Department of Radiology and Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Radiology. 2010 Sep;256(3):998-1004. doi: 10.1148/radiol.10100485.
To assess the frequency and spectrum of abnormalities on routine screening chest radiographs in the pre-employment evaluation of health care workers with positive tuberculin skin test (TST) results.
The institutional review board approved this HIPAA-compliant retrospective study and waived the need for written informed patient consent. Chest radiographic reports of all 2586 asymptomatic individuals with positive TST results who underwent pre-employment evaluation between January 1, 2003, and December 31, 2007, were evaluated to determine the frequency of detection of evidence of active tuberculosis (TB) or latent TB infection (LTBI) and the spectrum of imaging findings. All chest radiographs interpreted as positive were reviewed by an experienced board-certified radiologist. If there was a discrepancy between the two readings, a second experienced radiologist served as an independent and final arbiter. Any follow-up chest radiographs or computed tomographic images that had been acquired by employee health services or by the employee's private physician as a result of a suspected abnormality detected at initial screening were also evaluated.
Of the 159 (6.1%) chest radiographic examinations that yielded abnormal results, there were no findings that were consistent with active TB. There were 92 cases of calcified granulomas, calcified lymph nodes, or both; 25 cases of apical pleural thickening; 16 cases of fibrous scarring; and 31 cases of noncalcified nodules. All cases of fibrous scarring involved an area smaller than 2 cm(2). All noncalcified nodules were 4 mm in diameter or smaller, with the exception of one primary lung malignancy and one necrotizing granuloma (negative for acid-fast bacilli) that grew Mycobacterium kansasii on culture.
Universal chest radiography in a large pre-employment TB screening program was of low yield in the detection of active TB or increased LTBI reactivation risk, and it provided no assistance in deciding which individuals to prioritize for LTBI treatment.
评估在有结核菌素皮肤试验（TST）阳性结果的医护人员入职体检中，常规筛查性胸部 X 光片的异常频率和类型。
该机构审查委员会批准了这项符合 HIPAA 标准的回顾性研究，并豁免了书面知情同意书的要求。对 2003 年 1 月 1 日至 2007 年 12 月 31 日期间进行入职体检且 TST 阳性的 2586 例无症状个体的胸部 X 光报告进行评估，以确定活动性肺结核（TB）或潜伏性 TB 感染（LTBI）的检出率以及影像学表现的类型。所有被解读为阳性的胸部 X 光片均由一位经验丰富的、有委员会认证的放射科医生进行复审。如果两位医生的解读结果存在差异，那么第二位有经验的放射科医生将作为独立的最终仲裁者。对因初次筛查发现疑似异常而由员工健康服务机构或员工私人医生进行的任何后续胸部 X 光片或 CT 成像也进行了评估。
在 159 例（6.1%）产生异常结果的胸部 X 光检查中，没有发现与活动性 TB 相符的结果。有 92 例为钙化性肉芽肿、钙化性淋巴结或两者均有；25 例为尖段胸膜增厚；16 例为纤维性瘢痕；31 例为非钙化性结节。所有纤维性瘢痕的面积均小于 2cm²。所有非钙化性结节的直径均为 4mm 或更小，除了 1 例原发性肺部恶性肿瘤和 1 例坏死性肉芽肿（抗酸杆菌阴性），后者培养出堪萨斯分枝杆菌。
在大型 TB 筛查入职体检计划中，普遍进行胸部 X 光检查对检测活动性 TB 或增加 LTBI 再激活风险的效果不佳，并且无法帮助确定哪些个体需要优先进行 LTBI 治疗。
