X-ray is not inferior to CT in terms of F1 score in the diagnosis of foreign body aspiration: a recall, precision and F1 score performance analysis based on bronchoscopically proven cases

Abstract

Objective  In this study, we aimed to evaluate the diagnostic accuracy of X-ray and CT by using the F1 score with its non-inferiority margin in patients who underwent bronchoscopy with suspected diagnoses of foreign body aspiration (FBA).

Methods  All children aged under 18 who underwent bronchoscopy with suspected diagnoses of FBA between June 2020 and December 2023 were included. The patient’s medical records were examined retrospectively.

Results  A total of 310 patients were included. Foreign bodies were most frequently located in the right main bronchus (47.52 %). The bronchoscopy (-) rate was 18 % in patients who had X-ray (+), 24 % in those who had CT (+), and 15 % in those who had X-ray (+) and CT (+). Chest x-rays were found to exhibit 42 % sensitivity, 74 % specificity, a positive predictive value (PPV) of 61 %, a negative predictive value (NPV) of 51 %, accuracy of 66 %, precision: 0.63, recall: 0.82, and F1 score: 0.71. Analysis showed that CT exhibited 82 % sensitivity, 37 % specificity, a PPV of 75 %, NPV of 47 %, an accuracy rate of 69 %, precision: 0.83, recall: 0.76, and F1 score: 0.79. In the present study, the diagnostic F1 score was calculated as 0.79 for CT and 0.71 for X-ray.

Conclusion  Despite a negative bronchoscopy rate of 34.83 % in this study, since the authors observed no severe complications or mortality, the authors recommend that it be performed on all patients with suspected foreign body aspiration. When a 10 % non-inferiority margin was applied, X-ray was found to be not inferior to CT in terms of F1 score.

Keywords
Aspiration; Airway; Bronchoscopy; Child; Foreign body