Diagnostic accuracy of the Xpert MTB/Rif Ultra for tuberculosis adenitis
| dc.contributor.author | Antel, Katherine | |
| dc.contributor.author | Oosthuizen, Jenna | |
| dc.contributor.author | Malherbe, Francois | |
| dc.contributor.author | Louw, Vernon J | |
| dc.contributor.author | Nicol, Mark P | |
| dc.contributor.author | Maartens, Gary | |
| dc.contributor.author | Verburgh, Estelle | |
| dc.date.accessioned | 2020-01-20T06:49:36Z | |
| dc.date.available | 2020-01-20T06:49:36Z | |
| dc.date.issued | 2020-01-13 | |
| dc.date.updated | 2020-01-19T04:31:34Z | |
| dc.description.abstract | Abstract Background The WHO recently recommended the new Xpert MTB/RIF Ultra assay (Ultra) instead of the Xpert MTB/RIF assay because Ultra has improved sensitivity. We report the diagnostic accuracy of Ultra for tuberculous adenitis in a tuberculosis and HIV endemic setting. Methods We obtained fine-needle aspirates (FNA) and lymph node tissue by core-needle biopsy in adult patients with peripheral lymphadenopathy of >20 mm. Ultra and mycobacterial culture were performed on FNA and tissue specimens, with histological examination of tissue specimens. We assessed the diagnostic accuracy of Ultra against a composite reference standard of ‘definite tuberculosis’ (microbiological criteria) or ‘probable tuberculosis’ (histological and clinical criteria). Results We prospectively evaluated 99 participants of whom 50 were HIV positive: 21 had ‘definite tuberculosis’, 15 ‘probable tuberculosis’ and 63 did not have tuberculosis (of whom 38% had lymphoma and 19% disseminated malignancy). Using the composite reference standard the Ultra sensitivity on FNA was 70% (95% CI 51–85; 21 of 30), and on tissue was 67% (45–84; 16/24) these were far superior to the detection of acid-fast bacilli on an FNA (26%; 7/27); AFB on tissue (33%; 8/24); or tissue culture (39%; 9/23). The detection of granulomas on histology had high senstivity (83%) but the lowest specficity. When compared with culture the Ultra on FNA had a sensitvity of 78% (40-97; 7/9) and tissue 90% (55-100; 9/10). Conclusions Ultra performed on FNA or tissue of a lymph node had good sensitivity and high specificity. Ultra had a higher yield than culture and has the advantage of being a rapid test. Ultra on FNA would be an appropriate initial investigation for lymphadenopathy in tuberculosis endemic areas followed by a core biopsy for histopathology with a repeat Ultra on tissue if granulomas are present. | |
| dc.identifier.apacitation | Antel, K., Oosthuizen, J., Malherbe, F., Louw, V. J., Nicol, M. P., Maartens, G., & Verburgh, E. (2020). Diagnostic accuracy of the Xpert MTB/Rif Ultra for tuberculosis adenitis. http://hdl.handle.net/11427/30753 | en_ZA |
| dc.identifier.chicagocitation | Antel, Katherine, Jenna Oosthuizen, Francois Malherbe, Vernon J Louw, Mark P Nicol, Gary Maartens, and Estelle Verburgh "Diagnostic accuracy of the Xpert MTB/Rif Ultra for tuberculosis adenitis." (2020) http://hdl.handle.net/11427/30753 | en_ZA |
| dc.identifier.citation | BMC Infectious Diseases. 2020 Jan 13;20(1):33 | |
| dc.identifier.ris | TY - Journal Article AU - Antel, Katherine AU - Oosthuizen, Jenna AU - Malherbe, Francois AU - Louw, Vernon J AU - Nicol, Mark P AU - Maartens, Gary AU - Verburgh, Estelle AB - Abstract Background The WHO recently recommended the new Xpert MTB/RIF Ultra assay (Ultra) instead of the Xpert MTB/RIF assay because Ultra has improved sensitivity. We report the diagnostic accuracy of Ultra for tuberculous adenitis in a tuberculosis and HIV endemic setting. Methods We obtained fine-needle aspirates (FNA) and lymph node tissue by core-needle biopsy in adult patients with peripheral lymphadenopathy of >20 mm. Ultra and mycobacterial culture were performed on FNA and tissue specimens, with histological examination of tissue specimens. We assessed the diagnostic accuracy of Ultra against a composite reference standard of ‘definite tuberculosis’ (microbiological criteria) or ‘probable tuberculosis’ (histological and clinical criteria). Results We prospectively evaluated 99 participants of whom 50 were HIV positive: 21 had ‘definite tuberculosis’, 15 ‘probable tuberculosis’ and 63 did not have tuberculosis (of whom 38% had lymphoma and 19% disseminated malignancy). Using the composite reference standard the Ultra sensitivity on FNA was 70% (95% CI 51–85; 21 of 30), and on tissue was 67% (45–84; 16/24) these were far superior to the detection of acid-fast bacilli on an FNA (26%; 7/27); AFB on tissue (33%; 8/24); or tissue culture (39%; 9/23). The detection of granulomas on histology had high senstivity (83%) but the lowest specficity. When compared with culture the Ultra on FNA had a sensitvity of 78% (40-97; 7/9) and tissue 90% (55-100; 9/10). Conclusions Ultra performed on FNA or tissue of a lymph node had good sensitivity and high specificity. Ultra had a higher yield than culture and has the advantage of being a rapid test. Ultra on FNA would be an appropriate initial investigation for lymphadenopathy in tuberculosis endemic areas followed by a core biopsy for histopathology with a repeat Ultra on tissue if granulomas are present. DA - 2020-01-13 DB - OpenUCT DP - University of Cape Town KW - Tuberculosis KW - Xpert MTB/RIF Ultra KW - HIV KW - Fine-needle aspiration KW - Core needle biopsy LK - https://open.uct.ac.za PY - 2020 T1 - Diagnostic accuracy of the Xpert MTB/Rif Ultra for tuberculosis adenitis TI - Diagnostic accuracy of the Xpert MTB/Rif Ultra for tuberculosis adenitis UR - http://hdl.handle.net/11427/30753 ER - | en_ZA |
| dc.identifier.uri | https://doi.org/10.1186/s12879-019-4749-x | |
| dc.identifier.uri | http://hdl.handle.net/11427/30753 | |
| dc.identifier.vancouvercitation | Antel K, Oosthuizen J, Malherbe F, Louw VJ, Nicol MP, Maartens G, et al. Diagnostic accuracy of the Xpert MTB/Rif Ultra for tuberculosis adenitis. 2020; http://hdl.handle.net/11427/30753. | en_ZA |
| dc.language.rfc3066 | en | |
| dc.rights.holder | The Author(s). | |
| dc.subject | Tuberculosis | |
| dc.subject | Xpert MTB/RIF Ultra | |
| dc.subject | HIV | |
| dc.subject | Fine-needle aspiration | |
| dc.subject | Core needle biopsy | |
| dc.title | Diagnostic accuracy of the Xpert MTB/Rif Ultra for tuberculosis adenitis | |
| dc.type | Journal Article |