Impact of thyroid nodule size on prevalence and post-test probability of malignancy: A systematic review

2014 ◽  
Vol 125 (1) ◽  
pp. 263-272 ◽  
Author(s):  
Jennifer J. Shin ◽  
Diana Caragacianu ◽  
Gregory W. Randolph
Keyword(s):  
Systematic Review ◽  
Thyroid Nodule ◽  
Nodule Size ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

scholarly journals Atypical Endometrial Hyperplasia and Unexpected Cancers at Final Histology: A Study on Endometrial Sampling Methods and Risk Factors

Diagnostics ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. 474 ◽  
Author(s):  
Luca Giannella ◽  
Giovanni Delli Carpini ◽  
Francesco Sopracordevole ◽  
Maria Papiccio ◽  
Matteo Serri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endometrial Hyperplasia ◽  
Probability Analysis ◽  
Secondary Outcome ◽  
Endometrial Sampling ◽  
Final Histology ◽  
Atypical Endometrial Hyperplasia ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

Background: Up to 40% of women with atypical endometrial hyperplasia (AEH) can reveal endometrial cancer (EC) at hysterectomy. The pre-operative endometrial sampling method (ESM) and some independent cancer predictors may affect this outcome. The present study aimed to compare the rate of EC at hysterectomy in women with AEH undergoing dilation and curettage (D&C), hysteroscopically-guided biopsy (HSC-bio), or hysteroscopic endometrial resection (HSC-res). The secondary outcome was to compare the reliability of ESMs in women showing independent variables associated with EC. Methods: Two-hundred-and-eight consecutive women with AEH and undergoing hysterectomy between January 2000 and December 2017 were analyzed retrospectively. Based on pre- and post-test probability analysis for EC, three ESMs were compared: D&C, HSC-bio, and HSC-res. Univariate and multivariate analyses were performed to assess risk factors predicting cancer on final histology. Finally, the patient’s characteristics were compared between the three ESM groups. Results: D&C and HSC-bio included 75 women in each group, while HSC-res included 58 women. Forty-nine women (23.6%) revealed cancer at hysterectomy (pre-test probability). Post-test probability analysis showed that HSC-res had the lowest percentage of EC underestimation: HSC-res = 11.6%; HSC-bio = 19.5%; D&C = 35.3%. Patient characteristics showed no significant differences between the three ESMs. Multivariate analysis showed that body mass index ≥40 (Odds Ratio (OR) = 19.75; Confidence Intervals (CI) 2.193–177.829), and age (criterion > 60 years) (OR = 1.055, CI 1.002–1.111) associated significantly with EC. In women with one or both risk factors, post-test probability analysis showed that HSC-res was the only method with a lower EC rate at hysterectomy compared to a pre-test probability of 44.2%: HSC-res = 19.96%; HSC-bio = 53.81%; D&C = 63.12%. Conclusions: HSC-res provided the lowest rate of EC underestimation in AEH, also in women showing EC predictors. These data may be considered for better diagnostic and therapeutic planning of AEH.

scholarly journals Ultrasound diagnosis of molar pregnancy

Ultrasound ◽  
2018 ◽  
Vol 26 (3) ◽  
pp. 153-159 ◽  
Author(s):  
Jackie A. Ross ◽  
Alina Unipan ◽  
Jackie Clarke ◽  
Catherine Magee ◽  
Jemma Johns
Keyword(s):  
Likelihood Ratio ◽  
Gestational Trophoblastic Disease ◽  
Ultrasound Diagnosis ◽  
Histopathological Diagnosis ◽  
Molar Pregnancy ◽  
Diagnostic Challenge ◽  
Trophoblastic Disease ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

