Chest radiograph reading and recording system: Evaluation for tuberculosis screening in patients with advanced HIV
International Journal of Tuberculosis and Lung Disease
University of Cape Town Lung Institute, Division of Pulmonology, Groote Schuur Hospital, Cape Town, South Africa; Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa; Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
SETTING: An antiretroviral treatment (ART) service in Gugulethu township, Cape Town, South Africa. OBJECTIVE: To assess the inter-observer agreement when using the chest radiographic reading and reporting system (CRRS) to detect radiographic abnormalities in patients with advanced human immunodeficiency virus (HIV) associated immunodeficiency being actively screened for tuberculosis (TB). Second, to assess the associated performance characteristics of radiology as a routine screening test for detection of culture-confirmed pulmonary TB. DESIGN: Radiographs from a study in which patients were actively screened for TB just before starting ART were independently reported by two CRRS-certified readers blinded to clinical status. RESULTS: Good kappa statistic agreements between observers were found when reporting any radiological abnormality consistent with TB among all patients (n = 203, κ = 0.63, 95%CI 0.52-0.73) and among those with culture-confirmed TB (n = 53, κ = 0.61, 95%CI 0.40-0.83). However, in comparison with sputum culture, the sensitivity (0.68, 95%CI 0.54-0.79) and specificity (0.53, 95%CI 0.45-0.61) of radiology in this patient group were low. CONCLUSION: This study provides evidence of the good inter-observer agreement using the CRRS standardised reporting methodology when used among patients with advanced HIV-associated immunodeficiency and a high prevalence of culture-proven pulmonary TB. The utility of radiology as a screening test for TB in this patient group, however, remains limited. ©2010 The Union.
adult; article; bacterium culture; confidence interval; controlled study; evaluation; female; human; Human immunodeficiency virus infected patient; image analysis; immune deficiency; kappa statistics; lung tuberculosis; major clinical study; male; methodology; performance measurement system; priority journal; screening; sensitivity analysis; sputum culture; thorax radiography; Adult; AIDS-Related Opportunistic Infections; Female; HIV Infections; Humans; Male; Mass Screening; Observer Variation; Radiography, Thoracic; Sensitivity and Specificity; Single-Blind Method; South Africa; Sputum; Tuberculosis, Pulmonary