ASSESSMENT OF THE DIAGNOSTIC ACCURACY OF ENDOMETRIAL BIOPSY AND PCR IN SUSPECTED CASES OF FEMALE GENITAL TUBERCULOSIS

Abstract

Female genital tuberculosis (FGTB) is a significant but often underdiagnosed cause of infertility and chronic pelvic morbidity, particularly in developing countries. Conventional diagnostic methods, such as histopathology, often suffer from low sensitivity due to the paucibacillary nature of the disease. This study aimed to assess the diagnostic accuracy of endometrial biopsy (histopathology) and polymerase chain reaction (PCR) in the detection of FGTB, using a composite reference standard (CRS) as the benchmark.

Methods:
This cross-sectional study was conducted at Jinnah Post Graduate Medical Center Karachi for a period of six months from February, 2024 to July, 2024, and included 80 women presenting with symptoms suggestive of FGTB, such as infertility, abnormal uterine bleeding, chronic pelvic pain, or amenorrhea. Endometrial samples were collected during the secretory phase and processed for histopathological examination and PCR targeting the IS6110 sequence specific to Mycobacterium tuberculosis. The chi-square test and Fisher's exact test were applied, and p ≤ 0.05 is considered significant.

Results:
Histopathology demonstrated a sensitivity of 11.5%, specificity of 92.9%, PPV of 75.0%, and diagnostic accuracy of 40.0%. In contrast, PCR showed significantly higher sensitivity (80.8%), specificity (78.6%), PPV (87.5%), NPV (68.8%), and diagnostic accuracy of 80.0%. A statistically significant association was found between PCR and CRS diagnosis (p < 0.001), while histopathology showed no significant association (p = 0.531).

Conclusion:
PCR markedly improves the diagnostic yield of FGTB compared to histopathology and should be incorporated into routine diagnostic algorithms, particularly in high-risk and symptomatic populations.