Hysteroscopy for Assessing Fallopian Tubal Obstruction: A Systematic Review and Diagnostic Test Accuracy Meta-analysis

Abstract

To assess the diagnostic accuracy of hysteroscopy compared with that of laparoscopic chromopertubation for the detection of fallopian tubal obstruction. Data Sources: An electronic search from inception to March 31, 2020, was performed in Medline, Scopus, EMBASE, and the Cochrane Central Register of Controlled Trials. Methods of Study Selection: This diagnostic accuracy meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesizing Evidence from Diagnostic Accuracy Tests recommendations. A combination of the following Medical Subject Headings terms and keywords was included in the search strategy: "hysteroscopy[MeSH]," "tubal obstruction," "tubal patency," "tubal dysfunction," and "tubal blockage." Quality assessment of the included studies was conducted using the Quality Assessment Tool for Diagnostic Accuracy Studies−2 (University of Bristol, Bristol, United Kingdom). Publication bias was evaluated by means of the Deek funnel plot asymmetry test. The following outcomes were analyzed: diagnostic odds ratio, area under hierarchical summary receiver operating characteristic and area under receiver operating characteristic curve, sensitivity, specificity, and positive and negative likelihood ratios. Tabulation, Integration, and Results: Six studies comparing hysteroscopy with laparoscopic chromopertubation were included in the meta-analysis. After pooling all the studies, the diagnostic odds ratio was 43. The evaluated area under receiver operating characteristic curve was 0.93, correlating with high diagnostic accuracy for the index test. Sensitivity and specificity were 88% and 85%, respectively. In addition, the positive and negative likelihood ratios were 5.88 and 0.16, respectively. Conclusion: Hysteroscopic techniques are highly accurate and sensitive for detecting fallopian tubal obstruction. Interventional assessment enhances diagnostic accuracy compared with observational assessment, as does the office setting compared with the operating room. Additional studies, along with a refinement of the techniques, could facilitate the widespread use of hysteroscopic techniques for the detection of fallopian tube occlusion.

Ultra-minimally invasive surgery in gynecological patients: a review of the literature

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Can hysteroscopy be substituted to hysterosalpingography in the assessment of infertility? Methods of showing tubal transition as hysteroscopic

“…Alternative methods to HSG have been tried to be developed for years. However, studies on the evaluation of tubal patency by hysteroscopy are very limited in the literature [18,19]. It is a known fact that hysteroscopy is the gold standard method for detecting lesions related to the uterine cavity [20].…”

Preliminary hysteroscopic tubal hydrotubation improves fertility outcomes after laparoscopic salpingotomy for tubal ampullary pregnancy

“…As the structure and function of the fallopian tube need to be rebuilt after laparoscopic salpingotomy, it would be great to have an effective approach which can improve the recovery of fallopian and pelvic function. Recently, hysteroscopic techniques are highly accurate and sensitive for detecting fallopian tubal obstruction [ 22 ]. Therefore, the HTH was hypothesized as a beneficial approach for the recovery of fallopian.…”