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Accuracy of hysteroscopic examination in intrauterine pathology: a Brazilian experience
respectively). Sixty percent of spontaneous pregnancies were observed in the first year of follow-up. Using monofilament thread showed better results than braided thread for the anatomical and functional studied parameters. CONCLUSIONS: Transient ovariopexy is a simple, reproducible and effective technique for adhesion prevention in severe endometriotic patients with very low morbidity and no effect on ovarian reserve. Subsequent fertility seemed improved. The thread used for this surgical tool had also an impact on anatomical and functional results. Supported by: None.
P-178 ADDING ENDOMETRIAL BIOPSY TO POLYPECTOMY: IS IT ´ vila. WORTHWHILE? M. M. Carneiro, I. D. Filogonio, P. S. Gouvea, I. A Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Hospital Biocor, Belo Horizonte, Brazil. OBJECTIVE: To establish the role of adding endometrial biopsy to polypectomy in the diagnosis of intrauterine pathology. DESIGN: Retrospective study of consecutive patients referred for hysteroscopic polypectomy at Biocor Hospital. MATERIALS AND METHODS: One-hundred and thirty-three consecutive patients who underwent hysteroscopic polypectomy with random endometrial biopsy from July 1997 to June 2004 were included. Diagnostic hysteroscopy was performed before surgery in all patients. Hysteroscopic diagnosis was defined by the appearance of the uterine cavity before biopsy or surgery. Standard histopathological criteria were used for diagnosing the lesions and as the gold standard against which the hysteroscopic view was compared. Random endometrial biopsy was performed in all cases. Description of the surgical procedure and the hysterosocpic view, as well as histological diagnosis were recorded for all patients. Study protocol was approved by the local Institutional Review Board. Sensitivity and specificity were calculated using the Statistical Package for the Social Sciences. McNemar test was used to test the value of adding biopsy to polypectomy. RESULTS: One hundred thirty-three polypectomies were analysed. Mean patient age was 59 years (range 30-85 years). Endometrial polyp (58.6%) was the main surgical indication. The presence of clinical symptoms (bleeding or abnormal endometrium on ultrasound) showed a low sensitivity (36.9% 95%CI 27.3-47.5) and specificity (61.2% 95%CI 47.2-73.5) in the diagnosis of endometrial hyperplasia or cancer. Hysteroscopic view also revealed a low sensitivity (75% 95%CI61-84) and specificity (44.4% 95%CI 34-55) in the diagnosis of atypical endometrial hyperplasia and cancer. For simple hyperplasia, sensitivity was 43.5%(95%CI 32.4-55.2) and specificity 71.9(95%CI 59.8-81.4).The addition of endometrial biopsy significantly increased the diagnosis of atypical hyperplasia and cancer (McNemar test p¼0.000) as well as of simple hyperplasia (p¼0.008). The most frequent additional diagnosis obtained by random biopsy in patients with false negative hysteroscopies were simple endometrial hyperplasia (n¼66), followed by atypical endometrial hyperplasia (n¼10), endometrial cancer (n¼3) and myoma (n¼2). CONCLUSIONS: The addition of endometrial sampling to polypectomy significantly increased the diagnosis of concomitant endometrial abnormalities which could have been missed otherwise, mainly endometrial hyperplasia and cancer. Thus endometrial biopsy should be added to polypectomy. Supported by: None.
