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Best AM, Lang TA, Greenberg BL, Gunsolley JC, Ioannidou E. The Oral Health Statistics Guidelines for Reporting Observational Studies and Clinical Trials in Oral Health Research: Explanation and Elaboration. J Oral Maxillofac Surg 2024:S0278-2391(24)00584-6. [PMID: 39032518 DOI: 10.1016/j.joms.2024.06.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 06/24/2024] [Indexed: 07/23/2024]
Abstract
Adequate and transparent reporting is necessary for critically appraising research. Yet, evidence suggests that the design, conduct, analysis, interpretation, and reporting of oral health research could be greatly improved. Accordingly, the Task Force on Design and Analysis in Oral Health Research-statisticians and trialists from academia and industry-empaneled a group of authors to develop methodological and statistical reporting guidelines identifying the minimum information needed to document and evaluate observational studies and clinical trials in oral health: the Oral Health Statistics Guidelines. Drafts were circulated to the editors of 85 oral health journals and to task force members and sponsors and discussed at a December 2020 workshop attended by 49 researchers. The final version was subsequently approved by the task force in September 2021, submitted for journal review in 2022, and revised in 2023. The checklist consists of 48 guidelines: 5 for introductory information, 17 for methods, 13 for statistical analysis, 6 for results, and 7 for interpretation; 7 are specific to clinical trials. Each of these guidelines identifies relevant information, explains its importance, and often describes best practices. The checklist was published in multiple journals. The article was published simultaneously in JDR Clinical and Translational Research, the Journal of the American Dental Association, and the Journal of Oral and Maxillofacial Surgery. Completed checklists should accompany manuscripts submitted for publication to these and other oral health journals to help authors, journal editors, and reviewers verify that the manuscript provides the information necessary to adequately document and evaluate the research.
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Affiliation(s)
- Al M Best
- Professor Emeritus, School of Dentistry and Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Thomas A Lang
- Adjunct Faculty, University of Chicago Medical Writing Program
| | - Barbara L Greenberg
- Adjunct Professor, Epidemiology and Biostatistics, Touro College of Dental Medicine at New York Medical College, Valhalla, NY
| | - John C Gunsolley
- Professor Emeritus, School of Dentistry, Virginia Commonwealth University, Richmond, VA
| | - E Ioannidou
- Professor and Chair of Orofacial Sciences, UCSF School of Dentistry, San Francisco, CA.
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Best AM, Lang TA, Greenberg BL, Gunsolley JC, Ioannidou E. The OHStat Guidelines for Reporting Observational Studies and Clinical Trials in Oral Health Research: explanation and elaboration. J Am Dent Assoc 2024:S0002-8177(24)00316-7. [PMID: 39001723 DOI: 10.1016/j.adaj.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2024]
Abstract
Adequate and transparent reporting is necessary for critically appraising research. Yet, evidence suggests that the design, conduct, analysis, interpretation, and reporting of oral health research could be greatly improved. Accordingly, the Task Force on Design and Analysis in Oral Health Research-statisticians and trialists from academia and industry-empaneled a group of authors to develop methodological and statistical reporting guidelines identifying the minimum information needed to document and evaluate observational studies and clinical trials in oral health: the OHstat Guidelines. Drafts were circulated to the editors of 85 oral health journals and to Task Force members and sponsors and discussed at a December 2020 workshop attended by 49 researchers. The final version was subsequently approved by the Task Force in September 2021, submitted for journal review in 2022, and revised in 2023. The checklist consists of 48 guidelines: 5 for introductory information, 17 for methods, 13 for statistical analysis, 6 for results, and 7 for interpretation; 7 are specific to clinical trials. Each of these guidelines identifies relevant information, explains its importance, and often describes best practices. The checklist was published in multiple journals. The article was published simultaneously in JDR Clinical and Translational Research, the Journal of the American Dental Association, and the Journal of Oral and Maxillofacial Surgery. Completed checklists should accompany manuscripts submitted for publication to these and other oral health journals to help authors, journal editors, and reviewers verify that the manuscript provides the information necessary to adequately document and evaluate the research.
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Best AM, Lang TA, Greenberg BL, Gunsolley JC, Ioannidou E. The OHStat Guidelines for Reporting Observational Studies and Clinical Trials in Oral Health Research: Explanation and Elaboration. JDR Clin Trans Res 2024:23800844241247029. [PMID: 38993046 DOI: 10.1177/23800844241247029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
Adequate and transparent reporting is necessary for critically appraising research. Yet, evidence suggests that the design, conduct, analysis, interpretation, and reporting of oral health research could be greatly improved. Accordingly, the Task Force on Design and Analysis in Oral Health Research-statisticians and trialists from academia and industry-empaneled a group of authors to develop methodological and statistical reporting guidelines identifying the minimum information needed to document and evaluate observational studies and clinical trials in oral health: the OHstat Guidelines. Drafts were circulated to the editors of 85 oral health journals and to Task Force members and sponsors and discussed at a December 2020 workshop attended by 49 researchers. The final version was subsequently approved by the Task Force in September 2021, submitted for journal review in 2022, and revised in 2023. The checklist consists of 48 guidelines: 5 for introductory information, 17 for methods, 13 for statistical analysis, 6 for results, and 7 for interpretation; 7 are specific to clinical trials. Each of these guidelines identifies relevant information, explains its importance, and often describes best practices. The checklist was published in multiple journals. The article was published simultaneously in JDR Clinical and Translational Research, the Journal of the American Dental Association, and the Journal of Oral and Maxillofacial Surgery. Completed checklists should accompany manuscripts submitted for publication to these and other oral health journals to help authors, journal editors, and reviewers verify that the manuscript provides the information necessary to adequately document and evaluate the research.
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Affiliation(s)
- A M Best
- School of Dentistry and Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - T A Lang
- University of Chicago Medical Writing Program, Chicago, IL, USA
| | - B L Greenberg
- Epidemiology and Biostatistics, Touro College of Dental Medicine at New York Medical College, Valhalla, NY, USA
| | - J C Gunsolley
- School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA
| | - E Ioannidou
- UCSF School of Dentistry, San Francisco, CA, USA
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Ding Y, Mo C, Ding Q, Lin T, Gao J, Chen M, Lu W, Sun J, Wang F, Zang S, Zhang Q, Zhang S, Guo H. Prediction of T staging in PI-RADS 4-5 prostate cancer by combination of multiparametric MRI and 68Ga-PSMA-11 PET/CT. BMC Urol 2023; 23:206. [PMID: 38082379 PMCID: PMC10712094 DOI: 10.1186/s12894-023-01376-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND In this study, we explored the diagnostic performances of multiparametric magnetic resonance imaging (mpMRI), 68 Ga-PSMA-11 PET/CT and combination of 68 Ga-PSMA-11 PET/CT and mpMRI (mpMRI + PET/CT) for extracapsular extension (ECE). Based on the analyses above, we tested the feasibility of using mpMRI + PET/CT results to predict T staging in prostate cancer patients. METHODS By enrolling 75 patients of prostate cancer with mpMRI and 68 Ga-PSMA-11 PET/CT before radical prostatectomy, we analyzed the detection performances of ECE in mpMRI, 68 Ga-PSMA-11 PET/CT and mpMRI + PET/CT on their lesion images matched with their pathological sample images layer by layer through receiver operating characteristics (ROC) analysis. By inputting the lesion data into Prostate Imaging Reporting and Data System (PI-RADS), we divided the lesions into different PI-RADS scores. The improvement of detecting ECE was analyzed by net reclassification improvement (NRI). The predictors for T staging were evaluated by using univariate and multivariable analysis. The Kappa test was used to evaluate the prediction ability. RESULTS One hundred three regions of lesion were identified from 75 patients. 50 of 103 regions were positive for ECE. The ECE diagnosis AUC of mpMRI + PET/CT is higher than that of mpMRI alone (ΔAUC = 0.101; 95% CI, 0.0148 to 0.1860; p < 0.05, respectively). Compared to mpMRI, mpMRI + PET/CT has a significant improvement in detecting ECE in PI-RADS 4-5 (NRI 36.1%, p < 0.01). The diagnosis power of mpMRI + PET/CT was an independent predictor for T staging (p < 0.001) in logistic regression analysis. In patients with PI-RADS 4-5 lesions, 40 of 46 (87.0%) patients have correct T staging prediction from mpMRI + PET/CT (κ 0.70, p < 0.01). CONCLUSION The prediction of T staging in PI-RADS 4-5 prostate cancer patients by mpMRI + PET/CT had a quite good performance.
