Evaluation of safety and diagnostic performance for flexible hysteroscopy in 1591 outpatient cases

Yusuke Kobayashi, Kosuke Tsuji, Kanako Nakamura, Shimpei Nagai, Takayuki Takahashi, Arata Kobayashi, Mayuka Anko, Takuro Hirano, Keiko Watanabe, Yusuke Matoba, Haruko Kunitomi, Masataka Adachi, Wataru Yamagami, Eiichirou Tominaga, Kouji Banno, Daisuke Aoki

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background: To date, only few large studies are available concerning the safety and diagnostic concordance rates of outpatient flexible hysteroscopy. In our institution, outpatient hysteroscopy has been routinely and educationally applied Kosuke Tsuji to intrauterine lesions; thus, we retrospectively investigated the institution's outpatient flexible hysteroscopy cases. Methods: A total of 1591 cases of outpatient flexible hysteroscopy conducted at our institution in 2012-2016 were retrospectively analyzed in terms of their clinical background, complications and diagnostic concordance rates. Results: A total of 1591 cases included 546 cases of benign tumors (317 endometrial polyps, 168 myomas and 61 endometrial hyperplasia), 361 cases of atypical endometrial hyperplasia, 571 cases of endometrial cancers and 113 cases of other diagnoses. No major complications, including uterine perforation, occurred. However, one patient (0.06%) was diagnosed with septic shock caused by intrauterine infection that required prolonged immunosuppressive drug administration. Meanwhile, 335 patients diagnosed with benign tumors through outpatient flexible hysteroscopy underwent operation, and the diagnostic concordance rate was 74.6% (250 cases). However, this rate included 14 cases (4.2%) diagnosed with malignant tumors postoperatively. In preoperative endometrial cancer cases, the sensitivity and specificity for cervical invasion diagnosis were 39.4 and 90.8%, respectively. In addition, only one patient manifested positive ascites cytology intraoperatively, possibly caused by outpatient hysteroscopy. Conclusions: Outpatient flexible hysteroscopy is highly safe, with a slight negligible effect on ascites cytology. However, the diagnosis should be determined by multidisciplinary approaches, as hysteroscopy alone can miss malignancy.

Original languageEnglish
Pages (from-to)1157-1161
Number of pages5
JournalJapanese journal of clinical oncology
Issue number10
Publication statusPublished - 2020 Oct 1


  • diagnostic concordance rates
  • outpatient flexible hysteroscopy
  • safety

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research


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