Diagnostic Accuracy and Receiver-Operating Characteristics Curve Analysis in Surgical Research and Decision Making

Abstract Introduction The significance of 18-fluorodeoxyglucose PET/CT for predicting the estimation of a positive biopsy in cases of lymphoma is unknown. Diagnosis of lymphoma is based on a lymph node biopsy, however, the use of 18-fluorodeoxyglucose PET/CT for selecting a biopsy site that would provide the best the yield for accurate diagnosis remains unknown. Patients and Methods Data on 165 patients with initial suspicion of lymphoma that underwent PET/CT scans and biopsy as part of their initial evaluation were prospectively collected and reviewed. Standadized uptake value (SUVmax) of the biopsy site and others was collected from radiology reports. The association between the SUVmax on FDG-PET/CT before excision and the estimation of lymphoma diagnosis at biopsy was examined using a receiver operating characteristics curve analysis (ROC). Results 159/165 (84.5%) cases suspected of lymphoma underwent PET/CT scan performed prior excisional/FNA biopsy. Ninety six cases were diagnosed of diffuse large B cell lymphoma (DLBCL), 24 follicular lymphoma, 34 Hodgkin lymphoma, 15 plasmablastic lymphomas, and 6 marginal zone lymphoma. Receiver operating characteristics curve analysis demonstrated an area under the curve (AUC) of 0.6 with a borderline p-value of 0.06, which reached level of significance when the methodology of diagnosis only involved fine needle aspiration (FNA, AUC: 0.645, p= 0.05) or when the analysis was performed in patients with a diagnosis of follicular lymphoma (AUC:0.8, p<0.05). We identified several factors that influence SUVmax intensity, which included lymphoma subtype, stage and LDH. Consistent with prior reviews, tumor type was associated with higher SUVmax withDLBCL and plasmablastic with the highest SUV, followed by Hodgkin lymphoma and low grade lymphoma (p<0.05). Tumors with advance stage (stage 4) and high LDH levels were also associated with higher SUVmax. Conclusion SUVmax on FDG-PET/CT is potentially useful for guiding biopsy sites that will provide the best yield to diagnose lymphoma. SUVmax is particularly useful to diagnose lymphoma when FNA is performed as diagnostic procedure of choice. We identified that tumor type, stage and LDH can affect SUV intensity. Performing a Receiver operating characteristics curve analysis of the SUVmax on FDG-PET/CT in a larger samples size is warranted for defining thresholds that predict the estimation of a positive biopsy. Disclosures Cohen: Celgene, Pharmacyclics, Millennium, Seattle Genetics: Consultancy; BMS, Janssen: Research Funding. Flowers:TG Therapeutics: Research Funding; Seattle Genetics: Consultancy; Acerta: Research Funding; Pharmacyclics: Research Funding; Spectrum: Research Funding; Genentech: Research Funding; Onyx Pharmaceuticals: Research Funding; Takeda: Research Funding; AbbVie: Research Funding; Infinity Pharmaceuticals: Research Funding; Gilead Sciences: Research Funding; Celgene: Research Funding; OptumRx: Consultancy; Janssen: Research Funding. Bernal-Mizrachi:Takeda: Research Funding; Empire Genomics: Consultancy, Patents & Royalties.

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qTICI: Quantitative assessment of brain tissue reperfusion on digital subtraction angiograms of acute ischemic stroke patients

International Journal of Stroke ◽

10.1177/1747493020909632 ◽

2020 ◽

pp. 174749302090963

Author(s):

Haryadi Prasetya ◽

Lucas A Ramos ◽

Thabiso Epema ◽

Kilian M Treurniet ◽

Bart J Emmer ◽

...

Keyword(s):

Functional Outcome ◽

Digital Subtraction Angiography ◽

Quantitative Measure ◽

Receiver Operating Characteristics ◽

Binary Logistic Regression Analysis ◽

Digital Subtraction ◽

Operating Characteristics ◽

Vessel Occlusion ◽

Receiver Operating Characteristics Curve ◽

Receiver Operating

Background The Thrombolysis in Cerebral Infarction (TICI) scale is an important outcome measure to evaluate the quality of endovascular stroke therapy. The TICI scale is ordinal and observer-dependent, which may result in suboptimal prediction of patient outcome and inconsistent reperfusion grading. Aims We present a semi-automated quantitative reperfusion measure (quantified TICI (qTICI)) using image processing techniques based on the TICI methodology. Methods We included patients with an intracranial proximal large vessel occlusion with complete, good quality runs of anteroposterior and lateral digital subtraction angiography from the MR CLEAN Registry. For each vessel occlusion, we identified the target downstream territory and automatically segmented the reperfused area in the target downstream territory on final digital subtraction angiography. qTICI was defined as the percentage of reperfused area in target downstream territory. The value of qTICI and extended TICI (eTICI) in predicting favorable functional outcome (modified Rankin Scale 0–2) was compared using area under receiver operating characteristics curve and binary logistic regression analysis unadjusted and adjusted for known prognostic factors. Results In total, 408 patients with M1 or internal carotid artery occlusion were included. The median qTICI was 78 (interquartile range 58–88) and 215 patients (53%) had an eTICI of 2C or higher. qTICI was comparable to eTICI in predicting favorable outcome with area under receiver operating characteristics curve of 0.63 vs. 0.62 (P = 0.8) and 0.87 vs. 0.86 (P = 0.87), for the unadjusted and adjusted analysis, respectively. In the adjusted regression analyses, both qTICI and eTICI were independently associated with functional outcome. Conclusion qTICI provides a quantitative measure of reperfusion with similar prognostic value for functional outcome to eTICI score.

