Jornal de Patologia Médica e Cirúrgica
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Role of Chromo-hysteroscopy with Toluidine Blue in Diagnosing Endometrial Pathology after 40 years of Age

Nisha Singh, Gargi Agarwal, Uma Singh, SP Jaiswar

Objective: To evaluate diagnostic accuracy of Chromo hysteroscopy with Toluidine Blue for endometrial pathology in women with AUB after 40 years of age.
Material and Methods: This cross-sectional interventional study was conducted in 50 cases with menorrhagia, metrorrhagia, polymenorrhagia or postmenopausal bleeding. After excluding thyroid disorders, coagulation disorders and cervical & vaginal causes, diagnostic hysteroscopy was done and findings recorded. Chromohysteroscopy was done by instillation of 1% toluidine blue dye. Hysteroscopic biopsy was taken from stained area & unstained area separately followed by endometrial aspiration biopsy. The histopathological results of these three samples were compared for each participant.
Results: The ability of hysteroscopy to diagnose endometrial pathology was significantly higher (p=0.013) in comparison to TVS. 24% cases showed endometrial hyperplasia/carcinoma. 75% cases of endometrial hyperplasia/ carcinoma showed >50% endometrial surface staining while only 52.63% of cases with normal HPE showed similar staining but the difference was not statistically significant. The sensitivity, NPV and diagnostic accuracy of Stained biopsy (83.3%, 95% & 96%), unstained biopsy (83.3%, 95% & 96%) and endometrial aspiration (75%, 92.6% & 94%) did not show any statistically significant difference.
Conclusions: Toluidine blue dye does not specifically stain endometrial hyperplasia or endometrial carcinoma and hence is NOT a useful stain for Chromo hysteroscopy guided biopsy in diagnostic evaluation of cases of AUB.