BACKGROUND: The development of advanced endoscopic instrumentation in recent years has demonstrated the superiority of direct visual examination over radiographic demonstration of various body cavities. Just as laparoscopy has gradually taken a primary role in the surgical investigation of the ovulatory infertile patient, the role of intrauterine endoscopy in comparison to hysterosalpingography (HSG) needs to be reevaluated. METHODS: Four hundred and sixty-four infertile women had undergone both hysterosalpingography and a diagnostic hysteroscopy and the findings were analysed. RESULTS: Compared to hysteroscopy the sensitivity of HSG was 98%, but its specificity only 15%, the positive predictive value 45%, and negative predictive value 95%. On hysteroscopy a normal uterine cavity was found in 53% of the cases with a filling defect and in 56% of those with uterine wall irregularity on HSG. CONCLUSIONS: Hysteroscopy, a safe and rapid direct visualisation of the uterine cavity, is superior to HSG in the identification of intrauterine pathology. In view of the low positive predictive value and the low specificity of the HSG, we believe it should be replaced by the diagnostic hysteroscopy as a first line infertility investigation.
BACKGROUND: The development of advanced endoscopic instrumentation in recent years has demonstrated the superiority of direct visual examination over radiographic demonstration of various body cavities. Just as laparoscopy has gradually taken a primary role in the surgical investigation of the ovulatory infertile patient, the role of intrauterine endoscopy in comparison to hysterosalpingography (HSG) needs to be reevaluated. METHODS: Four hundred and sixty-four infertile women had undergone both hysterosalpingography and a diagnostic hysteroscopy and the findings were analysed. RESULTS: Compared to hysteroscopy the sensitivity of HSG was 98%, but its specificity only 15%, the positive predictive value 45%, and negative predictive value 95%. On hysteroscopy a normal uterine cavity was found in 53% of the cases with a filling defect and in 56% of those with uterine wall irregularity on HSG. CONCLUSIONS: Hysteroscopy, a safe and rapid direct visualisation of the uterine cavity, is superior to HSG in the identification of intrauterine pathology. In view of the low positive predictive value and the low specificity of the HSG, we believe it should be replaced by the diagnostic hysteroscopy as a first line infertility investigation.
Authors: Janine G Smit; Jenneke C Kasius; Marinus J C Eijkemans; Carolien A M Koks; Ron Van Golde; Jurjen G E Oosterhuis; Annemiek W Nap; Gabrielle J Scheffer; Petra A P Manger; Annemiek Hoek; Mesrure Kaplan; Dick B C Schoot; Arne M van Heusden; Walter K H Kuchenbecker; Denise A M Perquin; Kathrin Fleischer; Eugenie M Kaaijk; Alexander Sluijmer; Jaap Friederich; Joop S E Laven; Marcel van Hooff; Leonie A Louwe; Janet Kwee; Jantien J Boomgaard; Corry H de Koning; Ineke C A H Janssen; Femke Mol; Ben W J Mol; Helen L Torrance; Frank J M Broekmans Journal: BMC Womens Health Date: 2012-08-08 Impact factor: 2.809
Authors: Jan Bosteels; Steffi van Wessel; Steven Weyers; Frank J Broekmans; Thomas M D'Hooghe; M Y Bongers; Ben Willem J Mol Journal: Cochrane Database Syst Rev Date: 2018-12-05