Correlation between hysteroscopy findings and chronic endometritis

Abstract

Objective: To evaluate the role of hysteroscopy in the diagnosis of chronic endometritis (CE). Design: Retrospective cohort study. Setting: University teaching hospital. Patient(s): A consecutive series of 1,189 cases of diagnostic hysteroscopy. Intervention(s): Endometrial biopsy specimens were obtained after hysteroscopy for routine histology and immunohistochemistry for plasma cells using a CD138 epitope. Main Outcome Measure(s): Observer variability, sensitivity, specificity, and accuracy of the hysteroscopic features in the diagnosis of CE. Result(s): Immunohistochemistry of biopsy specimens showed presence of CD138 cells in 322 of 1,189 cases (27.1%). Among cases that tested positive for CD138 cells, the prevalence of hysteroscopic features was as follows: endometrial hyperemia, 169 of 322 (52.5%); endometrial interstitial edema, 27 of 322 (8.4%); and micro-polyps, 11 of 322 (3.4%). The k value of intraobserver and interobserver agreement on the presence or absence of the hysteroscopic feature of CE was 0.86 and 0.73, respectively. The sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy of the presence of one or more hysteroscopy features were 59.3%, 69.7%, 42.1%, 82.8%, and 66.9%, respectively. Conclusion(s):The finding of endometrial hyperemia, micro-polyps or endometrial interstitial edema during hysteroscopy should alert to the diagnosis of CE, but the overall accuracy of hysteroscopic examination with regard to the diagnosis of CE is only 67%, so it should not be used to replace histologic examination as the diagnostic tool of choice. In women in whom a diagnosis of CE is considered likely, endometrial biopsy should be obtained to examine plasma cells by immunohistochemistry, which should remain the preferred method for diagnosis. (Fertil Steril Ò 2019;111:772-9. Ó2018 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

In women with chronic or subclinical endometritis is hysteroscopy suitable for setting the diagnosis? A systematic review

“…Micropolyps (less than 1 mm), hyperemia and edema are also strong correlated with CE in various studies. 7,15,18 Nevertheless, Song et al 7 suggests that their presence should alert a hysteroscopist but does not set the diagnosis because in their retrospective study the diagnostic accuracy of the hysteroscopy was quite moderate (67%). Strawberry effect 13 is also a common hysteroscopic pattern in cases of CE, characterized by focal or diffuse hyperemia, stromal edema homogenous or nonhomogenous endometrial thickening.…”

“…Sixteen studies were selected in full text as potentially suitable for inclusion. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] One study was subsequently excluded:…”

“…One study had an hysteroscopic indication of AUB, 22 another of endometrial hyperplasia, 18 as well as of endometrial polyp 10 and the remaining four had no specific indication rather than common gynecological conditions including the ones mentioned previously. 7,12,15,16 The authors compared their hysteroscopically suspected cases with methods of histology, immunochemistry, molecular biology and microbiology. In the majority of hysteroscopically suspected cases of CE the confirmation was made through histology (13 out of 15), in which CD-138 immunoreactivity, was used as a marker for CE in only five out of 15 histologic confirmations ( Table 2).…”

“…15 Two or more suggestive of CE, hysteroscopic findings provided higher accuracy of the method in the diagnosis of CE. 7,18 In women suffering from infertility, common hysteroscopic findings suggestive of CE are micropolyps, usually located near endocervix and strawberry effect, meaning hyperemia with a white central point, localized or scattered throughout the cavity. 9,[13][14][15]19 In terms of histologic confirmation of CE, Cicinelli et al, 6 using CD-138 immunoreactivity, specific for inflammation, suggested the positive for CD-138 Endometrial polyps were not always correlated with CE, meaning that the common pattern of inflammation in both CE and endometrial polyps potentially links the presence of endometrial polyps with CE, but implies.…”

“…6 A number of studies found histology with CD-138 to be superior of conventional histology, meaning plain identification of plasma cells in an endometrial biopsy. 7,13 In an interesting randomized-controlled observer study, Cicinelli et al 12 proposed the 'Delphi' diagnostic criteria for setting the diagnosis of CE:…”