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PubMed2002

[Intelligent system to perform a diagnostic protocol for lymphatic invasion in laryngeal cancer].

Laryngeal carcinoma is the most frequent malignant tumour in head and neck. Node invasion is known to be one of the most important prognostic factors. The aim of this study has been to design an intelligent system to perform a diagnostic algorithm of metastasic neck nodes. 122 clinical reports of patients diagnosed of laryngeal carcinoma in our department have been reviewed. The compiled data have been: tumor site, T stage, N stage (clinical, after CT scan and post-surgery). The method used to design the intelligent system has been the ID3, which is able to generate a minimal decision tree. Palpation has been the variable that has given more information about node invasion. CT has proved to be more efficient in supraglottic tumours. ID3 method has shown to be useful in performing diagnostic algorithms, specially when the number of cases and diagnostic tests are high.

Adult↗
PubMed2005

Chest radiography with a digital flat-panel detector: experimental receiver operating characteristic analysis.

PURPOSE: To evaluate the influence of different detector radiation doses and peak kilovoltage settings on diagnostic performance and radiation dose at posteroanterior (PA) chest radiography performed with an amorphous silicon flat-panel detector (FPD). MATERIALS AND METHODS: All examinations were performed by using a digital FPD. PA chest radiographs of an anthropomorphic chest phantom were obtained with detector radiation doses of 2.50 microGy (system speed, 400), 1.56 microGy (speed, 640), and 1.25 microGy (speed, 800) and with peak kilovoltage values of 100, 120, and 140 kVp. Four types of simulated lesions-nodules of different sizes, polylobulated lesions, interstitial-nodular lesions, and interstitial-reticular lesions-were superimposed on the phantom. After four radiologists assessed all of the images, receiver operating characteristics analysis was performed. In addition, the entrance surface dose was measured and the effective dose was calculated. RESULTS: Reduced detector dose led to significantly decreased diagnostic performance in overall lesion detection (P <.05). However, over pulmonary areas only, this effect could not be seen. With use of the same kilovoltage values, reducing the detector dose, even to 1.25 microGy (speed, 800), did not lead to significantly decreased lesion detectability. In terms of diagnostic performance and effective dose, 120 kVp was the most effective. CONCLUSION: Standard PA chest radiographs should still be acquired at a detector dose of 2.50 microGy (speed, 400) with 120 kVp to yield the highest diagnostic performance. However, when the present analysis was focused on the lung fields only, no significant loss in diagnostic performance could be demonstrated, even after a 50% reduction in radiation dose.

Observer Variation↗
PubMed2006

An in vitro comparison between two methods of electrical resistance measurement for occlusal caries detection.

Because of different measurement techniques and the easier design of the CRM prototype, this in vitro study aimed to compare the diagnostic performance and reproducibility of two electrical methods (Electronic Caries Monitor III, ECM and Cariometer 800, CRM) for occlusal caries detection, and to evaluate the effect of staining/discoloration of fissures on diagnostic performance. Hundred and seventeen third molars with no apparent occlusal cavitation were selected. Six examiners inspected all specimens independently, using the CRM, and a subgroup of 4 using the ECM. Histological validation using a stereomicroscope was performed after hemisectioning. Intra- and interexaminer reproducibility was assessed by Lin's concordance correlation coefficient (CCC) and Bland and Altman analysis. Diagnostic performance parameters included sensitivity (SE), specificity (SP) and area under the ROC curve (Az). The CCC yielded an intra- and interexaminer reproducibility of 0.69/0.62 (ECM) and of 0.79/0.74 (CRM). The mean intra- and interexaminer 95% range of measurements (range between Bland and Altman limits of agreement) given in percentages of the instrument reading were 67%/65% for the ECM and 28%/33% for the CRM. Az at the D3-4 level was 0.74 (ECM) and 0.78 (CRM). The CRM showed at least equivalent diagnostic performance to the ECM. However, improvement is still desirable. Diagnostic performance appeared to be enhanced in discolored lesions; however, this may be related to sample lesion distribution characteristics.

Dental Caries↗
PubMed2002

Performance of a flat-panel detector in detecting artificial bone lesions: comparison with conventional screen-film and storage-phosphor radiography.

