Diagnostic Accuracy Of Hysterosalpingography Research Articles

Diagnostic Accuracy of Hysterosalpingography and Outpatient Hysteroscopy in Suspected Tubal Obstruction: A Comparative Study

Diagnostic Accuracy of Hysterosalpingography and Outpatient Hysteroscopy in Suspected Tubal Obstruction: A Comparative Study

Diagnostic Accuracy of Hysterosalpingography in the Identification of Intrauterine Adhesions in Infertile Women in a Referral Centre, Southern Nigeria

Background: Examination of the endometrial cavity is crucial in the management of infertile women. This evaluation is done by Hysterosalpingography (HSG) in the University of Port Harcourt Teaching Hospital. The diagnostic value and accuracy of hysterosalpingography varies in various centres and has not been assessed in the University of Port Harcourt Teaching Hospital (UPTH), hence this study. Methodology: A prospective cross sectional study done among 101 infertile women at the gynaecology clinic of the UPTH from December 2018 to July 2019. Socio-demographic data of women who met the eligibility criteria were collected. Their hysterosalpingographic and outpatient hysteroscopic findings were statistically analyzed using IBM SPSS for windows version 20.0. The validity and reliability statistics of hysterosalpingography for the identification of endometrial adhesions were determined and significance was reported at p-value Result: The respondents were all married, 66.3% of them were nulliparous, while 54.5% were above 35 years of age. Most, 93.1% of the studied group had at least secondary education and had duration of infertility of more than 2 years. There was a moderate strength of agreement in the diagnostic accuracy of HSG with hysteroscopy in the diagnosis of intrauterine adhesions; showing sensitivity and specificity of 59.6% and 90.9% respectively. The accuracy of HSG in the identification of intrauterine adhesions in this study was 73.3%. The agreement in the diagnostic accuracy of HSG using Hysteroscopy as a gold standard for intrauterine adhesions was therefore moderately significant (k = 0.482). Conclusion: HSG had an overall fair strength of agreement with office hysteroscopy in the identification of intrauterine adhesions. It is a specific but not a sensitive predictor of intrauterine adhesion.

Diagnostic accuracy of hysterosalpingography in comparison to laparoscopy to detect tubal occlusion in female infertility: An observational study

Background: An accurate diagnosis of tubal occlusion is a crucial part of infertility management of women for which Hysterosalpingography is an integral part for this purpose. Objective: The study is designed to find out tubal occlusion by hysterosalpingography (HSG) and comparing the findings with diagnostic laparoscopy with chromopertubation (laparoscopy) by determining validity and agreement of findings in the study group. Materials and Methods: In this observational study, one hundred and ninety-seven women with infertility were recruited from an infertility clinic of a tertiary care hospital ofWest Bengal, in between April 2018 and March 2020, i.e. 24 months’ period. Women, who were exposed to both of the investigations i.e. HSG and laparoscopy tests, were our study subjects. HSG findings were compared with the findings of laparoscopy to detect tubal occlusion by analyzing sensitivity, specificity, positive predictive value, negative predictive value and kappa. Results: We found mean age of women with primary infertility (66%) was 27.23 years and with secondary infertility (34%) was 32.02 years. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of HSG in comparison to laparoscopy to detect tubal occlusion were 80.85%, 74%, 49.35%, 92.5% and 75.63% respectively. Findings showed statistically significant (p Conclusion: This study provides strong supportive evidence to utilise HSG as a screening test for diagnosing tubal occlusion in infertility work up with high accuracy, especially in low resourceful area of rural India. Keywords: Infertility, Hysterosalpingography, Laparoscopy, Chromopertubation.

