한빛사
>
한빛사논문
한빛사논문
- 조회54
Lancet Digit. Health, Nov 26 2025, S2589-7500(25)00116-5 | https://doi.org/10.1016/j.landig.2025.100934
Performance of universal and stratified computer-aided detection thresholds for chest x-ray-based tuberculosis screening: a cross-sectional, diagnostic accuracy study
Joowhan Sung MD a,b, Peter James Kitonsa MBChB b, Annet Nalutaaya MS b, David Isooba b, Susan Birabwa b, Keneth Ndyabayunga b, Rogers Okura b, Jonathan Magezi b, Deborah Nantale b, Ivan Mugabi b, Violet Nakiiza b, Prof David W Dowdy MD b,c, Achilles Katamba PhD b,d, Emily A Kendall MD a,b,c
aDivision of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
bWalimu, Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
cDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
dMakerere University College of Health Science, Department of Internal Medicine, Clinical Epidemiology and Biostatistics Unit, Kampala, Uganda
Correspondence to: Dr Joowhan Sung
aDivision of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
bWalimu, Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
cDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
dMakerere University College of Health Science, Department of Internal Medicine, Clinical Epidemiology and Biostatistics Unit, Kampala, Uganda
Correspondence to: Dr Joowhan Sung
Abstract
Background: Computer-aided detection (CAD) software analyses chest x-rays for features suggestive of tuberculosis and provides a numeric abnormality score. However, estimates of CAD accuracy for tuberculosis screening are hindered by the scarcity of confirmatory data among people with lower x-ray scores, including those without symptoms. Additionally, the appropriate x-ray score thresholds for obtaining further testing might vary according to population and client characteristics. We aimed to evaluate the accuracy of CAD among all screened individuals and assess whether stratifying CAD thresholds by age and sex could improve performance.
Methods: In this cross-sectional, diagnostic accuracy study, we screened for tuberculosis in individuals aged 15 years and older in Uganda using portable chest x-rays with CAD (qXR version 3.2). Participants not on active tuberculosis treatment were offered screening regardless of their symptoms. We included data from all participants from both facility-based and community-based sites who were screened from June 1, 2022 (study start), to March 31, 2024. Individuals with x-ray scores above a threshold of 0·1 (range 0-1) were asked to provide sputum for Xpert MTB/RIF Ultra (Xpert) testing. We estimated the diagnostic accuracy (sensitivity, specificity, and area under the curve [AUC]) of CAD for detecting Xpert-positive tuberculosis when using the same threshold for all individuals (under different assumptions about tuberculosis prevalence among people with x-ray scores <0·1), and compared this estimate with approaches stratified by age, sex, or both.
Findings: 54 840 individuals were assessed for eligibility, 52 835 of whom were screened for tuberculosis using CAD. The median age was 38 years (IQR 26-50), 23 586 (44·6%) participants were male, and 29 249 (55·4%) were female. 8949 (16·9%) had x-ray scores of 0·1 or more. Of 7219 participants with valid Xpert results, 382 (5·3%) were Xpert-positive, including 81 with trace results. Assuming 0·1% of participants with x-ray scores less than 0·1 would have been Xpert-positive if tested, qXR had an estimated AUC of 0·92 (95% CI 0·90-0·94) for Xpert-positive tuberculosis. Stratifying x-ray score thresholds according to age and sex improved accuracy; for example, at 96·1% (95% CI 95·9-96·3) specificity, estimated sensitivity was 75·0% (69·9-79·5) for a universal threshold (of ≥0·65) versus 76·9% (71·9-81·2) for thresholds stratified by age and sex (p=0·046).
Interpretation: Our findings suggest that the accuracy of CAD for tuberculosis screening among all screening participants, including those without symptoms or abnormal chest x-rays, is higher than previously estimated. Stratifying x-ray score thresholds based on client characteristics such as age and sex could further improve accuracy, enabling a more effective and personalised approach to tuberculosis screening.
Methods: In this cross-sectional, diagnostic accuracy study, we screened for tuberculosis in individuals aged 15 years and older in Uganda using portable chest x-rays with CAD (qXR version 3.2). Participants not on active tuberculosis treatment were offered screening regardless of their symptoms. We included data from all participants from both facility-based and community-based sites who were screened from June 1, 2022 (study start), to March 31, 2024. Individuals with x-ray scores above a threshold of 0·1 (range 0-1) were asked to provide sputum for Xpert MTB/RIF Ultra (Xpert) testing. We estimated the diagnostic accuracy (sensitivity, specificity, and area under the curve [AUC]) of CAD for detecting Xpert-positive tuberculosis when using the same threshold for all individuals (under different assumptions about tuberculosis prevalence among people with x-ray scores <0·1), and compared this estimate with approaches stratified by age, sex, or both.
Findings: 54 840 individuals were assessed for eligibility, 52 835 of whom were screened for tuberculosis using CAD. The median age was 38 years (IQR 26-50), 23 586 (44·6%) participants were male, and 29 249 (55·4%) were female. 8949 (16·9%) had x-ray scores of 0·1 or more. Of 7219 participants with valid Xpert results, 382 (5·3%) were Xpert-positive, including 81 with trace results. Assuming 0·1% of participants with x-ray scores less than 0·1 would have been Xpert-positive if tested, qXR had an estimated AUC of 0·92 (95% CI 0·90-0·94) for Xpert-positive tuberculosis. Stratifying x-ray score thresholds according to age and sex improved accuracy; for example, at 96·1% (95% CI 95·9-96·3) specificity, estimated sensitivity was 75·0% (69·9-79·5) for a universal threshold (of ≥0·65) versus 76·9% (71·9-81·2) for thresholds stratified by age and sex (p=0·046).
Interpretation: Our findings suggest that the accuracy of CAD for tuberculosis screening among all screening participants, including those without symptoms or abnormal chest x-rays, is higher than previously estimated. Stratifying x-ray score thresholds based on client characteristics such as age and sex could further improve accuracy, enabling a more effective and personalised approach to tuberculosis screening.
논문정보
- Research article
- 2025년 11월 (BRIC 등록일 2025-12-03)
- 국외 연구진
- 의약학 > 감염의학
댓글 작성 로그인
팝업 닫기관련 링크
연구자 키워드
관련분야 연구자보기
소속기관 논문보기
관련분야 논문보기
해당논문 저자보기