PURPOSE: To compare a large-area direct-readout flat-panel detector system with a conventional screen-film system and a storage-phosphor system in detecting small artificial osseous lesions simulating osteolytic disease and to assess diagnostic performance with decreasing exposure dose. MATERIALS AND METHODS: Artificial lesions (0.5-3.0 mm) were created in 100 of 200 predefined regions in 20 porcine femoral specimens. Specimens were enclosed in containers filled with water to create absorption and scatter radiation conditions comparable with those in a human extremity. Imaging was performed with a flat-panel detector system, a conventional screen-film system, and a storage-phosphor system. Levels of exposure equivalent to speed classes 400, 800, 1600, and 3200 were used. In all images, the presence or absence of a lesion was assessed by three radiologists using a five-point confidence scale. Receiver operating characteristic (ROC) analysis was performed for 4,800 observations (600 for each imaging modality and exposure level) and diagnostic performance estimated with the area under the ROC curve (A(z)). The significance of differences in diagnostic performance was tested with analysis of variance. RESULTS: ROC analysis showed A(z) values of 0.820 (speed class 400), 0.780 (class 800), 0.758 (class 1600), and 0.676 (class 3200) for the flat-panel detector; 0.761 (class 400), 0.725 (class 800), and 0.662 (class 1600) for the storage-phosphor system; and 0.788 (class 400) for the conventional screen-film system. The A(z) value for the flat-panel detector at speed class 400 was significantly higher than that for all other systems (P <.05). A(z) values for the speed class 400 screen-film system and flat-panel detector system at speed class 800 were not significantly different. CONCLUSION: The flat-panel detector has diagnostic performance superior to that of conventional screen-film and storage-phosphor radiography for detecting small artificial osseous lesions at clinical exposure settings. With the flat-panel detector, exposure dose can be reduced by 50% to obtain diagnostic performance comparable with that of a conventional speed class 400 screen-film system.

Animals↗
PubMed1991

Evaluation of congenital heart disease by three-dimensional magnetic resonance imaging.

This study was undertaken to compare electrocardiographically gated magnetic resonance imaging (MRI) to established imaging modalities in the detection of complex intra- and extracardiac morphologic defects. Twenty-three patients with congenital cardiac abnormalities were imaged by four methods: cardiac catheterization, echocardiography, two-dimensional (2D) transaxial MRI, and three-dimensional (3D) MRI surface reconstruction. Observers with experience in congenital cardiac disease diagnosis (two for echo, one for catheterization, two for 2D MR, and three for 3D MR) evaluated the images in a blinded fashion, and the results were analyzed with receiver operating characteristic (ROC) analysis. Overall, cardiac catheterization had the best diagnostic performance. The diagnostic value of routine 2D cardiac MR images and 3D MR reconstruction images were similar to that of echocardiography. All of the modalities performed poorly in the diagnosis of extracardiac defects and atrial septal defects.

Cardiac Catheterization↗
PubMed2005

A systematic review of whether oral contrast is necessary for the computed tomography diagnosis of appendicitis in adults.

BACKGROUND: There are several methods of contrast administration when performing computed tomography (CT) scanning for suspected appendicitis. In this systematic review we evaluated the diagnostic performance of CT with and without contrast material. METHODS: Twenty-three reports were identified using a Medline search. RESULTS: The aggregated diagnostic performance characteristics of all modes of CT scanning were excellent with a range of sensitivity (83--97%), specificity (93--98%), positive predictive value (86--98%), negative predictive value (94--99%), and accuracy (92--97%). The diagnostic performance of CT without oral contrast was similar (sensitivity, 95% vs. 92% [not statistically significant]; negative predictive value, 96% for both protocols) or surprisingly better (specificity, 97% vs. 94%; positive predictive value, 97% vs. 89%; accuracy, 96% vs. 92%; P<.0001) than with oral contrast. CONCLUSIONS: Noncontrast CT techniques to diagnose appendicitis showed equivalent or better diagnostic performance compared with CT scanning with oral contrast. A prospective comparative trial of CT with and without oral contrast for appendicitis should be performed to assess the adequacy of this modality.

Appendicitis↗
PubMed1994

Performance of diagnostic systems in occlusal caries detection compared.

