Diagnostic accuracy of Xpert MTB/RIF assay for musculoskeletal tuberculosis: a meta-analysis

Figures & data

Table 1 Characteristics of studies included in the meta-analysis

Study	Country	Sample size	Prevalence (%)	Case–control study	Specimen type	Reference standard	QUADAS	Test results of diagnosing musculoskeletal TB				Test results of detecting RIF resistance
								TP	FP	FN	TN	TP	FP	FN	TN
Arockiaraj et al^Citation20	India	338	55.6	No	Tissue/pus of spine	Culture/histology	9	152	29	36	121	12	0	1	99
Chen et al^Citation21	People’s Republic of China	139	77.7	No	Pus of bone/joint/spine	Culture/histology	9	89	11	19	20	–	–	–	–
Dong et al^Citation22	People’s Republic of China	272	92.3	No	Tissue/pus of bone/joint/spine	CRS	9	196	0	55	21	–	–	–	–
Gu et al^Citation16	People’s Republic of China	60	83.3	No	Pus of bone/joint/spine	CRS	9	41	0	9	10	6	0	0	18
Held et al^Citation15	South Africa	71	38.0	No	Tissue of spine	Culture only	9	25	9	2	35	–	–	–	–
Held et al^Citation23	South Africa	109	21.1	No	Tissue/pus of bone/joint/spine	Culture/histology	11	17	0	6	86	0	0	0	9
Jia and Li^Citation24	People’s Republic of China	81	60.5	Yes	Pus of bone/joint/spine	CRS	9	46	1	3	31	–	–	–	–
Li^Citation25	People’s Republic of China	312	81.1	No	Tissue of bone/joint/spine	CRS	11	199	0	54	59	26	5	3	88
Massi et al^Citation26	Indonesia	70	31.4	No	Tissue/pus of spine	Culture only	9	22	40	0	8	–	–	–	–
Tang et al^Citation27	People’s Republic of China	49	59.2	No	Pus of knee joint	CRS	10	20	2	9	18	–	–	–	–
Zhou et al^Citation28	People’s Republic of China	92	78.3	Yes	Tissue/pus of spine	CRS	9	55	1	17	19	18	5	4	11
Zhu et al^Citation29	People’s Republic of China	97	69.1	Yes	Pus of bone/joint/spine	CRS	9	55	1	12	29	–	–	–	–

Abbreviations: QUADAS, Quality Assessment of Diagnostic Accuracy Studies; TB, tuberculosis; RIF, rifampicin; TP, true positive; FP, false positive; FN, false negative; TN, true negative; CRS, composite reference standard.

Figure 1 Flow chart of study selection in this meta-analysis.

Figure 2 Analysis of sensitivity and specificity of Xpert MTB/RIF assay. Forest plots of sensitivity and specificity of the assay in (A) diagnosing musculoskeletal TB and (B) detecting RIF-resistance. Point estimates of sensitivity and specificity from each study are shown as solid circles. Error bars indicate 95% confidence interval.

Abbreviation: CI, confidence interval.

Figure 3 SROC curves of Xpert for the (A) diagnosis of musculoskeletal TB and (B) detection of RIF resistance. The size of each solid circle represents the sample size of individual study. The regression SROC curves summarize the overall diagnostic accuracy.

Abbreviations: SROC, summary receiver operating characteristic; TB, tuberculosis; RIF, rifampicin; AUC, area under the curve; SE, standard error.

Table 2 Subgroup analysis of the results of Xpert for detecting musculoskeletal TB

Variables	Number of studies	Sensitivity (95% CI)	I^2	Specificity (95% CI)	I^2	AUC
Prevalence (%)
≥50	9	0.80 (0.77–0.82)	32.2%	0.88 (0.84–0.91)	83.5%	0.8820
<50	3	0.89 (0.79–0.95)	79.1%	0.72 (0.65–0.79)	98.4%	0.9568
Reference standard
Culture only	2	0.96 (0.86–1.00)	59.2%	0.47 (0.36–0.57)	97.5%	NE
Culture/histology	3	0.81 (0.76–0.85)	0.0%	0.85 (0.80–0.89)	94.7%	0.8780
CRS	7	0.79 (0.76–0.82)	46.0%	0.97 (0.94–0.99)	22.4%	0.9429

Abbreviations: TB, tuberculosis; CI, confidence interval; AUC, the area under the curve; NE, not estimable; CRS, composite reference standard.

Figure 4 Deeks’ funnel plot indicating no significant risk of publication bias (p = 0.621). Solid circles represent each study included in the meta-analysis.

Abbreviation: ESS, effective sample size.

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