Abstract:

Objective: To systematically assess the diagnostic utility of oral swab testing in identifying pulmonary tuberculosis through a comprehensive meta-analysis. Methods: We conducted a detailed search of several databases including PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang, VIP, and CBM, to gather relevant studies published until April 12, 2024, that investigate the use of oral swabs for detecting pulmonary tuberculosis. Literature search, screening, data extraction, and quality evaluation were independently executed by two researchers. We employed STATA 16.0 to compute the aggregated sensitivity, specificity, positive likelihood ratios, negative likelihood ratios, and diagnostic odds ratios for both overall and subgroup analyses. Publication bias was methodically evaluated using Deek’s funnel plot analysis. Results: We retrieved a total of 173 records, of which 15 studies met the predefined inclusion and exclusion criteria. Our meta-analysis revealed that the aggregate sensitivity of oral swabs for the diagnosis of pulmonary tuberculosis was 65.0% (95%CI: 54.0%-75.0%), while the overall specificity reached 96.0% (95%CI: 92.0%-98.0%). In subgroup analyses focusing on adult patients with pulmonary tuberculosis, oral swabs demonstrated a sensitivity of 73.0% (95%CI: 64.0%-80.0%) and a specificity of 95.0% (95%CI: 83.0%-98.0%).The sensitivity of tongue swabs in diagnosing pulmonary tuberculosis was 73.0% (95%CI: 63.0%-80.0%), surpassing that of cheek swabs, which registered a sensitivity of 52.0% (95%CI: 34.0%-70.0%). Conclusion: Oral swabs represent a viable alternative diagnostic tool for pulmonary tuberculosis. Notably, tongue swabs exhibit greater sensitivity compared to cheek swabs in detecting pulmonary tuberculosis cases.

Key words: Tuberculosis, Diagnosis, Oral cavity, Meta-analysis