scholarly journals The Value of a Systematic Protocol Using Endobronchial Ultrasound and Endoscopic Ultrasound in Staging of Lung Cancer for Patients with Imaging iN0–N1 Disease

2021 ◽  
pp. 92-101
Author(s):  
Rosa Cordovilla ◽  
Marco López Zubizarreta ◽  
Antonio Velasco ◽  
Alberto Álvarez ◽  
Marta Rodríguez ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Negative Likelihood Ratio ◽  
Endobronchial Ultrasound ◽  
Multidisciplinary Study ◽  
Mediastinal Metastasis ◽  
Post Test ◽  
To Receive ◽  
Test Probability ◽  
Higher Sensitivity ◽  
Prospective Database

<b><i>Introduction:</i></b> We hypothesize that systematic, combined, and multidisciplinary study of the mediastinum (endobronchial ultrasound [EBUS] and endoscopic ultrasound [EUS]) in patients with NSCLC with radiologically normal mediastinum improves the results of mediastinal staging obtained with EBUS alone. <b><i>Material and Methods:</i></b> A retrospective study of the prospective database collected on the patients with NSCLC with a radiologically normal mediastinum and an indication for systematic staging with EBUS and EUS. EBUS staging was followed by EUS in patients in which the results from the pathological analysis of EBUS were negative. <b><i>Results:</i></b> Forty-five patients were included in the analysis. The combination of EBUS followed by EUS provided better results than EBUS alone: sensitivity (S) 95% versus 80%, negative predictive value (NPV) 96.15% versus 86.21%, negative likelihood ratio 0.05 versus 0.20, and post-test probability 3.8% versus 13.8%. This represents an increase in S (15%), the validity index (6.6%), and NPV (9.9%) compared to EBUS alone. There were 4 false negatives (FNs) (8.8%) with the EBUS test alone. After adding EUS, 3 more cases were positive (6.6%) and only 1 FN (2.2%). <b><i>Conclusions:</i></b> In patients with NSCLC and a radiographically normal mediastinum, a systematic and combined staging with EBUS and EUS show higher sensitivity in the detection of mediastinal metastasis than with the use of EBUS alone. The high accuracy of the test means that the use of mediastinoscopy is not necessary to confirm the results in these patients. Since the availability of EUS is low, it may be advisable for the interventional pulmonologist to receive training in EUS-b.

IGF-1 assessed by pubertal status has the best positive predictive power for GH deficiency diagnosis in peripubertal children

2019 ◽  
Vol 32 (2) ◽  
pp. 173-179 ◽  
Author(s):  
Thais H. Inoue-Lima ◽  
Gabriela A. Vasques ◽  
Renata C. Scalco ◽  
Marilena Nakaguma ◽  
Berenice B. Mendonca ◽  
...  
Keyword(s):  
Short Stature ◽  
Predictive Power ◽  
Gh Deficiency ◽  
Roc Curves ◽  
Bone Age ◽  
Predictive Values ◽  
Pubertal Status ◽  
Post Test ◽  
Test Probability ◽  
Higher Sensitivity

Abstract Background When evaluating peripubertal short stature patients, the interpretation of insulin-like growth factor 1 (IGF-1) levels based on chronological age (CA) can be inaccurate due to the influence of sex steroids and, presently, there is no evidence to support the assessment of IGF-1 values according to bone age (BA) and pubertal status (PS). Our objective was to assess the discriminatory performance of IGF-1 levels based on CA, BA and PS in the diagnosis of growth hormone (GH) deficiency. Methods We evaluated IGF-1 levels from 154 peripubertal short stature patients classified as GH deficient (GHD, n=23) or non-GHD (n=131). IGF-1 was assayed by a chemiluminescent immunometric assay and transformed into standard deviation scores (SDS) according to CA (IGF-1-SDS-CA), BA (IGF-1-SDS-BA) and PS (IGF-1-SDS-PS). Results The performances of IGF-1-SDS-CA, IGF-1-SDS-BA and IGF-1-SDS-PS in the receiver operator characteristics (ROC) curves were similar. There were greater accuracy and specificity of IGF-1-SDS-PS (98.4% and 93.3%, respectively) and IGF-1-SDS-BA (92.7% and 90.1%, respectively) when compared to IGF-1-SDS-CA (65.6% and 69.5%, respectively). The post-test probability of the IGF-1-SDS was also improved when compared to PS and BA – 44.8% (IGF-1-SDS-PS), 16.8% (IGF-1-SDS-BA) and 5.1% (IGF-1-SDS-CA), with similar negative predictive values. Conclusions The evaluation of IGF-1 levels based on CA has a higher sensitivity than those based on BA or PS, which justify its use as a screening tool. Additionally, IGF-1 assessed by PS has the best positive predictive power for GHD diagnosis in peripubertal age and could reduce the necessity of a second GH stimulation test.

