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Accuracy of the Bronchoalveolar Lavage Enzyme-Linked Immunospot Assay for the Diagnosis of Pulmonary Tuberculosis

View Article: PubMed Central - PubMed

ABSTRACT

Assessing of local immune response may improve the accuracy of pulmonary tuberculosis (PTB) diagnosis. Many studies have investigated diagnosing PTB based on enzyme-linked immunospot (ELISPOT) assay of bronchoalveolar lavage (BAL) fluid, but the results have been inconclusive. We meta-analyzed the available evidences on overall diagnostic performance of ELISPOT assay of BAL fluid for diagnosing PTB.

A systematic literature search was performed using PubMed, Embase, Wangfang, Weipu, and CNKI. Data were pooled on sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). Overall test performance was summarized using summary receiver operating characteristic curves and the area under the curve (AUC). Deeks test was used to test for potential publication bias.

Seven publications with 814 subjects met our inclusion criteria and were included in this meta-analysis. The following pooled estimates for diagnostic parameters were obtained: sensitivity, 0.90 (95% CI: 0.85–0.94); specificity, 0.80 (95% CI: 0.77–0.84); PLR, 5.08 (95% CI: 2.70–9.57); NLR, 0.13 (95% CI: 0.06–0.28); DOR, 49.12 (95% CI: 12.97–186.00); and AUC, 0.96. No publication bias was identified.

The available evidence suggests that ELISPOT assay of BAL fluid is a useful rapid diagnostic test for PTB. The results of this assay should be interpreted in parallel with clinical findings and the results of conventional tests.

No MeSH data available.


Flow diagram of included and excluded studies.
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Figure 1: Flow diagram of included and excluded studies.

Mentions: Seven studies assessing BAL ELISPOT for PTB diagnosis were included in the meta-analysis based on the inclusion criteria (Figure 1, Table 1).27–33 The average sample size was 116 (range, 32–347). All patients had been enrolled consecutively and prospectively. Patients were diagnosed with tuberculosis using a recently developed algorithm,34 and M. tuberculosis culture served as the reference standard. In all 7 studies, the ELISPOT-based T-SPOT-TB assay was performed. In 6 studies, the BAL ELISPOT result was considered positive when the test well contained at least 5 more spot-forming cells (SFCs) as the control well and when the test well contained twice the number of SFCs as the control well.27–32 The BAL ELISPOT result was considered negative if it did not meet the criteria for a positive result and if the positive control well contained at least twice the number of SFCs as the control well. Results that met neither of these definitions were considered to be indeterminate. In 1 study, in contrast, a BAL ELISPOT result was considered positive when the test well contained at least 6 more SFCs and had twice the number of SFCs as the control well.33


Accuracy of the Bronchoalveolar Lavage Enzyme-Linked Immunospot Assay for the Diagnosis of Pulmonary Tuberculosis
Flow diagram of included and excluded studies.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998406&req=5

Figure 1: Flow diagram of included and excluded studies.
Mentions: Seven studies assessing BAL ELISPOT for PTB diagnosis were included in the meta-analysis based on the inclusion criteria (Figure 1, Table 1).27–33 The average sample size was 116 (range, 32–347). All patients had been enrolled consecutively and prospectively. Patients were diagnosed with tuberculosis using a recently developed algorithm,34 and M. tuberculosis culture served as the reference standard. In all 7 studies, the ELISPOT-based T-SPOT-TB assay was performed. In 6 studies, the BAL ELISPOT result was considered positive when the test well contained at least 5 more spot-forming cells (SFCs) as the control well and when the test well contained twice the number of SFCs as the control well.27–32 The BAL ELISPOT result was considered negative if it did not meet the criteria for a positive result and if the positive control well contained at least twice the number of SFCs as the control well. Results that met neither of these definitions were considered to be indeterminate. In 1 study, in contrast, a BAL ELISPOT result was considered positive when the test well contained at least 6 more SFCs and had twice the number of SFCs as the control well.33

View Article: PubMed Central - PubMed

ABSTRACT

Assessing of local immune response may improve the accuracy of pulmonary tuberculosis (PTB) diagnosis. Many studies have investigated diagnosing PTB based on enzyme-linked immunospot (ELISPOT) assay of bronchoalveolar lavage (BAL) fluid, but the results have been inconclusive. We meta-analyzed the available evidences on overall diagnostic performance of ELISPOT assay of BAL fluid for diagnosing PTB.

A systematic literature search was performed using PubMed, Embase, Wangfang, Weipu, and CNKI. Data were pooled on sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). Overall test performance was summarized using summary receiver operating characteristic curves and the area under the curve (AUC). Deeks test was used to test for potential publication bias.

Seven publications with 814 subjects met our inclusion criteria and were included in this meta-analysis. The following pooled estimates for diagnostic parameters were obtained: sensitivity, 0.90 (95% CI: 0.85–0.94); specificity, 0.80 (95% CI: 0.77–0.84); PLR, 5.08 (95% CI: 2.70–9.57); NLR, 0.13 (95% CI: 0.06–0.28); DOR, 49.12 (95% CI: 12.97–186.00); and AUC, 0.96. No publication bias was identified.

The available evidence suggests that ELISPOT assay of BAL fluid is a useful rapid diagnostic test for PTB. The results of this assay should be interpreted in parallel with clinical findings and the results of conventional tests.

No MeSH data available.