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

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Performance of Xpert MTB/RIF in the diagnosis of tuberculous mediastinal lymphadenopathy by endobronchial ultrasound. / Dhasmana, Devesh J; Ross, Clare; Bradley, Clare J; Connell, David W; George, Peter M; Singanayagam, Aran; Jepson, Annette; Craig, Clare; Wright, Corrina; Molyneaux, Philip L; Wickremasinghe, Melissa; Lalvani, Ajit; Cooke, Graham S; Kon, Onn Min.

In: Annals of the American Thoracic Society, Vol. 11, No. 3, 03.2014, p. 392-6.

Research output: Contribution to journalArticle

Harvard

Dhasmana, DJ, Ross, C, Bradley, CJ, Connell, DW, George, PM, Singanayagam, A, Jepson, A, Craig, C, Wright, C, Molyneaux, PL, Wickremasinghe, M, Lalvani, A, Cooke, GS & Kon, OM 2014, 'Performance of Xpert MTB/RIF in the diagnosis of tuberculous mediastinal lymphadenopathy by endobronchial ultrasound', Annals of the American Thoracic Society, vol. 11, no. 3, pp. 392-6. https://doi.org/10.1513/AnnalsATS.201308-250OC

APA

Dhasmana, D. J., Ross, C., Bradley, C. J., Connell, D. W., George, P. M., Singanayagam, A., ... Kon, O. M. (2014). Performance of Xpert MTB/RIF in the diagnosis of tuberculous mediastinal lymphadenopathy by endobronchial ultrasound. Annals of the American Thoracic Society, 11(3), 392-6. https://doi.org/10.1513/AnnalsATS.201308-250OC

Vancouver

Dhasmana DJ, Ross C, Bradley CJ, Connell DW, George PM, Singanayagam A et al. Performance of Xpert MTB/RIF in the diagnosis of tuberculous mediastinal lymphadenopathy by endobronchial ultrasound. Annals of the American Thoracic Society. 2014 Mar;11(3):392-6. https://doi.org/10.1513/AnnalsATS.201308-250OC

Author

Dhasmana, Devesh J ; Ross, Clare ; Bradley, Clare J ; Connell, David W ; George, Peter M ; Singanayagam, Aran ; Jepson, Annette ; Craig, Clare ; Wright, Corrina ; Molyneaux, Philip L ; Wickremasinghe, Melissa ; Lalvani, Ajit ; Cooke, Graham S ; Kon, Onn Min. / Performance of Xpert MTB/RIF in the diagnosis of tuberculous mediastinal lymphadenopathy by endobronchial ultrasound. In: Annals of the American Thoracic Society. 2014 ; Vol. 11, No. 3. pp. 392-6.

Bibtex - Download

@article{77d2b85e5f52446298d956376d07d1fc,
title = "Performance of Xpert MTB/RIF in the diagnosis of tuberculous mediastinal lymphadenopathy by endobronchial ultrasound",
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.",
keywords = "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",
author = "Dhasmana, {Devesh J} and Clare Ross and Bradley, {Clare J} and Connell, {David W} and George, {Peter M} and Aran Singanayagam and Annette Jepson and Clare Craig and Corrina Wright and Molyneaux, {Philip L} and Melissa Wickremasinghe and Ajit Lalvani and Cooke, {Graham S} and Kon, {Onn Min}",
year = "2014",
month = "3",
doi = "10.1513/AnnalsATS.201308-250OC",
language = "English",
volume = "11",
pages = "392--6",
journal = "Annals of the American Thoracic Society",
issn = "2325-6621",
publisher = "American Thoracic Society",
number = "3",

}

RIS (suitable for import to EndNote) - Download

TY - JOUR

T1 - Performance of Xpert MTB/RIF in the diagnosis of tuberculous mediastinal lymphadenopathy by endobronchial ultrasound

AU - Dhasmana, Devesh J

AU - Ross, Clare

AU - Bradley, Clare J

AU - Connell, David W

AU - George, Peter M

AU - Singanayagam, Aran

AU - Jepson, Annette

AU - Craig, Clare

AU - Wright, Corrina

AU - Molyneaux, Philip L

AU - Wickremasinghe, Melissa

AU - Lalvani, Ajit

AU - Cooke, Graham S

AU - Kon, Onn Min

PY - 2014/3

Y1 - 2014/3

N2 - 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.

AB - 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.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Antibiotics, Antitubercular

KW - Bronchoscopy

KW - Cohort Studies

KW - Drug Resistance, Bacterial

KW - Endoscopic Ultrasound-Guided Fine Needle Aspiration

KW - Female

KW - Humans

KW - Lymphatic Diseases

KW - Male

KW - Mediastinal Diseases

KW - Middle Aged

KW - Mycobacterium tuberculosis

KW - Polymerase Chain Reaction

KW - Rifampin

KW - Sensitivity and Specificity

KW - Tuberculosis, Multidrug-Resistant

KW - Young Adult

U2 - 10.1513/AnnalsATS.201308-250OC

DO - 10.1513/AnnalsATS.201308-250OC

M3 - Article

VL - 11

SP - 392

EP - 396

JO - Annals of the American Thoracic Society

JF - Annals of the American Thoracic Society

SN - 2325-6621

IS - 3

ER -

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