Diagnostic Implications of Bronchial Lavage in Patients with Pleural Tuberculosis

Sumalani, Kamran Khan; Akhter, Nousheen; Ahmed, Maqbool; Chawla, Dimple; Rizvi, Nadeem

doi:10.5603/arm.a2020.0149

Cited by 4 publications

(5 citation statements)

References 11 publications

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“…One (1.4%) study was conducted exclusively in HIV seropositive patients [ 43 ], while seven (9.5%) others included a variable number of such subjects [ 37 , 38 , 42 , 44 , 53 , 70 , 89 ]. There were no HIV seropositive patients in thirteen (17.6%) publications [ 30 , 47 , 63 , 73 , 74 , 76 , 78 , 79 , 83 , 84 , 88 , 92 , 96 ], while the remaining did not provide any information. Ten investigators thawed cryopreserved fluid samples for their tests [ 23 , 31 , 35 , 42 , 60 , 66 , 73 , 78 , 80 , 84 ].…”

Section: Resultsmentioning

confidence: 99%

Xpert MTB/RIF Ultra versus Xpert MTB/RIF for diagnosis of tuberculous pleural effusion: A systematic review and comparative meta-analysis

et al. 2022

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Objective We compared diagnostic accuracy of pleural fluid Xpert MTB/RIF (Xpert) and Xpert MTB/RIF Ultra (Ultra) assays for diagnosing tuberculous pleural effusion (TPE), through systematic review and comparative meta-analysis. Methods We searched PubMed and Embase databases for publications reporting diagnostic accuracy of Xpert or Ultra for TPE. We used bivariate random-effects modeling to summarize diagnostic accuracy information from individual studies using either mycobacterial culture or composite criteria as reference standard. We performed meta-regression through hierarchical summary receiver operating characteristic (HSROC) modeling to evaluate comparative performance of the two tests from studies reporting diagnostic accuracy of both in the same study population. Results We retrieved 1097 publications, and included 74 for review. Summary estimates for sensitivity and specificity for Xpert were 0.52 (95% CI 0.43–0.60, I2 82.1%) and 0.99 (95% CI 0.97–0.99, I2 85.1%), respectively, using culture-based reference standard; and 0.21 (95% CI 0.17–0.26, I2 81.5%) and 1.00 (95% CI 0.99–1.00, I2 37.6%), respectively, using composite reference standard. Summary estimates for sensitivity and specificity for Ultra were 0.68 (95% CI 0.55–0.79, I2 80.0%) and 0.97 (95% CI 0.97–0.99, I2 92.1%), respectively, using culture-based reference standard; and 0.47 (95% CI 0.40–0.55, I2 64.1%) and 0.98 (95% CI 0.95–0.99, I2 54.8%), respectively, using composite reference standard. HSROC meta-regression yielded relative diagnostic odds ratio of 1.28 (95% CI 0.65–2.50) and 1.80 (95% CI 0.41–7.84) respectively in favor of Ultra, using culture and composite criteria as reference standard. Conclusion Ultra provides superior diagnostic accuracy over Xpert for diagnosing TPE, mainly because of its higher sensitivity.

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Section: Resultsmentioning

confidence: 99%

Xpert MTB/RIF Ultra versus Xpert MTB/RIF for diagnosis of tuberculous pleural effusion: A systematic review and comparative meta-analysis

et al. 2022

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“…Finally, 18 articles were included for meta‐analysis. 5 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 …”

Section: Resultsmentioning

confidence: 99%

Accuracy of Xpert MTB/RIF assay for the diagnosis of tuberculous pleural effusion

Qiu

Chen

et al. 2021

Clinical Laboratory Analysis

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Background Tuberculosis poses a severe threat to human health. At present, compared with the traditional diagnostic methods for tuberculosis pleural effusion, such as Löwenstein–Jensen culture, pleural biopsy, and Ziehl–Neelsen smear microscopy, Xpert MTB/RIF was regarded as an emerging technology for its efficiency. The Xpert MTB/RIF accuracy for tuberculous pleural effusion diagnosis was evaluated in this systematic study. Materials and methods We searched the relevant literature published before January 2021 in PubMed, Cochrane, EMBASE, and Web of Science databases. Utilizing Review Manager 5.3 software, the quality of the included literature was evaluated based on the Quality Assessment of Diagnostic Accuracy Studies criteria. Sensitivity, specificity, and the summary receiver operating characteristic curves were plotted and analyzed with Metadisc 1.40 software. We used Stata 12.0 software to evaluate the publication bias of this study. Results Eighteen articles were identified in total. The sensitivity of Xpert MTB/RIF in the pleural effusion was 0.24, and specificity was 1.00, respectively. The area under the summary receiver operating characteristic curve was 0.9737, which indicated that the overall accuracy of the Xpert MTB/RIF was high. In addition, based on the Deeks funnel plot, no publication bias of the study was found. Conclusion Xpert MTB/RIF is a rapid method with high specificity but relatively low sensitivity for detecting Mycobacterium tuberculosis in pleural effusion. Its less sensitivity made it difficult to be used clinically, but the high specificity suggests that it can be used as a specific diagnostic method for tuberculous pleural effusion.

