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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.


Related in: MedlinePlus

Summary receiver operating characteristic (SROC) curves for the bronchoalveolar lavage enzyme-linked immunospot assay. Solid circles represent each study included in the meta-analysis. The size of each study is indicated by the size of the solid circle. The regression SROC curves summarize the overall diagnostic accuracy.
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Figure 5: Summary receiver operating characteristic (SROC) curves for the bronchoalveolar lavage enzyme-linked immunospot assay. Solid circles represent each study included in the meta-analysis. The size of each study is indicated by the size of the solid circle. The regression SROC curves summarize the overall diagnostic accuracy.

Mentions: An SROC curve was calculated for BAL ELISPOT, this curve plots sensitivity against 1-specificity from individual studies (Figure 5). As a global measure of test efficacy, we determined the Q-value; this is the point of intersection between the SROC curve and the diagonal running from the left upper corner to the lower right corner of the ROC space. The Q-value corresponds to the highest common value of sensitivity and specificity, as well as the point where sensitivity equals specificity. The SROC curve was positioned near the desirable upper left corner of the plot, suggesting good performance, and Q-value for sensitivity and specificity was 0.90 (SEM 0.036), with an AUC of 0.96 (SEM 0.025). These data indicated high overall accuracy for the BAL ELISPOT assay in PTB diagnosis.


Accuracy of the Bronchoalveolar Lavage Enzyme-Linked Immunospot Assay for the Diagnosis of Pulmonary Tuberculosis
Summary receiver operating characteristic (SROC) curves for the bronchoalveolar lavage enzyme-linked immunospot assay. Solid circles represent each study included in the meta-analysis. The size of each study is indicated by the size of the solid circle. The regression SROC curves summarize the overall diagnostic accuracy.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Summary receiver operating characteristic (SROC) curves for the bronchoalveolar lavage enzyme-linked immunospot assay. Solid circles represent each study included in the meta-analysis. The size of each study is indicated by the size of the solid circle. The regression SROC curves summarize the overall diagnostic accuracy.
Mentions: An SROC curve was calculated for BAL ELISPOT, this curve plots sensitivity against 1-specificity from individual studies (Figure 5). As a global measure of test efficacy, we determined the Q-value; this is the point of intersection between the SROC curve and the diagonal running from the left upper corner to the lower right corner of the ROC space. The Q-value corresponds to the highest common value of sensitivity and specificity, as well as the point where sensitivity equals specificity. The SROC curve was positioned near the desirable upper left corner of the plot, suggesting good performance, and Q-value for sensitivity and specificity was 0.90 (SEM 0.036), with an AUC of 0.96 (SEM 0.025). These data indicated high overall accuracy for the BAL ELISPOT assay in PTB diagnosis.

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.


Related in: MedlinePlus