key: cord-0749963-l5koqyzf authors: Adams, Hugo J.A.; Kwee, Thomas C.; Kwee, Robert M. title: COVID-19 and chest CT: do not put the sensitivity value in the isolation room and look beyond the numbers date: 2020-04-27 journal: Radiology DOI: 10.1148/radiol.2020201709 sha: b6cc5260f745302bf23c5f76b8e4ae83782cd2d0 doc_id: 749963 cord_uid: l5koqyzf nan (95% confidence interval 26%-50%). However, we believe that there is no convincing evidence yet that chest CT achieves such a high sensitivity in diagnosing COVID-19 in clinical practice. Note that the far majority of studies that were included in the meta-analysis by Kim et al. (1) (58 of 63 studies) only enrolled patients with proven COVID-19 infection while cases without the disease were lacking. Strikingly, this is not in line with their exclusion criterion number 3: "lack of extractable data for a two-by-two contingency table". As a result, these 58 studies only allowed for the calculation of sensitivity, and not specificity. However, the diagnostic value of a test depends on its ability to discriminate between diseased and non-diseased cases (2) . Sensitivity and specificity are intertwined entities and are both dependent on the threshold value which is applied to discriminate between positive and negative cases (2) . Generally, creating a high sensitivity by applying a low threshold is at the expense of specificity (2) . Multiple studies in Kim (1) may have been overestimated. It should also be noted that the 5 studies that did provide a 2×2 diagnostic contingency table, suffered from numerous methodological flaws. The lack of high-quality evidence, rather than the mathematical numbers, should have been the main conclusion in the otherwise excellent work by Kim et al. (1) . studies, the reported sensitivity ranged from 94% to 100%, and the specificity ranged from 25% to 56%. Based on the visual evaluation of the coupled forest plot, there was no decrease in sensitivities according to increase in specificities. Furthermore, we conducted an additional subgroup analysis for the studies with a low risk of bias for the CT interpretation, which clarified that the image readers were blinded to the clinical information or used radiology reports obtained from the routine clinical practice (2, . Again, the pooled sensitivity (93%; 95% CI: 86%, 96%; I 2 =96%) was comparable to that of the primary analysis. Although there was a huge heterogeneity in the included studies, we believe our findings would help guide the radiology practice during the outbreak of coronavirus disease 2019. 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