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The following is a summary of “Hysteroscopic Criteria for the Diagnosis of Chronic Endometritis: a Systematic Review and Diagnostic Test Accuracy Meta-analysis,” published in the March 2025 issue of American Journal of Obstetrics & Gynecology by Riemma et al. 

Researchers conducted a retrospective study to assess the diagnostic accuracy of hysteroscopic criteria compared with histopathological analysis, with or without immunohistochemistry, for detecting chronic endometritis.  

They followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesizing Evidence from Diagnostic Accuracy Tests guidelines, and MEDLINE, Scopus, Embase, Cielo ClinicalTrials.gov, LILACS, Cochrane Central Register of Controlled Trials, conference proceedings, and international controlled trials registries were searched without restrictions on date or language. Studies included were randomized, prospective, or retrospective and assessed hysteroscopic diagnostic accuracy for chronic endometritis by comparing hysteroscopic criteria with histopathological diagnosis (with or without immunohistochemistry). Primary outcomes were diagnostic odds ratio, the area under the summary receiver operating characteristic curve, specificity and sensitivity, while positive and negative likelihood ratios were secondary outcomes. The Quality Assessment Tool for Diagnostic Accuracy Studies−2 (QUADAS-2) was used to assess study quality, and the Deeks funnel plot asymmetry test evaluated publication bias.  

The results showed that 13 studies compared hysteroscopic criteria (stromal edema, diffuse or focal hyperemia, “strawberry aspect,” micropolyposis) with histopathological analysis of endometrial sampling. The pooled diagnostic odds ratio was 40 (95% CI 12−133) and the area under the summary receiver operating characteristic curve indicated a very high diagnostic accuracy of 0.93 (95% CI 0.90−0.95). Sensitivity was 84% (95% CI 0.68−0.93), and specificity was 89% (95% CI 0.75−0.95). The positive likelihood ratio was 7.4 (95% CI 3.2−17.0), and the negative likelihood ratio was 0.19 (95% CI 0.09−0.39).  

Investigators concluded that while hysteroscopy is highly accurate for detecting chronic endometritis and its absence can likely rule it out, endometrial biopsy is necessary to confirm positive hysteroscopic findings due to potential false positives. 

Source: ajog.org/article/S0002-9378(25)00148-6/fulltext