ABSTRACT
Background: Normally, endometrium comprises of non-absorptive epithelium and does not take up stain. Conventional staining with methylene blue is explained on the basis of existence of apoptotic cells in endometrium.Methods: Of 50 patients of unexplained infertility, AUB, recurrent pregnancy loss were randomly selected and included in the study. Those with abnormal ultrasound and history of tuberculosis were excluded. Conventional hysteroscopy was performed using normal saline as distending medium and in those with grossly normal endometrium were subjected to staining with 5% methylene blue instilled trans cervically. After 5 min, irrespective of the size and pattern, focal dark blue stained areas were considered abnormal and randomly biopsied. Incidence of endometritis in both groups was compared after histopathological examination.Results: Of total 50 patients, histopathological report of only one patient with dark blue staining had evidence of endometritis. Rest had no evidence, of which 73.5% had light blue or unstained areas and 26.5% showed dark blue staining. No statistically significant difference was found between histopathological reports and light or dark blue staining (p=0.28). When percentage stained area was considered more than 50% only to be positive, sensitivity was 100%, specificity 94%, PPV 25% and NPV 100%. False positives were 75% and no false negatives were observed. Although p values improved but still statistically insignificant.Conclusions: Present study failed to establish any significant correlation between staining pattern and detection rate of endometritis. With no Indian studies published on chromohysteroscopy so far, role of methylene blue in detection of subtle endometrial changes in modern gynaecology in Indian subpopulation is yet to be established.
ABSTRACT
Background: Abnormal uterine bleeding is one of the most common clinical problems encountered in gynaecological practice. Chromohysteroscopy is thought to improve the diagnostic accuracy of hysteroscopy and reach the final diagnosis in AUB and is the subject matter of this study.Methods: A prospective cross-sectional study was performed on 35 women with AUB, who presented to the Dept. of Obstetrics and Gynecology, JNMCH, Aligarh, over a period of 2 years (2014-2016). After transvaginal sonography, all cases underwent hysteroscopy followed by chromohysteroscopy using 5% methylene blue dye. Differentially stained pattern of the uterine cavity was observed and hysteroscopic guided biopsy was taken from stained and unstained areas, followed by endometrial aspiration biopsy. All three samples were sent for histopathological examination. Results were analyzed and compared.Results: Out of 35 cases studied, 13 cases showed diffuse light staining, while 22 cases had focal dark staining. Histopathology results from diffuse light stained group showed 9 (69.2%) had normal endometrium. Out of 22 cases with focal dark staining, 20 (90.0%) cases had abnormal histopathology. It was found that focal dark staining to detect endometrial pathology had a sensitivity of 83.3%, specificity of 81.8%, positive predictive value of 90.9 %, negative predictive value of 69.2% and accuracy 82.8%. The difference in the diagnostic ability of stained tissue biopsy was highly significant (p< 0.001) when compared to blind endometrial aspiration biopsy.Conclusions: Chromohysteroscopy is an efficacious simple tool for detecting endometrial pathology in cases of AUB.
ABSTRACT
Aim: To evaluate the role of chromohysteroscopy in detection of intracavitary lesions in perimenopausal women with abnormal uterine bleeding. Methods: This was a prospective study conducted in 100 perimenopausal women with AUB who underwent transvaginal sonography, conventional hysteroscopy and chromohysteroscopy. Atotal of 34 cases in our study group underwent hysterectomy and specimens were sent for histopathology. Histopathological examination was carried out by a clinical pathologist who was blinded regarding hysteroscopic findings. Diagnostic accuracy of hysteroscopy and chromohysteroscopy in detection of intracavitary lesions was then studied keeping histopathology as the gold standard.Results: 2Mean age of the study group was 43.49 ± 3.42yrs, average parity was 3 and mean BMI was 25.41± 3.41 Kg/m. 40% cases presented with menorrhagia, 38% with polymenorhagia, 9% with metrorrhagia and 4% with postmenopausal bleeding. Hysteroscopy revealed normal cavity in 59 cases, intracavitary lesions were detected in 26 cases (submucous fibroids in 14, endometrial polyps in 11, and growth with areas of necrosis in one case), synechiae in 2 cases and diffuse endometrial disease was suspected in 17 cases (hyperplastic in 13 cases and polypoidal in 4 cases. On chromohysteroscopy, most of the intracavitary lesions (72%) either did not stain or the uptake was very minimal giving an unstained appearance in comparison to the surrounding endometrium. The lesions thus got demarcated and separated from the surrounding endometrium. The conventional hysteroscopic, chromohysteroscopic and histopathologic findings were then compared with each other. The diagnostic accuracy of conventional hysteroscopy in detecting polyps was found to be high (Sensitivity-85.71 %, specificity- 92.59%, positive predictive value- 75.0%, negative predictive value- 96.15% ; P<0.001). Its diagnostic accuracy in detecting submucous fibroids was also high (Sensitivity-92.31 %, specificity- 90.47%, positive predictive value 85.71%, negative predictive value- 95.00 %;(P<0.001). The diagnostic accuracy of chromohysteroscopy in detecting intracavitary lesions as unstained areas was also found to be significantly high (Sensitivity-80.0 %, specificity- 78.57%, positive predictive value- 84.2%, negative predictive value- 73.34% ; (P<0.01).Conclusion:The diagnostic accuracy of both hysteroscopy and chromohysteroscopy in detecting intracavitary lesions is high. However, differential staining on chromohysteroscopy made these lesions look more prominent and easily identifiable to the observer.