四川省第五次结核病抽样调查X线胸片诊断一致性分析

Consistency of Pulmonary Tuberculosis Diagnosis by Chest X-ray Images in Fifth Tuberculosis Sampling Survey in Sichuan

目的了解四川省第五次结核病流行病抽样调查中X线胸片诊断水平现状。方法抽取全省11个国家级流调点拍摄的15 187张胸片中的异常胸片314张,分别由省级阅片小组和国家级阅片小组进行复核,计算出3组阅读同一胸片结果的一致性Kappa值(K)和比较阅片诊断类型中的差异性。结果县级与省级、国家级的阅片结果一致性K值分别为0.173和0.206;省级与国家级的阅片结果一致性K值为0.613。在阅片诊断类型上,差异最大的为疑似肺结核和非结核的诊断。结论国家级与省级判定结果的一致性K值较高,国家级与县级、省级与县级判定结果一致性K值均较低。

Objective To understand the diagnosis level of pulmonary tuberculosis by chest X-ray images in county medical institutions in Sichuan.Methods A total of 314 X-ray images showing abnormalities were selected from 15 187 X-ray images taken in 11 national epidemiological survey sites in Sichuan,and checked by the experts both at province level and at national level.The Kappa values indicating consistency on the diagnosis of one X-ray image between three level diagnosis were calculated,and the differences on diagnosis were compared.Results The Kappa value between county level diagnosis and provincial level diagnosis was 0.173,the Kappa value between county level diagnosis and national level diagnosis was 0.206,and the Kappa value between provincial level diagnosis and national level diagnosis was 0.613.The greatest difference was found on the diagnosis of suspected pulmonary tuberculosis and non-pulmonary tuberculosis.Conclusion The Kappa value between provincial level diagnosis and national level diagnosis was high,but the Kappa values between county level diagnosis and provincial level diagnosis,and between county level diagnosis and national level diagnosis were relatively low.