it was found that the endometrium in majority of cases (80%) was homogenously stained, 17% cases showed partial staining pattern and 3% cases attained dark staining of the endometrium. On histopathology, abnormal findings were detected in 13 cases (polypoidal endometrium in four, chronic endometritis in 4, simple hyperplasia in 3 and atrophic endometrium in 2 cases, 1 case had both chronic endometritis with polypoidal endometrium. The conventional hysteroscopic, chromohysteroscopic and histopathologic findings were then compared with each other. No pathology was detected on histology in 76 out of 80 cases that got homogenously stained (Sensitivity-69.23%, specificity- 87.35%, positive predictive value 45.0%, and negative predictive value- 95.0%). Thus, it is evident that in cases with homogenous light staining endometrium (on chromohysteroscopy), detection of an endometrial disease at histology is significantly less frequent (P< 0.001).

Conclusion: No case with homogenously stained endometrium is likely to have an abnormal histopathology i.e. homogenously light stained endometrium on chromohysteroscopy excludes Endometrial Disease.