Relevance of the correlation between tomography findings and laboratory test results in the accuracy of the diagnosis of pulmonary tuberculosis

Cunha, Daniel Lopes da; Rossetti, Maria Lucia; Nunes, Evaldo Teixeira; Martins, Eduardo Bruno Lobato; Ferreira, Aila de Menezes; Ribeiro, Sariane Coelho

doi:10.1590/0100-3984.2023.0079-en

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Original Article • Radiol Bras 57 • 2024 • https://doi.org/10.1590/0100-3984.2023.0079-en copy

Relevance of the correlation between tomography findings and laboratory test results in the accuracy of the diagnosis of pulmonary tuberculosis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To evaluate the correlation between multidetector computed tomography (MDCT) findings and laboratory test results in patients with pulmonary tuberculosis (PTB).

Materials and Methods:

A total of 57 patients were evaluated. Patients with suspected PTB were divided into groups according to the final diagnosis (confirmed or excluded), and the groups were compared in terms of sociodemographic variables, clinical symptoms, tomography findings, and laboratory test results.

Results:

Among the patients with a confirmed diagnosis of PTB, small pulmonary nodules with a peribronchovascular distribution were significantly more common in the patients with a positive sputum smear microscopy result (47.4% vs. 8.3%; p = 0.046), as were a miliary pattern (36.8% vs. 0.0%; p = 0.026), septal thickening (84.2% vs. 41.7%; p = 0.021), and lymph node enlargement (52.6% vs. 8.3%; p = 0.020). Small pulmonary nodules with a centrilobular distribution were significantly more common among the culture-positive patients (75.0% vs. 35.7%; p = 0.045), as was a tree-in-bud pattern (91.7% vs. 42.9%; p = 0.014). A tree-in-bud pattern, one of the main tomography findings characteristic of PTB, had a sensitivity, specificity, positive predictive value, and negative predictive value of 71.0%, 73.1%, 75.9%, and 67.9%, respectively.

Conclusion:

MDCT presented reliable predictive values for the main tomography findings in the diagnosis of PTB, being a safe tool for the diagnosis of PTB in patients with clinical suspicion of the disease. It also appears to be a suitable tool for the selection of patients who are candidates for more complex, invasive examinations from among those with high clinical suspicion of PTB and a negative sputum smear microscopy result.

Keywords:
Tuberculosis; pulmonary; Multidetector computed tomography; Diagnostic techniques; respiratory system; Clinical laboratory techniques; Molecular diagnostic techniques; Sputum/microbiology

Variable	Diagnosis of PTB		Total (N = 57)	P
Variable	Confirmed (n = 31)	Excluded (n = 26)	Total (N = 57)	P
Age (years), mean ± SD	53.7 ± 19.6	47.1 ± 15.9	50.7 ± 18.2	0.169^* * Frequencies only for the “yes” category.
Sex, n (%)				0.105^‡ ‡ Pearson’s chi-square test.
Male	22 (71.0%)	13 (50.0%)	35 (61.4%)
Female	9 (29,0%)	13 (50.0%)	22 (38.6%)
Symptoms, n (%)^* * Frequencies only for the “yes” category.
Cough	22 (71.0%)	20 (76.9%)	42 (73.7%)	0.611^* * Frequencies only for the “yes” category.
Expectoration	9 (29.0%)	7 (26.9%)	16 (28.1%)	0.860^* * Frequencies only for the “yes” category.
Hemoptysis	6 (19.4%)	5 (19.2%)	11 (19.3%)	0.991^* * Frequencies only for the “yes” category.
Chest pain	6 (19.4%)	15 (57.7%)	21 (36.8%)	0.003^* * Frequencies only for the “yes” category.
Fever (> 38.5°C)	19 (61.3%)	10 (38.5%)	29 (50.9%)	0.086^* * Frequencies only for the “yes” category.
Night sweats	1 (3.2%)	5 (19.2%)	6 (10.5%)	0.083^§ § Fisher’s exact test.
Weight loss	15 (48.4%)	16 (61.5%)	31 (54.4%)	0.321^* * Frequencies only for the “yes” category.
Dyspnea	11 (35.5%)	9 (34.6%)	20 (35.1%)	0.945^* * Frequencies only for the “yes” category.

