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Diagnostics
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Hysteroscopic Approach to Intrauterine Diseases
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Hysteroscopic Approach to Intrauterine Diseases

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (31 August 2020) | Viewed by 21009

Special Issue Editor

Dr. Salvatore Giovanni Vitale

E-Mail Website
Guest Editor
Division of Gynecology and Obstetrics, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
Interests: hysteroscopy; infertility; minimally invasive surgery; uterine fibroids

Special Issue Information

Dear Colleagues,

Intrauterine pathologies, such as endometrial polyps, myomas, synechiae, hyperplasia, and endometrial cancer, are one of the most common disorders in the female population, both in reproductive-aged women and postmenopausal ones. Also inflammatory diseases, in particular endometritis, are a very common pathology often difficult to identify that may cause abnormal uterine bleeding and infertility.

Hysteroscopy represents the gold standard management of these diseases. On the one hand, diagnostic hysteroscopy, using small diameter scopes in ambulatory setting, offers the possibility of direct vision and biopsy of vagina and fornices, cervical canal, uterine cavity and tubal ostia; on the other hand, intracavitary surgical procedures may be performed both in office setting (see-and-treat approach) or operating room, depending on the complexity of the procedure.

Despite the recent technical improvements of hysteroscopy, the pathogenesis of several intrauterine diseases, such as polyps, submucosal myomas, uterine anomalies as well as endometrial pre-cancerous lesions, still remains to be clearly determined.

In this scenario, the possibility offered by hysteroscopy-guided targeted endometrial biopsy may enhance the possibility to study these conditions even from the molecular point of view, from the genetic background to the epigenetic modifications that may lead to endometrial/myometrial pathological changes.

In addition, the improved understanding of molecular mechanism behind intrauterine disease may lead to a proper, molecular-based, early diagnosis and target therapy, taking into account also the clear role of hormonal changes. Finally, the combination of intracavitary view offered by hysteroscopy and investigation of expression of some genes pivotal for the correct anatomical development of the reproductive tract, such as the ones from HOX transcription family, could be useful to shed new lights about common uterine malformation, such as uterine septa and subsepta, and even less common ones.

Considering all these elements, the Special Issue “Hysteroscopic approach to intrauterine diseases: from molecular basis to clinical management” aims to publish both original researches as well as comprehensive review about molecular mechanisms involved in the clinical management of intrauterine diseases diagnosed and treated by hysteroscopy as well as the impact of these pathologies on female fertility. In particular, the Special Issue welcomes the possibility to explore the role of the knowledge about molecular processes in the clinical practice for the diagnosis and treatments of these diseases.

You may choose our Joint Special Issue in IJMS.

Salvatore Giovanni Vitale M.D. Ph.D.
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hysteroscopy
  • intrauterine pathologies
  • endometrial cancer
  • endometrial polyps
  • endometritis
  • endometrial hyperplasia
  • intrauterine synechiae
  • myomas
  • pathogenesis
  • diagnosis
  • treatment

Published Papers (5 papers)

