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Hysteroscopy: An Analysis of 523 Patients
Author(s) -
Finikiotis George
Publication year - 1989
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.1989.tb01731.x
Subject(s) - hysteroscopy , medicine , curettage , endometrial cancer , uterine bleeding , endometrial polyp , vaginal bleeding , surgery , lesion , radiology , cancer , pregnancy , biology , genetics
EDITORIAL COMMENT: There is always the problem of when to perform curet‐tage in the premenopausal patient with irregular or heavy bleeding, when the clinical findings and cervical smear are normal, and the risk of significant endometrial pathology is low. Curettage is not without risk, inconvenience or expense and may be followed by irregular bleeding or infection. On the other hand oncologists remind us that about 20% of cases of endometrial cancer occur in premenopausal patients whose abnormal bleeding therefore warrants endometrial sampling. This paper makes a strong case for the more widespread use of hysteroscopy which does not enjoy the popularity it deserves. It may be used without anaesthesia, perhaps removing the need for hospitalization, and it can, as shown in this paper, select the patient with endometrial pathology that requires sampling by curettage. Hysteroscopy also has the added advantage, when used at the time of curettage, of ensuring that a macroscopic lesion has not been missed, or in the case of endometrial polyps, removed incompletely (figure 1). Summary: An analysis is presented of the indications for, and findings on, hysteroscopy in 523 patients undergoing gynaecological investigation or treatment. Abnormal uterine bleeding or discharge was the indication for investigation in 202 patients. Based on hysteroscopic observation, dilatation and curettage (D & C) was adjudged unnecessary in 114 (56%) and a subsequent D & C on these patients revealed no histological abnormalities. In the remainder, more abnormalities were observed visually on hysteroscopy than were detected by D & C. The results suggest that D & C should be replaced by hysteroscopy and biopsy as a first‐line investigation of abnormal uterine bleeding or discharge.