Biadglegne et al. Level III-2 BacT/Alert N=32 culture-positive Xpert RIF 2 1 0 29 None reported () 3D DST FNA samples Some risk of Ethiopia and bias Germany BAL = bronchoalveolar lavage; DST = drug susceptibility testing; FNA = fine-needle aspirate; L-J = Lowenstein-Jensen; MDR = multidrug-resistant; MGIT = Mycobacterium Growth Indicator Tubes; RIF = rifampicin Table 91 Diagnostic accuracy of NAAT and AFB microscopy using culture as the reference standard for diagnosis of NTM Evidence Reference Study Population Tests Notes level and risk standard Country Samples of bias results results results results Abdalla et al. () Level II L-J culture N=27 FFPE skin biopsy AFB –ve In-house NTM-NAAT 1 13 0 13 Culture not performed MTB culture-negative on 3/34 specimens High risk of Brazil specimens bias 4/34 were MTB C+ Bogner et al. () Level III-1 BACTEC N=540 blood specimens HIV+ In-house MAC-NAAT 12 2 34 492 Only MAC-positive and 12B and/or MAC-negative results Germany Low risk of L-J culture considered bias Results include 6 MTB and 18 non-MAC NTM C+ specimens Mahaisavariya Level III-1 Culture N=131 tissue biopsies AFB 15 26 21 69 11/131 specimens had et al. () no culture results and High risk of In-house NTM-NAAT 16 31 20 64 were included as Thailand bias 5 n=41 AFB +ve In-house MTM-NAAT 7 5 8 21 culture-negative 6 n=90 AFB –ve In-house MTM-NAAT 9 26 12 43 Results includes 2 MTB C+ specimens Kox et al. () Level III-2 Culture N=238 MTB AFB (ZN) 32 22 7 177 21/259 specimens were specimens In-house NTM-NAAT 37 27 2 172 MTB C+ The Netherlands Low risk of bias n=53 AFB +ve In-house NTM-NAAT 31 17 1 4 n=185 AFB –ve In-house NTM-NAAT 6 10 1 168
Biadglegne et al. () Ethiopia and Germany Level III-2 Some risk of bias BacT/Alert 3D DST N=32 culture-positive FNA samples Xpert RIF 2 1 0 29 None reported BAL = bronchoalveolar lavage; DST = drug susceptibility testing; FNA = fine-needle aspirate; L-J = Lowenstein-Jensen; MDR = multidrug-resistant; MGIT = Mycobacterium Growth Indicator Tubes; RIF = rifampicin Table 91 Diagnostic accuracy of NAAT and AFB microscopy using culture as the reference standard for diagnosis of NTM Study Country Evidence level and risk of bias Reference standard Population Samples Tests results results results results Notes Abdalla et al. () Brazil Level II High risk of bias L-J culture N=27 FFPE skin biopsy MTB culture-negative specimens AFB –ve In-house NTM-NAAT 1 13 0 13 Culture not performed on 3/34 specimens 4/34 were MTB C+ Bogner et al. () Germany Level III-1 Low risk of bias BACTEC 12B and/or L-J culture N=540 blood specimens HIV+ In-house MAC-NAAT 12 2 34 492 Only MAC-positive and MAC-negative results considered Results include 6 MTB and 18 non-MAC NTM C+ specimens Mahaisavariya et al. () Thailand Level III-1 High risk of bias Culture N=131 tissue biopsies 5 n=41 6 n=90 AFB In-house NTM-NAAT AFB +ve In-house MTM-NAAT AFB –ve In-house MTM-NAAT 15 16 7 9 26 31 5 26 21 20 8 12 69 64 21 43 11/131 specimens had no culture results and were included as culture-negative Results includes 2 MTB C+ specimens Kox et al. () The Netherlands Level III-2 Low risk of bias Culture N=238 MTB specimens n=53 n=185 AFB (ZN) In-house NTM-NAAT AFB +ve In-house NTM-NAAT AFB –ve In-house NTM-NAAT 32 37 31 6 22 27 17 10 7 2 1 1 177 172 4 168 21/259 specimens were MTB C+
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