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Evidence-Based Comparison of Commercial Interferon-γ Release Assays for Detecting Active TB: A Metaanalysis

Roland Diel, MD, MPH; Robert Loddenkemper, MD, FCCP; Albert Nienhaus, MD, MPH
Author and Funding Information

From the Department of Pulmonary Medicine (Dr Diel), Medical School (MHH) Hannover; German Central Committee against Tuberculosis (Dr Loddenkemper), Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin; and Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (Dr Nienhaus), Hamburg, Germany.

Correspondence to: Roland Diel, MD, MPH, Assistant Professor, Department of Pulmonary Medicine, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany; e-mail: Diel.Roland@mh-hannover.de


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(4):952-968. doi:10.1378/chest.09-2350
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Test accuracy of interferon-γ release assays (IGRAs) for diagnosing TB differs when using older or precommercial tools and inconsistent diagnostic criteria. This metaanalysis critically appraises studies investigating sensitivity and specificity of the commercial T-Spot.TB and the QuantiFERON-TB Gold In-Tube Assay (QFT-IT) among definitely confirmed TB cases. We searched Medline, EMBASE, and Cochrane bibliographies of relevant articles. Sensitivities, specificities, and indeterminate rates were pooled using a fixed effect model. Sensitivity of the tuberculin skin test (TST) was evaluated in the context of IGRA studies. In addition, the rates of indeterminates of both IGRAs were assessed. The pooled sensitivity of TST was 70% (95% CI, 0.67-0.72) compared with 81% (95% CI, 0.78-0.83) for the QFT-IT and 88% (95% CI, 0.85-0.90) for the T-Spot.TB. Sensitivity increased to 84% (95%CI, 0.81-0.87) and 89% (95% CI, 0.86-0.91) for the QFT-IT and T-Spot.TB, respectively, when restricted to performance in developed countries. In contrast, specificity of the QFT-IT was 99% (95% CI, 0.98-1.00) vs 86% for the T-Spot.TB (95% CI, 0.81-0.90). The pooled rate of indeterminate results was low, 2.1% (95% CI, 0.02-0.023) for the QFT-IT and 3.8% (95% CI, 0.035-0.042) for the T-Spot.TB, increasing to 4.4% (95% CI, 0.039-0.05) and 6.1% (95% CI, 0.052-0.071), respectively, among immunosuppressed hosts. The newest commercial IGRAs are superior, in comparison with the TST, for detecting confirmed active TB disease, especially when performed in developed countries.

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