Discriminating Capacity of Indole Markers in the Diagnosis of Carcinoid Tumors

Abstract Background: We evaluated the discriminating capacity of the indole markers urinary 5-hydroxyindoleacetic acid (5-HIAA), urinary serotonin, and platelet serotonin in the diagnosis of carcinoid tumors. Methods: Indole markers were measured in 688 patients with suspected carcinoid disease. The initial values of indole markers from patients in whom a carcinoid tumor was confirmed during follow-up (n = 98) were used for ROC analysis. Two groups served as reference populations. The first consisted of 45 healthy individuals (“healthy controls”). The second was a random sample of 40 patients, drawn from the 590 (688 minus 98) patients with carcinoid-like symptoms but without a carcinoid tumor (“clinically suspected patients”). Results: ROC curve analysis showed platelet serotonin to have the highest discriminating capacity, especially in foregut carcinoids. Cutoff values for platelet serotonin obtained from ROC analysis with healthy controls as reference group (5.4 nmol/109 platelets) gave a sensitivity of 74%, specificity of 91%, positive predictive value of 63%, and negative predictive value of 95% when applied to the initial 688 patients. Using the cutoff value with the clinically suspected patients as the reference group (9.3 nmol/109 platelets) gave a sensitivity of 63%, specificity of 99%, positive predictive value of 89%, and negative predictive value of 93%. Indole markers were increased in 169 (25%) of 688 patients. In 76 (45%) of these 169 patients, a carcinoid tumor was present. Slight increases of markers were associated with non-carcinoid neuroendocrine tumors, non-neuroendocrine tumors, and disturbed bowel motility. Conclusions: ROC curve analysis shows that platelet serotonin is the most discriminating indole marker for the diagnosis of carcinoid tumors. Platelet serotonin especially improves the diagnosis of carcinoids producing small amounts of serotonin.

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P204 Re-established CRP cut-off in UC; it may be a better predictor of mucosal remission

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.333 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S240-S240

Author(s):

O K Bakkaloglu ◽

T Eskazan ◽

S Bozcan ◽

S Yıldırım ◽

E A Kurt ◽

...

Keyword(s):

Ulcerative Colitis ◽

Positive Predictive Value ◽

Roc Curve ◽

Predictive Value ◽

Curve Analysis ◽

Roc Curve Analysis ◽

Predictive Values ◽

Mucosal Disease ◽

Mayo Score ◽

Montreal Classification

Abstract Background Although faecal calprotectin can predict mucosal remission in ulcerative colitis, the CRP level in this context is insufficient and frequently stay under the current cut off level. While some patients with active mucosal disease have normal CRP levels most patients in mucosal remission have much lower CRP levels. The aim of this study is to define CRP cut off levels in the prediction of mucosal remission, considering both extensiveness and severity, in ulcerative colitis. Methods We retrospectively reviewed colonoscopy reports of ulcerative colitis patients (who are not on any steroid treatment at that time) which were performed between December 2016 and March 2019 and also their CRP levels which were obtained at the same week of the colonoscopy examination. We excluded the data of patients with any other possible cause of inflammation or infection at the time of laboratory assessment. Degree of mucosal disease at colonoscopy was evaluated according to endoscopic Mayo score. Mucosal remission was defined as endoscopic Mayo score 0 or 1. The extent of mucosal inflammation was classified according to Montreal classification. The CRP level with optimal sensitivity and specificity for mucosal remission prediction was assessed by ROC curve analysis and positive and negative predictive values were also calculated. Results A total of 331 colonoscopy reports of 260 patients (122 m, 138 f) were involved in this study. There were no significant differences between ages of patients when compared with ex, and Montreal classification and we did not find any correlation between age and CRP levels. Sensitivity, specificity, positive predictive value and negative predictive values for 5 mg/l, 3 mg /l and 2 mg/l are summarised in Table 1. CRP levels which predict Mayo 0 disease, mucosal remission (Mayo 0–1) and Mayo 3 disease are shown in Table 2. At the ROC curve analysis, we found that CRP level of approximately 2.9 mg/l can predict mucosal remission with a 77% sensitivity and % 80 specificity in all examinations without grouping into a separate segmental disease. For subgroups with Montreal E1, E2 and E3 ROC curve analysis suggested 1,8 mg/l (sn. 84%, sp. 90%), 2,7 mg/l (sn. 75%, sp. 75%) and 3 mg/l (sn. 80%, sp. 80%) CRP levels can be used for prediction of mucosal remission respectively (Table 3). It is important to emphasise that 30% of all patients with Mayo 3 colonoscopy and further 23% of patients with Montreal E3–Mayo 3 activity have CRP levels below the regular cut-off value of 5 mg/l. Conclusion CRP cut-off level of approximately 2.9 mg/l can predict mucosal remission in ulcerative colitis better than standard cut-off of 5 mg/l which has a low positive predictive value and specificity even at extended and active mucosal disease.

