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Meta-Analysis
. 2022 Jan;36(1):e24185.
doi: 10.1002/jcla.24185. Epub 2021 Dec 17.

Accuracy of Xpert MTB/RIF assay for the diagnosis of tuberculous pleural effusion

Yi-Ran Qiu  1   2 , Yu-Yan Chen  1   3 , Xin-Ran Wu  1   2 , Ya-Ping Li  1   2 , Xun-Jie Cao  1   4 , Zi-Yuan Yu  1   4 , Min Lin  1   5 , Qiu-Yin Li  1   4 , Ji-Chun Chen  1   4 , Xin Yin  1   6 , Shu-Chang Weng  1   4 , Xu-Guang Guo  1   4   7   8
Affiliations
Meta-Analysis

Accuracy of Xpert MTB/RIF assay for the diagnosis of tuberculous pleural effusion

Yi-Ran Qiu et al. J Clin Lab Anal. 2022 Jan.

Abstract

Background: Tuberculosis poses a severe threat to human health. At present, compared with the traditional diagnostic methods for tuberculosis pleural effusion, such as Löwenstein-Jensen culture, pleural biopsy, and Ziehl-Neelsen smear microscopy, Xpert MTB/RIF was regarded as an emerging technology for its efficiency. The Xpert MTB/RIF accuracy for tuberculous pleural effusion diagnosis was evaluated in this systematic study.

Materials and methods: We searched the relevant literature published before January 2021 in PubMed, Cochrane, EMBASE, and Web of Science databases. Utilizing Review Manager 5.3 software, the quality of the included literature was evaluated based on the Quality Assessment of Diagnostic Accuracy Studies criteria. Sensitivity, specificity, and the summary receiver operating characteristic curves were plotted and analyzed with Metadisc 1.40 software. We used Stata 12.0 software to evaluate the publication bias of this study.

Results: Eighteen articles were identified in total. The sensitivity of Xpert MTB/RIF in the pleural effusion was 0.24, and specificity was 1.00, respectively. The area under the summary receiver operating characteristic curve was 0.9737, which indicated that the overall accuracy of the Xpert MTB/RIF was high. In addition, based on the Deeks funnel plot, no publication bias of the study was found.

Conclusion: Xpert MTB/RIF is a rapid method with high specificity but relatively low sensitivity for detecting Mycobacterium tuberculosis in pleural effusion. Its less sensitivity made it difficult to be used clinically, but the high specificity suggests that it can be used as a specific diagnostic method for tuberculous pleural effusion.

Keywords: Xpert MTB/RIF; diagnostic; mycobacterium tuberculosis; pleural effusion; tuberculosis.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Quality assessment of the selected studies
FIGURE 2
FIGURE 2
The bias risk and applicability diagram of Xpert for tuberculous pleural effusion
FIGURE 3
FIGURE 3
Forest plot of the sensitivity of the included studies
FIGURE 4
FIGURE 4
Forest plot of the specificity of the included studies
FIGURE 5
FIGURE 5
Forest plot of the positive LR of the included studies
FIGURE 6
FIGURE 6
Forest plot of the negative LR of the included studies
FIGURE 7
FIGURE 7
Forest plot of the diagnostic OR of the included studies
FIGURE 8
FIGURE 8
SROC curve of Xpert MTB/RIF for diagnosis of Mycobacterium tuberculosis in tuberculous pleural effusion
FIGURE 9
FIGURE 9
Deek's funnel plot asymmetry test to evaluate publication bias of the included studies for Xpert MTB/RIF detection of tuberculous pleural effusion
See this image and copyright information in PMC

References

    1. Chakaya J, Khan M, Ntoumi F, et al. Global Tuberculosis Report 2020 – Reflections on the Global TB burden, treatment and prevention efforts. Int J Infect Dis. 2021;S1201‐9712(21):193‐194. - PMC - PubMed
    1. Shaw JA, Irusen EM, Diacon AH, Koegelenberg CF. Pleural tuberculosis: a concise clinical review. Clin Respir J. 2018;12(5):1779‐1786. - PubMed
    1. Gao S, Wang C, Yu X, et al. Xpert MTB/RIF Ultra enhanced tuberculous pleurisy diagnosis for patients with unexplained exudative pleural effusion who underwent a pleural biopsy via thoracoscopy: a prospective cohort study. Int J Infect Dis. 2021;106:370‐375. - PubMed
    1. Saeed M, Ahmad M, Iram S, Riaz S, Akhtar M, Aslam M. GeneXpert technology A breakthrough for the diagnosis of tuberculous pericarditis and pleuritis in less than 2 hours. Saudi Med J. 2017;38(7):699‐705. - PMC - PubMed
    1. Christopher DJ, Dinakaran S, Gupta R, James P, Isaac B, Thangakunam B. Thoracoscopic pleural biopsy improves yield of Xpert MTB/RIF for diagnosis of pleural tuberculosis. Respirology (Carlton, Vic). 2018;23(7):714‐717. - PubMed

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