A 28-year-old woman presents with infertility. Hysterosalpingography (HSG) shows a classical 'golf club' or 'pipe stem' appearance of the fallopian tube with multiple constrictions. Endometrial biopsy shows epithelioid granulomas on Histopathology. Mantoux test is 18 mm. Which investigation has the HIGHEST sensitivity for confirming active genital tuberculosis in this setting?
- A Endometrial culture on Lowenstein-Jensen medium (LJ medium)
- B Nucleic acid amplification test (NAAT/GeneXpert) on endometrial aspirate ✓
- C Serum adenosine deaminase (ADA) levels
- D Laparoscopy with peritoneal biopsy for acid-fast bacilli
Correct answer: B. Nucleic acid amplification test (NAAT/GeneXpert) on endometrial aspirate
Explanation
GeneXpert MTB/RIF (NAAT) applied to endometrial aspirate has the highest sensitivity (approximately 80–90%) among rapid diagnostic tests for endometrial tuberculosis and simultaneously detects rifampicin resistance. Culture on LJ medium remains the gold standard but takes 4–8 weeks. ADA is a non-specific marker for TB overall. Laparoscopy with biopsy is invasive and provides histological confirmation but not necessarily higher microbiological sensitivity than NAAT on a proper specimen. NAAT is now the recommended first-line diagnostic tool per NTEP guidelines.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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