The Role of Core Needle Biopsy Pathology Combined with Molecular Tests in the Diagnosis of Lymph Node Tuberculosis

Figures & data

Table 1 Clinical Characteristics of the Included Patients

Characteristics	All (n = 289)	Confirmed LNTB (n = 61)	Probable LNTB (n = 192)	Non-LNTB (n = 36)
Age (year, mean ± SD)	39.7±19.0	47.7±20.7	36.4±16.4	44.8±23.1
Male (n, %)	127 (43.9)	25 (41.0)	81 (42.2)	21 (58.3)
HIV positive (n, %)	1 (0.3)	1 (1.6)	0 (0.0)	0 (0.0)
Symptoms (n, %)
Fever	76 (26.3)	19 (31.1)	49 (25.5)	8 (22.2)
Night sweat	40 (13.8)	17 (27.9)	21 (10.9)	2 (5.6)
Pain	74 (25.6)	21 (34.4)	32 (16.7)	21 (58.3)
Dysphagia	9 (3.1)	4 (6.6)	3 (1.6)	2 (5.6)
Weigh loss	38 (13.1)	19 (31.1)	17 (8.9)	2 (5.6)
LN sites (n, %)
Cervical LN	264 (91.3)	57 (93.4)	174 (90.6)	33 (91.7)
Axillary LN	23 (8.0)	4 (6.6)	16 (8.3)	3 (8.3)
Inguinal LN	2 (0.7)	0 (0.0)	2 (1.0)	0 (0.0)
Other sites involved of TB (n, %)
Pulmonary TB	122 (42.2)	26 (42.6)	90 (46.9)	6 (16.7)
Pleural TB	13 (4.5)	1 (1.6)	11 (5.7)	1 (2.8)
Specimen type (n, %)
CNB	191 (66.1)	48 (78.7)	117 (60.9)	26 (72.2)
Tissue	98 (33.9)	13 (21.3)	75 (39.1)	10 (27.8)
Pathological antacid staining (+) (n, %)	13 (4.5)	13 (21.3)	0 (0.0)	0 (0.0)

Abbreviations: LNTB, lymph node tuberculosis; HIV, human immunodeficiency virus; LN, lymph node; TB, tuberculosis; CNB, core needle biopsy.

Figure 1 Diagnostic classification of the study participants.

Abbreviations: LNTB, Lymph node tuberculosis; CNB, core needle biopsy.

Figure 2 Venn diagram of positive tests. (A) All specimens. (B) Tissue specimens. (C) Core needle biopsy specimens.

Table 2 Accuracy of Pathology, Molecular Tests, and Parallel Test (Positive Result for Either of the Two Assays) for the Diagnosis of Lymph Node Tuberculosis Against a Composite Reference Standard

Test	Sample	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	AUC
Pathology	All	94.5 (90.9–96.9)	97.2 (85.5–99.9)	99.6 (97.7–100.0)	71.4 (56.7–83.4)	0.96 (0.93–0.98)
	Tissue	96.6 (90.4–99.3)	100.0 (69.2–100.0)	100.0 (95.8–100.0)	76.9 (46.2–95.0)	0.98 (0.93–1.00)
	CNB	93.3 (88.4–96.6)	96.2 (80.4–99.9)	99.4 (96.5–100.0)	69.4(51.9–83.7)	0.95 (0.91–0.97)
Molecular test	All	73.1 (67.2–78.5)	100.0 (90.3–100.0)	100.0 (98.0–100.0)	34.6 (25.6–44.6)	0.87 (0.82–0.90)
	Tissue	67.1 (56.2–76.7)	100.0 (69.2–100.0)	100.0 (93.9–100.0)	25.6 (13.0–42.1)	0.84 (0.75–0.90)
	CNB	76.4 (69.1–82.6)	100.0 (86.8–100.0)	100.0 (97.1–100.0)	40.0 (28.0–52.9)	0.88 (0.83–0.92)
Parallel test	All	98.4 (96.0–99.6)	97.2 (85.5–99.9)	99.6 (97.8–100.0)	89.7 (75.8–97.1)	0.98 (0.95–0.99)
	Tissue	96.6 (90.4–99.3)	100.0 (69.2–100.0)	100.0 (95.8–100.0)	76.9 (46.2–95.0)	0.98 (0.93–1.00)
	CNB	99.4 (96.7–100.0)	96.2 (80.4–99.9)	99.4 (96.7–100.0)	96.2 (80.4–99.9)	0.98 (0.95–0.99)

Abbreviations: PPV, positive predictive value; NPV, negative predictive value; AUC, area under the curve; CNB, core needle biopsy.

Table 3 Comparison of the Diagnostic Efficiency Between Pathology, Molecular Tests, and Parallel Test for the Diagnosis of Lymph Node Tuberculosis

Sample Type	Test	Sensitivity (P-value)	Specificity (P-value)	PPV (P-value)	NPV (P-value)	AUC (P-value)
Overall	Pathology vs Molecular test	< 0.001	0.314	0.379	< 0.001	< 0.001
	Pathology vs Parallel test	0.016	1.000	0.977	0.034	0.188
	Molecular test vs Parallel test	< 0.001	0.314	0.389	< 0.001	< 0.001
Tissue	Pathology vs Molecular test	< 0.001	1.000	1.000	0.001	< 0.001
	Pathology vs Parallel test	1.000	1.000	1.000	1.000	1.000
	Molecular test vs Parallel test	< 0.001	1.000	1.000	0.001	< 0.001
CNB	Pathology vs Molecular test	< 0.001	0.313	0.366	0.005	0.053
	Pathology vs Parallel test	0.003	1.000	0.965	0.009	0.199
	Molecular test vs Parallel test	< 0.001	0.313	0.381	< 0.001	0.003

Abbreviations: PPV, positive predictive value; NPV, negative predictive value; AUC, area under the curve; CNB, core needle biopsy.

Table 4 Comparison of the Diagnostic Efficiency of Pathology, Molecular Tests, and Parallel Test Using Different Specimen Types for the Diagnosis of Lymph Node Tuberculosis

Test	Sensitivity (P-value)	Specificity (P-value)	PPV (P-value)	NPV (P-value)	AUC (P-value)
Pathology (Tissue vs CNB)	0.280	0.529	0.458	0.609	0.188
Molecular test (Tissue vs CNB)	0.111	1.000	1.000	0.136	0.346
Parallel test (Tissue vs CNB)	0.089	0.529	0.472	0.062	0.843

Abbreviations: PPV, positive predictive value; NPV, negative predictive value; AUC, area under the curve; CNB, core needle biopsy.