Efficacy of hysterosalpingography in evaluating endometriosis

Endometriosis is a common disease in young women being evaluated for infertility. Although endometriosis may cause tubal abnormalities on hysterosalpingography, efficacy of radiographic evaluation in this disease is not clear. We reviewed the radiographic and laparoscopic examinations in 50 women being studied for infertility. Laparoscopy was normal in 15 women and showed endometriosis in 35 patients. Endometriosis was staged at laparoscopy using the classification of the American Fertility Society. Radiographic examinations were reviewed blindly and tubal status noted in each patient. Criteria for tubal abnormality included incomplete or absent filling and ampullary dilatation or convolution. Radiographic efficacy was determined by correlating the tubal appearance to the severity and location of endometriosis. A total of 98 tubes were correlated but only 10 (10%) were felt to be involved by endometriosis based on laparoscopic findings. Radiologic sensitivity was 40% (4 of 10) and specificity was 83% (73 of 88). Positive predictive value was 21% (4 of 19) due to 15 false-positive diagnoses in tubes uninvolved by endometriosis. In conclusion, endometriosis, regardless of its severity, rarely causes radiographic abnormalities on hysterosalpingography because of the location of disease in the pelvis.