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Deep learning–based automated detection algorithm for active pulmonary tuberculosis on chest radiographs: diagnostic performance in systematic screening of asymptomatic individuals

Abstract

Objectives

Performance of deep learning–based automated detection (DLAD) algorithms in systematic screening for active pulmonary tuberculosis is unknown. We aimed to validate DLAD algorithm for detection of active pulmonary tuberculosis and any radiologically identifiable relevant abnormality on chest radiographs (CRs) in this setting.

Methods

We performed out-of-sample testing of a pre-trained DLAD algorithm, using CRs from 19.686 asymptomatic individuals (ages, 21.3 ± 1.9 years) as part of systematic screening for tuberculosis between January 2013 and July 2018. Area under the receiver operating characteristic curves (AUC) for diagnosis of tuberculosis and any relevant abnormalities were measured. Accuracy measures including sensitivities, specificities, positive predictive values (PPVs), and negative predictive values (NPVs) were calculated at pre-defined operating thresholds (high sensitivity threshold, 0.16; high specificity threshold, 0.46).

Results

All five CRs from four individuals with active pulmonary tuberculosis were correctly classified as having abnormal findings by DLAD with specificities of 0.959 and 0.997, PPVs of 0.006 and 0.068, and NPVs of both 1.000 at high sensitivity and high specificity thresholds, respectively. With high specificity thresholds, DLAD showed comparable diagnostic measures with the pooled radiologists (p values > 0.05). For the radiologically identifiable relevant abnormality (n = 28), DLAD showed an AUC value of 0.967 (95% confidence interval, 0.938–0.996) with sensitivities of 0.821 and 0.679, specificities of 0.960 and 0.997, PPVs of 0.028 and 0.257, and NPVs of both 0.999 at high sensitivity and high specificity thresholds, respectively.

Conclusions

In systematic screening for tuberculosis in a low-prevalence setting, DLAD algorithm demonstrated excellent diagnostic performance, comparable with the radiologists in the detection of active pulmonary tuberculosis.

Key Points

• Deep learning–based automated detection algorithm detected all chest radiographs with active pulmonary tuberculosis with high specificities and negative predictive values in systematic screening.

• Deep learning–based automated detection algorithm had comparable diagnostic measures with the radiologists for detection of active pulmonary tuberculosis on chest radiographs.

• For the detection of radiologically identifiable relevant abnormalities on chest radiographs, deep learning–based automated detection algorithm showed excellent diagnostic performance in systematic screening.

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Abbreviations

CRs:

Chest radiographs

DLAD:

Deep learning–based automated detection

TB:

Tuberculosis

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Acknowledgments

This study was supported by the Seoul Research & Business Development Program (grant number FI170002), and Lunit Inc. provided technical supports for this study. There is a major research agreement between Seoul National University Hospital and Lunit Inc., in which the roles of researchers and Lunit Inc. were described. However, the funder and Lunit Inc. did not have any role either in the study design; in the collection, analysis, and interpretation of the data; in the writing of the report; and in the decision to submit the article for publication. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Researchers (J.H.L., E.J.H., W.Y.L., S.L., J.R.A.) who controlled, manipulated, and analyzed data did not have any conflict of interest. Three authors (J.M.G., H.K., C.M.P.) received research grants from Lunit Inc. for outside of this study. The authors state that this work has not received any funding.

Funding

This study was supported by the Seoul Research & Business Development Program (grant number FI170002).

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Correspondence to Chang Min Park.

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Guarantor

The scientific guarantor of this publication is Chang Min Park.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Three authors (J.M.G., H.K., C.M.P.) received research grants from Lunit Inc. for outside of this study. The authors state that this work has not received any funding.

Statistics and biometry

Two of the authors has significant statistical expertise (Chang Min Park and Jong Hyuk Lee).

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic study

• performed at one institution

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Lee, J.H., Park, S., Hwang, E.J. et al. Deep learning–based automated detection algorithm for active pulmonary tuberculosis on chest radiographs: diagnostic performance in systematic screening of asymptomatic individuals. Eur Radiol 31, 1069–1080 (2021). https://doi.org/10.1007/s00330-020-07219-4

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Keywords

  • Tuberculosis
  • Mass screening
  • Radiography
  • Deep learning
  • Diagnosis, computer-assisted