Diagnostic Performance of Office Hysteroscopy Versus Dilation and Curettage in Women With Postmenopausal Bleeding

Background: Postmenopausal bleeding (PMB) is a potential indicator of endometrial malignancy. Blind dilation and curettage (D&C) may fail to detect focal lesions, whereas office hysteroscopy (OH) could improve diagnostic accuracy. However, direct comparative evidence between the two methods remains limited. This study aimed to compare the diagnostic outcomes of OH and D&C in women with PMB and to evaluate their diagnostic accuracy, lesion detection rate, and the clinical application. Methods: A retrospective analysis was conducted on the clinical data of 108 patients with PMB who visited the gynecology outpatient clinic of our hospital from August 2023 to May 2025. Of these, 56 patients underwent D&C, and 52 patients underwent OH. Using postoperative pathological results as the diagnostic gold standard, the detection of various types of uterine cavity lesions by the two examination methods was documented. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of each method were calculated and compared. Additionally, the incidence of adverse events, pain scores, patient satisfaction, and specimen quality were analyzed. Results: According to the gold standard, there was no significant difference in the distribution of pathological diagnoses between the D&C and the OH groups (p > 0.05). Regarding diagnostic efficacy, the OH group exhibited higher diagnostic accuracy (94.23%), sensitivity (94.00%), and NPV (40.00%) compared with the D&C group (46.43%, 43.40%, and 9.09%, respectively). The overall incidence of adverse events was lower in the OH group (3.85%) than in the D&C group (17.86%) (p = 0.030). Furthermore, the OH group experienced less pain, higher patient satisfaction, and superior specimen quality (p < 0.05), with no significant difference in examination duration compared to the D&C group (p = 0.256). Conclusions: OH demonstrates higher diagnostic accuracy, sensitivity, and specificity than D&C, along with a lower incidence of adverse events in the evaluation of PMB. Although the direct visualization of hysteroscopy is key to improving sampling for pathological analysis, gross diagnostic impressions alone are unreliable. Clinicians should rely on definitive pathological results before establishing a final diagnosis.