Related Experiment Video
Updated: Jan 10, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Comparative diagnostic accuracy of metagenomic next-generation sequencing and targeted next-generation sequencing for
Lina Wang1, Zhongyuan Zhao2, Yuchi Zhao2
1Affiliated Hospital of Qingdao University, Department of Infectious Diseases, Qingdao, Shandong, China.
Objectives:
The aim of this meta-analysis was to assess the diagnostic performance of metagenomic next-generation sequencing and targeted next-generation sequencing for periprosthetic joint infection (PJI).
Background:
Next-generation sequencing (NGS) is increasingly used for diagnosing periprosthetic joint infection (PJI), but its clinical utility remains poorly defined. Discrepancies between metagenomic NGS (mNGS) and targeted NGS (tNGS) results pose a significant clinical challenge for PJI diagnosis. To address this, we conducted a systematic review and meta-analysis comparing the diagnostic accuracy of mNGS and tNGS for PJI.
Methods:
This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We comprehensively searched PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus from inception through June 1, 2025. Two reviewers independently extracted data and assessed study quality using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. Pooled sensitivity, specificity, diagnostic odds ratio (DOR), and the area under the hierarchical summary receiver operating characteristic curve (AUC) were calculated.
Results:
Following screening and eligibility assessment, 23 studies were included in the analysis. The pooled sensitivity and specificity for diagnosing PJI were 0.89 (95% CI: 0.84-0.93) and 0.92 (95% CI: 0.89-0.95) for mNGS, and 0.84 (95% CI: 0.74-0.91) and 0.97 (95% CI: 0.88-0.99) for tNGS. The DORs were 58.56 (95% CI: 38.41-89.26) for mNGS and 106.67 (95% CI: 40.93-278.00) for tNGS. The areas under the summary receiver-operating characteristic curves (AUCs) were 0.935 (95% CI: 0.90-0.95) for mNGS and 0.911 (95% CI: 0.85-0.95) for tNGS. Comparisons of DOR and AUC between mNGS and tNGS revealed no statistically significant differences (P > 0.05).
Conclusions:
This meta-analysis indicates that mNGS demonstrates higher sensitivity and a numerically greater AUC than tNGS for diagnosing PJI, with acceptable specificity, although the difference in AUC was not statistically significant. Conversely, tNGS exhibits higher specificity and DOR, alongside acceptable sensitivity, making it valuable for confirming PJI. Overall, the diagnostic accuracy of both next-generation sequencing (NGS) methods is comparable, with each possessing distinct advantages and limitations.
Insights
Metagenomic next-generation sequencing (mNGS) and targeted next-generation sequencing (tNGS) show comparable diagnostic accuracy for periprosthetic joint infection (PJI). mNGS offers higher sensitivity, while tNGS provides greater specificity for confirming PJI.
Area of Science:
- Microbiology and Infectious Diseases
- Genomics and Molecular Diagnostics
- Orthopedic Surgery and Biomaterials
Background:
- Next-generation sequencing (NGS) is increasingly utilized for diagnosing periprosthetic joint infection (PJI), but its clinical utility requires further definition.
- Discrepancies between metagenomic NGS (mNGS) and targeted NGS (tNGS) present challenges in PJI diagnosis.
- This meta-analysis systematically reviews and compares the diagnostic accuracy of mNGS and tNGS for PJI.
Conclusions:
- Metagenomic NGS (mNGS) shows higher sensitivity and a numerically greater AUC for PJI diagnosis compared to targeted NGS (tNGS), with acceptable specificity.
- Targeted NGS (tNGS) demonstrates higher specificity and DOR, making it valuable for confirming PJI, alongside acceptable sensitivity.
- Both NGS methods offer comparable diagnostic accuracy for PJI, each with unique strengths and limitations.
