Diagnostic Accuracy of T-SPOT.TB Assay for Tuberculous Meningitis: An Updated Meta-Analysis

Abstract

Background: The role of T-SPOT.TB (T-SPOT) assay for tuberculous meningitis (TBM) diagnosis has not been fully assessed. Here, we conducted an updated meta-analysis to evaluate the diagnostic accuracy of peripheral blood (PB) T-SPOT and cerebrospinal fluid (CSF) T-SPOT for diagnosing TBM. Methods: Relevant studies in the PubMed database, EmBase database, Cochrane database, Scopus database, Google Scholar, China National Knowledge Internet, and Wan-Fang database were retrieved from August 1, 2005, to June 22, 2020. Statistical analysis was performed using Stata, Revman, and Meta-Disc software. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), summary receiver operating characteristic curves, and the area under the curve were determined and analyzed. Results: A total of 27 studies were eligible for inclusion within the meta-analysis. The pooled sensitivity and specificity of PB T-SPOT for TBM diagnosis were 0.78 (95% CI, 0.76-0.81) and 0.68 (95% CI, 0.66-0.71), respectively, whereas the pooled PLR, NLR, and DOR were 2.80 (95% CI, 2.29-3.42), 0.32 (95% CI, 0.27-0.38), and 10.08 (95% CI, 7.21-14.08), respectively. On the other hand, the pooled sensitivity and specificity of CSF T-SPOT on diagnosing TBM were 0.76 (95% CI, 0.72-0.80) and 0.88 (95% CI, 0.85-0.90), respectively, whereas the pooled PLR, NLR, and DOR were 5.92 (95% CI, 4.25-8.25), 0.28 (95% CI, 0.21-0.39), and 29.05 (95% CI, 16.40-51.45), respectively. The area under the summary receiver operating characteristic curve values of PB T-SPOT and CSF T-SPOT for TBM diagnosis were 0.83 (95% CI, 0.80-0.86) and 0.92 (95% CI, 0.89-0.94), respectively. Conclusions: CSF T-SPOT showed a higher specificity compared with PB T-SPOT for diagnosing TBM. Both two T-SPOT assays have considerable potential in improving the diagnosis of TBM. Furthermore, the standardization of the operating procedure is further needed when performing CSF T-SPOT.

Diagnostic Model for Discrimination Between Tuberculous Meningitis and Bacterial Meningitis

“…Nevertheless, a recent meta-analysis conducted by Luo et al. ( 13 ) revealed a pooled sensitivity of 78% and specificity of 68% using peripheral blood T-SPOT and a pooled sensitivity of 76% and specificity of 88% using CSF T-SPOT in the diagnosis of TBM. Beyond that, indeterminate results are commonly noted, as sufficient sample volumes are usually unavailable, further limiting the use of CSF T-SPOT in clinical practice ( 14 ).…”

Tuberculosis-specific antigen stimulated and unstimulated interferon-γ for tuberculous meningitis diagnosis: A systematic review and meta-analysis

“…In 2020, Luo et al included 27 articles and showed that, for TBM diagnosis, the pooled sensitivity and specificity of blood T-SPOT.TB were 0.78 and 0.68, and the pooled sensitivity and specificity of CSF T-SPOT.TB were 0.76 and 0.88 [ 50 ]. However, this research also included intracranial tuberculoma patient data for one article [ 20 ] and overlapping datasets in four articles [ 21 , 36 , 48 , 49 ], causing unreliable pooled results.…”

Mesenchymal Stem Cells and Tuberculosis: Clinical Challenges and Opportunities

“…In addition, Escherichia coli, Mycobacterium kansasii, or Mycobacterium gordonae infection can cause false positives in experimental results (145). A recent study found that large volumes are required to get adequate cerebrospinal fluid mononuclear cells when the assay is used on cerebrospinal fluid, which hinders its clinical use (146). Therefore, the specificity and sensitivity of T-SPOT ® needs to be further improved.…”