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Published on: August 7, 2019
Metagenomic Next-Generation Sequencing-Based Fine-Needle Aspiration in Patients With Suspected Infected Pancreatic
Donghuang Hong1,2, Peng Wang2, Yao Xu2
1Department of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China.
Introduction:
Fine-needle aspiration (FNA) is no longer recommended for diagnosing infected pancreatic necrosis (IPN) due to a high false-negative rate. Metagenomic next-generation sequencing (mNGS) is a valuable tool for identifying potential pathogens. We hypothesized that adding mNGS to the standard FNA procedure may increase diagnostic accuracy.
Methods:
This is a prospective, single-arm feasibility study enrolling patients with acute necrotizing pancreatitis complicated by suspected IPN. Computed tomography-guided FNA was performed immediately after enrollment, and the drainage samples were subjected to culture and mNGS assays simultaneously. Confirmatory IPN within the following week of the index FNA procedure was the reference standard. The diagnostic performance of FNA-mNGS and the impact of mNGS results on treatment were evaluated. Historical controls were used for comparison of clinical outcomes.
Results:
There was no significant difference between mNGS and culture in the positive rate (75% vs 70%, P = 0.723). The accuracy of FNA-mNGS was 80.0%, with a sensitivity of 82.35%, specificity of 66.67%, positive predictive value of 93.3%, and negative predictive value of 40.0%. The results of the mNGS led to treatment change in 16 of 20 patients (80%), including implementing percutaneous catheter drainage (n = 7), expanding antibiotic coverage (n = 2), percutaneous catheter drainage and expanding coverage (n = 4), narrowing antibiotic coverage (n = 1), and discontinuation of antibiotics (n = 2). The FNA-mNGS approach was not associated with improved clinical outcomes compared with the historical control group.
Discussion:
The addition of mNGS to standard FNA has comparable diagnostic accuracy with culture-based FNA and may not be associated with improved clinical outcomes.
Insights
Adding metagenomic next-generation sequencing (mNGS) to fine-needle aspiration (FNA) for infected pancreatic necrosis (IPN) shows similar diagnostic accuracy to traditional methods but did not improve patient outcomes.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Diagnostic Microbiology
Background:
- Fine-needle aspiration (FNA) has limitations in diagnosing infected pancreatic necrosis (IPN) due to high false-negative rates.
- Metagenomic next-generation sequencing (mNGS) offers a potential advancement for pathogen identification in clinical diagnostics.
Purpose of the Study:
- To evaluate the diagnostic performance of combining mNGS with FNA for IPN.
- To assess the impact of mNGS results on treatment decisions and clinical outcomes in IPN patients.
Main Methods:
- A prospective, single-arm feasibility study involving patients with suspected IPN.
- Simultaneous culture and mNGS analysis of FNA drainage samples.
- Comparison of diagnostic accuracy and clinical outcomes against a reference standard and historical controls.
Main Results:
- FNA-mNGS demonstrated 80.0% accuracy, with 82.35% sensitivity and 66.67% specificity.
- mNGS results influenced treatment changes in 80% of patients.
- No significant difference in positive detection rates between mNGS and culture (75% vs 70%).
Conclusions:
- The addition of mNGS to FNA for IPN diagnosis yields comparable accuracy to culture-based methods.
- This combined approach did not demonstrate an improvement in clinical outcomes compared to historical controls.