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Influence of lesion location on the accuracy of CT derived FFR: head-to-head comparison with invasive FFR

European Heart Journal ◽

10.1093/ehjci/ehaa946.0158 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Moshage ◽

S Smolka ◽

S Achenbach ◽

F Ammon ◽

P Ferstl ◽

...

Keyword(s):

Coronary Angiography ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Predictive Value ◽

Invasive Coronary Angiography ◽

Roc Curve Analysis ◽

Jude Medical ◽

Lesion Location ◽

Distal Vessel

Abstract Background The accuracy of CT-derived FFR (FFRCT) has been repeatedly reported. However, the influence of lesion location on accuracy is unknown. Therefore, we evaluated the diagnostic accuracy of FFRCT to detect lesion-specific ischemia and determined the influence of lesion location (proximal vs. distal vessel segments) compared to invasively measured FFR in patients with suspected CAD. Methods A total of 136 vessels in which “Dual-Source”-CT coronary angiography had been performed due to suspected CAD and who were further referred for invasive coronary angiography with invasive FFR measurement within three months of the index CT examination were retrospectively identified and screened for inclusion in this analysis. Patients with either left main coronary artery stenoses, bifurcation or ostial stenoses were excluded. Invasive FFR was measured using a pressure wire (CERTUS®, St. Jude Medical, Minnesota, USA or Verrata®, Volcano, San Diego, USA). FFRCT was calculated using an on-site prototype (cFFR Version 3.0, Siemens Healthineers, Forchheim, Germany). All vessels were analyzed by an experienced observer blinded to the results of invasive FFR. Stenoses with invasively measured FFR ≤0.80 were classified as hemodynamically significant. We evaluated the diagnostic accuracy of FFRCT in proximal vs. non-proximal vessel segments. Proximal lesions included stenoses located in segment one, six, eleven and twelve. All other stenoses were categorized as distal lesions. Results Out of 136 coronary stenoses, 47 (35%) were located in proximal segments and 89 (65%) lesions were located in distal segments. Compared to invasive FFR, the sensitivity of FFRCT to correctly identify/exclude hemodynamically significant stenoses in proximal vessel segments was 93% (95% CI: 68–99.8%) and the specificity was 100% (95% CI: 89–100%), compared to a sensitivity of 72% (95% CI: 46.5–90%) and a specificity of 87% (95% CI: 77–94%) for FFRCT in distal lesions. The positive predictive value was 100% and the negative predictive value was 97% (95% CI: 82.8–99.5%) compared to a positive predictive value of 59% (95% CI: 42–93.9%) and a negative predictive value of 93% (95% CI: 85.4–96.3%) for proximal vs. distal vessel segment, respectively. This corresponds to an accuracy of 98% vs. 84%, respectively (p=0.02). ROC-Curve analysis showed a slightly higher – albeit non-significant – area under the curve for FFRCT to detect hemodynamic relevance in proximal lesions compared to distal lesions (AUC 0.95, p<0.001 vs. AUC: 0.86, p<0.001, respectively, p=0.2). Conclusion FFRCT obtained using an on-site prototype shows overall a high diagnostic accuracy for detecting lesions causing ischemia as compared to invasive FFR with a trend towards better diagnostic performance in proximal vessel segments. Funding Acknowledgement Type of funding source: None

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Evaluation of a novel immunoassay to detect p-tau Thr217 in the CSF to distinguish Alzheimer disease from other dementias

Neurology ◽

10.1212/wnl.0000000000010814 ◽

2020 ◽

Vol 95 (22) ◽

pp. e3026-e3035

Author(s):

Jozef Hanes ◽

Andrej Kovac ◽

Hlin Kvartsberg ◽

Eva Kontsekova ◽

Lubica Fialova ◽

...

