Figure 14 SROC curve for all studies investigating the sensitivity and specificity of AFB plus NAAT versus culture in the diagnosis of TB for all studies based on NAAT methodology (A), and for sputum (B) and non-sputum (C) specimens based on incidence of TB
AUC = area under curve; SROC = summary receiver–operator characteristic
Meta-analysis of studies assessing the diagnostic accuracy of NAAT compared with culture
Forest plots showing the sensitivity and specificity for the 68 studies that compared the diagnostic accuracy of NAAT with culture in patients suspected of having TB are shown in Figure 41 and Figure 42 (Appendix D). Although the sensitivity ranged from 6% to 100%, it was less variable than for AFB microscopy (Appendix E), with only 12/68 (18%) having a sensitivity below 70%. Meta-analysis showed that the overall pooled sensitivity for NAAT compared with culture was 89% (95%CI 85, 92). There were no significant differences in the pooled sensitivities for in-house compared with the commercial NAAT (Xpert) for any subgroup investigated; however, there was a slight trend suggesting that in-house NAATs were more sensitive than the commercial NAAT for most comparisons (Figure 15).
Figure 15 Forest plot showing the pooled sensitivity and specificity values for NAAT compared with culture for studies grouped according to the NAAT comparator, specimen type and incidence of TB in the country in which the study was conducted
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