Negative Predictive Value of a Population-based Preschool Vision Screening Program

ObjectivesMost children with prenatally diagnosed congenital pulmonary malformations (CPM) are asymptomatic at birth. We aimed to develop a parsimonious prognostic model for predicting the risk of neonatal respiratory distress (NRD) in preterm and term infants with CPM, based on the prenatal attributes of the malformation.MethodsMALFPULM is a prospective population-based nationally representative cohort including 436 pregnant women. The main predictive variable was the CPM volume ratio (CVR) measured at diagnosis (CVR first) and the highest CVR measured (CVR max). Separate models were estimated for preterm and term infants and were validated by bootstrapping.ResultsIn total, 67 of the 383 neonates studied (17%) had NRD. For infants born at term (>37 weeks, N=351), the most parsimonious model included CVR max as the only predictive variable (ROC area: 0.70±0.04, negative predictive value: 0.91). The probability of NRD increased linearly with increasing CVR max and remained below 10% for CVR max<0.4. In preterm infants (N=32), both CVR max and gestational age were important predictors of the risk of NRD (ROC area: 0.85±0.07). Models based on CVR first had a similar predictive ability.ConclusionsPredictive models based exclusively on CVR measurements had a high negative predictive value in infants born at term. Our study results could contribute to the individualised general risk assessment to guide decisions about the need for newborns with prenatally diagnosed CPM to be delivered at specialised centers.

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Accuracy of Visual Tests for Primary Cervical Cancer Screening in Rural Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.3857 ◽

2018 ◽

Vol 56 (214) ◽

pp. 917-923

Author(s):

Niresh Thapa ◽

Muna Maharjan ◽

Girishma Shrestha ◽

Narayani Maharjan ◽

Deborah Lindell ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Screening ◽

Negative Predictive Value ◽

Cervical Cancer Screening ◽

Predictive Value ◽

Odds Ratio ◽

Screening Program ◽

Diagnostic Odds Ratio ◽

Screening Tests ◽

Resource Setting

Introduction: In Nepal, cervical cancer is the most common female cancer. Unfortunately, there is no uniform effective screening system available all around the country. The objective of this study is to evaluate the cytology, Visual Inspection with Acetic Acid and with Lugol’s Iodine alone or in combination to detect a pre-cancerous lesion in rural Nepal.Methods: It is an analytical cross-sectional study. Convenience sampling technique was used to select participants who were apparently healthy, married, non- pregnant women of aged 20-65 years for cervical cancer screening program. Screening tests were performed on all eligible women (n=2143) after socio-demographic and reproductive health data collection. A biopsy was applied as a gold standard test. Cross-tabulations were used to describe the test sensitivity, specificity, positive predictive value, and negative predictive value at a 95% confidence interval. Diagnostic odds ratio was also calculated. Results: A majority, 2143 (94%), of women accepted and participated in this study. The sensitivity vs specificity of cytology, VIA, and VILI was 57.1% vs 98.3%, 71.4% vs 88.8% and 78.6% vs 85.1%, and of the co-testing of ‘Both positive VIA and VILI’ and ‘Either positive VIA or VILI’ was 64.3% vs 85.7% and 90.1% vs 83.7% respectively. Negative predictive value of all tests exceeded 99.7%. Cytology had the highest Diagnostic odds ratio (64.9), followed by the co-test ‘Either positive VIA or VILI’ (27.7).Conclusions: Cervical cancer screening by co-testing ‘Either positive VIA or VILI’ is more useful than cytology; VIA and or VILI are easy, safe, feasible and well-accepted tests in a low resource setting, Nepal.

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Investigating the impact of disease and health record duration on the eMERGE algorithm for rheumatoid arthritis

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocaa014 ◽

2020 ◽

Vol 27 (4) ◽

pp. 601-605

Author(s):

Vanessa L Kronzer ◽

Liwei Wang ◽

Hongfang Liu ◽

John M Davis ◽

Jeffrey A Sparks ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Index Date ◽