Keyword(s):

Alzheimer Disease ◽

Positive Predictive Value ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Healthy Controls ◽

Class Iii ◽

Total Tau ◽

Β Amyloid ◽

Healthy Participants

ObjectiveTo investigate whether tau phosphorylated at Thr217 (p-tau T217) assay in CSF can distinguish patients with Alzheimer disease (AD) from patients with other dementias and healthy controls.MethodsWe developed and validated a novel Simoa immunoassay to detect p-tau T217 in CSF. There was a total of 190 participants from 3 cohorts with AD (n = 77) and other neurodegenerative diseases (n = 69) as well as healthy participants (n = 44).ResultsThe p-tau T217 assay (cutoff 242 pg/mL) identified patients with AD with accuracy of 90%, with 78% positive predictive value (PPV), 97% negative predictive value (NPV), 93% sensitivity, and 88% specificity, compared favorably with p-tau T181 ELISA (52 pg/mL), showing 78% accuracy, 58% PPV, 98% NPV, 71% specificity, and 97% sensitivity. The assay distinguished patients with AD from age-matched healthy controls (cutoff 163 pg/mL, 98% sensitivity, 93% specificity), similarly to p-tau T181 ELISA (cutoff 60 pg/mL, 96% sensitivity, 86% specificity). In patients with AD, we found a strong correlation between p-tau T217 and p-tau T181, total tau and β-amyloid 40, but not β-amyloid 42.ConclusionsThis study demonstrates that p-tau T217 displayed better diagnostic accuracy than p-tau T181. The data suggest that the new p-tau T217 assay has potential as an AD diagnostic test in clinical evaluation.Classification of evidenceThis study provides Class III evidence that a CSF immunoassay for p-tau T217 distinguishes patients with AD from patients with other dementias and healthy controls.

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Measurement of urinary kininogen (KNG) fragments as a noninvasive tool for early diagnosis of pancreatic cancer (PaCa).

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.4_suppl.209 ◽

2019 ◽

Vol 37 (4_suppl) ◽

pp. 209-209

Author(s):

Izumi Ohno ◽

Shuichi Mitsunaga ◽

Motoyasu Kan ◽

Masafumi Ikeda ◽

Hironobu Tsubouchi ◽

...

Keyword(s):

Early Diagnosis ◽

Healthy Volunteers ◽

Roc Curve ◽

High Speed ◽

Curve Analysis ◽

Urine Samples ◽

Healthy Controls ◽

Roc Curve Analysis ◽

Diagnostic Capability ◽

Urinary Levels

209 Background: There is a clear need to identify a non-invasive biomarker for early diagnosis of PaCa, in order to improve the overall survival of PaCa patients. Secretion of large amounts of proteases is a hallmark of PaCa, which results in an abundance of protease-induced cleavage products being excreted in the urine. This has led to speculation that measurement of PaCa-specific fragments in the urine might be useful as a tool for discrimination between PaCa patients and healthy controls. Herein, we introduce urinary KNG fragments as a promising biomarker for early diagnosis of PaCa. Methods: Urine samples were collected from PaCa patients and healthy volunteers, with the written informed consent, from January 2014 to July 2016. Urinary protein tryptic fragments derived from protein C-termini were measured using isobaric tags (iTRAQ) for their relative quantitation, and the diagnostic ability of the urinary levels of these fragments was evaluated by receiver operating characteristic (ROC) curve analysis. The fragments which showed an area-under-the-curve (AUC) of over 0.8 were selected as candidate fragments for further validation by the multiple-reaction-monitoring technique (MRM) combined with high-speed liquid chromatography. The urinary level of each candidate fragment was quantified by MRM, and the diagnostic capability of each for discriminating PaCa patients from healthy controls was evaluated by ROC curve analysis. Results: Urine samples of 39 PaCa patients (7 resectable, 32 unresectable) and 42 healthy controls were examined by iTRAQ to find 12,783 fragments. ROC curve analysis was carried out to select two candidate fragments (fragments A, B), both of which turned out to be KNG cleavage products. The urinary levels of the two fragments were measured in 23 resectable PaCa, 118 unresectable PaCa patients, and 42 healthy volunteers using high-speed-LC-/MRM. The AUCs of serum CA19-9 and urinary levels of fragments A and B for discriminating patients of PaCa from healthy controls were 0.89, 0.81 and 0.70, respectively. Conclusions: Urinary KNG fragments showed favorable diagnostic capability and were considered as promising, noninvasively measurable biomarkers of PaCa.

