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Sci Rep. 2018 Aug 17;8(1):12339. doi: 10.1038/s41598-018-30810-1.

Evaluation of the diagnostic accuracy of Computer-Aided Detection of tuberculosis on Chest radiography among private sector patients in Pakistan.

Author information

1
Community Health Solutions, Karachi, 74000, Pakistan.
2
Community Health Solutions, Karachi, 74000, Pakistan. shifa.habib@chshealthcare.org.
3
Radboud University Medical Center, 6525 GA, Nijmegen, Netherlands.
4
London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom.
5
StopTB Partnership, 1214 Geneva, 1214, Vernier, Switzerland.
6
Interactive Research & Development, Karachi, 75190, Pakistan.

Abstract

The introduction of digital CXR with automated computer-aided interpretation, has given impetus to the role of CXR in TB screening, particularly in low resource, high-burden settings. The aim of this study was to evaluate the diagnostic accuracy of CAD4TB as a screening tool, implemented in the private sector in Karachi, Pakistan. This study analyzed retrospective data from CAD4TB and Xpert MTB/RIF testing carried out at two private TB treatment and diagnostic centers in Karachi. Sensitivity, specificity, potential Xperts saved, were computed and the receiver operator characteristic curves were constructed for four different models of CAD4TB. A total of 6,845 individuals with presumptive TB were enrolled in the study, 15.2% of which had MTB + ve result on Xpert. A high sensitivity (range 65.8-97.3%) and NPV (range 93.1-98.4%) were recorded for CAD4TB. The Area under the ROC curve (AUC) for CAD4TB was 0.79. CAD4TB with patient demographics (age and gender) gave an AUC of 0.83. CAD4TB offered high diagnostic accuracy. In low resource settings, CAD4TB, as a triage tool could minimize use of Xpert. Using CAD4TB in combination with age and gender data enhanced the performance of the software. Variations in demographic information generate different individual risk probabilities for the same CAD4TB scores.

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