| Título: |
Hysteroscopic diagnostic accuracy in post-menopausal bleeding. Eficácia diagnóstica da histeroscopia nas metrorragias pós-menopausa. |
| Autores: |
Metello, José; Unidade de histeroscopia, Serviço de Ginecologia e Obstetrícia, Hospital Garcia Orta, Almada. Relva, Andreia Milheras, Elsa Colaço, João Retto, Hélio |
| Fecha: | 2008-10-30 |
| Publicador: | Ordem dos Médicos |
| Fuente: |
Ver documento |
| Tipo: |
article article |
| Tema: | No aplica |
| Descripción: |
To evaluate the diagnostic accuracy of hysteroscopy at our unit for postmenopausal bleeding, specially concerning proliferative lesions.We analyzed the results of 335 hysteroscopies that were done during the last 8 years in our hysteroscopic unit and we compared the hysteroscopic diagnosis with the biopsy result done during the procedure. Data were group according to pathologic findings in three groups normal, proliferative lesions and benign lesions. Data were analyzed by direct comparison. Sensitivity and specificity were calculated, Kappa index was used to access the inter-rater reliability, and likelihood ratio and the post test probability were used to analyze the true value of hysteroscopy.Women were aged between 36 and 88 years, with an average of 61,5. Histological diagnosis was atrophy in 42,1% patients, polyps in 43,3%, sub-mucous fibromioma in 5%, hyperplasic lesions in 9,6%, half of them being carcinomas. Overall Kappa index for the 3 groups was 0,831 which is in line with excellent agreement. Concerning proliferative lesions (hyperplasia + carcinoma vs carcinoma alone) and comparing to histology, sensitivity was 78,1% vs 81,3%; specificity 95,7% vs 98,7%. The positive likelihood ratio was 18,2 vs 64,8 and the negative likelihood ratio was 0,23 vs 0,19. The probability post positive test was 66% vs 76% and the probability post negative test was 2,4% vs 0,95%. No cases of carcinoma were identified among the 129 women diagnosed as having atrophy. However 3,9% of all the lesions regarded as being polyps at the hysteroscopy proved to be proliferative lesions at hysteroscopy.Hysteroscopy at our unit is a highly accurate procedure concerning post menopausal endometrial bleeding, with its results being in line with the literature. Diagnosing atrophy or excluding a proliferative lesion by the observer was highly predictive of a negative carcinoma in the histology. Using this argument whenever a proliferative lesion was excluded, only 1 in 302 hysteroscopies hid a carcinoma. Polyps should be regarded as possible proliferative lesions. Despite this result we believe a biopsy should always be undertaken no matter the observer's diagnosis. To evaluate the diagnostic accuracy of hysteroscopy at our unit for postmenopausal bleeding, specially concerning proliferative lesions.We analyzed the results of 335 hysteroscopies that were done during the last 8 years in our hysteroscopic unit and we compared the hysteroscopic diagnosis with the biopsy result done during the procedure. Data were group according to pathologic findings in three groups normal, proliferative lesions and benign lesions. Data were analyzed by direct comparison. Sensitivity and specificity were calculated, Kappa index was used to access the inter-rater reliability, and likelihood ratio and the post test probability were used to analyze the true value of hysteroscopy.Women were aged between 36 and 88 years, with an average of 61,5. Histological diagnosis was atrophy in 42,1% patients, polyps in 43,3%, sub-mucous fibromioma in 5%, hyperplasic lesions in 9,6%, half of them being carcinomas. Overall Kappa index for the 3 groups was 0,831 which is in line with excellent agreement. Concerning proliferative lesions (hyperplasia + carcinoma vs carcinoma alone) and comparing to histology, sensitivity was 78,1% vs 81,3%; specificity 95,7% vs 98,7%. The positive likelihood ratio was 18,2 vs 64,8 and the negative likelihood ratio was 0,23 vs 0,19. The probability post positive test was 66% vs 76% and the probability post negative test was 2,4% vs 0,95%. No cases of carcinoma were identified among the 129 women diagnosed as having