The validity of HSG in infertility work up

BackgroundOur purpose was to evaluate the diagnostic accuracy of hysterosalpingography (HSG) in the diagnosis of the uterine cavity and tuboperitoneal abnormalities in infertile women. Reproducibility and consistency were also assessed. Two hundred infertile females underwent HSG, hysteroscopy, and/or laparoscopy as part of infertility workup. HSG examinations were retrospectively reviewed by three radiologists; we compared interobserver variability, and differences between the two results of reading the same examination after 3 months were compared to calculate intraobserver variability.HSG sensitivity, specificity, PPV, NPV, and accuracy were calculated.ResultsThe overall accuracy of HSG in diagnosing tubal, uterine cavity, and peritoneal abnormalities was 95.5%, 95%, and 89%, respectively (P value < 0.04).HSG is reproducible in diagnosing normal versus abnormal examinations. Reproducibility in diagnosing uterine cavity, tubal, and peritoneal abnormalities was (ICC = 0.90), (ICC = 0.70), and (ICC = 0.31), respectively. Best agreement was seen in diagnosing luminal filling defect (sub mucous fibroid/polyp) (ICC = 0.90) (95% CI 0.86–0.98), whereas poorest agreement was found in diagnosing uterine adhesions (ICC = 0.13) (95% CI 0.10–0.13) and pelvic adhesions (ICC = 0.12) (95% CI 0.10–0.13) (P value < 0.03).HSG consistency ranged from moderate to good (K = 0.49–0.79). It was highest in diagnosing normal versus abnormal examination (P value < 0.01); poorest in diagnosing pelvic adhesions.ConclusionHSG has high validity in negative results; it can minimize the use of invasive procedures. Laparoscopy is recommended in patients who had a pelvic disease or showing tubal obstruction on HSG.

Comparative Prospective Study of Hysterosalpingography and Hysteroscopy in Infertile Women.

Aim:To compare the findings and diagnostic accuracy of Hysterosalpingography (HSG) and hysteroscopy in infertile women.Setting and Design:Prospective comparative study in a tertiary care Centre.Material and Methods:108 women with primary or secondary infertility were recruited. In all women after basic infertility workup, both HSG and hysteroscopy were performed.Results:Out of 108 women, in 3 women HSG couldn’t be done and in one woman there was uterine perforation on hysteroscopy. HSG showed normal uterine cavity in 77.8% (81/105) women and abnormal in 22.85% (24/105). Hysteroscopy findings were normal in 70.09% (75/107) and abnormal in 29.91% (32/107). Hysteroscopy detected incidental findings in 15.38% (16/104) cases. HSG showed irregular uterine cavity in 14.15% (15/105) women but on hysteroscopy; normal cavity was present in 6 (40%) women and abnormality was detected in 9 (60%) women. The sensitivity, specificity, positive predictive and negative predictive value of HSG in evaluating uterine cavity abnormalities were 44.83% (95% confidence interval (CI); 0.26–0.64), 86.67% (95% CI; 0.76–0.93), 56.52% (95% CI; 0.34–0.76) and 80.25% (95%CI; 0.69–0.88). Positive likelihood ratio and negative likelihood ratio of HSG in detecting uterine cavity abnormality was 3.36 and 0.64 respectively. The agreement between HSG and hysteroscopy was 75%. This was statistically significant (P value = 0.001) with fair strength of agreement between HSG and hysteroscopy. (k value= 0.336).Conclusion:Hysteroscopy should be performed in all infertile patients as it can detect significant number of incidental findings missed by HSG.

Evaluation of Selective hydrotubation under hysterofiberscopy

Objective: Tubal disease is the main cause of infertility and 10-25% of the cases are due to proximal tubal obstruction. Hysterosalpingography (HSG) is part of the standard diagnostic work-up for infertility; however, the diagnostic accuracy of HSG has been criticized. Selective hydrotubation is a useful tool by which to evaluate tubal obstruction. The aim of this study was to estimate the diagnostic findings and fertility outcomes after selective hydrotubation and to determine the prognostic significance of Chlamydia trachomatis infection for recanalization.Patients: Fifty-seven women undergoing selective hydrotubation for proximal tubal obstruction detected on HSG between January 2000 and December 2007 in the Department of Obstetrics and Gynecology of the University of Tokyo were studied.Results: Of the proximally occluded tubes detected by HSG, 41.9% were shown to be patent after selective hydrotubation. The success rate of recanalization by selective hydrotubation in unilateral obstruction (62.5%) was significantly higher than in bilateral obstruction (17.6%; P<0.01) . After recanalization by selective hydrotubation, 33.3% of the patients conceived without IVF or ICSI. With respect to C. trachomatis infection, the success rate of recanalization in patients with negative chlamydial antibodies was significantly higher (65.6%) than in patients with positive chlamydial antibodies (30.4%; P<0.01) .Conclusions: Selective hydrotubation is a useful tool in the diagnosis and treatment of proximal tubal obstruction detected by HSG. Especially in cases of proximal tubal obstruction with negative chlamydial antibodies, the success rate of recanalization can be high.