Abstract
Objective: To characterize office and operating room hysteroscopy in
women 70 years of age or older. Design: This was a retrospective chart
analysis. Setting: A single tertiary-care medical center. Population:
All women aged 70 years of age or older who underwent a hysteroscopy
procedure between March 2011 and August 2018. Methods: All hysteroscopic
interventions performed during the study period were reviewed. All
patients had at least one gynecological examination that included an
ultrasound study prior to the hysteroscopy. Main outcome measures:
Primary outcomes included procedure success and histopathological
findings. Secondary outcomes included short-term complications of the
procedure. Results: The data of 577 patients were analyzed. The median
age at the time of the procedure was 76 years. 225 office hysteroscopy
procedures and 405 operating room procedures were included. Of the 236
patients with PMB, 73(30.9%) were diagnosed as having malignancy
compared to 25 (7.3%) of the 341 patients with no PMB (p <
.001, odds ratio (OR) = 5.66; confidence interval (CI) 3.46-9.26). The
office procedure was successful in 194 (87%) patients. 53 patients
required a second hysteroscopy, which revealed 12 cases of premalignant
or malignant lesions. The volume of procedures in the office increased
16 times during the study period. Conclusions: Office hysteroscopy for
women over the age of 70 is safe, feasible, and reliable for diagnosis
of endometrial malignancy. Failed hysteroscopy and a moderate-to-high
index of suspicion for malignancy indicates the need for a repeat
hysteroscopy. The diagnostic yield using the office procedure has
increased over time.