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Research

11 pages, 1262 KiB  
Article
Comparison between Different Diagnostic Strategies in Low-Risk Reproductive Age and Pre-Menopausal Women Presenting Abnormal Uterine Bleeding
by Chiara Belcaro, Federica Scrimin, Alessandro Mangogna, Emanuele Filippo Galati, Stefania Biffi, Lorenzo Monasta, Federico Romano and Giuseppe Ricci
Diagnostics 2020, 10(11), 884; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics10110884 - 30 Oct 2020
Cited by 3 | Viewed by 4238
Abstract
Abnormal uterine bleeding (AUB) is a common symptom in the female population, with an estimated prevalence of 10 to 30% in fertile age and up to 90% in perimenopausal women. In most cases, AUB is due to a benign cause. However, it can [...] Read more.
Abnormal uterine bleeding (AUB) is a common symptom in the female population, with an estimated prevalence of 10 to 30% in fertile age and up to 90% in perimenopausal women. In most cases, AUB is due to a benign cause. However, it can also be a symptom of atypical endometrial hyperplasia or endometrial cancer, a more common disease during menopause which can also affect women in their reproductive age. Considering the high prevalence of this symptom an appropriate diagnostic algorithm is needed. Concerns about the risks, pain, and stress associated with an endometrial biopsy and its impact on the healthcare system make the choice of AUB diagnostic strategy extremely relevant. Even if the scientific community agrees on the definition of AUB, International Guidelines show some differences in the management of women of reproductive age with AUB, especially regarding the age cut-off as an independent indication for endometrial biopsy. This study compared different diagnostic strategies to identify a diagnostic pathway with high sensitivity and specificity but low impact on the health system’s resources. The analysis was based on three diagnostic algorithms defined as part of the guidelines of leading scientific societies. Women of reproductive age with AUB (n = 625) and without risk of endometrial cancer were included in the study. Results showed that the best criterion to investigate AUB in women at low risk of endometrial cancer is not age cut-off but the presence or absence of focal endometrial pathology at the ultrasound and the response to the progestin therapy. This approach makes it possible to perform fewer outpatient hysteroscopic biopsies without excluding positive cases from the examination. Full article
(This article belongs to the Special Issue Hysteroscopic Approach to Intrauterine Diseases)
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14 pages, 1857 KiB  
Article
Insights on Hysteroscopic Procedures and Their Place in Romanian Gynecologic Practice—The Experience of Two Medical Units
by Alexandra Matei, Cringu Ionescu, Florin Gorun, Diana Gheorghiu, George-Alexandru Rosu, Adelina Dan, Romina-Marina Sima, Cristian George Furau, Corina Ilinca and Dan Navolan
Diagnostics 2020, 10(5), 281; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics10050281 - 06 May 2020
Cited by 1 | Viewed by 2959
Abstract
Hysteroscopy has known an increasing use in Romania over the last decade, succeeding to mark an impact on lowering the costs of medical services. The strategy of this study was to present the experience of two Romanian medical units with different experiences using [...] Read more.
Hysteroscopy has known an increasing use in Romania over the last decade, succeeding to mark an impact on lowering the costs of medical services. The strategy of this study was to present the experience of two Romanian medical units with different experiences using inpatient regimen hysteroscopy, and to further compare it with current worldwide tendencies. Strong points in our practice were sought, as well as components that require improvement. Overall, abnormal uterine bleeding stands for most hospital case presentations in our study group; hysteroscopy had the highest accuracy and positive predictive value in identifying uterine myomas: 91.03% and 100%, respectively; for endometrial polyps, statistical analysis showed the highest sensitivity: 100%, with 83.89% specificity and a 77.64% positive predictive value. The applicability of hysteroscopy was further described for infertility cases and isthmocele repair. Full article
(This article belongs to the Special Issue Hysteroscopic Approach to Intrauterine Diseases)
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11 pages, 598 KiB  
Article
Endometrial Cancer Risk Prediction According to Indication of Diagnostic Hysteroscopy in Post-Menopausal Women
by Carlo Saccardi, Amerigo Vitagliano, Matteo Marchetti, Alice Lo Turco, Sofia Tosatto, Michela Palumbo, Luciana Serena De Lorenzo, Salvatore Giovanni Vitale, Marco Scioscia and Marco Noventa
Diagnostics 2020, 10(5), 257; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics10050257 - 27 Apr 2020
Cited by 23 | Viewed by 5912
Abstract
We conducted a prospective observational study investigating the clinical relevance of endometrial thickness (ET) and abnormal uterine bleeding (AUB) on endometrial cancer (EC) risk in a cohort of postmenopausal patients undergoing diagnostic hysteroscopy and endometrial biopsy. Patients were divided into two groups according [...] Read more.
