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Computer-assisted chest radiography reading for tuberculosis screening in people living with diabetes mellitus

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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.
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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

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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