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Affiliation(s)
- Yuanzhen Ding
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Chenghao Mo
- Department of Urology, Drum Tower Hospital Clinical College of Nanjing Medical University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Qiubo Ding
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Tingsheng Lin
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Jie Gao
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Mengxia Chen
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Wenfeng Lu
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Jiyuan Sun
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Shiming Zang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, 68 Changle Road, Nanjing, 210006, Jiangsu, China
| | - Qing Zhang
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
| | - Shiwei Zhang
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
| | - Hongqian Guo
- Department of Urology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
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Metser U, Kulanthaivelu R, Chawla T, Johnson S, Avery L, Hussey D, Veit-Haibach P, Bernardini M, Hogen L. 18F-DCFPyL PET/CT in advanced high-grade epithelial ovarian cancer: A prospective pilot study. Front Oncol 2022; 12:1025475. [PMID: 36313720 PMCID: PMC9606351 DOI: 10.3389/fonc.2022.1025475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Glutamate carboxypeptidase-II (GCP-II), a zinc metalloenzyme that resides in cell membrane, has been reported as overexpressed in the neovasculature of ovarian cancers. The study objective was to determine whether GCP-II targeted imaging with 18F-DCFPyL PET/CT can detect disease sites in women with advanced high-grade serous ovarian cancer (HGSOC). Materials and methods Twenty treatment-naïve women with advanced HGSOC were recruited (median age 60 years). Prior to commencing therapy (primary cytoreductive surgery [n=9] or neoadjuvant chemotherapy [n=11]), subjects underwent routine staging with contrast-enhanced abdominopelvic CT (=CT), followed by 18F-DCFPyL PET/CT (=PET). CT and PET were reported independently using a standardized reporting template assessing 25 sites. The performance of PET was compared to CT in all subjects and to surgery and surgical histopathology in 9 patients who underwent primary cytoreductive surgery. Results Of the 25 sites assessed in 20 patients, CT detected disease in 292/500 (58.4%) locations and PET detected disease in 171/500 (34.2%). Compared to CT the sensitivity (95% CI) of PET to detect disease in the upper abdomen, the gastrointestinal tract or the peritoneum was 0.29 (0.20,0.40), 0.21 (0.11,0.33) and 0.74 (0.64,0.82), respectively. In the surgical cohort, 220 sites in 9 patients were evaluated. The sensitivity and specificity of CT and PET were 0.85 versus 0.54 (p<0.001) and 0.73 versus 0.93 (p<0.001), respectively. Conclusion Although 18F-DCFPyL has higher specificity than CT in detecting advanced HGSOC tumor sites, it detects less disease sites than CT, especially in the upper abdomen and along the gastrointestinal tract, likely limiting its clinical utility. Clinical trial registration ClinicalTrials.gov, NCT03811899.
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Affiliation(s)
- Ur Metser
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON, Canada
- *Correspondence: Ur Metser,
| | - Roshini Kulanthaivelu
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Tanya Chawla
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Sarah Johnson
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Lisa Avery
- Department of Biostatistics, University Health Network, Toronto, ON, Canada
| | - Douglas Hussey
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON, Canada
| | - Marcus Bernardini
- Division of Gynecologic Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Liat Hogen
- Division of Gynecologic Oncology, University Health Network, University of Toronto, Toronto, ON, Canada
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Evaluation of a novel Echinococcus granulosus recombinant fusion B-EpC1 antigen for the diagnosis of human cystic echinococcosis using indirect ELISA in comparison with a commercial diagnostic ELISA kit. Exp Parasitol 2022; 240:108339. [PMID: 35863520 DOI: 10.1016/j.exppara.2022.108339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 07/03/2022] [Accepted: 07/13/2022] [Indexed: 11/22/2022]
Abstract
Cystic echinococcosis (CE) is a zoonotic parasitic disease caused by the metacestode of Echinococcus granulosus sensu lato (s.l.). A large proportion of the patients are asymptomatic at the early and late stages of the disease. CE diagnosis is mainly based on imaging techniques. Laboratory diagnosis including antibody-antigen (recombinant or fusion recombinant) can be used for the diagnosis and follow up of CE and alveolar echinococcosis (AE), but need optimization and standardization. This study aimed to evaluate the efficacy of a recombinant B-EpC1 (rB-EpC1) fusion antigen comprising B1, B2, B4, and EpC1 antigens of E. granulosus using indirect ELISA in comparison with a commercial ELISA kit for the serodiagnosis of CE. The recombinant protein was expressed in the expression host, E. coli BL21, and purified. This recombinant antigen was then evaluated by indirect ELISA and compared to the commercial CE diagnostic kit (Vircell, Spain). The study samples included 124 human sera consisting of 62 sera of patients with CE, and 62 sera of individuals without clinical evidences of CE and specific anti-CE antibodies in routine indirect ELISA. The diagnostic sensitivity and specificity of the indirect rB-EpC1-ELISA test for detection of specific anti-hydatid cyst antibodies in human CE were 95.2% and 96.8%, respectively. Also, the diagnostic sensitivity and specificity of the commercial ELISA test were 96.8% in this study. Initial evaluation of the recombinant fusion antigen (B-EpC1) was promising for the detection of CE by ELISA in clinical settings. Standardization and evaluation of recombinant fusion protein require further studies.
