Enhancing endometrial pathology detection: chromohysteroscopy vs. conventional hysteroscopy in infertility evaluation

Abstract

Endometrial pathology is a recognized contributor to infertility and recurrent implantation failure, but its detection during hysteroscopy, particularly in the absence of visible lesions, is challenging. Chromohysteroscopy, involving the use of methylene blue dye, has shown promise in improving diagnostic accuracy. This interventional cross-sectional study compared the diagnostic accuracy of chromohysteroscopy and conventional hysteroscopy, using histopathology as the gold standard. A total of 100 consenting infertility patients were included, in a sequential step, hysteroscopy followed by chromohysteroscopy using methylene blue dye was performed to enhance the detection of subtle endometrial pathologies. Among the 100 women who underwent diagnostic hysteroscopy, 76 exhibited normal findings, while 24 had abnormal findings. During chromohysteroscopy, 62 cases displayed a light staining pattern, and 38 cases exhibited dark staining. Histopathological analysis of biopsy tissue from the dark-stained areas revealed endometrial pathology in 84.2% (32/38) and normal endometrium in 15.8% (6/38) cases. In contrast, biopsies from the light-stained areas indicated abnormal endometrium in only 3.23% (2/62) cases, with the remaining 96.77% having a normal histology. Chromohysteroscopy demonstrated a significantly higher diagnostic accuracy (92%) for endometrial pathology compared to conventional hysteroscopy (58%). Notably, chromohysteroscopy’s sensitivity was 94.12%, and its specificity was 90.9%. The staining patterns observed during chromohysteroscopy correlated well with histological findings, highlighting its effectiveness in identifying structurally damaged endometrium. Chromohysteroscopy emerges as a valuable diagnostic tool for assessing endometrial pathology, especially in infertility cases. This technique offers superior accuracy compared to conventional hysteroscopy, providing clinicians with a more precise means of diagnosis and potential targeted treatments.