Preoperative CT-based detection of extrapancreatic perineural invasion in pancreatic cancer

AbstractAccuracy for computed tomography (CT) diagnosis of extrapancreatic perineural invasion (EPNI) in pancreatic ductal adenocarcinoma (PDAC), which is a significant cause of recurrence, has not been established. The aim of the study was to evaluate the diagnostic accuracy of CT in detecting EPNI preoperatively in resectable PDAC of the pancreatic head. Retrospective study design was approved by institutional review board. Preoperative CT-series of 46 patients with resectable PDAC were evaluated by two independent observers. Plexus Pancreaticus Capitalis-II (PPC-II) was assessed as this area is more susceptible for EPNI. All patients underwent surgery with dedicated histopathology, which served as the reference standard. Histologically EPNI was confirmed in 63.1%. Sensitivity of MDCT was 93.1% (95% confidence interval (CI) 77.23% to 99.15%), specificity 64.7% (95% CI 38.33% to 85.79%) with area under the curve (AUC) 0.789 for the first observer. Positive predictive value (PPV) was 81.82% (95% CI 70.12% to 89.62%), negative predictive value (NPV—84.62% (95% CI 57.98% to 95.64%) with diagnostic accuracy of 82.61% (95% CI 68.58% to 92.18%). Interobserver agreement showed k-value of 0.893 ($${p} < 0.001$$ p < 0.001 ), which represents very good agreement between observers. Median actual survival in patients without EPNI was 30 months (95% CI 18.284–41.716), in patients with EPNI—13 months (95% CI 12.115–13.885). CT provides sufficient diagnostic information to detect PPC-II invasion in patients with resectable PDAC of the pancreatic head. Preoperative detection of EPNI might be an additional argument to perform neoadjuvant chemotherapy in patients with resectable PDAC. It should be included in preoperative evaluation form of CT-findings.

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Prognostic Nomogram for Patients With Pancreatic Ductal Adenocarcinoma of Pancreatic Head After Pancreaticoduodenectomy

Clinical Medicine Insights Oncology ◽

10.1177/11795549211024149 ◽

2021 ◽

Vol 15 ◽

pp. 117955492110241

Author(s):

Hongkai Zhuang ◽

Zixuan Zhou ◽

Zuyi Ma ◽

Shanzhou Huang ◽

Yuanfeng Gong ◽

...

Keyword(s):

Regression Analysis ◽

Pancreatic Ductal Adenocarcinoma ◽

Perineural Invasion ◽

Cox Regression ◽

Area Under The Curve ◽

Pancreatic Head ◽

Ductal Adenocarcinoma ◽

R0 Resection ◽

Cox Regression Analysis ◽

Ajcc Stage

Background: The prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) of pancreatic head remains poor, even after potentially curative R0 resection. The aim of this study was to develop an accurate model to predict patients’ prognosis for PDAC of pancreatic head following pancreaticoduodenectomy. Methods: We retrospectively reviewed 112 patients with PDAC of pancreatic head after pancreaticoduodenectomy in Guangdong Provincial People’s Hospital between 2014 and 2018. Results: Five prognostic factors were identified using univariate Cox regression analysis, including age, histologic grade, American Joint Committee on Cancer (AJCC) Stage 8th, total bilirubin (TBIL), CA19-9. Using all subset analysis and multivariate Cox regression analysis, we developed a nomogram consisted of age, AJCC Stage 8th, perineural invasion, TBIL, and CA19-9, which had higher C-indexes for OS (0.73) and RFS (0.69) compared with AJCC Stage 8th alone (OS: 0.66; RFS: 0.67). The area under the curve (AUC) values of the receiver operating characteristic (ROC) curve for the nomogram for OS and RFS were significantly higher than other single parameter, which are AJCC Stage 8th, age, perineural invasion, TBIL, and CA19-9. Importantly, our nomogram displayed higher C-index for OS than previous reported models, indicating a better predictive value of our model. Conclusions: A simple and practical nomogram for patient prognosis in PDAC of pancreatic head following pancreaticoduodenectomy was established, which shows satisfactory predictive efficacy and deserves further evaluation in the future.

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Comment on “Implications of Perineural Invasion on Disease Recurrence and Survival After Pancreatectomy for Pancreatic Head Ductal Adenocarcinoma by Crippa et al.”

Annals of Surgery ◽

10.1097/sla.0000000000005275 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Ingrid Garajová ◽

Rita Balsano ◽

Valentina Donati ◽

Letizia Gnetti ◽

Mjriam Capula ◽

...

