title: Is it possible to predict office hysteroscopy failure?
abstract: OBJECTIVE
  The purpose of this study was to develop a clinical tool, the HFI (Hysteroscopy Failure Index), which gives criteria to predict hysteroscopic examination failure.
  
  
  METHODS
  This was a retrospective diagnostic test study, aimed to validate the HFI, set at the Department of Gynaecology, Obstetric and Reproductive Science of the Second University of Naples, Italy. The HFI was applied to our database of 995 consecutive women, who underwent office based to assess abnormal uterine bleeding (AUB), infertility, cervical polyps, and abnormal sonographic patterns (postmenopausal endometrial thickness of more than 5mm, endometrial hyperechogenic spots, irregular endometrial line, suspect of uterine septa). Demographic characteristics, previous surgery, recurrent infections, sonographic data, Estro-Progestins, IUD and menopausal status were collected. Receiver operating characteristic (ROC) curve analysis was used to assess the ability of the model to identify patients who were correctly identified (true positives) divided by the total number of failed hysteroscopies (true positives+false negatives). Positive and Negative Likelihood Ratios with 95%CI were calculated.
  
  
  RESULTS
  The HFI score is able to predict office hysteroscopy failure in 76% of cases. Moreover, the Positive likelihood ratio was 11.37 (95% CI: 8.49-15.21), and the Negative likelihood ratio was 0.33 (95% CI: 0.27-0.41).
  
  
  CONCLUSIONS
  Hysteroscopy failure index was able to retrospectively predict office hysteroscopy failure.
authors.affiliation: Department of the Woman, the Child and General and Specialized Surgery, Second University of Naples, Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Cobellis
authors.affiliation: Department of the Woman, the Child and General and Specialized Surgery, Second University of Naples, Naples, Italy. Electronic address: mantocastaldi@msn.com.
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Castaldi
authors.affiliation: Department of the Woman, the Child and General and Specialized Surgery, Second University of Naples, Naples, Italy.
authors.forename: Valentino
authors.initials: V
authors.lastname: Giordano
authors.affiliation: Department of the Woman, the Child and General and Specialized Surgery, Second University of Naples, Naples, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: De Franciscis
authors.affiliation: Department of Public Medicine, Section of Statistics, Second University of Naples, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Signoriello
authors.affiliation: Department of the Woman, the Child and General and Specialized Surgery, Second University of Naples, Naples, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Colacurci
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D019540:Area Under Curve; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D015907:Hysteroscopy; D016013:Likelihood Functions; D008875:Middle Aged; D009819:Office Visits; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D017211:Treatment Failure; D014591:Uterine Diseases / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult
keywords: Hysteroscopy failure; Infertility; Mathematical model; Office hysteroscopy; Statistics