Skip to content

Research at St Andrews

Performance of Xpert MTB/RIF in the diagnosis of tuberculous mediastinal lymphadenopathy by endobronchial ultrasound

Research output: Contribution to journalArticle

Author(s)

Devesh J Dhasmana, Clare Ross, Clare J Bradley, David W Connell, Peter M George, Aran Singanayagam, Annette Jepson, Clare Craig, Corrina Wright, Philip L Molyneaux, Melissa Wickremasinghe, Ajit Lalvani, Graham S Cooke, Onn Min Kon

School/Research organisations

Abstract

RATIONALE: The Xpert (GeneXpert) MTB/RIF, an integrated polymerase chain reaction assay, has not been systematically studied in extrapulmonary and in particular mediastinal tuberculosis (TB).

OBJECTIVES: To investigate the performance of Xpert MTB/RIF in the diagnosis of intrathoracic nodal TB in a large tertiary urban medical center in the UK.

METHODS: We collected clinical, cytological, and microbiological data from two cohorts: 116 consecutive patients referred with mediastinal lymphadenopathy with detailed diagnostic information obtained, and an immediately subsequent second cohort of 52 consecutive patients with microbiologically confirmed mediastinal TB lymphadenopathy. All data were derived between January 2010 and October 2012. All patients underwent endobronchial ultrasound and transbronchial needle aspiration (TBNA). The performance of a single Xpert MTB/RIF assay alongside standard investigations, cytology, and microscopy/culture was evaluated against culture-confirmed TB.

MEASUREMENTS AND MAIN RESULTS: Microbiologically confirmed TB mediastinal lymphadenopathy was diagnosed in a total of 88 patients from both cohorts. Three culture-negative cases with associated caseating granulomatous inflammation on TBNA were given a probable diagnosis. A single Xpert MTB/RIF assay demonstrated overall sensitivity for culture-positive TB of 72.6% (62.3-81.0%). Xpert specificity from cohort 1 was 96.3% (89.1-99.1%). The positive predictive value was 88.9% (69.7-97.1%), negative predictive value was 86.5% (76.9-92.1%), and odds ratio was 51.3 (24.0-98.0) for correctly identifying culture-positive disease. Xpert captured all microscopy-positive cases (14 of 14) and the majority of microscopy-negative cases (48 of 71, 67.6%). Among the cases that were culture positive by TBNA, Xpert identified two-thirds of the multiple drug-resistant TB cases, leading to immediate regimen change up to 5 weeks ahead of positive cultures. The use of Xpert combined with cytology increased the sensitivity to 96.6%.

CONCLUSIONS: Xpert MTB/RIF provides a rapid, useful, and accurate test to diagnose mediastinal nodal TB in intermediate-incidence settings. The additional use of TBNA cytology further enhances the sensitivity of Xpert. This combination can facilitate rapid risk assessment and prompt TB treatment.

Close

Details

Original languageEnglish
Pages (from-to)392-6
Number of pages5
JournalAnnals of the American Thoracic Society
Volume11
Issue number3
DOIs
Publication statusPublished - Mar 2014

    Research areas

  • Adolescent, Adult, Aged, Aged, 80 and over, Antibiotics, Antitubercular, Bronchoscopy, Cohort Studies, Drug Resistance, Bacterial, Endoscopic Ultrasound-Guided Fine Needle Aspiration, Female, Humans, Lymphatic Diseases, Male, Mediastinal Diseases, Middle Aged, Mycobacterium tuberculosis, Polymerase Chain Reaction, Rifampin, Sensitivity and Specificity, Tuberculosis, Multidrug-Resistant, Young Adult

Discover related content
Find related publications, people, projects and more using interactive charts.

View graph of relations

Related by author

  1. An international perspective on hospitalized patients with viral community-acquired pneumonia

    Radovanovic, D., Sotgiu, G., Jankovic, M., Mahesh, P. A., Marcos, P. J., Abdalla, M. I., Di Pasquale, M. F., Gramegna, A., Terraneo, S., Blasi, F., Santus, P., Aliberti, S., Reyes, L. F., Restrepo, M. I. & GLIMP Study Group, Feb 2019, In : European Journal of Internal Medicine. 60, p. 54-70 17 p.

    Research output: Contribution to journalArticle

  2. Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia: a multinational point prevalence study of hospitalised patients

    Restrepo, M. I., Babu, B. L., Reyes, L. F., Chalmers, J. D., Soni, N. J., Sibila, O., Faverio, P., Cilloniz, C., Rodriguez-Cintron, W., Aliberti, S. & GLIMP, 9 Aug 2018, In : European Respiratory Journal. 52, 2, 1701190.

    Research output: Contribution to journalArticle

  3. Genomic investigation unmasks evidence of transmission across mycobacterium abscessus cystic fibrosis patients

    Alateah, S., Peters, C., Dhasmana, DJ., Pettigrew, K., Fallon, R., Seagar, A., Sloan, DJ., Laurenson, IF., Holden, M. & Gillespie, S., 15 Dec 2017, In : Thorax. 72, Suppl 3, p. A56-A56

    Research output: Contribution to journalAbstract

  4. Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: an international case-cohort study

    Walsh, S. L. F., Maher, T. M., Kolb, M., Poletti, V., Nusser, R., Richeldi, L., Vancheri, C., Wilsher, M. L., Antoniou, K. M., Behr, J., Bendstrup, E., Brown, K., Calandriello, L., Corte, T. J., Cottin, V., Crestani, B., Flaherty, K., Glaspole, I., Grutters, J., Inoue, Y. & 25 others, Kokosi, M., Kondoh, Y., Kouranos, V., Kreuter, M., Johannson, K., Judge, E., Ley, B., Margaritopoulos, G., Martinez, F. J., Molina-Molina, M., Morais, A., Nunes, H., Raghu, G., Ryerson, C. J., Selman, M., Spagnolo, P., Taniguchi, H., Tomassetti, S., Valeyre, D., Wijsenbeek, M., Wuyts, W., Hansell, D., Wells, A., IPF Project Consortium & Dhasmana, D. J., 31 Aug 2017, In : European Respiratory Journal. 50, 2, 10 p., 1700936.

    Research output: Contribution to journalArticle

  5. Burkholderia cepacia complex and limited cutaneous vasculitis in patients with cystic fibrosis: a case series

    Kayria, M., Chris, O., Dhasmana, D. J., Nilesh, M., Hodson, M. E., Khin, G., Diana, B. & Simmonds, N. J., 3 Apr 2017, In : JRSM Open. 8, 4, p. 1-4

    Research output: Contribution to journalArticle

ID: 241184998

Top