Flexible outpatient hysterofibroscopy without anesthesia: a feasible and valid procedure.

BACKGROUND To evaluate the feasibility and validity of a large series of outpatient diagnostic hysteroscopies using a 4.9 mm flexible hysterofibroscope without anesthesia. METHODS In this observational clinical study, 2033 consecutive women referred with various indications underwent an outpatient hysteroscopy without analgesia or anesthesia. A 4.9 mm flexible hysterofibrescope (Olympus Corporation, Shinjuku-ku, Tokyo, Japan) was used to perform the examination. The diagnostic efficacy and patient tolerance were evaluated. RESULT The whole procedure was finished within 3 minutes. The hysteroscopy could not be completed in 41 (2.2%) women. Three hundred sixty-six patients (18.0%) required cervical dilatation before insertion of the hysteroscope. Severe discomfort including vagal reflex and ascending infection occurred in 4 (0.19%) women. Normal results were found in 60.1% of women with premenopausal and 59.3% with postmenopausal abnormal uterine bleeding. In women who underwent transvaginal ultrasound and hysteroscopic examination concomitantly, the accuracy of ultrasound diagnosis of an intrauterine mass was 83.3%, and the predictive rate for submucosal myoma was significantly higher than that for endometrial polyps (91.2% vs. 76.2%, p = 0.001). Correlation between histological and hysteroscopic diagnoses showed the accuracy of hysteroscopic diagnosis of submucosal myoma was higher than that for endometrial polyps (81.3% vs. 68.4%, p = 0.034). Physiologic endometrial changes were misdiagnosed as endometrial hyperplasia more often than they were misdiagnosed as endometrial cancer (39.5% vs. 4.2%, p = 0.027). CONCLUSIONS Low failure and complication rates indicate that flexible hysterofibroscopy is feasible when performed in an outpatient setting without anesthesia. Extensive experience and histological confirmation are necessary for accurate endometrial evaluation.