Hysteroscopic versus histopathological agreement in the diagnosis of chronic endometritis: results from a retrospective observational study

Abstract

Purpose To evaluate the agreement rate between hysteroscopy and pathological examination in case of chronic endometritis. Methods A retrospective observational study carried out at Gynecology and Obstetrics Department, Puerta de Hierro Hospital, Autónoma University of Madrid, Spain, from January 2021 to June 2022 was performed by obtaining data from 115 medical records of women who underwent office hysteroscopies that was compared with the findings of final histological examination of endometrial biopsy. Cohen's kappa index was used to evaluate this agreement rate. In addition, sensitivity, specificity, positive and negative predictive value and diagnostic accuracy were obtained. Results The agreement between hysteroscopic findings and histological examination showed a modest result with a Cohen’s kappa index of 34%. In addition, we obtained a specificity of 70% and a sensitivity of 64%. The positive and negative predictive value were 60.8% and 73.4%, respectively. An excellent agreement rate (100%) between histological and hysteroscopic results was observed in presence of hyperemia and micropolyps. Conclusion Although the sample size is not as large as that of other studies published so far, the first glance of our experience is that hysteroscopic signs are not yet sufficient to make an accurate diagnosis of chronic endometritis, thus requiring a histopathological confirmation to make it.

Endometrial congestion is the only hysteroscopic finding indicative of chronic endometritis

“…reported that the diagnostic discordance rate for CE between hysteroscopic findings and endometrial histopathology was high, at 58.5% (2018), which also implies a low diagnostic concordance rate [ 2 ]. A low concordance rate between hysteroscopic findings and histological examination was reported more recently, with the authors concluding that hysteroscopic signs are not yet sufficient to make an accurate diagnosis of CE [ 22 ]. The view that hysteroscopy alone cannot accurately diagnose CE is corroborated by further studies [ 15 , 18 , 23 ].…”