Correspondence between hysteroscopic and histologic findings in women with chronic endometritis

OBJECTIVE: To estimate if findings in women with chronic endometritis (CE) at fluid hysteroscopy correlate with the severity of inflammation at histology and to assess the possibility to score the severity of inflammation by fluid hysteroscopy. DESIGN: Controlled clinical study. SETTING: University hospital. POPULATION: A total of 211 outpatient women with a hysteroscopic diagnosis of CE and 30 control women without any such signs. METHODS: All patients underwent endometrial biopsy by means of a 3-mm Novak's curette connected to a 20-ml syringe without any anesthesia. MAIN OUTCOME MEASURES: Hysteroscopic records were reviewed and compared with histologic findings by using an arbitrary inflammation score (Grades 0-2, no inflammation to severe infiltration, nodules and glands disruption, respectively). RESULTS: A significant correlation between focal hyperemia and isolated micropolyps with Grade 1 inflammation and between generalized hyperemia, presence of diffuse micropolyps and polypoid endometrium with Grade 2 inflammation was found. Hysteroscopic and histologic grading showed good agreement (kappa index = 0.62). CONCLUSIONS: In women affected by CE the severity of histological alterations may be reliably evaluated by fluid hysteroscopy. This information may be clinically useful not only for giving a prognosis and as a basis for interpretation of patients' complaints, but also for monitoring treatment.???

Colpocytological abnormalities in HIV infected and uninfected pregnant women: prevalence, persistence and progression

In this retrospective case-control study, we analyse data of 48 HIV-positive pregnant patients, versus a control group of 99 HIV-negative pregnant women, followed as outpatients by our department from 2009 to 2014. The aims of the study were to investigate the prevalence, persistence and progression of cervical squamous intraepithelial lesions (SIL) in each group and to correlate colpo-cytological lesions to the socio-demographic and clinical-laboratory findings in the HIVâ\u80\u89+â\u80\u89pregnant women. In our study we observed that immunosuppression, HPV infection and vaginal coinfections were predictive of cervical lesions. Pap smear and colposcopy should be part of routine care for HIV-infected pregnant women because these lesions behave aggressively in these patients. Success of prevention depends on massive access of patients to screening. HAART reduces viral load and maintains CD4 count and can affect progression of SIL. Multidisciplinary services on the same site appear to be one promising strategy to improve compliance in patients.Impact StatementWhat is already known on this subject: Our study provided novel information on a highly vulnerable population of young HIVâ\u80\u89+â\u80\u89pregnant women.What the results of this study add: We observed that immunosuppression, HPV infection and vaginal coinfections were predictive of cervical lesions remarkable with colposcopy. We could consider these important risk factors to evaluate to establish an appropriate strategy of management for these patients.What the implications are of these findings for clinical practice and/or further research: Association of the risk between SIL presence and HIV and HPV infection also deserves additional investigation. We believe that Pap smears and colposcopies should be part of the routine care for HIV-infected women because these lesions behave particularly aggressively in these patients

