Key result
Serum CMV PCR demonstrated a pooled sensitivity of 62% and specificity of 90% for diagnosing CMV ileocolitis, indicating it cannot replace colonoscopy but is useful when endoscopy is not feasible.
Why the study?
Diagnosis of CMV ileocolitis traditionally requires colonoscopy with biopsy, which carries potential complications in high-risk patients, prompting interest in noninvasive serum and stool tests.
Do noninvasive tests (serum/stool CMV PCR and Ag) accurately diagnose CMV ileocolitis compared to tissue histopathology/PCR?
Meta-Analysis
Do noninvasive tests (serum/stool CMV PCR and Ag) accurately diagnose CMV ileocolitis compared to tissue histopathology/PCR?
Odds Ratio: 16 (95% CI 7–34)
Serum and stool tests have high specificity but low sensitivity for diagnosing CMV ileocolitis, meaning they cannot replace colonoscopy but may aid diagnosis when colonoscopy is not feasible.
Noninvasive CMV tests cannot replace colonoscopy due to low sensitivity; supports adjunctive role when invasive testing is infeasible.
BACKGROUND/AIMS: Diagnosis of cytomegalovirus (CMV) ileocolitis traditionally requires colonoscopy with tissue biopsy. Due to potential complications in high-risk patients, there is growing interest in serum and stool tests for diagnosing this condition. We aimed to evaluate the diagnostic accuracy of these noninvasive tests compared to traditional gold standards. METHODS: Two independent reviewers performed a comprehensive search on MEDLINE and Embase from inception up to October 1, 2023. Prospective and retrospective studies evaluating the performance of serum CMV polymerase chain reaction (PCR), serum CMV antigen (Ag), and stool CMV PCR in diagnosing CMV ileocolitis were included. Tissue histopathology or tissue CMV PCR served as reference standards. Diagnostic performances of each serum and stool test were calculated based on a meta-analysis using random-effects model. RESULTS: A total of 30 studies, comprising 23 studies of serum CMV PCR, 9 of serum CMV Ag, and 7 of stool CMV PCR, were included. The pooled sensitivity, specificity, and area under summary receiver operating characteristic curves were 62% (95% confidence interval [CI], 51%-72%), 90% (95% CI, 79%-96%), and 0.81 for serum CMV PCR, 38% (95% CI, 26%-51%), 94% (95% CI, 70%-99%), and 0.56 for serum CMV Ag, and 53% (95% CI, 35%-70%), 91% (95% CI, 84%-95%), and 0.84 for stool CMV PCR. CONCLUSIONS: Serum and stool tests cannot replace colonoscopy for diagnosing CMV ileocolitis due to their low sensitivities but may be useful when colonoscopy is not feasible. Positive results can aid diagnosis, given their high specificities. Serum and/or stool CMV PCR are preferred over CMV Ag.
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Chaemsupaphan et al. (2025) conducted a meta-analysis in Cytomegalovirus (CMV) ileocolitis. Serum CMV PCR vs. Tissue histopathology or tissue CMV PCR was evaluated on Diagnostic performance of serum CMV PCR for CMV ileocolitis (OR 16, 95% CI 7-34). Serum CMV PCR demonstrated a pooled sensitivity of 62% and specificity of 90% for diagnosing CMV ileocolitis, indicating it cannot replace colonoscopy but is useful when endoscopy is not feasible.
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