The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis.

OBJECTIVE: To assess the value of hysterosalpingography (HSG) in diagnosing tubal patency and peritubal adhesions using laparoscopy with chromopertubation as the gold standard.

DESIGN: Meta-analysis of 20 studies comparing HSG and laparoscopy for tubal patency and peritubal adhesions.

PATIENTS: Four thousand one hundred seventy-nine patients with infertility in 20 studies.

INTERVENTION: Hysterosalpingography and diagnostic laparoscopy as part of infertility workup.

MAIN OUTCOME MEASURE: Tubal patency and peritubal adhesions.

RESULTS: For tubal patency the 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 calculated. For peritubal adhesions a summary receiver operating characteristic curve could be estimated.

CONCLUSIONS: Although HSG is of limited use for detecting tubal patency because of its low sensitivity, its high specificity makes it a useful test for ruling in tubal obstruction. For the evaluation of peritubal adhesions HSG is not reliable.