Recall accuracy of notifications about incidental findings from an MRI examination: results from a population-based study

2020 ◽  
pp. jech-2019-212824
Author(s):  
Katharina Piontek ◽  
Adrian Richter ◽  
Katrin Hegenscheid ◽  
Jean-Francois Chenot ◽  
Carsten Oliver Schmidt
Keyword(s):  
Predictive Value ◽  
False Positive ◽  
Incidental Findings ◽  
False Negative ◽  
Population Based ◽  
Whole Body ◽  
Population Based Study ◽  
Recall Accuracy ◽  
Whole Body Mri ◽  
Self Reports

BackgroundSelf-reports of medical findings are indispensable in clinical practice and research but subject to recall bias. We analysed the recall accuracy of notifications about incidental findings (IFs) from a whole-body MRI examination and assessed determinants of recall error.MethodsData from 3746 participants of a postal follow-up survey conducted on average 2.47 years after examination in the population-based Study of Health in Pomerania were analysed. Among those, 2185 (58.3%) underwent whole-body MRI at baseline, and findings of potential clinical relevance were disclosed in standardised postal letters. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to determine the accuracy of self-reports. Poisson regression analysis was conducted to analyse predictors for false-positive and false-negative recall.ResultsAn IF was disclosed to 622 (28.5%) individuals; 81.5% had tumour relevance. The overall sensitivity and PPV of participants’ self-reports were 80% and 60%, respectively. PPvs were higher among women, better educated and married participants and among those with good verbal memory. Among MRI participants, lower educational level was associated with a higher risk of false-positive recall (risk ratio (RR) 1.44, 95% CI 1.01 to 2.03), while increasing age was associated with a higher risk of false-negative recall (RR 1.64, 95% CI 1.33 to 2.01).ConclusionsMost participants correctly recalled disclosed IFs. However, the probability of an event in case of a positive recall is barely above 50%. Therefore, relying on subjects’ recall of disclosed IFs will lead to a relevant proportion of errors. Clinicians and researchers should be aware of this problem and of participants’ characteristics which may moderate the probability of correct decisions based on recalled findings.

scholarly journals The effects of incidental findings from whole-body MRI on the frequency of biopsies and detected malignancies or benign conditions in a general population cohort study

2020 ◽  
Vol 35 (10) ◽  
pp. 925-935 ◽  
Author(s):  
Adrian Richter ◽  
Elizabeth Sierocinski ◽  
Stephan Singer ◽  
Robin Bülow ◽  
Carolin Hackmann ◽  
...  
Keyword(s):  
Cohort Study ◽  
Incidental Findings ◽  
Rate Ratio ◽  
Negative Binomial ◽  
Population Based ◽  
Whole Body ◽  
Laboratory Findings ◽  
Cancer History ◽  
Whole Body Mri ◽  
General Population Cohort

Abstract Magnetic resonance imaging (MRI) yields numerous tumor-related incidental findings (IFs) which may trigger diagnostics such as biopsies. To clarify these effects, we studied how whole-body MRI IF disclosure in a population-based cohort affected biopsy frequency and the detection of malignancies. Laboratory disclosures were also assessed. Data from 6753 participants in the Study of Health in Pomerania (SHIP) examined between 2008 and 2012 were utilized. All underwent laboratory examinations and 3371 (49.9%) a whole-body MRI. Electronic biopsy reports from 2002 to 2017 were linked to participants and assigned to outcome categories. Biopsy frequency 2 years pre- and post-SHIP was investigated using generalized estimating equations with a negative-binomial distribution. Overall 8208 IFs (laboratory findings outside reference limits: 6839; MRI: 1369) were disclosed to 4707 participants; 2271 biopsy reports belonged to 1200 participants (17.8%). Of these, 938 biopsies occurred pre-SHIP; 1333 post-SHIP (event rate/100 observation years = 6.9 [95% CI 6.5; 7.4]; 9.9 [9.3; 10.4]). Age, cancer history, recent hospitalization, female sex, and IF disclosure were associated with higher biopsy rates. Nonmalignant biopsy results increased more in participants with disclosures (post-/pre-SHIP rate ratio 1.39 [95% CI 1.22; 1.58]) than without (1.09 [95% CI 0.85; 1.38]). Malignant biopsy results were more frequent post-SHIP (rate ratio 1.74 [95% CI 1.27; 2.42]). Biopsies increased after participation in a population-based cohort study with MRI and laboratory IF disclosure. Most biopsies resulted in no findings and few malignancies were diagnosed, indicating potential overtesting and overdiagnosis. A more restrictive policy regarding IF disclosure from research findings is required.

