Correlations between hysteroscopy and histopathology to consider for the diagnosis of impaired inflammatory states of the endometrium: a narrative review

Endometrial inflammatory disorders are histologically characterized by a number of features which to date, are not fully taken into consideration in our practice of diagnostic hysteroscopy. A part of the current clinical and hysteroscopic consensual approach is in contradiction with many basics of histopathology and immunology, ultimately biasing research.
Objective. Analysis of the histopathological features of endometrial inflammation which provide a ground for correlations with hysteroscopy in order to improve the endometrial sampling and to standardize the diagnosis of inflammatory disorders for the benefit of practice and research.
Methods. A narrative review via a search in MEDLINE, EMBASE, Global Health, The Cochrane Library and Web of Science. Pertinent book chapters, original and review articles, published in English until December 31st, 2021 were selected, focusing on the changes of endometrial glands and stroma during inflammatory disorders. Those which can be correlated with hysteroscopy have been selected in order to define a list of well founded diagnostic criteria, serving as guidelines for an optimal visually-guided biopsy.
Results. A list of correlations between hysteroscopy and histopathology is established, with a particular focus on the morphological patterns to guide the hysteroscopist during diagnosis. The histopathological changes to be screened by the pathologist are also defined.
Conclusions. Growing awareness of the well established features of the endometrial histopathology provides the right basis for a standardized well-founded practice of diagnostic hysteroscopy in inflammatory disorders, which is a sine qua none prerequisite for evidence-base and interpretable clinical trials.


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