U N Jindal1, Y Bala, S Sodhi, S Verma, S Jindal. 1. Gynae and Fertility Research Centre, Jindal In-Vitro Fertilisation and Sant Memorial Hospital, Chandigarh, India. skjindal@ indiachest.org
Abstract
OBJECTIVE: To evaluate the efficacy of laparoscopic visual inspection vs. endometrial tuberculosis (TB) polymerase chain reaction (PCR) for an early diagnosis and management of female genital TB (GTB) in India. DESIGN: Observational case study. RESULTS: Both laparoscopy and endometrial (endo) TB-PCR were performed on 162 infertile women: 52 endo TB-PCR-positive patients were diagnosed as definite GTB, of whom 44 (84.6%) also showed laparoscopic findings suspicious of TB (Type I). Subgroup analysis showed a similar PCR positivity of 54.5% (24/44) in the strongly suspicious and 54.1% (20/37) in the mildly suspicious patients. Using the Bayesian approach, the maximum likelihood estimates of the sensitivity and specificity of laparoscopy in diagnosing GTB were 0.96 and 0.93 and those of a positive PCR were respectively 0.59 and 0.92. Of the 52 women who were TB-PCR positive, 16 (30.8%) conceived following treatment. CONCLUSIONS: Endo TB-PCR had high specificity to diagnose GTB, as did laparoscopy. Laparoscopy may therefore be avoided in TB-PCR-positive patients for diagnosis but may still be required to rule out GTB in PCR-negative cases.
OBJECTIVE: To evaluate the efficacy of laparoscopic visual inspection vs. endometrial tuberculosis (TB) polymerase chain reaction (PCR) for an early diagnosis and management of female genital TB (GTB) in India. DESIGN: Observational case study. RESULTS: Both laparoscopy and endometrial (endo) TB-PCR were performed on 162 infertile women: 52 endo TB-PCR-positive patients were diagnosed as definite GTB, of whom 44 (84.6%) also showed laparoscopic findings suspicious of TB (Type I). Subgroup analysis showed a similar PCR positivity of 54.5% (24/44) in the strongly suspicious and 54.1% (20/37) in the mildly suspicious patients. Using the Bayesian approach, the maximum likelihood estimates of the sensitivity and specificity of laparoscopy in diagnosing GTB were 0.96 and 0.93 and those of a positive PCR were respectively 0.59 and 0.92. Of the 52 women who were TB-PCR positive, 16 (30.8%) conceived following treatment. CONCLUSIONS: Endo TB-PCR had high specificity to diagnose GTB, as did laparoscopy. Laparoscopy may therefore be avoided in TB-PCR-positive patients for diagnosis but may still be required to rule out GTB in PCR-negative cases.
Authors: M M Sankar; P Kumar; A Munawwar; M Kumar; J Singh; A Singh; D Parashar; N Malhotra; S Duttagupta; S Singh Journal: Eur J Clin Microbiol Infect Dis Date: 2012-09-30 Impact factor: 3.267