Many investigations have been conducted to evaluate existing and new diagnostic systems in the detection of occlusal carious lesions. The performances of these systems are difficult to compare with each other, because of the disadvantages associated with the widely used validity parameters sensitivity and specificity. In this study a meta-analysis was performed to facilitate a comparison between the performances of diagnostic systems which are currently in use in occlusal caries diagnosis. Nine in vitro studies and one in vivo study complied with the selected criteria for inclusion in the analysis. The sensitivity and specificity values obtained from these studies were converted into normal deviate values, and plotted on linearly scaled normal-deviate axes. DZ values, which quantify the performance above chance of a diagnostic test in one single value, were calculated. Averaged DZ values of the diagnostic systems were subsequently compared to each other. The results indicate that electrical resistance measurements and fiber-optic transillumination had a comparatively good, and visual inspection and xeroradiography a poor, performance in occlusal caries diagnosis. All the other radiographic image modalities had intermediate performances.

Contrast Media↗
PubMed2002

Performance of a flat-panel detector in the detection of artificial erosive changes: comparison with conventional screen-film and storage-phosphor radiography.

The purpose of this study was to compare a large-area, direct-readout, flat-panel detector system with a conventional screen-film system, a storage-phosphor system, and a mammography screen-film system with regard to the detection of artificial bone erosions simulating rheumatoid disease, and to assess its diagnostic performance with decreasing exposure dose. Six hundred forty regions were defined in 160 metacarpophalangeal and proximal interphalangeal joint specimens from 20 monkey paws (4 regions per joint). Artificial bone erosions were created in 320 of these 640 regions. Specimens were enclosed in containers filled with water to obtain absorption and scatter radiation conditions similar to those of a human hand. Imaging was performed using a flat-panel system, a speed class 200 screen-film system, a mammography screen-film system, and a storage-phosphor system under exactly matched conditions. Different exposure doses equivalent to speed classes of S=100, 200, 400, 800, 1600, and 3200 were used. In all images the presence or absence of a lesion was assessed by three radiologists using a five-level confidence scale. Receiver operating characteristic (ROC) analysis was performed for a total of 21,120 observations (1920 for each imaging modality and exposure level) and diagnostic performance estimated by the area under the ROC curve (A(z)). The significance of differences in diagnostic performance was tested with analysis of variance. The ROC analysis showed A(z) values of 0.809 (S=200), 0.768 (S=400), 0.737 (S=800), 0.710 (S=1600), and 0.685 (S=3200) for the flat-panel system, 0.770 for the speed class 200 screen-film system, 0.781 (S=200), 0.739 (S=400), 0.724 (S=800), 0.680 (S=1600) for the storage-phosphor system, and 0.798 for the mammography screen-film system. Analysis of variance showed significant differences between different combinations of imaging modalities and exposure doses ( p<0.05). The diagnostic performance of the flat-panel detector system is superior to that of a screen-film system and a storage-phosphor system for the detection of erosive lesions at clinical exposure settings (S=200). Using the flat-panel system the exposure dose can be reduced by 50% to obtain a diagnostic performance comparable to a speed class 200 screen-film system.

Animals↗
PubMed2001

The role of maternal serum C-reactive protein and white blood cell count in the prediction of chorioamnionitis in women with premature rupture of membranes.

This study was performed to evaluate the diagnostic performance of maternal serum C-reactive protein, maternal white blood cell (WBC), and neutrophil counts in the detection of histologic chorioamnionitis. One hundred and twenty six pregnant women after at least 28 weeks of gestation with premature rupture of membranes (PROM) were studied. Blood samples for C-reactive protein, WBC and neutrophil counts were taken at delivery. Placental histology was evaluated for histologic chorioamnionitis. Maternal and neonatal complications were observed. Among women with and without histologic chorioamnionitis, the maternal WBC and neutrophil counts were different (P<0.05) but the maternal serum C-reactive protein was not. Cutoff values for C-reactive protein, WBC, and neutrophil counts were 0.5 mg/dL, 15,000 cell/mm3, and 80 per cent, respectively. Sensitivity and specificity were 56 per cent and 58 per cent for C-reactive protein, 60 per cent and 63 per cent for WBC count, and 62 per cent and 54 per cent for neutrophil count, respectively. In conclusion, the maternal serum C-reactive protein, WBC, and neutrophil counts have poor diagnostic performance for histologic chorioamnionitis.

Adolescent↗
PubMed2004

Spectrum bias: a quantitative and graphical analysis of the variability of medical diagnostic test performance.

