Efficacy of hysterosalpingography in evaluating endometriosis

William K. Johnson, W K Johnson, D J Ott, M Y Chen, M. Y. M. Chen, Jamil A. Fayez, J A Fayez, D W Gelfand
Abdominal imaging · 1994 · vol. 19(3) , pp. 278–280 · doi:10.1007/bf00203528 · PMID:8019364 · W1983068715
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-10 ⓘ

This study found hysterosalpingography has low sensitivity (40%) and positive predictive value (21%) for detecting endometriosis-related tubal abnormalities in infertile women.

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This study evaluated whether hysterosalpingography (radiographic assessment of tubal filling and peritubal morphology) can detect endometriosis by reviewing laparoscopic and radiographic findings in 50 infertile women undergoing evaluation. Laparoscopy was normal in 15 and showed endometriosis in 35, with disease staged by American Fertility Society criteria, while radiographs were reviewed blindly and tubal abnormalities defined by incomplete/absent filling and ampullary dilatation or convolution; radiologic efficacy was assessed by correlating tubal appearance with laparoscopic severity and location. Only 10 of 98 tubes (10%) were judged involved by endometriosis based on laparoscopic findings, yielding sensitivity of 40% (4/10) and specificity of 83% (73/88), with a low positive predictive value of 21% due to 15 false positives. The authors conclude that, because endometriosis is often located in the pelvis away from the fallopian tubes, it rarely produces radiographic abnormalities on hysterosalpingography, including regardless of severity—thereby limiting radiographic usefulness. This paper is centrally about endometriosis — it tests the diagnostic efficacy of hysterosalpingography for detecting endometriosis-related tubal/peritubal involvement in infertile women.

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Abstract

Endometriosis is a common disease in young women being evaluated for infertility. Although endometriosis may cause tubal abnormalities on hysterosal-pingography, efficacy of radiographic evaluation in this disease is not clear. We reviewed the radiographic and laparoscopic examinations in 50 women being studied for infertility. Laparoscopy was normal in 15 women and showed endometriosis in 35 patients. Endometriosis was staged at laparoscopy using the classification of the American Fertility Society. Radiographic examinations were reviewed blindly and tubal status noted in each patient. Criteria for tubal abnormality included incomplete or absent filling and ampullary dilatation or convolution. Radiographic efficacy was determined by correlating the tubal appearance to the severity and location of endometriosis. A total of 98 tubes were correlated but only 10 (10%) were felt to be involved by endometriosis based on laparoscopic findings. Radiologic sensitivity was 40% (4 of 10) and specificity was 83% (73 of 88). Positive predictive value was 21% (4 of 19) due to 15 false-positive diagnoses in tubes uninvolved by endometriosis. In conclusion, endometriosis, regardless of its severity, rarely causes radiographic abnormalities on hysterosalpingography because of the location of disease in the pelvis. Similar content being viewed by others

References

Buttram VC Jr. Endometriosis. In Behrman SJ, Kistner RW, Patton GW Jr, eds. Progress in infertility, 3rd ed. Boston: Little,Brown, 1988:273–329 Strathy JH, Molgaard CA, Coulam CB, Melton LJ III. Endometriosis and infertility: a laparoscopic study of endometriosis among fertile and infertile women. Fertil Steril 1982;38:667–672 Wood GP. Laparoscopic examination of the normal infertile woman. Obstet Gynecol 1983;62:642–643 Weitzman GA, Buttram VC. Classification of endometriosis. Obstet Gynecol Clin North Am 1989;16:61–77 Adamson GD. Diagnosis and clinical presentation of endometriosis. Am J Obstet Gynecol 1990;162:568–569 Siegler AM. Hysterosalpingography. Fertil Steril 1983;40:139–158 Belaish J. Hysterographic images of genital endometriosis. Contrib Gynecol Obstet 1987;16:109–118 Winfield AC, Wentz AC. Diagnostic imaging of infertility, Baltimore: Williams & Wilkins, 1987:105–125 Chen YM, Ott DJ, Pittaway DE, Fayez JA, Gelfand DW. Efficacy of hysterosalpingography in evaluating tubal and peritubal disease in 200 patients with infertility. Rays 1988;13:27–32 Karasick S, Goldfarb AF. Peritubal adhesions in infertile women: diagnosis with hysterosalpingography. AJR 1989;152:777–779 Ott DJ, Fayez JA. Hysterosalpingography: a text and atlas. Baltimore: Urban & Schwarzenberg, 1991:103–125 Yoder IC, Hall DA. Hysterosalpingography in the 1990's. AJR 1991;157:675–683 Author information Authors and Affiliations Rights and permissions About this article Cite this article Johnson, W.K., Ott, D.J., Chen, M.Y.M. et al. Efficacy of hysterosalpingography in evaluating endometriosis. Abdom Imaging 19, 278–280 (1994). https://doi.org/10.1007/BF00203528 Received: Accepted: Issue date: DOI: https://doi.org/10.1007/BF00203528

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Hysterosalpingography Adult Endometriosis Female Humans Infertility, Female Infertility, Female Laparoscopy

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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