THE ACCURACY OF HYSTEROSALPINGOGRAPHY IN THE DIAGNOSIS OF TUBAL PATHOLOGY - A METAANALYSIS

Objective: To assess the Value of hysterosalpingography (HSG) in diagnosing tubal patency and peritubal adhesions using laparoscopy with chromopertubation as the gold standard. Design: Meta-analysis of 20 studies comparing HSG and laparoscopy for tubal patency and peritubal adhesions. Patients: Four thousand one hundred seventy-nine patients with infertility in 20 studies. Intervention: Hysterosalpingography and diagnostic laparoscopy as part of infertility workup. Main Outcome Measure: Tubal patency and peritubal adhesions. Results: For tubal patency the reported sensitivity and specificity differed between studies. In a subset of studies that evaluated HSG and laparoscopy independently, a point estimate of 0.65 for sensitivity and 0.83 for specificity was calculated. For peritubal adhesions a summary receiver operating characteristic curve could be estimated. Conclusions: Although HSG is of limited use for detecting tubal patency because of its low sensitivity, its high specificity makes it a useful test for ruling in tubal obstruction. For the evaluation of peritubal adhesions HSG is not reliable.