Computer-assisted chest radiography reading for tuberculosis screening in people living with diabetes mellitus
Computer-assisted chest radiography reading for tuberculosis screening in people living with diabetes mellitus
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DOI：
10.5588/ijtld.17.0827
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发表时间：
2018-09-01
影响因子：
4
通讯作者：
Hill, P. C.
中科院分区：
文献类型：
--
作者：
Koesoemadinata, R. C.;Kranzer, K.;Hill, P. C.
背景：糖尿病是结核病（TB）的一个重要危险因素。我们评估了计算机辅助结核病检测 (CAD4TB) 在印度尼西亚糖尿病患者 (PLWD) 中的表现。方法：PLWD 接受了症状筛查和胸部 X 光检查 (CXR)；对有阳性症状和/或 CXR 的患者进行痰检查。使用 CAD4TB 对数字 CXR 进行评分，并使用临床和微生物诊断作为参考进行回顾性分析。确定 CAD4TB 评分的受试者工作曲线下面积 (AUC)，并建立最佳阈值评分。确定 CAD4TB 与放射科医师读数之间的一致性。 结果：在 346 名 PLWD 患者中，7 名 (2.0%) 经微生物学确诊，2 名 (0.6%) 经临床诊断为结核病。使用 70 的阈值分数实现 CAD4TB 与放射科医生读数的最高一致性（kappa = 0.41，P < 0.001）。 CAD4TB 的 AUC 为 0.89 (95% CI 0.73-1.00)。 CAD4TB 的阈值评分为 65 分，敏感性、特异性、阳性预测值和阴性预测值分别为 88.9% (95% CI 51.8-99.7)、88.5% (95% CI 84.6-91.7)、17.0% (95% CI 7.6-30.8) 和 99.6% (95% CI) 98.2-100）。在此阈值下，有 48 人 (13.9%) 需要进行微生物学检查，并且没有遗漏任何微生物学确诊病例。 结论：CAD4TB 有潜力作为 PLWD 结核病筛查的分类工具，从而显着减少微生物学检查的需要。
BACKGROUND: Diabetes mellitus is a significant risk factor for tuberculosis (TB). We evaluated the performance of computer-aided detection for tuberculosis (CAD4TB) in people living with diabetes mellitus (PLWD) in Indonesia.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 (kappa = 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.