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“…The comparison of AFB positivity showed that bronchial aspirate/bronchoalveolar lavage produced the highest diagnostic yield (51.5%) as compared to endobronchial biopsy (37.3%), transbronchial lung biopsy (45.5%), and transbronchial needle aspiration (33%) (26). For patients with pleural TB, where it is difficult to obtain sputum even after induction in some patients, bronchial lavage AFB smear, culture, and the Xpert assay were positive in 9.5, 17.9, and 26.2% patients, respectively (27). Bronchial lavage provided an immediate diagnosis in 22 (26.2%) patients (27).…”

Section: Discussionmentioning

confidence: 98%

“…For patients with pleural TB, where it is difficult to obtain sputum even after induction in some patients, bronchial lavage AFB smear, culture, and the Xpert assay were positive in 9.5, 17.9, and 26.2% patients, respectively (27). Bronchial lavage provided an immediate diagnosis in 22 (26.2%) patients (27). Bronchial lavage, although not a surrogate to pleural biopsy, offers an additional approach to the early diagnosis of pleural TB in patients unable to produce sputum.…”

Section: Discussionmentioning

confidence: 99%

“…Bronchial lavage, although not a surrogate to pleural biopsy, offers an additional approach to the early diagnosis of pleural TB in patients unable to produce sputum. In addition to being a diagnostic tool, this method also has epidemiological significance in containing TB epidemic (27). When nonneoplastic and neoplastic bronchopulmonary lesions were pooled together, bronchial brushing showed good sensitivity (80.9%) and specificity (85.7%) as compared to bronchial washing, which had sensitivity and specificity of 47.6 and 71.4%, respectively, for the final pulmonary cytology (28).…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Efficacy of Xpert MTB/RIF Assay in Bronchoalveolar Lavage Fluid for Tracheobronchial Tuberculosis: A Retrospective Analysis

et al. 2021

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Background: The Xpert Mycobacterium tuberculosis/rifampin (MTB/RIF) assay has shown good diagnostic efficacy in brushing and biopsy tissue samples from patients with tracheobronchial tuberculosis (TBTB). However, its diagnostic value in bronchoalveolar lavage fluid (BALF) is still unclear. Therefore, the present retrospective study aimed to evaluate the diagnostic value of the Xpert MTB/RIF assay in BALF.Methods: The clinical data of 266 patients with suspected TBTB from January 2018 to October 2020 were pooled with complete details of bronchial brush and bronchoalveolar lavage samples. Smears of the bronchial brushings were stained with Auramine O stain to detect acid-fast bacilli (AFB), and BALF samples were used for culturing MTB with the BACTEC MGIT 960 system and the Xpert MTB/RIF assay. The diagnostic performance of these methods was assessed and compared.Results: A total of 266 patients suspected to have TBTB were enrolled in the final analysis. Of these patients, 179 patients were confirmed to have TBTB and 87 patients were non-TBTB. The sensitivity of the Xpert MTB/RIF assay in BALF (87.2%) was significantly higher than that of the brush smear for AFB (35.2%, p < 0.001). No significant difference was observed between the sensitivities of the Xpert MTB/RIF assay in BALF and MTB culture in BALF (87.2 vs. 84.9%, p = 0.542). The specificities of the Xpert MTB/RIF assay in BALF, MTB culture in BALF, and the bronchial brush smear were 97.7, 97.7, and 98.9%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) of the Xpert MTB/RIF assay in BALF, MTB culture in BALF, and the bronchial brush smear were 98.7 and 78.7%, 98.7 and 75.9%, and 98.4 and 42.6%, respectively. Among the MTB culture-positive patients with TBTB detected by the Xpert assay, 27.0% (20/74) were identified to be resistant to RIF.Conclusions: The Xpert MTB/RIF assay in BALF enables a rapid and accurate diagnosis of TBTB and identification of RIF resistance, which is crucial for timely and proper treatment. Moreover, in patients with TBTB, BALF could be used as an alternative to bronchial brushing and biopsy tissues for the Xpert MTB/RIF assay.

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Diagnostic Implications of Bronchial Lavage in Patients with Pleural Tuberculosis

Cited by 4 publications

References 11 publications

Xpert MTB/RIF Ultra versus Xpert MTB/RIF for diagnosis of tuberculous pleural effusion: A systematic review and comparative meta-analysis

Xpert MTB/RIF Ultra versus Xpert MTB/RIF for diagnosis of tuberculous pleural effusion: A systematic review and comparative meta-analysis

Accuracy of Xpert MTB/RIF assay for the diagnosis of tuberculous pleural effusion

Diagnostic Efficacy of Xpert MTB/RIF Assay in Bronchoalveolar Lavage Fluid for Tracheobronchial Tuberculosis: A Retrospective Analysis

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