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Combine preoperative estimation of serum thyroglobulin and ACR-thyroid imaging reporting and data system scoring could accurately define malignant thyroid nodules

International Surgery Journal ◽

10.18203/2349-2902.isj20205866 ◽

2020 ◽

Vol 8 (1) ◽

pp. 32

Author(s):

Waseem A. Shoda

Keyword(s):

Roc Curve ◽

Predictive Value ◽

Thyroid Nodules ◽

Curve Analysis ◽

Data System ◽

Operating Characteristics ◽

Roc Curve Analysis ◽

Serum Thyroglobulin ◽

Thyroid Imaging ◽

Significant Difference

Background: Evaluation of diagnostic ability of preoperative estimation of serum thyroglobulin (TG) to detect malignant thyroid nodules (TN) in comparison to the American College of Radiology, Thyroid imaging reporting and data system (ACR-TIRADS), fine needle aspiration cytology (FNAC) and intraoperative frozen section (IO-FS).Methods: 34 patients with ACR-TIRADS 2-4 TN were evaluated preoperatively for identification of malignancy and all underwent total thyroidectomy with bilateral neck block dissection if indicated. Results of preoperative investigations were statistically analyzed using the Receiver operating characteristics (ROC) curve analysis as predictors for malignancy in comparison to postoperative paraffin sections.Results: Preoperative serum TG levels had 100% sensitivity and negative predictive value, while ACR-TIRADS scoring had 100% specificity and positive predictive value with accuracy rates of 95.35% and 97.67% for TG and TIRADS, respectively. ROC curve analysis defined preoperative ACR-TIRADS class and serum TG as highly diagnostic than FNAC for defining malignancy with non-significant difference between areas under curve for TIRADS and TG. For cases had intermediate risk of malignancy on TIRADS, IO-FS had missed 3, FNAC missed 4, while serum TG levels were very high in the 13 cases and were defined by ROC curve as the only significant predictor for malignancy.Conclusions: Preoperative estimation of serum TG showed higher diagnostic validity than FNAC, high predictability of cancer and ability to verify the intermediate findings on TIRADS. Combined preoperative TIRADS and TG estimation could accurately discriminate malignant TN with high accuracy and spare the need for preoperative FNAC or IO-FS.

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Comparison Between Normobaric Hypoxia Altitude Simulation Test and Altitude Hypoxia Predictive Equations in Cystic Fibrosis Patients

10.1101/570754 ◽

2019 ◽

Author(s):

Christine Costa ◽

André Barros ◽

João Valença Rodrigues ◽

Richard Staats ◽

Mariana Alves ◽

...

Keyword(s):

Cystic Fibrosis ◽

Individual Differences ◽

Positive Predictive Value ◽

Predictive Value ◽

Gold Standard ◽

Healthy Controls ◽

Simulation Test ◽

Oxygen Supplementation ◽

Predictive Equations ◽

The Individual

AbstractBackground:The Hypoxia Altitude Simulation Test (HAST) is the Gold Standard to evaluate hypoxia in response to altitude and to decide on in-flight requirements for oxygen supplementation. Several equations are available to predict PaO2 in altitude (PaO2alt), but it remains unclear whether their predictive value is equivalent. We aimed to compare the results obtained by the available methods in a population of cystic fibrosis (CF) adults.Methods:Eighty-eight adults (58 healthy controls and 30 CF patients) performed a spirometry followed by an HAST. HAST results were compared with the predicted PaO2alt made by five equations: 1st: PaO2alt= 0,410 x PaO2ground + 1,7652; 2nd: PaO2alt= 0,519 x PaO2ground + 11,855 x FEV1 (L) − 1,760; 3rd: PaO2alt= 0,453 x PaO2ground + 0,386 x FEV1 (%) + 2,44; 4th: PaO2alt= 0,88 + 0,68 x PaO2ground; 5th: PaO2alt= PaO2ground − 26,6.Results:None of the controls required in-flight oxygen neither by HAST or by the five predictive equations. Eleven CF-patients had PaO2alt < 50 mmHg, accessed by HAST. The positive predictive value was 50% (1st), 87.5% (2nd and 3rd), 77.78% (4th) and 58.33% (5th). Areas under the curve were 78.95% (1st), 84.69% (2nd), 88.04% (3rd) and 78.95% (4th and 5th). FEV1 and PaO2ground were correlated with HAST results.Conclusions:The 3rd equation gave the best predictions in comparison with results obtained by HAST. However, because the individual differences found were substantial for all equations, we still recommend performing a HAST whenever possible to confidently access in-flight hypoxia and the need for oxygen.

