Sensitivity of hysterosalpingography after tubal surgery

Abstract

Hysterosalpingography (HSG) to assess tubal patency in the postoperative evaluation of the infertile patient has been well described. However, the sensitivity and specificity of HSG after tubal surgery has not been reported. We correlated HSG and laparoscopic findings in 25 patients who had tubal surgery (microsurgical tubal reanastomoses [11] and distal salpingostomies [14]). HSG provided a more reliable means of assessing tubal patency (sensitivity and specificity of 96% and 61% respectively) than in detecting pelvic adhesive disease (PAD) (sensitivity and specificity of 12% and 75% respectively) regardless of tubal surgical procedure. HSG was associated with a high false negative rate (60%) due primarily to the inability to detect PAD. Complete agreement between HSG and laparoscopy was noted in only 15% of cases. These data suggest that HSG is a sensitive means to determine tubal patency, but was not sufficiently sensitive or specific to detect PAD after tubal surgery. These limitations should be noted in the interpretation of HSG in any infertile patient with a history of tubal surgery, and severely limits the application of HSG to the management of the post-operative infertile patient.

PIP: Researchers analyzed data on 25 women who underwent either tubal reanastomosis or distal salpingostomy at least 12 months earlier and came to the Tripler Army Medical Center in Honolulu, Hawaii, for hysterosalpingography (HSG) to compare HSD findings with those of laparoscopy, thereby determining HSG's sensitivity and specificity after tubal repair. They were only able to evaluate 42 tubes, since 2 patients had severe pelvic adhesive disease. HSG was more reliable in determining tubal patency (sensitivity of 96% and specificity of 61%) than in detecting pelvic adhesive disease (12% and 75%, respectively). HSG and laparoscopy findings agreed in just 15% of cases. HSG's inability to detect pelvic adhesions was responsible for this low agreement rate. Specifically, HSG found adhesions in only 6% of patients compared to 65% for laparoscopy (false negative rate = 60%). The adhesions completely covered all pelvic structures in 8% of cases at the same frequency for both reanastomosis and salpingostomy, thereby making it impossible to evaluate the anatomy. Further, HSG did not detect other pelvic pathologies (mild endometriosis, uterine fibroids, and ampullary fistulae) in 10% of cases. These findings suggest that HSG is sensitive and specific enough to assess tubal patency following reanastomosis, but is basically not specific enough to do so after distal salpingostomy. Therefore, clinicians should be aware of HSG's limitations when interpreting any HSG findings in infertile patients who had tubal surgery. Further, it limits their ability to manage postoperative infertile patients.