Hysteroscopic criteria for the diagnosis of chronic endometritis

Key Findings:

High diagnostic accuracy:
- Area under curve (AUC): 0.93
- Sensitivity: 84%
- Specificity: 89%
- Positive likelihood ratio (PLR): 7.4
- Negative likelihood ratio (NLR): 0.19
Absence of hysteroscopic signs may be enough to exclude CE in many cases.
When hysteroscopic features are present, endometrial biopsy is still recommended to confirm diagnosis and avoid false positives.
CE is more common in women with infertility, recurrent implantation failure (RIF), or recurrent pregnancy loss (RPL).
Integration of hysteroscopy with targeted biopsy improves detection compared to blind biopsy.
Molecular diagnostics (RT-PCR, NGS) could enhance accuracy in unclear cases but are not yet standard.
The study calls for standardized diagnostic criteria for CE and further research on combining hysteroscopy with advanced molecular tests.

Core Hysteroscopic Signs:
- Stromal edema
- Focal or diffuse hyperemia
- Micropolyps
- Strawberry pattern (less common in studies)
Clinical Relevance:
- CE impacts fertility outcomes; early and accurate detection is important in infertility workup.
- Hysteroscopy offers real-time visualization, enabling targeted biopsies.
Best Practice:
- Use hysteroscopy as a first-line tool in infertility or recurrent pregnancy loss cases.
- Confirm suspicious findings histologically before treatment.
- Consider antibiotic therapy when diagnosis is confirmed.