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Liu YL, Ying GS, Quinn GE, Zhou XH, Chen Y. Extending Hui-Walter framework to correlated outcomes with application to diagnosis tests of an eye disease among premature infants. Stat Med 2022; 41:433-448. [PMID: 34859902 PMCID: PMC8884176 DOI: 10.1002/sim.9269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 08/28/2021] [Accepted: 11/05/2021] [Indexed: 11/08/2022]
Abstract
Diagnostic accuracy, a measure of diagnostic tests for correctly identifying patients with or without a target disease, plays an important role in evidence-based medicine. Diagnostic accuracy of a new test ideally should be evaluated by comparing to a gold standard; however, in many medical applications it may be invasive, costly, or even unethical to obtain a gold standard for particular diseases. When the accuracy of a new candidate test under evaluation is assessed by comparison to an imperfect reference test, bias is expected to occur and result in either overestimates or underestimates of its true accuracy. In addition, diagnostic test studies often involve repeated measurements of the same patient, such as the paired eyes or multiple teeth, and generally lead to correlated and clustered data. Using the conventional statistical methods to estimate diagnostic accuracy can be biased by ignoring the within-cluster correlations. Despite numerous statistical approaches have been proposed to tackle this problem, the methodology to deal with correlated and clustered data in the absence of a gold standard is limited. In this article, we propose a method based on the composite likelihood function to derive simple and intuitive closed-form solutions for estimates of diagnostic accuracy, in terms of sensitivity and specificity. Through simulation studies, we illustrate the relative advantages of the proposed method over the existing methods that simply treat an imperfect reference test as a gold standard in correlated and clustered data. Compared with the existing methods, the proposed method can reduce not only substantial bias, but also the computational burden. Moreover, to demonstrate the utility of this approach, we apply the proposed method to the study of National-Eye-Institute-funded Telemedicine Approaches to Evaluating of Acute-Phase Retinopathy of Prematurity (e-ROP), for estimating accuracies of both the ophthalmologist examination and the image evaluation.
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Affiliation(s)
- Yu-Lun Liu
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.,Correspondence to: Yong Chen, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA or Yu-Lun Liu, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA. or
| | - Gui-Shuang Ying
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Graham E. Quinn
- Division of Pediatric Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, PA 19104, USA
| | - Xiao-Hua Zhou
- Department of Biostatistics, School of Public Health, Peking University, China.,Beijing International Center for Mathematical Research, Peking University, China
| | - Yong Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA.,Correspondence to: Yong Chen, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA or Yu-Lun Liu, Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA. or
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Langbein T, Wang H, Rauscher I, Krönke M, Knorr K, Wurzer A, Schwamborn K, Maurer T, Horn T, Haller B, Wester HJ, Eiber M. Utility of 18F-rhPSMA-7.3 positron emission tomography for imaging of primary prostate cancer and pre-operative efficacy in N-staging of unfavorable intermediate to very high-risk patients validated by histopathology. J Nucl Med 2022; 63:1334-1342. [PMID: 34992154 DOI: 10.2967/jnumed.121.263440] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
18F-rhPSMA-7.3, the lead compound of a new class of radiohybrid prostate-specific membrane antigen (rhPSMA) ligands, is currently in phase III trials for prostate cancer (PCa) imaging. Here, we describe our experience in primary PCa staging. Methods: We retrospectively identified 279 patients with primary PCa who underwent 18F-rhPSMA-7.3 PET/CT (staging cohort). A subset of patients (83/279) subsequently underwent prostatectomy with lymph node (LN) dissection without prior treatment (efficacy cohort). Distribution of tumor lesions was determined for the staging cohort and stratified by National Comprehensive Cancer Network (NCCN) risk score. Involvement of pelvic LN was assessed retrospectively by 3 blinded independent central readers, and a majority rule was used for analysis. Standard surgical fields were rated on a five-point scale independently for PET and for morphological imaging. Results were compared to histopathological findings on a patient-, right vs. -left, and template-basis. Results: For the staging cohort 18F-rhPSMA-7.3 PET was positive in 275/279 (98.6%), 106/279 (38.0%), 46/279 (16.5%), 65/279 (23.3%) and 5/279 (1.8%) patients for local, pelvic nodal, extrapelvic nodal, metastatic bone, and visceral metastatic disease. In the efficacy cohort, LN metastases were present in 24/83 patients (29%), located in 48/420 (11%) resected templates and in 33/166 (19.9%) hemi-pelvic templates in histopathology. Based on majority vote results, the patient-level sensitivity, specificity and accuracy for pelvic nodal metastases were 66.7% (95%CI, 44.7-83.6%), 96.6% (95%CI, 87.3-99.4%) and 88.0% (95%CI, 78.5-93.8%) for 18F-rhPSMA-7.3 PET and 37.5% (95%CI, 19.6-59.2%), 91.5% (95%CI, 80.6-96.8%) and 75.9% (95%CI, 65.0-84.3%) for morphological imaging, respectively. 18F-rhPSMA-7.3 showed higher interobserver agreement than morphological imaging (patient-level Fleiss' κ=0.54; 95%CI, 0.47-0.62 vs. 0.24; 95%CI, 0.17-0.31). A mean standardized uptake value ratio of 6.6 (95%CI, 5.2-8.1) documented a high image contrast between local tumors and adjacent low urinary tracer retention. Conclusion: 18F-rhPSMA-7.3 PET offers superior diagnostic performance to morphological imaging for primary N-staging of newly diagnosed PCa, shows lower inter-reader variation, and offers good distinction between primary tumor and bladder background activity. With increasing NCCN risk group an increasing frequency of extra-prostatic tumor lesions was observed.
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Affiliation(s)
- Thomas Langbein
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Nuclear Medicine, Germany
| | - Hui Wang
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Nuclear Medicine, Germany
| | - Isabel Rauscher
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Nuclear Medicine, Germany
| | - Markus Krönke
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Nuclear Medicine, Germany
| | - Karina Knorr
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Nuclear Medicine, Germany
| | | | - Kristina Schwamborn
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Institute of Pathology, Germany
| | - Tobias Maurer
- Martini-Klinik and Department of Urology, University Hospital Hamburg-Eppendorf, Germany
| | - Thomas Horn
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Urology, Germany
| | - Bernhard Haller
- Technical University of Munich, School of Medicine, Institute of Medical Informatics, Statistics and Epidemiology, Germany
| | | | - Matthias Eiber
- Technical University of Munich, School of Medicine, Klinikum rechts der Isar, Department of Nuclear Medicine, Germany
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Hwang EJ, Lee JS, Lee JH, Lim WH, Kim JH, Choi KS, Choi TW, Kim TH, Goo JM, Park CM. Deep Learning for Detection of Pulmonary Metastasis on Chest Radiographs. Radiology 2021; 301:455-463. [PMID: 34463551 DOI: 10.1148/radiol.2021210578] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background A computer-aided detection (CAD) system may help surveillance for pulmonary metastasis at chest radiography in situations where there is limited access to CT. Purpose To evaluate whether a deep learning (DL)-based CAD system can improve diagnostic yield for newly visible lung metastasis on chest radiographs in patients with cancer. Materials and Methods A regulatory-approved CAD system for lung nodules was implemented to interpret chest radiographs from patients referred by the medical oncology department in clinical practice. In this retrospective diagnostic cohort study, chest radiographs interpreted with assistance from a CAD system after the implementation (January to April 2019, CAD-assisted interpretation group) and those interpreted before the implementation (September to December 2018, conventional interpretation group) of the CAD system were consecutively included. The diagnostic yield (frequency of true-positive detections) and false-referral rate (frequency of false-positive detections) of formal reports of chest radiographs for newly visible lung metastasis were compared between the two groups using generalized estimating equations. Propensity score matching was performed between the two groups for age, sex, and primary cancer. Results A total of 2916 chest radiographs from 1521 patients (1546 men, 1370 women; mean age, 62 years) and 5681 chest radiographs from 3456 patients (2941 men, 2740 women; mean age, 62 years) were analyzed in the CAD-assisted interpretation and conventional interpretation groups, respectively. The diagnostic yield for newly visible metastasis was higher in the CAD-assisted interpretation group (0.86%, 25 of 2916 [95% CI: 0.58, 1.3] vs 0.32%, 18 of 568 [95% CI: 0.20, 0.50%]; P = .004). The false-referral rate in the CAD-assisted interpretation group (0.34%, 10 of 2916 [95% CI: 0.19, 0.64]) was not inferior to that in the conventional interpretation group (0.25%, 14 of 5681 [95% CI: 0.15, 0.42]) at the noninferiority margin of 0.5% (95% CI of difference: -0.15, 0.35). Conclusion A deep learning-based computer-aided detection system improved the diagnostic yield for newly visible metastasis on chest radiographs in patients with cancer with a similar false-referral rate. © RSNA, 2021 Online supplemental material is available for this article.
