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

Objective: To assess the Value of hysterosalpingography (HSG) in diagn osing tubal patency and peritubal adhesions using laparoscopy with chr omopertubation as the gold standard. Design: Meta-analysis of 20 studi es comparing HSG and laparoscopy for tubal patency and peritubal adhes ions. Patients: Four thousand one hundred seventy-nine patients with i nfertility in 20 studies. Intervention: Hysterosalpingography and diag nostic laparoscopy as part of infertility workup. Main Outcome Measure : Tubal patency and peritubal adhesions. Results: For tubal patency th e 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 ca lculated. For peritubal adhesions a summary receiver operating charact eristic curve could be estimated. Conclusions: Although HSG is of limi ted use for detecting tubal patency because of its low sensitivity, it s high specificity makes it a useful test for ruling in tubal obstruct ion. For the evaluation of peritubal adhesions HSG is not reliable.