scholarly journals How Helpful Is aEEG? Context and User Experience Matter

2020 ◽  
Author(s):  
Amanda G. Sandoval Karamian ◽  
Courtney J. Wusthoff
Keyword(s):  
Likelihood Ratio ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Neonatal Seizure ◽  
Neonatal Seizures ◽  
Extreme Prematurity ◽  
Clinical Scenarios ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

Objective The aim of the study is to model amplitude-integrated electroencephalography (aEEG) utility to diagnose seizures in common clinical scenarios. Study Design Using reported neonatal seizure prevalence and aEEG sensitivities and specificities, likelihood ratios (LRs) and post-test probabilities were calculated to quantify aEEG utility to diagnose seizures in three typical clinical scenarios. Results Prevalence data supported pretest probabilities for neonatal seizures of 0.4 in neonatal hypoxic ischemic encephalopathy (HIE), 0.27 in bacterial meningitis, and 0.05 in extreme prematurity. Reported sensitivity of 85% and specificity of 90% for seizures with expert aEEG interpretation yielded a positive likelihood ratio (LR+) of 8.7 and a negative likelihood ratio (LR−) of 0.17. Reported sensitivity of 65% and specificity of 70% with intermediate interpretation yielded LR+ 2.17 and LR− 0.5. Reported sensitivity of 40% and sensitivity of 50% with inexperienced interpretation gave LR+ 0.8 and LR− 1.2. These translate the ability to move pretest to post-test probability highly dependent on user expertise. For HIE, a pretest probability of seizure of 0.4 moves to a post-test probability of 0.85 when aEEG is positive for seizures by expert interpretation, and down to 0.1 when aEEG is negative. In contrast, no useful information was gained between pretest and post-test probability by aEEG interpreted as negative or positive for seizure at the inexperienced user level. Similarly, in the models of meningitis or extreme prematurity, incremental information gained from aEEG ranged widely based on interpreter experience. Conclusion aEEG is most useful to screen for neonatal seizures when used in conditions with high seizure prevalence, and when interpretation has a sensitivity and specificity as reported for expert users. In contrast, aEEG can become negligible in providing meaningful clinical information when applied in conditions having lower seizure prevalence or when interpretation has low accuracy. Appropriate patient selection and high quality interpretation are essential for aEEG utility in neonatal seizure detection. Key Points

scholarly journals A Mobile Terminal-based Nomogram for Early Predicting Severity of Acute Pancreatitis

2021 ◽  
Author(s):  
Na Shi ◽  
Xiaoxin Zhang ◽  
Wenhua He ◽  
Lihui Deng ◽  
Lan Li ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Prognostic Factors ◽  
Likelihood Ratio ◽  
Clinical Utility ◽  
Negative Likelihood Ratio ◽  
Mobile Terminal ◽  
Prognostic Scores ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