Keyword(s):

Perineural Invasion ◽

Pancreatic Head ◽

Disease Recurrence ◽

Ductal Adenocarcinoma

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Diagnostic accuracy of IGF-1 for screening growth hormone deficiency: a prospective, single-center, diagnostic accuracy study

10.21203/rs.3.rs-430014/v1 ◽

2021 ◽

Author(s):

Hideyuki Iwayama ◽

Sachiko Kitagawa ◽

Jyun Sada ◽

Ryosuke Miyamoto ◽

Tomohito Hayakawa ◽

...

Keyword(s):

Growth Hormone ◽

Diagnostic Accuracy ◽

Growth Hormone Deficiency ◽

Predictive Value ◽

Screening Test ◽

Characteristic Curve ◽

Area Under The Curve ◽

Rank Correlation ◽

Hormone Deficiency ◽

Height Velocity

Abstract Purpose We evaluated the diagnostic accuracy of insulin-like growth factor-1 (IGF-1) for screening growth hormone deficiency (GHD) to determine the usefulness of IGF-1 as a screening test. Methods On 298 consecutive children who had short stature or decreased height velocity, we measured IGF-1 levels and performed growth hormone (GH) secretion test using clonidine, arginine, and, in cases with different results of the two tests, L-dopa. Patients with congenital abnormalities were excluded. GHD was defined as peak GH ≤ 6.0 ng/mL in the two tests. Results We identified 60 and 238 patients with and without GHD, respectively. The mean IGF-1 (SD) was not significantly different between the GHD and non-GHD groups (p = 0.23). Receiver operating characteristic curve analysis demonstrated the best diagnostic accuracy at an IGF-1 cutoff of −1.493 SD, with sensitivity of 0.685, specificity of 0.417, positive predictive value of 0.25, negative predictive value of 0.823, and area under the curve of 0.517. Spearman’s rank correlation coefficient showed that IGF-1 (SD) was weakly correlated with age, bone age, height velocity before examination, weight (SD), and BMI (SD) and very weakly correlated with height (SD), target height (SD), and maximum GH peak. Conclusion IGF-1 level had poor diagnostic accuracy as a screening test for GHD. Correlation analysis revealed that none of the items increased the diagnostic power of IGF-1. Therefore, IGF-1 should not be used alone in the screening of GHD. A predictive biomarker for GHD should be developed in the future.

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The role of red cell distribution width in the differential diagnosis of iron deficiency anemia and non-transfusion dependent thalassemia patients

Hematology Reports ◽

10.4081/hr.2018.7605 ◽

2018 ◽

Vol 10 (3) ◽

Cited By ~ 3

Author(s):

Pokpong Piriyakhuntorn ◽

Adisak Tantiworawit ◽

Thanawat Rattanathammethee ◽

Chatree Chai-Adisaksopha ◽

Ekarat Rattarittamrong ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Area Under The Curve ◽

Microcytic Anemia ◽

Deficiency Anemia ◽

Operating Characteristics ◽

Training Set ◽

Distribution Width ◽

Validation Set ◽

Sensitivity Specificity

This study aims to find the cut-off value and diagnostic accuracy of the use of RDW as initial investigation in enabling the differentiation between IDA and NTDT patients. Patients with microcytic anemia were enrolled in the training set and used to plot a receiving operating characteristics (ROC) curve to obtain the cut-off value of RDW. A second set of patients were included in the validation set and used to analyze the diagnostic accuracy. We recruited 94 IDA and 64 NTDT patients into the training set. The area under the curve of the ROC in the training set was 0.803. The best cut-off value of RDW in the diagnosis of NTDT was 21.0% with a sensitivity and specificity of 81.3% and 55.3% respectively. In the validation set, there were 34 IDA and 58 NTDT patients using the cut-off value of >21.0% to validate. The sensitivity, specificity, positive predictive value and negative predictive value were 84.5%, 70.6%, 83.1% and 72.7% respectively. We can therefore conclude that RDW >21.0% is useful in differentiating between IDA and NTDT patients with high diagnostic accuracy

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Use of a New Monoclonal Antibody-Based Enzyme Immunoassay for Soluble Fibrin to Exclude Pulmonary Embolism

Thrombosis and Haemostasis ◽

10.1055/s-0037-1614047 ◽

2000 ◽

Vol 84 (09) ◽

pp. 474-477 ◽

Cited By ~ 1

Author(s):

Bernd-Jan Sanson ◽

Wouter de Monyé ◽

Jeroen Lijmer ◽

Menno Huisman ◽

Harry Büller ◽

...

