Radiografi Toraks dalam Deteksi Tuberkulosis Paru: Tinjauan Literatur tentang Temuan, Akurasi Skrining, dan Computer-Aided Detection

Niken Kasati

doi:10.71456/jik.v5i1.2916

Authors

Niken Kasati RS Tk.II Udayana Denpasar Bali

DOI:

https://doi.org/10.71456/jik.v5i1.2916

Keywords:

Radiografi Toraks, Tuberkulosis Paru, Skrining, Computer-Aided Detection, Pencitraan Diagnostik

Abstract

Tuberkulosis (TB) paru masih merupakan masalah kesehatan masyarakat yang substansial, sementara Indonesia menyumbang sekitar 10% beban TB global. Penemuan kasus tetap menjadi tantangan karena sebagian individu berada pada fase subklinis dan berpotensi tidak teridentifikasi melalui skrining berbasis gejala semata. Tinjauan ini menganalisis peran radiografi toraks (chest X-ray/CXR) dalam deteksi TB paru dengan menitikberatkan pada pola radiografis, kinerja skrining dan triase, keterbatasan diagnostik, serta perkembangan computer-aided detection (CAD). Tinjauan naratif terstruktur dilakukan melalui penelusuran PubMed, PubMed Central, dan dokumen resmi World Health Organization (WHO), terutama untuk publikasi tahun 2020–2026, kemudian bukti disintesis secara tematik tanpa meta-analisis. Bukti yang tersedia menunjukkan bahwa CXR memiliki sensitivitas tinggi sebagai alat skrining, yaitu sekitar 94% dengan spesifisitas 89% ketika setiap abnormalitas dianggap positif, serta sekitar 85% dengan spesifisitas 96% ketika penilaian dibatasi pada abnormalitas yang sugestif TB. Konsolidasi, opasitas nodular, kavitas, limfadenopati hilus atau mediastinum, efusi pleura, fibrosis, dan pola milier dapat meningkatkan kecurigaan terhadap TB paru; namun, tidak satu pun bersifat patognomonik, dan radiograf yang tampak normal tidak menyingkirkan penyakit aktif. Sistem CAD menunjukkan kinerja yang menjanjikan dan telah direkomendasikan WHO untuk skrining individu berusia 15 tahun atau lebih, meskipun performanya dipengaruhi oleh ambang skor, karakteristik populasi, dan versi perangkat lunak. Dengan demikian, CXR paling tepat ditempatkan sebagai modalitas skrining, triase, dan pemeriksaan penunjang yang terintegrasi dengan konfirmasi mikrobiologis atau molekuler. Dalam konteks negara dengan beban TB tinggi seperti Indonesia, manfaat klinis dan programatiknya sangat bergantung pada validasi lokal ambang CAD, efektivitas sistem rujukan, dan kesinambungan tindak lanjut pasien.

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