Potentially relevant incidental findings on research whole-body MRI in the general adult population: frequencies and management

2012 ◽  
Vol 23 (3) ◽  
pp. 816-826 ◽  
Author(s):  
Katrin Hegenscheid ◽  
Rebecca Seipel ◽  
Carsten O. Schmidt ◽  
Henry Völzke ◽  
Jens-Peter Kühn ◽  
...  
Keyword(s):  
Incidental Findings ◽  
Adult Population ◽  
Whole Body ◽  
Whole Body Mri ◽  
General Adult Population

scholarly journals A new criterion for the alarm point using a combination of waveform amplitude and onset latency in Br(E)-MsEP monitoring in spine surgery

2018 ◽  
Vol 29 (4) ◽  
pp. 435-441 ◽  
Author(s):  
Kazuyoshi Kobayashi ◽  
Kei Ando ◽  
Ryuichi Shinjo ◽  
Kenyu Ito ◽  
Mikito Tsushima ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Predictive Value ◽  
False Positive ◽  
Roc Analysis ◽  
False Positive Rate ◽  
False Negative ◽  
False Negative Rate ◽  
High Rate ◽  
Motor Deficit ◽  
Onset Latency

OBJECTIVEMonitoring of brain evoked muscle-action potentials (Br[E]-MsEPs) is a sensitive method that provides accurate periodic assessment of neurological status. However, occasionally this method gives a relatively high rate of false-positives, and thus hinders surgery. The alarm point is often defined based on a particular decrease in amplitude of a Br(E)-MsEP waveform, but waveform latency has not been widely examined. The purpose of this study was to evaluate onset latency in Br(E)-MsEP monitoring in spinal surgery and to examine the efficacy of an alarm point using a combination of amplitude and latency.METHODSA single-center, retrospective study was performed in 83 patients who underwent spine surgery using intraoperative Br(E)-MsEP monitoring. A total of 1726 muscles in extremities were chosen for monitoring, and acceptable baseline Br(E)-MsEP responses were obtained from 1640 (95%). Onset latency was defined as the period from stimulation until the waveform was detected. Relationships of postoperative motor deficit with onset latency alone and in combination with a decrease in amplitude of ≥ 70% from baseline were examined.RESULTSNine of the 83 patients had postoperative motor deficits. The delay of onset latency compared to the control waveform differed significantly between patients with and without these deficits (1.09% ± 0.06% vs 1.31% ± 0.14%, p < 0.01). In ROC analysis, an intraoperative 15% delay in latency from baseline had a sensitivity of 78% and a specificity of 96% for prediction of postoperative motor deficit. In further ROC analysis, a combination of a decrease in amplitude of ≥ 70% and delay of onset latency of ≥ 10% from baseline had sensitivity of 100%, specificity of 93%, a false positive rate of 7%, a false negative rate of 0%, a positive predictive value of 64%, and a negative predictive value of 100% for this prediction.CONCLUSIONSIn spinal cord monitoring with intraoperative Br(E)-MsEP, an alarm point using a decrease in amplitude of ≥ 70% and delay in onset latency of ≥ 10% from baseline has high specificity that reduces false positive results.

Transcutaneous Bilirubin Measurements in Full-Term Infants

PEDIATRICS ◽  
1982 ◽  
Vol 70 (3) ◽  
pp. 464-467 ◽  
Author(s):  
M. Jeffrey Maisels ◽  
Sarah Conrad
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
False Positive ◽  
Neonatal Jaundice ◽  
Serum Bilirubin ◽  
False Negative ◽  
Full Term ◽  
Bilirubin Concentration ◽  
Term Infants ◽  
Transcutaneous Bilirubin

A total of 292 transcutaneous bilirubin (TcB) measurements were performed in 157 white full-term infants: 157 were obtained from the forehead and 135 from the midsternum. TcB measurements correlated well with serum bilirubin determinations (r = .93, P &lt; .0001). The sensitivity of the test was 100% and the specificity 97%. It was possible to establish guidelines for the TcB measurement which identified all infants whose serum bilirubin concentrations exceeded 12.9 mg/100 ml (221 µmoles/liter) with no false-negative and only five false-positive determinations (3%). The positive predictive value for the TcB measurements was 58%. This implies that, in our population, an infant with a TcB index ≥24 has a 58% chance of having a serum bilirubin concentration &gt;12.9 mg/100 ml. The negative predictive value was 100%. Thus, a negative test will correctly predict the absence of hyperbilirubinemia in all cases. As these measurements were obtained prospectively in a well-baby population with a prevalence of hyperbilirubinemia (&gt;12.9 mg/100 ml) of 4.5%, the positive predictive value should be applicable to other similar populations and will, in fact, increase in populations with a higher prevalence of hyperbilirubinemia. TcB measurements can be recommended for the identification of significant neonatal jaundice in full-term infants. It is important to recognize, however, that because of potential variations in TcB meters as well as serum bilirubin measurements in different laboratories, each institution should establish its own criteria for the use of this instrument.

scholarly journals Re-attendance after false-positive screening mammography: a population-based study in the Netherlands

2013 ◽  
Vol 109 (8) ◽  
pp. 2044-2050 ◽  
Author(s):  
W Setz-Pels ◽  
L E M Duijm ◽  
J W Coebergh ◽  
M Rutten ◽  
J Nederend ◽  
...  
Keyword(s):  
The Netherlands ◽  
False Positive ◽  
Population Based ◽  
Screening Mammography ◽  
Population Based Study

