Correlating clinical, hysteroscopic, and histological findings in chronic pelvic inflammatory disease: diagnostic challenges and preliminary scoring system development

ABSTRACT

Objective. Chronic pelvic inflammatory disease (CPID) encompasses various clinical presentations, notably chronic pelvic pain, infertility, abnormal uterine bleeding (AUB), and miscarriage, yet its diagnostic criteria remain elusive, leading to underdiagnosis and inadequate management. This study aimed to evaluate the correlation between clinical symptoms, hysteroscopic findings, and histopathological results in CPID, addressing diagnostic challenges and proposing a preliminary scoring system to improve patient care.

Materials and Methods. We conducted a retrospective analysis of 213 women with symptoms suggestive of CPID who had undergone hysteroscopy and endometrial biopsy between October 2016 and March 2022. Data analysis included examination of clinical presentation, hysteroscopic findings (using predefined criteria), and histopathological results (using standardized plasma cell counts). A preliminary scoring system integrating key diagnostic parameters was developed based on our findings and literature review.

Results. Among 213 patients (mean age 41.9 ± 10.8 years), hysteroscopic findings suggestive of endometritis (endometrial wall edema, micro polyps, and erythema) were observed in 126 cases (59.2%); however, histopathology-confirmed endometritis (≥5 plasma cells/10 HPF) was observed in only 23 cases (10.8%). Significant paired discordance was found between hysteroscopic signs and histological confirmation of endometritis (McNemar test, p < 0.001). Diagnostic accuracy analysis revealed area under curve (AUC) values ranging from 0.46 to 0.67 for various parameter combinations, indicating modest discrimination. Based on these findings and literature review, we developed a preliminary scoring system incorporating clinical, imaging, operative, and histopathological parameters.

Conclusions. Correlating clinical, hysteroscopic, and histological findings is essential but challenging in CPID diagnosis.  The proposed preliminary scoring system offers a structured framework for CPID assessment but requires validation. Further research is warranted to validate and refine diagnostic approaches for CPID, as early recognition and intervention are paramount to mitigate adverse outcomes.

Key words

Chronic pelvic inflammatory disease; chronic pelvic pain; infertility; abnormal uterine bleeding; miscarriage; hysteroscopy; endometritis.