title: Are patient characteristics associated with the accuracy of hysterosalpingography in diagnosing tubal pathology? An individual patient data meta-analysis.
abstract: BACKGROUND
  Conventional meta-analysis has estimated the sensitivity and specificity of hysterosalpingography (HSG) to be 65% and 83%. The impact of patient characteristics on the accuracy of HSG is unknown. The aim of this study was to assess by individual patient data meta-analysis whether the accuracy of HSG is associated with different patient characteristics.
  
  
  METHODS
  We approached authors of primary studies reporting on the accuracy of HSG using findings at laparoscopy as the reference. We assessed whether patient characteristics such as female age, duration of subfertility and a clinical history without risk factors for tubal pathology were associated with the accuracy of HSG, using a random intercept logistic regression model.
  
  
  RESULTS
  We acquired data of seven primary studies containing data of 4521 women. Pooled sensitivity and specificity of HSG were 53% and 87% for any tubal pathology and 46% and 95% for bilateral tubal pathology. In women without risk factors, the sensitivity of HSG was 38% for any tubal pathology, compared with 61% in women with risk factors (P = 0.005). For bilateral tubal pathology, these rates were 13% versus 47% (P = 0.01). For bilateral tubal pathology, the sensitivity of HSG decreased with age [factor 0.93 per year (P = 0.05)]. The specificity of HSG was very stable across all subgroups.
  
  
  CONCLUSIONS
  The accuracy of HSG in detecting tubal pathology was similar in all subgroups, except for women without risk factors in whom sensitivity was lower, possibly due to false-positive results at laparoscopy. HSG is a useful tubal patency screening test for all infertile couples.
authors.affiliation: Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. k.a.broeze@amc.uva.nl
authors.forename: K A
authors.initials: KA
authors.lastname: Broeze
authors.forename: B C
authors.initials: BC
authors.lastname: Opmeer
authors.forename: N
authors.initials: N
authors.lastname: Van Geloven
authors.forename: S F P J
authors.initials: SF
authors.lastname: Coppus
authors.forename: J A
authors.initials: JA
authors.lastname: Collins
authors.forename: J E
authors.initials: JE
authors.lastname: Den Hartog
authors.forename: P J Q
authors.initials: PJ
authors.lastname: Van der Linden
authors.forename: P
authors.initials: P
authors.lastname: Marianowski
authors.forename: E H Y
authors.initials: EH
authors.lastname: Ng
authors.forename: J W
authors.initials: JW
authors.lastname: Van der Steeg
authors.forename: P
authors.initials: P
authors.lastname: Steures
authors.forename: A
authors.initials: A
authors.lastname: Strandell
authors.forename: F
authors.initials: F
authors.lastname: Van der Veen
authors.forename: B W J
authors.initials: BW
authors.lastname: Mol
mesh_terms: D000328:Adult; D000367:Age Factors; D005184:Fallopian Tube Diseases / Q000000981:diagnostic imaging*; D005186:Fallopian Tube Patency Tests / Q000379:methods; D005260:Female; D006801:Humans; D007047:Hysterosalpingography / Q000379:methods*; D007247:Infertility, Female / Q000000981:diagnostic imaging; D012044:Regression Analysis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013997:Time Factors