A New Hysteroscopic Scoring System for Diagnosing Chronic Endometritis

Study Objective To develop a new hysteroscopic morphologic scoring system to diagnose chronic endometritis (CE). Design Prospective study. Setting Medical hysteroscopy office. Patients In total, 320 patients underwent hysteroscopy, dilation and curettage, and endometrial biopsies from February 2017 to June 2018 with the intention of undergoing assisted reproductive technology treatment because of infertility or recurrent miscarriage. Interventions All patients underwent hysteroscopy, dilation and curettage, and endometrial biopsies for histologic examination and were classified according to the new hysteroscopic morphologic scoring system. Measurements and Main Results Of the 320 patients, 164 received a diagnosis of CE by histology (group A), whereas 156 patients were found not to have CE (group B). A total of 116 patients were diagnosed by our hysteroscopy scoring system to have CE, and 204 patients did not have CE. The scoring system showed a sensitivity and specificity of 62.8% and 91.7%, respectively. The positive predictive values and negative predictive values were 88.8% and 70.1%, respectively. Receiver operating characteristic analysis showed a cutoff value of >2 and an area under the curve of 0.823. Hysteroscopic and histologic grading showed moderate agreement (κ index = 0.529). Conclusion Our hysteroscopic scoring system has a high sensitivity and specificity for CE; it is hoped that its use can reduce interobserver variability. Future clinical studies are warranted to confirm the validity and clinical applicability of the proposed hysteroscopic morphologic scoring system for CE.