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<div><p>The prevalence and clinical implications of discordance between Xpert MTB/RIF assays and the AdvanSure TB/NTM real-time polymerase chain reaction (PCR) for bronchial washing specimens have not been studied in pulmonary TB (PTB) patients. The discordant proportion and its clinical impact were evaluated in 320 patients from the bronchoscopy registry whose bronchial washing specimens were tested simultaneously with Xpert MTB/RIF and the TB/NTM PCR assay for three years, and the accuracy of the assays, including the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were studied. The clinical risk factors for discordance and false positivity of assays were also studied. Among 130 patients who were clinically diagnosed with PTB, 64 patients showed positive acid-fast bacilli culture results, 56 patients showed positive results in molecular methods and clinician diagnosed PTB without results of microbiology in 10 patients. The sensitivity, specificity, PPV, and NPV were 80.0%, 98.95%, 98.1%, and 87.9%, respectively, for Xpert MTB/RIF and 81.5%, 92.6%, 88.3%, and 88.0%, respectively, for TB/NTM PCR. The discordant proportion was 16.9% and was higher in culture-negative PTB compared to culture-confirmed PTB (24.3% vs. 9.4%, p = 0.024). However, there were no significant differences in the clinical characteristics, regardless of the discordance. The diagnostic yield increased with an additional assay (7.7% for Xpert MTB/RIF and 9.2% for TB/NTM PCR). False positivity was less common in patients tested with Xpert MTB/RIF (1.05% vs. 7.37%, p = 0.0035). No host-related risk factor for false positivity was identified. The Xpert MTB/RIF and TB/NTM PCR assay in bronchial washing specimens can improve the diagnostic yields for PTB, although there were considerable discordant results without any patient-related risk factors.</p></div

Clinical characteristics of patients with false positivity in either real time TB PCR or Xpert MTB/RIF assay.

<p>Clinical characteristics of patients with false positivity in either real time TB PCR or Xpert MTB/RIF assay.</p

Discordance between real time TB PCR and Xpert MTB/RIF assay in bronchial washing specimen collected from patients treated with pulmonary TB^*.

<p>Discordance between real time TB PCR and Xpert MTB/RIF assay in bronchial washing specimen collected from patients treated with pulmonary TB^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0164923#t003fn001" target="_blank">*</a>}.</p

Diagnostic accuracy of TB PCR and Xpert MTB/RIF assay for the diagnosis of pulmonary TB among AFB culture negative or positive patients.

<p>Diagnostic accuracy of TB PCR and Xpert MTB/RIF assay for the diagnosis of pulmonary TB among AFB culture negative or positive patients.</p

Clinical characteristics of patients tested for AFB stain/culture, TB PCR and Xpert MTB/RIF assay in bronchial washing specimen^a.

<p>Clinical characteristics of patients tested for AFB stain/culture, TB PCR and Xpert MTB/RIF assay in bronchial washing specimen<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0164923#t001fn001" target="_blank">^a</a>.</p

Study flow.

<p>Abbreviation: AFB = acid-fast bacilli, TB = tuberculosis, PCR = polymerase chain reaction, NTM = non-tuberculosis mycobacterium. * other diseases (number): bronchiectasis(3), empyema(3), benign bronchial stenosis(2), anthracofibrosis(1), fungal ball(1), lung abscess(1), diffuse panbronchiolitis(1). ** Pulmonary TB (PTB) with growth of <i>M</i>. <i>tuberculosis</i> in culture study. ^† PTB without growth of <i>M</i>. <i>tuberculosis</i> which was diagnosed with PCR for TB or clinical decision.</p

sj-docx-1-tar-10.1177_17534666231169472 – Supplemental material for Heterogeneity of asthma–chronic obstructive pulmonary disease (COPD) overlap from a cohort of patients with severe asthma and COPD

Supplemental material, sj-docx-1-tar-10.1177_17534666231169472 for Heterogeneity of asthma–chronic obstructive pulmonary disease (COPD) overlap from a cohort of patients with severe asthma and COPD by Joon Young Choi, Chin Kook Rhee, Kwang Ha Yoo, Ki-Suck Jung, Jae Ha Lee, Hyoung Kyu Yoon, Seung Won Ra, Myung Goo Lee and Yong Suk Jo in Therapeutic Advances in Respiratory Disease</p