Prediction of Adnexal Torsion by Ultrasound in Women with Acute Abdominal Pain

2019 ◽  
Vol 41 (06) ◽  
pp. 688-694
Author(s):  
Ron Bardin ◽  
Noga Perl ◽  
Reuven Mashiach ◽  
Eitan Ram ◽  
Sharon Orbach-Zinger ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
False Positive ◽  
Acute Abdominal Pain ◽  
Cohort Analysis ◽  
False Negative ◽  
True Positive ◽  
Adnexal Torsion ◽  
Positive Group

Abstract Purpose To investigate the accuracy of ultrasound in the diagnosis of adnexal torsion. Materials and Methods Retrospective cohort analysis of 322 women, presenting to a tertiary medical center with acute abdominal pain, who underwent gynecological examination, sonographic evaluation and laparoscopic surgery, between 2010 and 2016. Findings for adnexal torsion were compared among three groups: positive sonographic findings consistent with surgically confirmed adnexal torsion (true positive, n = 228); negative sonographic findings inconsistent with surgically confirmed adnexal torsion (false negative, n = 42); and positive sonographic findings inconsistent with a surgical diagnosis other than adnexal torsion (false positive, n = 52). Outcome measures were sensitivity and positive predictive value of ultrasound, and its specific features, for the diagnosis of adnexal torsion. Results The sensitivity of ultrasound for adnexal torsion diagnosis was 84.4 %, and the positive predictive value was 81.4 %. Edematous ovary and/or tube, as well as positive whirlpool sign had the highest sensitivity and positive predictive value. The false-negative group had the highest frequency of ovarian cysts (p = 0.0086) and the lowest frequency of ovarian edema (p < 0.0001). The false-positive group had the lowest proportion of pregnant women (p = 0.0022). Significantly more women in the true-positive group had a prior event of adnexal torsion (p = 0.026). Conclusion Ultrasound examination is highly accurate in the diagnosis of adnexal torsion. Clinicians should be aware of the presence of demographic and clinical characteristics that may positively or negatively affect sonographic diagnostic accuracy.

Concordance assessment between self-reports of substance use and urinalysis: A population-based study in Mashhad, Iran

2020 ◽  
pp. 1-15
Author(s):  
Mohammad Khajedaluee ◽  
Seyed Abdolrahim Rezaee ◽  
Narges Valizadeh ◽  
Tahereh Hassannia ◽  
Toktam Paykani
Keyword(s):  
Substance Use ◽  
Population Based ◽  
Population Based Study ◽  
Self Reports

scholarly journals The epidemiology of pituitary adenomas in Iceland, 1955–2012: a nationwide population-based study

2015 ◽  
Vol 173 (5) ◽  
pp. 655-664 ◽  
Author(s):  
Tomas Thor Agustsson ◽  
Tinna Baldvinsdottir ◽  
Jon G Jonasson ◽  
Elinborg Olafsdottir ◽  
Valgerdur Steinthorsdottir ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Incidental Findings ◽  
Disease Burden ◽  
Clinical Information ◽  
Population Based ◽  
Incidence Rates ◽  
Allocation Of Resources ◽  
Population Based Study ◽  
Total Prevalence ◽  
Clinically Significant

ObjectivePituitary adenomas (PA) are among the most common human neoplasms. To describe the epidemiology and assess the disease burden of clinically significant PAs, population-based studies are needed. Iceland has a small well-defined population. The aim of this study is to describe the epidemiology of PAs in Iceland over an expanded period of time.DesignThis is a retrospective observational study, including all PAs diagnosed in Iceland from 1955 to 2012.MethodsExtensive clinical information was gathered in a database. Prevalence rates for all PA subtypes were calculated along with standardized incidence rates (SIR). Sex ratios and relationships with adenoma size, age, and symptoms were assessed.ResultsWe identified 471 individuals: 190 men and 281 women. Total prevalence in 2012 was 115.57/100 000, prolactinomas were most prevalent (54.37/100 000) followed by non-functioning adenomas (NFPAs) (42.32/100 000). Throughout the period, NFPAs were most common (43.0%) followed by prolactinomas (39.9%) and 11.3% had acromegaly and 5.7% Cushing's disease. Women are diagnosed younger with smaller adenomas. Total SIR has increased significantly and is now 5.8/100 000 per year.ConclusionIn this nationwide study spanning six decades, we have confirmed PAs rising prevalence and incidence rates noted in recent studies. We demonstrated higher overall prevalence and incidence rates than ever previously recorded with an increasing predominance of NFPAs, which is not explained by incidental findings alone. There is a relationship with the introduction of imaging modalities, but the vast majority of patients are symptomatic at diagnosis. This underlines the importance of increased awareness, education, and appropriate allocation of resources for this growing group of patients.

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