Comparison of sputum induction and bronchoscopy in diagnosis of sputum smear-negative pulmonary tuberculosis: a systemic review and meta-analysis.

Abstract Background and Objectives: Pulmonary tuberculosis is one of the most common infectious diseases worldwide. Patients with suspected pulmonary tuberculosis with negative smear are recommended to undergo further tests including sputum induction and bronchoscopy. Our study is aimed to compare sputum induction and bronchoscopic specimens in the diagnosis of sputum smear-negative pulmonary tuberculosis. Method: PubMed, Web of Science, Cochrane Library and Embase were searched for eligible studies. The pooled sensitivities (SEN), specificities (SPE), positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and 95% confidence interval (CIs) were constructed, and the areas under the curves (AUCs) were calculated.Results: Five studies with a total number of 586 cases were included. For mycobacterial culture, the SEN and SPE of sputum induction were 0.72(95% CI, 0.66-0.77) and 1.00 (95%CI, 0.99-1.000) respectively, whereas the SEN and SPE of bronchoscopy were 0.70(95%CI, 0.64-0.75) and 1.00 (95%CI, 0.99-1.00) respectively. Sputum induction had a similar AUC(0.9564, SE=0.0749) with bronchoscopy (0.8618, SE=0.1652) ( P =0.602). For specimen of acid-fast bacilli smear, the SEN and SPE of sputum induction were 0.35 (95% CI, 0.29-0.42) and 0.99(95% CI, 0.96-1.00) respectively, whereas the SEN and SPE of bronchoscopy were 0.38 (95% CI, 0.32-0.45) and 0.99 (95% CI, 0.96-1.00) respectively. Sputum induction had a familiar AUC (0.6016) with bronchoscopy (0.8163) ( P =0.792).Conclusions: For the diagnosis of sputum smear-negative pulmonary tuberculosis, the diagnosis yield of sputum induction and bronchoscopy is similar.