P-179 ACCURACY OF HYSTEROSCOPIC EXAMINATION IN INTRAUTERINE PATHOLOGY: A BRAZILIAN EXPERIENCE. M. M. Car´ vila, P. S. Gouvea, I. D. Filogonio. Universidade Federal de Minas neiro, I. A Gerais, Belo Horizonte, Brazil; Biocor Hospital, Belo Horizonte, Brazil. OBJECTIVE: To evaluate the accuracy of hysteroscopic view in the diagnosis of intrauterine pathology. DESIGN: Retrospective study of surgical records of all patients who underwent hysteroscopic surgery from July 1997 to June 2004 at Biocor hospital. MATERIALS AND METHODS: Nine hundred and eighty-three consecutive patients who underwent hysteroscopic examination with conclusive histologic results were included. The study was approved by the local Institutional Review Board. Standard histopathological criteria was the gold standard against which the hysterosocpic view was compared. Hysteroscopic
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Abstracts
diagnosis was defined by the appearance of the surface of the uterine cavity before biopsy or surgery and then matched to histopathology to evaluate accuracy. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and likelihood ratios (LR) were calculated using the Statistical Package for Social Sciences. RESULTS: Mean patient age was 51 years (5113.5) and the majority (48%) was older than 51 years of age. The most frequent surgical indications were endometrial polyps (44%), abnormal uterine bleeding (29%) and abnormal endometrium on ultrasound (10%). Polypectomy (48%), endometrial biopsy (15%) and polypectomy with endometrial biopsy (14%) were the most frequent surgeries performed. Endometrial polyps (57%) and myomas (10%) were the most frequent diagnosis made by hysteroscopy and histopathologic study (51% and 10% respectively). For endometrial polyps the sensitivity was 93.9% (95%CI 92-96.2), specificity 81.4% (95%CI 77.9-84.9), PPV 83.87(95%CI 80.8-86.9) and NPV 92.9%(95%CI 90.5-100). For myomas sensitivity was 96.8% (95%CI 93.8-100) and specificity 98.9%(95%CI 98.3-99.6), PPV 91.2%(95%CI 85.7-96.7) and NPV 99.7%(95%CI 99.7100). For endometrial cancer sensitivity was 71.4%(95%CI 47.7-95.1) and specificity 99.9%(95%CI 99.7-100), PPV 90.9%(95%CI 73.9-100) and NPV 99.6%(95%CI 99.2-100). As for simple endometrial hyperplasia sensitivity was 44.4%(95%CI 28.2-60.7) and specificity 97%(95%CI 98.1-99.5), PPV 57.2%(95%CI 38.8-75.5) and NPV 97.9%(95%CI 97-100). Positive LR for polyps (5.0 95%CI 4.1-6.1) was moderate and high for myomas (95.4), endometrial hyperplasia (35.0) and cancer (692.1). CONCLUSIONS: Hysteroscopy appears to be an accurate method to distinguish between normal and abnormal endometrium and can reliably identify endometrial polyps and myomas but cannot safely diagnose or exclude endometrial hyperplasias and cancer. Thus histopathologic should always be performed. Supported by: None.
P-180 EVALUATION OF A PERIOPERATIVE PAIN MANAGEMENT REGIMEN FOR REDUCING POSTOPERATIVE PAIN MEASURES AND IMPROVING RECOVERY TIME IN FEMALE PATIENTS UNDERGOING LAPAROTOMY. S. Coleman, C. W. Lipari, M. Fox. Obstetrics and Gynecology, University of Florida & Shands Hospital, Jacksonville, FL. OBJECTIVE: To evaluate a pain management regimen currently being used to reduce recovery time and narcotic use following laparotomy. DESIGN: Retrospective chart review. MATERIALS AND METHODS: Patients were stratified into one of two groups. Group A was comprised of patients that underwent a perioperative regimen consisting of: preoperative counseling, avoidance of retractors, preincisional local blockade, immediate removal of the Foley catheter, resumption of regular diet and ambulation on the day of surgery, avoidance of patient-controlled anesthesia, and the use of scheduled NSAIDs and oral narcotics. Group B consisted of patients who were not exposed to the pain regimen. Parameters evaluated included time