Interobserver Variability in Hysterosalpingography Interpretation: Radiologists vs Gynecologists

Ceyda Karadag,1 Cemil Gurses,2 Adnan Kabaalioglu,3 Bengi Gurses,3 İsmail Güzelmansur,4 Turgay Daplan,4 Arzu Turan,5 Hakan Artas,6 Sadan Tutus,7 Safak Olgan,8 İlknur Col Madendag,7 Ahmet Demir,9 Sezcan Mumusoglu,10 Yunus Aydin,11 Emre Goksan Pabuccu12 1Department of Obstetrics and Gynecology, Antalya City Hospital, Antalya, Turkey; 2Department of Radiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey; 3Department of Radiology, Koç University Faculty of Medicine, Istanbul, Turkey; 4Department of Radiology, Hatay State Hospital, Hatay, Turkey; 5Department of Radiology, Acıbadem Bodrum Hospital, Bodrum, Turkey; 6Department of Radiology, Firat University Faculty of Medicine, Elazig, Turkey; 7Department of Radiology, University of Health Sciences Kayseri Training and Research Hospital, Kayseri, Turkey; 8Department of Obstetrics and Gynecology, Memorial Antalya Hospital, Antalya, Turkey; 9Department of Radiology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey; 10Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey; 11Department of IVF, Private Health Hospital, Denizli, Turkey; 12Department of Obstetrics and Gynecology, Ufuk University Faculty of Medicine, Ankara, TurkeyCorrespondence: Ceyda Karadag, Department of Obstetrics and Gynecology, Antalya City Hospital, Dumlupınar Bulvarı, Antalya, 07070, Turkey, Tel +905345942264, Email [email protected]: To evaluate interobserver variability in the interpretation of hysterosalpingography (HSG) examinations among radiologists, gynecologists, and between the two specialties, highlighting areas of diagnostic agreement and discrepancy.Materials and Methods: In this prospective, multicenter study, 12 specialists (6 radiologists and 6 gynecologists) independently reviewed HSG images from 100 patients, evaluating 10 predefined diagnostic categories and overall image quality. Fleiss’ kappa (κ) was used to assess interobserver agreement within and between groups.Results: Interobserver agreement ranged from poor to moderate across most diagnostic categories. The highest agreement was observed for tubal occlusion (κ = 0.508 radiologists vs gynecologists; κ = 0.536 among radiologists; κ = 0.460 among gynecologists), followed by uterine anomalies and hydrosalpinx. Poor agreement was noted for subjective parameters such as image quality and additional findings (κ values < 0.1), with some negative kappa scores indicating agreement below chance.Conclusion: Significant interobserver variability exists in HSG interpretation, particularly between radiologists and gynecologists. Structured findings yielded higher agreement, while subjective assessments showed poor reproducibility. These findings underscore the need for standardized reporting guidelines, interdisciplinary collaboration, and the potential integration of AI-assisted interpretation to enhance diagnostic consistency and improve patient outcomes.Keywords: hysterosalpingography, interobserver variability, radiologists, gynecologists, infertility, diagnostic imaging, Fleiss’ kappa, standardization, artificial intelligence