Predictive value of hysteroscopic examination in intrauterine abnormalities L. Birinyi * , P. Darago ´, P. To ¨ro ¨k, P. Csisza ´r, T. Major, A. Borsos, Gy. Bacsko ´ Department of Obstetrics and Gynecology, Medical and Health Science Center, University of Debrecen, Nagyerdei krt. 98, Debrecen H-4012, Hungary Received 25 June 2003; received in revised form 15 September 2003; accepted 17 September 2003 Abstract Study objective: This study was set up to evaluate the predictive value of hysteroscopic examination in patients referred to the Department of Obstetrics and Gynecology at the Medical and Health Science Center, Debrecen, Hungary. Study design: The authors performed 835 biopsies by hysteroscopy over more than 13 years. They compared their findings with histological findings held in a a computerized clinical database. Results: The sensitivity of hysteroscopy was 0.52 for hyperplasia, 0.87 for polyps, 0.85 for myomas, 0.68 for carcinoma, and 0.73 for atrophy. Conclusion: It seems that for findings facing into the uterine cavity (such as submucosal myomas and peduncular polyps), hysteroscopy can predict the histological results. The evaluation of endometrial cycles and of the thickness of the endometrium by hysteroscopy is less accurate. # 2004 Elsevier Ireland Ltd. All rights reserved. Keywords: Hysteroscopic examination; Endometrium; Carcinoma 1. Introduction The sudden developments in medical technology in the 20th century have created a background enabling doctors to offer methods of treatment that are less stressful for their patients. Laparoscopy and hysteroscopy are typical exam- ples of the so-called minimally invasive techniques that have expanded our diagnostic and therapeutic resources. In addi- tion to organ-preserving surgery, endoscopy offers mini- mally invasive techniques that are instrumental in preserving the integrity of the human organism. By applying laparo- scopy and hysteroscopy we can avoid abdominal sections, which also means fewer post-operative complications and shorter stays in hospital and/or dependence on sickness benefit. Preserving the uterus is another significant advan- tage, since the structure of the lower pelvis is not disturbed and there are fewer symptoms suggesting prolapse of the other internal genitalia. All this implies the possibility of a significant reduction in the cost of health care, even though the initial acquisition of modern endoscopic equipment is a heavy financial burden on the particular institutions concerned. Patients frequently consult gynecologists about abnormal uterine bleeding. About one-third of gynecological patients have this problem; among peri- and post-menopausal patients if accounts for 69% of gynecological consultations [1]. Until recently, the two therapeutic weapons most fre- quently applied in the treatment of bleeding disorders were dilatation and curettage (D&C), providing the lesion causing the signs and symptoms was big enough to ensure that it would not be missed by blind curettage. According to different reports, the accuracy of findings on curettage is between 10 and 25% [2,3], since some of the lesions are small (e.g. polyps, submucosal myoma, early neoplastic processes) and even an experienced surgeon finds it difficult to remove no more than 50% of the endometrium during curettage [4]. Sampling by hysteroscopy eliminates the disadvantages of these blind techniques [5]. 2. Patients and methods Most of the patients in this study received an injected general anesthetic; in a few cases a paracervical block was accomplished with lidocaine before diagnostic or operative hysteroscopy, which was scheduled for performance in each patient’s early proliferative period, mostly 1 or 2 days after menstruation. It is easier to carry out the operation in this European Journal of Obstetrics & Gynecology and Reproductive Biology 115 (2004) 75–79 * Corresponding author. Tel.: þ36-52417-144; fax: þ36-52417-171. E-mail address: birinyi@haon.hu (L. Birinyi). 0301-2115/$ – see front matter # 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ejogrb.2003.09.048