AUTHOR=Gong Xue , He Yunru , Zhou Kaiyu , Hua Yimin , Li Yifei 

TITLE=Efficacy of Xpert in tuberculosis diagnosis based on various specimens: a systematic review and meta-analysis

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=Volume 13 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2023.1149741

DOI=10.3389/fcimb.2023.1149741

ISSN=2235-2988

ABSTRACT=Objective
The GeneXpert MTB/RIF assay (Xpert) is a diagnostic tool that has been shown to significantly improve the accuracy of tuberculosis (TB) detection in clinical settings, with advanced sensitivity and specificity. Early detection of TB can be challenging, but Xpert has enhanced the efficacy of the diagnostic process. Nevertheless, the accuracy of Xpert varies across different specimen types and particular types of TB. Therefore, the selection of optimal specimens is critical when applying Xpert to identify suspected TB infections. As such, we conducted a meta-analysis to evaluate the effectiveness of Xpert across various specimen types in detecting different forms of TB.
Methods
We conducted a comprehensive search of several electronic databases, including Pubmed, Embase, the Cochrane Central Register of Controlled Trials, and the World Health Organization clinical trials registry center, covering studies published until the end of July 2022. RStudio was utilized to analyze the results, employing the meta4diag, robvis, and metafor packages.
Results
After excluding duplicates, a total of 2163 studies were identified, and ultimately, 144 studies from 107 articles were included in the meta-analysis based on predetermined inclusion and exclusion criteria. Sensitivity, specificity, and diagnostic accuracy were estimated for various specimen types and types of TB. In the case of pulmonary TB, Xpert using sputum (0.95 95%CI 0.91-0.98) and gastric juice (0.94 95%CI 0.84-0.99) demonstrated similarly high sensitivity, surpassing other specimen types. Additionally, Xpert exhibited high specificity for detecting TB across all specimen types. For bone and joint TB, Xpert, based on both biopsy and joint fluid specimens, demonstrated high accuracy in TB detection. Furthermore, Xpert effectively detected unclassified extrapulmonary TB and tuberculosis lymphadenitis. However, Xpert needed to be more accurate in distinguishing tuberculosis meningitis, tuberculous pleuritis, and unclassified TB.
Conclusion
Xpert has exhibited satisfactory diagnostic accuracy for most TB infections, but the efficacy of detection may vary depending on the specimens analyzed. Therefore, selecting appropriate specimens for Xpert analysis is essential, as using unselected specimens can reduce the ability to distinguish TB. Therefore, careful selection of specimens is crucial for effective TB detection using Xpert.