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Evaluating and comparing biomarkers with respect to the area under the receiver operating characteristics curve in two-phase case–control studies

Biostatistics ◽

10.1093/biostatistics/kxw003 ◽

2016 ◽

Vol 17 (3) ◽

pp. 499-522 ◽

Cited By ~ 4

Author(s):

Ying Huang

Keyword(s):

Case Control ◽

Receiver Operating Characteristics ◽

Biased Sampling ◽

Second Phase ◽

Operating Characteristics ◽

Case Control Studies ◽

Two Phase ◽

Receiver Operating Characteristics Curve ◽

The Impact ◽

Receiver Operating

Abstract Two-phase sampling design, where biomarkers are subsampled from a phase-one cohort sample representative of the target population, has become the gold standard in biomarker evaluation. Many two-phase case–control studies involve biased sampling of cases and/or controls in the second phase. For example, controls are often frequency-matched to cases with respect to other covariates. Ignoring biased sampling of cases and/or controls can lead to biased inference regarding biomarkers' classification accuracy. Considering the problems of estimating and comparing the area under the receiver operating characteristics curve (AUC) for a binary disease outcome, the impact of biased sampling of cases and/or controls on inference and the strategy to efficiently account for the sampling scheme have not been well studied. In this project, we investigate the inverse-probability-weighted method to adjust for biased sampling in estimating and comparing AUC. Asymptotic properties of the estimator and its inference procedure are developed for both Bernoulli sampling and finite-population stratified sampling. In simulation studies, the weighted estimators provide valid inference for estimation and hypothesis testing, while the standard empirical estimators can generate invalid inference. We demonstrate the use of the analytical variance formula for optimizing sampling schemes in biomarker study design and the application of the proposed AUC estimators to examples in HIV vaccine research and prostate cancer research.

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Predicting fluid responsiveness in whom? A simulated example of patient spectrum influencing the receiver operating characteristics curve

Journal of Clinical Monitoring and Computing ◽

10.1007/s10877-017-0019-x ◽

2017 ◽

Vol 32 (2) ◽

pp. 215-219 ◽

Cited By ~ 2

Author(s):

Lars Øivind Høiseth ◽

Jostein S. Hagemo

Keyword(s):

Fluid Responsiveness ◽

Receiver Operating Characteristics ◽

Operating Characteristics ◽

Receiver Operating Characteristics Curve ◽

Receiver Operating

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Identifying threshold values of an open source software using Receiver Operating Characteristics curve (ROC)

Journal of Information and Optimization Sciences ◽

10.1080/02522667.2015.1135592 ◽

2017 ◽

Vol 38 (1) ◽

pp. 39-69 ◽

Cited By ~ 3

Author(s):

Ruchika Malhotra ◽

Ankita Bansal

Keyword(s):

Open Source ◽

Open Source Software ◽

Receiver Operating Characteristics ◽

Threshold Values ◽

Operating Characteristics ◽

Receiver Operating Characteristics Curve ◽

Receiver Operating

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Higher Baseline Cortical Score Predicts Good Outcome in Patients With Low Alberta Stroke Program Early Computed Tomography Score Treated with Endovascular Treatment

Neurosurgery ◽

10.1093/neuros/nyaa472 ◽

2020 ◽

Author(s):

Peng-fei Xing ◽

Yong-wei Zhang ◽

Lei Zhang ◽

Zi-fu Li ◽

Hong-jian Shen ◽

...

Keyword(s):

Computed Tomography ◽

Endovascular Treatment ◽

Receiver Operating Characteristics ◽

Operating Characteristics ◽

Good Outcome ◽

Poor Outcome ◽

Poor Outcome Group ◽

Outcome Group ◽

Receiver Operating Characteristics Curve ◽

Receiver Operating

Abstract BACKGROUND Patients with large vessel occlusion and noncontrast computed tomography (CT) Alberta Stroke Program Early CT Score (ASPECTS) <6 may benefit from endovascular treatment (EVT). There is uncertainty about who will benefit from it. OBJECTIVE To explore the predicting factors for good outcome in patients with ASPECTS <6 treated with EVT. METHODS We retrospectively reviewed 60 patients with ASPECTS <6 treated with EVT in our center between March 2018 and June 2019. Patients were divided into 2 groups because of the modified Rankin Score (mRS) at 90 d: good outcome group (mRS 0-2) and poor outcome group (mRS ≥3). Baseline and procedural characteristics were collected for unilateral variate and multivariate regression analyses to explore the influent variates for good outcome. RESULTS Good outcome (mRS 0-2) was achieved in 24 (40%) patients after EVT and mortality was 20% for 90 d. Compared with the poor outcome group, higher baseline cortical ASPECTS (c-ASPECTS), lower intracranial hemorrhage, and malignant brain edema after thrombectomy were noted in the good outcome group (all P < .01). Multivariate logistic regression showed that only baseline c-ASPECTS (≥3) was positive factor for good outcome (odds ratio = 4.29; 95% CI, 1.21-15.20; P = .024). The receiver operating characteristics curve indicated a moderate value of c-ASPECTS for predicting good outcome, with the area under receiver operating characteristics curve 0.70 (95% CI, 0.56-0.83; P = .011). CONCLUSION Higher baseline c-ASPECTS was a predictor for good clinical outcome in patients with ASPECTS <6 treated with EVT, which could be helpful to treatment decision.

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