Improvement of hysterosalpingographic accuracy in the diagnosis of peritubal adhesions

OBJECTIVE. Our purpose was to compare hysterosalpingography with laparoscop y in the diagnosis of peritubal adhesions and to verify whether a combinati on of radiographic signs improves hysterosalpingographic accuracy. SUBJECTS AND METHODS. Thirty candidates for laparoscopy underwent hysterosa lpingography before surgery, Two radiologists evaluated the presence or abs ence and types of radiographic signs of peritubal adhesions (convoluted tub es, vertical tubes, loculation of contrast medium in peritoneum, halo effec t, and fixed laterodeviation of the uterus) using two different criteria fo r normality or abnormality: no sign means a normal result, one or more sign s mean an abnormal result (first criterion); no sign or one sign means a no rmal result, two or more signs mean an abnormal result (second criterion). interpretation discrepancies were resolved by consensus. Peritubal and peri ovarian adhesions were evaluated by a single operating surgeon during lapar oscopy (recorded on S-VHS videotape) and by a different surgeon reviewing t he videotape. The radiographic results obtained using the two criteria in r adiologi- cally patent as well as in distally nonpatent tubes were compared with corresponding laparoscopic results by 2 x 2 tables and were statistic ally analyzed (kappa statistics). RESULTS, The first criterion displayed poor diagnostic accuracy. The correl ation with laparoscopy was not statistically significant in either radiolog ically patent or distally nonpatent tubes. The second criterion greatly imp roved the agreement with laparoscopy, but only in patent tubes (kappa = 0.7 789; p < 0.001). CONCLUSION. Hysterosalpingographic accuracy in peritubal adhesion diagnosis can be improved in patent tubes by taking into account more than one of th e reported radiographic signs.