Evidence map›Paper›PMID 31931736›Full record

ArticleBMC infectious diseases2020

Diagnostic accuracy of the Xpert MTB/Rif Ultra for tuberculosis adenitis.

Katherine Antel, Jenna Oosthuizen, Francois Malherbe, Vernon J Louw, Mark P Nicol, Gary Maartens, Estelle Verburgh

Erratum issuedOpen access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC infectious diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 23 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 3 pooled it
3.9field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 3 syntheses or guidelines pooled it, 39 citations in OpenAlex.

  1. Pooled it
  2. Evaluating the efficacy of stool sample on Xpert MTB/RIF Ultra and its comparison with other sample types by meta-analysis for TB diagnostics.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2022
    Pooled it
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  11. Silicotuberculosis: a critical narrative review.European respiratory review : an official journal of the European Respiratory Society · 2024
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 1 institution in 1 country.

Katherine AntelDivision of Haematology, Department of Medicine, University of Cape Town, Anzio Rd, Observatory, Cape Town, 7925, South Africa. katherineantel@gmail.com.ORCID http://orcid.org/0000-0002-9000-5504
Jenna OosthuizenDivision of Haematology, Department of Medicine, University of Cape Town, Anzio Rd, Observatory, Cape Town, 7925, South Africa.
Francois MalherbeDepartment of Surgery, University of Cape Town, Cape Town, South Africa.
Vernon J LouwDivision of Haematology, Department of Medicine, University of Cape Town, Anzio Rd, Observatory, Cape Town, 7925, South Africa.
Mark P NicolDivision of Medical Microbiology, University of Cape Town, Cape Town, South Africa.
Gary MaartensDivision of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
Estelle VerburghDivision of Haematology, Department of Medicine, University of Cape Town, Anzio Rd, Observatory, Cape Town, 7925, South Africa.
University of Cape Town · ZA

Funding

Partnership for Global Health Research Training Program (Renewal)-Supplement for OBSSR, NCI, NCI-AIDS and NIDCDD43TW010543 · FIC · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · PI Wafaie W Fawzi, DAVIDSON HOWES HAMER · 2017 to 2026
$12.1M
Research training in HIV-related transfusion medicine and hematology in South AfricaD43TW010345 · FIC · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI UTE JENTSCH, EDWARD L MURPHY · 2017 to 2026
$3.0M
FIC NIH HHS D43 TW010345FIC NIH HHS D43 TW010543Foundation for the National Institutes of Health D43-TW010345National Research Foundation 119078NIH HHS D43-TW010543]
6 · The paper itself

Abstract

backgroundThe 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.

methodsWe 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).

resultsWe 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).

conclusionsUltra 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.

Indexed as

Data AccuracyAdultBiopsy, Fine-NeedleDiagnostic Tests, RoutineFemaleHIVHIV SeropositivityHumansLymph NodesMaleMiddle AgedMycobacterium tuberculosisNucleic Acid Amplification TechniquesProbabilityProspective StudiesSensitivity and SpecificityCore needle biopsyFine-needle aspirationHIVTuberculosisXpert MTB/RIF Ultra

Identifiers

PMID31931736
PMCPMC6958753
OpenAlexW3002483726

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.