Accuracy of computer-aided chest X-ray in community-based tuberculosis screening: lessons from the 2016 Kenya National Tuberculosis Prevalence Survey

Majumdar, S. et al. (2022) Accuracy of computer-aided chest X-ray in community-based tuberculosis screening: lessons from the 2016 Kenya National Tuberculosis Prevalence Survey. PLoS Global Public Health, 2(11), e0001272. (doi: 10.1371/journal.pgph.0001272) (PMID:36962655) (PMCID:PMC10022380)

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Community-based screening for tuberculosis (TB) could improve detection but is resource intensive. We set out to evaluate the accuracy of computer-aided TB screening using digital chest X-ray (CXR) to determine if this approach met target product profiles (TPP) for community-based screening. CXR images from participants in the 2016 Kenya National TB Prevalence Survey were evaluated using CAD4TBv6 (Delft Imaging), giving a probabilistic score for pulmonary TB ranging from 0 (low probability) to 99 (high probability). We constructed a Bayesian latent class model to estimate the accuracy of CAD4TBv6 screening compared to bacteriologically-confirmed TB across CAD4TBv6 threshold cut-offs, incorporating data on Clinical Officer CXR interpretation, participant demographics (age, sex, TB symptoms, previous TB history), and sputum results. We compared model-estimated sensitivity and specificity of CAD4TBv6 to optimum and minimum TPPs. Of 63,050 prevalence survey participants, 61,848 (98%) had analysable CXR images, and 8,966 (14.5%) underwent sputum bacteriological testing; 298 had bacteriologically-confirmed pulmonary TB. Median CAD4TBv6 scores for participants with bacteriologically-confirmed TB were significantly higher (72, IQR: 58-82.75) compared to participants with bacteriologically-negative sputum results (49, IQR: 44-57, p<0.0001). CAD4TBv6 met the optimum TPP; with the threshold set to achieve a mean sensitivity of 95% (optimum TPP), specificity was 83.3%, (95% credible interval [CrI]: 83.0%-83.7%, CAD4TBv6 threshold: 55). There was considerable variation in accuracy by participant characteristics, with older individuals and those with previous TB having lowest specificity. CAD4TBv6 met the optimal TPP for TB community screening. To optimise screening accuracy and efficiency of confirmatory sputum testing, we recommend that an adaptive approach to threshold setting is adopted based on participant characteristics.

Item Type:Articles
Additional Information:This research was funded by the National Institute for Health Research (NIHR) (IMPALA, grant reference 16/136/35) using UK aid from the UK Government to support global health research to SBS. SBS was Director of the IMPALA Global Health Research Unit at the time of this work and BNM was a PhD candidate funded through IMPALA. PM was funded by Wellcome (200901/Z/16/Z). MYRH was in part supported by a strategic award from Wellcome to Malawi-LiverpoolWellcome Trust Clinical Research programme (206545/Z/17/Z).
Glasgow Author(s) Enlighten ID:MacPherson, Professor Peter
Authors: Majumdar, S., Mungai, B., Ong‘angò, J., Ku, C. C., Henrion, M. Y. R., Morton, B., Joekes, E., Onyango, E., Kiplimo, R., Kirathe, D., Masini, E., Sitienei, J., Manduku, V., Mugi, B., Squire, S. B., and MacPherson, P.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
Journal Name:PLoS Global Public Health
Publisher:Public Library of Science
ISSN (Online):2767-3375
Copyright Holders:Copyright © 2022 Mungai et al.
First Published:First published in PLoS Global Public Health 2(11):e0001272
Publisher Policy:Reproduced under a Creative Commons licence

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