Diagnostic accuracy of computer aided reading of chest x-ray in screening for pulmonary tuberculosis in comparison with Gene-Xpert

Nishtar, Tahira; Burki, Shamsullah; Ahmad, Fatima Sultan; Ahmad, Tabish

doi:10.12669/pjms.38.1.4531

Cited by 10 publications

(9 citation statements)

References 14 publications

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“…The findings of this study point to a feasible, effective, and even cost-effective strategy for TB screening in a symptomatic group that combines CAD4TB and symptomatology. Earlier research from different contexts are consistent with our findings ( 41 – 43 ).…”

Section: Discussionsupporting

confidence: 93%

Computer-aided diagnostic accuracy of pulmonary tuberculosis on chest radiography among lower respiratory tract symptoms patients

Abuzerr,

Zinszer

2023

Front. Public Health

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Even though the Gaza Strip is a low pulmonary tuberculosis (TB) burden region, it is well-known that TB is primarily a socioeconomic problem associated with overcrowding, poor hygiene, a lack of fresh water, and limited access to healthcare, which is the typical case in the Gaza Strip. Therefore, this study aimed at assessing the accuracy of the automatic software computer-aided detection for tuberculosis (CAD4TB) in diagnosing pulmonary TB on chest radiography and compare the CAD4TB software reading with the results of geneXpert. Using a census sampling method, the study was conducted in radiology departments in the Gaza Strip hospitals between 1 December 2022 and 31 March 2023. A digital X-ray, printer, and online X-ray system backed by CAD4TBv6 software were used to screen patients with lower respiratory tract symptoms. GeneXpert analysis was performed for all patients having a score > 40. A total of 1,237 patients presenting with lower respiratory tract symptoms participated in this current study. Chest X-ray readings showed that 7.8% (n = 96) were presumptive for TB. The CAD4TBv6 scores showed that 11.8% (n = 146) of recruited patients were presumptive for TB. GeneXpert testing on sputum samples showed that 6.2% (n = 77) of those with a score > 40 on CAD4TB were positive for pulmonary TB. Significant differences were found in chest X-ray readings, CAD4TBv6 scores, and GeneXpert results among sociodemographic and health status variables (P-value < 0.05). The study showed that the incidence rate of TB in the Gaza Strip is 3.5 per 100,000 population in the Gaza strip. The sensitivity of the CAD4TBv6 score and the symptomatic review for tuberculosis with a threshold score of >40 is 80.2%, and the specificity is 94.0%. The positive Likelihood Ratio is 13.3%, Negative Likelihood Ratio is 0.2 with 7.8% prevalence. Positive Predictive Value is 52.7%, Negative Predictive Value is 98.3%, and accuracy is 92.9%. In a resource-limited country with a high burden of neglected disease, combining chest X-ray readings by CAD4TB and symptomatology is extremely valuable for screening a population at risk. CAD4TB is noticeably more efficient than other methods for TB screening and early diagnosis in people who would otherwise go undetected.

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Section: Discussionsupporting

confidence: 93%

Computer-aided diagnostic accuracy of pulmonary tuberculosis on chest radiography among lower respiratory tract symptoms patients

Abuzerr,

Zinszer

2023

Front. Public Health

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“…In the screening context, some studies used human CXR interpretation, 19 or varying clinical thresholds to decide who needed to submit a sputum test. 20 , 21 Although most studies did not assess CAD performance in true screening applications, some did. In a formal evidence review of the ‘screening use-case’ undertaken as part of the WHO guidelines process, 12 AUCs ranged from 0.76–0.83 for CAD4TBv6, qXRv2 and Lunitv4.9.0.…”

Section: Diagnostic Performance Of Cad For Tbmentioning

confidence: 99%

The rise of artificial intelligence reading of chest X-rays for enhanced TB diagnosis and elimination

