Detection of chronic endometritis at fluid hysteroscopy.
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.
Cicinelli
Ettore
E
1st Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Bari, and the Department of Obstetrics and Gynecology, Hospital of Rimini, Italy.
Resta
Leonardo
L
Nicoletti
Roberto
R
Tartagni
Massimo
M
Marinaccio
Marco
M
Bulletti
Carlo
C
Colafiglio
Giuseppe
G
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