Model Performance ◽

Area Under The Curve ◽

Population Based ◽

Health Record ◽

The Impact

Abstract Objective The study sought to determine the dependence of the Electronic Medical Records and Genomics (eMERGE) rheumatoid arthritis (RA) algorithm on both RA and electronic health record (EHR) duration. Materials and Methods Using a population-based cohort from the Mayo Clinic Biobank, we identified 497 patients with at least 1 RA diagnosis code. RA case status was manually determined using validated criteria for RA. RA duration was defined as time from first RA code to the index date of biobank enrollment. To simulate EHR duration, various years of EHR lookback were applied, starting at the index date and going backward. Model performance was determined by sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC). Results The eMERGE algorithm performed well in this cohort, with overall sensitivity 53%, specificity 99%, positive predictive value 97%, negative predictive value 74%, and AUC 76%. Among patients with RA duration <2 years, sensitivity and AUC were only 9% and 54%, respectively, but increased to 71% and 85% among patients with RA duration >10 years. Longer EHR lookback also improved model performance up to a threshold of 10 years, in which sensitivity reached 52% and AUC 75%. However, optimal EHR lookback varied by RA duration; an EHR lookback of 3 years was best able to identify recently diagnosed RA cases. Conclusions eMERGE algorithm performance improves with longer RA duration as well as EHR duration up to 10 years, though shorter EHR lookback can improve identification of recently diagnosed RA cases.

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Preschool vision screening: negative predictive value for amblyopia

British Journal of Ophthalmology ◽

10.1136/bjo.83.6.676 ◽

1999 ◽

Vol 83 (6) ◽

pp. 676-679 ◽

Cited By ~ 9

Author(s):

D. K Newman ◽

M. M East

Keyword(s):

Negative Predictive Value ◽

Predictive Value ◽

Vision Screening

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Even non-experts identify non-dysplastic lesions in inflammatory bowel disease via chromoendoscopy: results of a screening program in real-life

Endoscopy International Open ◽

10.1055/a-0839-4514 ◽

2019 ◽

Vol 07 (06) ◽

pp. E743-E750

Author(s):

Beatriz Aladrén ◽

Yago González-Lama ◽

María García-Alvarado ◽

Mónica Sierra ◽

Jésus Barrio ◽

...

Keyword(s):

Colorectal Cancer ◽

Inflammatory Bowel Disease ◽

Negative Predictive Value ◽

Bowel Disease ◽

Predictive Value ◽

Screening Program ◽

Real Life ◽

Pit Pattern ◽

High Negative Predictive Value ◽

Inflammatory Bowel

Abstract Background and study aims Chromoendoscopy with targeted biopsy is the technique of choice for colorectal cancer screening in longstanding inflammatory bowel disease. We aimed to analyze results of a chromoendoscopy screening program and to assess the possibility of identifying low-risk dysplastic lesions by their endoscopic appearance in order to avoid histological analysis. Materials and methods We retrospectively reviewed chromoendoscopies performed between February 2011 and June 2017 in seven Spanish hospitals in a standardized fashion. We analyzed the findings and the diagnostic yield of the Kudo pit pattern for predicting dysplasia. Results A total of 709 chromoendoscopies (569 patients) were reviewed. Median duration of disease was 16.7 years (SD 8.1); 80.4 % had ulcerative colitis. A total of 2025 lesions (3.56 lesions per patient) were found; two hundred and thirty-two lesions were neoplastic (11.5 %) (223 were LGD (96.1 %), eight were HGD (3.4 %), and one was colorectal cancer (0.5 %). The correlation between dysplasia and Kudo pit patterns predictors of dysplasia (≥ III) was low, with an area under the curve of 0.649. Kudo I and II lesions were correctly identified with a high negative predictive value (92 %), even by non-experts. Endoscopic activity, Paris 0-Is classification, and right colon localization were risk factors for dysplasia detection, while rectum or sigmoid localization were protective against dysplasia. Conclusions Chromoendoscopy in the real-life setting detected 11 % of dysplastic lesions with a low correlation with Kudo pit pattern. A high negative predictive value would prevent Kudo I and, probably, Kudo II biopsies in the left colon, reducing procedure time and avoiding complications.

