Xpert MTB/RIF Assay for the Diagnosis of Lymph Node Tuberculosis in Children: A Systematic Review and Meta-Analysis

Abstract

Background: Lymph node tuberculosis (LNTB) is the leading type of extrapulmonary tuberculosis (EPTB) causing death in children. The Xpert MTB/RIF assay is a novel rapid test for the diagnosis of LNTB. Although previous evidence suggests that Xpert is reliably accurate in diagnosing EPTB in children, information is lacking for the specific type of LNTB in children. The aim of this study was to systematically assess the accuracy and reliability of Xpert for the diagnosis of LNTB in children. Methods: We systematically searched four databases, Embase, Cochrane Library, PubMed, and Web of Science, which extracted relevant data according to predefined inclusion and exclusion criteria. The data were analyzed by meta-Disc 1.4 and Stata 12.0 software to determine sensitivity, specificity, diagnostic odds ratio (DOR), etc. Results: A total of 646 samples from 8 studies were included in the analysis. The pooled sensitivity, specificity, negative likelihood ratio (NLR), positive likelihood ratio (PLR,) and combined diagnostic odds ratio (DOR) of Xpert for all samples were 0.79 (95% CI 0.70, 0.87), 0.90 (95% CI 0.86, 0.92), 0.29 (95% CI 0.19, 0.43), 7.20 (95% CI 3.32, 15.60), and 37.56 (95% CI 13.04, 108.15), respectively. The area under the curve (AUC) of the summary receiver operating characteristic (sROC) curve was 0.9050. Conclusion: Overall, Xpert showed moderate sensitivity and high specificity compared with culture in the diagnosis of LNTB in children. In addition, after analyzing the combined diagnostic odds ratio and positive LR, our study showed that Xpert has excellent diagnostic accuracy.

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“…This is because bacteriological evidence has shown it, and the amount of microbes outside the lungs is typically very small [18]. The sensitivity and specificity of FNAB cytology in the diagnosis of tuberculous lymphadenopathy were 88% and 96% [4] as well as 92.50% and 96.49%, respectively [23] while Xpert MTB/RIF has sensitivity and specificity; 78%, 74% [14]; 82.6%, 85% [15]; and 79%, 90% [16]. This study results showed that the pathology report of FNAB is statistically consistent with Xpert MTB/RIF result, while the description does not.…”

“…The International Standard for Tuberculosis Care (ISTC) suggests collecting samples for histological analysis and microbiological testing for suspected extrapulmonary TB [12]. Xpert MTB/RIF, in diagnosing LNTB, has sensitivity and specificity; 78%, 74% [14]; 82.6%, 85% [15]; and 79%, 90% [16]. For the diagnosis of tuberculous lymphadenopathy, Xpert MTB/RIF Ultra has 91%, 72% sensitivity and specificity, respectively [11].…”