Accuracy of five different diagnostic techniques in mild-to-moderate pelvic inflammatory disease.
OBJECTIVE
To evaluate the clinical diagnosis of pelvic inflammatory disease (PID) compared with the diagnosis of PID made by laparoscopy, endometrial biopsy, transvaginal ultrasound, and cervical and endometrial cultures.


METHODS
A diagnostic performance test study was carried out by cross-sectional analysis in 61 women. A group presenting PID (n = 31) was compared with a group (n = 30) presenting another cause for non-specific lower abdominal pain (NSLAP). Diagnosis provided by an evaluated method was compared with a standard diagnosis (by surgical findings, histopathology, and microbiology). The pathologist was unaware of the visual findings and presumptive diagnoses given by other methods.


RESULTS
All clinical and laboratory PID criteria showed low discrimination capacity. Adnexal tenderness showed the greatest sensitivity. Clinical diagnosis had 87% sensitivity, while laparoscopy had 81% sensitivity and 100% specificity; transvaginal ultrasound had 30% sensitivity and 67% specificity; and endometrial culture had 83% sensitivity and 26% specificity.


CONCLUSIONS
Clinical criteria represent the best diagnostic method for discriminating PID. Laparoscopy showed the best specificity and is thus useful in those cases having an atypical clinical course for discarding abdominal pain when caused by another factor. The other diagnostic methods might have limited use.
Gaitán
Hernando
H
Obstetrics and Gynecology Department, Universidad Nacional de Columbia, Bogotá, Columbia. hggaitin@cable.net.co
Angel
Edith
E
Diaz
Rodrigo
R
Parada
Arturo
A
Sanchez
Lilia
L
Vargas
Cara
C
D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D001706:Biopsy / Q000592:standards; D002584:Cervix Uteri / Q000382:microbiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000592:standards*; D004717:Endometrium / Q000382:microbiology; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000592:standards; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D000292:Pelvic Inflammatory Disease / Q000150:complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000592:standards; D014621:Vagina