to: ambulation, removal of Foley catheter, resumption of regular diet and discharge from hospital. Inpatient narcotic requirement and postoperative complication rates were also measured. Information regarding patient demographics was obtained from the patients admission history & physical and/or nursing notes, as indicated. RESULTS: Statistically significant reductions were noted in all measured variables. Mean time to removal of Foley catheter was reduced from 22.0 to 4.2 hours; mean time to regular diet was reduced from 46.0 to 16.9 hours; median duration of admission was reduced from 74 to 24 hours; and mean inpatient narcotic use was reduced from 51.9 to 11.6 milligrams of morphine. The postoperative complication rate was reduced from 38.7% to 18.4% (P¼.01), with no readmits noted in the study group. TABLE 1. Patient Demographics
Group A
Age Gravida Parity BMI (kg/m2)
Group B
Mean
Standard Deviation
Mean
Standard Deviation
p value
36.3 0.8 0.3 29.8
4.3 1.1 0.6 6.2
35.4 1.2 0.8 29.6
4.9 1.3 1.1 7.6
0.27 0.07 0.002 0.85
Vol. 90, Suppl 1, September 2008
P-178 ADDING ENDOMETRIAL BIOPSY TO POLYPECTOMY: IS IT ´ vila. WORTHWHILE? M. M. Carneiro, I. D. Filogonio, P. S. Gouvea, I. A Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Hospital Biocor, Belo Horizonte, Brazil. OBJECTIVE: To establish the role of adding endometrial biopsy to polypectomy in the diagnosis of intrauterine pathology. DESIGN: Retrospective study of consecutive patients referred for hysteroscopic polypectomy at Biocor Hospital. MATERIALS AND METHODS: One-hundred and thirty-three consecutive patients who underwent hysteroscopic polypectomy with random endometrial biopsy from July 1997 to June 2004 were included. Diagnostic hysteroscopy was performed before surgery in all patients. Hysteroscopic diagnosis was defined by the appearance of the uterine cavity before biopsy or surgery. Standard histopathological criteria were used for diagnosing the lesions and as the gold standard against which the hysteroscopic view was compared. Random endometrial biopsy was performed in all cases. Description of the surgical procedure and the hysterosocpic view, as well as histological diagnosis were recorded for all patients. Study protocol was approved by the local Institutional Review Board. Sensitivity and specificity were calculated using the Statistical Package for the Social Sciences. McNemar test was used to test the value of adding biopsy to polypectomy. RESULTS: One hundred thirty-three polypectomies were analysed. Mean patient age was 59 years (range 30-85 years). Endometrial polyp (58.6%) was the main surgical indication. The presence of clinical symptoms (bleeding or abnormal endometrium on ultrasound) showed a low sensitivity (36.9% 95%CI 27.3-47.5) and specificity (61.2% 95%CI 47.2-73.5) in the diagnosis of endometrial hyperplasia or cancer. Hysteroscopic view also revealed a low sensitivity (75% 95%CI61-84) and specificity (44.4% 95%CI 34-55) in the diagnosis of atypical endometrial hyperplasia and cancer. For simple hyperplasia, sensitivity was 43.5%(95%CI 32.4-55.2) and specificity 71.9(95%CI 59.8-81.4).The addition of endometrial biopsy significantly increased the diagnosis of atypical hyperplasia and cancer (McNemar test p¼0.000) as well as of simple hyperplasia (p¼0.008). The most frequent additional diagnosis obtained by random biopsy in patients with false negative hysteroscopies were simple endometrial hyperplasia (n¼66), followed by atypical endometrial hyperplasia (n¼10), endometrial cancer (n¼3) and myoma (n¼2). CONCLUSIONS: The addition of endometrial sampling to polypectomy significantly increased the diagnosis of concomitant endometrial abnormalities which could have been missed otherwise, mainly endometrial hyperplasia and cancer. Thus endometrial biopsy should be added to polypectomy. Supported by: None.
