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Abstract Postmenopausal state is considered established after one year of amenorrhea above 45 years. Any vaginal bleeding following one year amenorrhea or more from the date of last menstrual period is called postmenopausal bleeding (PMB). Any woman who is still menstruating after 55 years should be viewed with suspicion and postmenopausal blood stained discharge has equal significance to that of PMB. PMB must be considered as a symptom and not a diagnosis. Moreover, it must be regarded as a symptom of genital tract malignancy until proved otherwise. The direct view of the uterine cavity afforded by hysteroscopy offers a significant advantage over the other methods such as hysterosalpingography, dilatation and curettage, endometrial biopsy and ultrasound, as these other modalities offer only a blind or indirect view of the cavity. At hysteroscopy, lesions can be clearly identified and their location and size accurately determined and tissue samples can be obtained for pathological examination In fact, some have advocated hysteroscopy as the primary tool for the diagnosis of PMB. Although it is highly accurate for identifying endometrial cancer, it is less accurate for endometrial hyperplasia. Thus, some recommend endometrial biopsy or endometrial curettage in conjunction with hysteroscopy. Moreover, the success of hysteroscopy depends on appropriate selection of the patient, the absence of contraindications, adequate instrumentation and meticulous technique. Today diagnostic hysteroscopy can be considered the optimal method of assessing all cases where visualizing the cervical canal, uterine cavity and tubal ostea will improve diagnostic accuracy and guide therapeutic management. It is in the field of improved diagnosis that hysteroscopy has made the most significant progress, mainly because the ability to use fine diameter instruments makes it feasible to avoid both anaesthesia and cervical dilatation. The procedure may therefore be performed in an outpatient setting without the need for hospitalization. The use of diagnostic hysteroscopy in the management of PMB may, in many instances, replace procedures such as D&C. The magnifying power of the microhysteroscope and its ability to penetrate the cervical canal to regions inaccessible to the colposcope suggest a very real role in the assessment of precancerous and cancerous lesions of the endometr Hysteroscopy is no longer a ”procedure looking for an indication”. The aim of the present study is to estimate the accuracy of hysteroscopy in predicting endometrial histopathology in cases of postmenopousal bleeding. The mean age of 657 women participating in the study was 50+6 years (range 44–86 years) and they were postmenopausal for an average of 11.6 ± 8.4 years (range 1–31 years). Endometrial polyps was the most common hysteroscopic pathologies observed in 130 (19.70%), this result was overestimated as only 66 cases of endometrial polyps confirmed by histopathology, the remaining 64 cases ( 32 of them confirmed normal variants of endometrium, 16 confirmed endometritis, and 16 cases diagnosed as endometrial hyperplasia). We had exelent result regarding hysteroscopic prediction of cancer, as all the 86 (13.13%) cases that were confirmed by histology, were suspected by hysteroscopy, in addition seven cases diagnosed as cancer by hysteroscopy but confirmed to be endometrial hyperplasia by histopathology. While endometrial hyperplasia diagnosed visually by the hysteroscopist in 66 (10.10%). The hysteroscopic findings an the histological diagnoses were compared in 657 cases. Of note, hyperplastic endometrium was confirmed by histology in 100 (15.15%), 66 cases had been suspected by the hysteroscope, the other 34 cases were not suspected during visual diagnosis of the uterine cavity, (16 diagonsed by fault as endometrial polyps , 7 diagonsed as endometrial cancer , 6 as myomas). The seven myomas at hysteroscopy were confirmed by biopsy, in addition six cases diagnosed by fault as myomas and confirmed to be hyperplastic polyps in histology reports. In cases of normal endometrium Hysteroscopy has a sensitivity of (89%), specificity (100%) and accuracy (94.9%). In cases of abnormal endometrium Hysteroscopy has a sensitivity of (83.6%), specificity (77.7%) and accuracy (91.4%). In cases of endometrial hyperplasia Hysteroscopy has a sensitivity 66.67%, specificity 100.00%, and accuracy (94.9%). In cases of Endometrial polyps Hysteroscopy has a sensitivity100%, specificity89.33%, and accuracy (90.4%) In cases of cancer Hysteroscopy has a sensitivity100%, specificity98.84%, and accuracy (98.9%). In cases of atrophic endomertrium: Hysteroscopy has a sensitivity of (100%), specifcity (98.95%) and accuracy (98.98%). In cases of myomas Hysteroscopy has a sensitivity (100.00%), specificity(89.98%), and accuracy (92.3%). Outpatient hysteroscopy was a feasible and welltolerated technique. All women for whom cervical stenosis and hysteroscopy could not be performed were excluded. We did not report adverse experiences, such as uterine perforation or failure to visualize the uterine cavity during the performance of all the hysteroscopies. Using pathologic diagnoses as gold standard, the calculated sensitivity, specificity, PPV, and NPV showing good hysteroscopic performance in visual diagnosis of cancer and the overall uterine cavity abnormality. However, the same parameters showing its limited value for the detection of endometrial hyperplasia. |