Journal of thoracic disease · 2025
Performance of metagenomic next-generation sequencing, Xpert MTB/RIF and acid-fast staining for diagnosing tuberculous pleurisy and empyema.
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Liu Hong, Ji Saiguang, Xing Fuchen, Wang Chenyan, Sun Wei, Shao Hongan, Hu Chunmei
Аннотация
BACKGROUND: The detection of Mycobacterium tuberculosis (MTB) is an important basis for the diagnosis of tuberculosis. Detecting fresh tissue, pus, and other samples is challenging. Both metagenomic next-generation sequencing (mNGS) and Xpert MTB/RIF have demonstrated excellent performance in the diagnosis of tuberculosis; however, their research base is still lacking in tissue or pus samples. We hope to explore the detection performance of mNGS and Xpert MTB/RIF in these sample types through this study.
METHODS: This study enrolled 154 patients suspected of having tuberculosis. Fresh tissues, pleural fluid or pus were collected from these patients and performed mNGS, Xpert, and acid-fast staining (AFS) tests. Their detection performance was statistically analyzed and compared.
RESULTS: Overall, the positivity rate of mNGS was 48.05% (74/154), Xpert was 44.44% (44/99), and AFS was 57.34% (82/143). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of mNGS were 55.22%, 100%, 100% and 25%, respectively. The sensitivity, specificity, PPV and NPV of Xpert were 48.35%, 100%, 100%, 18.97%, respectively. The sensitivity, specificity, PPV and NPV of acid-fast stain were 58.59%, 53.33%, 91.46%, 13.11%, respectively. A total of 93 samples underwent all three types of testing, and 45.16% (42/93) were completely consistent in the results of the three tests. The analysis results of these samples showed that the sensitivity, specificity, PPV and NPV of mNGS were 65.88%, 100%, 100%, 21.62%, respectively. The sensitivity, specificity, PPV and NPV of Xpert were 49.41%, 100%, 100%, 15.69%, respectively. The sensitivity, specificity, PPV and NPV of acid-fast stain were 57.65%, 62.50%, 94.23%, 12.20%, respectively. The sensitivity of mNGS was significantly higher than that of Xpert (P=0.01).
CONCLUSIONS: Our research results indicate that mNGS and AFS have higher sensitivity compared to Xpert, while mNGS and Xpert have higher specificity.
METHODS: This study enrolled 154 patients suspected of having tuberculosis. Fresh tissues, pleural fluid or pus were collected from these patients and performed mNGS, Xpert, and acid-fast staining (AFS) tests. Their detection performance was statistically analyzed and compared.
RESULTS: Overall, the positivity rate of mNGS was 48.05% (74/154), Xpert was 44.44% (44/99), and AFS was 57.34% (82/143). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of mNGS were 55.22%, 100%, 100% and 25%, respectively. The sensitivity, specificity, PPV and NPV of Xpert were 48.35%, 100%, 100%, 18.97%, respectively. The sensitivity, specificity, PPV and NPV of acid-fast stain were 58.59%, 53.33%, 91.46%, 13.11%, respectively. A total of 93 samples underwent all three types of testing, and 45.16% (42/93) were completely consistent in the results of the three tests. The analysis results of these samples showed that the sensitivity, specificity, PPV and NPV of mNGS were 65.88%, 100%, 100%, 21.62%, respectively. The sensitivity, specificity, PPV and NPV of Xpert were 49.41%, 100%, 100%, 15.69%, respectively. The sensitivity, specificity, PPV and NPV of acid-fast stain were 57.65%, 62.50%, 94.23%, 12.20%, respectively. The sensitivity of mNGS was significantly higher than that of Xpert (P=0.01).
CONCLUSIONS: Our research results indicate that mNGS and AFS have higher sensitivity compared to Xpert, while mNGS and Xpert have higher specificity.