Comparison of diagnostic efficacy of USG, Tuberculin test, Nucleic acid amplification test (PCR) & histopathology for diagnosis of genital tuberculosis in infertile women, assuming culture as gold standard
Abstract
Female genital tuberculosis is one of the major etiological factors of female infertility. Diagnosis of genital tuberculosis is very important in such cases. So this comparative observational type of study was carried out on infertile women to compare the diagnostic effectively of ultrasonograpgy (USG), genital tuberculosis, Tuberculin test, Nucleic acid amplification test (PCR), histopathology and hysteroscopy & laparoscopy (DHL) assuming culture as gold standard. It was observed that the 28% of infertile cases were found positive for genital tuberculosis on culture. Sensitivity of PCR 64.28%, DHL 92.85%, USG 42.85%, Histopathology 60.71% and Tuberculin Test 64.28%. So sensitivity was found with significant variation ranging from 42.85% with ultrasonography (USG) to 92.85% with DHL. Specificity of PCR 52.77%, DHL 55.55%, USG 98.61%, Histopathology 91.66% and Tuberculin Test 36.11%. So specificity was also found with significant variation being found maximum with USG (98.61%) and minimum with tuberculin test (36.11%). Positive predictive value (PPV) was found maximum (92.3%) with USG and minimum (28.12%) with tuberculin test and negative predictive value (NPV) was found maximum (95.23%) with DHL and minimum (72.22%) with tuberculin test. Diagnostic effectively of diagnosing GTB with various studied modalities vary with significant variation.
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Introduction
Infertility is defined as inability of a couple to conceive even after 1 year of unprotected and regular intercourse.1 Various Indian studies have shown that tuberculosis endometritis and salpingitis account for 4-9 per cent of all infertility cases.2 Female genital tuberculosis is 10-15 times more common in developing countries.3 Prevalence of genital tuberculosis worldwide is between 5% and 10%, while in India it is 19%.4
Female genital tuberculosis is one of the major etiological factors of female infertility. It has been estimated that approximately 5 – 10 % of females presenting to subfertility clinics worldwide have genital TB.5 Prevalence of genital tuberculosis is much higher than one might imagine, as based on lack of report available in the literature, it may account for significant amount of female infertility.6 Genital TB may be asymptomatic and diagnosis requires a high index of suspicion.
Conclusion
It can be concluded from this present study that endoscopic evaluation is undoubtedly a very valuable tool in diagnosis of genital TB. Routine application of nucleic acid amplification test and culture in addition to clinical and endoscopic evaluation carries a great potential in improving diagnosis of genital TB especially in countries where TB is endemic.
The 28% of infertile cases were found positive for genital tuberculosis on culture. 84% cases were positive on DHL, 52% cases were positive by PCR, 64% cases positive on Tuberculin test, 23% cases were positive on histopathologically and 13% cases were positive by ultrasonography in this study. Sensitivity and specificity of PCR 64.28% and 52.77%, DHL 92.85 and 55.55%, USG 42.85% and 98.61%, Histopathology 60.71% and 91.66% and Tuberculin Test 64.28% and 36.11% respectively.