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

Abstract

The role of hysteroscopy in cases of chronic or subclinical endometritis remains uncertain. Reevaluating the clinical relevance of diagnostic hysteroscopic in these cases will improve the level of case in women's health worldwide. The objective of this systematic review was to assess the suitability of hysteroscopy in detecting and diagnosing female patients with chronic or subclinical endometritis, as a first‐line diagnostic tool. For this systematic review, five major search engines PubMed, Embase, MEDLINE, Google Scholar, as well as ResearchGate were searched using MeSH (medical subject headings) without language or year restrictions up to November 2019. All types of scientific papers were taken into consideration, with a priority to randomized control trials enrolling women with chronic or subclinical endometritis and compared with standard diagnostic tools such as histology or immunohistochemistry, in order to ensure the efficacy of the method. Risk of bias was assessed using the recommended Cochrane Collaboration criteria. In order to gather more information and data, we have decided to include all the scientific evidence regardless of study design. Data collection and analysis were performed according to PRISMA protocol. Hysteroscopy is an important diagnostic tool in cases of endometritis when accompanied by endometrial samples assessment techniques. In cases of high suspicion endometritis facilitates greater diagnostic accuracy. Hysteroscopy facilitates also the assessment of antibiotic administration efficacy in cases of confirmed endometritis. Micropolyposis, stromal edema or congestion, diffuse or focal hyperemia are the dominant hysteroscopic features that are considered by most studies as suggestive of chronic or subclinical endometritis. The heterogeneity of the included studies presents a high risk of bias as assessed according to Cochrane Collaboration criteria. Hysteroscopy is not suitable as a first‐line diagnostic tool in cases of chronic or subclinical endometritis. Further randomized controlled trials need to be conducted in order to define the role of hysteroscopy as a first‐line diagnostic tool in cases of chronic or subclinical endometritis.

Investigation of the Relationship between Chronic Endometritis Manifestations under Hysteroscope and CD138 Expression

“…In addition, it is not suitable for patients who need multiple reexaminations. Hysteroscopy is less traumatic and suitable for multiple reexaminations; however, since hysteroscopy tends to be more subjective, it cannot completely replace histological examinations [26,27].…”

Chronic Endometritis: Diagnostic Considerations in Patients With Infertility

“…6,21,22 Fluid hysteroscopy has been proposed as an alternative method to diagnose CE; however, histology remains the gold standard. 20,25 As described previously, results from a meta-analysis by Huang et al 22 showed that reproductive outcomes are different when different diagnostic criteria for CE are applied. This is not an unexpected result and supports the importance of defining and applying consistent diagnostic criteria for CE.…”

“…A substantial number of articles in the fertility literature use a threshold of 1 or more PCs identified using CD138 IHC as the minimal diagnostic criterion for CE 6,21,22 . Fluid hysteroscopy has been proposed as an alternative method to diagnose CE; however, histology remains the gold standard 20,25 . As described previously, results from a meta-analysis by Huang et al 22 showed that reproductive outcomes are different when different diagnostic criteria for CE are applied.…”

Approaches to Improve Endometrial Receptivity in Case of Repeated Implantation Failures

“…EC diagnosis is rather complicated. Endometrial cavity assessment is initially performed via hysteroscopy, recognizing subtle endometrial lesions like micropolyps, stromal edema and profound vascularity attributed to inflammatory angiogenesis (Gkrozou et al, 2020). The gold standard in establishing CE diagnosis is the recognition of increased plasma cell density in the endometrial stroma, either by standard histology (Kasius et al, 2012), or even better, by immunohistochemically marking plasma cells with anti-CD163 (Fan et al, 2019;Li et al, 2020;Xu et al, 2020).…”