Sebastian J, Olaru I D, Giannakis A, Arentz M, Kik S V, Ruhwald M, Linsen S, Günther G, Wolf P, Herth F J, Weber T, Denkinger C M
Division of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany.
Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK.
IJTLD Open. 2024 Dec 1;1(12):533-539. doi: 10.5588/ijtldopen.24.0428. eCollection 2024 Dec.
Computer-aided detection (CAD) tools for TB detection have the potential to enable screening programmes and reduce the diagnostic gap in settings where access to radiologists is limited. However, there are concerns that other common chest X-ray (CXR) abnormalities not due to TB may be missed.
We assessed the performance of three commercialised CAD tools (qXR, INSIGHT CXR and DrAID TB XR) to detect common non-TB abnormalities against readings with a standardised annotation guide by an expert radiologist. More than 20 well-characterised diagnoses besides TB significant in TB high-burden countries were examined.
The 517 CXRs included were deemed abnormal by the three CAD with a sensitivity of respectively 97% (95% CI 95-98), 94% (95% CI 91-95), and 87% (95% CI 84-90) for INSIGHT CXR, qXR, and DrAID. The CAD generally detected abnormalities in patients with critical diagnoses such as lung cancer or heart failure. Performance for detecting other abnormalities was variable.
This study showed that the three CAD tools identified CXRs as abnormal when diseases other than TB were present. Our findings alleviate ethical concerns of missing abnormalities other than TB when using commercially available CAD for TB screening and show their potential broader applicability.
用于结核病检测的计算机辅助检测（CAD）工具有可能推动筛查计划，并缩小在放射科医生资源有限地区的诊断差距。然而，人们担心可能会漏诊其他非结核病所致的常见胸部X线（CXR）异常。
我们通过一名专家放射科医生依据标准化注释指南的判读，评估了三款商业化CAD工具（qXR、INSIGHT CXR和DrAID TB XR）检测常见非结核病异常的性能。除结核病外，还对在结核病高负担国家中具有重要意义的20多种特征明确的诊断进行了检查。
纳入的517份胸部X线片被这三款CAD判定为异常，INSIGHT CXR、qXR和DrAID的灵敏度分别为97%（95%CI 95-98）、94%（95%CI 91-95）和87%（95%CI 84-90）。CAD通常能检测出患有肺癌或心力衰竭等危急诊断患者的异常情况。检测其他异常情况的性能各不相同。
本研究表明，当存在结核病以外的疾病时，这三款CAD工具将胸部X线片判定为异常。我们的研究结果减轻了在使用商用CAD进行结核病筛查时漏诊结核病以外异常情况的伦理担忧，并显示了它们更广泛的潜在适用性。
