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.