Performance of Xpert® MTB/RIF in diagnosing tuberculous pleuritis using thoracoscopic pleural biopsy

Liu, Chengjun; Liu, Chang; Sun, Bingqi; Zhang, Wei; Wang, Yan; Sun, Jiao; Ma, Fei; Chen, Yú

doi:10.1186/s12879-020-05578-3

Cited by 17 publications

(14 citation statements)

References 18 publications

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“…High specificity with a small sample size is not reliable. One study showed 65% specificity when compared with a composite reference standard (CRS), 16 almost comparable with our results. The positive predictive value was 22.2%, the negative predictive value was 52.1% and the area under the curve (ROC) was 58% in our study.…”

Section: Discussionsupporting

confidence: 91%

“…Results from previous studies are conflicting in this regard. The positive predictive value and negative predictive value of GeneXpert were 56.4 and 75.6%, respectively in a study conducted in China, 16 supporting our results. The positive predictive value was 100% in a local study conducted in Karachi, 14 but pleural tissue was used instead of pleural fluid, which may be the cause of the high positive predictive value in this study.…”

Section: Discussionsupporting

confidence: 89%

“…This difference may be due to the smaller number of participants in this study. A study conducted by Li et al 16 showed a sensitivity of 68.8% with an adequate sample size. These results are in contrast with our results, but there was an important difference in methodology as Li et al, used pleural tissue and we used pleural fluid to detect mycobacterium by GeneXpert which may be the reason for high sensitivity.…”

Section: Discussionmentioning

confidence: 94%

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Is GeneXpert MTB/RIF assay reliable for the diagnosis of pleural tuberculosis?

Shafiq

Nadeem²,

Zaidi

et al. 2022

JRMC

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Introduction: Tuberculosis is the most common cause of infectious diseases related mortality globally. Tuberculous pleural effusion is a common presentation of extra pulmonary tuberculosis and a diagnostic challenge most of the time. The rapid diagnosis of tuberculous pleural effusion is essential for early treatment. GeneXpert is a new tool for rapid diagnosis but the ability to correctly diagnose of GeneXpert is a vital concern in the diagnosis of extra pulmonary tuberculosis. Objective: To determine the accurate ability of diagnosing the pleural fluid GeneXpert MTB/RIF assessment in the suspected pleural tuberculosis patients considering as gold standard to the pleural biopsy. Methods: This study was a validational cross sectional survey and it was conducted in pulmonology department of Pakistan Institute of Medical Sciences, Islamabad from 1st July to 31st December 2018 after approval of IRB. Participants with suspected pathology ≥ 18 year with exudative pleural effusion were included in the study. By implementing the process of standard technique, closed needle pleural biopsy was executed by means of ABRAM’S needle. The collected samples of patients were sent to the pathology department of Pakistan Institute of Medical Sciences for histopathology. Pleural fluid was referred to National Institute of Health Islamabad for GeneXpert MTB/RIF assessment on the alike day and reports were assembled. All findings were entered in a structured Proforma. Data was entered in SPSS version 20 and analyzed. Results: Total 180 patients were included; 65.6% patients were male. When the sensitivity of pleural fluid GeneXpert MTB/RIF examination was calculated it was 10.4% whereas, the calculated specificity was 72.8%. While +ve predictive value of GeneXpert was 22.2% and -ve predictive value was 52.1%. Likelihood ratio was 8.25 and ROC curve also showed similar values. Conclusion: The sensitivity of pleural fluid GeneXpert MTB/RIF assay is very low and specificity is moderate for diagnosis of pleural tuberculosis when compared with pleural biopsy.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 94%

See 1 more Smart Citation

Is GeneXpert MTB/RIF assay reliable for the diagnosis of pleural tuberculosis?

Shafiq

Nadeem²,

Zaidi

et al. 2022

JRMC

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“…The sensitivity of TB-LAMP was 67.2% lower than that of pathology at 77.7% ( P < 0.05). In our previous study, which also evaluated the positivity rate of pleural biopsy at endoscopy in 113 patients with pleural tuberculosis, 71 patients (71/113 62.8%) were positive for caseous granuloma, a result similar to the findings of the present study ( 19 ). TB-LAMP has an additional advantage over pathology in areas with a high burden of TB.…”

Section: Discussionsupporting

confidence: 90%

Performance of TB-LAMP in the Diagnosis of Tuberculous Empyema Using Samples Obtained From Pleural Decortication

Liu¹,

Fan²,

Zhang³

et al. 2022

Front. Med.