The performance of a medical diagnostic test may vary in a subgroup of patients according to the severity and clinical presentation of the disease. This phenomenon is often referred to as the spectrum effect. There is currently no technique to determine in which situations this spectrum effect may lead to a spectrum bias, that is, a distortion of the posterior probability which can potentially affect the clinical decision. We show that spectrum bias, on either a positive or a negative test result, can be expressed as the subgroup-specific likelihood ratio (LR) divided by the LR in the overall population of patients. This assessment of spectrum bias is independent of the pretest probability. We present here the test statistic and its variance and also propose a mode of graphically visualizing the presence of spectrum bias. We applied it to 15 examples from the literature, of which three are discussed in detail. In two examples, there was spectrum bias: (1) diagnosis of urinary tract infection in subgroups of low or high risk patients when using the dipstick test, and (2) diagnosis of left ventricular hypertrophy using electrocardiography in subjects with different body mass index. In a third example, there was no spectrum bias for the diagnosis of coronary heart disease in subgroups of patients defined by age, sex or comorbidities when using exercise electrocardiography. As sensitivity and specificity usually vary in opposite directions from one subgroup to the other, the ratio of LRs tends to remain constant, resulting in no or little spectrum bias. We conclude that spectrum effect is more common than spectrum bias and that clinical decisions are affected only under certain conditions.

Adult↗
PubMed2000

An assessment of the effectiveness of magnetic resonance imaging of the shoulder: literature review.

OBJECTIVE: To analyse and compare all papers published to date (August 2000) that quantify the effectiveness, defined as the impact of clinician's diagnosis or management plans, or patient outcome, of MRI of the shoulder. DESIGN: A computerised search of Index Medicus with a broad search strategy relating to shoulder MRI was performed. Manual assessment of all papers listed was undertaken with classification of each paper depending on whether it addressed questions of (1) technical performance, (2) diagnostic performance or (3) outcome. RESULTS: Four of 265 qualifying papers addressed aspects of effectiveness and these were reviewed. The impact on the clinician's diagnosis varied widely between papers: the primary diagnosis was altered in 23% to 68% of cases, and the management plans were subsequently changed in 15% to 61% of cases. Only one paper addressed the impact on patient health. CONCLUSIONS: The effectiveness of MRI of the shoulder depends on the clinical skills of the referring clinician and prevalence of disease in the study population. This will have implications when the effectiveness of an imaging technique between different institutions is compared, and this in turn will influence any comparisons of cost-effectiveness.

Cost-Benefit Analysis↗
PubMed2000

Serological methods for diagnosis of Helicobacter pylori infection and monitoring of eradication therapy.

Several methods can be used to diagnose Helicobacter pylori infection. Invasive methods include detection of the bacterium in gastric biopsy specimens by culture, immunohistochemistry, rapid urease tests, or the polymerase chain reaction. Noninvasive or less invasive detection methods include the urea breath test and serological methods. The urea breath test is based on the detection of 13CO2 or 14CO2 in breath, produced by bacterial urease in the stomach after labelled urea is swallowed. Serological methods are based on the detection of Helicobacter pylori-specific antibodies in serum, saliva, or urine. In this review, the performance and diagnostic value of several serological methods, such as enzyme immunoassay, rapid office-based assays, and Western blot, will be discussed in relation to biopsy-based methods and the urea breath test. In addition, the value of serological assays for monitoring eradication of Helicobacter pylori infection following treatment will be discussed. The diagnostic performance of properly evaluated serological assays is comparable to that of biopsy-based methods and the urea breath test. To monitor eradication of Helicobacter pylori infection following therapy, quantitative enzyme immunoassays can be used, especially in patients with high pretreatment antibody titres.

Antibodies, Bacterial↗
PubMed2006

Comparison of independent double readings and computer-aided diagnosis (CAD) for the diagnosis of breast calcifications.

