Meta-analysis Of Diagnostic Value Of Four-dimensional Hysterosalpingography For Tubal Patency

Objective Meta-analysis was used to evaluate the accuracy and safety of4D-HyCoSy in diagnosing tubal patency.It provides theoretical support for the clinical application of 4D-HyCoSy in the clinical diagnosis of tubal infertility.Method The databases of China National Knowledge Infrastructure(CNKI),Wanfang Database,China Biomedical Literature Database(CBM),Weip Database,Embase,PubMed,PubMed,Web of Science,Elsevier Science Direct were searched for records.Meanwhile,related magazines and search engines were manually searched up to March 2020.Related researches on 4D-HyCoSy in evaluating tubal patency were collected.Inclusive criteria: patients' inclusive criteria:(1)Meet female infertility diagnosis;(2)Comply with the inspection standards of 4D-HyCoSy and laparoscopy.Literature inclusive criteria:(1)Chinese or English literature;(2)All included subjects only passed 4D-HyCoSy examination;(3)The gold standard for assessing tubal patency was laparoscopic fluid drainage.The number of cases of each document that passed the gold standard examination was not less than 35;(4)The original data of the test could be obtained directly or indirectly,such as the number of true positives(true-positive,TP),the number of true negatives(true-negative,TN),the number of false positives(false-positive,FP)and false negative number(false-negative,FN),etc.Literature exclusive criteria:(1)Literatures that did not use laparoscopic fluid drainage as the "gold standard";(2)Documents that were determined to be duplicates;(3)The literature used modified 4D-HyCoSy inspection or other inspection methods at the same time;(4)Documents that could not obtain detailed diagnostic research programs and original data,such as reviews,meta-analysis,reviews,conference papers,case report analysis,etc;(5)Literature research data was incomplete or missing,and could not be obtained by contacting the original author Literature.Meta-Disc 1.4 software and RevMan 5.3 software were used to perform a meta-analysis on the data and literature.Result A total of 21 literatures were included in the study,and a total of 1708 samples were included,including analysis of 3349 tubal patency.Meta analysis results showed that the sensitivity of 4D-HyCoSy in the diagnosis of tubal patency was 0.92(95% CI,0.91-0.93),P<0.001,specificity=0.90(95% CI,0.89-0.92),P=0.0035,positive likelihood ratio=8.66(95% CI,6.98-10.75),P=0.0191,negativelikelihood ratio=0.10(95% CI,0.07-0.13),P<0.001,area under the SROC curve AUC=0.9616,SE(AUC=0.0058),Q Index=0.9069.At the same time,the reasons for the misdiagnosis and adverse reactions(pain,vagal reflex,etc.)in the 4D-HyCoSy examination included in the study were summarized and analyzed.The results showed that the main causes of the misdiagnosis were tubal spasm,contrast agent diffusion,pelvic adhesions,and imaging improper operation;All patients included in the study did not have serious adverse reactions.Conclusion 4D-HyCoSy has the advantages of good sensitivity and high specificity for diagnosing the fallopian tube patency,and has higher safety,and the patient is easier to accept and tolerate,so this test has high clinical diagnostic value.