Causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography

SUMMARY OBJECTIVE This study aims to investigate the causes of misdiagnosis in assessing tubal patency by transvaginal real-time three-dimensional hysterosalpingo-contrast sonography (TVS RT-3D-HyCoSy), in order to improve the diagnostic efficiency of TVS RT-3D-HyCoSy. METHODS A total of 162 oviducts of 83 infertility patients were examined by TVS RT-3D-HyCoSy. These results were compared with the gold standard for laparoscopic dye studies, and the misdiagnosed cases were analyzed. RESULTS TVS RT-3D-HyCoSy revealed that 68 oviducts were unobstructed and 94 obstructed. The results for the 144 oviducts were in line with the gold standard, while those for 18 oviducts were not. The accuracy rate of the TVS RT-3D-HyCoSy was 88.9%, and the misdiagnosis rate was 11.1%. The main causes of misdiagnosis included contrast medium countercurrent and diffusion, oviduct spasm, abnormal shape or position of the oviduct, pelvic adhesion, and poor imaging operation. CONCLUSION TVS RT-3D-HyCoSy can well-evaluate tubal patency, and understand and improve the cause of misdiagnosis. Furthermore, the diagnostic efficiency of TVS RT-3D-HyCoSy can still be further improved.

RESUMO OBJETIVO Este estudo tem como objetivo investigar as causas do diagnóstico equivocado na avaliação da patência tubária por meio da ultrassonografia de contraste histerosalpingo em tempo real transvaginal (TVS RT-3D-HyCoSy), a fim de melhorar a eficiência diagnóstica das TVS RT-3D-HyCoSy. MÉTODOS Um total de 162 ovidutos em 83 pacientes da infertilidade foi examinado por TVS RT-3D-HyCoSy. Esses resultados foram comparados com o padrão ouro para estudos de tintura laparoscópica, e os casos diagnosticados erroneamente foram analisados. RESULTADOS TVS RT-3D-HyCoSy revelaram que 68 ovidutos foram desobstruídos e 94 ovidutos foram obstruídos. Os resultados para os 144 ovidutos estavam em consonância com o padrão ouro, enquanto que aqueles para os 18 ovidutos, não. A taxa de acurácia do TVS RT-3D-HyCoSy foi de 88,9%, e a taxa de erro de diagnóstico foi de 11,1%. As principais causas de erro de diagnóstico incluíram contraponto e difusão do meio de contraste, espasmo do oviduto, forma ou posição anormal do oviduto, adesão pélvica e má operação de imagem. CONCLUSÃO TVS RT-3D-HyCoSy pode bem avaliar a patência tubária, e compreender e melhorar a causa do erro de diagnóstico. Além disso, a eficiência diagnóstica do TVS RT-3D-HyCoSy ainda pode ser melhorada.

Cromotubación histeroscópica: técnica alternativa para la evaluación de la permeabilidad tubárica y la cavidad uterina en un solo paso / Hysteroscopic chromotubation: an alternative technique for the evaluation of tubal patency and uterine cavity in a single step

La evaluación de la permeabilidad tubárica es un paso esencial en el estudio de la infertilidad femenina. Existen varios métodos que permiten realizar esta evaluación. La histerosalpingografía (HSG) se ha considerado el método estándar, sin embargo es conocida su limitación en la evaluación de la obstrucción proximal con alta tasa de falsos positivos. Presentamos una técnica alternativa para la evaluación por medio de cromotubación histeroscópica, que tiene entre otras, la ventaja de permitir la evaluacion del factor uterino y tubárico en un solo paso y además, supera la dificultad de los falsos positivos de la HSG, en cuanto a la obstrucción proximal.

The evaluation of tubal patency is an essential step in the study of female infertility. There are several methods to perform this evaluation. Hysterosalpingography (HSG) has been considered the standard method, however it is known to limitations in the assessment of proximal obstruction with high false positive rate. We present an alternative technique for evaluation by hysteroscopic chromo tubation, which has among others, the advantage of allowing the evaluation of uterine and tubal factor in one step and also overcomes the difficulty of false-positive HSG, as to the proximal obstruction.

Hysterosalpingographic accuracy of peritubal adhesion.

The purpose of this study was to determine diagnostic accuracy of hysterosalpingography by using different diagnostic criteria in peritubal adhesion diagnosis. The authors retrospectively reviewed cases in which both hysterosalpingography and laparoscopy were performed. Fifty-nine of 84 cases had laparoscopy proved peritubal adhesion. Five hysterosalpingographic signs (convoluted tube, vertical tube, ampullary dilatation, peritubal halo and loculation of the spillage of contrast material) defined by Karasick and Goldfarb were used to diagnose peritubal adhesion. All cases were analyzed by two different diagnostic criteria: first diagnostic criterion, presence of one or more signs means abnormal; second diagnostic criterion, presence of two or more signs means abnormal. Peritubal adhesion was diagnosed in 70 of 84 cases by using the first diagnostic criterion, 53 of 84 cases by using the second diagnostic criterion. The first diagnostic criterion displayed 94.9 per cent sensitivity, 44 per cent specificity, 80 per cent positive predictive value, 79.76 per cent accuracy and the likelihood ratio of 1.69. The second diagnostic criterion showed 74.6 per cent sensitivity, 64 per cent specificity, 83 per cent positive predictive value, 71.43 per cent accuracy and the likelihood ratio of 2.07. The authors conclude that using the 2nd diagnostic criterion is more appropriate than using the 1st diagnostic criterion in diagnosing peritubal adhesion.

Hyterosalpingoscintigraphic [HSS] evaluation of fallopian tubes patency and physiology in normal and patients with unexplained infertility

In this work, 135 female patients with unexplained infertility as well as 45 age-matched controls were subjected to radionuclide HSS between day 9-16 of their menstrual cycles aiming to examine ovarian regulation on functional Fallopian tube patency in normal females, quantification of radiotracer Fallopian tubal transit time [TTT] in both normal and females with unexplained infertility and evaluation of functional Fallopian tube obstruction as a possible cause of unexplained infertility. HSS was done using 10 MBq 99 mTc- MAA of 5-40 um in diameter placed on posterior vaginal fornix. Serial anterior pelvic gamma camera images were obtained at five-minute intervals up to one hour and every 0.5 hour up to 4 hours. Delayed 24 hours images were taken if required. The results were related to the sonographically determined dominant follicle. Dominant follicle sided functional tubal patency was observed in 97% of normal with mean TTT 10 +/- 4 minutes as well as 40% of patients with their mean TTT 110 +/- 10 minutes. Functional Fallopian tube obstruction was observed in 60% of patients with unexplained infertility. The results indicated that HSS is a simple, noninvasive, sensitive and valuable method for evaluation of Fallopian tube patency and physiology in patients with unexplained infertility