Diagnostic yield of Xpert MTB/RIF on contrast-enhanced ultrasound-guided pleural biopsy specimens for pleural tuberculosis

Sun, Wenwen; Zhou, Yiming; Li, Wenting; Wang, Yin; Xiong, Kunlong; Zhang, Zhemin; Fan, Lin

doi:10.1016/j.ijid.2021.05.023

Cited by 11 publications

(15 citation statements)

References 20 publications

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“…Previous study included 58 patients with pleural-based peripheral pulmonary lesions to evaluate the diagnostic value of CEUS guided biopsy and obtained an overall diagnostic rate of 98.3% [ 9 ]. Our previous studies also found the diagnostic efficiency of CEUS guided biopsy in superficial lymph nodes and pleural tuberculosis [ 10 , 11 ]. Furthermore, we conducted a 3-year prospective clinical study to evaluate the value-added effect of CEUS-guided pleural biopsy in the diagnosis of pleural based lesions determined by imaging.…”

Section: Introductionmentioning

confidence: 59%

“…However, the majority of CEUS diagnostic studies are focused on malignant tumors. Our recent study showed that CEUS-guided biopsy could increase the pathogenetic detection rate of pleural TB by accurately identifying necrosis [ 11 ]. In the present study, 100% infectious pleural lesions were diagnosed by CEUS guided biopsy and 71.88% obtained the microbiological evidence.…”

Section: Discussionmentioning

confidence: 99%

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Contrast-enhanced ultrasound guided pleural biopsy improves diagnostic confidence for pleural based lesions: a 3-year prospective study

et al. 2021

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Objective To evaluate the accuracy and safety of contrast-enhanced ultrasound (CEUS) guided biopsy in the diagnosis of radiologically determined pleural based lesions. Method A prospective study was conducted on patients with radiologically determined pleural based lesions. Patients who met the inclusion criteria received pleural biopsy guided by CEUS to obtain specimens, followed by histomathological and microbiological examinations. After treatment and follow-up, surgical thoracoscopy was performed on cases with undefinite diagnosis. Result A total of 460 patients were finally included. CEUS showed internal necrosis in 72.17% cases and obvious peripheral vessels in 55.43% cases, both of which were significantly higher than the conventional ultrasound imaged (p < 0.05). The diagnostic accuracy through CEUS guided biopsy sampling was 98.91% (455/460). The microbiological diagnostic yield achieved 71.88% (225/313) in infectious lesions. In 330 cases combined pleural effusion, CEUS guided biopsy increased the diagnostic yield from 60.30% (199 /330) to 98.36% (325 /330) in all cases (p < 0.05), from 15.56% (14/90) to 94.44% (85/90) in malignant lesions (p < 0.01) and from 77.08% (185/240) to 100% (240/240) in infectious lesions (p < 0.05). No serious adverse events occurred. Conclusion CEUS guided biopsy provides a minimally invasive, effective and safe diagnostic biopsy method for pleural lesions. Clinical Trials Registration: Chinese Clinical Trial Registry ChiCTR2000029749 (ChiCTR, www.chictr.org.cn).

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Section: Introductionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced ultrasound guided pleural biopsy improves diagnostic confidence for pleural based lesions: a 3-year prospective study

et al. 2021

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“…We found 1095 citations through a search of electronic databases and located another two from additional sources ( Fig 1 ). In all we assessed 146 full-text publications in detail against our inclusion criteria, and finally included 74 for our analysis [ 23 – 96 ]. Of these, 64 (86.5%) studies evaluated Xpert alone, five (6.8%) evaluated Ultra alone, and five (6.8%) evaluated both tests concurrently ( S1 Table of online supplement).…”

Section: Resultsmentioning

confidence: 99%

“…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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“…Ultrasound-assisted Abrams' needle biopsy still seems to be the better choice in allowing the diagnosis of pleural tuberculosis compared to ultrasound-guided Tru-Cut needle biopsy (65-67). Sun et al (68) showed that the Xpert MTB/RIF assay may increase the diagnostic sensitivity for TB in histological pleura samples obtained through contrast enhanced ultrasound (CEUS) guided biopsy. CEUS, on turn, demonstrated to be an efficient, minimally invasive, and safe method for guide biopsy.…”

Section: Pleural Effusionmentioning

confidence: 99%

Chest Imaging in the Diagnosis and Management of Pulmonary Tuberculosis: The Complementary Role of Thoraci Ultrasound

et al. 2021

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Tuberculosis (TB) is a severe infectious disease that still represents a major cause of mortality and morbidity worldwide. For these reasons, clinicians and radiologists should use all the available diagnostic tools in the assessment of the disease in order to provide precise indications about starting an anti-tubercular treatment and reduce risk of TB transmission and complications especially in developing countries where the disease is still endemic. As TB mycobacteria are mainly transmitted through respiratory droplets, the pulmonary parenchyma is usually the first site of infection. As a result, chest imaging plays a central role in the diagnostic process. Thoracic ultrasound (TUS) is a portable, non-invasive, radiation-free, and cost-contained technology which could be easily available in resource-limited settings. This perspective article focuses on the potential role of TUS in the diagnosis and management of patients with pulmonary TB. Unfortunately, there are still insufficient evidence and too contrasting data to judge TUS as an appropriate diagnostic method for the screening of the disease. Despite this, TUS may have a useful role in identifying pleural and anterior pericardial effusions or in the identification of abscesses of the anterior chest wall and paraspinal collections in low- and middle-income settings. In addition, TUS seems to have a milestone role in guiding minimally invasive interventional procedures, such as placement of chest tubes, drainage of loculated collections, thoracentesis and pericardiocentesis, and percutaneous biopsy of subpleural pulmonary consolidations or pleural plaques.

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Diagnostic yield of Xpert MTB/RIF on contrast-enhanced ultrasound-guided pleural biopsy specimens for pleural tuberculosis

Cited by 11 publications

References 20 publications

Contrast-enhanced ultrasound guided pleural biopsy improves diagnostic confidence for pleural based lesions: a 3-year prospective study

Contrast-enhanced ultrasound guided pleural biopsy improves diagnostic confidence for pleural based lesions: a 3-year prospective study

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

Chest Imaging in the Diagnosis and Management of Pulmonary Tuberculosis: The Complementary Role of Thoraci Ultrasound

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