Retrospective analysis of 1000 hysteroscopic cases performed in our department

Objective: The aim of this study is to retrospectively analyze patients who underwent diagnostic and/or operative hysteroscopy at our gynecology clinic with different complaints within a specific time frame. The study aims to examine demographic data, indications for hysteroscopy, procedures performed, procedure durations, types of anesthesia used, types of distension media used, complication rates associated with hysteroscopic procedures, additional surgical/interventional requirements, intraoperative hysteroscopic diagnoses, and histopathological findings. The study also aims to evaluate the reliability and diagnostic accuracy of hysteroscopy in light of these results and in accordance with existing literature. Materials and methods: This retrospective study was conducted using clinical and pathological data of 1016 patients who underwent diagnostic or operative hysteroscopy between January 2020 and September 2022 at the Department of Obstetrics and Gynecology, Ankara University Faculty of Medicine. Reproductive, perimenopausal, and postmenopausal patients aged 18-80 years who presented to our clinic were included. Demographic data (age, body mass index), smoking status, systemic comorbidities, preoperative diagnosis, type of procedure (diagnostic/operative hysteroscopy), details of operative hysteroscopy procedures, type of anesthesia used, complications related to the operation (bleeding, rupture, etc.), procedure duration, type of distension media used during the procedure, whether an additional procedure was performed during hysteroscopy, hysteroscopic diagnosis, and histopathological diagnosis results were recorded. The data obtained were analyzed and statistically evaluated using the SPSS 11.5 program. Results: A total of 1016 patients were included in the study. The mean age of the included patients was 39.84 ± 10.88 years (range: 19-78), and the mean BMI was calculated as 26.97 ± 5.42 kg/m2. Of these, 49 (4.8%) underwent diagnostic hysteroscopy, and 967 (95.2%) underwent operative hysteroscopic procedures. The most common indication for diagnostic hysteroscopy was primary infertility (n=14, 28.57%), while the most common indication for operative hysteroscopy was endometrial polyp (n=273, 28.23%). Among the 967 patients who underwent operative hysteroscopy, the most frequently performed procedure was polypectomy (n=335, 34.64%), followed by septum resection and cavity optimization (n=145, 14.99%). Complications developed in 14 (1.4%) patients, including uterine perforation in 4 (0.39%), bleeding in 4 (0.39%), excessive fluid loading in 2 (0.19%), cervical laceration in 2 (0.19%), and postoperative infection in 2 (0.19%). The most common hysteroscopic diagnosis was polyp (n=347, 34.05%), followed by uterine septum (n=194, 19.09%) and myomatous uterus (n=99, 9.74%). Histopathologically, the most common diagnosis was endometrial polyp (n=366, 36.02%), followed by leiomyoma (n=96, 9.44%) and chronic endometritis (n=44, 4.33%). While the histopathological results of 651 (64.1%) patients were benign pathologies, 10 (0.98%) were diagnosed with endometrial intraepithelial neoplasia (EIN), 3 (0.29%) with endometrioid-type endometrial cancer, and 1 (0.098%) with neuroendocrine carcinoma. Our study compared hysteroscopic results with histopathological results, and it was determined that the method showed 79.8% sensitivity and 91.7% specificity for polyps, while for fibroids, it showed 87.5% sensitivity and 98.4% specificity. The positive predictive value for polyps was 84.4%, and the negative predictive value was 89.0%. For fibroids, the positive predictive value was 84.8%, and the negative predictive value was 98.7%. When the accuracy rates of hysteroscopy for polyps and fibroids were examined, they were found to be 87.0% and 97.0%, respectively. When the correlation between hysteroscopic results and the material sent for histopathological study was examined for endometrial polyps and fibroids, significant concordance was found. For polyps, the p-value was <0.001, and the correlation coefficient was 0.72. For fibroids, the p-value was also <0.001, and the correlation coefficient was 0.84. Conclusion: As our study has determined, hysteroscopy is a first-line investigation method in diagnosis and treatment for abnormal uterine bleeding, infertility, and other conditions related to the uterine cavity due to its high selectivity and accuracy rates, minimal invasiveness, high reliability, and low complication rates. It will continue to be used for an extended period.