Characteristic	Diagnosis of TBP		Total (N = 57) n (%)	P
Characteristic	Confirmed (n = 31) n (%)	Excluded (n = 26) n (%)	Total (N = 57) n (%)	P
Positive sputum smear microscopy result	19 (61.3%)	0 (0.0%)	19 (33.3%)	<0.001^* * Frequencies only for the “yes” category.
Positive GeneXpert MTB/RIF result	28 (90.3%)	0 (0.0%)^b b Data available for only 25 patients.	28 (50.0%)^c c Data available for only 56 patients.	<0.001^‡ ‡ Fisher’s exact test.
Positive culture	12 (46.2%)^a a Data available for only 26 patients.	0 (0.0%)^b b Data available for only 25 patients.	12 (23.5%)^d d Data available for only 51 patients.	<0.001^* * Frequencies only for the “yes” category.
MDCT findings^* * Frequencies only for the “yes” category.
Small pulmonary nodules (< 10 mm)	18 (58.1%)	6 (23.1%)	24 (42.1%)	0.008^* * Frequencies only for the “yes” category.
Centrilobular	18 (58.1%)	6 (23.1%)	24 (42.1%)	0.008^* * Frequencies only for the “yes” category.
Perilymphatic	17 (54.8%)	5 (19.2%)	22 (38.6%)	0.006^* * Frequencies only for the “yes” category.
Peribronchovascular	10 (32.3%)	2 (7.7%)	12 (21.1%)	0.023^* * Frequencies only for the “yes” category.
Septal	11 (35.5%)	3 (11.5%)	14 (24.6%)	0.036^* * Frequencies only for the “yes” category.
Subpleural	14 (45.2%)	5 (19.2%)	19 (33.3%)	0.039^* * Frequencies only for the “yes” category.
Random (miliary) distribution	7 (22.6%)	1 (3.8%)	8 (14.0%)	0.059^§ § Student’s t-test.
Tree-in-bud pattern	22 (71%)	7 (26.9%)	29 (50.9%)	0.001^* * Frequencies only for the “yes” category.
Large pulmonary nodules (10-30 mm)	3 (9.7%)	2 (7.7%)	5 (8.8%)	0.999^§ § Student’s t-test.
Lung mass (> 30 mm)	2 (6.5%)	0 (0%)	2 (3.5%)	0.495^§ § Student’s t-test.
Ground-glass opacity	14 (45.2%)	9 (34.6%)	23 (40.4%)	0.419^* * Frequencies only for the “yes” category.
Consolidation	19 (61.3%)	7 (26.9%)	26 (45.6%)	0.009^* * Frequencies only for the “yes” category.
Cavitation	14 (45.2%)	4 (15.4%)	18 (31.6%)	0.016^* * Frequencies only for the “yes” category.
Bronchial wall thickening	19 (61.3%)	4 (15.4%)	23 (40.4%)	<0.001^* * Frequencies only for the “yes” category.
Septal thickening	21 (67.7%)	10 (38.5%)	31 (54.4%)	0.027^* * Frequencies only for the “yes” category.
Fibrotic opacities/distortion of lung architecture	23 (74.2%)	12 (46.2%)	35 (61.4%)	0.030^* * Frequencies only for the “yes” category.
Pleural effusion	15 (48.4%)	4 (15.4%)	19 (33.3%)	0.008^* * Frequencies only for the “yes” category.
Lymph node enlargement (short axis > 1 cm)	11 (35.5%)	6 (23.1%)	17 (29.8%)	0.308^* * Frequencies only for the “yes” category.
Lymph node enlargement with central necrosis	2 (6.5%)	0 (0%)	2 (3,5%)	0.495^§ § Student’s t-test.

