Saline-Air-HyCoSy Is Equivalent to the Modified HSG Following Hysteroscopic Sterilization [11M

Abstract

INTRODUCTION: Transvaginal ultrasound (TVU) is FDA approved for coil location (CL) only following hysteroscopic sterilization. We compared saline-air-hysterosalpingo-contrast-sonography (SA-HyCoSy) to modified HSG (mHSG) for confirmation of both CL and tubal occlusion (TO). METHODS: 19 women underwent SA-HyCoSy and mHSG after random assignment to one followed by the other. Percent agreement and predictive values of SA-HyCoSy for CL and TO compared to mHSG by two interpreters were calculated along with inter-rater reliability. Differences in procedural time and pain score using a Likert 11-point pain scale were recorded. RESULTS: In total, 38 fallopian tubes were evaluated. For each interpreter, satisfactory CL was noted with mHSG in 97.4% and 100% compared to satisfactory-optimal CL with TVU in 100% for a PPV of 97.4% and 100%, respectively. TO on mHSG was noted in 97.3% of tubes compared with SA-HyCoSy in 97.3% and 94.6% for a PPV of 100% and NPV of 50% and 33%, respectively. SA-HyCoSy agreed with mHSG for both interpreters in 97.4% and 95.7% (kappa=0.67, P<.01). SA-HyCoSy changed CL in 50% and 44.7% (P-NS), being down-graded from optimal to satisfactory in 42.9% (9/21) and 36% (9/25) and upgraded to optimal in 58.8% (10/17) and 61.5% (8/13) (P-NS) for each, respectively. Procedural time (7.5 vs 9.4 min) and pain scores (2.3 vs 3.1) were similar for mHSG and SA-HyCoSy. CONCLUSION: There is a high degree of accuracy for TO with SA-HyCoSy, though CL was changed in nearly half of cases. While procedural time and pain were higher, avoidance of radiation with SA-HyCoSy may outweigh any drawbacks.