The value of hysterosalpingography in the diagnosis of tubal pathology among infertile patients.

OBJECTIVE: To evaluate the diagnostic accuracy of hysterosalpingography in the diagnosis of tubal pathology among infertile patients. PATIENTS AND METHODS: A prospective cross-sectional study in Kaunas University of Medicine Hospital within the period of 18 months was performed. Consecutive infertile women formed the study group according to defined criteria. Hysterosalpingography was performed in the preovulatory phase of the menstrual cycle. Laparoscopy and dye test was performed within one - three months after hysterosalpingography. General tubal pathology, tubal occlusion, and peritubal adhesions detected at hysterosalpingography were compared with general tubal pathology, tubal occlusion, and peritubal adhesions detected at laparoscopy.
RESULTS: The study population comprised 149 infertile women. The sensitivity of 81.4% and specificity of 47.8% the likelihood ratio of a positive test result of 1.6 and a negative test result of 0.4 for hysterosalpingography while evaluating general tubal pathology was determined. Sensitivity of 84.1% and specificity of 59.1% and likelihood ratios of 2.1 and 0.3, respectively, were calculated, when tubal occlusion was defined as any abnormality of tubal patency. When definition of tubal occlusion was limited to two-sided occlusion, the sensitivity and specificity were 89.5% and 90% and likelihood ratios 9.0 and 0.1, respectively. As a test of peritubal adhesions, hysterosalpingography had sensitivity of 35.5% and specificity of 81.3% and likelihood ratios of 1.9 and 0.8, respectively.
CONCLUSION: The diagnostic performance of hysterosalpingography in the diagnosis of general tubal pathology and peritubal adhesions is poor. Hysterosalpingography is more accurate in the diagnosis of tubal occlusion.