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.