PT  - JOURNAL ARTICLE
AU  - G H Swingler
AU  - G du Toit
AU  - S Andronikou
AU  - L van der Merwe
AU  - H J Zar
TI  - Diagnostic accuracy of chest radiography in detecting mediastinal lymphadenopathy in suspected pulmonary tuberculosis
AID  - 10.1136/adc.2004.062315
DP  - 2005 Nov 01
TA  - Archives of Disease in Childhood
PG  - 1153--1156
VI  - 90
IP  - 11
4099  - http://adc.bmj.com/content/90/11/1153.short
4100  - http://adc.bmj.com/content/90/11/1153.full
SO  - Arch Dis Child2005 Nov 01; 90
AB  - Objective: To estimate the diagnostic accuracy of chest radiography in the detection of chest lymphadenopathy in children with clinically suspected pulmonary tuberculosis.Methods: Design: Prospective cross sectional study. Setting: A short stay ward in a children’s hospital in South Africa. Patients: Consecutive children under 14 years of age admitted with suspected pulmonary tuberculosis. Diagnostic test: Antero-posterior and/or lateral chest x rays interpreted independently and blind to the reference standard by three primary care clinicians and three paediatricians, all with a special interest in tuberculosis. Reference standard: Spiral chest computed tomography (CT) with contrast injection.Results: One hundred children (median age 21.5 months) were enrolled. Lymphadenopathy was present in 46 of 100 reference CT scans and judged to be present in 47.1% of x ray assessments. Overall sensitivity was 67% and specificity 59%. Primary care clinicians were more sensitive (71.5% v 63.3%, p = 0.047) and less specific (49.8% v 68.9%, p<0.001) than paediatricians. Overall accuracy was higher for the paediatricians (diagnostic odds ratio 3.83 v 2.49, p = 0.008). The addition of a lateral to an antero-posterior view did not significantly increase accuracy (diagnostic odds ratio 3.09 v 3.73, p = 0.16). Chance adjusted inter-observer agreement (κ) varied widely between viewer pairs, but was around 30%.Conclusions: Detection of mediastinal lymphadenopathy on chest x ray to diagnose pulmonary tuberculosis in children must be interpreted with caution. Diagnostic accuracy might be improved by refining radiological criteria for lymphadenopathy.