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    Is genetic testing for cancer survivors underutilized?


    Can in-office hysteroscopy reliably evaluate uterine pathology?

    According to a new retrospective analysis in Menopause, outpatient hysteroscopy may be a reliable tool for evaluating and diagnosing uterine pathology.

    Researchers studied data from all women who had been referred to a tertiary center outpatient hysteroscopy clinic between March 2011 and October 2016 for any of the following indications: thick endometrium, postmenopausal bleeding, and suspected polyp. Specimens obtained by hysteroscopy and hysterectomy were compared and evaluated for histological accuracy. Visual accuracy of hysteroscopy was evaluated by comparison with specimens collected through biopsy. Likelihood ratio, positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity were calculated to examine visual accuracy.

    Related: Are hysterectomy volumes in the US really falling?

    The average age of women in the study was 54.14 (interquartile range 43.0-64.0). During the 712 visits recorded in the clinic log, a total of 408 pathological specimens were collected through outpatient hysteroscopies. Histological accuracy was examined in 15 women who eventually had hysterectomies. The total percent of agreement between hysteroscopy biopsies and pathology found by hysterectomy was 73% (kappa = 0.47). Visual accuracy was calculated with a 93.1% sensitivity, 52.1% specificity, 90.4% PPV, and 61.0% NPV.

    Visual accuracy with hysteroscopy was generally higher for benign pathology than for pre- and malignant lesions. It was poor for diagnosis of hyperplasia, with sensitivity and specificity of 25.0% and 96.6%, respectively. For diagnosis of endometrial carcinoma, it was satisfactory, with sensitivity and specificity of 71.4% and 98.9%, respectively.

    The researchers concluded that outpatient hysteroscopy is an adequate tool for evaluating benign pathology in the uterus. However, visual findings may not be sufficient and directed biopsies may be needed to improve diagnostic accuracy.

    NEXT: Mammographic density as indicator of breast cancer risk

    Miranda Hester
    Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.
    Judith M. Orvos, ELS
    Judith M. Orvos, ELS, is a a BELS-certified medical writer and editor and an editorial consultant for Contemporary OB/GYN.

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    • UBM User
      Barriers to Entry: CIGNA makes me, a board certified Ob/Gyn who personally is a BRCA carrier & utilizes NCCN guidelines, send to a GC (genetics counselor) to authorize BRCA-panel testing. Patients don't take the extra step to go or call to someone they don't know and thus CIGNA has effectively saved money which is their true mission statement! #Shameful!


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