MDCT findingss^* * Frequencies only for the “yes” category.	Sputum smear microscopy (n = 31)			GeneXpert MTB/RIF^* * Frequencies only for the “yes” category. (n = 31)			Culture (n = 26)
MDCT findingss^* * Frequencies only for the “yes” category.	Positive (n = 19) n (%)	Negative (n = 12) n (%)	P	Positive (n = 28) n (%)	Negative (n = 3) n (%)	P	Positive (n = 12) n (%)	Negative (n = 14) n (%)	P
Small pulmonary nodules	13 (68.4)	5 (41.7)	0.141^‡ ‡ Pearson’s chi-square test.	18 (64.3)	0 (0.0)	0,064^§ § Fisher’s exact test.	7 (58.3)	6 (42.9)	0.431^* * Frequencies only for the “yes” category.
Centrilobular	13 (68.4)	5 (41.7)	0.130^§ § Fisher’s exact test.	18 (64.3)	1 (33.3)	0,543^§ § Fisher’s exact test.	9 (75.0)	5 (35.7)	0.045^* * Frequencies only for the “yes” category.
Perilymphatic	13 (68.4)	4 (33.3)	0.056^* * Frequencies only for the “yes” category.	17 (60.7)	0 (0.0)	0,081^§ § Fisher’s exact test.	7 (58.3)	6 (42.9)	0.431^* * Frequencies only for the “yes” category.
Peribronchovascular	9 (47.4)	1 (8.3)	0.046^§ § Fisher’s exact test.	10 (35.7)	0 (0.0)	0,533^§ § Fisher’s exact test.	3 (25.0)	3 (21.4)	1.000^§ § Fisher’s exact test.
Septal	9 (47.4)	2 (16.7)	0.128^§ § Fisher’s exact test.	11 (39.3)	0 (0.0)	0,535^§ § Fisher’s exact test.	5 (41.7)	4 (28.6)	0.683^§ § Fisher’s exact test.
Subpleural	11 (57.9)	3 (25.0)	0.073^* * Frequencies only for the “yes” category.	14 (50.0)	0 (0.0)	0,232^§ § Fisher’s exact test.	7 (58.3)	4 (28.6)	0.126^* * Frequencies only for the “yes” category.
Random (miliary) distribution	7 (36.8)	0 (0.0)	0.026^§ § Fisher’s exact test.	7 (25.0)	0 (0.0)	1,000^§ § Fisher’s exact test.	4 (33.3)	2 (14.3)	0.365^§ § Fisher’s exact test.
Tree-in-bud pattern	16 (84.2)	6 (50.0)	0.056^§ § Fisher’s exact test.	21 (75.0)	1 (33.3)	0,195^§ § Fisher’s exact test.	11 (91.7)	6 (42.9)	0.014^§ § Fisher’s exact test.
Large pulmonary nodules (10-30 mm)	3 (15.8)	0 (0.0)	0.265^§ § Fisher’s exact test.	3 (10.7)	0 (0.0)	1,000^§ § Fisher’s exact test.	2 (16.7)	1(7-1)	0.580^§ § Fisher’s exact test.
Lung mass (> 30 mm)	0 (0.0)	2 (16.7)	0.142^§ § Fisher’s exact test.	2 (7.1)	0 (0.0)	1,000^§ § Fisher’s exact test.	0 (0.0)	2 (14.3)	0.483^§ § Fisher’s exact test.
Ground-glass opacity	10 (52.6)	4 (33.3)	0.293^* * Frequencies only for the “yes” category.	14 (50.0)	0 (0.0)	0,232^§ § Fisher’s exact test.	7 (58.3)	6 (42.9)	0.431^* * Frequencies only for the “yes” category.
Consolidation	13 (68.4)	6 (50.0)	0.452^§ § Fisher’s exact test.	18 (64.3)	1 (33.3)	0,543^§ § Fisher’s exact test.	9 (75.0)	7 (50.0)	0.248^§ § Fisher’s exact test.
Cavitation	11 (57.9)	3 (25.0)	0.073^* * Frequencies only for the “yes” category.	12 (42.9)	2 (66.7)	0,576^§ § Fisher’s exact test.	8 (66.7)	4 (28.6)	0.052^* * Frequencies only for the “yes” category.
Bronchial wall thickening	13 (68.4)	6 (50.0)	0.452^§ § Fisher’s exact test.	18 (64.3)	1 (33.3)	0,543^§ § Fisher’s exact test.	9 (75.0)	7 (50.0)	0.248^§ § Fisher’s exact test.
Septal thickening	16 (84.2)	5 (41.7)	0.021^§ § Fisher’s exact test.	19 (67.9)	2 (66.7)	1,000^§ § Fisher’s exact test.	10 (83.3)	9 (64.3)	0.391^§ § Fisher’s exact test.
Fibrotic opacities	14 (73.7)	9 (75.0)	1.000^§ § Fisher’s exact test.	20 (71.4)	3 (100.0)	0,550^§ § Fisher’s exact test.	10 (83.3)	11 (78.6)	1.000^§ § Fisher’s exact test.
Pleural effusion	10 (52.6)	5 (41.7)	0.552^* * Frequencies only for the “yes” category.	14 (50.0)	1 (33.3)	1,000^§ § Fisher’s exact test.	6 (50.0)	6 (42.9)	0.716^* * Frequencies only for the “yes” category.
Lymph node enlargement	10 (52.6)	1 (8.3)	0.020^§ § Fisher’s exact test.	10 (35.7)	1 (33.3)	1,000^§ § Fisher’s exact test.	5 (41.7)	5 (35.7)	1.000^§ § Fisher’s exact test.
Lymph node enlargement with central necrosis	2 (10.5)	0 (0.0)	0.510^§ § Fisher’s exact test.	2 (7.1)	0 (0.0)	1,000^§ § Fisher’s exact test.	0 (0.0)	2 (14.3)	0.483^§ § Fisher’s exact test.

MDCT findings	Sen.	Spe.	VPP	VPN
Small pulmonary nodules	58.1	76.9	75.0	60.6
Centrilobular	61.3	80.8	79.2	63.6
Perilymphatic	54.8	80.8	77.3	60.0
Peribronchovascular	32.3	92.3	83.3	53.3
Septal	35.5	88.5	78.6	53.5
Subpleural	45.2	80.8	73.7	55.3
Random distribution (miliary)	22.6	96.1	87.5	51.0
Tree-in-bud pattern	71.0	73.1	75.9	67.9
Large pulmonary nodules (10-30 mm)	9.7	92.3	60.0	46.1
Lung mass (> 30 mm)	6.4	100.0	100.0	47.3
Ground-glass opacity	45.2	65.4	60.9	50.0
Consolidation	61.3	73.1	73.1	61.3
Cavitation	45.2	84.6	77.8	56.4
Bronchial wall thickening	61.3	84.6	82.6	64.7
Septal thickening	67.7	61.5	67.7	61.5
Fibrotic opacities	74.2	53.8	65.7	63.6
Pleural effusion	48.4	84.6	78.9	57.9
Lymph node enlargement	35.5	76.9	64.7	50.0
Lymph node enlargement with central necrosis	6.4	100.0	100.0	47.3

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[1] Correspondence: Dr. Daniel Lopes da Cunha. Rua Anfrisio Lobão, 1550, ap. 1801, Jóquei. Teresina, PI, Brazil, 64049-280. E-mail: danlopescunha@gmail.com