AAGL 2013: Hysteroscopic Chromopertubation for Assessing Tubal Patency?
Chromopertubation is typically performed laparoscopically. However, hysteroscopic chromopertubation may spare patients from multiple procedures. But is it accurate?
Chromopertubation, or instilling dye through the fallopian tubes to assess tubal patency, is a common part of laparoscopy performed for diagnostic or therapeutic purposes in women with infertility.
According to new research presented last month at the 42nd Global Congress on Minimally Invasive Gynecology, hysteroscopic chromopertubation may be an alternative to performing the procedure laparoscopically. The benefit to patients: When chromopertubation is performed via office hysteroscopy, it allows for concomitant evaluation of the endometrial cavity without subjecting the patient to multiple procedures.
Anna Lyapis, MD, Danielle Luciano, MD, and Anthony Luciano, MD, of The Hospital of Central Connecticut, New Britain, performed chromopertubation during hysteroscopy by injecting 10cc of diluted indigo carmine solution (5cc in 100cc 0.9% normal saline) in each fallopian tube through a 5.0 French selective salpingography catheter inserted into the tubal ostia.
If blue fluid flowed easily into the tube, the tube was considered patent. If the dye flowed back into the endometrial cavity, the tube was considered blocked. To confirm their hysteroscopic findings, the physicians then performed laparoscopic chromopertubation with installation of the dye through the uterine manipulator. Patients underwent the procedures for management of infertility, symptomatic endometriosis, leiomyomas, or pelvic adhesions.
A total of 54 women aged 19 to 44 years underwent both procedures, and 108 fallopian tubes were evaluated. Of 108 tubes, 9 tubes were not visualized by hysteroscopy, and 99 tubes were assessed using both hysteroscopic and laparoscopic chromopertubation.
The hysteroscopic findings were concordant with the laparoscopic findings in 82 cases of patent tubes and 9 cases of blocked tubes. In 3 cases, the tubes were designated blocked on hysteroscopy but were patent on laparoscopy. Conversely, the tubes appeared patent on hysteroscopy but were blocked on laparoscopy in 5 cases.
Overall, the sensitivity and specificity of hysteroscopic chromopertubation were 64.3% and 96.5%, respectively. In addition, the positive and negative predictive values were 75% and 94.3%, respectively.
Hysteroscopic chromopertubation has poor sensitivity, but it is a highly specific method of determining tubal patency, concluded the physicians. Currently, this procedure is not recommended as the method of choice for evaluation of tubal status.
