Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
Thorax. 2021 Jun;76(6):607-614. doi: 10.1136/thoraxjnl-2020-216123. Epub 2021 Jan 27.
The prevalence of diseases other than TB detected during chest X-ray (CXR) screening is unknown in sub-Saharan Africa. This represents a missed opportunity for identification and treatment of potentially significant disease. Our aim was to describe and quantify non-TB abnormalities identified by TB-focused CXR screening during the 2016 Kenya National TB Prevalence Survey.
We reviewed a random sample of 1140 adult (≥15 years) CXRs classified as 'abnormal, suggestive of TB' or 'abnormal other' during field interpretation from the TB prevalence survey. Each image was read (blinded to field classification and study radiologist read) by two expert radiologists, with images classified into one of four major anatomical categories and primary radiological findings. A third reader resolved discrepancies. Prevalence and 95% CIs of abnormalities diagnosis were estimated.
Cardiomegaly was the most common non-TB abnormality at 259 out of 1123 (23.1%, 95% CI 20.6% to 25.6%), while cardiomegaly with features of cardiac failure occurred in 17 out of 1123 (1.5%, 95% CI 0.9% to 2.4%). We also identified chronic pulmonary pathology including suspected COPD in 3.2% (95% CI 2.3% to 4.4%) and non-specific patterns in 4.6% (95% CI 3.5% to 6.0%). Prevalence of active-TB and severe post-TB lung changes was 3.6% (95% CI 2.6% to 4.8%) and 1.4% (95% CI 0.8% to 2.3%), respectively.
Based on radiological findings, we identified a wide variety of non-TB abnormalities during population-based TB screening. TB prevalence surveys and active case finding activities using mass CXR offer an opportunity to integrate disease screening efforts.
National Institute for Health Research (IMPALA-grant reference 16/136/35).
在撒哈拉以南非洲，胸部 X 光（CXR）筛查中发现的除结核病以外的疾病的流行情况尚不清楚。这代表着错失了识别和治疗潜在重大疾病的机会。我们的目的是描述和量化 2016 年肯尼亚国家结核病患病率调查中通过结核病重点 CXR 筛查发现的非结核病异常。
我们回顾了从结核病患病率调查中随机抽取的 1140 名成年（≥15 岁）CXR 样本，这些 CXR 在现场解释中被归类为“异常，提示结核病”或“异常其他”。每幅图像均由两位专家放射科医生进行阅读（对现场分类和研究放射科医生阅读均为盲法），图像分为四个主要解剖类别和主要放射学发现之一。第三位读者解决了差异。异常诊断的患病率和 95%置信区间（CI）进行了估计。
心胸比增大是最常见的非结核病异常，在 1123 例中的 259 例中（23.1%，95%CI 20.6%至 25.6%），而在 1123 例中有 17 例（1.5%，95%CI 0.9%至 2.4%）出现心胸比增大伴有心力衰竭特征。我们还发现了慢性肺部病理学，包括疑似 COPD 在 3.2%（95%CI 2.3%至 4.4%）和非特异性模式在 4.6%（95%CI 3.5%至 6.0%）中。活动性结核病和严重的结核病后肺部改变的患病率分别为 3.6%（95%CI 2.6%至 4.8%）和 1.4%（95%CI 0.8%至 2.3%）。
根据放射学发现，我们在人群为基础的结核病筛查中发现了多种非结核病异常。基于大规模 CXR 的结核病患病率调查和主动病例发现活动为整合疾病筛查工作提供了机会。
英国国家卫生研究院（IMPALA 赠款参考号 16/136/35）。
