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Hysteroscopic appearance of malignant and benign endometrial lesions: a case-control study
Fábio E Zola1, Antonio A Nogueira, Jurandyr M de Andrade
1Department of Gynecology and Obstetrics, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av Bandeirantes, no. 3900, 8 andar, Ribeirão Preto, Sao Paulo, CEP 14049-900, Brazil.
Objective:
To analyze hysteroscopic appearance of benign and malignant endometrial lesions in order to identify patterns to estimate the risk of malignance.
Study Design:
Matched case-control study; two controls per case. The cases were 21 women (age range 40-90 years, median 63) with histologically confirmed endometrial malignancy, and the control group 42 women submitted to diagnostic hysteroscopy for benign lesions (age range 37-81 years, median 57).
Results:
Hysteroscopic findings associated with malignancy were papillary aspect (OR 26.0, 95%CI 6.4-105.3), size>1/2 uterine cavity (OR 22.0, 95%CI 5.1-95.8), irregular surface (OR 8.0, 95%CI 2.7-23.2), mixed color (OR 10.0, 95%CI 3.6-28.0), diffuse vascular arrangement (OR 5.3, 95%CI 1.3-21.5), little branched vessels (OR 15.0, 95%CI 3.0-74.9), and discordance between the main vascular axe and the direction of the lesion growth (OR 37.0; 95% CI 10.7-128.3). Ulcerated surface and anarchic vascular aspect were present only in malignant cases.
Conclusion:
The analyzes of general aspect, size, surface, color, vascular arrangement and vascular aspect allowed the estimation of the risk of malignancy, and the identification of points for targeted sampling.