Abstract Background: Early prediction of the severity of acute pancreatitis (AP) is important but there is no preferred method in China. We aimed to develop and validate a simple-to-use predictive nomogram for persistent organ failure (POF) on admission in patients with AP. Methods: Data from 816 consecutive patients was obtained from internal (Chengdu) retrospective datasets and formed the training cohort for nomogram development. Data from 398 and 880 consecutive patients from internal (Chengdu) and external (Nanchang) prospective datasets formed the validation cohorts (all admitted < 48 hours of symptom onset). Univariate and multivariate logistic regressions were used to identify independent prognostic factors to establish the nomogram for POF. The calibration curves, concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC) were used to evaluate the performance of the nomogram and its clinical utility. The area under the receiver-operating characteristic curve (AUC) with 95% CI and likelihood ratio as well as post-test probability were applied. Measurements and main results: Age, respiratory rate, albumin, lactate dehydrogenase, oxygen support, and pleural effusion were identified as independent prognostic factors for POF and were included in the nomogram model (web-based calculator: https://shina.shinyapps.io/DynNomapp/). This predictive nomogram had good predictive ability for POF (C-indexes of 0.88, 0.91 and 0.81 for the training and two validation cohorts) and promising clinical utility (DCA: better or equivalent than prognostic scores; CIC: high clinical net benefit). The AUC of (0.91 [0.88-0.94] and 0.81 [0.79-0.84]), negative likelihood ratio (NLR 0.11 and 0.29), post-test probability of negative (0.9% and 6.7%) of the nomogram were superior in predicting POF than all other routinely used clinical prognostic scoring systems in both validation cohorts. Similar findings were observed for predicting major infection (superior to other prognostic scores) and mortality (superior or equally to others). Conclusions: The validated nomogram comprises 6 independent prognostic factors to predict major clinical outcomes of patients with AP in two distinct Chinese centers. This mobile terminal-based nomogram should be validated in other settings and considered for clinical practice and trial allocation, until more accurate biomarkers are discovered.

The incremental yield of endoscopic ultrasound over endobronchial ultrasound and CT for detection of extrathoracic metastases in lung cancer

Endoscopy ◽  
2006 ◽  
Vol 39 (S 1) ◽  
Author(s):  
J Conway ◽  
G Silvestri ◽  
C Reed ◽  
J Romagnuolo ◽  
R Hawes ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Endoscopic Ultrasound ◽  
Endobronchial Ultrasound

Prediction of encephalopathy in perinatal asphyxia score: reaching the unreached

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Srinivasa Murthy Doreswamy ◽  
Amulya Ramakrishnegowda
Keyword(s):  
Therapeutic Hypothermia ◽  
Sensitivity And Specificity ◽  
Perinatal Asphyxia ◽  
High Specificity ◽  
Test Sample ◽  
Therapeutic Benefit ◽  
Primary Outcome Measure ◽  
Primary Objective ◽  
Post Test ◽  
Test Probability

Abstract Objectives Neonates who develop moderate to severe encephalopathy following perinatal asphyxia will benefit from therapeutic hypothermia. Current National Institute of Child Health and Human Development (NICHD) criteria for identifying encephalopathic neonates needing therapeutic hypothermia has high specificity. This results in correctly identifying neonates who have already developed moderate to severe encephalopathy but miss out many potential beneficiaries who progress to develop moderate to severe encephalopathy later. The need is therefore not just to diagnose encephalopathy, but to predict development of encephalopathy and extend the therapeutic benefit for all eligible neonates. The primary objective of the study was to develop and validate the statistical model for prediction of moderate to severe encephalopathy following perinatal asphyxia and compare with current NICHD criteria. Methods The study was designed as prospective observational study. It was carried out in a single center Level 3 perinatal unit in India. Neonates>35 weeks of gestation and requiring resuscitation at birth were included. Levels of resuscitation and blood gas lactate were used to determine the pre-test probability, Thompson score between 3 and 5 h of life was used to determine post-test probability of developing encephalopathy. Primary outcome measure: Validation of Prediction of Encephalopathy in Perinatal Asphyxia (PEPA) score by Holdout method. Results A total of 55 babies were included in the study. The PEPA score was validated by Holdout method where the fitted receiver-operating characteristic (ROC) area for the training and test sample were comparable (p=0.758). The sensitivity and specificity of various PEPA scores for prediction of encephalopathy ranged between 74 and 100% in contrast to NICHD criteria which was 42%. PEPA score of 30 had a best combination of sensitivity and specificity of 95 and 89% respectively. Conclusions PEPA score has a higher sensitivity than NICHD criteria for prediction of Encephalopathy in asphyxiated neonates.

Does ProCore fine needle biopsy really improve the clinical outcome of endoscopic ultrasound-guided sampling of pancreatic masses?

