Comparison of Pleural Fluid Gene Xpert MTB/RIF Assay with Pleural Biopsy for The Evaluation of Pleural Tuberculosis

Objective: To assess the efficacy of gene Xpert assay in comparison of Pleural biopsy to diagnose of pleural tuberculosis.Methodology: This study was conducted at PIMS/SZABMU, Islamabad, Adult population, both genders, aged between 14-70 years presented to hospital with complaints of fever, cough and exudative lymphocytic pleural effusion who were requested to enroll in the study. Included groups of positive and negative for Pleural tuberculosis underwent near neural biopsy using ABRAM's needle approach. SPSS (Statistical Package for Social Sciences) version 23, was used to analyze all of the data. For categorical variables such as gender, frequency and percentage were calculated. For continuous variables such as age, the mean +/- standard deviation was calculated.Results: A total of 190 patients were included in the study with mean age of 27.4 ± 4.8 years; The frequency of Pleural effusion site reported right sided effusion in 108 (56.8%) and left sided effusion in 82 (43.2%) of patients. The Gene xpert results were reported as positive in 55 (28.9%) and negative in 135 (71.1%) of patients; pleural biopsy was reported as positive in 77 (40.5%) and negative in 113 (59.5%) of patients. Correlation of pleural biopsy with gene Xpert results indicated 47 gene xpert patients with Pleural biopsy as positive and 8 as negative while gene xpert negative results were reported in 30 patients with pleural biopsy positive results and 105 negative results, p-value was estimated at 0.0007. Sensitivity was reported as 71.2%, specificity at 92.4%, PPV was 88.2%, NPV at 81.9% and Accuracy was 84.2% respectively.Conclusion: Mycobacterium TB can be accurately detected in patients with exudative pleural effusions using gene xpert analysis.Keywords: Myobacterium TB, Gene Xpert assay, Pleural effusion, Pleural Biopsy