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Xpert MTB/RIF assay for the differential diagnosis between sarcoidosis and tuberculosis intrathoracic lymphadenopathy
Open accessAbstract
Background: The aim of this study was to evaluate the role of Xpert MTB/RIF assay in the detection of Mycobacterium tuberculosis for differentiating tuberculosis intrathoracic lymphadenopathy from sarcoidosis intrathoracic lymphadenopathy. Methods: The patients who were suspected to having sarcoidosis or tuberculosis intrathoracic lymphadenopathy at the Shanghai Pulmonary Hospital between October 1, 2020 and June 30, 2021 were retrospectively evaluated in this study. All patients underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and Xpert analysis. Differences in clinical and radiological features were recorded. The diagnostic performances of EBUS-TBNA Xpert, acid-fast bacilli, culture, and peripheral blood QuantiFERON-TB Gold (QFT) for differentiating sarcoidosis from tuberculosis intrathoracic lymphadenopathy were analyzed. Results: A total of 119 patients were included in this analysis. Of those, 83 patients were finally diagnosed with sarcoidosis (N = 50) and tuberculosis (N = 33) intrathoracic lymphadenopathy. Young individuals were more likely to have tuberculosis versus sarcoidosis intrathoracic lymphadenopathy (P = 0.006). Markers of inflammation, including fever, leukocytes, and serum ferritin levels, were significantly higher in tuberculosis versus sarcoidosis intrathoracic lymphadenopathy (P < 0.01). Bilateral lung involvement and symmetry intrathoracic lymphadenopathy were more common in sarcoidosis intrathoracic lymphadenopathy (P < 0.01). In addition, the longest diameter of intrathoracic lymphadenopathy (in cm) was significantly larger in sarcoidosis intrathoracic lymphadenopathy (P = 0.001). However, the largest diameter of lung lesions was significantly shorter (P = 0.005). The sensitivity and specificity values of Xpert and QFT for differentiating these two diseases were 69.70% and 100%, and 96.43% and 91.84%, respectively. Conclusion: Xpert MTB/RIF is recommended for the diagnosis of tuberculosis intrathoracic lymphadenopathy using EBUS-TBNA samples. A negative QFT suggests the exclusion of the diagnosis of tuberculosis intrathoracic lymphadenopathy.
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“The Xpert MTB/RIF assay and QuantiFERON-TB Gold tests have shown high specificity and sensitivity in distinguishing TB from sarcoidosis. These tests can detect mycobacterial DNA or immune response to TB antigens, which are absent in sarcoidosis [57].”
From Head and Neck Tuberculosis: A Rare Diagnosis and the Role of Surgical Biopsy and Histopathological Evaluation in Extrapulmonary Disease (2025) · cites this paper as [57]
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Xpert ® MTB/RIF assay for extrapulmonary tuberculosis and rifampicin resistance
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Mogoantă, C. A., Osman, A., Georgescu, A.-M., Mitroi, A. M., Busuioc, C. I., Tănase, I., Cioboată, R., Liliac, I. M., Cimpeanu, O. L., & Ciolofan, M. S. (2025) · Pathogens · doi:10.3390/pathogens14050479 · Cited by 2
“These tests can detect mycobacterial DNA or immune response to TB antigens, which are absent in sarcoidosis [57].”
Maturu, V. N., Pranitha, P., Prasad, V. P., Rachel, R., Garg, V. K., Kotla, S. S., Milap, S., & Prakasham, P. S. (2025) · Journal of Bronchology & Interventional Pulmonology · doi:10.1097/lbr.0000000000001047 · Cited by 2
Lymphoproliferative Disorders Mimicking Rheumatologic Disease: A Clinical Reasoning Perspective
Shen, J. Z., Carlsen, E. D., Carrillo, L. F., Cintrón-López, D., Kellogg, B., Lim, J. L., Nicholas, M. W., Lackey, E., & Dasher, J. (2025) · Current Allergy and Asthma Reports · doi:10.1007/s11882-025-01220-x · Cited by 1
Kamel, F. Z., Ismail, N. A., Khater, A., Shahaway, A. A. E., Almadani, N. A., Sankarapandian, C., & Hammad, N. (2026) · Microorganisms · doi:10.3390/microorganisms14020369
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Metadata
- Authors
- He, X., Zhang, Y., Zhou, Y., Li, L., & Li, Q.
- Affiliations
- Tongji University (CN)
- Corresponding author
- Li, Qiuhong
- Venue
- BMC Infectious Diseases
- Published
- 2023-10-25
- Volume
- 23
- Issue
- 1
- Pages
- 725-725
- ISSN
- 1471-2334 (ISSN-L)
- PMC
- PMC10601222
- OpenAlex
- W4387935482
- Cited by
- 5
- References
- 20
- Citations by year
- 2026: 2 · 2025: 3
- FWCI
- 1.03
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Infectious Diseases (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Natural Science Foundation of China (81200046, 81903977, 82000068)
- Natural Science Foundation of Shanghai (18ZR1431400, 21ZR1447700, 20ZR1446800)
- Science and Technology Innovation Research Project of Shanghai Science and Technology Commission (20Y11902700)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Sarcoidosis and Beryllium Toxicity Research
- Health Sciences › Medicine › Infectious Diseases › Diagnosis and treatment of tuberculosis
- Keywords
- Xpert MTB/RIF, sarcoidosis, tuberculosis, intrathoracic lymphadenopathy, differential diagnosis, endobronchial ultrasound-guided transbronchial needle aspiration, QuantiFERON-TB Gold, Mycobacterium tuberculosis detection, acid-fast bacilli, serum ferritin
- MeSH terms
- Lymphadenopathy, China, Diagnosis, Differential, Humans, Mycobacterium tuberculosis, Retrospective Studies, Sarcoidosis, Sensitivity and Specificity, Tuberculosis
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