Value Of Hysteroscopy In Diagnosis Of Perimenopausal Abnormal Uterine Bleeding

Objective:To explore the value of hysteroscopy in diagnosis of perimenopausal abnormal uterine bleeding.Methods: In this study,100 patients with perimenopausal abnormal uterine bleeding treated in our hospital from April 2017 to April 2021 were selected as the research objects.All patients hysteroscopy first,then dilation and curettage him to pathology,finally,a biopsy was performed under hysteroscope to confirm pathology.The general data such as age,weight,number of births,basic medical history,diagnostic curettage,hysteroscopy and pathological biopsy results were collected.The characteristics and causes of uterine bleeding,the composition of diagnosed diseases,and the sensitivity,specificity,positive predictive value and negative predictive value of curettage and hysteroscopy in the diagnosis of different diseases were analyzed..Results:(1)Among the 100 cases of perimenopausal abnormal uterine bleeding,91 cases were non malignant tumors,accounting for 91.00%.The malignant tumors were endometrial cancer,accounting for 9.00%.endometrial hyperplasia in 39 cases(39.00%),endometrial polyps in 23 cases(23.00%),submucosal myoma in 16 cases(16.00%),there were 13 cases(13.00%)of normal endometrium(proliferative and secretory phase).(2)According to the pathological diagnosis after hysteroscopy and tissue biopsy,the patients were divided into group 1(endometrial non malignant tumor group)and group 2(endometrial malignant tumor group).The comparative study showed that there was no significant difference in the average age between the two groups(P> 0.05);The average thickness of endometrium in the group 1 was significantly lower than that in the group 2(P< 0.05);The proportion of patients with hypertension and diabetes mellitus in the group 1were significantly lower than those in the group 2(P<0.05).(3)A total of 100 patients with perimenopausal abnormal uterine bleeding were included in this study.Their clinical manifestations were different.The main clinical manifestations included menstrual disorder,increased menstrual volume,prolonged menstrual cycle,irregular bleeding,contact bleeding,etc.among them,irregular bleeding accounted for 44.00%(44 / 100)and decreased menstrual volume accounted for 2.00%(2 /100),Prolonged menstruation accounted for 28.00%(28 / 100),and increased menstrual volume accounted for 26.00%(26 / 100).(4)Among the 100 patients,37 cases were pathologically diagnosed as endometrial hyperplasia by curettage,39 cases were pathologically confirmed by hysteroscopic biopsy,and the true positive rate was 94.87%;There were 16 cases of endometrial polyps diagnosed by curettage and 23 cases confirmed by hysteroscopic biopsy.The true positive rate was69.57%;There were 0 cases of submucosal myoma diagnosed by curettage and 16 cases confirmed by hysteroscopic biopsy.The coincidence rate was 0.00%;There were 6 cases of endometrial cancer diagnosed by curettage pathology,9 cases confirmed by hysteroscopic biopsy pathology,with a true positive rate of 66.67%,41 cases of normal endometrium diagnosed by curettage pathology,13 cases confirmed by hysteroscopic biopsy pathology,with a true positive rate of 100%.(5)36 cases of endometrial hyperplasia were diagnosed by hysteroscopy,39 cases were confirmed by hysteroscopic biopsy and pathology,and the true positive rate was 92.31%;22cases of endometrial polyps were diagnosed by hysteroscopy,23 cases were confirmed by hysteroscopic biopsy and pathology,and the true positive rate was 95.65%;15 cases of submucosal myoma were diagnosed by hysteroscopy,16 cases were confirmed by hysteroscopic biopsy and pathology,and the true positive rate was 93.75%;There were 8cases of endometrial cancer diagnosed by hysteroscopy,9 cases were confirmed by hysteroscopic biopsy pathology,and the true positive rate was 88.89%.19 cases of normal endometrium were diagnosed by hysteroscopy,and 13 cases were confirmed by hysteroscopic pathology,and the true positive rate was 100%.(6)The sensitivity,specificity,positive predictive rate and negative predictive rate of hysteroscopy in the diagnosis of endometrial hyperplasia were 92.31%,100%,100% and95.31% respectively.The sensitivity,specificity,positive predictive rate and negative predictive rate of curettage pathological results in the diagnosis of endometrial hyperplasia were 94.87%,100%,100% and 96.83% respectively,There was no significant difference in sensitivity,specificity,positive predictive rate and negative predictive rate between hysteroscopy and curettage(P > 0.05).(7)The sensitivity,specificity,positive predictive rate and negative predictive rate of hysteroscopy in the diagnosis of endometrial polyps were 95.65%,100%,100% and 98.72%respectively.The sensitivity,specificity,positive predictive rate and negative predictive rate of curettage pathological results in the diagnosis of endometrial polyps were 69.57%,100%,100% and 91.67% respectively,There were significant differences in the sensitivity of hysteroscopy and curettage in the diagnosis of endometrial polyps(P < 0.05),but there was no significant difference in specificity,positive predictive rate and negative predictive rate(P > 0.05).(8)The sensitivity,specificity,positive predictive rate and negative predictive rate of hysteroscopy in the diagnosis of submucosal myoma were 93.75%,100%,100% and98.82% respectively.The sensitivity,specificity,positive predictive rate and negative predictive rate of curettage pathological results in the diagnosis of submucosal myoma were0.00%,100.00%,0.00% and 84.00% respectively,There were significant differences in sensitivity,positive predictive rate and negative predictive rate between hysteroscopy and curettage(P < 0.05),but there was no significant difference in diagnostic specificity(P >0.05).(9)The sensitivity,specificity,positive predictive rate and negative predictive rate of hysteroscopy in the diagnosis of endometrial cancer were 88.89%,100%,100% and 98.91%respectively.The sensitivity,specificity,positive predictive rate and negative predictive rate of curettage pathological results in the diagnosis of endometrial cancer were 66.67%,100.00%,100.00% and 96.81% respectively,There was significant difference in the sensitivity of hysteroscopy and curettage in the diagnosis of endometrial cancer(P < 0.05),but there was no significant difference in specificity,positive predictive rate and negative predictive rate(P > 0.05).(10)The sensitivity,specificity,positive predictive rate and negative predictive rate of hysteroscopy in the diagnosis of normal endometrium were 100%,93.55%,68.42% and100% respectively.The sensitivity,specificity,positive predictive rate and negative predictive rate of curettage pathological results in the diagnosis of normal endometrium were 100%,67.82%,31.71% and 100% respectively,There was no significant difference in sensitivity and negative predictive rate of hysteroscopy and curettage in the diagnosis of normal endometrium(P > 0.05),but there was significant difference in diagnostic specificity and positive predictive rate(P < 0.05).Conclusion:1.The common causes of perimenopausal abnormal uterine bleeding include endometrial hyperplasia,endometrial polyps,submucosal myoma,and endometrial cancer.2.Age,endometrial thickness,history of hypertension and history of diabetes are related risk factors for endometrial malignancies.Clinically,attention should be paid to patients with abnormal age,abnormal endometrial thickness,and history of hypertension and diabetes.3.Compared with diagnostic curettage(postoperative pathological results),hysteroscopy has significant advantages in the diagnosis of submucosal myoma,endometrial polyps,endometrial cancer and normal endometrium,but there is no significant difference in the diagnosis of endometrial hyperplasia.