Jun -Jun Yeh1,2,3,4,5. 1. Department of Chest Medicine, Section of Thoracic Imaging, Ditmanson Medical Foundation Chia-Yi Christian Hospital, No. 539, Zhongxiao Rd., Chiayi City, 600, Taiwan. anvin.funlan@msa.hinet.net. 2. Chia Nan University of Pharmacy and Science, Tainan, Taiwan. anvin.funlan@msa.hinet.net. 3. Meiho University, Pingtung, Taiwan. anvin.funlan@msa.hinet.net. 4. Pingtung Christian Hospital, Pingtung, Taiwan. anvin.funlan@msa.hinet.net. 5. Heng Chun Christian Hospital, Pingtung, Taiwan. anvin.funlan@msa.hinet.net.
Abstract
OBJECTIVES: The objective of this study was to develop a predictive model for final smear-positive (SP) active pulmonary tuberculosis (aPTB) in patients with initial negative acid fast bacilli (AFB) sputum smears (iSN-SP-aPTB) based on high-resolution computed tomography (HRCT). METHOD AND MATERIALS: Eighty (126, 21) patients of iSN-SP-aPTB and 402 (459, 876) patients of non-initial positive acid fast bacilli (non-iSP) pulmonary disease without iSN-SP-aPTB were included in a derivation (validation, prospective) cohort. HRCT characteristics were analysed, and multivariable regression and receiver operating characteristic (ROC) curve analysis was performed to develop a score predictive of iSN-SP-aPTB. RESULTS: The derivation cohort showed clusters of nodules/mass of the right upper lobe or left upper lobe were independent predictors of iSN-SP-aPTB, while bronchiectasis in the right middle lobe or left lingual lobe were negatively associated with iSN-SP-aPTB. A predictive score for iSN-SP-aPTB based on these findings was tested in the validation and prospective cohorts. With an ideal cut-off score = 1, the sensitivity, specificity, positive predictive value, and negative predictive value of the prediction model were 87.5% (90%, 90.5%), 99% (97.1%, 98.4%), 94.6% (81.3%, 57.5%), and 97.6% (97%, 99.8%) in the derivation (validation, prospective) cohorts, respectively. CONCLUSIONS: The model may help identify iSN-SP-aPTB among patients with non-iSP pulmonary diseases. KEY POINTS: • Smear-positive active pulmonary tuberculosis that is initial smear-negative (iSN-SP-aPTB) is infectious. • High-resolution computed tomography can identify iSN-SP-aPTB among non-iSP pulmonary diseases. • Clusters nodules/mass in right/left upper lobe are positively associated with iSN-SP-aPTB. • Bronchiectasis in right middle/left lingual lobe is negatively associated with iSN-SP-aPTB. • The model may have high post-test probability in identifying iSN-SP-aPTB.
OBJECTIVES: The objective of this study was to develop a predictive model for final smear-positive (SP) active pulmonary tuberculosis (aPTB) in patients with initial negative acid fast bacilli (AFB) sputum smears (iSN-SP-aPTB) based on high-resolution computed tomography (HRCT). METHOD AND MATERIALS: Eighty (126, 21) patients of iSN-SP-aPTB and 402 (459, 876) patients of non-initial positive acid fast bacilli (non-iSP) pulmonary disease without iSN-SP-aPTB were included in a derivation (validation, prospective) cohort. HRCT characteristics were analysed, and multivariable regression and receiver operating characteristic (ROC) curve analysis was performed to develop a score predictive of iSN-SP-aPTB. RESULTS: The derivation cohort showed clusters of nodules/mass of the right upper lobe or left upper lobe were independent predictors of iSN-SP-aPTB, while bronchiectasis in the right middle lobe or left lingual lobe were negatively associated with iSN-SP-aPTB. A predictive score for iSN-SP-aPTB based on these findings was tested in the validation and prospective cohorts. With an ideal cut-off score = 1, the sensitivity, specificity, positive predictive value, and negative predictive value of the prediction model were 87.5% (90%, 90.5%), 99% (97.1%, 98.4%), 94.6% (81.3%, 57.5%), and 97.6% (97%, 99.8%) in the derivation (validation, prospective) cohorts, respectively. CONCLUSIONS: The model may help identify iSN-SP-aPTB among patients with non-iSP pulmonary diseases. KEY POINTS: • Smear-positive active pulmonary tuberculosis that is initial smear-negative (iSN-SP-aPTB) is infectious. • High-resolution computed tomography can identify iSN-SP-aPTB among non-iSP pulmonary diseases. • Clusters nodules/mass in right/left upper lobe are positively associated with iSN-SP-aPTB. • Bronchiectasis in right middle/left lingual lobe is negatively associated with iSN-SP-aPTB. • The model may have high post-test probability in identifying iSN-SP-aPTB.
Authors: David E Griffith; Timothy Aksamit; Barbara A Brown-Elliott; Antonino Catanzaro; Charles Daley; Fred Gordin; Steven M Holland; Robert Horsburgh; Gwen Huitt; Michael F Iademarco; Michael Iseman; Kenneth Olivier; Stephen Ruoss; C Fordham von Reyn; Richard J Wallace; Kevin Winthrop Journal: Am J Respir Crit Care Med Date: 2007-02-15 Impact factor: 21.405
Authors: David M Hansell; Alexander A Bankier; Heber MacMahon; Theresa C McLoud; Nestor L Müller; Jacques Remy Journal: Radiology Date: 2008-01-14 Impact factor: 11.105
Authors: J P Laissy; M Cadi; A Cinqualbre; Z E Boudiaf; S Lariven; E Casalino; M Wolff; E Schouman-Claeys Journal: J Comput Assist Tomogr Date: 1997 Mar-Apr Impact factor: 1.826
Authors: Myung Jin Chung; Kyung Soo Lee; Won-Jung Koh; Ju Hyun Lee; Tae Sung Kim; O Jung Kwon; Seonwoo Kim Journal: J Korean Med Sci Date: 2005-10 Impact factor: 2.153
Authors: O N Hatipoğlu; E Osma; M Manisali; E S Uçan; P Balci; A Akkoçlu; O Akpinar; C Karlikaya; C Yüksel Journal: Thorax Date: 1996-04 Impact factor: 9.139