scholarly journals 1515. Distinguishing Kawasaki Disease Initially Presenting as Cervical Lymphadenopathy from Bacterial Cervical Lymphadenitis Using the Decision Tree Analysis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S551-S552
Author(s):  
Jihye Kim
Keyword(s):  
Decision Tree ◽  
Early Stage ◽  
Cervical Lymphadenopathy ◽  
Final Diagnosis ◽  
Percentage Change ◽  
Decision Tree Analysis ◽  
Cervical Lymphadenitis ◽  
Tree Analysis ◽  
Group A ◽  
Group B

Abstract Background Kawasaki disease (KD) can present initially with fever and cervical lymphadenopathy before other characteristic clinical signs appear. It is important to recognize KD at an early stage for appropriate treatment to be started and reduce cardiac complications. We sought to identify variables which distinguish early stage of node first presentation of KD from bacterial cervical lymphadenitis (BCL). Methods We retrospectively reviewed records of patients presenting with cervical lymphadenopathy and fever as primary diagnosis who discharged from the inpatient ward between January 2010 and December 2017. Only the patients who underwent radiologic studies (CT or US) were included. Patients were divided into 3 groups by their final diagnosis; CL with abscess (Group A), CL without abscess (Group B), and Node first presentation of KD (Group C). Initial clinical, laboratory, and imaging characteristics of the 3 groups were compared. Sequential laboratory data performed on the third hospital day was used to calculate their percentage differences. A clinical prediction model for KD in patients with CL was constructed using the decision tree analysis. Results Patients with KD had a longer duration of fever after admission and longer duration of fever prior to final diagnosis compared with BCL patients. Compared with group A or B, group C patients had higher neutrophil counts, neutrophil-lymphocyte ratio, C-reactive protein (CRP), erythrocyte sedimentation rates (ESR), alanine transaminase (ALT), aspartate transaminase (AST). In radiologic studies, no differences were observed in node sizes or palatine tonsil enlargement among the 3 groups. Retropharyngeal edema was more commonly associated with group C than group A and B combined, but was not significantly different between group A and C. By decision tree analysis, factors contributing to classification included presence of abscess, CRP percentage change, and neutrophil percentage change (Figure 1). Strong predictivity of the decision tree was observed in classifying Group C, with an overall accuracy of 87.9% for Group A, 82.6% for Group B, and 91.4% for Group C. Conclusion Decision tree analysis showed that the presence of abscess, CRP percentage change, and neutrophil percentage change could classify KD from BCL with an accuracy of 91.4%. Disclosures All authors: No reported disclosures.

scholarly journals Metabolic Tumor Volume for Early Response Assessment in Early-Stage Unfavorable Hodgkin Lymphoma Treated with Nivolumab in the GHSG Nivahl Phase II Trial

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4020-4020
Author(s):  
Conrad-Amadeus Voltin ◽  
Jasmin Mettler ◽  
Horst Mueller ◽  
Michael Fuchs ◽  
Christian Baues ◽  
...  
Keyword(s):  
Survival Data ◽  
Research Funding ◽  
Early Stage ◽  
Response Assessment ◽  
Early Response ◽  
Percentage Change ◽  
Response To Treatment ◽  
Deauville Score ◽  
Group A ◽  
Group B

