title: Detection of chronic endometritis at fluid hysteroscopy.
abstract: OBJECTIVE
  Chronic endometritis is a subtle condition that is difficult to detect; however, it may cause abnormal uterine bleeding and infertility. Few data exist about the appearance of chronic endometritis at fluid hysteroscopy and about the value of diagnostic fluid hysteroscopy in the detection of this condition. In our experience, at fluid hysteroscopy chronic endometritis is characterized by consistent association of stromal edema and either focal or diffuse hyperemia; in some cases, this finding is associated with endometrial micropolyps (less than 1 mm in size). This study attempted to describe diagnostic criteria for chronic endometritis at fluid hysteroscopy and assess the diagnostic accuracy of fluid hysteroscopy in the detection of this condition.
  
  
  METHODS
  Retrospective Study (Canadian Task Force classification II-2).
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Nine hundred-ten women in whom hysteroscopy was indicated.
  
  
  METHODS
  Fluid hysteroscopy followed by endometrial biopsy.
  
  
  RESULTS
  Sensitivity, specificity, positive and negative predictive values, and accuracy of fluid hysteroscopy in the detection of chronic endometritis, based on the association of edema; hyperemia; and, if present, micropolyps were calculated. Based on the presence of hyperemia and edema, chronic endometritis was diagnosed in 158 patients (17.4%); in 61 patients (6.7%), micropolyps also were present. Histology confirmed the diagnosis in 101 patients (63.9% of positive cases at hysteroscopy) and was positive in 9 additional cases not detected by hysteroscopy. Chronic endometritis at histology was found in approximately 30% of infertile women and 35% of cases related to abnormal uterine bleeding. The sensitivity, specificity, and positive and negative predictive values of hysteroscopy for chronic endometritis based on detection of only hyperemia and edema were 91.8%, 92.9%, 63.9%, and 98.8%, respectively; the diagnostic accuracy was 92.7 %. The combination of hyperemia, edema, and micropolyps had sensitivity, specificity, and positive and negative predictive values of 55.4%, 99.9%, 98.4%, 94.5%, respectively, with a diagnostic accuracy of 93.4%.
  
  
  CONCLUSIONS
  Fluid hysteroscopy is very reliable in diagnosing no inflammation, while detection of micropolyps is a very reliable sign of inflammation. When performing hysteroscopy for abnormal uterine bleeding or infertility, signs of chronic endometritis should always be sought.
authors.affiliation: 1st Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Bari, and the Department of Obstetrics and Gynecology, Hospital of Rimini, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Cicinelli
authors.forename: Leonardo
authors.initials: L
authors.lastname: Resta
authors.forename: Roberto
authors.initials: R
authors.lastname: Nicoletti
authors.forename: Massimo
authors.initials: M
authors.lastname: Tartagni
authors.forename: Marco
authors.initials: M
authors.lastname: Marinaccio
authors.forename: Carlo
authors.initials: C
authors.lastname: Bulletti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Colafiglio
mesh_terms: D001706:Biopsy; D004716:Endometritis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D004717:Endometrium / Q000473:pathology*; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D007247:Infertility, Female / Q000209:etiology; D011127:Polyps / Q000175:diagnosis / Q000473:pathology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014591:Uterine Diseases / Q000175:diagnosis / Q000473:pathology; D014592:Uterine Hemorrhage / Q000209:etiology