Kenya Medical Research Institute (KEMRI)/Centers for Disease Control and Prevention Research and Public Health Collaboration, Kisumu, Kenya.
Int J Tuberc Lung Dis. 2011 Oct;15(10):1308-14. doi: 10.5588/ijtld.11.0004.
Chest radiographs (CXRs) are used in tuberculosis (TB) prevalence surveys to identify participants for bacteriological examination. Expert readers are rare in most African countries. In our survey, clinical officers scored CXRs of 19 216 participants once. We assessed to what extent missed CXR abnormalities affected our TB prevalence estimate.
Two experts, a radiologist and pulmonologist, independently reviewed 1031 randomly selected CXRs, mixed with lms of confirmed TB cases. CXRs with disagreement on 'any abnormality' or 'abnormality consistent with TB' were jointly reviewed during a consensus panel. We compared the nal expert and clinical of cer classifications with bacteriologically confirmed TB as the gold standard.
After the panel, 199 (19%) randomly selected CXRs were considered abnormal by both expert reviewers and another 82 (8%) by one reviewer. Agreement was good among the experts (κ 0.78, 95%CI 0.73-0.82) and moderate between the clinical officers and experts (κ range 0.50-0.62). The sensitivity of 'any abnormality' was 95% for the clinical officers and 83% and 81% for the respective experts. The specificities were respectively 73%, 74% and 80%. TB prevalence was underestimated by 1.5-5.0%.
Acceptable CXR screening can be achieved with clinical officers. Reviewing a sample of CXRs by two experts allows an assessment of prevalence underestimation.
胸部 X 光片（CXRs）用于结核病（TB）患病率调查，以确定接受细菌学检查的参与者。在大多数非洲国家，专家读者都很稀缺。在我们的调查中，临床医生对 19216 名参与者的 CXR 进行了一次评分。我们评估了错过 CXR 异常对我们的 TB 患病率估计的影响程度。
两位专家（放射科医生和肺病专家）独立审查了 1031 张随机选择的 CXR 片，这些 CXR 片与确诊 TB 病例的胶片混合在一起。对于在“任何异常”或“与 TB 一致的异常”上存在分歧的 CXR，在共识小组会议上进行联合审查。我们将最终的专家和临床医生分类与细菌学确诊的 TB 作为金标准进行比较。
在专家组会议之后，有 199 张（19%）随机选择的 CXR 被两位专家审查认为异常，另外 82 张（8%）被一位专家审查认为异常。专家之间的一致性很好（κ 0.78，95%CI 0.73-0.82），临床医生和专家之间的一致性为中度（κ 范围 0.50-0.62）。“任何异常”的灵敏度分别为临床医生的 95%、专家的 83%和 81%。特异性分别为 73%、74%和 80%。TB 患病率被低估了 1.5-5.0%。
临床医生可以实现可接受的 CXR 筛查。由两位专家审查 CXR 样本可以评估患病率的低估程度。