atrophy. However 3,9% of all the lesions regarded as being polyps at the hysteroscopy proved to be proliferative lesions at hysteroscopy.Hysteroscopy at our unit is a highly accurate procedure concerning post menopausal endometrial bleeding, with its results being in line with the literature. Diagnosing atrophy or excluding a proliferative lesion by the observer was highly predictive of a negative carcinoma in the histology. Using this argument whenever a proliferative lesion was excluded, only 1 in 302 hysteroscopies hid a carcinoma. Polyps should be regarded as possible proliferative lesions. Despite this result we believe a biopsy should always be undertaken no matter the observer's diagnosis. |
| Idioma: | No aplica |
1 Health Science Research: The Role of Translation,Investigação em Ciência da Saúde: O Papel da Translação por Sobrinho Simões, Manuel; Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP). Porto. Portugal. | 6 Biomarkers of Cervical Carcinogenesis Associated with Genital HPV Infection,Indicadores de Prognóstico da Carcinogénese do Colo do Útero Associada à Infecção por HPV por Bicho, Maria Clara; Serviço de Ginecologia. Hospital de Santiago. Setúbal. & Serviço de Ginecologia Oncologica. British Medical Hospital. Lisboa. Portugal. |
2 Em destaque na Acta Médica Portuguesa: O que é a “Saúde”,Highlights in Acta Médica Portuguesa: What is “Health” por Marinho, Rui Tato; Editor-Chefe. Acta Médica Portuguesa. Lisboa. & Serviço de Gastroenterologia e Patologia. Hospital de Santa Maria. Centro Hospitalar Lisboa Norte. Lisboa. Portugal. | 7 Suicide in the Elderly: Crucial Not to Forget!,Suicídio nos Mais Velhos: Fundamental Não Esquecer! por Sampaio, Daniel; Serviço de Psiquiatria. Hospital de Santa Maria/Faculdade de Medicina de Lisboa. Lisboa. Portugal.,Telles-Correia, Diogo; Serviço de Psiquiatria. Hospital de Santa Maria/Faculdade de Medicina de Lisboa. Lisboa. Portugal. |
3 Renovando a Acta Médica Portuguesa...,Renovating Acta Médica Portuguesa... por Marinho, Rui Tato; Editor-Chefe. Acta Médica Portuguesa. Lisboa. & Serviço de Gastrenterologia e Hepatologia. Hospital de Santa Maria. Centro Hospitalar Lisboa & Faculdade de Medicina da Universidade de Lisboa. Lisboa. Portugal.,Fernandez-Llimos, Fernando; Editor Associado Acta Médica Portuguesa. Lisboa. & Departamento de Sócio-Farmácia, Faculdade de Farmácia, Universidade de Lisboa. Lisboa. Portugal. | 8 The Integration of Health Promotion and Injuries Prevention on the Physical Exercise Dynamics,A Integração da Promoção da Saúde e da Prevenção das Lesões na Dinâmica do Exercício Físico por Ribeiro, Basil; Serviço de Medicina Desportiva. Centro Hospitalar Vila Nova de Gaia. Gaia. Federação Portuguesa de Futebol. Lisboa. Portugal. |
4 Acta Médica Portuguesa and Peer-review: Quick and Brutal!,Acta Médica Portuguesa e o Peer-review: Quick and Brutal! por Donato, Helena; Editora Associada. Acta Médica Portuguesa. Lisboa. & Serviço de Documentação do Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal.,Marinho, Rui Tato; Editor-Chefe. Acta Médica Portuguesa. Lisboa. & Serviço de Gastrenterologia e Hepatologia. Hospital de Santa Maria. Centro Hospitalar Lisboa. Lisboa. Portugal. | 9 New Paths for Anatomy,Novos Caminhos Para a Anatomia por Goyri-O'Neill, João; Sociedade Anatómica Portuguesa. Lisboa. Portugal.,Furtado, Ivo A.; Sociedade Anatómica Portuguesa. Lisboa. Portugal. |
5 Originais para Translação!,Originals in Translation! por Marinho, Rui Tato; Editor-Chefe. Acta Médica Portuguesa. Lisboa. & Serviço de Gastrenterologia e Hepatologia. Hospital de Santa Maria. Centro Hospitalar Lisboa. Lisboa. Portugal. | 10 Dementia: Not Only Alzheimer’s disease, an Eye on Frontotemporal Dementia,Demência: Mais do que uma Doença de Alzheimer, um Olhar sobre a Demência Frontotemporal por Galimberti, Daniela; Neurology Unit. Dept. of Pathophysiology and Transplantation. University of Milan. Fondazione IRCCS Cà Granda. Ospedale Policlinico. Milan. Italy.,Scarpini, Elio; Neurology Unit. Dept. of Pathophysiology and Transplantation. University of Milan. Fondazione IRCCS Cà Granda. Ospedale Policlinico. Milan. Italy. |