Tests based on polymerase chain reactions are increasingly important in the microbiological diagnosis of tuberculosis (TB). Park et al1 have extended the use of Xpert Ultra to include material obtained at bronchoscopy, and particularly its use for samples obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In addition, immediate cytology with rapid onsite evaluation contributed significantly to the differential diagnosis of enlarged mediastinal lymph node (MLN) disease. A review panel of the results in combination with clinical features was an important element of the study. In 2010, the WHO recommended that nucleic acid amplification tests (NAATs) be used to identify Mycobacterium tuberculosis (Mtb) in pulmonary and extrapulmonary TB.2 A Cochrane review noted that Xpert Ultra was better than Xpert MTB/RIF in the diagnosis of TB meningitis.3 However, aspirates from MLNs were not included in either analysis. One previous study has investigated the role of EBUS-TBNA and presented data with a diagnosis based on a combination of Xpert MTB/RIF, a positive tuberculin skin test and heterogeneity in the ultrasound texture of the MLN(s) with or without central necrosis.4 The scientific basis underlying these NAATs will help understand their benefits and potential problems, as well as clarify areas …

中文翻译：

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Xpert Ultra 用于支气管镜检查诊断结核病：实际应用的思考


基于聚合酶链反应的检测在结核病 (TB) 微生物学诊断中变得越来越重要。 Park 等人1 将 Xpert Ultra 的用途扩展至包括支气管镜检查获得的材料，特别是其用于通过支气管内超声引导经支气管针吸活检 (EBUS-TBNA) 获得的样本。此外，立即细胞学检查和快速现场评估对于纵隔淋巴结肿大（MLN）疾病的鉴别诊断有显着贡献。结合临床特征对结果进行审查是该研究的一个重要组成部分。 2010 年，世界卫生组织建议使用核酸扩增测试 (NAAT) 来识别肺结核和肺外结核中的结核分枝杆菌 (Mtb)。2 Cochrane 综述指出，Xpert Ultra 在诊断结核性脑膜炎方面优于 Xpert MTB/RIF .3 然而，MLN 的抽吸物并未包含在这两项分析中。之前的一项研究调查了 EBUS-TBNA 的作用，并提供了基于 Xpert MTB/RIF、阳性结核菌素皮试以及有或无中央坏死的 MLN 超声纹理异质性的诊断数据。 4 这些 NAAT 背后的科学基础将有助于了解其好处和潜在问题，并阐明领域……