Advertisement

Role of GeneXpert MTB/RIF Assay for Diagnosis of Tuberculous Mastitis

  • Jayashri Pandya
  • Ajeet Ramamani TiwariEmail author
  • Varun Thareja
Original Article
  • 8 Downloads

Abstract

The role of GeneXpert MTB/RIF (GX) in tuberculous (TB) mastitis is not defined. The aim of this study was to evaluate the role of GX in the diagnostic evaluation of TB mastitis. Patients presenting with signs and symptoms of breast abscess, previously drained breast abscess that did not heal, and recurrent breast abscesses were included in the study. GX (cartridge-based nucleic acid amplification test), FNAC, abscess wall scrapings for histopathology, pus for culture and sensitivity, chest X-ray, serum adenosine deaminase (ADA), and ESR levels were performed in all patients. Female patients (n = 228) were enrolled in the study between August 2013 and December 2017. A total of 26 (11.4%) patients were diagnosed with TB mastitis using multiple clinical/biochemical/histopathological parameters. GX was positive for Mycobacterium TB (MTB) in 22 patients whereas FNAC and combined ADA+ESR (ADA > 23.5, ESR > 25) were suggestive of TB mastitis in 6 and 18 patients respectively. The sensitivity, specificity, positive predictive value, and negative predictive value for GX test, FNAC, and combined ADA+ESR were 83.3%, 99%, 90.9%, 98.1%, 16.7%, 99.0%, 66.7%, 91%, 66.7%, 99%, 88.9%, and 96.2% respectively. Our study concludes that GX is an important tool with moderate sensitivity (83.3%) and high specificity (99%) for detection of TB mastitis. It should be considered in all suspicious cases of TB mastitis where patients fail to respond to conventional treatment of breast abscess. However, it cannot be used alone and other clinical and complementary laboratory parameters (ADA, ESR) should be used in the diagnostic pathway.

Keywords

Tuberculous mastitis GeneXpert Breast abscess Adenosine deaminase ESR 

Notes

Acknowledgments

We would like to thank Dr. Durgesh Sahoo for his help with statistical analysis for the study.

Author Contribution

All authors of this research paper have directly participated in the conception and design of the study, acquisition of data, and analysis and interpretation of data. All authors of this paper have read and approved the final version submitted.

Compliance with Ethical Standards

The study was approved by the ethics committee of B.Y.L. Nair Charitable Hospital and written informed consent was obtained from all the enrolled patients.