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Diagnostic accuracy of a dynamically increased red blood cell distribution width in very low birth weight infants with serious bacterial infection

Italian Journal of Pediatrics ◽

10.1186/s13052-021-00994-w ◽

2021 ◽

Vol 47 (1) ◽

Author(s):

Bin-Fang Guo ◽

Su-Zhen Sun

Keyword(s):

Birth Weight ◽

Bacterial Infection ◽

Preterm Infants ◽

Roc Curve ◽

Very Low Birth Weight ◽

Reference Group ◽

Curve Analysis ◽

Cell Distribution ◽

Roc Curve Analysis ◽

Distribution Width

Abstract Objective Serious bacterial infection (SBI) remains an important cause of morbidity and mortality in preterm infants. The objective of this study was to evaluate the dynamically increased value of the red cell distribution width (RDW) in the diagnosis of SBI. Methods This retrospective study enrolled 334 preterm infants with birth weight less than 1500 g. The initial RDW and the maximum value of RDW during hospitalization were extracted from the MIMIC-III database (version 1.4). Infants were categorized into four groups according to baseline RDW value and ΔRDW (ΔRDW = RDW at maximum- RDW at baseline). Logistic regression analysis was used to assess the risk of developing SBI in each group. A receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of RDW at baseline alone, ΔRDW alone, and in combination. Results Infants with increased RDW at baseline (> 17%) and ΔRDW > 2% exhibited the highest risk of developing SBI, whereas the patients with normal RDW level at baseline (≤ 17%) and ΔRDW≤2% (the reference group) had the lowest risk. This association remained unaltered even after adjustment in multivariable models. Basing on ROC curve analysis, the area under the curve predicted by the combination of RDW at baseline and ΔRDW for SBI was 0.81 (95% CI, 0.76–0.87). Sensitivity and specificity were 78.16 and 72.47% respectively. Conclusions We observed that combination of elevated RDW at baseline and dynamic increases during hospitalization is significantly associated with SBI. Therefore, that combination could be a promising independent diagnostic indicator of SBI in newborns.

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A multi prototype classification algorithm and its application to multi class diagnostics

10.7287/peerj.preprints.1180v1 ◽

2015 ◽

Author(s):

Mario Ziller

Keyword(s):

Approximate Solution ◽

Positive Predictive Value ◽

Metric Space ◽

Predictive Value ◽

Roc Analysis ◽

Geometric Model ◽

Classification Procedure ◽

Discrete Optimisation ◽

Diagnostic Decision ◽

Prototype Classification

This paper introduces a novel, universal distance-based classification procedure. It is based on a simple geometric model. Considering all objects as points in a metric space, a class is imagined as covered by potentially differentsized hyperspheres, the centres of which are referred to as prototypes. The radii of the hyperspheres are individually optimised by a generalised ROC-analysis. For the approximate solution of the entire discrete optimisation problem, a greedy algorithm was developed and implemented in R. It runs in O(k2∙n2∙log(n)) time where k is the number of prototypes to be selected and n the number of training objects. For application to multi class problems, one against all approach is performed. The diagnostic decision is finalised for that class of maximum positive predictive value when in doubt. Objects not recognised as a member of any of the classes are assigned to an additional residual class. The performance of the classification system presented is demonstrated on various data examples, and in comparison with other methods.

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Thrombocytopenia as a Diagnostic Marker for Malaria in Patients with Acute Febrile Illness

Journal of Tropical Medicine ◽

10.1155/2021/5585272 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Angesom Gebreweld ◽