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Affiliation(s)
- Eui Jin Hwang
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Jeong Su Lee
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Jong Hyuk Lee
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Woo Hyeon Lim
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Jae Hyun Kim
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Kyu Sung Choi
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Tae Won Choi
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Tae-Hyung Kim
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Jin Mo Goo
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
| | - Chang Min Park
- From the Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (E.J.H., J.S.L., J.H.L., W.H.L., J.H.K., K.S.C., T.W.C., T.H.K., J.M.G., C.M.P.); Department of Radiology, Namwon Medical Center, Namwon, Korea (W.H.L.); Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Korea (K.S.C.); and Department of Radiology, Naval Pohang Hospital, Pohang, Korea (T.H.K.)
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10
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Repeated Endoscopic Submucosal Dissection for Esophageal Neoplasia Located Close to a Previous Endoscopic Submucosal Dissection Scar. Clin Transl Gastroenterol 2021; 11:e00226. [PMID: 32955199 PMCID: PMC7423925 DOI: 10.14309/ctg.0000000000000226] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION: Endoscopic submucosal dissection (ESD) could become a standard treatment for early stage esophageal neoplasia. Recurrence sometimes develops close to a previous ESD scar. These lesions are predictably difficult to treat with ESD because of severe fibrosis. We evaluated the clinical outcomes of ESD for esophageal neoplasia located close to a previous ESD scar. METHODS: This was a retrospective observational study in a single institution. A total of 549 consecutive patients with 927 esophageal lesions were treated with ESD. The primary outcomes were resectability and adverse events of esophageal neoplasia located close to previous ESD scars (ESD scar group) than in primary esophageal ESD (primary group). Furthermore, predictive factors of perforation were examined. RESULTS: A total of 545 primary and 29 ESD scars in consecutive patients were evaluated. En bloc and complete (R0) resection rates in the ESD scar group were lower than those in the primary group (79.3% vs 98.3%, P < 0.01 and 75.9% vs 93.4%, P < 0.01). Perforations occurred more frequently in the ESD scar group (10.3% vs 2.0%, P = 0.03). The ESD scar group was a predictive factor for perforation (odds ratio = 10.37, 95% confidence interval: 2.15–49.94, P = 0.004). There were similar results for inverse probability of treatment weighting methods (odds ratio = 6.78, 95% confidence interval: 1.40–32.98, P = 0.018). DISCUSSION: ESD for esophageal neoplasia located close to a previous ESD scar was difficult to completely resect and increased the likelihood of perforation but could be a treatment option.
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11
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Identification of immunodominant proteins of Leishmania infantum by immunoproteomics to evaluate a recombinant multi-epitope designed antigen for serodiagnosis of human visceral leishmaniasis. Exp Parasitol 2021; 222:108065. [PMID: 33428893 DOI: 10.1016/j.exppara.2021.108065] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/16/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022]
Abstract
Visceral leishmaniasis (VL) is a protozoan disease caused by Leishmania infantum in the Mediterranean region including Iran. In 95% of cases, the disease can be fatal if not rapidly diagnosed and left untreated. We aimed to identify immunoreactive proteins of L. infantum (Iranian strain), and to design and evaluate a recombinant multi-epitope antigen for serodiagnosis of human VL. To detect the immunoreactive proteins of L. infantum promastigotes, 2DE immunoblotting technique was performed using different pooled sera of VL patients. The candidate immunoreactive proteins were identified using MALDI-TOF/TOF mass spectrophotometry. Among 125 immunoreactive spots detected in 2-DE gels, glucose-regulated protein 78 (GRP78), ubiquitin-conjugating enzyme E2, calreticulin, mitochondrial heat shock 70-related protein 1 (mtHSP70), heat shock protein 70-related protein, i/6 autoantigen-like protein, ATPase beta subunit, and proteasome alpha subunit 5 were identified. The potent epitopes from candidate immunodominant proteins including GRP78, mtHSP70 and ubiquitin-conjugating enzyme E2 were then selected to design a recombinant antigenic protein (GRP-UBI-HSP). The recombinant antigen was evaluated by ELISA and compared to direct agglutination test for detection of anti L. infantum human antibodies. We screened 34 sera of VL patients from endemic areas and 107 sera of individuals without L. infantum infection from non-endemic area of VL. The recombinant protein-based ELISA provided a sensitivity of 70.6% and a specificity of 84.1%. These results showed that GRP78, ubiquitin-conjugating enzyme E2, and mtHSP70 proteins are potential immunodominant targets of the host immune system in response to the parasite and they can be considered as potential candidate markers for diagnosis purposes.
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12
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Kroenke M, Wurzer A, Schwamborn K, Ulbrich L, Jooß L, Maurer T, Horn T, Rauscher I, Haller B, Herz M, Wester HJ, Weber WA, Eiber M. Histologically Confirmed Diagnostic Efficacy of 18F-rhPSMA-7 PET for N-Staging of Patients with Primary High-Risk Prostate Cancer. J Nucl Med 2019; 61:710-715. [PMID: 31836681 DOI: 10.2967/jnumed.119.234906] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/03/2019] [Indexed: 01/06/2023] Open
Abstract
18F-rhPSMA-7 (radiohybrid prostate-specific membrane antigen [PSMA]) is a novel ligand for PET imaging. Here, we present data from a retrospective analysis using PET/CT and PET/MRI examinations to investigate the efficacy of 18F-rhPSMA-7 PET for primary N-staging of patients with prostate cancer (PC) compared with morphologic imaging (CT or MRI) and validated by histopathology. Methods: Data from 58 patients with high-risk PC (according to the D'Amico criteria) who were staged with 18F-rhPSMA-7 PET/CT or PET/MRI at our institution between July 2017 and June 2018 were reviewed. The patients had a median prescan prostate-specific antigen value of 12.2 ng/mL (range, 1.2-81.6 ng/mL). The median injected activity of 18F-rhPSMA-7 was 327 MBq (range, 132-410 MBq), with a median uptake time of 79.5 min (range, 60-153 min). All patients underwent subsequent radical prostatectomy and extended pelvic lymph node dissection. The presence of lymph node metastases was determined by an experienced reader independently for both the PET and the morphologic datasets using a template-based analysis on a 5-point scale. Patient-level and template-based results were both compared with histopathologic findings. Results: Lymph node metastases were present in 18 patients (31.0%) and were located in 52 of 375 templates (13.9%). Receiver-operating-characteristic analyses showed 18F-rhPSMA-7 PET to perform significantly better than morphologic imaging on both patient-based and template-based analyses (areas under curve, 0.858 vs. 0.649 [P = 0.012] and 0.765 vs. 0.589 [P < 0.001], respectively). On patient-based analyses, the sensitivity, specificity, and accuracy of 18F-rhPSMA-7 PET were 72.2%, 92.5%, and 86.2%, respectively, and those of morphologic imaging were 50.0%, 72.5%, and 65.5%, respectively. On template-based analyses, the sensitivity, specificity, and accuracy of 18F-rhPSMA-7 PET were 53.8%, 96.9%, and 90.9%, respectively, and those of morphologic imaging were 9.6%, 95.0%, and 83.2%, respectively. Conclusion: 18F-rhPSMA-7 PET is superior to morphologic imaging for N-staging of high-risk primary PC. The efficacy of 18F-rhPSMA-7 is similar to published data for 68Ga-PSMA-11.
