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대한생식의학회지 제32권 제3호 2010년
불임 검사시 자궁난관 조영술의 진단 정확도
계명대학교 의과대학 산부인과학교실
박준철, ,김종인,이정호
The Accuracy of Hysterosalpingography for Evaluating Female Infertility
Joon Cheol Park, Jong In Kim, Jeong Ho Rhee
Department of Obstetrics & Gynecology, Keimyung University, School of Medicine, Daegu, Korea
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Objective: This study was performed to evaluate the accuracy of hysterosalpingography (HSG) for evaluating female infertility patients by comparison with hysteroscopic and laparoscopic examination.
Methods and Material: Total 219 infertile patients were retrospectively analyzed between January 1,2002 and December 31, 2003. Ninety seven patients (44.3%) were primary infertility, 122 patients (55.7%) were secondary infertility. We performed hysteroscopic and laparoscopic examination on next cycle when HSG revealed any abnormal finding, and 3~6 cycles later if HSG was normal.
Results: The accuracy of HSG was 65.2% compared with hysteroscopic examination (sensitivity
88.4%, specificity 46.4%, false positive rate 53.6%, false negative rate 11.6%). The most common abnormal finding of hysteroscopy was uterine synechia (67.4%) followed by endometrial polyp, uterine anomaly (e.g. uterine septum), endometrial hyperplasia. Compared with laparoscopic examination, the accuracy of HSG was 76.9% (sensitivity 98.9%, specificity 70.6%, +LR 3.36, -LR 0.02). The positive predictive value of normal patent tube was excellent (99.6%) but that of proximal tubal blockage was only 46.7%. The unilateral tubal obstruction of HSG was poor accuracy (+LR 3.85 -LR 0.68) and 70% of those was patent by laparoscopic examination. Laparoscopic examination also revealed that 53% of patients had peritubal adhesion and 37% of patients has additional pelvic findings, especially endometriosis. Among the patients had normal HSG, 53.5% patients with normal ultrasonography was diagnosed endometriosis (25.6% of them had endometriosis stage I-II).
Conclusion: Normal HSG shows a high negative predictive value. Nevertheless, the incidence of associated pelvic disease in the normal HSG group is high enough to warrant diagnostic laparoscopy if nonsurgical treatment is unsuccessful. Because HSG has poor accuracy in predicting distal tubal blockage and peritubal adhesion, and poor positive predictive value of proximal tubal blockage, laparoscopic examination could be considered in abnormal HSG group.
키워드 : Hysterosalpingography, Infertility, Hysteroscopy, Laparoscopy
교신저자 : jcpark@dsmc.or.kr
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