Thoracoscopic pleural biopsy improves yield of Xpert MTB/RIF for diagnosis of pleural tuberculosis

Christopher, Devasahayam Jesudas; Dinakaran, Sridevi; Gupta, Richa; James, Prince; Isaac, Bina; Thangakunam, Balamugesh

doi:10.1111/resp.13275

Cited by 51 publications

(43 citation statements)

References 12 publications

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“…The sensitivity of pleural biopsy is 69–97%, and tends to be higher in HIV‐positive individuals . The technique used to acquire pleural tissue is often dictated by the local expertise and resource availability, and while medical thoracoscopy has a sensitivity of up to 100% for tuberculous pleuritis, and is known to improve the yield for both culture and Xpert, it is not always available . In resource‐limited settings, an ultrasound‐guided closed pleural biopsy represents a reasonable alternative with a diagnostic yield of up to 90% .…”

Section: Diagnosismentioning

confidence: 99%

“…22,78 The technique used to acquire pleural tissue is often dictated by the local expertise and resource availability, and while medical thoracoscopy has a sensitivity of up to 100% for tuberculous pleuritis, and is known to improve the yield for both culture and Xpert, it is not always available. 3,82,83 In resource-limited settings, an ultrasound-guided closed pleural biopsy represents a reasonable alternative with a diagnostic yield of up to 90%. 84 In this case, the yield is maximized by the use of an Abrams biopsy needle (compared to Tru-Cut needle) and harvesting more than six biopsy specimens.…”

Section: Pleural Biopsymentioning

confidence: 99%

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Tuberculous pleural effusion

2019

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Tuberculous effusion is a common disease entity with a spectrum of presentations from a largely benign effusion, which resolves completely, to a complicated effusion with loculations, pleural thickening and even frank empyema, all of which may have a lasting effect on lung function. The pathogenesis is a combination of true pleural infection and an effusive hypersensitivity reaction, compartmentalized within the pleural space. Diagnostic thoracentesis with thorough pleural fluid analysis including biomarkers such as adenosine deaminase and gamma interferon achieves high accuracy in the correct clinical context. Definitive diagnosis may require invasive procedures to demonstrate histological evidence of caseating granulomas or microbiological evidence of the organism on smear or culture. Drug resistance is an emerging problem that requires vigilance and extra effort to acquire a complete drug sensitivity profile for each tuberculous effusion treated. Nucleic acid amplification tests such as Xpert MTB/RIF can be invaluable in this instance; however, the yield is low in pleural fluid. Treatment consists of standard anti‐tuberculous therapy or a guideline‐based individualized regimen in the case of drug resistance. There is low‐quality evidence that suggests possible benefit from corticosteroids; however, they are not currently recommended due to concomitant increased risk of adverse effects. Small studies report some short‐ and long‐term benefit from interventions such as therapeutic thoracentesis, intrapleural fibrinolytics and surgery but many questions remain to be answered.

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Section: Diagnosismentioning

confidence: 99%

Section: Pleural Biopsymentioning

confidence: 99%

Tuberculous pleural effusion

2019

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“…Molecular diagnostic tools are increasingly utilized to diagnose TB and detect drug resistance for both pulmonary and extrapulmonary diseases . In a study by Christopher et al , Xpert MTB/RIF assay on the thoracoscopic biopsy gave a substantially higher yield of 45% than biopsy culture (39%), pleural fluid culture (17%) or pleural fluid Xpert MTB/RIF (14%) among 73 patients with TB confirmed by histopathology on thoracoscopic biopsy. Among 61 cases of endobronchial TB diagnosed on bronchoscopic features, histology and positive sputum or tissue TB cultures in another study by Zhang et al , Xpert MTB/RIF performed on bronchoscopic brushing and biopsy had sensitivities of 57% and 64%, respectively, as compared to 13.1%, 32.8%, 36.1% and 68.9% for sputum smear, bronchial brush smear, sputum culture and tissue culture, respectively.…”

Section: Tuberculosismentioning

confidence: 99%

Contemporary Concise Review 2018: Respiratory infections and tuberculosis

Hui

Leung

2019

Respirology

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“…13.3% (95% CI: 4-31%); thus, the authors suggested that Xpert was not the ideal diagnostic tool for pleural tuberculosis [24]. The same team improved their methods and increased the sensitivity of Xpert in diagnosing tuberculous pleuritis to 45.0% (95% CI: 32.1-58.4) [14]. They explained that the low sensitivity in their previous study published in 2013 was probably due to the small amount of pleural tissue taken using a closed pleural biopsy.…”

Section: Discussionmentioning

confidence: 99%

“…The pooled sensitivity of Xpert in the diagnosis of tuberculous pleural effusion (TPE) was between 30% and 51% [10][11][12]. Studies have shown that pleural biopsies taken under medical thoracoscopy are better specimens for diagnosing tuberculous pleuritis compared to pleural fluid [9,13,14]. Our group previously evaluated the performance of Xpert on urine specimens for the rapid diagnosis of urinary tract tuberculosis and indicated that Xpert showed a better performance than smears and cultures in detecting urinary tract tuberculosis and that it could be considered for the diagnosis of urinary tract tuberculosis [15].…”

Section: Introductionmentioning

confidence: 99%

Performance of Xpert® MTB/RIF in diagnosing tuberculous pleuritis using thoracoscopic pleural biopsies

Liu¹,

Liu²,

Sun³

et al. 2020

Preprint

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Background: Etiological diagnosis of tuberculous pleuritis is challenging owing to the low number of Mycobacterium tuberculosis (MTB) cells in the affected region. Moreover, currently available methods, such as detection of acid-fast bacilli and microbiological cultures, are not always conducive to timely diagnosis and treatment. Objectives: We evaluated the performance of GeneXpert MTB/RIF assay (referred to as “Xpert” hereafter) in detecting MTB in difficult-to-diagnose patients using suspensions of pleural biopsy tissue specimens under direct thoracoscopic guidance. Methods: All suspected patients with pleural effusion who visited Shenyang Tenth People’s Hospital and Shenyang Chest Hospital between 2017 and 2018 were screened. Excluding the confirmed patients, the remaining 160 patients with unexplained pleural effusion underwent local anesthesia, and an intercostal incision of approximately 1.0 cm was made for biopsy. The specimen was used for pathological and etiological examination. The performance of Xpert MTB/RIF test was evaluated for its sensitivity, specificity, and the positive and negative predictive values (PPV and NPV, respectively) against the gold standards, MGIT 960 culture, and a composite reference standard (CRS). Results: The sensitivity and specificity of Xpert were 69.84% and 66.67%, respectively against those of MGIT 960. The PPV and NPV of Xpert were 59.46% and 75.95%, respectively. The sensitivity of Xpert was 70.27% against CRS, which was significantly higher than that of MGIT at 59.26%. The PPV and NPV of Xpert against CRS were 100.0% and 58.75%, respectively. Conclusions: Xpert showed better sensitivity than MGIT in the pleural biopsy and is a potential tool for diagnosing tuberculous pleuritis.

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Thoracoscopic pleural biopsy improves yield of Xpert MTB/RIF for diagnosis of pleural tuberculosis

Abstract: Thoracoscopic pleural biopsy results in increased sensitivity on Xpert testing.

Cited by 51 publications

References 12 publications

Tuberculous pleural effusion

Tuberculous pleural effusion

Contemporary Concise Review 2018: Respiratory infections and tuberculosis

Performance of Xpert® MTB/RIF in diagnosing tuberculous pleuritis using thoracoscopic pleural biopsies

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