Accuracy and efficacy of narrow-band imaging versus white light hysteroscopy for the diagnosis of endometrial cancer and hyperplasia: a multicenter controlled study

Objective: The aim of this study was to evaluate, in a multicenter study, whether the narrow-band imaging (NBI) technology may improve the diagnostic reliability of hysteroscopy in the diagnosis of endometrial cancer and hyperplasia. Methods: A total of 801 outpatient women undergoing diagnostic hysteroscopy were enrolled. All women underwent fluid minihysteroscopy with white light (WL) and NBI exploration with endometrial eye-directed biopsy. Results: NBI hysteroscopy significantly improved the sensitivity for diagnosing endometrial cancer compared with WL (93% and 81%, P < 0.05). In detecting low-risk hyperplasia, the use of NBI significantly improved the sensitivity (82% vs 56%, P < 0.005) and positive predictive value (79% and 71%, P < 0.05) compared with WL hysteroscopy. In the diagnosis of high-risk hyperplasia, NBI significantly improved the sensitivity (60% vs 20%, P < 0.005) and positive predictive value (67% and 25%, P < 0.0001), whereas no difference was seen for specificity (99% and 99%, P > 0.005), negative predictive value (99% and 99%, P > 0.05), and accuracy (99% and 98%, P > 0.05). Conclusions: NBI showed significantly higher values in sensitivity for the detection of low-risk and high-risk hyperplasia, and this could be useful for reducing the risk of missing severe pathologies at hysteroscopy, and improving the diagnosis of preneoplastic and neoplastic pathologies. NBI hysteroscopy showed a very high diagnostic accuracy for the exploration of the uterine cavity, reducing the number of biopsies performed in wrong areas, although multicenter randomized trials are required to establish the true value of this interesting technological advancement.