SynthesisThe Lancet. Microbe2023
Accuracy of upper respiratory tract samples to diagnose Mycobacterium tuberculosis: a systematic review and meta-analysis.
Synthesis in The Lancet. Microbe, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 3 of them syntheses that pooled it.
What it found
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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.
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.
Who cites it
17 citing papers in PubMed, 3 syntheses or guidelines pooled it, 23 citations in OpenAlex.
- Lateral-flow device for the diagnosis of invasive aspergillosis: a systematic review and diagnostic meta-analysis.BMC infectious diseases · 2025Pooled it
- Oral swabs with a rapid molecular diagnostic test for pulmonary tuberculosis in adults and children: a systematic review.The Lancet. Global health · 2024Pooled it
- Revolutionizing diagnosis of pulmonaryFrontiers in microbiology · 2024Pooled it
- Diagnostic Accuracy of Molecular Testing on Saliva and Oral Swabs for Pulmonary Tuberculosis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Xpert MTB/XDR performance in non-sputum samples for diagnosis of drug-resistant tuberculosis at a North Indian tertiary care center.Journal of clinical microbiology · 2026Article
- Bacterial topography of the respiratory tract, including pulmonary site-of-disease, in people with active tuberculosis: a case-control study.Research square · 2026Article
- Article
- Rapid Molecular Diagnostics of Tuberculosis: What Do We Have, What Do We Need?Pulmonary medicine · 2026Review
- Oral Rinse versus Facemask Capture for Nonsputum Diagnosis of Pulmonary Tuberculosis.American journal of respiratory and critical care medicine · 2025Article
- Preferences for tongue swab-based versus sputum-based testing in the context of TB care: a best-worst scaling exercise in Vietnam and Zambia.BMJ global health · 2025Article
- Tuberculosis and HIV coinfection: Progress and challenges towards reducing incidence and mortality.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2025Review
- Closing the gaps in childhood TB detection.IJTLD open · 2025Article
- Non-sputum-based samples and biomarkers for detection of Mycobacterium tuberculosis: the hope to improve childhood and HIV-associated tuberculosis diagnosis.European journal of medical research · 2024Review
- Classification of early tuberculosis states to guide research for improved care and prevention: an international Delphi consensus exercise.The Lancet. Respiratory medicine · 2024Review
- Finding the missed millions: innovations to bring tuberculosis diagnosis closer to key populations.BMC global and public health · 2024Review
- Advancing tuberculosis diagnosis and management in cynomolgus macaques using Xpert MTB/RIF ultra assay.Scientific reports · 2024Article
- Pediatric Drug-Resistant Tuberculosis: The Current and Future Prospects for Management and Prevention.Pathogens (Basel, Switzerland) · 2023Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 5 institutions in 3 countries.
Funding
Abstract
backgroundPulmonary tuberculosis due to Mycobacterium tuberculosis can be challenging to diagnose when sputum samples cannot be obtained, which is especially problematic in children and older people. We systematically appraised the performance characteristics and diagnostic accuracy of upper respiratory tract sampling for diagnosing active pulmonary tuberculosis.
methodsIn this systematic review and meta-analysis, we searched MEDLINE, Cinahl, Web of Science, Global Health, and Global Health Archive databases for studies published between database inception and Dec 6, 2022 that reported on the accuracy of upper respiratory tract sampling for tuberculosis diagnosis compared with microbiological testing of sputum or gastric aspirate reference standard. We included studies that evaluated the accuracy of upper respiratory tract sampling (laryngeal swabs, nasopharyngeal aspirate, oral swabs, saliva, mouth wash, nasal swabs, plaque samples, and nasopharyngeal swabs) to be tested for microbiological diagnosis of tuberculous (by culture and nucleic acid amplification tests) compared with a reference standard using either sputum or gastric lavage for a microbiological test. We included cohort, case-control, cross-sectional, and randomised controlled studies that recruited participants from any community or clinical setting. We excluded post-mortem studies. We used a random-effects meta-analysis with a bivariate hierarchical model to estimate pooled sensitivity, specificity, and diagnostics odds ratio (DOR; odds of a positive test with disease relative to without), stratified by sampling method. We assessed bias using QUADAS-2 criteria. This study is registered with PROSPERO (CRD42021262392).
findingsWe screened 10 159 titles for inclusion, reviewed 274 full texts, and included 71, comprising 119 test comparisons published between May 13, 1933, and Dec 19, 2022, in the systematic review (53 in the meta-analysis). For laryngeal swabs, pooled sensitivity was 57·8% (95% CI 50·5-65·0), specificity was 93·8% (88·4-96·8), and DOR was 20·7 (11·1-38·8). Nasopharyngeal aspirate sensitivity was 65·2% (52·0-76·4), specificity was 97·9% (96·0-99·0), and DOR was 91·0 (37·8-218·8). Oral swabs sensitivity was 56·7% (44·3-68·2), specificity was 91·3% (CI 81·0-96·3), and DOR was 13·8 (5·6-34·0). Substantial heterogeneity in diagnostic accuracy was found, probably due to differences in reference and index standards.
interpretationUpper respiratory tract sampling holds promise to expand access to tuberculosis diagnosis. Exploring historical methods using modern microbiological techniques might further increase options for alternative sample types. Prospective studies are needed to optimise accuracy and utility of sampling methods in clinical practice.
fundingUK Medical Research Council, Wellcome, and UK Foreign, Commonwealth and Development Office.
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Registered trials
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.