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PurposeTo evaluate the performance of TB-LAMP in the diagnosis of TB empyema using pleural tissue specimens obtained during pleural decortication.MethodsUsing the clinical records and the different diagnostic test results of patients who underwent pleural decortication in a TB-designated hospital over 3.5 years, we calculated the sensitivity, specificity positive predictive, and negative predictive values of the pathology, MGIT 960 culture, and TB-LAMP obtained by using pleural tissue specimens against the etiologic diagnosis and composite clinical reference standard (CCRS) as the reference standards.ResultA total of 304 patients' records were extracted. All these patients had gone through pleural decortication. When the etiologic diagnosis was used as the reference, the sensitivity of TB-LAMP in identifying TB empyema was 77.8% (compared to 10.6% of MGIT 960 P < 0.05). The sensitivity of MGIT 960, pathology, and TB-LAMP was 8.2%, 77.7%, and 67.2% against CCRS as the reference; and the specificity of the three was 100.0, 100.0, and 96.2% against the same standard. A combination of pathology and TB-LAMP would increase the sensitivity and specificity to 84.7 and 96.0%. Using TB-LAMP to diagnose TB empyema using pleural tissue samples obtained from pleural decortication was faster with satisfactory performance.ConclusionTB-LAMP has great potential in faster and more accurate diagnosis of TB empyema. Our findings provide insights for optimizing diagnostic algorithms for TB empyema.

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“…Data regarding the performance of this assay in pleural tissue samples and against the composite reference standard is scarce: the aforementioned Cochrane analysis only found a single study on this topic including 55 patients, 14 out of them with tuberculous effusions, and with surprising and disappointing results (sensitivity of 0%, specificity of 98%) [66]. Subsequently, three additional studies of 73, 113 and 27 patients diagnosed with TPE and who underwent thoracoscopic pleural biopsy reported a sensitivity of the Xpert MTB/RIF assay of 45%, 69% and 85%, respectively in pleural tissue samples against the composite reference standard [68][69][70]. Our study showed a five-fold higher sensitivity of the Xpert MTB/RIF assay in pleural tissue compared to pleural fluid (57% versus 11%), and close to that obtained with culture of pleural fluid (56%) or closed biopsy pleural specimens (58%).…”

Section: Plos Onementioning

confidence: 99%

Diagnostic accuracy of adenosine deaminase for pleural tuberculosis in a low prevalence setting: A machine learning approach within a 7-year prospective multi-center study

et al. 2021

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Objective To analyze the performance of adenosine deaminase in pleural fluid combined with other parameters routinely measured in clinical practice and assisted by machine learning algorithms for the diagnosis of pleural tuberculosis in a low prevalence setting, and secondly, to identify effusions that are non-tuberculous and most likely malignant. Patients and methods We prospectively analyzed 230 consecutive patients diagnosed with lymphocytic exudative pleural effusion from March 2013 to June 2020. Diagnosis according to the composite reference standard was achieved in all cases. Pre-test probability of pleural tuberculosis was 3.8% throughout the study period. Parameters included were: levels of adenosine deaminase, pH, glucose, proteins, and lactate dehydrogenase, red and white cell counts and lymphocyte percentage in pleural fluid, as well as age. We tested six different machine learning-based classifiers to categorize the patients. Two different classifications were performed: a) tuberculous/non-tuberculous and b) tuberculous/malignant/other. Results Out of a total of 230 patients with pleural effusion included in the study, 124 were diagnosed with malignant effusion and 44 with pleural tuberculosis, while 62 were given other diagnoses. In the tuberculous/non-tuberculous classification, and taking into account the validation predictions, the support vector machine yielded the best result: an AUC of 0.98, accuracy of 97%, sensitivity of 91%, and specificity of 98%, whilst in the tuberculous/malignant/other classification, this type of classifier yielded an overall accuracy of 80%. With this three-class classifier, the same sensitivity and specificity was achieved in the tuberculous/other classification, but it also allowed the correct classification of 90% of malignant cases. Conclusion The level of adenosine deaminase in pleural fluid together with cell count, other routine biochemical parameters and age, combined with a machine-learning approach, is suitable for the diagnosis of pleural tuberculosis in a low prevalence scenario. Secondly, non-tuberculous effusions that are suspected to be malignant may also be identified with adequate accuracy.

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Performance of Xpert® MTB/RIF in diagnosing tuberculous pleuritis using thoracoscopic pleural biopsy

Cited by 17 publications

References 18 publications

Is GeneXpert MTB/RIF assay reliable for the diagnosis of pleural tuberculosis?

Is GeneXpert MTB/RIF assay reliable for the diagnosis of pleural tuberculosis?

Performance of TB-LAMP in the Diagnosis of Tuberculous Empyema Using Samples Obtained From Pleural Decortication

Diagnostic accuracy of adenosine deaminase for pleural tuberculosis in a low prevalence setting: A machine learning approach within a 7-year prospective multi-center study

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