Abstract
The introduction of digital CXR with automated computer-aided interpretation, has given impetus to the role of CXR in TB screening, particularly in low resource, high-burden settings. The aim of this study was to evaluate the diagnostic accuracy of CAD4TB as a screening tool, implemented in the private sector in Karachi, Pakistan. This study analyzed retrospective data from CAD4TB and Xpert MTB/RIF testing carried out at two private TB treatment and diagnostic centers in Karachi. Sensitivity, specificity, potential Xperts saved, were computed and the receiver operator characteristic curves were constructed for four different models of CAD4TB. A total of 6,845 individuals with presumptive TB were enrolled in the study, 15.2% of which had MTB + ve result on Xpert. A high sensitivity (range 65.8–97.3%) and NPV (range 93.1–98.4%) were recorded for CAD4TB. The Area under the ROC curve (AUC) for CAD4TB was 0.79. CAD4TB with patient demographics (age and gender) gave an AUC of 0.83. CAD4TB offered high diagnostic accuracy. In low resource settings, CAD4TB, as a triage tool could minimize use of Xpert. Using CAD4TB in combination with age and gender data enhanced the performance of the software. Variations in demographic information generate different individual risk probabilities for the same CAD4TB scores.
Highlights
Tuberculosis (TB) remains a major cause of morbidity and mortality globally
The advent of digital chest radiography along with software capable of automated interpretation such as the “Computer Assisted Diagnosis for TB” (CAD4TB) software developed by the Diagnostic Image Analysis Group of the Radboud University Medical Centre has prompted reconsideration of the role of chest x-rays (CXR) in TB screening, in low resource, high-burden settings[9]
A total of 6,845 individuals with presumptive TB were enrolled in the study between October 2013 to September 2015
Summary
Tuberculosis (TB) remains a major cause of morbidity and mortality globally. In 2015, there were an estimated 10.4 million incident cases of TB and 1.8 million TB deaths[1]. There has been growing interest in the use of chest x-rays (CXR) as a screening tool for TB within active and enhanced case finding programs[4]. The advent of digital chest radiography along with software capable of automated interpretation such as the “Computer Assisted Diagnosis for TB” (CAD4TB) software developed by the Diagnostic Image Analysis Group of the Radboud University Medical Centre has prompted reconsideration of the role of CXR in TB screening, in low resource, high-burden settings[9]. An increasing body of evidence from high burden countries suggests that the use of digital CXR equipment and the automated reading of CXR with Computer Aided Detection (CAD), as a pre-screening tool, in conjunction with an expensive molecular test such as Xpert can improve case finding efforts[23]
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