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Reliability of narrow-band imaging (NBI) hysteroscopy: A comparative study
Full text linkFertil Steril. 2010 Nov;94(6):2303-7. Epub 2010 Feb 21.
Reliability of narrow-band imaging (NBI) hysteroscopy: a comparative study.
Cicinelli E, Tinelli R, Colafiglio G, Pastore A, Mastrolia S, Lepera A, Clevin L.
Source
First Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Bari, Bari, Italy. [email protected]
Abstract
OBJECTIVE:
To evaluate the usefulness of narrow-band imaging (NBI) technology for improving the diagnostic reliability of hysteroscopy.
DESIGN:
Prospective controlled clinical study (Canadian Task Force classification II-2).
SETTING:
University hospital.
PATIENT(S):
Three hundred ninety-five outpatient women undergoing diagnostic hysteroscopy were enrolled.
INTERVENTION(S):
All patients underwent fluid minihysteroscopy with white light (WL) and NBI exploration with endometrial eye-directed biopsy.
MAIN OUTCOME MEASURE(S):
Hysteroscopic findings with WL and NBI were compared with histology, which was considered the gold standard.
RESULT(S):
Overall, the number of correct diagnoses with NBI was significantly higher than with WL. For differentiating normal from abnormal endometrial histopathology, the use of NBI showed a significantly higher specificity (0.93 vs. 0.78) and negative predictive value (0.92 vs. 0.81); NBI hysteroscopy significantly improved the sensitivity for the diagnosis of proliferative endometrium (0.93 vs. 0.78), chronic endometritis (0.88 vs. 0.70), low-risk hyperplasia (0.88 vs. 0.70), and high-risk hyperplasia (0.60 vs. 0.40).
CONCLUSION(S):
The use of NBI improved the reliability of diagnostic hysteroscopy. The high specificity and the low number of false negatives may reduce the number of unnecessary biopsies or of those performed in wrong areas. Moreover, compared with WL observation, NBI hysteroscopy showed significantly higher sensitivity for the detection of chronic endometritis and low-risk and high-risk hyperplasia.
Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
PMID: 20176350 [PubMed - indexed for MEDLINE
Risk of long-term pelvic recurrences after fluid minihysteroscopy in women with endometrial carcinoma: a controlled randomized study
No full textMenopause. 2010 May-Jun;17(3):511-5.
Risk of long-term pelvic recurrences after fluid minihysteroscopy in women with endometrial carcinoma: a controlled randomized study.
Cicinelli E, Tinelli R, Colafiglio G, Fortunato F, Fusco A, Mastrolia S, Fucci AR, Lepera A.
Source
Department of Obstetrics and Gynecology, University Medical School of Bari, 70124 Bari, Italy. [email protected]
Abstract
OBJECTIVE:
Concerns exist about the risk of endometrial cancer cells spreading into the peritoneal cavity after fluid minihysteroscopy. The aim of our study was to evaluate the 5-year incidence of pelvic recurrences in women affected by early-stage endometrial carcinoma (stage IA or IB) who did or did not undergo preoperative hysteroscopy with low pressure (<70 mm Hg) saline uterine distention.
METHODS:
A total of 140 women were randomized into two groups of 70 women who underwent or did not undergo diagnostic fluid minihysteroscopy before surgical staging. Women were followed up every 6 months for at least 5 years. Diagnosis of pelvic recurrence was based on a positive result at clinical examination and/or at vaginal cytology and/or at magnetic resonance imaging/positron emission tomography scan. Univariate analysis of disease-free survival was performed with the Kaplan-Meier method and survival curves were compared using the long-rank test.
RESULTS:
No difference in peritoneal cytology was observed between the two groups (5.7% and 8.5% of cases in the hysteroscopy and control group, respectively). After a mean duration of follow-up of 62 months, 2 (2.85%) pelvic recurrences in the hysteroscopy group and 3 (4.28%) in the control group were found. No significant difference was found between the two groups when the recurrence rate was compared. Overall survival rates and disease-free survival projected by Kaplan-Meier curves were not significantly different for the two groups.
CONCLUSIONS:
Preoperative low-pressure fluid minihysteroscopy does not increase the risk of intraperitoneal transport of endometrial carcinoma cells during the examination or the risk of pelvic recurrence at the 5-year follow-up. It does not seem to modify the recurrence rate, disease-free survival, and overall survival, although multicenter randomized trials and long-term follow-up are required to evaluate the overall oncologic outcomes of this procedure.
PMID:2008 1548 [PubMed - indexed for MEDLINE
Succesful management of a cervical twin pregnancy: neoadjuvant systemic methotrexate and prophylactic high cervical cerclage before curettage. A case report
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Laparoscopy vs minilaparotomy in women with symptomatic uterine myomas: a prospective randomized study
No full textIs it possible to score the severity of endometrial inflammation by hysteroscopy in women with chronic endometritis? A retrospective clinical study
No full text
Effetti a lungo termine del tibolone sui livelli circolanti delle molecole di adesione cellulare in donne in post-menopausa
No full textLong-term effects of tibolone on circulating levels of vascular cell adhesion molecules and E-selectin in postmenopausal women
No full textDetection of chronic endometritis at fluid hysteroscopy
No full textAbstract
STUDY OBJECTIVE:
Chronic endometritis is a subtle condition that is difficult to detect; however, it may cause abnormal uterine bleeding and infertility. Few data exist about the appearance of chronic endometritis at fluid hysteroscopy and about the value of diagnostic fluid hysteroscopy in the detection of this condition. In our experience, at fluid hysteroscopy chronic endometritis is characterized by consistent association of stromal edema and either focal or diffuse hyperemia; in some cases, this finding is associated with endometrial micropolyps (less than 1 mm in size). This study attempted to describe diagnostic criteria for chronic endometritis at fluid hysteroscopy and assess the diagnostic accuracy of fluid hysteroscopy in the detection of this condition.
DESIGN:
Retrospective Study (Canadian Task Force classification II-2).
SETTING:
University hospital.
PATIENTS:
Nine hundred-ten women in whom hysteroscopy was indicated.
INTERVENTIONS:
Fluid hysteroscopy followed by endometrial biopsy.
MEASUREMENTS AND MAIN RESULTS:
Sensitivity, specificity, positive and negative predictive values, and accuracy of fluid hysteroscopy in the detection of chronic endometritis, based on the association of edema; hyperemia; and, if present, micropolyps were calculated. Based on the presence of hyperemia and edema, chronic endometritis was diagnosed in 158 patients (17.4%); in 61 patients (6.7%), micropolyps also were present. Histology confirmed the diagnosis in 101 patients (63.9% of positive cases at hysteroscopy) and was positive in 9 additional cases not detected by hysteroscopy. Chronic endometritis at histology was found in approximately 30% of infertile women and 35% of cases related to abnormal uterine bleeding. The sensitivity, specificity, and positive and negative predictive values of hysteroscopy for chronic endometritis based on detection of only hyperemia and edema were 91.8%, 92.9%, 63.9%, and 98.8%, respectively; the diagnostic accuracy was 92.7 %. The combination of hyperemia, edema, and micropolyps had sensitivity, specificity, and positive and negative predictive values of 55.4%, 99.9%, 98.4%, 94.5%, respectively, with a diagnostic accuracy of 93.4%.
CONCLUSIONS:
Fluid hysteroscopy is very reliable in diagnosing no inflammation, while detection of micropolyps is a very reliable sign of inflammation. When performing hysteroscopy for abnormal uterine bleeding or infertility, signs of chronic endometritis should always be sought
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