Performance of TB-LAMP in the Diagnosis of Tuberculous Empyema Using Samples Obtained From Pleural Decortication

To evaluate the performance of TB-LAMP in the diagnosis of TB empyema using pleural tissue specimens obtained during pleural decortication.

Using the clinical records and the different diagnostic test results of patients who underwent pleural decortication in a TB-designated hospital over 3.5 years, we calculated the sensitivity, specificity positive predictive, and negative predictive values of the pathology, MGIT 960 culture, and TB-LAMP obtained by using pleural tissue specimens against the etiologic diagnosis and composite clinical reference standard (CCRS) as the reference standards.

A total of 304 patients' records were extracted. All these patients had gone through pleural decortication. When the etiologic diagnosis was used as the reference, the sensitivity of TB-LAMP in identifying TB empyema was 77.8% (compared to 10.6% of MGIT 960 P < 0.05). The sensitivity of MGIT 960, pathology, and TB-LAMP was 8.2%, 77.7%, and 67.2% against CCRS as the reference; and the specificity of the three was 100.0, 100.0, and 96.2% against the same standard. A combination of pathology and TB-LAMP would increase the sensitivity and specificity to 84.7 and 96.0%. Using TB-LAMP to diagnose TB empyema using pleural tissue samples obtained from pleural decortication was faster with satisfactory performance.

TB-LAMP has great potential in faster and more accurate diagnosis of TB empyema. Our findings provide insights for optimizing diagnostic algorithms for TB empyema.