Geric

Qin

Denkinger

et al. 2023

int j tuberc lung dis

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We provide an overview of the latest evidence on computer-aided detection (CAD) software for automated interpretation of chest radiographs (CXRs) for TB detection. CAD is a useful tool that can assist in rapid and consistent CXR interpretation for TB. CAD can achieve high sensitivity TB detection among people seeking care with symptoms of TB and in population-based screening, has accuracy on-par with human readers. However, implementation challenges remain. Due to diagnostic heterogeneity between settings and sub-populations, users need to select threshold scores rather than use pre-specified ones, but some sites may lack the resources and data to do so. Efficient standardisation is further complicated by frequent updates and new CAD versions, which also challenges implementation and comparison. CAD has not been validated for TB diagnosis in children and its accuracy for identifying non-TB abnormalities remains to be evaluated. A number of economic and political issues also remain to be addressed through regulation for CAD to avoid furthering health inequities. Although CAD-based CXR analysis has proven remarkably accurate for TB detection in adults, the above issues need to be addressed to ensure that the technology meets the needs of high-burden settings and vulnerable sub-populations.

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“…This confirms the hypothesis that when gastric lavage samples are used on Gene X-pert, there is a lower TB positivity rate in children under 10 years of age at this hospital compared to when X-ray imaging is employed. Similarly, in the study by Nishtar et al (2022), the sensitivity of CAD4TB, a diagnostic tool based on CXR, was reported to be 83.2%, while its specificity was only 12.7%, using GeneXpert as the reference standard.…”

Section: Discussionmentioning

confidence: 82%

Prevalence of Tuberculosis in children using Gene Xpert on Gastric lavage samples

Chisompola,

Chanda,

Moono

et al. 2023

Preprint

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Background Tuberculosis (TB), caused by Mycobacterium tuberculosis (MTB), affects the lungs, kidneys, spine, and brain, has a significant global health challenge affecting 10–20% of children. Zambia is ranked in thirty countries with heavy burden. Early detection and intervention are crucial for managing the disease and preventing its progression to severe forms. Objective The aim of this study was to assess the prevalence of tuberculosis among children aged 0 to 10 years at the Arthur Davison Children's Hospital in Ndola, Zambia. The study specifically focused on children with coughs, and the preferred gastric lavage technique was used for sampling. Methodology: A cross-sectional study was conducted, we enrolled 138 children who were assessed using a structured questionnaire. To diagnosis TB, we employed x-rays and GeneXpert analysis of gastric lavage samples collected from January 2022 to February 2022. Results The results revealed that out of the 138 participants, 119 (86.2%) tested negative for mycobacterium tuberculosis, while 19 (13.8%) tested positive. GeneXpert detected 2 out of the 19 positives (1.4%), whereas chest x-ray identified all 19 positive cases (100%). Males showed a higher prevalence of MTB (52.6%) compared to females (47.4%), and the 0–4 age group had a higher MTB prevalence of 13 cases (68.4%) compared to 6 cases (31.6%) in the 5–10 age group. Conclusion In conclusion, the study showed a low prevalence of MTB (1.4%) in children under 10 years when using GeneXpert with gastric lavage samples. However, chest x-ray outperformed GeneXpert in detecting positive cases. The potential issues with the cumbersome process and the influence of gastric lavage sample acidity raise concerns about GeneXpert's effectiveness as the preferred choice for TB diagnosis in this population.

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Diagnostic accuracy of computer aided reading of chest x-ray in screening for pulmonary tuberculosis in comparison with Gene-Xpert

Cited by 10 publications

References 14 publications

Computer-aided diagnostic accuracy of pulmonary tuberculosis on chest radiography among lower respiratory tract symptoms patients

Computer-aided diagnostic accuracy of pulmonary tuberculosis on chest radiography among lower respiratory tract symptoms patients

The rise of artificial intelligence reading of chest X-rays for enhanced TB diagnosis and elimination

Prevalence of Tuberculosis in children using Gene Xpert on Gastric lavage samples

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