International Journal of Gynecology & Obstetrics 49 (1995) 35-40 Article Morphologic hysteroscopic criteria suggestive of endometrial hyperplasia L.H. Uno*a, 0. Sugimotob, F.M. Carvalho”, V.R. Bagnoli”, A.M. Fonsecaa, J.A. Pinotti” aDepartment of Gynecology and Obstetrics, Faculty of Medicine. University of Go Paulo. So Paula, Brazil bDepartment of Obstetrics and Gynecology, Osaka Medical College, Osaka, Japan Received 31 May 1994;revision received 1 December 1994;accepted 12 December 1994 Abstract Objectives: To evaluate the morphologic hysteroscopic criteria leading to a diagnosis of endometrial hyperplasia and compare their accuracy with that of histology. Met/&s: A total of 95 hysteroscopic examinations were evaluated. Of these, 37 had a histologic diagnosis of normal endometrium and the remaining 58 of simple or complex endometrial hyperplasia. We compared the morphologic hysteroscopic criteria for the two groups using Pearson’schi-squared and Fisher’s exact test. Results: Only the presence of endometrial glands presenting a cystic pattern at hysteroscopy gave statistically significant results (P < 0.05), with low sensitivity (15.79%), high specificity (97.29%) and a relative risk of 6.75. With a prevalenceof endometrial hyperplasia of 22.97%in a population of women with metrorrhagia, the posi- tive predictive value was 63.53% and the negative predictive value was 79.40%. Conclusion: Additional, prospective studies are needed to determine the real value of the diagnostic morphologic parameters under consideration. Keywords: Hysteroscopy; Endometrial hyperplasia; Morphologic diagnostic criteria 1. Introduction The general frequency of endometrial hyper- plasia is difficult to establish. The lack of a standardized classification, the heterogeneity of the populations studied, and the therapeutic in- * Corresponding author, Rua FradiqueCoutinho 1692/31, so Paula, Brazil, CEP05416002, Tel.: +55 1 I 2123473; Fax: +55 11 8670409. terference both with its genesisand course impair a comparison of data obtained by different in- vestigators [l-4]. Endometrial hyperplasia has recently begun to be diagnosed by hysteroscopy. The frequency of endometrial hyperplasia among women of different ages with abnormal uterine bleeding is presentedin Table 1. According to dif- ferent investigators, the efficacy of hysteroscopy in diagnosing the presence of endometrial hyper- plasia ranges from 56 to 82% compared with his- 0020-7292/95/$09.50 0 1995International Federation of Gynecology and Obstetrics SSDI 0020-7292(94)02303-G