Keyword(s):

Monoclonal Antibody ◽

Pulmonary Embolism ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Diagnostic Performance ◽

Area Under The Curve ◽

Study Cohort ◽

Suspected Pulmonary Embolism ◽

Soluble Fibrin

SummaryWe prospectively evaluated the diagnostic performance of a new soluble fibrin assay in 303 consecutive patients with suspected pulmonary embolism and examined potentially useful cut-off levels at which this disease can be safely excluded. In addition, the diagnostic accuracy was calculated in the subgroups of in- and outpatients. The ROC curve of the assay in the total study cohort had an area under the curve of 0.69. The cut-off level associated with a sensitivity and negative predictive value of 100% was 20 ng/ml, but the specificity was only 4%. The cut-off level with a sensitivity of 90% was 30 ng/ml, which corresponded with a specificity and negative predictive value of 27% and 86%, respectively. The diagnostic performance was comparable in the subgroups of in- and outpatients. We conclude that the soluble fibrin assay has a low diagnostic accuracy and seems unsuitable as a screening test for the exclusion of pulmonary embolism.

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Comparison of Mammography and Ultrasonography in Evaluation of Breast Masses

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v13i2.41368 ◽

2019 ◽

Vol 13 (2) ◽

pp. 22-24

Author(s):

Zebun Nahar ◽

Md Enamul Kabir ◽

Taharul Alam ◽

Shamoli Yasmin ◽

Maisha Naowar

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Breast Tumour ◽

Military Hospital ◽

Kappa Statistics ◽

K Value ◽

Breast Masses ◽

Malignant Breast ◽

Diagnostic Modalities ◽

Sensitivity Specificity

Introduction: Breast cancer is the most common cancer and second leading cause of cancer deaths in women. Early detection, efficient and accurate diagnosis can reduce the mortality rate. Objectives: To compare the screening accuracy of mammography (MMG) and ultrasonography (USG) in suspected cases of breast masses. Material and Methods: This cross-sectional analytical study was carried out in the Department of Radiology and Imaging, Combined Military Hospital, Dhaka from June 2016 to July 2017. A total of 100 clinically suspected case of breast masses aged from 20 to 75 years referred for MMG and USG was selected. Each patient underwent USG and MMG followed by a histopathological examination of the biopsy material taken from the lump lesion. Two cases histopathological report was not found. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of USG and MMG were compared with histopathology as the gold standard. In order to determine the agreement of diagnoses between USG and MMG, consistency analysis was performed using Kappa-statistics. Results: Sensitivity, specificity, PPV, NPV and diagnostic accuracy of USG was 58.8%, 98.4%, 77.8%, 85.0% and 83.6% and for MMG 92.0%, 84.5%, 67.6%, 96.8% and 84.7% respectively. Kappa-statistics shows that the two diagnostic modalities had a test agreement in 39.8% cases to differentiate malignant breast tumour from the benign one (k-value = 0.398, p > 0.05). Conclusion: Two diagnostic modalities USG and MMG had a fair agreement in the differentiation of malignant breast tumour from the benign. Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 22-24

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Developing a preoperative serum metabolome-based recurrence-predicting nomogram for patients with resected pancreatic ductal adenocarcinoma

Scientific Reports ◽

10.1038/s41598-019-55016-x ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Seoung Yoon Rho ◽

Sang-Guk Lee ◽

Minsu Park ◽

Jinae Lee ◽

Sung Hwan Lee ◽

...

Keyword(s):

Pancreatic Cancer ◽

Pancreatic Ductal Adenocarcinoma ◽

Area Under The Curve ◽

Pancreatic Head ◽

Cancer Recurrence ◽

Disease Free Survival ◽

Early Recurrence ◽

Ductal Adenocarcinoma ◽

Free Survival ◽

Preoperative Serum

AbstractWe investigated the potential application of preoperative serum metabolomes in predicting recurrence in patients with resected pancreatic cancer. From November 2012 to June 2014, patients who underwent potentially curative pancreatectomy for pancreatic ductal adenocarcinoma were examined. Among 57 patients, 32 were men; 42 had pancreatic head cancers. The 57 patients could be clearly categorized into two main clusters using 178 preoperative serum metabolomes. Patients within cluster 2 showed earlier tumor recurrence, compared with those within cluster 1 (p = 0.034). A nomogram was developed for predicting the probability of early disease-free survival in patients with resected pancreatic cancer. Preoperative cancer antigen (CA) 19–9 levels and serum metabolomes PC.aa.C38_4, PC.ae.C42_5, and PC.ae.C38_6 were the most powerful preoperative clinical variables with which to predict 6-month and 1-year cancer recurrence-free survival after radical pancreatectomy, with a Harrell’s concordance index of 0.823 (95% CI: 0.750–0.891) and integrated area under the curve of 0.816 (95% CI: 0.736–0.893). Patients with resected pancreatic cancer could be categorized according to their different metabolomes to predict early cancer recurrence. Preoperative detectable parameters, serum CA 19–9, PC.aa.C38_4, PC.ae.C42_5, and PC.ae.C38_6 were the most powerful predictors of early recurrence of pancreatic cancer.

