Cicinelli Ettore, Resta Leonardo, Nicoletti Roberto, Tartagni Massimo, Marinaccio Marco, Bulletti Carlo, Colafiglio Giuseppe
1st Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Bari, and the Department of Obstetrics and Gynecology, Hospital of Rimini, Italy.
J Minim Invasive Gynecol. 2005 Nov-Dec;12(6):514-8. doi: 10.1016/j.jmig.2005.07.394.
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.
Retrospective Study (Canadian Task Force classification II-2).
University hospital.
Nine hundred-ten women in whom hysteroscopy was indicated.
Fluid hysteroscopy followed by endometrial biopsy.
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%.
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.
慢性子宫内膜炎是一种难以察觉的隐匿病症；然而，它可能导致异常子宫出血和不孕。关于液体宫腔镜检查时慢性子宫内膜炎的表现以及诊断性液体宫腔镜检查在检测该病症中的价值，相关数据较少。根据我们的经验，在液体宫腔镜检查中，慢性子宫内膜炎的特征是基质水肿与局灶性或弥漫性充血持续并存；在某些情况下，这一发现与子宫内膜微小息肉（大小小于1毫米）有关。本研究试图描述液体宫腔镜检查时慢性子宫内膜炎的诊断标准，并评估液体宫腔镜检查在检测该病症中的诊断准确性。
回顾性研究（加拿大工作组分类II - 2）。
大学医院。
910名有宫腔镜检查指征的女性。
液体宫腔镜检查后进行子宫内膜活检。
基于水肿、充血以及（若存在）微小息肉的关联，计算液体宫腔镜检查在检测慢性子宫内膜炎时的敏感性、特异性、阳性和阴性预测值以及准确性。基于充血和水肿的存在，158例患者（17.4%）被诊断为慢性子宫内膜炎；61例患者（6.7%）还存在微小息肉。组织学检查在101例患者中证实了诊断（占宫腔镜检查阳性病例的63.9%），另外在宫腔镜检查未检测到的9例病例中组织学检查呈阳性。组织学检查发现，约30%的不孕女性和35%与异常子宫出血相关的病例存在慢性子宫内膜炎。仅基于充血和水肿的检测，宫腔镜检查对慢性子宫内膜炎的敏感性、特异性、阳性和阴性预测值分别为91.8%、92.9%、63.9%和98.8%；诊断准确性为92.7%。充血、水肿和微小息肉同时存在时，敏感性、特异性、阳性和阴性预测值分别为55.4%、99.9%、98.4%、94.5%，诊断准确性为93.4%。
液体宫腔镜检查在诊断无炎症方面非常可靠，而检测到微小息肉是炎症的一个非常可靠的迹象。在对异常子宫出血或不孕进行宫腔镜检查时，应始终寻找慢性子宫内膜炎的迹象。
