Patient Sharing of Hysteroscopy Images for Polyp Identification
While patients can share hysteroscopy images with their healthcare providers, these images alone cannot definitively identify polyps or assess overall uterine health—direct visualization during hysteroscopy by a trained clinician or tissue sampling remains essential for accurate diagnosis and to exclude malignancy. 1, 2
Why Hysteroscopy Images Have Limitations
Diagnostic accuracy requires real-time evaluation: Hysteroscopy is considered the gold standard for evaluating intrauterine pathology including polyps, but its accuracy depends on direct visualization by an experienced operator during the procedure, not static images reviewed afterward 3, 4.
Critical distinction between benign and malignant lesions cannot be made visually: Even with direct hysteroscopic visualization, neither hysteroscopy nor any imaging modality can distinguish between benign endometrial pathology (like polyps) and endometrial cancer with high certainty 1, 2, 5. This is why tissue sampling or biopsy is mandatory when any focal endometrial abnormality is identified 5, 6.
What Hysteroscopy Can and Cannot Do
Hysteroscopy excels at identifying structural abnormalities: It is highly accurate for diagnosing abnormalities projecting into the uterine cavity such as polyps, submucous myomas, endometrial hyperplasia, and endometrial adenocarcinoma 3, 4.
Images alone miss critical diagnostic information: The American College of Radiology guidelines emphasize that endometrial sampling or direct visualization with hysteroscopy is recommended in women with suspected endometrial pathology—not review of images 1. The procedure allows for targeted biopsy and safe removal of endometrial polyps during the same session 4.
Histopathological analysis is mandatory: Due to the risk of malignancy, histopathological analysis of any identified polyp is mandatory, regardless of its appearance on hysteroscopy 6.
Clinical Algorithm for Proper Evaluation
For symptomatic patients or those with abnormal bleeding:
- Combined transabdominal and transvaginal ultrasound with Doppler is the most appropriate initial imaging study 1
- If a polyp is suspected on ultrasound, diagnostic hysteroscopy with the capability for immediate polypectomy and tissue sampling should be performed 1, 6
- In-office hysteroscopy has the highest diagnostic accuracy with high cost-benefit ratio for premalignant and malignant pathologies 6, 4
For postmenopausal women with bleeding:
- Endometrial thickness ≥5 mm requires tissue sampling 2, 5
- Diagnostic hysteroscopy with hysteroscopic polypectomy should be offered if endometrial polyps are present 6
Critical Pitfalls to Avoid
Never rely on visual appearance alone: The presence of what appears to be a benign polyp on images does not exclude concurrent endometrial pathology, including cancer 5. Blind dilation and curettage should be avoided due to inaccuracy for focal endometrial pathology 6.
Concurrent pathology may be missed: In studies of cervical polyps, 7.7% were associated with an endometrial polyp, and 16.7% of lesions initially identified as cervical polyps were actually endometrial 7. This demonstrates why complete intrauterine evaluation is essential.
Expectant management is inappropriate for symptomatic patients: Expectant management is not recommended in symptomatic patients, especially in postmenopausal women, due to malignancy risk 6.