Introduction The primary aims of this study were to establish what proportion of ultrasonically suspected molar pregnancies were proven on histological examination and what proportion of histologically diagnosed molar pregnancies were identified by ultrasound pre-operatively. The secondary aim was to review the features of these scans to help identify criteria that may improve ultrasound diagnosis. Methods This was a retrospective observational study conducted in the Early Pregnancy Unit at King’s College Hospital London over an 11-year period. Cases of ultrasonically suspected molar pregnancy or other gestational trophoblastic disease were identified and compared with the final histopathological diagnosis. In addition, cases which were diagnosed on histopathology that were not suspected on ultrasound were also examined. In discrepant cases, the images were reviewed unblinded by two senior sonographers. Statistical analysis for likelihood ratio and post-test probabilities was performed. Results One hundred eighty-two women had gestational trophoblastic disease suspected on ultrasound examination (1:360, 0.3%); 106/182 (58.2%, 95% CI 51.0 to 65.2%) had histologically confirmed gestational trophoblastic disease. The likelihood ratio for gestational trophoblastic disease after a positive ultrasound was 607.27, with a post-test probability of 0.628.The sensitivity of ultrasound for gestational trophoblastic disease was 70.7% (95% CI 62.9% to 77.4%) with an estimated specificity of 99.88% (95% CI 99.85% to 99.91%); 102/143 (71.3%, 95% CI 63.4 to 78.1%) molar pregnancies were suspected on pre-op ultrasound; 60/68 (88.2%, 95% CI 78.2 to 94.2%) of complete moles were suspected on pre-op ultrasound, compared with 42/75 (56.0%, 95% CI 44.7 to 66.7%) of partial moles. On retrospective review of the pre-op ultrasound images, there were cases that could have been suspected prior to surgery. Conclusion Detecting molar pregnancy by ultrasound remains a diagnostic challenge, particularly for partial moles. These data suggest that there has been an increase in both the predictive value and the sensitivity of ultrasound over time, with a high LR and post-test probability; however, the diagnostic criteria remain ill-defined and could be improved.

scholarly journals Post-test Probability According to Prevalence

2011 ◽  
Vol 26 (10) ◽  
pp. 1090-1090 ◽  
Author(s):  
Benjamin T. Galen
Keyword(s):  
Post Test ◽  
Post Test Probability ◽  
Test Probability

A Randomized Trial of Ways To Describe Test Accuracy: The Effect on Physicians' Post-Test Probability Estimates

2005 ◽  
Vol 143 (3) ◽  
pp. 184 ◽  
Author(s):  
Milo A. Puhan ◽  
Johann Steurer ◽  
Lucas M. Bachmann ◽  
Gerben ter Riet
Keyword(s):  
Randomized Trial ◽  
Test Accuracy ◽  
Probability Estimates ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

Volume, Conductivity and Scatter Properties of Leukocytes (VCS Technology) in Detecting Sepsis in Critically Ill Adult Patients

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4729-4729 ◽  
Author(s):  
Aikaterini Dilmoula ◽  
Zaina Kassengera ◽  
Hulyan Turkan ◽  
Dyanne Dalcomune ◽  
Dmitry Sukhachev ◽  
...  
Keyword(s):  
Critically Ill ◽  
Blood Count ◽  
Complete Blood Count ◽  
Adult Patients ◽  
Lower Quartile ◽  
Post Test ◽  
Reasonable Evidence ◽  
Light Loss ◽  
Post Test Probability ◽  
Test Probability

