REPRODUCIBILITY OF THE INTERPRETATION OF HYSTEROSALPINGOGRAPHY IN THEDIAGNOSIS OF TUBAL PATHOLOGY

The aim of the study was to estimate the inter- and intra-observer rep roducibility of the interpretation of hysterosalpingography (HSG) in t he diagnosis of tubal pathology, and associate reproducibility with di agnostic accuracy, Four observers evaluated 143 HSGs twice, on proxima l tubal obstruction, distal tubal obstruction, hydrosalpinx and peritu bal adhesions, Diagnostic laparoscopy with chromopertubation was consi dered to be the reference strategy, Reproducibility (inter- and intra- observer agreement) was expressed in terms of kappa-values, Accuracy w as expressed in terms of sensitivity, specificity and likelihood ratio s, kappa-values for reproducibility between observers were almost perf ect for proximal obstruction, substantial for distal obstruction and h ydrosalpinx, and moderate for adhesions, kappa-values for reproducibil ity within observers were almost perfect for proximal obstruction and substantial for distal obstruction, hydrosalpinx and adhesions, HSG ha d a high specificity for proximal obstruction, but a low sensitivity, Distal obstruction, absence of hydrosalpinx and adhesions had a poor a ccuracy, The likelihood ratio for the presence of hydrosalpinx was hig h, In conclusion, proximal tubal obstruction detected on HSG changes t he pre-test probability of proximal tubal obstruction from 16 to 50%, Proximal tubal patency detected on HSG changes the pre-test probabilit y of proximal tubal patency from 16 to 9%, It is unlikely that a lack of reproducibility of the interpretation of proximal tubal patency is responsible for the low sensitivity; alternative explanations are arte facts occurring while performing HSG or an imperfect reference strateg y diagnostic laparoscopy, HSG is of limited use in diagnosing distal t ubal obstruction and hydrosalpinx, and has no value in the detection o f peritubal adhesions.