Afnan-Holmes, H

Brockbank, E

Chandrasekaran, D

Lawrence, A

Manchanda, R

Musa, E

Osman, M

BJOG An International Journal of Obstetrics & Gynaecology

Queen Mary Research Online

Title: Evaluation of the diagnostic hysteroscopy service in Gynaecology OncologyAuthor(s): MA Osman, D Chandrasekaran, E Musa, H Afnan-Holmes, E Brockbank, A Lawrence, R ManchandaInstitution: Royal London Hospital, Barts Health NHS TrustIntroduction: Hysteroscopy is a diagnostic procedure routinely used to investigate abnormal uterine bleeding. RCOG recommends a dedicated outpatient hysteroscopy (OPH) service, which is both acceptable to patients and cost effective. We aim to evaluate outcomes of diagnostic OPH and post-hysteroscopy telephone follow up service for two-week wait (2WW) referrals in gynaecology oncology. Methods: Retrospective review of 253 patients who underwent diagnostic hysteroscopy under gynaecology oncology between September 2015 and June 2016. Data was extracted from electronic notes. Results: Postmenopausal bleeding (175/253, 69%) was the commonest indication for referral.  235/253 (93%) patients were referred via 2WW referral, with 18/253 (7%) referred from secondary care. 206/253 (81%) underwent diagnostic hysteroscopy, with 129/206 (63%) presenting to the one-stop OPH clinic as their first visit. 169/206 (82%) patients underwent OPH. The failure rate of OPH was 15% (26/169), secondary to cervical stenosis, (14/26, 54%) pain (7/26, 27%), endocervical polyp (4/26, 15%) and vasovagal symptoms (1/26, 4%).  153/206 (74%) patients underwent endometrial biopsy, with 140/153 (92%) reported as benign pathology and 13/153 (8%) reported as malignant/pre-malignant. 64/140 (46%) patients with benign pathology were followed up by telephone, whilst 72/140 (51%) received clinic follow up due to the need for an advocate (26/72, 36%), discussion of further investigations (10/72, 14%) and management (9/72, 13%), and 27/72 (38%) had no clear indication. Conclusion: The incidence of malignant/premalignant pathology and the OPH failure rate is consistent with the reported literature. Increased utilisation of telephone follow-up in patients with benign pathology could lead to further cost savings. 

Evaluation of the diagnostic hysteroscopy service in gynaecology oncology

Evaluation of the diagnostic hysteroscopy service in gynaecology oncology

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Queen Mary Research Online