Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital & University of Ottawa, Ottawa, Ontario, Canada.
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
J Obstet Gynaecol Res. 2022 Sep;48(9):2452-2458. doi: 10.1111/jog.15329. Epub 2022 Jun 15.
Failure to obtain an office-based endometrial biopsy for abnormal uterine bleeding is not uncommon. Although operating room-based procedures are traditionally considered the gold standard assessment tool in these circumstances, outpatient hysteroscopy is a less invasive, more cost-effective, and safer alternative. However, there is no contemporary Canadian literature on the effectiveness of an outpatient approach for this specific population.
We aim to evaluate the effectiveness and outcomes of outpatient hysteroscopy for uterine cavity evaluation for patients who have failed an in-office endometrial biopsy attempt.
We conducted a retrospective cohort study of all patients referred to an academic outpatient hysteroscopy unit between January 2015 and January 2018, who underwent an outpatient hysteroscopy following failed endometrial biopsy. Data were collected from electronic medical records.
Of the 407 consecutive patients who underwent an outpatient hysteroscopic procedure, 68 met inclusion criteria. Postmenopausal bleeding was the most common indication for initial biopsy, and most failures were attributed to cervical stenosis. Outpatient hysteroscopies were successfully completed in 96% of cases (n = 65/68). Failure resulted from either anxiety and discomfort (n = 2), or severe intrauterine adhesions (n = 1). Overall, 10% of patients subsequently required an operating room-based hysteroscopy, either to complete a myomectomy or polypectomy, or to allow general anesthesia. Outpatient hysteroscopy identified endometrial hyperplasia and cancer in 4.5% and 3% of patients, respectively.
Outpatient hysteroscopy following unsuccessful office endometrial biopsy attempts appears to be a feasible, safe, and cost-effective investigation strategy that may prevent the need for an operating room-based procedure in 90% of cases.
对于异常子宫出血，未能进行门诊子宫内膜活检并不少见。虽然传统上认为手术室的操作是这些情况下的金标准评估工具，但门诊宫腔镜检查是一种侵入性更小、更具成本效益且更安全的替代方法。然而，加拿大目前没有关于该特定人群门诊方法有效性的文献。
我们旨在评估门诊宫腔镜检查在已尝试门诊子宫内膜活检失败的患者中进行子宫腔评估的效果和结果。
我们对 2015 年 1 月至 2018 年 1 月期间在学术性门诊宫腔镜检查单位就诊并在子宫内膜活检失败后接受门诊宫腔镜检查的所有患者进行了回顾性队列研究。数据从电子病历中收集。
在连续 407 例接受门诊宫腔镜检查的患者中，有 68 例符合纳入标准。绝经后出血是最初活检的最常见指征，大多数失败归因于宫颈狭窄。在 96%的病例中（n=65/68）成功完成了门诊宫腔镜检查。失败的原因是焦虑和不适（n=2）或严重宫腔粘连（n=1）。总体而言，10%的患者随后需要手术室宫腔镜检查，要么完成子宫肌瘤切除术或息肉切除术，要么允许全身麻醉。门诊宫腔镜检查分别发现子宫内膜增生和癌症患者的比例分别为 4.5%和 3%。
对于门诊子宫内膜活检尝试失败的患者，门诊宫腔镜检查似乎是一种可行、安全且具有成本效益的检查策略，可能会避免 90%的患者需要手术室操作。