We conducted a prospective observational study investigating the clinical relevance of endometrial thickness (ET) and abnormal uterine bleeding (AUB) on endometrial cancer (EC) risk in a cohort of postmenopausal patients undergoing diagnostic hysteroscopy and endometrial biopsy. Patients were divided into two groups according to the indication of diagnostic hysteroscopy: ET_Group (asymptomatic patients with endometrial thickness ≥ 4 mm) and AUB_Group (patients with a history of abnormal uterine bleeding). We further divided the AUB_Group into two subgroups based on endometrial thickness (AUB_Subgroup1: ET < 4 mm; AUB_Subgroup2: ET ≥ 4 mm). The primary outcome was the risk of endometrial cancer and atypical hyperplasia according to the indications of diagnostic hysteroscopy (AUB, ET ≥ 4 mm or both). The secondary outcome was to determine the best cut-off value of endometrial thickness to predict endometrial cancer in asymptomatic postmenopausal women. The prevalence of endometrial cancer and atypical hyperplasia in AUB_Group and ET_Group was 21% and 6.7% respectively. As well as for EC alone, higher prevalence of both conditions was observed in AUB_Subgroup2 (29.3%) in comparison to AUB_Subgroup1 (10.6%; p < 0.001). In asymptomatic patients the cut-off of endometrial thickness that showed the best sensitivity and specificity to diagnose endometrial cancer (100% and 80% respectively) was 11 mm (AUC of 91.4%; Expβ: 1067; CI 95%). In conclusion, considering the high risk of neoplasia, diagnostic hysteroscopy with endometrial biopsy should be mandatory in cases of abnormal uterine bleeding in postmenopausal patients. Moreover, we want to emphasize the need for further evidence stating the clinical relevance of endometrial thickness value in asymptomatic patients and the impact of individual risk factors on endometrial cancer development. Full article
(This article belongs to the Special Issue Hysteroscopic Approach to Intrauterine Diseases)
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7 pages, 234 KiB  
Article
Müllerian Anomalies Prevalence Diagnosed by Hysteroscopy and Laparoscopy in Mexican Infertile Women: Results from a Cohort Study
by Enrique Reyes-Muñoz, Salvatore Giovanni Vitale, Deisi Alvarado-Rosales, Esther Iyune-Cojab, Amerigo Vitagliano, Franziska Michaela Lohmeyer, Yenara Patricia Guevara-Gómez, Alma Villarreal-Barranca, José Romo-Yañez, Araceli Montoya-Estrada, Fela Vanesa Morales-Hernández and Patricia Aguayo-González
Diagnostics 2019, 9(4), 149; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics9040149 - 17 Oct 2019
Cited by 23 | Viewed by 3448
Abstract
Background: To evaluate the prevalence of Müllerian anomalies (MAs) in a cohort of infertile Mexican women candidates for infertility treatments (intrauterine insemination or IVF (In vitro fertilization) cycles). Methods: We performed a retrospective observational study on a cohort of consecutive women, who underwent [...] Read more.
Background: To evaluate the prevalence of Müllerian anomalies (MAs) in a cohort of infertile Mexican women candidates for infertility treatments (intrauterine insemination or IVF (In vitro fertilization) cycles). Methods: We performed a retrospective observational study on a cohort of consecutive women, who underwent hysteroscopy and laparoscopy as part of the basic infertility workup from 2002 to 2014, at our center. Our aim was to calculate the prevalence of MAs and each subtype. Results: A total of 4005 women were included in the study. The MA prevalence was 4.4% (95% CI; 3.8–5.1; n = 177). Among women with MAs, the prevalence of different MA types was: septate uterus 54.2% (n = 96), arcuate uterus 15.8% (n = 28), bicornuate uterus 10.7% (n = 19), unicornuate uterus 8.5% (n = 15), didelphys uterus 6.2% (n = 11) and hypoplasia/agenesis 3.4% (n = 6), unclassifiable 1.1% (n = 2). Women with MAs who achieved pregnancy were: 33.3% (n = 59). The MA associated with the highest pregnancy rate was septate uterus after hysteroscopic correction, at 38.5% (37/96). Conclusions: The prevalence of MAs among infertile Mexican women can be considered as low, but not negligible. The septate uterus is the most common MA in women with infertility. Full article
(This article belongs to the Special Issue Hysteroscopic Approach to Intrauterine Diseases)
9 pages, 225 KiB  
Article
Concordance between the Hysteroscopic Diagnosis of Endometrial Hyperplasia and Histopathological Examination
by Pasquale De Franciscis, Gaetano Riemma, Antonio Schiattarella, Luigi Cobellis, Maria Guadagno, Salvatore Giovanni Vitale, Lavinia Mosca, Antonio Cianci and Nicola Colacurci
Diagnostics 2019, 9(4), 142; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics9040142 - 07 Oct 2019
Cited by 31 | Viewed by 3817
Abstract
The goal of this paper is to assess the concordance between the clinical diagnosis of Endometrial Hyperplasia (EH), suspected by senior gynecologists throughout outpatient office hysteroscopy, and the results from histopathological examination, in order to evaluate hysteroscopic accuracy for EH. A prospective cohort [...] Read more.
The goal of this paper is to assess the concordance between the clinical diagnosis of Endometrial Hyperplasia (EH), suspected by senior gynecologists throughout outpatient office hysteroscopy, and the results from histopathological examination, in order to evaluate hysteroscopic accuracy for EH. A prospective cohort study was done at a Tertiary University Hospital. From January to December 2018, we enrolled women with the following criteria: abnormal uterine bleeding in post-menopause and endometrial thickening in pre-or post-menopause. Patients underwent office hysteroscopy with a 5 mm continuous-flow hysteroscope, and endometrial biopsies were taken using miniaturized instruments. Senior operators had to foresee histopathological diagnosis using a questionnaire. Histopathological examination was conducted to confirm the diagnosis. This study was approved by the local ethical and registered in the ClinicalTrials.gov registry (ID no. NCT03917147). In 424 cases, 283 clinical diagnoses of EH were determined by senior surgeons. A histopathological diagnosis was then confirmed in 165 cases (58.3%; p = 0.0001). Furthermore, 14 endometrial carcinoma and atypical hyperplasia were found. The sensitivity, positive predictive value, and negative predictive values for EH were, respectively, 90.4, 58.4, and 86.6%. Subdivided by clinical indication, the sensitivity was higher in patients with post-menopause endometrial thickening. The diagnostic accuracy of office hysteroscopy in the diagnosis and prediction of endometrial hyperplasia was high. Senior operators could foresee EHs in more than half the cases. Full article
(This article belongs to the Special Issue Hysteroscopic Approach to Intrauterine Diseases)
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