Comparison of cow-side diagnostic techniques for subclinical endometritis in dairy cows

A limited number of cow-side diagnostic techniques exist for the diagnosis of subclinical endometritis (SCE) in dairy cattle. The objectives of this study were to compare results of endometrial cytology from samples collected by cytobrush (CB) and low-volume lavage (LVL) and to assess leukocyte esterase (LE) test strips and Brix refractometry as surrogate cow-side tests for SCE. Two samples were consecutively collected from 248 Holstein cows between 29 and 35 days postpartum, using CB and LVL techniques. Each sample was analyzed using cytology with a cut-point of ≥5% polymorphonuclear (PMN) cells, LE strips using cut-points of ≥1 and ≥ 2, and a Brix refractometer. Each diagnostic technique was compared intra-sample using the respective cytology as a gold standard and inter-sample using CB samples as the referent. The concordance correlation coefficient (CCC, ρ_c) for PMN% between CB and LVL was ρ_c = 0.59 [95% confidence interval (CI): 0.50 to 0.67] and the Kappa (κ) for agreement was κ = 0.35 [sensitivity (Se) = 0.88, specificity (Sp) = 0.45]. The optimal cut-point of LE ≥ 2 resulted in moderate agreement between CB and LVL samples, κ = 0.56 (Se = 0.89, Sp = 0.65). Agreement between LE and cytology using CB (κ = 0.49; Se = 0.89, Sp = 0.57) and LVL (κ = 0.44; Se = 0.77, Sp = 0.67) were similar. The correlation between Brix values from CB and LVL was ρ_c = 0.12 (CI -0.01 to 0.26). The correlation between CB cytology and Brix was ρ_c = 0.33 (CI 0.20 to 0.45) but ρ_c = -0.07 (CI -0.21 to 0.06) between LVL cytology and Brix. While LE strips with a cut-point of LE ≥ 2 had moderate agreement with cytology, Brix refractometry had poor performance for the diagnosis of SCE. Samples taken by CB and LVL produced comparable cow-side diagnostic results and either is a viable method for the diagnosis of SCE.