Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou, China.
Front Cell Infect Microbiol. 2023 Mar 22;13:1154939. doi: 10.3389/fcimb.2023.1154939. eCollection 2023.
To compare the diagnostic performance of laboratory assays on the ultrasound-guided core needle biopsy samples for diagnosis of extra-pulmonary tuberculosis (EPTB) in HIV-positive and HIV-negative patients.
A total of 217 patients suspected to have EPTB underwent lesion biopsy from 2017 to 2020. Results of laboratory tests on the biopsy and non-biopsy samples were collected with clinical data for retrospective analysis of test utility. The calculated diagnostic accuracy of the tests was stratified according to the specimen types and HIV status.
The cohort contained 118 patients with a final positive diagnosis of extrapulmonary tuberculosis (EPTB group, 54.4%) and 99 finally diagnosed as without TB (non-EPTB group, 45.6%). The risk factor for EPTB was HIV co-infection (OR 2.22, 95% CI 1.17-4.28, = 0.014). In biopsy samples, GeneXpert (Xpert) showed higher sensitivity (96.6% [91.6-98.7], < 0.0001) than culture (56.1% [47.0-64.9]). Regardless of HIV status, Xpert had the highest sensitivity (>95%) and specificity (nearly 100%) of any methods. In non-biopsy samples, only T-SPOT. (T-SPOT) showed higher sensitivity than culture (90.9% [62.3-99.5] 35.3% [17.3-58.7], = 0.0037). Furthermore, the sensitivities of Xpert were lower in non-biopsy samples (60.0% [23.1-92.9], = 0.022) than in biopsy samples (100% [86.7-100]). Even in smear-negative biopsy samples, Xpert still had higher sensitivity than culture and retained high specificity (100% [95.7-100]).
Superior performance of Xpert in diagnosing EPTB was observed regardless of HIV status and specimen types. Nevertheless, the biopsy samples still substantially facilitated the accurate diagnosis of extrapulmonary tuberculosis.
比较实验室检测在超声引导下经皮肺穿刺活检标本对 HIV 阳性和 HIV 阴性患者肺外结核（EPTB）的诊断性能。
对 2017 年至 2020 年期间 217 例疑似 EPTB 患者进行了病变活检。对活检和非活检样本的实验室检测结果与临床资料进行回顾性分析，以评估检测的应用价值。根据标本类型和 HIV 状态对检测的计算诊断准确性进行分层。
该队列包含 118 例最终确诊为肺外结核（EPTB 组，54.4%）和 99 例最终诊断为非结核（非 EPTB 组，45.6%）的患者。EPTB 的危险因素是 HIV 合并感染（OR 2.22，95%CI 1.17-4.28， = 0.014）。在活检样本中，GeneXpert（Xpert）的敏感性（96.6%[91.6-98.7]）明显高于培养（56.1%[47.0-64.9]），差异具有统计学意义（ ＜0.0001）。无论 HIV 状态如何，Xpert 的敏感性（＞95%）和特异性（接近 100%）均高于任何其他方法。在非活检样本中，仅 T 细胞斑点试验（T-SPOT）的敏感性高于培养（90.9%[62.3-99.5]比 35.3%[17.3-58.7]， = 0.0037）。此外，Xpert 在非活检样本中的敏感性（60.0%[23.1-92.9]）明显低于活检样本（100%[86.7-100]），差异具有统计学意义（ = 0.022）。即使在痰涂片阴性的活检样本中，Xpert 仍然具有更高的敏感性和保持高特异性（100%[95.7-100]）。
无论 HIV 状态和标本类型如何，Xpert 在诊断 EPTB 方面的表现均优于其他方法。然而，活检样本仍然可以显著提高肺外结核的准确诊断率。
