Department of Tuberculosis Diagnosis and Treatment Center of Zhejiang Chinese and Western Medicine Integrated Hospital, No. 208 Huancheng East Road, Gongshu District, Hangzhou, Zhejiang, China.
Department of Tuberculosis Laboratory of Zhejiang Chinese and Western Medicine Integrated Hospital, No. 208 Huancheng East Road, Gongshu District, Hangzhou, Zhejiang, China.
BMC Infect Dis. 2024 Sep 20;24(1):1017. doi: 10.1186/s12879-024-09901-0.
The diagnosis of peripheral isolated nodular lesions that are suspected as pulmonary tuberculosis (PTB) is challenging, which are not easily accessible via conventional bronchoscopy. This study evaluated the combined use of Xpert MTB/RIF assay and endobronchial ultrasonography with a guide sheath (EBUS-GS) for detecting MTB infection in peripheral lung bands, for early detection of PTB.
The clinical data of 232 patients with suspected peripheral nodular PTB who underwent EBUS-GS between June 2020 and October 2023 were retrospectively reviewed. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) of acid-fast bacilli smear, culture, Xpert MTB/RIF assay, and pathological examination were calculated. To assess diagnostic accuracy, the results of the four methods were directly compared with the final clinical diagnosis.
In total, 146 and 86 patients were clinically diagnosed with peripheral nodular PTB and non-PTB, respectively. The sensitivity, specificity, PPV, NPV, and AUC values of combined Xpert MTB/RIF assay and EBUS-GS were 47.26%, 100.0%, 100.0%, 52.76%, and 0.74; those of acid-fast bacilli smear were 8.22%, 97.67%, 85.71%, 38.53%, and 0.53; those of culture were 31.51%, 100.0%, 100.0%, 46.24%, and 0.66; and those of pathological examination were 23.97%, 97.67%, 94.59%, 43.08%, and 0.61, respectively.
The diagnostic accuracy of the combined Xpert MTB/RIF assay and EBUS-GS was significantly better than that of other conventional tests. Hence, this novel technique can be routinely applied for diagnosing and managing peripheral nodular PTB.
外周孤立性结节性病变的诊断具有挑战性，这些病变通过常规支气管镜检查不易获得。本研究评估了 Xpert MTB/RIF 检测与支气管内超声引导下的外套管（EBUS-GS）联合应用，以检测外周肺带中的 MTB 感染，从而早期诊断肺结核（PTB）。
回顾性分析 2020 年 6 月至 2023 年 10 月期间 232 例疑似外周结节性 PTB 患者接受 EBUS-GS 的临床资料。计算抗酸杆菌涂片、培养、Xpert MTB/RIF 检测和病理检查的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和曲线下面积（AUC）。为了评估诊断准确性，将这四种方法的结果直接与最终临床诊断进行比较。
共 146 例和 86 例患者分别被临床诊断为外周结节性 PTB 和非 PTB。联合 Xpert MTB/RIF 检测和 EBUS-GS 的敏感性、特异性、PPV、NPV 和 AUC 值分别为 47.26%、100.0%、100.0%、52.76%和 0.74%；抗酸杆菌涂片的敏感性、特异性、PPV、NPV 和 AUC 值分别为 8.22%、97.67%、85.71%、38.53%和 0.53%；培养的敏感性、特异性、PPV、NPV 和 AUC 值分别为 31.51%、100.0%、100.0%、46.24%和 0.66%；而病理检查的敏感性、特异性、PPV、NPV 和 AUC 值分别为 23.97%、97.67%、94.59%、43.08%和 0.61%。
联合 Xpert MTB/RIF 检测和 EBUS-GS 的诊断准确性明显优于其他常规检测。因此，这种新技术可常规应用于外周结节性 PTB 的诊断和管理。
