Role of Diagnostic Laparoscopy and Hysteroscopy in Predicting Genital Tuberculosis - A Systematic Review.

Abstract

Genital tuberculosis (female genital tuberculosis [FGTB]) continues to be an essential underdiagnosed cause of infertility and reproductive morbidity, most significantly in resource-limited settings. Diagnostic laparoscopy and hysteroscopy have become crucial for assessing suspected FGTB cases, mainly when supported by molecular and histopathological tests. This systematic review has evaluated these modalities' diagnostic utility, sensitivity, specificity, and clinical outcomes for predicting FGTB. A comprehensive systematic review was performed with the help of the PECOS framework and PRISMA guidelines. Studies were identified by running Boolean operators and MeSH terms on seven databases: PubMed, Embase, Scopus, Web of Science, Cochrane Library, CINAHL, and Google Scholar. Cohort and cross-sectional designs were considered, focusing on clinically relevant outcomes such as sensitivity, specificity, prevalence, and procedural findings obtained from diagnostic laparoscopy and hysteroscopy. Data extraction was done using a standardized template, and bias was assessed using ROBINS-I and AXIS tools. The certainty of evidence was evaluated using the GRADE framework, and sensitivity analyses were performed to assess the robustness of the findings. Thirteen studies involving 2201 participants were included in the review. Tubal beading, adhesions, and hydrosalpinx were the constant findings of diagnostic laparoscopy, with sensitivities and specificities varying between 33% and 85.71% and 22.8% and 100%, respectively. Hysteroscopy revealed intrauterine fibrosis in up to 48.48% of cases. Adhesions and synechiae were seen in 46% and 18%, respectively. Molecular diagnostics GeneXpert and tuberculosis-polymerase chain reaction (TB-PCR) showed high sensitivity (up to 100%) and varied specificity (33% to 100%). The prevalence of FGTB ranged from 6.73% to 45%, with conception rates improved by 39% postantitubercular therapy. Sensitivity analyses revealed lower heterogeneity (I² <40%) in studies applying combined diagnostic modalities compared to single-method approaches. This systematic review showed that integrating diagnostic laparoscopy and hysteroscopy with molecular tools such as GeneXpert and TB-PCR improves the predictive and therapeutic approach to FGTB. These modalities effectively identify structural abnormalities and correlate the findings with molecular and histopathological results. Standardized protocols and more extensive multicenter studies will be required to reduce heterogeneity and further refine diagnostic accuracy.