title: Accuracy of bronchoalveolar lavage enzyme-linked immunospot assay to diagnose smear-negative tuberculosis: a meta-analysis.
abstract: OBJECTIVE
  While the bronchoalveolar lavage enzyme-linked immunospot assay (BAL-ELISPOT) shows promise for diagnosing smear-negative tuberculosis, its accuracy remains controversial. We meta-analyzed the available evidence to obtain a clearer understanding of the diagnostic accuracy.
  
  
  METHODS
  Studies of the diagnostic performance of ELI-SPOT on smear-negative tuberculosis were identified through systematic searches of the PubMed and EMBASE databases. Pooled data on sensitivity, specificity and other measures of accuracy were meta-analyzed using a random-effects model. Summary receiver operating characteristic curves were used to assess overall test performance.
  
  
  RESULTS
  A total of 7 studies were included in the meta-analysis. Diagnostic performance was as follows: sensitivity, 0.89 (95% CI 0.84 to 0.93); specificity, 0.78 (95% CI 0.74 to 0.81); positive likelihood ratio, 4.2 (95% CI 2.42 to 7.28); negative likelihood ratio, 0.14 (95% CI 0.06 to 0.33); diagnostic odds ratio, 36.16 (95% CI 9.70 to 134.73); and area under the curve, 0.9605 (SEM 0.0247).
  
  
  CONCLUSIONS
  Available evidence suggests that BAL-ELISPOT may perform better than blood-ELISPOT for both screening and confirming a diagnosis of smear-negative tuberculosis. Nevertheless, BAL-ELISPOT should be not used alone but rather in parallel with clinical manifestations and conventional tests to ensure reliable diagnosis.
authors.affiliation: West China School of Medicine/West China Hospital, Sichuan University Chengdu, Sichuan, China.
authors.forename: Zhenzhen
authors.initials: Z
authors.lastname: Li
authors.affiliation: West China School of Medicine/West China Hospital, Sichuan University Chengdu, Sichuan, China.
authors.forename: Wenzhe
authors.initials: W
authors.lastname: Qin
authors.affiliation: West China School of Medicine/West China Hospital, Sichuan University Chengdu, Sichuan, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.affiliation: West China School of Medicine/West China Hospital, Sichuan University Chengdu, Sichuan, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Respiratory and Critical Care Medicine, West China Hospital of Sichuan University Chengdu, Sichuan, China.
authors.forename: Xuerong
authors.initials: X
authors.lastname: Chen
keywords: Bronchoalveolar lavage enzyme-linked immunospot; diagnosis; meta-analysis; smear-negative tuberculosis