Fallopian tube disease: The cobblestone pattern as a radiographic sign

PURPOSE: To identify radiographic signs of mucosal damage by comparing hyst erosalpingography with salpingoscopy in a prospective study. MATERIALS AND METHODS: Forty-one candidates for laparoscopy underwent hyste rosaipingography and peroperative salpingoscopy; at both, tubal patency was noted. Radiographic criteria for mucosal abnormality were rounded filling defects (ie, the cobblestone pattern) and the absence of longitudinal radio lucent bands in the ampullary tract. At salpingoscopy, tubal mucosa was cat egorized by means of inspection into five classes of fold pattern: classes I and ii, normal; classes Ill-V, abnormal. Hysterosalpingographic and salpi ngoscopic results were compared by means of a two-by-two table and kappa st atistics. RESULTS: Seventy-four tubes were evaluated. At hysterosalpingography, 31 tu bes were distally nonpatent. Of these, 26 showed a distal obstruction at sa lpingoscopy. None of the patent tubes at hysterosalpingography showed obstr uction at salpingoscopy. The agreement between hysterosalpingography and sa lpingoscopy in detecting abnormal mucosal pattern was 89.2% (kappa, 6.73; P < .001). The cobblestone pattern always corresponded to intraluminal adhes ions at salpingoscopy. The absence of radiolucent bands corresponded to abn ormal mucosa at salpingoscopy in four of six cases. The cobblestone pattern was found only in hydrosalpinges and never in patent tubes. Six normal pat ent tubes at hysterosalpingography showed intraluminal adhesions at salping oscopy. CONCLUSION: Results indicate that the cobblestone pattern is an effective r adiographic sign of intraluminal adhesions in hydrosalpinges and suggest th at intraluminal disease in patent tubes might not always be excluded on nor mal hysterosalpingograms.