Computer-assisted chest radiography reading for tuberculosis screening in people living with diabetes mellitus.
Koesoemadinata, RC;
Kranzer, K;
Livia, R;
Susilawati, N;
Annisa, J;
Soetedjo, NNM;
Ruslami, R;
Philipsen, R;
van Ginneken, B;
Soetikno, RD;
+3 more...van Crevel, R;
Alisjahbana, B;
Hill, PC;
(2018)
Computer-assisted chest radiography reading for tuberculosis screening in people living with diabetes mellitus.
The international journal of tuberculosis and lung disease, 22 (9).
pp. 1088-1094.
ISSN 1027-3719
DOI: https://doi.org/10.5588/ijtld.17.0827
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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 (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.