Yonas Erkihun ◽

Daniel Getacher Feleke ◽

Gebru Hailu ◽

Temesgen Fiseha

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Diagnostic Marker ◽

Complete Blood Count ◽

Febrile Illness ◽

Severe Thrombocytopenia ◽

Acute Febrile Illness ◽

Roc Curve Analysis ◽

Cross Sectional

Background. Thrombocytopenia is the most common hematological abnormality in patients with acute malaria. This study aimed to determine the role of thrombocytopenia as a diagnostic marker for malaria in patients with acute febrile illness. Method. A cross-sectional health facility-based study was conducted on 423 consecutively selected acute febrile patients at Ataye District Hospital from February to May 2019 GC. A complete blood count and malaria microscopy were performed for each acute febrile patient. ROC curve analysis was performed to calculate sensitivity, specificity, positive predictive value, and negative predictive value of platelet count in predicting malaria. A P ≤ 0.05 was considered statistically significant. Result. Out of the 423 acute febrile patients, 73 (17.3%) were microscopically confirmed malaria cases and the rest 350 (82.7%) patients had negative blood film results. Of the microscopically confirmed malaria cases, 55 (75.34%) were P. vivax and 18 (24.66%) were P. falciparum. The prevalence of thrombocytopenia among malaria patients (79.5%) was significantly higher than those in malaria negative acute febrile patients (13.7%), P < 0.001. About 67% malaria-infected patients had mild to moderate thrombocytopenia and 12.3% had severe thrombocytopenia. The ROC analysis demonstrated platelet counts <150,000/μl as an optimal cutoff value with 0.893 area under the curve, 79.5% sensitivity, 86.3% specificity, 95.3% negative predictive value, and 54.7% positive predictive value to predict malaria. Conclusion. Malaria is still among the major public health problems in the country. Thrombocytopenia is a very good discriminatory test for the presence or absence of malaria with 79.5% sensitivity and 86.3% specificity. Therefore, this may be used in addition to the clinical and microscopic parameters to heighten the suspicion of malaria.

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P08.05 Cognitive impairment in patients with newly-diagnosed high-grade gliomas

Neuro-Oncology ◽

10.1093/neuonc/noz126.131 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii38-iii38

Author(s):

M Ribeiro ◽

T Durand ◽

J Jacob ◽

D Psimaras ◽

G Noel ◽

...

Keyword(s):

Cognitive Impairment ◽

Sensitivity And Specificity ◽

Curve Analysis ◽

Stepwise Logistic Regression ◽

High Grade ◽

Healthy Controls ◽

Newly Diagnosed ◽

Cognitive Screening ◽

Z Score ◽

Roc Curve Analysis

Abstract BACKGROUND Cognitive dysfunction is frequent in patients with primary brain tumor, impairing attention, memory and executive function. It compromises functional independence, decision making capacity and psycho-social well-being. Cognitive functioning is highly correlated to disease progression and quality of survival, thus cognitive follow-up is essential in the management of the disease. Cognitive screening tools are often used, since a comprehensive battery may be time consuming and challenging for patients. The objective of this study was to identify a pattern of cognitive dysfunction in patients with newly-diagnosed high-grade gliomas and evaluate the sensitivity and specificity of the MoCA (Montreal Cognitive Assessment) as a cognitive screening tool in the clinical practice. MATERIAL AND METHODS We compared performances in tests of memory, action speed, visuospatial ability and executive function of 156 patients with newly-diagnosed WHO Grade III and IV gliomas, after surgery and prior to radiochemotherapy, to those of a group of healthy controls (n=1003). Relatives assessed behavior through a questionnaire of behavioral dysexecutive syndrome. A stepwise logistic regression was performed to select cognitive domains better discriminating patients from healthy controls and we tested the sensitivity and specificity of the MOCA using ROC curve analysis. RESULTS The stepwise logistic regression analysis identified the 3 following factors better discriminating patients from controls: TMT-B completion time (OR: 0.673; 95% CI: 0.511–0.886; p=0.0005), a verbal memory index (OR:0.507; 95% CI: 0.358–0.718; p=0.0001) and a behavioral dysexecutive score (OR:0.616; 95% CI: 0.468–0.812, p=0.001). Prevalence of cognitive-behavioral impairment was of 35.94%; 95% CI: 28.3 - 43.5. The ROC curve analysis for the assessment of the MoCA sensitivity and specificity in detecting impairment yielded 0.795 (95%CI: 0.714–0.875) for the MoCA raw score, and 0.804 (95%CI: 0.727 - 0.881) for the adjusted z score. The optimal discrimination was obtained for a raw score ≤ 25 (sensitivity of 0.526; specificity of 0.832). For the adjusted score, optimal discrimination value was observed with a -0.603 z score (sensitivity of 0.716; specificity of 0.768). CONCLUSION Cognitive impairment and behavioral dysexecutive syndrome is frequent in patients with newly-diagnosed high-grade glioma. The MoCA lacks sensitivity in screening cognitive impairment to discriminate patients from healthy controls in this setting, and a comprehensive neuropsychological assessment is still recommended.

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