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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.


Quality assessment of studies of the bronchoalveolar lavage enzyme-linked immunospot assay. (A) Graph of risk of bias and applicability concerns. (B) Summary of risk of bias and applicability concerns.
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Figure 2: Quality assessment of studies of the bronchoalveolar lavage enzyme-linked immunospot assay. (A) Graph of risk of bias and applicability concerns. (B) Summary of risk of bias and applicability concerns.

Mentions: QUADAS-2 was proposed in 2011 and was integrated into RevMan 5.2 in 2012.22,35 This instrument assesses methodological quality in terms of patient selection, index test, reference standard, and flow and timing. When a criterion is fulfilled, an answer of Yes is given; if it is unclear whether a criterion is fulfilled, Unclear is reported; and if a criterion is not fulfilled, No is reported. These responses for each criterion are then converted into risk of bias and applicability concerns. The quality of studies in our meta-analysis was generally good, but 3 studies were judged to have unclear risk of bias (Figure 2). This risk of bias was related to the index test in all 3 studies27,28,33 as well as to the reference standard in 2 of them.27,33 Two studies were judged to have high risk of bias,29,31 related to flow and timing.


Accuracy of the Bronchoalveolar Lavage Enzyme-Linked Immunospot Assay for the Diagnosis of Pulmonary Tuberculosis
Quality assessment of studies of the bronchoalveolar lavage enzyme-linked immunospot assay. (A) Graph of risk of bias and applicability concerns. (B) Summary of risk of bias and applicability concerns.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Quality assessment of studies of the bronchoalveolar lavage enzyme-linked immunospot assay. (A) Graph of risk of bias and applicability concerns. (B) Summary of risk of bias and applicability concerns.
Mentions: QUADAS-2 was proposed in 2011 and was integrated into RevMan 5.2 in 2012.22,35 This instrument assesses methodological quality in terms of patient selection, index test, reference standard, and flow and timing. When a criterion is fulfilled, an answer of Yes is given; if it is unclear whether a criterion is fulfilled, Unclear is reported; and if a criterion is not fulfilled, No is reported. These responses for each criterion are then converted into risk of bias and applicability concerns. The quality of studies in our meta-analysis was generally good, but 3 studies were judged to have unclear risk of bias (Figure 2). This risk of bias was related to the index test in all 3 studies27,28,33 as well as to the reference standard in 2 of them.27,33 Two studies were judged to have high risk of bias,29,31 related to flow and timing.

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.