The sensitivity and specificity of using a computer aided diagnosis program for automatically scoring chest X-rays of presumptive TB patients compared with Xpert MTB/RIF in Lusaka Zambia

• Published in: PloS one 2014-04, Vol.9 (4), p.e93757
• Main Authors: Muyoyeta, Monde, Maduskar, Pragnya, Moyo, Maureen, Kasese, Nkatya, Milimo, Deborah, Spooner, Rosanna, Kapata, Nathan, Hogeweg, Laurens, van Ginneken, Bram, Ayles, Helen
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Area Under Curve; Biology and Life Sciences; Care and treatment; Chest; Comparative analysis; Computer and Information Sciences; Cough; Diagnosis; Fluorescence; Fluorescence microscopy; Health facilities; HIV; HIV testing; Human immunodeficiency virus; Human resources; Humans; Image Interpretation, Computer-Assisted - methods; Light-emitting diodes; Mass Chest X-Ray - methods; Medical diagnosis; Medicine; Medicine and Health Sciences; Microscopy; Microscopy, Fluorescence; Mycobacterium tuberculosis - isolation & purification; Open access; Patients; Physical Sciences; Population; Predictive Value of Tests; Primary care; Quality; Radiography; Risk factors; ROC Curve; Sensitivity; Sensitivity and Specificity; Smear; Sputum; Sputum - microbiology; Tuberculosis; Tuberculosis, Pulmonary - diagnosis; Tuberculosis, Pulmonary - diagnostic imaging; Tuberculosis, Pulmonary - epidemiology; X-rays; Zambia - epidemiology
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0093757

To determine the sensitivity and specificity of a Computer Aided Diagnosis (CAD) program for scoring chest x-rays (CXRs) of presumptive tuberculosis (TB) patients compared to Xpert MTB/RIF (Xpert). Consecutive presumptive TB patients with a cough of any duration were offered digital CXR, and opt out HIV testing. CXRs were electronically scored as normal (CAD score ≤ 60) or abnormal (CAD score > 60) using a CAD program. All patients regardless of CAD score were requested to submit a spot sputum sample for testing with Xpert and a spot and morning sample for testing with LED Fluorescence Microscopy-(FM). Of 350 patients with evaluable data, 291 (83.1%) had an abnormal CXR score by CAD. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CXR compared to Xpert were 100% (95%CI 96.2-100), 23.2% (95%CI 18.2-28.9), 33.0% (95%CI 27.6-38.7) and 100% (95% 93.9-100), respectively. The area under the receiver operator curve (AUC) for CAD was 0.71 (95%CI 0.66-0.77). CXR abnormality correlated with smear grade (r = 0.30, p