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Clinical utility of chromogranin A for the surveillance of succinate dehydrogenase B- and succinate dehydrogenase D-related paraganglioma

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/0004563218811865 ◽

2018 ◽

Vol 56 (1) ◽

pp. 163-169 ◽

Cited By ~ 1

Author(s):

Michael JW Thompson ◽

Venkat Parameswaran ◽

John R Burgess

Keyword(s):

Succinate Dehydrogenase ◽

Negative Predictive Value ◽

Predictive Value ◽

Chromogranin A ◽

Population Based ◽

Tertiary Referral Centre ◽

Sdhb Mutation ◽

Cross Sectional ◽

Pet Ct ◽

Plasma Metanephrines

Background Patients with mutations of succinate dehydrogenase B (SDHB) and succinate dehydrogenase D (SDHD) are at high risk of paraganglioma necessitating surveillance. Chromogranin A has been proposed as a biochemical marker of paraganglioma. We sought to determine the diagnostic utility of chromogranin A in a population-based SDHx sample. Methods Tasmania is an island state with one tertiary referral centre for endocrine neoplasia. We performed a cross-sectional analysis of all adult SDHB ( n = 52) and SDHD ( n = 10) patients undergoing paraganglioma surveillance between 2011 and 2017. Chromogranin A was referenced against the outcome of paraganglioma surveillance with a minimum of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and plasma metanephrines (metanephrine and normetanephrine). Results Chromogranin A correctly predicted the result of paraganglioma surveillance more often in patients with SDHB compared with those with SDHD (77% vs. 22%, P = 0.003). In the SDHB group, chromogranin A demonstrated a sensitivity of 67% and specificity of 79% compared with 22% and 0% in the SDHD group. Chromogranin A identified one of three PET/CT-visualized SDHB-related paragangliomas with normal plasma metanephrines at the expense of nine false-positive results. A normal chromogranin A demonstrated a negative predictive value of 92% for SDHB-related paraganglioma. In patients with SDHB, plasma normetanephrine and metanephrine offered superior specificity (100%, P = 0.01 and 100%, P < 0.01, respectively) with comparable sensitivity (67%, P = 1.0 and 11%, P = 0.06, respectively) to chromogranin A. Conclusion Chromogranin A does not provide additive benefit to standard surveillance for predicting the presence of SDHB- or SDHD-related paraganglioma, but has a useful negative predictive value when normal in patients with SDHB mutation.

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Detection Rate, Recall Rate, and Positive Predictive Value of Digital Compared to Screen-Film Mammography in the Quebec Population-Based Breast Cancer Screening Program

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2016.02.001 ◽

2016 ◽

Vol 67 (4) ◽

pp. 330-338 ◽

Cited By ~ 2

Author(s):

Isabelle Théberge ◽

Nathalie Vandal ◽

André Langlois ◽

Éric Pelletier ◽

Jacques Brisson

Keyword(s):

Positive Predictive Value ◽

Predictive Value ◽

Detection Rate ◽

Screening Program ◽

Computed Radiography ◽

Recall Rate ◽

Population Based ◽

Mixed Effect ◽

Detection Rates ◽

Institutional Review

Purpose The study sought to compare performance indicators of computed radiography (CR) using different plate readers, digital direct radiography (DR), and screen-film mammography (SFM) in a population-based screening program. Methods This analysis involved women 50-69 years of age who participated in the breast screening program of Quebec (Canada) and who had screening mammogram between January 1, 2007, and September 30, 2012. The detection rate, recall rate, and positive predictive value of CR (n = 672,125 mammograms) and DR (n = 60,023) were compared to SFM (n = 782,894) using mixed-effect logistic regression, adjusting for potential confounders. No institutional review board approval was required. Results CR was not associated with change in cancer detection rate (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.88-1.03), but with a small increase in recall rate (OR: 1.03; 95% CI: 1.01-1.06) compared to SFM. The association of CR with recall rate varies with the CR plate reader manufacturer ( P < .0001). DR was not associated with change in detection rate (OR: 1.06; 95% CI: 0.89-1.25), but with an increase in the recall rate (OR: 1.25; 95% CI: 1.19-1.30) compared to SFM. Conclusions In our screening program, digital mammograms gave detection rates equivalent to those of SFM, but with an increase of recall rate, particularly for DR. If this situation persists, the adoption of DR may increase the adverse effects of screening with little or no benefit for women.

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Performance of a universally offered prenatal screening program incorporating cfDNA in Ontario, Canada: a descriptive population-based cohort study of 280,000 pregnancies.