2021 ◽  
Author(s):  
Gabriele Delconte ◽  
Federica Cavalcoli ◽  
Andrea Magarotto ◽  
Giovanni Centonze ◽  
Cristina Bezzio ◽  
...  
Keyword(s):  
Adverse Events ◽  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Endoscopic Ultrasound ◽  
Needle Biopsy ◽  
Clinical Performance ◽  
Negative Likelihood Ratio ◽  
Fine Needle Biopsy ◽  
Fine Needle ◽  
Sensitivity Specificity

Introduction: Fine Needle Biopsy (FNB) has been suggested to provide better histological samples as compared to endoscopic ultrasound fine needle aspiration (EUS-FNA). However, studies comparing EUS-FNA and EUS-FNB for pancreatic lesions reported contrasting results. The aim of this study was to compare the clinical performance of EUS-FNA versus EUS-FNB with ProCore needle for the investigation of pancreatic lesions. Methods: We reviewed all patients undergoing EUS for the investigation of pancreatic lesions from August 2012 to September 2018. From August 2012 to January 2015 all procedures were performed with standard needles, whereas from February 2015 to September 2018 the use of ProCore needles had been introduced. Data on diagnostic accuracy, number of needle passes and/or adverse events were collected. Results: 324 patients were retrospectively evaluated: 190 (58.6%) underwent EUS-FNA and 134 (41.4%) EUS-FNB. Both EUS-FNA and EUS-FNB showed high diagnostic accuracy for malignancy [94% (CI 95%:89-97%) vs 94% (CI 95%:89-98%)]. Notable, there were no differences between EUS-FNA and EUS-FNB in terms of sensitivity, specificity, positive and negative likelihood ratio, histological core tissue retrieval, adverse events or number of needle passes. However, subgroup analysis noted a higher diagnostic accuracy for 25G EUS-FNB as compared to 25G EUS-FNA (85,7% vs 55,5%; *p=0.023). Conclusion: EUS-FNB with ProCore needle is safe and feasible in pancreatic lesions. ProCore needle did not provide any advantage in terms of diagnostic accuracy, sensitivity, specificity, positive and/or negative likelihood ratio, or acquisition of core specimen, therefore its routine application is not

scholarly journals Atypical Endometrial Hyperplasia and Unexpected Cancers at Final Histology: A Study on Endometrial Sampling Methods and Risk Factors

Diagnostics ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. 474 ◽  
Author(s):  
Luca Giannella ◽  
Giovanni Delli Carpini ◽  
Francesco Sopracordevole ◽  
Maria Papiccio ◽  
Matteo Serri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endometrial Hyperplasia ◽  
Probability Analysis ◽  
Secondary Outcome ◽  
Endometrial Sampling ◽  
Final Histology ◽  
Atypical Endometrial Hyperplasia ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

Background: Up to 40% of women with atypical endometrial hyperplasia (AEH) can reveal endometrial cancer (EC) at hysterectomy. The pre-operative endometrial sampling method (ESM) and some independent cancer predictors may affect this outcome. The present study aimed to compare the rate of EC at hysterectomy in women with AEH undergoing dilation and curettage (D&C), hysteroscopically-guided biopsy (HSC-bio), or hysteroscopic endometrial resection (HSC-res). The secondary outcome was to compare the reliability of ESMs in women showing independent variables associated with EC. Methods: Two-hundred-and-eight consecutive women with AEH and undergoing hysterectomy between January 2000 and December 2017 were analyzed retrospectively. Based on pre- and post-test probability analysis for EC, three ESMs were compared: D&C, HSC-bio, and HSC-res. Univariate and multivariate analyses were performed to assess risk factors predicting cancer on final histology. Finally, the patient’s characteristics were compared between the three ESM groups. Results: D&C and HSC-bio included 75 women in each group, while HSC-res included 58 women. Forty-nine women (23.6%) revealed cancer at hysterectomy (pre-test probability). Post-test probability analysis showed that HSC-res had the lowest percentage of EC underestimation: HSC-res = 11.6%; HSC-bio = 19.5%; D&C = 35.3%. Patient characteristics showed no significant differences between the three ESMs. Multivariate analysis showed that body mass index ≥40 (Odds Ratio (OR) = 19.75; Confidence Intervals (CI) 2.193–177.829), and age (criterion > 60 years) (OR = 1.055, CI 1.002–1.111) associated significantly with EC. In women with one or both risk factors, post-test probability analysis showed that HSC-res was the only method with a lower EC rate at hysterectomy compared to a pre-test probability of 44.2%: HSC-res = 19.96%; HSC-bio = 53.81%; D&C = 63.12%. Conclusions: HSC-res provided the lowest rate of EC underestimation in AEH, also in women showing EC predictors. These data may be considered for better diagnostic and therapeutic planning of AEH.

