Is outpatient diagnostic hysteroscopy more useful than endometrial biopsy alone for the investigation of abnormal uterine bleeding in unselected premenopausal women? A randomised comparison

Christine Bain, David Parkin, K. G. Cooper

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    22 Citations (Scopus)

    Abstract

    Objective To formally evaluate the clinical benefit of additional outpatient hysteroscopy over traditional vaginal examination and endometrial biopsy.

    Design A prospective randomised controlled trial.

    Setting A large teaching hospital in the northeast of Scotland.

    Sample Premenopausal women with abnormal uterine bleeding referred to the general gynaecologic clinic and requiring endometrial biopsy.

    Methods Women were randomised to either outpatient hysteroscopy and endometrial biopsy or endometrial biopsy alone.

    Main outcome measures Primary outcome: initial surgical intervention rates. Secondary outcomes: procedural success and acceptability, intrauterine pathology identified and changes in management.

    Results Three hundred and seventy women were recruited to the study. Initial trends in clinical management were comparable in both groups. No woman was advised to have removal of a localised lesion found at outpatient hysteroscopy and a normal uterine cavity at hysteroscopy did not influence the hysterectomy rate, which was similar in both groups. Outpatient hysteroscopy was found to be as acceptable as an outpatient endometrial biopsy and successfully completed in 85% compared with 91% of women who underwent endometrial biopsy alone. No cases of endometrial malignancy were identified.

    Conclusions Outpatient diagnostic hysteroscopy is an acceptable procedure and may give more reassurance. It did not influence clinical management, especially with respect to hysterectomy rate. Outpatient hysteroscopy may be useful in selected cases, but when performed in a non-selective manner, it has little influence on clinical management and increases costs.

    Original languageEnglish
    Pages (from-to)805-811
    Number of pages6
    JournalBJOG-An International Journal of Obstetrics and Gynaecology
    Volume109
    Issue number7
    Publication statusPublished - 2002

    Keywords

    • PLACEBO-CONTROLLED TRIAL
    • TRANSVAGINAL ULTRASONOGRAPHY
    • OFFICE HYSTEROSCOPY
    • CURETTAGE
    • RESECTION
    • POLYPS
    • ACCEPTABILITY
    • HYSTERECTOMY
    • MENORRHAGIA
    • MYOMECTOMY

    Cite this

    @article{fce30e3bd13b4fcf966a5765db60b856,
    title = "Is outpatient diagnostic hysteroscopy more useful than endometrial biopsy alone for the investigation of abnormal uterine bleeding in unselected premenopausal women? A randomised comparison",
    abstract = "Objective To formally evaluate the clinical benefit of additional outpatient hysteroscopy over traditional vaginal examination and endometrial biopsy.Design A prospective randomised controlled trial.Setting A large teaching hospital in the northeast of Scotland.Sample Premenopausal women with abnormal uterine bleeding referred to the general gynaecologic clinic and requiring endometrial biopsy.Methods Women were randomised to either outpatient hysteroscopy and endometrial biopsy or endometrial biopsy alone.Main outcome measures Primary outcome: initial surgical intervention rates. Secondary outcomes: procedural success and acceptability, intrauterine pathology identified and changes in management.Results Three hundred and seventy women were recruited to the study. Initial trends in clinical management were comparable in both groups. No woman was advised to have removal of a localised lesion found at outpatient hysteroscopy and a normal uterine cavity at hysteroscopy did not influence the hysterectomy rate, which was similar in both groups. Outpatient hysteroscopy was found to be as acceptable as an outpatient endometrial biopsy and successfully completed in 85{\%} compared with 91{\%} of women who underwent endometrial biopsy alone. No cases of endometrial malignancy were identified.Conclusions Outpatient diagnostic hysteroscopy is an acceptable procedure and may give more reassurance. It did not influence clinical management, especially with respect to hysterectomy rate. Outpatient hysteroscopy may be useful in selected cases, but when performed in a non-selective manner, it has little influence on clinical management and increases costs.",
    keywords = "PLACEBO-CONTROLLED TRIAL, TRANSVAGINAL ULTRASONOGRAPHY, OFFICE HYSTEROSCOPY, CURETTAGE, RESECTION, POLYPS, ACCEPTABILITY, HYSTERECTOMY, MENORRHAGIA, MYOMECTOMY",
    author = "Christine Bain and David Parkin and Cooper, {K. G.}",
    year = "2002",
    language = "English",
    volume = "109",
    pages = "805--811",
    journal = "BJOG-An International Journal of Obstetrics and Gynaecology",
    issn = "1470-0328",
    publisher = "John Wiley & Sons, Ltd (10.1111)",
    number = "7",

