Hysteroscopic appearance of malignant and benign endometrial lesions: a case-control study

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ObjectiveTo analyze hysteroscopic appearance of benign and malignant endometrial lesions in order to identify patterns to estimate the risk of malignance.Study designMatched 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).ResultsHysteroscopic 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.ConclusionThe 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.

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