By reviewing the clinical data and tests results (T-SPOT.TB, SAT and serum TB-Ab) of 980 patients hospitalized in Shanghai Pulmonary Hospital (689 patients with pulmonary tuberculosis and 291 patients with non-tuberculosis lung diseases) from Nov 2014 to Oct 2015, the diagnostic sensitivity and specificity of the three methods were compared. Taking the clinical diagnosis of pulmonary tuberculosis as the gold standard, we calculated the diagnostic efficiency indexes of the three methods, while they were separately or jointly tested in these patients, and drew the receiver operating characteristic (ROC) curves to evaluate their diagnostic value for tuberculosis. As to joint testing, patients were diagnosed as pulmonary tuberculosis if one of the involved tests showed positive results, whereas patients were judged as non-pulmonary tuberculosis if all involved tests showed negative results.

The sensitivity of T-SPOT.TB was 90.67% (593/654), while the specificity was 68.09% (192/282). The sensitivity of SAT was 30.43% (133/437), while the specificity was 100.00% (87/87). The sensitivity of TB-Ab was 43.95% (298/678), while the specificity was 78.82% (227/288). The sensitivity of the co-detection of the three methods was 93.14% (285/306), while the specificity was 53.41% (47/88). The sensitivity of T-SPOT.TB combined with TB-Ab was 92.83% (440/474), while the specificity was 52.11% (148/284). After drawing the ROC curves to evaluate T-SPOT.TB and SAT detections’ performances in diagnosing pulmonary tuberculosis, T-SPOT.TB and SAT-TB tests achieved the areas under the curve (AUC) of 0.798 and 0.652, respectively; and the AUC for T-SPOT.TB+SAT+TB-Ab and T-SPOT+TB-Ab were 0.865 and 0.843, respectively.

The co-detection of the three methods, T-SPOT.TB, SAT and TB-Ab, was the most valuable method for the diagnosis of pulmonary tuberculosis. Combining detection of T-SPOT.TB and TB-Ab could be the second choice. If we only tested one of the three, T-SPOT.TB was the highest valuable detection for the diagnosis of pulmonary tuberculosis, and the highest specificity belonged to sputum SAT detection.