    }

    TY - JOUR

    T1 - Is outpatient diagnostic hysteroscopy more useful than endometrial biopsy alone for the investigation of abnormal uterine bleeding in unselected premenopausal women? A randomised comparison

    AU - Bain, Christine

    AU - Parkin, David

    AU - Cooper, K. G.

    PY - 2002

    Y1 - 2002

    N2 - Objective To formally evaluate the clinical benefit of additional outpatient hysteroscopy over traditional vaginal examination and endometrial biopsy.Design A prospective randomised controlled trial.Setting A large teaching hospital in the northeast of Scotland.Sample Premenopausal women with abnormal uterine bleeding referred to the general gynaecologic clinic and requiring endometrial biopsy.Methods Women were randomised to either outpatient hysteroscopy and endometrial biopsy or endometrial biopsy alone.Main outcome measures Primary outcome: initial surgical intervention rates. Secondary outcomes: procedural success and acceptability, intrauterine pathology identified and changes in management.Results Three hundred and seventy women were recruited to the study. Initial trends in clinical management were comparable in both groups. No woman was advised to have removal of a localised lesion found at outpatient hysteroscopy and a normal uterine cavity at hysteroscopy did not influence the hysterectomy rate, which was similar in both groups. Outpatient hysteroscopy was found to be as acceptable as an outpatient endometrial biopsy and successfully completed in 85% compared with 91% of women who underwent endometrial biopsy alone. No cases of endometrial malignancy were identified.Conclusions Outpatient diagnostic hysteroscopy is an acceptable procedure and may give more reassurance. It did not influence clinical management, especially with respect to hysterectomy rate. Outpatient hysteroscopy may be useful in selected cases, but when performed in a non-selective manner, it has little influence on clinical management and increases costs.

    AB - Objective To formally evaluate the clinical benefit of additional outpatient hysteroscopy over traditional vaginal examination and endometrial biopsy.Design A prospective randomised controlled trial.Setting A large teaching hospital in the northeast of Scotland.Sample Premenopausal women with abnormal uterine bleeding referred to the general gynaecologic clinic and requiring endometrial biopsy.Methods Women were randomised to either outpatient hysteroscopy and endometrial biopsy or endometrial biopsy alone.Main outcome measures Primary outcome: initial surgical intervention rates. Secondary outcomes: procedural success and acceptability, intrauterine pathology identified and changes in management.Results Three hundred and seventy women were recruited to the study. Initial trends in clinical management were comparable in both groups. No woman was advised to have removal of a localised lesion found at outpatient hysteroscopy and a normal uterine cavity at hysteroscopy did not influence the hysterectomy rate, which was similar in both groups. Outpatient hysteroscopy was found to be as acceptable as an outpatient endometrial biopsy and successfully completed in 85% compared with 91% of women who underwent endometrial biopsy alone. No cases of endometrial malignancy were identified.Conclusions Outpatient diagnostic hysteroscopy is an acceptable procedure and may give more reassurance. It did not influence clinical management, especially with respect to hysterectomy rate. Outpatient hysteroscopy may be useful in selected cases, but when performed in a non-selective manner, it has little influence on clinical management and increases costs.

    KW - PLACEBO-CONTROLLED TRIAL

    KW - TRANSVAGINAL ULTRASONOGRAPHY

    KW - OFFICE HYSTEROSCOPY

    KW - CURETTAGE

    KW - RESECTION

    KW - POLYPS

    KW - ACCEPTABILITY

    KW - HYSTERECTOMY

    KW - MENORRHAGIA

    KW - MYOMECTOMY

    M3 - Article

    VL - 109

    SP - 805

    EP - 811

    JO - BJOG-An International Journal of Obstetrics and Gynaecology

    JF - BJOG-An International Journal of Obstetrics and Gynaecology

    SN - 1470-0328

    IS - 7

    ER -