ABSTRACT
Background & objectives: Female genital tuberculosis (FGTB) is an important variety of extrapulmonary TB causing significant morbidity, especially infertility, in developing countries like India. The aim of this study was to evaluate the laparoscopic findings of the FGTB. Methods: This was a cross-sectional study on 374 cases of diagnostic laparoscopy performed on FGTB cases with infertility. All patients underwent history taking and clinical examination and endometrial sampling/biopsy for acid-fast bacilli, microscopy, culture, PCR, GeneXpert (only last 167 cases) and histopathological evidence of epithelioid granuloma. Diagnostic laparoscopy was performed in all the cases to evaluate the findings of FGTB. Results: Mean age, parity, body mass index and duration of infertility were 27.5 yr, 0.29, 22.6 kg/m2 and 3.78 years, respectively. Primary infertility was found in 81 per cent and secondary infertility in 18.18 per cent of cases. Endometrial biopsy was positive for AFB microscopy in 4.8 per cent, culture in 6.4 per cent and epithelioid granuloma in 15.5 per cent. Positive peritoneal biopsy granuloma was seen in 5.88 per cent, PCR in 314 (83.95%) and GeneXpert in 31 (18.56%, out of last 167 cases) cases. Definite findings of FGTB were seen in 164 (43.86%) cases with beaded tubes (12.29%), tubercles (32.88%) and caseous nodules (14.96%). Probable findings of FGTB were seen in 210 (56.14%) cases with pelvic adhesions (23.52%), perihepatic adhesions (47.86%), shaggy areas (11.7%), pelvic adhesions (11.71%), encysted ascites (10.42%) and frozen pelvis in 3.7 per cent of cases. Interpretation & conclusions: The finding of this study suggests that laparoscopy is a useful modality to diagnose FGTB with a higher pickup rate of cases. Hence it should be included as a part of composite reference standard.
ABSTRACT
Background@#Pelvic ultrasonography is currently not recommended as a screening tool for endometrial cancer, particularly in asymptomatic women; however, its use for other indications such as pelvic masses has led to incidental findings of thickened endometrium in post menopausal women. @*Objectives@#The aim of the study is to evaluate the clinical utility of endometrial ultrasound in asymptomatic Filipino postmenopausal women and to provide a threshold for invasive endometrial sampling.@*Methodology@#A cohort of postmenopausal women (aged ?50 years) who underwent pelvic ultrasonography at a tertiary hospital for indications other than vaginal bleeding was retrospectively evaluated. Women were included if they had an endometrial lining of at least 5 mm and had an endometrial biopsy. Receiver operating characteristic (ROC) analysis was used to determine the endometrial thickness threshold for which endometrial thickness is able to correctly differentiate benign endometrial pathology from endometrial hyperplasia and carcinoma.@*Results@#Out of 90 women included in the study, carcinoma was identified in 3 (3.33%) and hyperplasia was noted in 4 (4.44%). The most common histopathology noted was: endometrial polyp (35.56%), atrophic endometrium (30%) and benign endometrial tissues (18.98%). The calculated area under ROC curve was 54.39% (95% CI 34.38-79.41%), which indicates the inability of endometrial thickness to differentiate benign endometrium from endometrial carcinoma or hyperplasia in asymptomatic women with an incidentally found thickened endometrium. @*Conclusion@#Based on the results of the study, endometrial thickness alone cannot be used as basis for deciding whether to perform endometrial sampling, there is no endometrial thickness threshold for which the endometrial hyperplasia and carcinoma can be correctly identified. The decision to perform an endometrial biopsy should be done on a case to case basis. In the absence of a high index of suspicion for endometrial hyperplasia and carcinoma even in the presence of thickened endometrium, endometrial sampling is unnecessary.
Subject(s)
Endometrial Neoplasms , Endometrial Hyperplasia , Incidental FindingsABSTRACT
Objective To probe into the diagnostic accuracy of endometrial sampling device in the detection of endometrial lesions by cytology. Methods Endometrial cytological examination was performed on totally 193 out-patients from January to May 2008,the results were compared with the histological results by diagnostic curettage (D&C). Results The sampling qualified rate of endometrial sampling device was 93.8% (181/193) while that of D&C was 99.0% (191/193,?2=7.412,P=0.006). Thirteen patients were diagnosed with endometrial malignant lesions by D&C. In these patients,the sensitivity and specificity of cytology was 69.2% (9/13) and 100.0% (166/166),respectively;and its accuracy rate was 97.8% (175/179). By D&C 18 patients were diagnosed with endometrial hyperplasia,in whom the sensitivity and specificity of cytology was 27.8% (5/18) and 98.8% (159/161),respectively,and the accuracy rate was 91.6% (164/179). Ten patients were confirmed as having endometrial benign lesions without hyperplasia by D&C,for whom the sensitivity and specificity of cytology was 60.0% (6/10) and 98.8% (167/169) respectively,and the accuracy rate was 96.6% (173/179). The accuracy rate of endometrial cytological examination for 80 infertility patients with satisfactory sample was 100%,when the main objective was to determine whether the endometrial gland secreted or not. Conclusion Cytological examination by endometrial sampling device is feasible in the detection of endometrial malignant lesions and inspection of endometrium for infertility patients,but further discussion is necessary in the detection of endometrial benign lesions.
ABSTRACT
This study was designed to compare the level of pain of patients during endometrial sampling, using a menstrual regulator and a standard uterine curette. A randomized single-blind clinical trial was conducted on eighty women who had abnormal uterine bleeding and needed diagnostic fractional curettage at the Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital. They were randomly assigned to two groups. The uterine curettage was performed using a menstrual regulator in the first group and a standard curette in the second group. The pain scores before, during and after the curettage procedure were determined by a visual analogue scale. The time for the procedure was observed and the tissue was sent for pathological evaluation. The median pain scores during and 30 minutes after the procedure were lower in the menstrual regulator group compared to those in the standard curette group (p<0.05). The time in the menstrual regulator group was shorter (p<0.05) and the quality of tissue for diagnosis was better (p<0.05) than in the standard curette group. No serious complications were observed between both groups. Using a menstrual regulator for endometrial sampling can significantly reduce the pain, is easier to perform and yields better tissue tissue quality compared to the standard curette.