Computer-assisted chest radiography reading for tuberculosis screening in people living with diabetes mellitus
METHODS: PLWD underwent symptom screening and chest X-ray (CXR); sputum was examined in those with positive symptoms and/or CXR. Digital CXRs were scored using CAD4TB and analysed retrospectively using clinical and microbiological diagnosis as a reference. The area under the receiver operator curve (AUC) of CAD4TB scores was determined, and an optimal threshold score established. Agreement between CAD4TB and the radiologist's reading was determined.
RESULTS: Among 346 included PLWD, seven (2.0%) had microbiologically confirmed and two (0.6%) had clinically diagnosed TB. The highest agreement of CAD4TB with radiologist reading was achieved using a threshold score of 70 (κ = 0.41, P < 0.001). The AUC for CAD4TB was 0.89 (95%CI 0.73–1.00). A threshold score of 65 for CAD4TB resulted in a sensitivity, specificity, positive predictive value and negative predictive value of respectively 88.9% (95%CI 51.8–99.7), 88.5% (95%CI 84.6–91.7), 17.0% (95%CI 7.6–30.8) and 99.6% (95%CI 98.2–100). With this threshold, 48 (13.9%) individuals needed microbiological examination and no microbiologically confirmed cases were missed.
CONCLUSIONS: CAD4TB has potential as a triage tool for TB screening in PLWD, thereby significantly reducing the need for microbiological examination.
Keywords: CAD4TB v 5; Indonesia; triage tool
Document Type: Research Article
Affiliations: 1: Infectious Disease Research Centre, Department of Biomedical Sciences, Faculty of Medicine Universitas Padjadjaran, Bandung, Indonesia 2: London School of Hygiene & Tropical Medicine, London, UK, National and Supranational Reference Laboratory, Research Centre Borstel, Germany 3: Infectious Disease Research Centre 4: Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia 5: Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands 6: Department of Radiology, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia 7: Infectious Disease Research Centre, Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia 8: Centre for International Health, University of Otago, Dunedin, New Zealand
Publication date: 01 September 2018
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