RATIONALE AND OBJECTIVES: The aim of the study is to compare independent double readings by radiologists and computer-aided diagnosis (CAD) in diagnostic interpretation of mammographic calcifications. MATERIALS AND METHODS: Ten radiologists independently interpreted 104 mammograms containing clustered microcalcifications. Forty-six of these were malignant and 58 were benign at biopsy. Radiologists read the images with and without a computer aid by using a counterbalanced study design. Sensitivity and specificity were calculated from observer biopsy recommendations, and receiver operating characteristic (ROC) curves were computed from their diagnostic confidence ratings. Unaided double-reading sensitivity and specificity values were derived post hoc by using three different objective rules and an additional rule of simulated-optimal double reading that assumed that consultations for resolving two radiologists' different independent diagnoses always produce the correct clinical recommendation. ROC curves of unaided double readings were obtained according to the literature. RESULTS: Single reading without computer aid yielded 74% sensitivity and 32% specificity, whereas CAD reading yielded 87% sensitivity and 42% specificity and appeared on a higher ROC curve (P < .0001). Three methods of formulating independent double readings generated sensitivities between 59% and 89%, specificities between 50% and 13%, and operating points that moved essentially along the average unaided single-reading ROC curve. ROC curves of unaided independent double readings showed small, statistically insignificant improvement over those of unaided single readings. Results of the simulated-optimal double reading were similar to CAD: 89% sensitivity and 50% specificity. CONCLUSION: Independent double readings of mammographic calcifications may not improve diagnostic performance. CAD reading improves diagnostic performance to an extent approaching the maximum possible performance.

Breast Diseases↗
PubMed2005

Detection of acute infections during HIV testing in North Carolina.

BACKGROUND: North Carolina has added nucleic acid amplification testing for the human immunodeficiency virus (HIV) to standard HIV antibody tests to detect persons with acute HIV infection who are viremic but antibody-negative. METHODS: To determine the effect of nucleic acid amplification testing on the yield and accuracy of HIV detection in public health practice, we conducted a 12-month observational study of methods for state-funded HIV testing. We compared the diagnostic performance of standard HIV antibody tests (i.e., enzyme immunoassay and Western blot analysis) with an algorithm whereby serum samples that yielded negative results on standard antibody tests were tested again with the use of nucleic acid amplification. A surveillance algorithm with repeated sensitive-less-sensitive enzyme immunoassay tests was also evaluated. HIV infection was defined as a confirmed positive result on a nucleic acid amplification test or as HIV antibody seroconversion. RESULTS: Between November 1, 2002, and October 31, 2003, 109,250 persons at risk for HIV infection who had consented to HIV testing presented at state-funded sites. There were 606 HIV-positive results. Established infection, as identified by standard enzyme immunoassay or Western blot analysis, appeared in 583 participants; of these, 107 were identified, with the use of sensitive-less-sensitive enzyme immunoassay tests, as recent infections. A total of 23 acutely infected persons were identified only with the use of the nucleic acid amplification algorithm. With all detectable infections taken into account, the sensitivity of standard antibody testing was 0.962 (95 percent confidence interval, 0.944 to 0.976). There were two false positive results on nucleic acid amplification tests. The specificity and positive predictive value of the algorithm that included nucleic acid amplification testing were greater than 0.999 (95 percent confidence interval, 0.999 to >0.999) and 0.997 (95 percent confidence interval, 0.988 to >0.999), respectively. Of the 23 acute HIV infections, 16 were detected at sexually transmitted disease clinics. Emergency measures for HIV prevention protected 48 sex partners and one fetus from high-risk exposure to HIV. CONCLUSIONS: The addition of nucleic acid amplification testing to an HIV testing algorithm significantly increases the identification of cases of infection without impairing the performance of diagnostic testing. The detection of highly contagious, acutely infected persons creates new opportunities for HIV surveillance and prevention.

Acute Disease↗
PubMed2003

Virus diagnostics on microarrays.

Whereas the majority of microarray applications still deal with expression analysis for gathering information about levels of gene products at certain cell states, other approaches simply ask the question whether particular genes, which are usually indicative for particular microorganisms and pathogens, are present in a sample or not. Investigations that are more detailed try to evaluate the presence of particular subtypes of a given pathogen. The combination of microarray technology and virus diagnostics promises to generate an ideal platform for fast, sensitive, specific, and parallelized virus diagnostics. Performing virus diagnostics on microarrays, however, requires other basic techniques to be optimized. This is necessary in order to obtain unambiguous and reproducible results, which are compatible with the needs for clinical routine. Parameters that have to be considered include supports, coupling chemistry, chemical oligonucleotide synthesis, signal enhancement strategies, and optimal coordination of PCR reactions, hybridizations, and signal detection, as well as interpretation strategies. Finally, considerations should be given to economic aspects, one chip-one patient strategies and low integrated arrays as a custom-tailored way to fast and accurate diagnostic tools.

