Narrow-Band Imaging in Diagnosis of Endometrial Cancer and Hyperplasia: A New Option?

Abstract 

Study Objective

To estimate whether the use of narrow-band imaging (NBI) hysteroscopy increases concordance between visual identification and a histologic diagnosis of endometrial cancer and hyperplasia.

Design

Prospective study (Canadian Task Force classification: II-2).

Setting

Department of obstetrics and gynecology, University of Eastern Piedmont, Novara, Italy.

Patients

209 consecutive patients with abnormal uterine bleeding.

Interventions

White-light hysteroscopy and NBI hysteroscopy followed by direct biopsy.

Measurements and Main Results

The sensitivity and specificity of conventional hysteroscopy in predicting a diagnosis of cancer and hyperplasia were, respectively, 84.21% (95% confidence interval [CI], 79.27–89.15) and 99.47% (95% CI, 98.49–100.0), and 64.86% (95% CI, 58.39–71.34) and 98.77% (95% CI, 97.27–100.0), and of NBI hysteroscopy were 94.74% (95% CI, 91.71–97.76) and 97.89% (95% CI, 95.95–99.84), and 78.38% (95% CI, 72.8–83.96) and 97.67% (95% CI, 96.63–99.72). The concordance of conventional and NBI hysteroscopy with the histopathologic findings (measured using the Cohen κ) was, respectively, 88.80% (95% CI, 86.2%–96.3%) and 91.78% (95% CI, 89.6%–98.2%), a difference of 2.98% (95% CI, 0–9) in favor of NBI.

Conclusion

Narrow-band imaging hysteroscopy can accurately predict a histologic diagnosis of endometrial cancer or hyperplasia.

Keywords: Endometrial cancer, Endometrial hyperplasia, Hysteroscopy, Narrow-band imaging