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Review
. 2015 May 12;35(4):e00232.
doi: 10.1042/BSR20140186.

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

Panwen Tian  1 , Yongchun Shen  1 , Ye Wang  1 , Chun Wan  1 , Mei Feng  1 , Jing Zhu  1 , Ting Yang  1 , Lei Chen  1 , Fuqiang Wen  2
Affiliations
Review

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

Panwen Tian et al. Biosci Rep. .

Abstract

The diagnosis of smear-negative pulmonary tuberculosis (SNPT) remains a clinical challenge. Many studies suggest that nucleic acid amplification tests (NAATs) on bronchoalveolar lavage fluid (BALF) plays a role in diagnosing SNPT, but with considerable varying results. The current study aimed to summarize the overall diagnostic accuracy of NAATs assay on BALF for SNPT. A systematic literature search was performed and data were retrieved. Pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) were calculated. A summary receiver operating characteristic curve and area under the curve (AUC) were used to evaluate the overall diagnostic performance. All the statistical analysis was performed by using STATA 12.0 and Meta-DiSc 1.4 software. A total of nine studies with 1214 subjects were included this meta-analysis. The pooled sensitivity, specificity, PLR, NLR and DOR were 0.54 [95% CI (confidence interval): 0.48-0.59], 0.97 (95% CI: 0.95-0.98), 12.13 (95% CI: 8.23-17.88), 0.36 (95% CI: 0.23-0.56) and 44.71 (95% CI: 22.30-89.63) respectively. The AUC was 0.96. Estimated positive and negative post-probability values for a SNPT prevalence of 20% were 82% and 7% respectively. No publication bias was identified. Current available evidence indicated that NAATs on BALF may play a role in diagnosing SNPT, whereas the results should be interpreted in parallel with clinical information of patients and the results of traditional tests. Further studies should be performed to confirm our findings.

Keywords: bronchoalveolar lavage; diagnosis; meta-analysis; nucleic acid amplification test; smear-negative pulmonary tuberculosis.

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Figures

Figure 1
Figure 1. Flow chart of selection process for eligible articles
Figure 2
Figure 2. Forest plots of the sensitivity of BALF–NAAT for the diagnosis of SNPT
The circles and the horizontal lines represent the point estimate and 95% CI for each included study and the diamond represents the pooled estimate.
Figure 3
Figure 3. Forest plots of the specificity of BALF–NAAT for the diagnosis of SNPT
The circles and the horizontal lines represent the point estimate and 95% CI for each included study and the diamond represents the pooled estimate.
Figure 4
Figure 4. Forest plots of the DOR of BALF–NAAT for the diagnosis of SNPT
The circles and the horizontal lines represent the point estimate and 95% CI for each included study and the diamond represents the pooled estimate.
Figure 5
Figure 5. SROC curves for BALF–NAAT in the diagnosis of SNPT
Figure 6
Figure 6. Fagan's nomogram for likelihood ratios and pre- and post-test probabilities of BALF–NAAT for the diagnosis of SNPT
Figure 7
Figure 7. Linear regression test of funnel plot asymmetry
The statistically non-significant value (P = 0.16) for the slope coefficient suggests symmetry in the data and a low likelihood of publication bias.
See this image and copyright information in PMC

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