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Performance of interferon- γ release assay in the diagnosis of tuberculous lymphadenitis: a meta-analysis

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ABSTRACT

Background: The diagnostic values of interferon-gamma release assays (IGRA) in tuberculosis (TB) vary a lot with different site of infections, with especially higher sensitivities in chronic forms of TB such as tuberculosis of the lymph node. We conducted a meta-analysis to comprehensively evaluate the overall accuracy of diagnostic IGRA for tuberculous lymphadenitis.

Methods: Pubmed, Web of Science, EMBASE, Wanfang and CNKI databases up to February 17, 2017 were searched to identify published studies. The study quality was evaluated using the QUADAS-2 checklist. The pooled estimates of diagnostic parameters were generated using a bivariate random-effects model and summary receiver operating characteristic (SROC) curves were used to summarize global performance.

Results: A total of ten qualified studies, performed in Korea or China, including 1,084 patients, were enrolled in this meta-analysis. The pooled estimates of diagnostic accuracy were as follows: sensitivity, 0.89 (95% CI [0.85–0.92]); specificity, 0.81 (95% CI [0.77–0.83]); positive likelihood ratio (PLR), 4.25 (95% CI [2.79–6.47]); negative likelihood ratio (NLR), 0.16 (95% CI [0.12–0.22]); and area under the curve (AUC) was 0.93. According to subgroup analyses, studies conducted using QuantiFERON-TB, in Korean population and focusing on cervical lymphadenitis exhibited relative higher specificity while lower sensitivity. No evidence of publication bias was identified.

Conclusions: IGRA exhibits high diagnostic accuracy in tuberculous lymphadenitis. The diagnostic value of IGRA differed by different IGRA methods, ethnicity and lymphadenitis location. Our conclusion may be more applicable to population from TB prevalent areas.

No MeSH data available.


Summary receiver operator characteristics (SROC) of IGRA on summary estimates of sensitivity and specificity.AUC, area under the curve; SE, standard error
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fig-3: Summary receiver operator characteristics (SROC) of IGRA on summary estimates of sensitivity and specificity.AUC, area under the curve; SE, standard error

Mentions: Chi-square values demonstrated no significant between-study heterogeneity among the following diagnostic parameters: sensitivity, 5.38 (P = 0.80) and NLR, 5.14 (P = 0.82), while significant heterogeneity was found for specificity (P < 0.10) and PLR (P < 0.10). The pooled estimates of diagnostic accuracy were listed as follows (Fig. 2): sensitivity, 0.89 (95% CI [0.85–0.92]); specificity, 0.81 (95% CI [0.77–0.83]); PLR, 4.25 (95% CI [2.79–6.47]); NLR, 0.16 (95% CI [0.12–0.22]). Figure 3 shows the SROC curve and the area under the curve (AUC) was 0.93.


Performance of interferon- γ release assay in the diagnosis of tuberculous lymphadenitis: a meta-analysis
Summary receiver operator characteristics (SROC) of IGRA on summary estimates of sensitivity and specificity.AUC, area under the curve; SE, standard error
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5391793&req=5

fig-3: Summary receiver operator characteristics (SROC) of IGRA on summary estimates of sensitivity and specificity.AUC, area under the curve; SE, standard error
Mentions: Chi-square values demonstrated no significant between-study heterogeneity among the following diagnostic parameters: sensitivity, 5.38 (P = 0.80) and NLR, 5.14 (P = 0.82), while significant heterogeneity was found for specificity (P < 0.10) and PLR (P < 0.10). The pooled estimates of diagnostic accuracy were listed as follows (Fig. 2): sensitivity, 0.89 (95% CI [0.85–0.92]); specificity, 0.81 (95% CI [0.77–0.83]); PLR, 4.25 (95% CI [2.79–6.47]); NLR, 0.16 (95% CI [0.12–0.22]). Figure 3 shows the SROC curve and the area under the curve (AUC) was 0.93.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: The diagnostic values of interferon-gamma release assays (IGRA) in tuberculosis (TB) vary a lot with different site of infections, with especially higher sensitivities in chronic forms of TB such as tuberculosis of the lymph node. We conducted a meta-analysis to comprehensively evaluate the overall accuracy of diagnostic IGRA for tuberculous lymphadenitis.

Methods: Pubmed, Web of Science, EMBASE, Wanfang and CNKI databases up to February 17, 2017 were searched to identify published studies. The study quality was evaluated using the QUADAS-2 checklist. The pooled estimates of diagnostic parameters were generated using a bivariate random-effects model and summary receiver operating characteristic (SROC) curves were used to summarize global performance.

Results: A total of ten qualified studies, performed in Korea or China, including 1,084 patients, were enrolled in this meta-analysis. The pooled estimates of diagnostic accuracy were as follows: sensitivity, 0.89 (95% CI [0.85&ndash;0.92]); specificity, 0.81 (95% CI [0.77&ndash;0.83]); positive likelihood ratio (PLR), 4.25 (95% CI [2.79&ndash;6.47]); negative likelihood ratio (NLR), 0.16 (95% CI [0.12&ndash;0.22]); and area under the curve (AUC) was 0.93. According to subgroup analyses, studies conducted using QuantiFERON-TB, in Korean population and focusing on cervical lymphadenitis exhibited relative higher specificity while lower sensitivity. No evidence of publication bias was identified.

Conclusions: IGRA exhibits high diagnostic accuracy in tuberculous lymphadenitis. The diagnostic value of IGRA differed by different IGRA methods, ethnicity and lymphadenitis location. Our conclusion may be more applicable to population from TB prevalent areas.

No MeSH data available.