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

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.

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

Bioscience Reports ◽

10.1042/bsr20140186 ◽

2015 ◽

Vol 35 (4) ◽

Cited By ~ 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..

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S38 Predictive accuracy and clinical impact of Xpert MTB/RIF for the diagnosis of sputum smear-negative pulmonary tuberculosis using bronchoalveolar lavage fluid

Thorax ◽

10.1136/thoraxjnl-2015-207770.44 ◽

2015 ◽

Vol 70 (Suppl 3) ◽

pp. A26.1-A26

Author(s):

W Ho ◽

DW Connell ◽

A Singanayagam ◽

H Donaldson ◽

...

Keyword(s):

Pulmonary Tuberculosis ◽

Bronchoalveolar Lavage ◽

Bronchoalveolar Lavage Fluid ◽

Predictive Accuracy ◽

Lavage Fluid ◽

Clinical Impact ◽

Sputum Smear ◽

Smear Negative

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

Journal of Clinical Microbiology ◽

10.1128/jcm.02170-20 ◽

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.

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