P-179 ACCURACY OF HYSTEROSCOPIC EXAMINATION IN INTRAUTERINE PATHOLOGY: A BRAZILIAN EXPERIENCE. M. M. Car´ vila, P. S. Gouvea, I. D. Filogonio. Universidade Federal de Minas neiro, I. A Gerais, Belo Horizonte, Brazil; Biocor Hospital, Belo Horizonte, Brazil. OBJECTIVE: To evaluate the accuracy of hysteroscopic view in the diagnosis of intrauterine pathology. DESIGN: Retrospective study of surgical records of all patients who underwent hysteroscopic surgery from July 1997 to June 2004 at Biocor hospital. MATERIALS AND METHODS: Nine hundred and eighty-three consecutive patients who underwent hysteroscopic examination with conclusive histologic results were included. The study was approved by the local Institutional Review Board. Standard histopathological criteria was the gold standard against which the hysterosocpic view was compared. Hysteroscopic
S168
Abstracts
diagnosis was defined by the appearance of the surface of the uterine cavity before biopsy or surgery and then matched to histopathology to evaluate accuracy. Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) and likelihood ratios (LR) were calculated using the Statistical Package for Social Sciences. RESULTS: Mean patient age was 51 years (5113.5) and the majority (48%) was older than 51 years of age. The most frequent surgical indications were endometrial polyps (44%), abnormal uterine bleeding (29%) and abnormal endometrium on ultrasound (10%). Polypectomy (48%), endometrial biopsy (15%) and polypectomy with endometrial biopsy (14%) were the most frequent surgeries performed. Endometrial polyps (57%) and myomas (10%) were the most frequent diagnosis made by hysteroscopy and histopathologic study (51% and 10% respectively). For endometrial polyps the sensitivity was 93.9% (95%CI 92-96.2), specificity 81.4% (95%CI 77.9-84.9), PPV 83.87(95%CI 80.8-86.9) and NPV 92.9%(95%CI 90.5-100). For myomas sensitivity was 96.8% (95%CI 93.8-100) and specificity 98.9%(95%CI 98.3-99.6), PPV 91.2%(95%CI 85.7-96.7) and NPV 99.7%(95%CI 99.7100). For endometrial cancer sensitivity was 71.4%(95%CI 47.7-95.1) and specificity 99.9%(95%CI 99.7-100), PPV 90.9%(95%CI 73.9-100) and NPV 99.6%(95%CI 99.2-100). As for simple endometrial hyperplasia sensitivity was 44.4%(95%CI 28.2-60.7) and specificity 97%(95%CI 98.1-99.5), PPV 57.2%(95%CI 38.8-75.5) and NPV 97.9%(95%CI 97-100). Positive LR for polyps (5.0 95%CI 4.1-6.1) was moderate and high for myomas (95.4), endometrial hyperplasia (35.0) and cancer (692.1). CONCLUSIONS: Hysteroscopy appears to be an accurate method to distinguish between normal and abnormal endometrium and can reliably identify endometrial polyps and myomas but cannot safely diagnose or exclude endometrial hyperplasias and cancer. Thus histopathologic should always be performed. Supported by: None.
P-180 EVALUATION OF A PERIOPERATIVE PAIN MANAGEMENT REGIMEN FOR REDUCING POSTOPERATIVE PAIN MEASURES AND IMPROVING RECOVERY TIME IN FEMALE PATIENTS UNDERGOING LAPAROTOMY. S. Coleman, C. W. Lipari, M. Fox. Obstetrics and Gynecology, University of Florida & Shands Hospital, Jacksonville, FL. OBJECTIVE: To evaluate a pain management regimen currently being used to reduce recovery time and narcotic use following laparotomy. DESIGN: Retrospective chart review. MATERIALS AND METHODS: Patients were stratified into one of two groups. Group A was comprised of patients that underwent a perioperative regimen consisting of: preoperative counseling, avoidance of retractors, preincisional local blockade, immediate removal of the Foley catheter, resumption of regular diet and ambulation on the day of surgery, avoidance of patient-controlled anesthesia, and the use of scheduled NSAIDs and oral narcotics. Group B consisted of patients who were not exposed to the pain regimen. Parameters evaluated included time to: ambulation, removal of Foley catheter, resumption of regular diet and discharge from hospital. Inpatient narcotic requirement and postoperative complication rates were also measured. Information regarding patient demographics was obtained from the patients admission history & physical and/or nursing notes, as indicated. RESULTS: Statistically significant reductions were noted in all measured variables. Mean time to removal of Foley catheter was reduced from 22.0 to 4.2 hours; mean time to regular diet was reduced from 46.0 to 16.9 hours; median duration of admission was reduced from 74 to 24 hours; and mean inpatient narcotic use was reduced from 51.9 to 11.6 milligrams of morphine. The postoperative complication rate was reduced from 38.7% to 18.4% (P¼.01), with no readmits noted in the study group. TABLE 1. Patient Demographics
Group A
Age Gravida Parity BMI (kg/m2)
Group B
Mean
Standard Deviation
Mean
Standard Deviation
p value
36.3 0.8 0.3 29.8
4.3 1.1 0.6 6.2
35.4 1.2 0.8 29.6
4.9 1.3 1.1 7.6
0.27 0.07 0.002 0.85
Vol. 90, Suppl 1, September 2008