A Nature report about a new, enzymatic assay of Mycobacterium tuberculosis is (inadvertently) mostly a stark reminder that the false positive and the false negative rates are both important for evaluating an assay’s performance. Superficially, no doubt the assay has advantages: it does not require PCR, prolonged bacterial culture or microscopy, and delivers a result in half an hour unlike current standard methods. It is also sensitive: in a test it flagged all samples positive which microscopy found. Microscopy missed 50% of all positive samples, but even of those missed by microscopy the new method flagged 80% positive. Overall the assay recognises 90% of the Tb+ cases as such.

Despite of these advantages this is not yet a promising method. There is a 27 % false positive rate, i. e. the assay flags a quarter of all tested patients as Tb positive even though there are no Tb-causing bacteria in their samples. This is a problem because only 2-400 / 100 000 people get tuberculosis in any country of the world (World Bank). The new test flags about 27 000 positive out of those 99 600 healthy persons in the population. Continue reading →