TB PCR in BAL and EBUS-TBNA samples for the diagnosis of pulmonary and mediastinal lymph node TB: retrospective TRiBE study.

IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Thorax Pub Date : 2024-08-19 DOI:10.1136/thorax-2023-220647
Mirae Park, Kartik Kumar, Meg Coleman, Laura Martin, Georgina Russell, Pauline Scheelbeek, Ajit Lalvani, Giovanni Satta, Onn Min Kon
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Abstract

Introduction: The role of Xpert Ultra in bronchoalveolar lavage (BAL) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples for pulmonary and mediastinal lymph node tuberculosis (TB) remains unclear.

Methods: This was a retrospective observational service evaluation at a tertiary TB centre in a low-incidence setting. The diagnostic indices of Xpert Ultra, smear and culture (with cytology for EBUS-TBNA samples) were compared with culture positivity or a composite reference standard of clinical TB diagnosis. Trace readouts, a new category of results for Xpert Ultra indicating low bacillary load, were analysed in two ways as a true positive or true negative result. 282 BAL and 139 EBUS-TBNA samples were included in the analysis.

Results: BAL: sensitivity with 95% CI against culture-confirmed pulmonary TB from BAL samples for Xpert Ultra (trace as positive) was 0.91 (0.82 to 0.98), Xpert Ultra (trace as negative) was 0.76 (0.69 to 0.83), smear was 0.38 (p=0.0009) and culture was 1.00 (0.91 to 1.00). Specificities for all the tests were ≥0.99 (0.98 to 1.00). The addition of smear to Xpert Ultra did not improve the diagnostic accuracy.EBUS-TBNA: sensitivity against culture-confirmed TB from EBUS-TBNA samples for Xpert Ultra (trace as positive) was 0.71 (0.63 to 0.78), Xpert Ultra (trace as negative) was 0.59 (0.54 to 0.63), smear was 0.12 (p=0.002), culture was 1.00 (0.89 to 1.00), cytology was 0.87 (0.76 to 0.98) and rapid on-site evaluation of cytology (ROSE) was 0.92 (0.78 to 1.00). Specificities were 0.99 (0.97 to 1.00), 0.99 (0.97 to 1.00), 1.00 (0.98 to 1.00), 1.00 (0.98 to 1.00), 0.67 (0.67 to 0.68) and 0.42, respectively.

Conclusion: Xpert Ultra had a significantly higher sensitivity compared with smear in both BAL and EBUS-TBNA samples. Xpert Ultra had a lower sensitivity compared with culture but comparable specificity with results being available within <24 hours. Trace readings in our low-incidence setting were associated with culture positivity in all BAL samples.

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用于肺和纵隔淋巴结结核诊断的 BAL 和 EBUS-TBNA 样本中的结核病 PCR:TRiBE 回顾性研究。
简介:Xpert Ultra 在支气管肺泡灌洗(BAL)和支气管内超声引导下经支气管针吸(EBUS-TBNA)样本检测肺结核和纵隔淋巴结结核(TB)中的作用尚不明确:这是一项在低发病率地区的三级结核病中心进行的回顾性观察服务评估。将 Xpert Ultra、涂片和培养(EBUS-TBNA 样本需进行细胞学检查)的诊断指标与培养阳性或临床结核病诊断的综合参考标准进行了比较。痕量读数是 Xpert Ultra 的一种新结果类别,表示结核菌载量较低,有两种分析方法,即真阳性或真阴性结果。分析包括 282 份 BAL 和 139 份 EBUS-TBNA 样本:BAL:Xpert Ultra(微量为阳性)对培养证实的肺结核的敏感性(95% CI)为 0.91(0.82 至 0.98),Xpert Ultra(微量为阴性)为 0.76(0.69 至 0.83),涂片为 0.38(p=0.0009),培养为 1.00(0.91 至 1.00)。所有检测的特异性均≥0.99(0.98 至 1.00)。EBUS-TBNA:Xpert Ultra(以微量为阳性)对 EBUS-TBNA 样本中经培养确诊的结核病的敏感性为 0.71(0.63 至 0.78),Xpert Ultra(以微量为阳性)对 EBUS-TBNA 样本中经培养确诊的结核病的敏感性为 0.73(0.91 至 1.00)。78),Xpert Ultra(微量为阴性)为 0.59(0.54 至 0.63),涂片为 0.12(P=0.002),培养为 1.00(0.89 至 1.00),细胞学为 0.87(0.76 至 0.98),细胞学快速现场评估(ROSE)为 0.92(0.78 至 1.00)。特异性分别为 0.99(0.97 至 1.00)、0.99(0.97 至 1.00)、1.00(0.98 至 1.00)、1.00(0.98 至 1.00)、0.67(0.67 至 0.68)和 0.42:结论:在 BAL 和 EBUS-TBNA 样本中,Xpert Ultra 的灵敏度明显高于涂片。与培养相比,Xpert Ultra 的灵敏度较低,但特异性不相上下,可在以下时间内得到结果
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来源期刊
Thorax
Thorax 医学-呼吸系统
CiteScore
16.10
自引率
2.00%
发文量
197
审稿时长
1 months
期刊介绍: Thorax stands as one of the premier respiratory medicine journals globally, featuring clinical and experimental research articles spanning respiratory medicine, pediatrics, immunology, pharmacology, pathology, and surgery. The journal's mission is to publish noteworthy advancements in scientific understanding that are poised to influence clinical practice significantly. This encompasses articles delving into basic and translational mechanisms applicable to clinical material, covering areas such as cell and molecular biology, genetics, epidemiology, and immunology.
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