Tuberculosis Department, Hangzhou Red Cross Hospital, Hangzhou, 310000, P.R. China.
Infectious Disease Department, Longyou People's Hospital, Quzhou, 324400, P.R. China.
BMC Infect Dis. 2024 Aug 26;24(1):861. doi: 10.1186/s12879-024-09761-8.
Microbiological diagnosis of pulmonary tuberculosis (PTB) is hampered by a low pathogen burden, low compliance and unreliable sputum sampling. Although endobronchial ultrasound-guided transbronchoscopic lung biopsy (EBUS-TBLB) has been found to be useful for the assessment of intrapulmonary nodules in adults, few data are available for the clinical diagnosis of pulmonary tuberculosis. Here, we evaluated EBUS-TBLB as a diagnostic procedure in adult patients with radiologically suspected intrapulmonary tuberculous nodules.
This was a retrospective analysis of patients admitted with pulmonary nodules between January 2022 and January 2023 at Hangzhou Red Cross Hospital. All patients underwent EBUS-TBLB, and lung biopsy samples were obtained during hospitalization. All samples were tested for Mycobacterium tuberculosis using acid‒fast smears, Bactec MGIT 960, Xpert MTB/RIF, next-generation sequencing (NGS), and DNA (TB‒DNA) and RNA (TB‒RNA). The concordance between different diagnostic methods and clinical diagnosis was analysed via kappa concordance analysis. The diagnostic efficacy of different diagnostic methods for PTB was analysed via ROC curve.
A total of 107 patients were included in this study. Among them, 86 patients were diagnosed by EBUS-TBLB, and the overall diagnostic rate was 80.37%. In addition, 102 enrolled patients had benign lesions, and only 5 were diagnosed with lung tumours. Univariate analysis revealed that the diagnostic rate of EBUS-TBLB in pulmonary nodules was related to the location of the probe. The consistency analysis and ROC curve analysis revealed that NGS had the highest concordance with the clinical diagnosis results (agreement = 78.50%, κ = 0.558) and had the highest diagnostic efficacy for PTB (AUC = 0.778). In addition, Xpert MTB/RIF + NGS had the highest concordance with the clinical diagnosis results (agreement = 84.11%, κ = 0.667) and had the highest efficacy in the diagnosis of PTB (AUC = 0.826).
EBUS-TBLB is a sensitive and safe method for the diagnosis of pathological pulmonary nodules. Xpert MTB/RIF combined with NGS had the highest diagnostic efficacy and can be used in the initial diagnosis of PTB.
微生物学诊断肺结核（PTB）受到病原体负担低、患者配合度低和不可靠的痰液采样的阻碍。虽然支气管内超声引导下经支气管镜肺活检（EBUS-TBLB）已被发现对评估成人肺部结节有用，但关于其在肺结核临床诊断中的应用的数据很少。在这里，我们评估了 EBUS-TBLB 作为疑似肺部结核性结节的成年患者的诊断程序。
这是对 2022 年 1 月至 2023 年 1 月在杭州市红十字会医院住院的肺部结节患者进行的回顾性分析。所有患者均接受 EBUS-TBLB 检查，并在住院期间获得肺活检样本。所有样本均使用抗酸染色、Bactec MGIT 960、Xpert MTB/RIF、下一代测序（NGS）、DNA（TB-DNA）和 RNA（TB-RNA）检测结核分枝杆菌。通过卡帕一致性分析分析不同诊断方法与临床诊断的一致性。通过 ROC 曲线分析不同诊断方法对肺结核的诊断效能。
共纳入 107 例患者。其中，86 例患者经 EBUS-TBLB 诊断，总体诊断率为 80.37%。此外，102 例纳入患者为良性病变，仅有 5 例被诊断为肺部肿瘤。单因素分析显示，EBUS-TBLB 对肺部结节的诊断率与探头位置有关。一致性分析和 ROC 曲线分析显示，NGS 与临床诊断结果的一致性最高（一致性=78.50%，κ=0.558），对肺结核的诊断效能最高（AUC=0.778）。此外，Xpert MTB/RIF+NGS 与临床诊断结果的一致性最高（一致性=84.11%，κ=0.667），对肺结核的诊断效能最高（AUC=0.826）。
EBUS-TBLB 是一种敏感、安全的肺部结节病理诊断方法。Xpert MTB/RIF 联合 NGS 具有最高的诊断效能，可用于肺结核的初步诊断。