Abstract Abstract 4729 Sepsis and its sequelae remain leading causes of death in critically ill patients. Early identification and subsequently prompt treatment of sepsis can have a major impact on the outcome of septic patients. White Blood Cell (WBC) count, neutrophils count or percentage and percentage of band and immature neutrophils have been included in the diagnostic criteria of sepsis d. Previous studies have shown that morphological changes of leukocytes during sepsis can be quantified using Volume, Conductivity and Scatter (VCS) technology by some hematology analyzers. DxH800 (Beckman Coulter, Fullerton, CA) has the potential to report, in addition to Volume and Conductivity, five extra-laser diffraction angles for each cellular event. The aim of the study was to evaluate the diagnostic accuracy of VCS parameters of leukocytes in detecting sepsis in critically ill adult patients. This prospective observational study involved all consecutive adult patients admitted to a 31-bed medico-surgical department of intensive care (ICU) for more than 4 hours in a 3.5-month period. Diagnosis of sepsis was based on standard definitions. Blood samples were run by DxH800. Complete blood count (CBC) and WBC differential, but not VCS parameters were reported to attending physicians. Of a total of 722 patients admitted during the observation period 422 had WBC differential (and thus VCS parameters) determined at admission, of whom 125 had sepsis Septic and non-septic patients had a median age (upper and lower quartile) of 60 (51-71) and 58 (45-72) years and APACHE II scores of 19 (14-25) and 11 (7-16). VCS parameters had higher Areas Under the Receiver Operating Characteristic Curve (AUC) than WBC or percentage of neutrophils for diagnosis of sepsis at admission (Table 1.).Table 1.DxH800 VCS parameters. Results as median values (upper and lower quartile)VCS parametersSepsis N=125No Sepsis N=317p valueAUC95%CI of AUCMean Volume of Neutrophils (MNVNE)153 (146–163)144 (140–148)<0.0010.780.72–0.83SD of Volume of Neutrophils (SDVNE)20 (18–23)17 (16–18)<0.0010.810.77–0.86Mean Axial Light loss of Neutrophils (MNAL2NE)155 (150–160)148 (144–151)<0.0010.780.73–0.84SD of Axial Light loss of Neutrophils (SDAL2NE)13 (12–16)11 (10–12)<0.0010.800.75–0.84Mean Volume of Monocytes (MNVMO)179 (169–189)163 (159–167)<0.0010.880.84–0.91SD of Volume of Monocytes (SDVMO)24 (21–28)18 (16–20)<0.0010.880.84–0.91SD of Axial Light loss of Monocytes (SDAL2MO)16 (15–20)13 (12–14)<0.0010.850.81–0.89WBC, 103/ml10.9 (7.3–15.3)10.5 (7.8–14.2)NS0.510.44–0.57Percent of Neutrophils, %85 (76–91)80 (68–88)<0.0010.610.55–0.67 On ICU admission, MNVMO had the highest discriminant values in detecting sepsis with sensitivity (Se) of 84%, specificity (Sp) 76%, positive predictive value (PPV)58%, negative predictive value (NPV) 92% and odds ratio (OR) 17 for a cutoff of 168. MNVMO<168 (59% of patients) gave reasonable evidence against sepsis (likelihood ratio (LR) of 0.21, pre- and post-test probability, 0.28 and 0.076,) and MNVMO≥175 (25% of patients) gave reasonable evidence for sepsis (LR of 6.85, pre- and post-test probability, 0.28 and 0.73, respectively). Only 16% of patients, in the intermediate range, had a rather uninformative test result (LR of 1.32). Combining monocyte or neutrophil VCS parameters with CRP slightly increases AUC to 0.91. During the ICU stay, VCS parameters were obtained in 316 initially non-septic patients, of whom 20 became septic. MNVMO < 174 excluded ICU-acquired infection with NPV of 99% and MNVMO > 174 predicted ICU-acquired infection 1.7 days earlier than clinical diagnosis (Se: 85%, Sp 68%, OR 12 and AUC=0.78, 95% CI: 66–90). CONCLUSIONS: This large prospective study in unselected critically ill adult patients demonstrates the diagnostic utility of VCS parameters, especially MNVMO, in detecting and, more importantly, excluding sepsis at admission and during ICU stay. VCS parameters are obtained automatically, routinely, within minutes, requiring neither additional sampling nor additional cost to that of complete blood count thus making their prospects very promising. Disclosures: Pradier: Beckman Coulter: Consultancy, Membership on an entity's Board of Directors or advisory committees.

Use of pre- and post-test probability of disease to interpret meningococcal PCR results

2004 ◽  
Vol 23 (8) ◽  
Author(s):  
H.C. Woerden ◽  
A. Howard ◽  
M. Lyons ◽  
D. Westmoreland ◽  
M. Thomas
Keyword(s):  
Post Test ◽  
Post Test Probability ◽  
Test Probability

scholarly journals Accuracy of closed pleural biopsy in the diagnosis of malignant pleural effusion

2017 ◽  
Vol 43 (6) ◽  
pp. 424-430 ◽  
Author(s):  
Renata Báez-Saldaña ◽  
Uriel Rumbo-Nava ◽  
Araceli Escobar-Rojas ◽  
Patricia Castillo-González ◽  
Santiago León-Dueñas ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Test ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Definitive Diagnosis ◽  
Accuracy Analysis ◽  
Pleural Biopsy ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