10.1101/2020.09.22.20195123 ◽

2020 ◽

Author(s):

Shelley D Dougan ◽

Nan Okun ◽

Kara Bellai-Dussault ◽

Lynn Meng ◽

Heather E Howley ◽

...

Keyword(s):

Cohort Study ◽

Predictive Value ◽

Prenatal Screening ◽

Screening Program ◽

Population Based ◽

Screening System ◽

Publicly Funded ◽

Increased Risk ◽

The Impact ◽

Cfdna Screening

Objectives: To measure the population-based performance and impact of Ontario, Canada's modified-contingent prenatal screening system for the detection of trisomies 21 (T21) and 18 (T18). Design: A retrospective, descriptive cohort study examining routinely collected data from BORN Ontario, which captures linkable population data for prenatal and neonatal health encounters across a variety of settings (e.g., laboratories, birthing hospitals and midwifery practice groups). Setting: A province-wide and publicly funded prenatal screening program in Ontario, Canada offering cfDNA screening for those at increased risk of having a pregnancy with T21 or T18. Participants: 373,682 singleton pregnancies with an estimated due date between September 1 2016 and March 31, 2019 who were offered publicly funded prenatal screening. Main outcome measures: Prenatal detection of T21 or T18, ascertained by cytogenetic results. Performance was assessed by calculating sensitivity, specificity, positive predictive value and negative predictive value against confirmatory diagnostic cytogenetic results and birth outcomes. The secondary objective was to determine the impact of contingent cfDNA screening by measuring uptake and the proportion of T21 screen-positive pregnancies undergoing subsequent cfDNA screening and invasive prenatal diagnostic testing (PND). Results: 69% of pregnancies in Ontario underwent prenatal screening for T21/T18. The modified-contingent screen sensitivity was 89.9% for T21 and 80.5% for T18. The modified-contingent screen-positive rate was 1.6% for T21 and 0.2% for T18. The cfDNA screening test failure rate was 2.2% (final result including multiple attempts). The PND rate among pregnancies screened was 2.4%. Conclusions: This study is the largest evaluation of population-based performance of a publicly funded cfDNA prenatal screening system. We demonstrated a robust screening system with high sensitivity and low PND consistent with smaller validation studies.

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Diagnostic performance of p16/Ki-67 dual immunostaining at different number of positive cells in cervical smears in women referred for colposcopy

Radiology and Oncology ◽

10.2478/raon-2021-0043 ◽

2021 ◽

Vol 55 (4) ◽

pp. 426-432

Author(s):

Ursula Salobir Gajsek ◽

Andraz Dovnik ◽

Iztok Takac ◽

Urska Ivanus ◽

Tine Jerman ◽

...

Keyword(s):

Negative Predictive Value ◽

Predictive Value ◽

Large Scale ◽

High Sensitivity ◽

Intraepithelial Neoplasia ◽

Population Based ◽

Cervical Cytology ◽

Published Data ◽

Ki 67 ◽

Randomised Controlled

Abstract Background The aim of the study was to evaluate the diagnostic accuracy of p16/Ki-67 dual immunostaining (p16/ Ki-67 DS) in cervical cytology and the number of positive p16/Ki-67 cells to diagnose high grade cervical intraepithelial neoplasia (CIN2+) in colposcopy population. Subjects and methods We performed an analysis on a subset cohort of 174 women enrolled within a large-scale randomised controlled human papillomavirus (HPV) self-sampling project organised as part of the population-based Cervical Cancer Screening Programme ZORA in Slovenia. This subset cohort of patients was invited to the colposcopy clinic, underwent p16/Ki-67 DS cervical cytology and had the number of p16/Ki-67 positive cells determined. Results Among analysed women, 42/174 (24.1%) had histologically confirmed CIN2+. The risk for CIN2+ was increasing with the number of positive cells (p < 0.001). The sensitivity of p16/Ki-67 DS for detection of CIN2+ was 88.1%, specificity was 65.2%, positive predictive value was 44.6% and negative predictive value was 94.5%. Conclusions Dual p16/Ki-67 immunostaining for the detection of CIN2+ has shown high sensitivity and high negative predictive value in our study, which is comparable to available published data. The number of p16/Ki-67 positive cells was significantly associated with the probability of CIN2+ detection. We observed a statistically significant and clinically relevant increase in specificity if the cut-off for a positive test was shifted from one cell to three cells.

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