Chromohysteroscopy role in evaluation of intrauterine cavity lesions in perimenopausal women of AUB

: Aim: To evaluate the role of chromohysteroscopy in detection of intracavitary lesions in perimenopausal women with abnormal uterine bleeding.

Methods: This was a prospective study conducted in 100 perimenopausal women with AUB who underwent transvaginal sonography, conventional hysteroscopy and chromohysteroscopy. A total of 34 cases in our study group underwent hysterectomy and specimens were sent for histopathology. Histopathological examination was carried out by a clinical pathologist who was blinded regarding hysteroscopic findings. Diagnostic accuracy of hysteroscopy and chromohysteroscopy in detection of intracavitary lesions was then studied keeping histopathology as the gold standard. Results: Mean age of the study group was 43.49 ± 3.42yrs, average parity was 3 and mean BMI was 25.41± 3.41 Kg/m². 40% cases presented with menorrhagia, 38% with polymenorhagia, 9% with metrorrhagia and 4% with postmenopausal bleeding. Hysteroscopy revealed normal cavity in 59 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 and diffuse endometrial disease was suspected in 17 cases (hyperplastic in 13 cases and polypoidal in 4 cases. On chromohysteroscopy, most of the intracavitary lesions (72%) either did not stain or the uptake was very minimal giving an unstained appearance in comparison to the surrounding endometrium. The lesions thus got demarcated and separated from the surrounding endometrium.  The conventional hysteroscopic, chromohysteroscopic and histopathologic findings were then compared with each other. The diagnostic accuracy of conventional hysteroscopy in detecting polyps was found to be high (Sensitivity–85.71 %, specificity– 92.59%, positive predictive value– 75.0%, negative predictive value– 96.15% ; P<0.001). Its diagnostic accuracy  in detecting submucous fioids was also high (Sensitivity–92.31 %, specificity– 90.47%, positive predictive value 85.71%, negative predictive value– 95.00 %;(P<0.001). The diagnostic accuracy of chromohysteroscopy in detecting intracavitary lesions as unstained areas was also found to be significantly high (Sensitivity–80.0 %, specificity– 78.57%, positive predictive value– 84.2%, negative predictive value– 73.34% ; (P<0.01).Conclusion: The diagnostic accuracy of both hysteroscopy and chromohysteroscopy in detecting intracavitary lesions is high. However, differential staining on chromohysteroscopy made these lesions look more prominent and easily identifiable to the observer.

perimenopausal   abnormal uterine bleeding   intrauterine cavity lesion staining   chromohysteroscopy