ABSTRACT Objective: Previous studies have demonstrated that closed pleural biopsy (CPB) has a sensitivity of less than 60% for diagnosing malignancy. Therefore, controversy has recently emerged regarding the value of CPB as a diagnostic test. Our objective was to assess the accuracy of CPB in diagnosing malignancy in patients with pleural effusion. Methods: This was a prospective 8-year study of individuals who underwent CPB to establish the etiology of pleural effusion. Information on each patient was obtained from anatomopathological reports and medical records. When CPB findings showed malignancy or tuberculosis, the biopsy was considered diagnostic, and that was the definitive diagnosis. In cases in which biopsy histopathological findings were nonspecific, a definitive diagnosis was established on the basis of other diagnostic procedures, such as thoracoscopy, thoracotomy, fiberoptic bronchoscopy, biochemical and cellular measurements in pleural fluid, and/or microbiological tests. The accuracy of CPB was determined with 2 × 2 contingency tables. Results: A total of 1034 biopsies from patients with pleural effusion were studied. Of those, 171 (16.54%) were excluded from the accuracy analysis either because of inadequate samples or insufficient information. The results of the accuracy analysis were as follows: sensitivity, 77%; specificity, 98%; positive predictive value, 99%; negative predictive value, 66%; positive likelihood ratio, 38.5; negative likelihood ratio, 0.23; pre-test probability, 2.13; and post-test probability, 82. Conclusions: CPB is useful in clinical practice as a diagnostic test, because there is an important change from pre-test to post-test probability.

scholarly journals Thresholds of impaired cerebral hemodynamics that predict short-term cognitive decline in asymptomatic carotid stenosis

2016 ◽  
Vol 36 (10) ◽  
pp. 1804-1812 ◽  
Author(s):  
Laura Buratti ◽  
Giovanna Viticchi ◽  
Lorenzo Falsetti ◽  
Clotilde Balucani ◽  
Claudia Altamura ◽  
...  
Keyword(s):  
At Risk ◽  
Carotid Stenosis ◽  
Mmse Score ◽  
Cerebral Hemodynamics ◽  
Cognitive Deterioration ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

Subjects with asymptomatic carotid stenosis (ACS) may be at risk of cognitive impairment due to cerebral hypoperfusion. In this study, we aimed to detect a threshold of cerebral hemodynamics which is able to identify subjects at risk of cognitive deterioration. In subjects with ACS, cerebral vasomotor reactivity (CVR) was assessed with the breath-holding index (BHI) transcranial Doppler-based method. Cognitive deterioration was defined as a decrease in the MMSE score by ≥2 points after one year. In order to define the threshold of impaired BHI, a ROC curve analysis was performed adopting the binary difference of MMSE score as the outcome and continuous BHI as the testing variable. A total of 548 subjects completed the follow-up. Cognitive deterioration was observed in 119 patients (21.7%). The BHI value ipsilateral to the stenosis was the strongest predictor of cognitive deterioration among the variables tested. The best cut-point to discriminate between normal and abnormal BHI resulted ≤0.89. The post-test probability of cognitive deterioration for an abnormal BHI was 44%, while a normal BHI showed a post-test probability of 9% for the same outcome. The present investigation provides a threshold of reduced CVR that can be useful to identify subjects with ACS at risk of cognitive deterioration.

scholarly journals A “Clinician’s Probability Calculator” to convert pre-test to post-test probability of COVID-19 , based on method validation from each laboratory

2020 ◽  
Author(s):  
Zoe Brooks ◽  
Saswati Das ◽  
Tom Pliura
Keyword(s):  
Health Staff ◽  
Test Results ◽  
Likelihood Ratios ◽  
Percent Agreement ◽  
Public Health Staff ◽  
Post Test ◽  
Online Calculator ◽  
Test Result ◽  
Post Test Probability ◽  
Test Probability

