Commentary: Diagnostic accuracy of oral swab for detection of pulmonary tuberculosis: a systematic review and meta-analysis

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Introduction:Pulmonary tuberculosis caused by Mycobacterium tuberculosis remains a major public health concern, requiring accurate diagnosis for effective treatment, prevention, and transmission control, particularly in vulnerable populations. Among available diagnostic approaches, oral swab is regarded as a promising non-invasive and alternative test, especially in cases where sputum collection is difficult. Thus, many studies have explored its potential in managing this disease (1–3).While analyzing the paper published by Zhang et al., Diagnostic Accuracy of Oral Swab for Detection of Pulmonary Tuberculosis: A Systematic Review and Meta-Analysis (https://doi.org/10.3389/fmed.2023.1278716), we found that the paper provides valuable insights on the topic; however, we identified an error that requires correction and felt it necessary to bring this to your attention. Therefore, this commentary addresses the diagnostic accuracy of the test, focusing on the impact of the identified publication bias.Subsections relevant for the subject:In results section, page 4, subsection “Publication bias assessment”, the statement “The funnel plot clearly indicated the absence of significant publication bias in this meta-analysis (P = 0.99)” is inaccurate. Given the z-Stat4life community's interest in this topic, we replicated the meta-analysis using R Program (metafor and meta) (4-5) and we found indications of the publication bias in the funnel plots and Egger test. For metafor, in adults, the P-values were 0.001 both for sensitivity (Se) and specificity (Sp) and for meta (Se: P=0.007; Sp: P=0.015), contrary to the paper's findings.Discussion:Publication bias affecting both Se and Sp in this meta-analysis may inflate the test's diagnostic accuracy, potentially misleading clinical decisions. Transparent reporting of all results, including negative findings, and prioritizing methodological rigor can help reduce bias and enhance scientific reliability. Therefore, your attention to this issue and the necessary editorial actions are required to maintain the journal’s quality and credibility.

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