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Affiliation(s)
- Markus Kroenke
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Kristina Schwamborn
- Institute of Pathology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lena Ulbrich
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lena Jooß
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tobias Maurer
- Martini-Klinik and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Horn
- Department of Urology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; and
| | - Isabel Rauscher
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Michael Herz
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | - Wolfgang A Weber
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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13
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Albuquerque A, Sheaff M, Stirrup O, Cappello C, Bowring J, Cuming T, De Masi A, Rosenthal AN, Nathan M. Performance of Anal Cytology Compared With High-Resolution Anoscopy and Histology in Women With Lower Anogenital Tract Neoplasia. Clin Infect Dis 2019; 67:1262-1268. [PMID: 29659752 DOI: 10.1093/cid/ciy273] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/03/2018] [Indexed: 12/26/2022] Open
Abstract
Background Information on the performance of anal cytology in women who are high risk for human papillomavirus-related lesions and the factors that might influence cytology are largely lacking. Methods Retrospective study including all new referrals of women with a previous history of anogenital neoplasia from January 2012 to July 2017, with concomitant anal cytology and high-resolution anoscopy with or without biopsies. Results Six hundred and thirty six anal cytology samples and 323 biopsies obtained from 278 women were included. Overall sensitivity and specificity of "any abnormality" on anal cytology to predict any abnormality in histology was 47% (95% confidence interval [CI], 41%-54%) and 84% (95% CI, 73%-91%), respectively. For detecting high-grade squamous intraepithelial lesions (HSIL)/cancer, sensitivity was 71% (95% CI, 61%-79%) and specificity was 73% (95% CI, 66%-79%). There was a poor concordance between cytological and histological grades (κ = 0.147). Cytology had a higher sensitivity to predict HSIL/cancer in immunosuppressed vs nonimmunosuppressed patients (92% vs 60%, P = .002). The sensitivity for HSIL detection was higher when 2 or more quadrants were affected compared with 1 (86% vs 57%, P = .006). A previous history of vulvar HSIL/cancer (odds ratio [OR], 1.71, 1.08-2.73; P = .023), immunosuppression (OR, 1.88, 1.17-3.03; P = .009), and concomitant genital HSIL/cancer (OR, 2.51, 1.47-4.29; P = .001) were risk factors for abnormal cytology. Conclusions Women characteristics can influence the performance of anal cytology. The sensitivity for detecting anal HSIL/cancer was higher in those immunosuppressed and with more extensive disease.
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Affiliation(s)
- Andreia Albuquerque
- Homerton Anal Neoplasia Service, Homerton University Hospital, London, United Kingdom.,Faculty of Medicine of the University of Porto, Portugal
| | - Michael Sheaff
- Cellular Pathology, Barts Health National Health Service Trust
| | - Oliver Stirrup
- Centre for Clinical Research in Infection and Sexual Heath, Institute for Global Health University College London, London, United Kingdom
| | - Carmelina Cappello
- Homerton Anal Neoplasia Service, Homerton University Hospital, London, United Kingdom
| | - Julie Bowring
- Homerton Anal Neoplasia Service, Homerton University Hospital, London, United Kingdom
| | - Tamzin Cuming
- Homerton Anal Neoplasia Service, Homerton University Hospital, London, United Kingdom
| | - Anke De Masi
- Homerton Anal Neoplasia Service, Homerton University Hospital, London, United Kingdom
| | - Adam N Rosenthal
- Homerton Anal Neoplasia Service, Homerton University Hospital, London, United Kingdom.,University College Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Mayura Nathan
- Homerton Anal Neoplasia Service, Homerton University Hospital, London, United Kingdom
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14
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Stummer W, Koch R, Valle RD, Roberts DW, Sanai N, Kalkanis S, Hadjipanayis CG, Suero Molina E. Intraoperative fluorescence diagnosis in the brain: a systematic review and suggestions for future standards on reporting diagnostic accuracy and clinical utility. Acta Neurochir (Wien) 2019; 161:2083-2098. [PMID: 31363920 PMCID: PMC6739423 DOI: 10.1007/s00701-019-04007-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 07/05/2019] [Indexed: 12/24/2022]
Abstract
Background Surgery for gliomas is often confounded by difficulties in distinguishing tumor from surrounding normal brain. For better discrimination, intraoperative optical imaging methods using fluorescent dyes are currently being explored. Understandably, such methods require the demonstration of a high degree of diagnostic accuracy and clinical benefit. Currently, clinical utility is determined by tissue biopsies which are correlated to optical signals, and quantified using measures such as sensitivity, specificity, positive predictive values, and negative predictive values. In addition, surgical outcomes, such as extent of resection rates and/or survival (progression-free survival (PFS) and overall survival (OS)) have been measured. These assessments, however, potentially involve multiple biases and confounders, which have to be minimized to ensure reproducibility, generalizability and comparability of test results. Test should aim at having a high internal and external validity. The objective of this article is to analyze how diagnostic accuracy and outcomes are utilized in available studies describing intraoperative imaging and furthermore, to derive recommendations for reliable and reproducible evaluations. Methods A review of the literature was performed for assessing the use of measures of diagnostic accuracy and outcomes of intraoperative optical imaging methods. From these data, we derive recommendations for designing and reporting future studies. Results Available literature indicates that potential confounders and biases for reporting the diagnostic accuracy and usefulness of intraoperative optical imaging methods are seldom accounted for. Furthermore, methods for bias reduction are rarely used nor reported. Conclusions Detailed, transparent, and uniform reporting on diagnostic accuracy of intraoperative imaging methods is necessary. In the absence of such reporting, studies will not be comparable or reproducible. Future studies should consider some of the recommendations given here. Electronic supplementary material The online version of this article (10.1007/s00701-019-04007-y) contains supplementary material, which is available to authorized users.