Background: Metabolic tumor volume (MTV) measured by FDG-PET/CT is becoming established as an independent risk factor for treatment failure in Hodgkin lymphoma (HL). Moreover, response to treatment with novel agents including checkpoint inhibitors may be better reflected by a decrease in MTV than by currently used response criteria. Our aim was to evaluate the early response to first-line HL treatment with the PD-1 inhibitor nivolumab using MTV. Methods: The analysis set included 59 patients with newly diagnosed, early-stage unfavorable HL treated within the prospective, multicenter, open label, randomized, phase II NIVAHL trial of the German Hodgkin Study Group (GHSG). Patients in NIVAHL were randomized to receive either four double cycles of nivolumab, doxorubicin, vinblastine, and dacarbazine (4x Nivo-AVD, group A, n=31) or a sequential therapy starting with 4x nivolumab monotherapy followed by 2xNivo-AVD and 2x AVD (group B, n=28). Early response to treatment was assessed at a 1st interim restaging after either 2x Nivo-AVD or 4x nivolumab. All NIVAHL patients who underwent PET at both initial staging and early response assessment, with images available to the central review panel for quantitative analysis before April 30th 2019, were included. MTV was calculated using a fixed SUV threshold of 4 for both staging and restaging. Results: Patient characteristics of the MTV analysis subset presented here did not differ in any relevant way from the overall NIVAHL trial population. Median age of the 59 patients was 27 years (range 18-57) with a female predominance (61%). All patients presented with stage II disease (IIB 27%) and ≥3 involved areas was the most common risk factor (75%) followed by elevated erythrocyte sedimentation rate (51%), extranodal disease (17%) and large mediastinal mass (14%). Mean MTV at initial staging was 124 ml (range 4 - 578 ml) and 177 ml (11 - 581 ml) in groups A and B, respectively. In both groups a marked decrease in MTV was observed at the 1st interim restaging (Figure 1): After 2x Nivo-AVD all patients in group A showed a reduction of MTV >80% (mean percentage change in MTV -99.8%). In group B a reduction of MTV >80% was observed in 26/28 patients (93%), while in 2/28 patients an increase <10% was observed (mean percentage change in MTV -91%; Figure 1). The mean residual MTV at interim restaging after 2x Nivo-AVD was 0.4 ml (range 0 - 8) in group A and 11 ml after 4x nivolumab in group B (range 0 - 176). The reduction of MTV was observed irrespective of initial MTV with a similar mean percentage change in patients above and below the median MTV in both groups. When applying the Deauville score, however, the number of patients presenting with a Deauville score ≥4 was higher in the group with an initial MTV above the median MTV than in the group where initial MTV lay below the median value. Using the Lugano criteria and a Deauville score of 4 or higher as cut-off for PET-positivity, early interim complete remission was observed in 81% of patients after 2xNivo-AVD, as compared to 51% after 4x nivolumab monotherapy. Further analyses regarding MTV and response at the 2nd and end-of-treatment restaging as well as survival data are not yet available due to limited follow-up. These data will be available at the time of presentation and shown at the meeting. Conclusions: Marked reductions of MTV demonstrate an excellent early efficacy for both 2x Nivo-AVD and 4x nivolumab as 1st-line therapy for early-stage unfavorable HL. The unexpectedly and previously unreported high MTV reduction with nivolumab monotherapy indicates a relevant potential of anti-PD1 mono- or debulking-therapy in the 1st-line treatment of early-stage unfavorable HL. Early interim response assessment based on MTV may help to identify HL patients treated with anti-PD1 antibodies in whom a significant reduction or even omission of chemotherapy could be considered. MTV appears to have the potential to accurately measure response to immune checkpoint inhibition. However, correlation of early MTV reduction with response at the end of treatment or with survival data is pending. Disclosures Borchmann: Novartis: Honoraria, Research Funding. Bröckelmann:Bristol-Myers Squibb: Honoraria, Other: Travel Support, Research Funding; Takeda: Consultancy, Honoraria, Other: Travel Support, Research Funding; MSD Sharpe & Dohme: Research Funding.

Early-Stage Endometrioid Ovarian Carcinoma: Population-Based Outcomes in British Columbia

2014 ◽  
Vol 24 (8) ◽  
pp. 1401-1405 ◽  
Author(s):  
Aalok Kumar ◽  
Nhu Le ◽  
Anna V. Tinker ◽  
Jennifer L. Santos ◽  
Christina Parsons ◽  
...  
Keyword(s):  
British Columbia ◽  
Decision Tree ◽  
Adjuvant Treatment ◽  
Early Stage ◽  
Stage Ii ◽  
Decision Tree Analysis ◽  
Tree Analysis ◽  
Endometrioid Ovarian Carcinoma ◽  
Stage Ia ◽  
The Impact

ObjectiveSpecific outcomes for early-stage ovarian endometrioid carcinoma (OEC) have not been well characterized. In addition, the benefit of any type of postsurgical therapy remains unclear. Our aims were to delineate (1) potential prognostic factors and (2) the impact of adjuvant treatment on survival in such patients.MethodsWomen with FIGO stages I and II OEC referred to one of the centers of the British Columbia Cancer Agency from 1984 to 2008 were included in a retrospectively abstracted computerized database. Irradiation (abdominal-pelvic) in addition to chemotherapy (3 cycles of platinum combination) was to be given for stage IA/B, grade 2/3; stage IC, any grade; and stage II, any grade, except from 1989 to 1994 when irradiation was dropped from the paradigm for all patients. Univariate analysis and a multivariate analysis, using a decision tree analysis, were carried out of disease-free survival (DFS).ResultsOne hundred seventy-two patients were identified. Twelve percent were grade 3; 55%, 85%, and 89% of stages IA/B, IC, and II received postoperative adjuvant treatment. Five-year DFS was 95%, 84%, and 74% for stages IA/B and IC based upon rupture alone, IC other (cytologic positivity and/or surface involvement), and II, respectively. No benefit in DFS was accrued in stage IA/B from adjuvant treatment. Decision tree analysis defined 2 poor prognostic groups: those 55 years or older with stage IC based upon positive washings or surface involvement and any patient with stage II disease; in these, an apparent DFS benefit from irradiation was seen (relative risk (RR), 1.77; 95% confidence interval (CI), 0.74–4.24).ConclusionOmission of adjuvant treatment can be considered in most early-stage OECs.