During coronavirus pandemic testing and identifying the virus has been a unique and constant challenge for the scientific community. In this paper, we discuss a practical solution to help guide clinicians and public health staff with the interpretation of the probability that a positive, or negative, COVID-19 test result indicates an infected person, based on their clinical estimate of pre-test probability of infection. The LinkedIn survey confirmed that the pre-test probability of COVID-19 increases with patient age, known contact, and severity of symptoms, as well as prevalence of disease in the local population. PPA (Positive Percent Agreement, PPA) and NPA (Negative Percent Agreement, specificity), differ between individual methods. Results vary between laboratories and the manufacturer for the same method. The confidence intervals of results vary with the number of samples tested, often adding a large range of possibilities to the reported test result. The online calculator met the objective.The authors postulated that the clinical pre-test probability of COVID-19 increases relative to local prevalence of disease plus patient age, known contact, and severity of symptoms. We conducted a small survey on LinkedIn to confirm that hypothesis. We examined results of PPA (Positive Percent Agreement, sensitivity) and NPA (Negative Percent Agreement, specificity) from 73 individual laboratory experiments for molecular tests for SARS-CoV-2as reported to the FIND database,(1) and for selected methods in FDA EUA submissions (2,3). We calculated likelihood ratios to convert pre-test to post-test probability of disease, then further calculated the number of true and false results expected in every ten positive or negative test results, plus an estimate that one in &lsquo;x&rsquo; test results is true. We designed an online calculator to create graphics and text to fulfill the objective. A positive or negative test result from one laboratory conveys a higher probability for the presence or absence of COVID-19 than the same result from another laboratory, depending on clinical pre-test probability of disease plus proven method PPA and NPA in each laboratory. Likelihood ratios and confidence intervals provide valuable information but are seldom used in clinical settings. We recommend that testing laboratories verify PPA and NPA, and utilize a tool such as the &ldquo;Clinician&rsquo;s Probability Calculator&rdquo; to verify acceptable test performance and create reports to help guide clinicians and public health staff with estimation of post-test probability of COVID-19 .

Prostate Cancer Probability after Total PSA and Percent Free PSA Determination

1998 ◽  
Vol 13 (2) ◽  
pp. 77-86 ◽  
Author(s):  
R. Mione ◽  
P. Barioli ◽  
M. Barichello ◽  
F. Zattoni ◽  
T. Prayer-Galetti ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Performance ◽  
Dose Range ◽  
Tumor Stage ◽  
Free Psa ◽  
Primary Prostate Cancer ◽  
Post Test ◽  
Total Psa ◽  
Post Test Probability ◽  
Test Probability

The percent free PSA value is a promising diagnostic tool for prostate cancer. However, its actual role has not yet been established because of the widely diverging sensitivity and specificity values. This could depend at least in part on analytical difficulties, since the free PSA concentration is much lower than that of total PSA. The present investigation was designed to evaluate the diagnostic performance of the percent free PSA in the most favorable analytical conditions. Materials and methods 81 patients affected by newly diagnosed, untreated primary prostate cancer (CaP) and 239 patients with untreated benign prostatic hyperplasia (BPH) were prospectively enrolled. Hybritech total and free PSA were measured by the same technician using the same reagent batch. Results The percent free PSA was not significantly associated with age, tumor stage, gland volume, Gleason score, and total PSA, nor was it significantly affected by concomitant prostatic complications either in CaP or BPH. Percent free PSA was more effective than total PSA in the differential diagnosis between CaP and BPH in every evaluated dose range of total PSA. Percent free PSA determination could have reduced the rate of unnecessary biopsies in cases with total PSA ≥ 4 ng/mL and ≥ 10 ng/mL (avoided biopsies 61% and 63%, respectively). The post-test probability of the disease, which represents the proportion of patients with a positive percent free PSA value who have the disease, was, however, relatively low in younger patients with total PSA within the normal range. Conclusions The diagnostic performance of the percent free PSA value is enhanced when the methodological variability is reduced, particularly in men with low total PSA. Percent free PSA is superior to total PSA in distinguishing primary CaP from BPH in patients with total PSA between 2 and 30 ng/mL. The percent free PSA value is effective in reducing the rate of unnecessary biopsies in men with total PSA higher than 4 or 10 ng/mL. However, due to its relatively low post-test probability, the percent free PSA value should be interpreted with caution in the decision-making related to individual patients and should be used in association with clinical and instrumental evaluation of the patient.

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