The performance of detecting Mycobacterium tuberculosis complex in lung biopsy tissue by metagenomic next-generation sequencing

Abstract

Background Tuberculosis (TB) is a chronic infectious disease caused by the Mycobacterium tuberculosis complex (MTBC), which is the leading cause of death from infectious diseases. The rapid and accurate microbiological detection of the MTBC is crucial for the diagnosis and treatment of TB. Metagenomic next-generation sequencing (mNGS) has been shown to be a promising and satisfying application of detection in infectious diseases. However, relevant research about the difference in MTBC detection by mNGS between bronchoalveolar lavage fluid (BALF) and lung biopsy tissue specimens remains scarce. Methods We used mNGS to detect pathogens in BALF and lung biopsy tissue obtained by CT-guide percutaneous lung puncture (CPLP) or radial endobronchial ultrasound transbronchial lung biopsy (R-EBUS-TBLB) from 443 hospitalized patients in mainland China suspected of pulmonary infections between May 1, 2019 and October 31, 2021. Aim to evaluate the diagnostic performance of mNGS for detecting MTBC and explore differences in the microbial composition in the 2 specimen types. Results Among the 443 patients, 46 patients finally were diagnosed with TB, of which 36 patients were detected as MTBC positive by mNGS (8.93%). Striking differences were noticed in the higher detection efficiency of lung biopsy tissue compared with BALF (P = 0.004). There were no significant differences between the 2 specimen types in the relative abundance among the 27 pathogens detected by mNGS from the 36 patients. Conclusions This study demonstrates that mNGS could offer an effective detection method of MTBC in BALF or lung tissue biopsy samples in patients suspected of TB infections. When it comes to the situations that BALF samples have limited value to catch pathogens for special lesion sites or the patients have contraindications to bronchoalveolar lavage (BAL) procedures, lung biopsy tissue is an optional specimen for MTBC detection by mNGS. However, whether lung tissue-mNGS is superior to BALF-mNGS in patients with MTBC infection requires further prospective multicenter randomized controlled studies with more cases.

Clinical Value of Metagenomic Next-Generation Sequencing Using Spinal Tissue in the Rapid Diagnosis of Spinal Tuberculosis

“…19 Notably, the accuracy of mNGS for PTB diagnosis was high. 28 Similar to PTB, previous studies had suggested that mNGS had good diagnostic performance in spinal TB. 19 These results were comparable to the findings of this study.…”

Metagenomic next-generation sequencing for Mycobacterium tuberculosis complex detection: a meta-analysis

“…The combined sensitivity and specificity of the summarized primary results were 0.69 [0.58-0.79] and specificity 1.00 [0.99-1.00] respectively (Figure 3). Because there were 5 studies with a high risk of bias in the patient domain, 3 studies with a high risk of bias in the test domain, 3 studies with an unknown risk of bias in the reference domain, and 7 studies with unclear case flow and timing domains or High risk and large bias, moderately conclusive evidence downgraded (12,13,15,19,(22)(23)(24)(25)(26). Supplementary Table S2 shows the subgroup analysis of potential sources for evaluating sensitivity and specificity.…”

Combined host depletion and metagenomics sequencing significantly improves the diagnosis of pulmonary tuberculosis.

“…In China, approximately 60% of pulmonary TB cases were bacteriologically negative in 2018 9 , indicating that many patients with TB negative should be misdiagnosed and delayed treatment. With the advantages of hypothesis-free, culture-independent, and unbiased pathogen detection directly from clinical specimens, clinical metagenomics next-generation sequencing (mNGS) has been applied to diagnose tuberculosis [10][11][12][13][14] . Some studies showed that the sensitivity and speci city of mNGS were comparable to that of the Xpert MTB/RIF assay (Cepheid, Sunnyvale, CA.…”