Role of Xpert MTB/RIF in differentiating tuberculosis from sarcoidosis in patients with mediastinal lymphadenopathy undergoing EBUS-TBNA: a study of 147 patients

Role of Xpert MTB/RIF in differentiating tuberculosis from sarcoidosis in patients with mediastinal lymphadenopathy undergoing EBUS-TBNA: a study of 147 patients

Authors

  • Sahajal Dhooria Assistant Professor Dept of Pulmonary Medicine Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh-160012 (India)
  • Nalini Gupta Additional Professor Dept of Cytology Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh-160012 (India)
  • Amanjit Bal Additional Professor Dept of Histopathology Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh-160012 (India)
  • Inderpaul Singh Sehgal Assistant Professor Dept of Pulmonary Medicine Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh-160012 (India)
  • Ashutosh Nath Aggarwal Professor Dept of Pulmonary Medicine Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh-160012 (India)
  • Sunil Sethi Professor Dept of Microbiology Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh-160012 (India)
  • Digambar Behera Professor Dept of Pulmonary Medicine Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh-160012 (India)
  • Ritesh Agarwal Additional Professor Dept of Pulmonary Medicine Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh-160012 (India)

Keywords:

sarcoidosis, tuberculosis, endobronchial ultrasound, endoscopic ultrasound, pcr, GeneXpert

Abstract

Background: In patients with intrathoracic lymphadenopathy, differentiating tuberculosis from sarcoidosis is often difficult. We hypothesized that Xpert MTB/RIF assay, a semi-automated hemi-nested PCR would help in this regard. Objective: To evaluate the performance of Xpert MTB/RIF in the differential diagnosis of tuberculosis and sarcoidosis. Methods: This was a retrospective analysis of patients with intrathoracic lymphadenopathy who underwent endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA), and were diagnosed as either tuberculosis or sarcoidosis. The results of Xpert MTB/RIF assay, tuberculin skin test and endosonographic characteristics (heterogeneous echotexture and coagulation necrosis sign) of the lymph nodes were compared between the two groups. Results: During the study period, 465 EBUS procedures were performed and a diagnosis of sarcoidosis (n=94) or tuberculosis (n=53) was made in 147 patients. Xpert MTB/RIF was positive in 26 (49.1%) and two (2.1%) patients with tuberculosis and sarcoidosis, respectively. The sensitivity, specificity, positive and negative predictive values of Xpert MTB/RIF in the diagnosis of tuberculosis were 49.1 %, 97.9%, 92.9% and 77.3%, respectively. The presence of any of the four features namely positive Xpert MTB/RIF, positive tuberculin skin test, heterogeneous echotexture of the lymph nodes, or the presence of endosonographic coagulation necrosis sign yielded a sensitivity and negative predictive value of 83.0% and 88.0%, respectively in the diagnosis of tuberculosis versus sarcoidosis. Conclusions: Xpert MTB/RIF has good specificity and positive predictive value in the diagnosis of tuberculosis, and is a useful investigation in separating tuberculosis from sarcoidosis. 

 

Author Biographies

Sahajal Dhooria, Assistant Professor Dept of Pulmonary Medicine Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh-160012 (India)

Assistant Professor
Dept of Pulmonary Medicine
Postgraduate Institute of Medical Education and Research, Chandigarh, India

Nalini Gupta, Additional Professor Dept of Cytology Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh-160012 (India)

Additional Professor
Dept of Cytology
Postgraduate Institute of Medical Education and Research, Chandigarh, India

Amanjit Bal, Additional Professor Dept of Histopathology Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh-160012 (India)

Additional Professor
Dept of Histopathology
Postgraduate Institute of Medical Education and Research, Chandigarh, India

Inderpaul Singh Sehgal, Assistant Professor Dept of Pulmonary Medicine Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh-160012 (India)

Assistant Professor
Dept of Pulmonary Medicine
Postgraduate Institute of Medical Education and Research, Chandigarh, India

Ashutosh Nath Aggarwal, Professor Dept of Pulmonary Medicine Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh-160012 (India)

Professor
Dept of Pulmonary Medicine
Postgraduate Institute of Medical Education and Research, Chandigarh, India

Sunil Sethi, Professor Dept of Microbiology Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh-160012 (India)

Professor
Dept of Microbiology
Postgraduate Institute of Medical Education and Research, Chandigarh, India

Digambar Behera, Professor Dept of Pulmonary Medicine Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh-160012 (India)

Professor
Dept of Pulmonary Medicine
Postgraduate Institute of Medical Education and Research, Chandigarh, India

Ritesh Agarwal, Additional Professor Dept of Pulmonary Medicine Postgraduate Institute of Medical Education and Research Sector-12 Chandigarh-160012 (India)

Additional Professor
Dept of Pulmonary Medicine
Postgraduate Institute of Medical Education and Research, Chandigarh, India

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Published

07-10-2016

Issue

Section

Original Articles: Clinical Research

How to Cite

1.
Dhooria S, Gupta N, Bal A, Sehgal IS, Aggarwal AN, Sethi S, et al. Role of Xpert MTB/RIF in differentiating tuberculosis from sarcoidosis in patients with mediastinal lymphadenopathy undergoing EBUS-TBNA: a study of 147 patients. Sarcoidosis Vasc Diffuse Lung Dis [Internet]. 2016 Oct. 7 [cited 2025 May 20];33(3):258-66. Available from: https://mattioli1885journals.com/index.php/sarcoidosis/article/view/4764