scholarly journals Value of Xpert MTB/RIF Using Bronchoalveolar Lavage Fluid for the Diagnosis of Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Hong-Chao Liu ◽  
Yu-Lu Gao ◽  
Dan-Feng Li ◽  
Xi-Yi Zhao ◽  
Yuan-Qing Pan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pulmonary Tuberculosis ◽  
Bronchoalveolar Lavage ◽  
Bronchoalveolar Lavage Fluid ◽  
Meta Analysis ◽  
Area Under The Curve ◽  
Culture Method ◽  
Lavage Fluid ◽  
Likelihood Ratios ◽  
Sensitivity Specificity

Background: The performance of Xpert MTB/RIF using bronchoalveolar lavage fluid (BAL) for the diagnosis of pulmonary tuberculosis (PTB) remains unclear. Therefore, a systematic review/meta-analysis was conducted. Methods: Studies published before December 31, 2019, were retrieved from the PubMed, Embase, and Web of Science databases using the keywords “pulmonary tuberculosis,” “Xpert MTB/RIF,” and “BAL.” Two independent evaluators extracted the data and assessed the bias risk of the included studies. A random-effects model was used to calculate the overall sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR, respectively), diagnostic odds ratio (DOR), and the area under the curve (AUC), as well as the respective 95% confidence intervals (CIs). Results: Nineteen trials involving 3019 participants met the inclusion criteria. Compared to the culture method, the pooled sensitivity, specificity, PLR, NLR, DOR, and the AUC with 95% CIs of Xpert MTB/RIF were 0.87 (0.84–0.90), 0.92 (0.91–0.93), 10.21 (5.78–18.02), 0.16 (0.12–0.22), 78.95 (38.59–161.53), and 0.9467 (0.9462-0.9472), respectively. Relative to the composite reference standard, the observed values were 0.69 (0.65–0.72), 0.98 (0.98–0.99), 37.50 (18.59–75.62), 0.30 (0.21–0.43), 171.98 (80.82–365.96), and 0.9691 (0.9683–0.9699), respectively. All subgroups, except children, showed high sensitivity and specificity. Conclusions: The use of Xpert MTB/RIF in the context of BAL samples has a high diagnostic performance for PTB (except for children) and may serve as an alternative rapid diagnostic tool.

scholarly journals Rapid Diagnosis of Childhood Pulmonary Tuberculosis by Xpert MTB/RIF Assay Using Bronchoalveolar Lavage Fluid

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Qing-Qin Yin ◽  
Wei-Wei Jiao ◽  
Rui Han ◽  
An-Xia Jiao ◽  
Lin Sun ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Bronchoalveolar Lavage ◽  
Predictive Value ◽  
Bronchoalveolar Lavage Fluid ◽  
Fiberoptic Bronchoscopy ◽  
Lavage Fluid ◽  
Rapid Diagnosis ◽  
Reference Standard ◽  
Younger Age ◽  
Sensitivity Specificity

In order to evaluate the diagnostic accuracy of the Xpert MTB/RIF assay on childhood pulmonary tuberculosis (PTB) using bronchoalveolar lavage fluid (BALF), we evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of Xpert MTB/RIF assay using BALF in comparison with acid-fast bacilli (AFB) microscopy andMycobacterium tuberculosis(MTB) culture for diagnosing childhood PTB using Chinese “composite clinical reference standard” (CCRS) as reference standard. Two hundred fifty-five children with suspected PTB were enrolled at Beijing Children’s Hospital from September 2010 to July 2013. Compared with Chinese CCRS, the sensitivity of AFB microscopy, MTB culture, and Xpert MTB/RIF assay was 8.4%, 28.9%, and 53.0%, respectively. The specificity of three assays was all 100%. Xpert MTB/RIF assay could detect 33.9% of cases with negative MTB culture, and 48.7% of cases with negative AFB microscopy. Younger age (<3 years), absence of BCG scar, and contact with TB patient were found significantly associated with a positive result of Xpert MTB/RIF assay. In conclusion, Xpert MTB/RIF assay using BALF can assist in diagnosing childhood PTB much faster when fiberoptic bronchoscopy is necessary according to the chest radiograph.

scholarly journals The value of GeneXpert MTB/RIF in bronchoalveolar lavage fluid in the diagnosis of smear-negative pulmonary tuberculosis