A Comparative Study of Amalaki Choorna along with Madhu and Vata Twak Kashaya Yoni Pichu Dharana in the Management of Shweta Pradara

2017 ◽  
Vol 2 (4) ◽  
Author(s):  
Renuka M. Tenahalli
Keyword(s):  
Vitamin C ◽  
Early Stage ◽  
Pathological Condition ◽  
Before And After ◽  
Group A ◽  
Phosphorus Iron ◽  
Group B ◽  
Busy Schedule ◽  
Iron And Calcium

Shweta Pradara (Leucorrhoea) is the disease which is characterized by vaginal white discharge. Vaginal white discharge this symptom is present in both physiological and pathological condition, when it becomes pathological it disturbs routine life style of the woman. Most of the women in the early stage will not express the symptoms because of hesitation and their busy schedule. If it is not treated it may leads to chronic diseases like PID (Garbhashaya Shotha etc.) Charaka mentioned Amalaki Choorna along with Madhu and Vata Twak Kashaya Yoni Pichu Dharana. This treatment is used in Shweta Pradara shown positive results, hence a study was under taken to assess its clinical efficacy. 30 diagnosed patients of Shweta Pradara were randomly selected, allocated in three groups. Group A and Group B received Amalaki Choorna with Madhu and Vata Twak Kashaya Yoni Pichu Dharana respectively and Group C received Amalaki Choorna with Madhu followed by Vata Twak Kashaya Yoni Pichu Dharana for 15 days. The patients were assessed for the severity of the symptoms subjectively and objectively before and after the treatment and at the end of the follow up. Data from each group were statistically analyzed and were compared. No side effects were noted and it may be considered as an effective alternative medicine in Shweta Pradara (leucorrhea). Amalaki is rich in natural source of vitamin C and contains phosphorus, iron and calcium. Honey contains carbohydrate, vitamin C, phosphorus iron and calcium. All together these help to increase Hb% and immunity. Vata Twak Kashaya contains tannin which helps to maintain normal pH of the vagina.

scholarly journals Risk of Pre-Malignancy or Malignancy in Postmenopausal Endometrial Polyps: A CHAID Decision Tree Analysis

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1094
Author(s):  
Michael Wong ◽  
Nikolaos Thanatsis ◽  
Federica Nardelli ◽  
Tejal Amin ◽  
Davor Jurkovic
Keyword(s):  
Decision Tree ◽  
Expectant Management ◽  
Decision Tree Model ◽  
Decision Tree Analysis ◽  
Focal Lesions ◽  
Tree Model ◽  
Normal Endometrium ◽  
Endometrial Polyps ◽  
Tree Analysis ◽  
Interaction Detection

Background and aims: Postmenopausal endometrial polyps are commonly managed by surgical resection; however, expectant management may be considered for some women due to the presence of medical co-morbidities, failed hysteroscopies or patient’s preference. This study aimed to identify patient characteristics and ultrasound morphological features of polyps that could aid in the prediction of underlying pre-malignancy or malignancy in postmenopausal polyps. Methods: Women with consecutive postmenopausal polyps diagnosed on ultrasound and removed surgically were recruited between October 2015 to October 2018 prospectively. Polyps were defined on ultrasound as focal lesions with a regular outline, surrounded by normal endometrium. On Doppler examination, there was either a single feeder vessel or no detectable vascularity. Polyps were classified histologically as benign (including hyperplasia without atypia), pre-malignant (atypical hyperplasia), or malignant. A Chi-squared automatic interaction detection (CHAID) decision tree analysis was performed with a range of demographic, clinical, and ultrasound variables as independent, and the presence of pre-malignancy or malignancy in polyps as dependent variables. A 10-fold cross-validation method was used to estimate the model’s misclassification risk. Results: There were 240 women included, 181 of whom presented with postmenopausal bleeding. Their median age was 60 (range of 45–94); 18/240 (7.5%) women were diagnosed with pre-malignant or malignant polyps. In our decision tree model, the polyp mean diameter (≤13 mm or >13 mm) on ultrasound was the most important predictor of pre-malignancy or malignancy. If the tree was allowed to grow, the patient’s body mass index (BMI) and cystic/solid appearance of the polyp classified women further into low-risk (≤5%), intermediate-risk (>5%–≤20%), or high-risk (>20%) groups. Conclusions: Our decision tree model may serve as a guide to counsel women on the benefits and risks of surgery for postmenopausal endometrial polyps. It may also assist clinicians in prioritizing women for surgery according to their risk of malignancy.

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