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Retrospective validation of a new volumetric capnography parameter for the exclusion of pulmonary embolism at the emergency department

ERJ Open Research ◽

10.1183/23120541.00099-2018 ◽

2018 ◽

Vol 4 (4) ◽

pp. 00099-2018

Author(s):

Timon M. Fabius ◽

Michiel M.M. Eijsvogel ◽

Marjolein G.J. Brusse-Keizer ◽

Olivier M. Sanchez ◽

Franck Verschuren ◽

...

Keyword(s):

Carbon Dioxide ◽

Emergency Department ◽

Pulmonary Embolism ◽

Diagnostic Accuracy ◽

Roc Curve ◽

Predictive Value ◽

Area Under The Curve ◽

Carbon Dioxide Production ◽

Pulmonary Angiography ◽

Volumetric Capnography

Volumetric capnography might be used to exclude pulmonary embolism (PE) without the need for computed tomography pulmonary angiography. In a pilot study, a new parameter (CapNoPE) combining the amount of carbon dioxide exhaled per breath (carbon dioxide production (VCO2)), the slope of phase 3 of the volumetric capnogram (slope 3) and respiratory rate (RR) showed promising diagnostic accuracy (where CapNoPE=(VCO2×slope 3)/RR).To retrospectively validate CapNoPE for the exclusion of PE, the volumetric capnograms of 205 subjects (68 with PE) were analysed, based on a large multicentre dataset of volumetric capnograms from subjects with suspected PE at the emergency department. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve and diagnostic accuracy of the in-pilot established threshold (1.90 Pa·min) were calculated. CapNoPE was 1.56±0.97 Pa·min in subjects with PE versus 2.51±1.67 Pa·min in those without PE (p<0.001). The AUC of the ROC curve was 0.714 (95% CI 0.64–0.79). For the cut-off of ≥1.90 Pa·min, sensitivity was 64.7%, specificity was 59.9%, the negative predictive value was 77.4% and the positive predictive value was 44.4%.The CapNoPE parameter is decreased in patients with PE but its diagnostic accuracy seems too low to use in clinical practice.

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Implications of Perineural Invasion on Disease Recurrence and Survival After Pancreatectomy for Pancreatic Head Ductal Adenocarcinoma

Annals of Surgery ◽

10.1097/sla.0000000000004464 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Stefano Crippa ◽

Ilaria Pergolini ◽

Ammar A. Javed ◽

Kim C. Honselmann ◽

Matthew J. Weiss ◽

...

Keyword(s):

Perineural Invasion ◽

Pancreatic Head ◽

Disease Recurrence ◽

Ductal Adenocarcinoma

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Diagnostic accuracy of interleukin 27 for tuberculous pleural effusion: two prospective studies and one meta-analysis

Thorax ◽

10.1136/thoraxjnl-2016-209718 ◽

2017 ◽

Vol 73 (3) ◽

pp. 240-247 ◽

Cited By ~ 19

Author(s):

Wen Wang ◽

Qiong Zhou ◽

Kan Zhai ◽

Yao Wang ◽

Jing-Yuan Liu ◽

...

Keyword(s):

Pleural Effusion ◽

Diagnostic Accuracy ◽

Adenosine Deaminase ◽

Interferon Gamma ◽

Predictive Value ◽

Meta Analysis ◽

Area Under The Curve ◽

Tuberculous Pleural Effusion ◽

Interleukin 27 ◽

Independent Population

BackgroundAccurate differentiating diagnosis is essential for choosing treatment for exudative pleural effusions.ObjectiveTo establish the diagnostic accuracy of interleukin 27 for tuberculous pleural effusion (TPE).MethodsFirst, the concentrations of pleural interleukin 27, interferon-gamma and adenosine deaminase were compared between 51 patients with TPE and 103 with non-TPEs (Beijing cohort), and their diagnostic values were evaluated. These were further verified in another independent population (Wuhan cohort, n=120). In the second part of the study, we performed a meta-analysis.ResultsWith a cut-off value of 591.4 ng/L in the Beijing cohort, the area under the curve, sensitivity, specificity, positive predictive value and negative predictive value of interleukin 27 to diagnose TPE were 0.983 (95% CI 0.947 to 0.997), 96.1% (86.5% to 99.5%), 99.0% (94.7% to 100%), 98.0 (89.4 to 99.9) and 98.1 (93.3 to 99.8), respectively. Excellent diagnostic accuracy of interleukin 27 was also found in the Wuhan cohort and was further confirmed in the meta-analysis. The diagnostic performance of interleukin 27 was comparable to that of interferon-gamma and was more accurate than that of adenosine deaminase. Since the post-test probability of a negative result was always <0.1%, a negative test was considered to exclude TPE in all tuberculosis prevalence settings.ConclusionsInterleukin 27 can be used to diagnose TPE in a high prevalence setting, and a negative result can also be reliably used to rule out TPE in all prevalence settings.

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