Multimodal hysterosalpingo-contrast sonography in the assessment of fallopian tubal patency: A retrospective study

Tubal factor infertility accounts for 25-35% of female infertility cases, requiring accurate fallopian tubal patency assessment for diagnosis and treatment. Traditional hysterosalpingography (HSG) carries radiation and allergy risks, while laparoscopic chromopertubation, the gold standard, is invasive and expensive. Multimodal hysterosalpingo-contrast sonography (HyCoSy) provides a radiation-free alternative. This retrospective study at Shenzhen Maternity and Child Healthcare Hospital, a tertiary maternity hospital in southern China (January 2019-December 2024) evaluated HyCoSy's diagnostic accuracy against laparoscopy in 62 infertile women (121 tubes, including three with unilateral salpingectomy). All underwent HyCoSy followed by laparoscopy within three months. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), Kappa coefficient, and area under the curve (AUC) were calculated using laparoscopy as reference. HyCoSy identified 90 obstructed and 31 patent tubes, versus 79 obstructed and 42 patent by laparoscopy, yielding sensitivity of 98.8%, specificity of 73.2%, PPV of 87.8%, NPV of 96.8%, and AUC of 0.86 (95% CI: 0.775-0.944). Agreement was substantial (Kappa = 0.72, P < 0.001). Misdiagnoses (n=12) mainly arose from venous reflux, pelvic adhesions, uterine malposition, or pain-induced spasm. Multimodal HyCoSy demonstrates high accuracy and substantial agreement with laparoscopy, positioning it as a promising non-invasive tool for tubal patency evaluation in infertility workup..