Center for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Hum Reprod Update. 2011 May-Jun;17(3):293-300. doi: 10.1093/humupd/dmq056. Epub 2010 Dec 8.
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.
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.
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.
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.
传统的荟萃分析估计子宫输卵管造影术（HSG）的灵敏度和特异度分别为 65%和 83%。患者特征对 HSG 准确性的影响尚不清楚。本研究的目的是通过个体患者数据荟萃分析评估 HSG 的准确性是否与不同的患者特征相关。
我们联系了报告 HSG 准确性的主要研究的作者，这些研究以腹腔镜检查结果作为参考。我们使用随机截距逻辑回归模型评估了患者特征（如女性年龄、不孕持续时间和无输卵管病变危险因素的临床病史）与 HSG 准确性的相关性。
我们获得了来自 7 项主要研究的数据，其中包含了 4521 名女性的数据。HSG 对任何输卵管病变的总体敏感性和特异性分别为 53%和 87%，对双侧输卵管病变的总体敏感性和特异性分别为 46%和 95%。在无危险因素的女性中，HSG 对任何输卵管病变的敏感性为 38%，而有危险因素的女性为 61%（P=0.005）。对于双侧输卵管病变，这些比率分别为 13%和 47%（P=0.01）。对于双侧输卵管病变，HSG 的敏感性随年龄增加而降低[每年下降 0.93（P=0.05）]。HSG 的特异性在所有亚组中均非常稳定。
除了无危险因素的女性，HSG 对检测输卵管病变的准确性在所有亚组中均相似，这些女性的敏感性较低，可能是由于腹腔镜检查的假阳性结果。HSG 是所有不孕夫妇有用的输卵管通畅性筛查试验。