2021 ◽  
Vol 62 (1) ◽  
pp. 28-36
Author(s):  
Yue-Ying Zhou ◽  
Ji-Chan Shi ◽  
Ning Pan ◽  
Zheng-Xing Wu ◽  
Ai-Qiong Cheng ◽  
...  
Keyword(s):  
Pulmonary Tuberculosis ◽  
Bronchoalveolar Lavage ◽  
Liquid Culture ◽  
Drug Sensitivity ◽  
Bronchoalveolar Lavage Fluid ◽  
Culture Method ◽  
Lavage Fluid ◽  
Diagnostic Value ◽  
Smear Negative ◽  
Acid Fast Staining

This study aims to evaluate the diagnostic value of Xpert MTB/ RIF assay in bronchoalveolar lavage fluid (BALF) in subjects with smear-negative pulmonary tuberculosis. From January 2019 to December 2019, 197 patients with suspected pulmonary tuberculosis were recruited, and bronchoalveolar lavage fluid was collected for acid-fast staining smear, liquid culture of Mycobacterium combined drug sensitivity and Xpert MTB/RIF detection. The sensitivity, specificity, positive predictive value and negative predictive value of Xpert MTB/RIF in bronchoalveolar lavage fluid (BALF) were calculated with smear-negative pulmonary tuberculosis as the reference standard. The consistency of xpert MTB/RIF in the diagnosis of rifampicin resistance was evaluated, with the results of Mycobacterium liquid culture drug sensitivity test and drug sensitivity test as the gold standards. The results showed that among 197 suspected tuberculosis patients, 55 patients were not diagnosed with tuberculosis and 142 patients were diagnosed with smear-negative pulmonary tuberculosis. One hundred and twenty three cases (86.62%) were positive for Xpert MTB/ RIF in bronchoalveolar lavage fluid, 15 cases (10.56%) were positive by acid-fast staining smear method, and 88 cases (61.97%) were positive by the liquid culture method. The positive rate of Xpert MTB / RIF was 93.18% (82 / 88), which was higher than that of 75.93% (41 / 54) of the negative BALF mycobacterium culture (χ 2 = 8.598, P<0.01). The sensitivity and specificity of Xpert MTB/RIF for rifampicin resistance were 100.00% and 97.30%, respectively. Therefore, the diagnostic value of Xpert MTB/RIF in bronchoalveolar lavage fluid for bacterialnegative pulmonary tuberculosis is superior to the acid-fast staining smear of lavage fluid and the mycobacterium culture method.

scholarly journals Diagnostic value of nucleic acid amplification tests on bronchoalveolar lavage fluid for smear-negative pulmonary tuberculosis: a meta-analysis

2015 ◽  
Vol 35 (4) ◽  
Author(s):  
Panwen Tian ◽  
Yongchun Shen ◽  
Ye Wang ◽  
Chun Wan ◽  
Mei Feng ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Pulmonary Tuberculosis ◽  
Bronchoalveolar Lavage ◽  
Bronchoalveolar Lavage Fluid ◽  
Meta Analysis ◽  
Lavage Fluid ◽  
Diagnostic Value ◽  
Nucleic Acid Amplification ◽  
Nucleic Acid Amplification Tests ◽  
Smear Negative

Based on current available evidence, NAAT on BALF plays a role in the diagnosis of smear-negative pulmonary tuberculosis, and further studies should be performed to confirm our findings..

scholarly journals Diagnostic Accuracy of Bronchoalveolar Lavage Fluid Galactomannan for Invasive Aspergillosis

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Xun-Jie Cao ◽  
Ya-Ping Li ◽  
Li-Min Xie ◽  
Hong-Lang Zhang ◽  
Yu-Shan Qin ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Invasive Aspergillosis ◽  
Test Performance ◽  
Bronchoalveolar Lavage Fluid ◽  
Meta Analysis ◽  
Lavage Fluid ◽  
Accurate Estimate ◽  
Likelihood Ratios ◽  
Summary Receiver Operating Characteristic ◽  
Underlying Diseases