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15
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John EM, Canchola AJ, Sangaramoorthy M, Koo J, Whittemore AS, West DW. Race/Ethnicity and Accuracy of Self-Reported Female First-Degree Family History of Breast and Other Cancers in the Northern California Breast Cancer Family Registry. Cancer Epidemiol Biomarkers Prev 2019; 28:1792-1801. [PMID: 31488412 DOI: 10.1158/1055-9965.epi-19-0444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/18/2019] [Accepted: 08/27/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Few studies have evaluated accuracy of self-reported family history of breast and other cancers in racial/ethnic minorities. METHODS We assessed the accuracy of cancer family history reports by women with breast cancer (probands) from the Northern California Breast Cancer Family Registry compared with 2 reference standards: personal cancer history reports by female first-degree relatives and California Cancer Registry records. RESULTS Probands reported breast cancer in first-degree relatives with high accuracy, but accuracy was lower for other cancers. Sensitivity (percentage correctly identifying relatives with cancer) was 93% [95% confidence interval (CI), 89.5-95.4] when compared with the relatives' self-report of breast cancer as the reference standard and varied little by proband race/ethnicity and other demographic factors, except for marginally lower sensitivity for Hispanic white probands (87.3%; 95% CI, 78.0-93.1; P = 0.07) than non-Hispanic white probands (95.1%; 95% CI, 88.9-98.0). Accuracy was also high when compared with cancer registry records as the reference standard, with a sensitivity of 95.5% (95% CI, 93.4-96.9) for breast cancer, but lower sensitivity for Hispanic white probands (91.2%; 95% CI, 84.4-95.2; P = 0.05) and probands with low English language proficiency (80%; 95% CI, 52.8-93.5; P < 0.01). CONCLUSIONS Non-Hispanic white, African American, and Asian American probands reported first-degree breast cancer family history with high accuracy, although sensitivity was lower for Hispanic white probands and those with low English language proficiency. IMPACT Self-reported family history of breast cancer in first-degree relatives is highly accurate and can be used as a reliable standard when other validation methods are not available.
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Affiliation(s)
- Esther M John
- Cancer Prevention Institute of California, Fremont, California. .,Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, California.,Department of Health Research and Policy (Epidemiology), Stanford University of School of Medicine, Stanford, California.,Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Alison J Canchola
- Cancer Prevention Institute of California, Fremont, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Meera Sangaramoorthy
- Cancer Prevention Institute of California, Fremont, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Jocelyn Koo
- Cancer Prevention Institute of California, Fremont, California.,Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Alice S Whittemore
- Department of Health Research and Policy (Epidemiology), Stanford University of School of Medicine, Stanford, California.,Department of Biomedical Data Science, Stanford University of School of Medicine, Stanford, California
| | - Dee W West
- Cancer Prevention Institute of California, Fremont, California.,Department of Health Research and Policy (Epidemiology), Stanford University of School of Medicine, Stanford, California
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16
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Lim Y. A GEE approach to estimating accuracy and its confidence intervals for correlated data. Pharm Stat 2019; 19:59-70. [PMID: 31448536 DOI: 10.1002/pst.1970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 11/11/2022]
Abstract
In this paper, we provide a method for constructing confidence interval for accuracy in correlated observations, where one sample of patients is being rated by two or more diagnostic tests. Confidence intervals for other measures of diagnostic tests, such as sensitivity, specificity, positive predictive value, and negative predictive value, have already been developed for clustered or correlated observations using the generalized estimating equations (GEE) method. Here, we use the GEE and delta-method to construct confidence intervals for accuracy, the proportion of patients who are correctly classified. Simulation results verify that the estimated confidence intervals exhibit consistent/appropriate coverage rates.
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Affiliation(s)
- Yaeji Lim
- Department of Applied Statistics, Chung-Ang University, Seoul, Republic of Korea
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17
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Nakamura M, Ueda M, Iwata T, Kiguchi K, Mikami Y, Kakuma T, Aoki D. A Clinical Trial to Verify the Efficiency of the LC-1000 Exfoliative Cell Analyzer as a New Method of Cervical Cancer Screening. Acta Cytol 2019; 63:391-400. [PMID: 31216550 DOI: 10.1159/000501118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 05/13/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The exfoliative cell analyzer, LC-1000 (Sysmex Corporation, Japan), is a medical device that presents the cell proliferation index and 23 research parameters as indicators of cellular proliferative potential. The objective was to evaluate the clinical usability of qualitative assessment by LC-1000 compared with cytology, the human papillomavirus (HPV) test, and histology as gold standard. STUDY DESIGN Women that visited 3 sites between July 2015 and March 2017 were registered. The primary endpoint in this study was the comparison between LC-1000 measurement and HPV test for sensitivity and specificity for cervical intraepithelial neoplasia 2+ (CIN2+). A tree model algorithm was newly constructed by a statistical method and its relationship with histological results was evaluated. RESULTS The sensitivity and specificity of LC-1000 were 78.3 and 74.1%, while those of the HPV test were 94.7 and 85.4%, respectively. A tree model comprising five categories was constructed. The proportion of advanced lesions was higher with the change in the rank classification results from 1 to 5. The positive predictive values of CIN2+ in the categories 4 and 5 were high. Despite the small number of subjects, cancer was undetected in categories 1 and 2. In addition, the comparison with follow-up results in 19 women assessed as CIN1 showed that the rate of progression in the categories 3-5 was 50% (7/14); progression in the categories 1 and 2 was 0% (0/5). CONCLUSIONS LC-1000 may be useful for cervical cancer screening as an index to qualitatively evaluate CIN and cancer based on the changes in characteristics of cells.
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Affiliation(s)
- Masaru Nakamura
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Masatugu Ueda
- Graduate School of Health Sciences, Kio University, Nara, Japan
| | - Takashi Iwata
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | | | - Yoshiki Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | | | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan,
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18
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Sakai T, Nagami Y, Shiba M, Hayashi K, Kinoshita Y, Maruyama H, Kato K, Minamino H, Ominami M, Fukunaga S, Otani K, Hosomi S, Tanaka F, Taira K, Kamata N, Yamagami H, Tanigawa T, Watanabe T, Fujiwara Y. Heparin-bridging therapy is associated with post-colorectal polypectomy bleeding in patients whose oral anticoagulation therapy is interrupted. Scand J Gastroenterol 2019; 53:1304-1310. [PMID: 30345853 DOI: 10.1080/00365521.2018.1503325] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The American and Japanese Societies for Gastrointestinal Endoscopy Guidelines recommend heparin-bridging therapy for patients whose oral anticoagulants are interrupted for endoscopic procedures. However, little is known about the potential association between heparin-bridging therapy and post-polypectomy bleeding (PPB). The aim was to investigate the incidence of PPB associated with heparin-bridging therapy administered to patients whose anticoagulants were interrupted. MATERIALS AND METHODS This was a retrospective observational study using inverse propensity analysis. Between 2013 and 2015, 1004 patients with 2863 lesions were included. The primary outcomes were the rates of PPB and thromboembolism associated with heparin-bridging therapy. The risk factors associated with PPB were identified using multivariate logistic regression analysis involving probability of treatment weighting (IPTW). RESULTS The patients were categorized into a heparin-bridging therapy group (78 patients with 255 lesions) or a control group (926 patients with 2608 lesions). The PPB rate in the heparin-bridging therapy group (10.2%, 8/78) was significantly higher than in the control group (1.1%, 11/926) (p <.01). Thromboembolism occurred in one patient in the control group. The multivariate analysis revealed that heparin-bridging therapy was an independent risk factor associated with PPB (odds ratio [OR], 8.21; 95% confidence interval [95% CI], 2.32-29.10; p <.01). IPTW showed heparin-bridging therapy increased PPB (OR, 7.68; 95% CI, 1.83-32.28; p <.01). CONCLUSIONS Heparin-bridging therapy administered to patients whose oral anticoagulants were interrupted was associated with an increased PPB risk.