Impact of thyroid nodule size on prevalence and post-test probability of malignancy: A systematic review

2014 ◽  
Vol 125 (1) ◽  
pp. 263-272 ◽  
Author(s):  
Jennifer J. Shin ◽  
Diana Caragacianu ◽  
Gregory W. Randolph
Keyword(s):  
Systematic Review ◽  
Thyroid Nodule ◽  
Nodule Size ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

scholarly journals Ultrasound diagnosis of molar pregnancy

Ultrasound ◽  
2018 ◽  
Vol 26 (3) ◽  
pp. 153-159 ◽  
Author(s):  
Jackie A. Ross ◽  
Alina Unipan ◽  
Jackie Clarke ◽  
Catherine Magee ◽  
Jemma Johns
Keyword(s):  
Likelihood Ratio ◽  
Gestational Trophoblastic Disease ◽  
Ultrasound Diagnosis ◽  
Histopathological Diagnosis ◽  
Molar Pregnancy ◽  
Diagnostic Challenge ◽  
Trophoblastic Disease ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

Introduction The primary aims of this study were to establish what proportion of ultrasonically suspected molar pregnancies were proven on histological examination and what proportion of histologically diagnosed molar pregnancies were identified by ultrasound pre-operatively. The secondary aim was to review the features of these scans to help identify criteria that may improve ultrasound diagnosis. Methods This was a retrospective observational study conducted in the Early Pregnancy Unit at King’s College Hospital London over an 11-year period. Cases of ultrasonically suspected molar pregnancy or other gestational trophoblastic disease were identified and compared with the final histopathological diagnosis. In addition, cases which were diagnosed on histopathology that were not suspected on ultrasound were also examined. In discrepant cases, the images were reviewed unblinded by two senior sonographers. Statistical analysis for likelihood ratio and post-test probabilities was performed. Results One hundred eighty-two women had gestational trophoblastic disease suspected on ultrasound examination (1:360, 0.3%); 106/182 (58.2%, 95% CI 51.0 to 65.2%) had histologically confirmed gestational trophoblastic disease. The likelihood ratio for gestational trophoblastic disease after a positive ultrasound was 607.27, with a post-test probability of 0.628.The sensitivity of ultrasound for gestational trophoblastic disease was 70.7% (95% CI 62.9% to 77.4%) with an estimated specificity of 99.88% (95% CI 99.85% to 99.91%); 102/143 (71.3%, 95% CI 63.4 to 78.1%) molar pregnancies were suspected on pre-op ultrasound; 60/68 (88.2%, 95% CI 78.2 to 94.2%) of complete moles were suspected on pre-op ultrasound, compared with 42/75 (56.0%, 95% CI 44.7 to 66.7%) of partial moles. On retrospective review of the pre-op ultrasound images, there were cases that could have been suspected prior to surgery. Conclusion Detecting molar pregnancy by ultrasound remains a diagnostic challenge, particularly for partial moles. These data suggest that there has been an increase in both the predictive value and the sensitivity of ultrasound over time, with a high LR and post-test probability; however, the diagnostic criteria remain ill-defined and could be improved.

Graphic Representation of Sequential Bayesian Analysis

1999 ◽  
Vol 38 (03) ◽  
pp. 182-186 ◽  
Author(s):  
I. Heller ◽  
M. Topilsky ◽  
I. Shapira ◽  
A. Isakov
Keyword(s):  
Medical Education ◽  
Receiver Operating Characteristic ◽  
Sequential Analysis ◽  
Operating Characteristic ◽  
Clinical Work ◽  
Bayes Theorem ◽  
Post Test ◽  
Straight Lines ◽  
Operating Points ◽  
Test Probability

AbstractPreviously undescribed algebraic transforms of Bayes’ theorem define families of operating points in the receiver operating characteristic (ROC) space which, at given pre-test probability, produce constant post-test probabilities. These isopredictive operating points form straight lines in the ROC space. The lines can be used to emulate Bayesian sequential analysis in a strictly graphic procedure, which can be applied in clinical work and medical education.

Sign in / Sign up

Export Citation Format

Share Document