Bronchial brushing Xpert improves the diagnostic efficiency of sputum Xpert in patients with pulmonary tuberculosis

BACKGROUND: The role of bronchial brushing Xpert MTB/RIF (hereafter referred to as Xpert) in patients with pulmonary tuberculosis (PTB) remains unclear. Therefore, a retrospective study was conducted aiming to evaluate the diagnostic efficiency of bronchial brushing Xpert in patients with PTB. METHODS: Between July 2018 and August 2019, suspected PTB patients who were admitted to our hospital and had bronchial brushing and matched sputum collection for acid-fast bacilli (AFB) smear, mycobacterial culture, and Xpert were included for further analysis. Subsequently, PTB was defined based on mycobacterial culture, and if an alternative diagnosis was established, ‘non-tuberculosis (TB)’ was considered. Comparison of bronchial brushing and matched sputum examination was performed between groups. Then, the differences in the sensitivities between bronchial brushing and sputum Xpert were examined using the chi-square test. RESULTS: A total of 111 patients were included and divided into TB and non-TB groups (52 versus 59 patients). The sensitivities of Xpert against culture were calculated as follows: sputum, 44.2% (23/52); bronchial brushing, 59.6% (31/52); sputum and bronchial brushing, 69.2% (36/52). The specificities of all Xpert assays were the same (100.0%, 59/59). A significant difference was found in the comparison of the sensitivities of Xpert using sputum, bronchial brushing and both, and the sensitivity of Xpert on both sputum and bronchial brushing was higher than that on sputum alone (p < 0.05). Moreover, it appears that bronchial brushing Xpert was more sensitive than sputum Xpert in the detection of PTB. CONCLUSION: Bronchial brushing Xpert improves the diagnostic efficiency of sputum Xpert in the detection of PTB.