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Affiliation(s)
- Taishi Sakai
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Yasuaki Nagami
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Masatsugu Shiba
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Kappei Hayashi
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Yosuke Kinoshita
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Hirotsugu Maruyama
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Kunihiro Kato
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Hiroaki Minamino
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Masaki Ominami
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Shusei Fukunaga
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Koji Otani
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Shuhei Hosomi
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Fumio Tanaka
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Koichi Taira
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Noriko Kamata
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Hirokazu Yamagami
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Tetsuya Tanigawa
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Toshio Watanabe
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
| | - Yasuhiro Fujiwara
- a Department of Gastroenterology , Osaka City University, Graduate School of Medicine , Osaka , Japan
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Fukunaga S, Nagami Y, Shiba M, Sakai T, Maruyama H, Ominami M, Otani K, Hosomi S, Tanaka F, Taira K, Tanigawa T, Yamagami H, Watanabe T, Fujiwara Y. Impact of preoperative biopsy sampling on severe submucosal fibrosis on endoscopic submucosal dissection for colorectal laterally spreading tumors: a propensity score analysis. Gastrointest Endosc 2019; 89:470-478. [PMID: 30201398 DOI: 10.1016/j.gie.2018.08.051] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/30/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS It is believed that preoperative biopsy sampling for superficial-type colorectal tumors should be avoided because submucosal fibrosis caused by biopsy sampling makes EMR impossible. However, few studies have reported the influence of biopsy sampling on colorectal endoscopic submucosal dissection (ESD). This study aimed to examine the effect of biopsy sampling on submucosal fibrosis and treatment outcomes of ESD for laterally spreading tumors (LSTs). METHODS Between April 2005 and September 2015, 441 consecutive patients underwent colorectal ESD in Osaka City University Hospital. Using propensity score matching and inverse probability of treatment weighting (IPTW), we retrospectively evaluated risk factors for severe submucosal fibrosis and treatment outcomes for patients with LSTs, with or without preoperative biopsy sampling. RESULTS A total of 428 LSTs resected using ESD were enrolled. After matching, there were 136 matched pairs of lesions that did or did not undergo biopsy sampling. Preoperative biopsy sampling increased severe fibrosis compared with that in the non-biopsy sampling group (20.6% vs 11.0%; P = .03) and was significantly associated with severe fibrosis after matching (odds ratio [OR], 2.09; 95% confidence interval [CI], 1.07-4.10; P = .03). After adjustment with IPTW, biopsy sampling also increased the risk of severe fibrosis (OR, 2.33; 95% CI, 1.17-4.63; P = .02). However, no significant differences were observed between the 2 groups in treatment outcomes. CONCLUSIONS Preoperative biopsy sampling for colorectal LSTs might cause severe submucosal fibrosis but has no adverse influence on clinical outcomes of ESD.
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Affiliation(s)
- Shusei Fukunaga
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masatsugu Shiba
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Taishi Sakai
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hirotsugu Maruyama
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masaki Ominami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koji Otani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Fumio Tanaka
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koichi Taira
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tetsuya Tanigawa
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hirokazu Yamagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toshio Watanabe
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
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Chen M, Zhang Q, Zhang C, Zhao X, Marra G, Gao J, Lv X, Zhang B, Fu Y, Wang F, Qiu X, Guo H. Combination of 68Ga-PSMA PET/CT and Multiparametric MRI Improves the Detection of Clinically Significant Prostate Cancer: A Lesion-by-Lesion Analysis. J Nucl Med 2018; 60:944-949. [PMID: 30552201 DOI: 10.2967/jnumed.118.221010] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/26/2018] [Indexed: 11/16/2022] Open
Abstract
Our purpose was to explore whether 68Ga-PSMA PET/CT alone (PET/CT) or in combination with multiparametric MRI (PET/MRI) can improve the detection of clinically significant prostate cancer (PCa). Methods: We retrospectively enrolled 54 patients who underwent both MRI and PET/CT before radical prostatectomy. Regions of interest on MR images, PET/CT images, and pathologic images were marked. A lesion was defined as a region of interest marked on images obtained with any of the 3 modalities. All lesions were characterized using the prostate imaging reporting and data system (PI-RADS), the molecular imaging PSMA expression score, and the pathologic results and analyzed. Diagnostic performance was analyzed by receiver-operating-characteristic analysis. Specific improvement for lesions with different PI-RADS scores was analyzed using the net reclassification index (NRI). Results: In total, 90 lesions from 54 patients were analyzed, among which 66 lesions represented clinically significant PCa. Receiver-operating-characteristic analysis showed PET/MRI to perform better than MRI in detecting clinically significant PCa (change in area under the curve, 0.06; 95% confidence interval, 0.01-0.12; P < 0.05). With the calculated cutoff, PET/MRI performed significantly better than MRI (NRI, 21.9%; P < 0.01), with an improvement in sensitivity (89% vs. 76%, P < 0.01) at no sacrifice of specificity (96% vs. 88%, P > 0.05). Improvement in diagnosing clinically significant PCa occurred for lesions classified as PI-RADS 3 (NRI, 66.7%; P < 0.01). Conclusion: PET/MRI improves the detection of clinically significant PCa for PI-RADS 3 lesions.
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Affiliation(s)
- Mengxia Chen
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, China
| | - Qing Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, China
| | - Chengwei Zhang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, China
| | - Xiaozhi Zhao
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, China
| | - Giancarlo Marra
- Department of Urology, San Glovanni Battista Hospital, Città della Salute Scienza and University of Turin, Turin, Italy
| | - Jie Gao
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, China
| | - Xiaoyu Lv
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, China
| | - Bing Zhang
- Department of Radiology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Yao Fu
- Department of Pathology, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China; and
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xuefeng Qiu
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, China
| | - Hongqian Guo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, China
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Pisa FE, Palese F, Romanese F, Barbone F, Logroscino G, Riedel O. How complete is the information on preadmission psychotropic medications in inpatients with dementia? A comparison of hospital medical records with dispensing data. Int J Methods Psychiatr Res 2018; 27:e1724. [PMID: 29869820 PMCID: PMC7133096 DOI: 10.1002/mpr.1724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/03/2018] [Accepted: 04/16/2018] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Reliable information on preadmission medications is essential for inpatients with dementia, but its quality has hardly been evaluated. We assessed the completeness of information and factors associated with incomplete recording. METHODS We compared preadmission medications recorded in hospital electronic medical records (EMRs) with community-pharmacy dispensations in hospitalizations with discharge code for dementia at the University Hospital of Udine, Italy, 2012-2014. We calculated: (a) prevalence of omissions (dispensed medication not recorded in EMRs), additions (medication recorded in EMRs not dispensed), and discrepancies (any omission or addition); (b) multivariable logistic regression odds ratio, with 95% confidence interval (95% CI), of ≥1 omission. RESULTS Among 2,777 hospitalizations, 86.1% had ≥1 discrepancy for any medication (Kappa 0.10) and 33.4% for psychotropics. When psychotropics were recorded in EMR, antipsychotics were added in 71.9% (antidepressants: 29.2%, antidementia agents: 48.2%); when dispensed, antipsychotics were omitted in 54.4% (antidepressants: 52.7%, antidementia agents: 41.5%). Omissions were 92% and twice more likely in patients taking 5 to 9 and ≥10 medications (vs. 0 to 4), 17% in patients with psychiatric disturbances (vs. none), and 41% with emergency admission (vs. planned). CONCLUSION Psychotropics, commonly used in dementia, were often incompletely recorded. To enhance information completeness, both EMRs and dispensations should be used.