Background. The pathogenesis of invasive aspergillosis (IA) is still unknown, but its progression is rapid and mortality rate remains high. Bronchoalveolar lavage fluid (BALF) galactomannan (GM) analysis has been used to diagnose IA. This study is aimed at making an accurate estimate of the whole accuracy of BALF-GM in diagnosing IA. Methods. After a systematic review of the study, a bivariate meta-analysis was used to summarize the specificity (SPE), the sensitivity (SEN), the positive likelihood ratios (PLR), and the negative likelihood ratios (NLR) of BALF-GM in diagnosing IA. The overall test performance was summarized using a layered summary receiver operating characteristic (SROC) curve. Subgroup analysis was performed to explore the heterogeneity between studies. Results. A total of 65 studies that are in line with the inclusion criteria were included. The summary estimates of BALF-GM analysis are divided into four categories. The first is the proven+probable vs. possible+no IA, with an SPE, 0.87 (95% CI, 0.85-0.98); SEN, 0.81 (95% CI, 0.76-0.84); PLR, 9.78 (5.78-16.56); and NLR, 0.20 (0.14-0.29). The AUC was 0.94. The BALF-GM test for proven+probable vs. no IA showed SPE, 0.88 (95% CI, 0.87-0.90); SEN, 0.82 (95% CI, 0.78-0.85); PLR, 6.56 (4.93-8.75); and NLR, 0.24 (0.17-0.33). The AUC was 0.93. The BALF-GM test for proven+probable+possible vs. no IA showed SPE, 0.82 (95% CI, 0.79-0.95); SEN, 0.59 (95% CI, 0.55-0.63); PLR, 3.60 (2.07-6.25); and NLR, 0.31 (0.15-0.61). The AUC was 0.86. The analyses for others showed SPE, 0.85 (95% CI, 0.83-0.87); SEN, 0.89 (95% CI, 0.86-0.91); PLR, 6.91 (4.67-10.22); and NLR, 0.18 (0.13-0.26). The AUC was 0.94. Conclusions. The findings of this BALF-GM test resulted in some impact on the diagnosis of IA. The BALF-GM assay is considered a method for diagnosing IA with high SEN and SPE. However, the patients’ underlying diseases may affect the accuracy of diagnosis. When the cutoff is greater than 1, the sensitivity will be higher.

Bronchoalveolar lavage fluid lymphocytosis in chronic hypersensitivity pneumonitis: a systematic review and meta-analysis

2020 ◽  
Vol 56 (2) ◽  
pp. 2000206 ◽  
Author(s):  
Nicola Adderley ◽  
Christopher J. Humphreys ◽  
Hayley Barnes ◽  
Brett Ley ◽  
Zahra A. Premji ◽  
...  
Keyword(s):  
Systematic Review ◽  
Bronchoalveolar Lavage ◽  
Hypersensitivity Pneumonitis ◽  
Bronchoalveolar Lavage Fluid ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Lavage Fluid ◽  
Patient Data ◽  
Cochrane Library ◽  
Chronic Hypersensitivity Pneumonitis

BackgroundThe role of bronchoalveolar lavage fluid (BALF) lymphocyte percentage in diagnosing chronic hypersensitivity pneumonitis (CHP) is unclear. We conducted a systematic review and meta-analysis of bronchoalveolar lavage (BAL) lymphocyte percentage in the diagnosis of CHP.MethodsWe searched Medline, Embase and the Cochrane Library from inception to August 2019. Individual patient data were obtained to test performance characteristics of BAL lymphocyte percentage at different thresholds. Random-effects models were used for pooled estimates, with comparisons made between CHP and non-CHP interstitial lung diseases (ILDs).ResultsFifty-three studies were included in the systematic review and 42 in the meta-analysis. The pooled estimate for BAL lymphocyte percentage was 42.8% (95% CI 37.7–47.8, I2=95.3%) in CHP, 10.0% (95% CI 6.9–13.1, I2=91.2%) in idiopathic pulmonary fibrosis (IPF), 23.1% (95% CI 3.0–43.2, I2=85.2%) in non-IPF idiopathic interstitial pneumonia (IIP), 23.4% (95% CI 11.0–35.9, I2=45.7%) in connective-tissue disease associated ILD (CTD-ILD) and 31.2% (95% CI 17.6–44.8, I2=95.2%) in sarcoidosis. Results differed between CHP and IPF (p<0.0001), non-IPF IIP (p=0.0309) or CTD-ILD (p=0.0824), but not between CHP and sarcoidosis (p=0.0966). Using individual patient data from eight studies, a lymphocyte percentage threshold of >20% provided a sensitivity of 68.1% and a specificity of 64.8% for CHP. Higher thresholds provided lower sensitivity with higher specificity. Older age and ever having smoked were associated with lower lymphocyte percentage in CHP.ConclusionsBAL lymphocyte percentage is higher in CHP compared to IPF and other IIPs, with higher thresholds providing improved specificity at the cost of sensitivity. However, the parent studies are at risk of incorporation bias and prospective studies should evaluate the additive discriminate value of BAL lymphocyte percentage to accurately diagnose CHP.

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