To evaluate the application value of sonography-guided core needle biopsy and semi-nest fully automatic real-time nucleic acid amplification detection technology (XpertMTB/RIF) in the diagnosis of peripheral tuberculosis.

A retrospective analysis was performed on 71 hospitalized patients with suspected peripheral tuberculosis at the Tuberculosis Department of Zhejiang Integrated Traditional Chinese and Western Medicine Hospital from June 2016 to June 2018. All patients who had lung masses underwent sonography-guided puncture biopsy. The puncture tissue specimens were subjected to routine pathological examination, XpertMTB/RIF assays, and Mycobacterium tuberculosis (MTB) culture. Using the "Guidelines for Diagnosis and Treatment of Tuberculosis" as the diagnostic gold criteria, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the three methods for the diagnosis of peripheral tuberculosis were calculated, and χ² test was used for comparison between groups. The area under the receiver operating characteristic (ROC) curve (AUC) was also calculated to compare the diagnostic efficacy of the three diagnostic methods. The sensitivity of the XpertMTB/RIF method to test rifampicin resistance was assessed using the drug sensitivity test as the diagnostic TB standard.

Forty patients were diagnosed with peripheral tuberculosis (tuberculosis) and thrity-one with non-peripheral tuberculosis (non-TB). The non-tuberculous group included ten cases of lung malignancies, one case of benign lung tumor, fourteen cases of interstitial pneumonia, three cases of intracellular mycobacterial pneumonia, and three cases of fungal pneumonia. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the conventional pathology, XpertMTB/RIF, and MTB culture were 80.0%, 92.5%, and 12.5%, 90.3%, 100%, and 100%, 91.4%, 100%, and 100%, 77.8%, 91.2%, and 47.0%, and 84.5%, 95.8%, and 50.7%, respectively. The diagnostic sensitivity of XpertMTB/RIF was higher than that of routine pathological examination or MTB culture (χ²=33.632 and 5.976, respectively; P＜0.05). ROC curve analysis showed that the AUC of onventional pathology, XpertMTB/RIF, and MTB culture was 0.814, 0.963, and 0.563, respectively; XpertMTB/RIF had a significantly better AUC than routine pathology examination and MTB culture (t=7.579 and 2.303, respectively; P＜0.05).

The sonography-guided core needle biopsy and XpertMTB/RIF detection technique can make a rapid and accurate diagnosis of peripheral tuberculosis, and has a high diagnostic efficacy compared to routine pathological examination and MTB culture.