title: The effectiveness of real-time PCR assay, compared with microbiologic results for the diagnosis of pulmonary tuberculosis.
abstract: BACKGROUND
  The incidence of tuberculosis (TB) in Korea is relatively high compared to the other Organisation for Economic Co-operation and Development (OECD) countries, with a prevalence of 71 per 100,000 in 2012, although the incidence is declining. Real-time polymerase chain reaction (PCR) has been introduced for the rapid diagnosis of TB. Recently, its advantage lies in higher sensitivity and specificity for the diagnosis of TB. This study evaluated the clinical accuracy of real-time PCR using respiratory specimens in a clinical setting.
  
  
  METHODS
  Real-time PCR assays using sputum specimens and/or bronchoscopic aspirates from 2,877 subjects were reviewed retrospectively; 2,859 subjects were enrolled. The diagnosis of TB was determined by positive microbiology, pathological findings of TB in the lung and pleura, or clinical suspicion of active TB following anti-TB medication for more than 6 months with a favorable response.
  
  
  RESULTS
  Sensitivity, specificity, and accuracy were 44%, 99%, and 86% from sputum, and 65%, 97%, and 87% from bronchoscopic aspirates, respectively. For overall respiratory specimens, sensitivity was 59%, specificity was 98%, and accuracy increased to 89%.
  
  
  CONCLUSIONS
  Positivity in real-time PCR using any respiratory specimens suggests the possibility of active TB in clinically suspected cases, guiding to start anti-TB medication. Real-time PCR from selective bronchoscopic aspirates enhances the diagnostic yield much more when added to sputum examination.
authors: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors: Seo Woo
authors: SW
authors: Kim
authors: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors: Sae In
authors: SI
authors: Kim
authors: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors: Seok Jeong
authors: SJ
authors: Lee
authors: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors: Jin Hwa
authors: JH
authors: Lee
authors: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors: Yun Ju
authors: YJ
authors: Ryu
authors: Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea.
authors: Sung Shine
authors: SS
authors: Shim
authors: Department of Radiology, Ewha Womans University School of Medicine, Seoul, Korea.
authors: Yookyoung
authors: Y
authors: Kim
authors: Department of Laboratory Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors: Mi Ae
authors: MA
authors: Lee
authors: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors: Jung Hyun
authors: JH
authors: Chang
keywords: Bronchoscopy; Diagnosis; Real-Time Polymerase Chain Reaction; Sputum; Tuberculosis, Pulmonary
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