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Harold FH, Thomas HR (1982) Mammary tuberculosis. J Royal Soc Med 75:764–765Google Scholar
  2. 2.
    Marinopoulos S, Lourantou D, Gatzionis T, Dimitrakakis C, Papaspyrou I, Antsaklis A (2012) Breast tuberculosis: diagnosis, management and treatment. Int J Surg Case Rep 3(11):548–550.  https://doi.org/10.1016/j.ijscr.2012.07.003 CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Mehta G, Mittal A, Verma S (2010) Breast tuberculosis- clinical spectrum and management. Indian J Surg 72(6):433–437.  https://doi.org/10.1007/s12262-010-0166-5 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Goksoy E, Duren M, Durgun V, Uygun N (1995) Tuberculosis of the breast. Eur J Surg 161:471–473PubMedGoogle Scholar
  5. 5.
    Polepole P, Kabwe M, Kasonde M, Tembo J, Shibemba A, O’Grady J, Kapata N, Zumla A, Bates M (2017) Performance of the Xpert MTB/RIF assay in the diagnosis of tuberculosis in formalin-fixed, paraffin-embedded tissues. Int J Mycobacteriol 6(1):87–93.  https://doi.org/10.4103/2212-5531.201892 CrossRefPubMedGoogle Scholar
  6. 6.
    Zeka AN, Tasbakan S, Cavusoglu C (2011) Evaluation of the GeneXpert MTB/RIF assay for rapid diagnosis of tuberculosis and detection of rifampin resistance in pulmonary and extrapulmonary specimens. J Clin Microbiol 49:4138–4141CrossRefGoogle Scholar
  7. 7.
    Lawn SD, Brooks SV, Kranzer K, Nicol MP, Whitelaw A, Vogt M et al (2011) Screening for HIV-associated tuberculosis and rifampicin resistance before antiretroviral therapy using the Xpert MTB/RIF assay: a prospective study. PLoS Med 8:e1001067CrossRefGoogle Scholar
  8. 8.
    O’Grady J, Maeurer M, Mwaba P, Kapata N, Bates M, Hoelscher M et al (2011) New and improved diagnostics for detection of drug-resistant pulmonary tuberculosis. Curr Opin Pulm Med 17:134–141CrossRefGoogle Scholar
  9. 9.
    Cooper A (1829) Illustration of the diseases of the breast: Part 1. Longman, Orne, Brown and Green, London, p 73Google Scholar
  10. 10.
    Tewari M, Shukla HS (2005) Breast tuberculosis: diagnosis, clinical features, and management. Indian J Med Res 122:103–110PubMedGoogle Scholar
  11. 11.
    Gupta R, Gupta AS, Duggal N (1982) Tubercular mastitis. Int Surg 67:422–424PubMedGoogle Scholar
  12. 12.
    Kedar GP, Bophate SK, Kherdekar M (1985) Tuberculosis of breast. Ind J Tub 32:146Google Scholar
  13. 13.
    Sharma PK, Babel AL, Yadav SS (1991) Tuberculosis of breast (study of 7 cases). J PostgradMed 7:24–26Google Scholar
  14. 14.
    Khanna R, Prasanna GV, Gupta P, Kumar M, Khanna S, Khanna AK (2002) Mammary tuberculosis: report on 52 cases. Post Grad Med J 78:422–424CrossRefGoogle Scholar
  15. 15.
    Singh S, Chhabra S, Yadav R, Duhan A (2011) Tuberculous mastitis: still a diagnostic dilemma. J Global Infect Dis 3(1):98–99.  https://doi.org/10.4103/0974-777X.77309 CrossRefGoogle Scholar
  16. 16.
    Kakkar S, Kapila K, Singh MK, Verma K (2000) Tuberculosis of the breast: a cytomorphological study. Acta Cytol 44:292–296CrossRefGoogle Scholar
  17. 17.
    Zhong L, Zhou XL, Li J, Zhang YM, Jiao YF, Guo BL, Yan ZQ, Zhang JG (2015 Winter) The T-SPOT.TB test for diagnosis of breast tuberculosis. Lab Med 46(1):14–19.  https://doi.org/10.1309/LMFBRT05MWV3AYIM CrossRefPubMedGoogle Scholar
  18. 18.
    World Health Organization (WHO) (2013) Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF assay for the diagnosis of pulmonary and extrapulmonary TB in adults and children: Policy update. In: Automated real-time nucleic acid amplification technology for rapid and simultaneous detection of tuberculosis and rifampicin resistance: Xpert MTB/RIF assay for the diagnosis of pulmonary and extrapulmonary TB in adults and children: policy update, 16th ed. Geneva: WHOGoogle Scholar
  19. 19.
    Denkinger CM, Schumacher SG, Boehme CC, Dendukuri N, Pai M, Steingart KR (2014) Xpert MTB/RIF assay for the diagnosis of extrapulmonary tuberculosis: a systematic review and meta-analysis. Eur Respir J 44:435–446CrossRefGoogle Scholar
  20. 20.
    Moussa HS, Bayoumi FS, Ali AM (2016) Evaluation of GeneXpert MTB/RIF assay for direct diagnosis of pulmonary tuberculosis. Saudi Med J 37(10):1076–1081.  https://doi.org/10.15537/smj.2016.10.14998 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Association of Surgeons of India 2019

Authors and Affiliations

  • Jayashri Pandya
    • 1
  • Ajeet Ramamani Tiwari
    • 2
    Email author
  • Varun Thareja
    • 1
  1. 1.Department of General SurgeryBai Yamunabai Laxman Nair Charitable HospitalMumbaiIndia
  2. 2.Department of Surgical OncologyKidwai Cancer InstituteBengaluruIndia

Personalised recommendations