Diagnostic Accuracy of Hysteroscopy for Chronic Endometritis in Reproductive-Age and Infertile Women: A Systematic...

To evaluate the diagnostic accuracy of hysteroscopy for chronic endometritis (CE) in reproductive-aged women, including those with infertility or recurrent pregnancy loss, considering histopathological, immunohistochemical, and microbiological tests as imperfect reference standards through a Bayesian latent class meta-analysis.

We included peer-reviewed diagnostic accuracy studies, cohort studies, and case series that assessed hysteroscopy as the index test for CE. Eligible studies applied histopathological, immunohistochemical, or microbiological reference standards to endometrial, endocervical, or vaginal samples, providing sufficient quantitative data. Searches across common databases and registries up to October 1st, 2025, were not restricted by language. Study quality was assessed using QUADAS-2.

Pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and likelihood ratios (LR) were obtained using an imperfect-standards Bayesian latent class meta-analysis approach. Subgroup and sensitivity analyses were performed regarding the profile of the studied populations and the risk of bias within and across the studies.

The 28 included studies (12 diagnostic accuracy, 5 cohort, 11 case series) yielded pooled hysteroscopy results of 0.816 sensitivity (95% CI: 0.728-0.882), 0.806 specificity (0.729-0.871), and a DOR of 18.895 (9.364-39.832). Hematoxylin-eosin staining was the most accurate reference standard. Subgroup and sensitivity analyses confirmed results consistency across reproductive-disorder populations and lower-bias studies, with a low estimated risk of reporting bias.

Hysteroscopy demonstrates high diagnostic performance for CE when compared against imperfect reference standards. Despite model-based limitations, evidence supports hysteroscopy as a reliable primary diagnostic tool in clinical assessment and treatment planning.

PROSPERO registration number: CRD420251087545.