Correlation of microbiological yield with radiographic activity on chest computed tomography in cases of suspected pulmonary tuberculosis

• Published in: PloS one 2018-08, Vol.13 (8), p.e0201748-e0201748
• Main Authors: Ko, Yousang, Lee, Ho Young, Park, Yong Bum, Hong, Su Jin, Shin, Jeong Hwan, Choi, Seok Jin, Kim, Changhwan, Park, So Young, Jeong, Jin Young
• Format: Article
• Language: English
• Subjects: Adult; Aged; Bacteriological Techniques; Biology and Life Sciences; Bronchoalveolar Lavage; Bronchoscopy; Calcification; Care and treatment; CAT scans; Chest; Clinical medicine; Computation; Computed tomography; Confidence intervals; Correlation; Critical care; Culture; Diagnosis; Diagnostic systems; Etiology; Female; Hospitals; Humans; Infections; Infectious diseases; Internal medicine; Laboratories; Lung - diagnostic imaging; Lung - microbiology; Lung diseases; Male; Medical diagnosis; Medical records; Medicine; Medicine and Health Sciences; Middle Aged; Mycobacterium tuberculosis - growth & development; Mycobacterium tuberculosis - isolation & purification; Patients; Pulmonary tuberculosis; Radiology; Research and Analysis Methods; Respiratory Tract Infections - diagnostic imaging; Respiratory Tract Infections - microbiology; Retrospective Studies; Sensitivity and Specificity; Studies; Thorax - diagnostic imaging; Tomography, X-Ray Computed; Tuberculosis; Tuberculosis, Pulmonary - diagnostic imaging; Tuberculosis, Pulmonary - microbiology
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0201748

Little is known about the correlation between microbiological yield and radiographic activity, on chest computed tomography (CT), in suspected pulmonary tuberculosis (PTB) cases, despite CT being widely used, clinically. We used multicenter retrospective data, obtained from medical records, focusing on the diagnostic performance for definite PTB. We categorized patients into four groups, by radiographic activity: definitely active, probably active, indeterminate activity, and probably inactive. Of the 650 patients included, 316 had culture-confirmed PTB; 190 (29.2%), 323 (49.7%), 70 (10.8%), and 67 (10.3%) were classified into the definitely active, probably active, indeterminate activity, and probably inactive groups, respectively. The corresponding observed culture rates for CT radiographic activity were 61.6%, 60.7%, 4.3% and 0%, respectively. When not only culture rates but TB-PCR and histological results were taken into consideration as definite PTB, it showed 66.6%, 67.2%, 14.3%, and 0% of each CT radiographic activity, respectively. Regarding the diagnostic performance for definite PTB, radiographic activity displayed high sensitivity (97.1%, 95% confidence interval (CI), 94.6-98.5) and negative predictive values (92.7%, 95% CI, 86.6-96.2), considered definitely and probably active PTB. Apart from PTB, other etiologies, according to radiographic activity, were predominantly respiratory infections such as bacterial pneumonia and non-tuberculous mycobacterial infection. Radiographic activity showed good diagnostic performance, and can be used easily in clinical practice. However, clinicians should consider other possibilities, because radiologic images do not confirm microbiological PTB.