İsmet HORTU, Seda AKGÜN KAVURMACI, Gökay ÖZÇELTİK, Elif KARADADAŞ, Fırat ÖKMEN, Ahmet Mete EREGENOĞLU

Tubal Açıklık Değerlendirilmesinde Histerosalpingografi ve Laparoskopinin Tanısal Değeri: Tersiyer Referans Merkez Deneyimi

GİRİŞ ve AMAÇ: İnfertilite araştırılmasında tubal açıklık değerlendirmesi ilk basamak testlerdendir. Çalışmanın amacı, infertil hastalarda tubal açıklıkların belirlenmesinde ilk basamak olarak kullanılan Histerosalpingografiyi (HSG) laparoskopik bulgularla karşılaştırmak ve referans bir merkez olan kliniğimize ait verileri retrospektif olarak gözden geçirmektir. YÖNTEM ve GEREÇLER: Ege Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı İnfertilite polikliniğine 2014-2019 tarihleri arasında başvurmuş 288 hastada tubal açıklıklar hem HSG hem laparoskopi ile değerlendirilmiştir. Tubal açıklık tanısında, laparoskopi, altın standart yöntem olarak kabul edildiği için, HSG’ye ait veriler, laparoskopi sonuçları baz alınarak analiz edilmiştir. BULGULAR: Tüm hastaların değerlendirmesinde, tubal açıklıkların saptanmasında, HSG’ye ait Pozitif Prediktif Değer (PPD) %81,1 ve Negatif Prediktif Değer (NPD) ise %53,2 bulunmuştur. Hastalar primer ve sekonder infertilite kategorilerinde baz alınarak analiz edildiğinde, PPD değerleri sırasıyla %79,2 ve % 83,3 ve NPD ise sırasıyla 56,7 ve 48,5 saptanmıştır. Sensitivite ve spesifite ise tüm hastalar için sırasıyla %59,5 ve %76,9, primer infertilitesi olan hastalarda %59,4 ve %77,3 ve sekonder infertilitesi olan hastalar için de sırasıyla %59,5 ve %76,2 olarak tespit edilmiştir. TARTIŞMA ve SONUÇ: Tubal açıklığı değerlendirmede HSG, ucuz, kolay erişilebilen, non-invaziv ilk basamak test olmasına rağmen sensitivite ve negatif prediktif değerlerinin düşük olması nedeniyle altın standart test olan laparoskopi ile tubaların durumu objektif olarak değerlendirilmelidir.

Diagnostic Value of Hysterosalpingography and Laparoscopy for Tubal Patency in İnfertile Women: A Tertiary Referral Center Experience

INTRODUCTION: The aim of this study was to compare Hysterosalpingography and Laparoscopy as the two methods for evaluation of tubal pathologies in infertile patients and assess sensitivity and specificity of HSG. In addition, we aimed to evaluate a retrospective data of our tertiary referral center. METHODS: Tubal pathologies were evaluated both with HSG and Laparoscopy in 288 patients who consulted to the infertility clinic. Data obtained with HSG is analysed based on laparoscopic findings where it is considered as the gold standard method. RESULTS: In all patients, positive predictive value (PPV) of HSG was 81,1% and negative predictive value (NPV) was 53,2%. The patients were analyzed based on primary and secondary infertility where PPVs were 79,2% and 83,3% and NPVs were 56,7% and 48,5%, respectively. The sensitivity and spesificity were 59,5% and 76,9% for all patients, 59,4% and 77,3% for patients with primary infertility and 59,5% and 76,2% for secondary patients, respectively. DISCUSSION and CONCLUSION: While the sensitivity and spesificity measures for HSG were in agreement with the current literature, Negative predictive values were low marking that laparoscopy should be considered to confirm tubal occlusions which could be overlooked by HSG

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