Reliability of narrow-band imaging (NBI) hysteroscopy: A comparative study

Fertil Steril. 2010 Nov;94(6):2303-7. Epub 2010 Feb 21. Reliability of narrow-band imaging (NBI) hysteroscopy: a comparative study. Cicinelli E, Tinelli R, Colafiglio G, Pastore A, Mastrolia S, Lepera A, Clevin L. Source First Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Bari, Bari, Italy. [email protected] Abstract OBJECTIVE: To evaluate the usefulness of narrow-band imaging (NBI) technology for improving the diagnostic reliability of hysteroscopy. DESIGN: Prospective controlled clinical study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENT(S): Three hundred ninety-five outpatient women undergoing diagnostic hysteroscopy were enrolled. INTERVENTION(S): All patients underwent fluid minihysteroscopy with white light (WL) and NBI exploration with endometrial eye-directed biopsy. MAIN OUTCOME MEASURE(S): Hysteroscopic findings with WL and NBI were compared with histology, which was considered the gold standard. RESULT(S): Overall, the number of correct diagnoses with NBI was significantly higher than with WL. For differentiating normal from abnormal endometrial histopathology, the use of NBI showed a significantly higher specificity (0.93 vs. 0.78) and negative predictive value (0.92 vs. 0.81); NBI hysteroscopy significantly improved the sensitivity for the diagnosis of proliferative endometrium (0.93 vs. 0.78), chronic endometritis (0.88 vs. 0.70), low-risk hyperplasia (0.88 vs. 0.70), and high-risk hyperplasia (0.60 vs. 0.40). CONCLUSION(S): The use of NBI improved the reliability of diagnostic hysteroscopy. The high specificity and the low number of false negatives may reduce the number of unnecessary biopsies or of those performed in wrong areas. Moreover, compared with WL observation, NBI hysteroscopy showed significantly higher sensitivity for the detection of chronic endometritis and low-risk and high-risk hyperplasia. Copyright © 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved. PMID: 20176350 [PubMed - indexed for MEDLINE

Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy

Study question: What is the prevalence of chronic endometritis (CE) in women with repeated unexplained implantation failure (RIF) at IVF, and how does antibiotic treatment affect the reproductive outcome? Summary answer: Chronic endometritis, associated with infection with common bacteria or mycoplasma, common in women complaining of RIF and antibiotic treatment significantly improves the reproductive outcome at a subsequent IVF cycle. What is known already: We have reported that CE is a frequent finding in women with repeated pregnancy loss and a significantly higher rate of successful pregnancies was achieved after adequate antibiotic treatment. Moreover, CE was identified in 30.3% of patients with repeated implantation failure at IVF and women diagnosed with CE had lower implantation rates (11.5%) after IVF cycles. By contrast, other authors reported that the clinical implication of CE should be considered minimal and that the reproductive outcome at IVF/ICSI cycles was not negatively affected by CE. Study design, size, duration: A retrospective study was performed from January 2009 through June 2012 on 106 women with unexplained infertility and a history of RIF. Participants/materials, setting, methods: All patients underwent hysteroscopy and endometrial sampling for histology and microbiological investigations. Women diagnosed with CE underwent antibiotic treatment and the effect of treatment was confirmed by hysteroscopy with biopsy. Within 6 months after treatment all women had a further IVF attempt. The IVF outcomes were compared in women without signs of CE (Group 1) and persistent CE (Group 2) after antibiotic treatment. Main outcome measure(s): Clinical pregnancy rate (PR), live birth rate (LBR) at post-treatment IVF attempt. Main results and the role of chance: Seventy (66.0%) women were diagnosed with CE at hysteroscopy. In 61 (57.5%) CE was confirmed by histology and 48 (45.0%) by cultures. Common bacteria and mycoplasma were the most prevalent agents. In 46 (75.4%) out of 61 women, with diagnosis of CE at hysteroscopy and histology, examinations were normal after appropriate antibiotic treatment control (Group 1) while in 15 (24.6%) cases signs of CE were still present (Group 2). At IVF attempt after treatment, a significantly higher PR and LBR was reported in women from Group 1 compared to women from Group 2 (65.2% versus33.0% p=0.039; 60.8% versus13.3%, p= 0, 02 respectively) Limitations, reasons for caution: possible biases related to retrospective studies, to preferential referral of patients with CE and limited number of cases. Wider implications of the findings: A prospective randomized clinical trial is needed to confirm our findings but in women with RIF a hysteroscopic evaluation of the uterine cavity to exclude CE should be considered and appropriate antibiotic treatment should be given before submitting the patient to a further IVF attempt. Study funding/competing interest(s): this research was funded by the University personal research grants of Ettore Cicinelli. The authors have no competing interests to declare. Key Words: IVF/ICSI outcome, chronic endometritis, antibiotic treatment, repeated implantation failure, hysteroscop