Animals↗
PubMed2006

NT-proBNP and BNP values in cardiac patients with different degree of left ventricular systolic dysfunction.

We investigated the performance of brain natriuretic peptides (BNP and NT-proBNP) in detecting various degrees of left ventricular systolic dysfunction. The NT-proBNP assay (Roche) and the BNP assay (Bayer Shionoria) were performed in 46 patients (mean age 50 years; range 20-79 years) with various types of heart disease (chronic heart failure due to coronary artery disease, cardiomyopathy, acquired valve disease, congenital heart diseases) and different impairment of left ventricular systolic dysfunction was assessed by echocardiography. Patients were divided into four groups according to the left ventricular ejection fraction (LVEF) correlated with clinical severity. Significant differences in medians of NT-proBNP and BNP values between all groups were determined (P= 0.0161 for NT-proBNP and P=0.0180 for BNP). For identifying patients with severe systolic dysfunction (LVEF<40%), receiver operating characteristic (ROC) analysis for both BNP and NT-proBNP was performed. The diagnostic performances expressed as areas under the curve were of 0.69 for NT-proBNP (cut off value 367 pg/ml) and 0.60 for BNP (cut off value 172 pg/ml). However, the BNP showed higher sensitivity (85 % vs. 63 %) and a higher positive predictive value (69 % vs 55 %) than the NT-proBNP. The negative predictive values of BNP and NT-proBNP were similar (70 % and 71 % respectively). Brain natriuretic peptides are promising markers for the diagnosis of severe left ventricular systolic dysfunction.

Adult↗
PubMed2002

Use of magnetic resonance angiography to select candidates with recently symptomatic carotid stenosis for surgery: systematic review.

OBJECTIVE: To determine if sufficient evidence exists to support the use of magnetic resonance angiography as a means of selecting patients with recently symptomatic high grade carotid stenosis for surgery. DESIGN: Systematic review of published research on the diagnostic performance of magnetic resonance angiography, 1990-9. MAIN OUTCOME MEASURES: Performance characteristics of diagnostic test. RESULTS: 126 potentially relevant articles were identified, but many articles failed to examine the performance of magnetic resonance angiography as a diagnostic test at the surgical decision thresholds used in major clinical trials on endarterectomy. 26 articles were included in a meta-analysis that showed a maximal joint sensitivity and specificity of 99% (95% confidence interval 98% to 100%) for identifying 70-99% stenosis and 90% (81% to 99%) for identifying 50-99% stenosis. Only four articles evaluated contrast enhanced magnetic resonance angiography. CONCLUSIONS: Magnetic resonance angiography is accurate for selecting patients for carotid endarterectomy at the surgical decision thresholds established in the major endarterectomy trials, but the evidence is not very robust because of the heterogeneity of the studies included. Research is needed to determine the diagnostic performance of the most recent developments in magnetic resonance angiography, including contrast enhanced techniques, as well as to assess the impact of magnetic resonance angiography on surgical decision making and outcomes.

Carotid Stenosis↗
PubMed1993

[Fiber optics bronchoscopy yield and predictive clinical, analytical, and radiologic factors in the etiologic diagnosis of pulmonary pathology in patients with HIV infection].

UNLABELLED: The aim of this study was to assess the diagnostic performance of fibrobronchoscopy (FBS) in the pulmonary pathology of HIV-positive patients, in order to study the effect of several factors on such performance and to evaluate if these factors could guide the etiologic diagnosis. A retrospective study of 49 FBS with bronchoalveolar lavage (BAL) was performed in 44 HIV-positive patients. The diagnostic performance of FBS with BAL was 71.4%, with no significant modifications caused by previous prophylactic or empirical therapies, time of clinical evolution, radiological pattern, presence of hypoxemia or CD4 count. On the contrary, a high LDH was associated to a higher diagnostic performance. DIAGNOSIS: Pneumonia by Pneumocystis carinii (36.7%), M. tuberculosis (28.6%) and bacterial pneumonias (16.3%). The presence of biliary adenopathies, evolution longer than 1 week and pO2 > 80 mm Hg had a high sensitivity of 28.5% and a specificity of 97% for the diagnosis of tuberculosis, with a positive predictive value of 80% and a negative predictive value of 77.7%.

Adult↗