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Affiliation(s)
- Federica Edith Pisa
- Clinical Epidemiology Department, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.,Institute of Hygiene and Clinical Epidemiology, University Hospital of Udine, Udine, Italy
| | | | | | - Fabio Barbone
- Department of Medicine, University of Udine, Udine, Italy
| | - Giancarlo Logroscino
- Neurodegenerative Diseases Unit, Department of Basic Medicine Neuroscience and Sense Organs, Department of Clinical Research in Neurology of the University of Bari at "Pia Fondazione Card. G. Panico" Hospital Tricase, Lecce, University of Bari, Lecce, Italy
| | - Oliver Riedel
- Clinical Epidemiology Department, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
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22
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Nagami Y, Ominami M, Shiba M, Sakai T, Fukunaga S, Sugimori S, Otani K, Hosomi S, Tanaka F, Taira K, Kamata N, Yamagami H, Tanigawa T, Watanabe T, Ishihara T, Yamamoto K, Fujiwara Y. Prediction of esophageal stricture in patients given locoregional triamcinolone injections immediately after endoscopic submucosal dissection. Dig Endosc 2018; 30:198-205. [PMID: 28803459 DOI: 10.1111/den.12946] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/08/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIM Esophageal endoscopic submucosal dissection (ESD) to resect widespread lesions has increased the incidence of strictures, and some patients develop strictures despite receiving prophylactic locoregional triamcinolone injections. The present study evaluated the predictive factors for esophageal stricture formation in patients given prophylactic triamcinolone injections after ESD. METHODS This was a retrospective observational study. Of 552 consecutive patients who underwent ESD, those who received prophylactic triamcinolone injections immediately after ESD were enrolled. Primary outcome was predictive factors for esophageal stricture formation in patients given prophylactic triamcinolone injections. RESULTS We evaluated 101 en bloc resections involving 144 lesions in 96 patients. Strictures occurred following 17 (16.8%) resections. Wider circumferential mucosal defect (odds ratio [OR] 2.42, 95% confidence interval [CI]: 1.01-5.80; P = 0.048) was an independent predictive factor for stricture development. Cut-off value associated with stricture formation was five-sixths of the circumferential mucosal defect. Propensity analysis determined that frequency of esophageal strictures increased in patients with circumferential mucosal defects of more than five-sixths compared with those less than five-sixths (OR = 5.70, 95% CI: 1.61-20.18; P = 0.007). CONCLUSION Resections involving circumferential mucosal defects of more than five-sixths increased the likelihood of stricture formation in patients given prophylactic locoregional triamcinolone injections after esophageal ESD.
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Affiliation(s)
- Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masaki Ominami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masatsugu Shiba
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan.,Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Taishi Sakai
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shusei Fukunaga
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Satoshi Sugimori
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koji Otani
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Fumio Tanaka
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Koichi Taira
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Noriko Kamata
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hirokazu Yamagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tetsuya Tanigawa
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toshio Watanabe
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takuma Ishihara
- Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kouji Yamamoto
- Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
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23
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Perera Y, Ren M, Punzalan JRB, Rudnisky CJ, de Leon AR. Binocular sensitivity and specificity of screening tests in cross-sectional diagnostic studies of paired organs. Stat Med 2017; 36:1754-1766. [DOI: 10.1002/sim.7251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 12/17/2016] [Accepted: 01/19/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Yamuni Perera
- Department of Mathematics and Statistics; University of Calgary; Calgary T2N 1N4 AB Canada
| | - Mingchen Ren
- Department of Mathematics and Statistics; University of Calgary; Calgary T2N 1N4 AB Canada
| | | | | | - Alexander R. de Leon
- Department of Mathematics and Statistics; University of Calgary; Calgary T2N 1N4 AB Canada
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24
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Rauscher I, Düwel C, Wirtz M, Schottelius M, Wester HJ, Schwamborn K, Haller B, Schwaiger M, Gschwend JE, Eiber M, Maurer T. Value of 111 In-prostate-specific membrane antigen (PSMA)-radioguided surgery for salvage lymphadenectomy in recurrent prostate cancer: correlation with histopathology and clinical follow-up. BJU Int 2016; 120:40-47. [PMID: 27862863 DOI: 10.1111/bju.13713] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the use of 111 In-labelled prostate-specific membrane antigen (PSMA)-I&T-based radioguided surgery (111 In-PSMA-RGS) for salvage surgery in recurrent prostate cancer (PCa) using comparison of intra-operative gamma probe measurements with histopathological results of dissected specimens. In addition, to determine the success of 111 In-PSMA-RGS with regard to postoperative prostate-specific antigen (PSA) responses, PCa-specific treatment-free survival rates and postoperative complication rates. PATIENTS AND METHODS A total of 31 consecutive patients with localized recurrent PCa undergoing salvage surgery with PSMA-targeted radioguided surgery using a 111 In-labelled PSMA ligand between April 2014 and July 2015 were retrospectively included in this study. The preoperative (interquartile range; range) median PSA level was 1.3 (0.57-2.53 ng/mL; 0.2-13.9 ng/mL). Results of ex vivo radioactivity rating (positive vs negative) of resected tissue specimens were compared with findings of postoperative histological analysis. Best PSA response without additional treatment was determined after 111 In-PSMA-RGS, and salvage-surgery-related postoperative complications and PCa-specific additional treatments were recorded. RESULTS In 30/31 patients, 111 In-PSMA-RGS allowed intra-operative identification of metastatic lesions. In total, 145 surgical specimens were removed and 51 showed metastatic involvement at histological analysis. According to 111 In-PSMA-RGS ex vivo measurements, 48 specimens were correctly classified as metastatic and 87 as cancer-free, four were false-negative and six were false-positive compared with histological evaluation. Follow-up information was available for 30/31 patients. PSA declines of >50% and >90% were observed in 23/30 patients and in 16/30 patients, respectively. In 18/30 patients, a PSA decline to <0.2 ng/mL was observed. In 10/30 patients further PCa-specific treatment was given after a median (range) of 125 (48-454) days post-111 In-PSMA-RGS. The remaining 20 patients remained treatment-free at a median (range) follow-up of 337 (81-591) days. Of 30 patients, 10 presented with surgery-related complications (Clavien-Dindo grade 1, n = 6, Clavien-Dindo grade 3b, n = 4). CONCLUSION 111 In-PSMA-RGS proved to be of high value for intra-operative detection of even small metastatic lesions in patients with PCa scheduled for salvage lymphadenectomy. It allows the exact localization and resection of metastatic tissue during 111 In-PSMA-RGS and is therefore anticipated to have a beneficial influence on further disease progression; however, identification of suitable patients on the basis of PSMA-positron-emission tomography imaging as well as clinical variables is essential for satisfactory results to be obtained.
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Affiliation(s)
- Isabel Rauscher
- Department of Nuclear Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Charlotte Düwel
- Department of Urology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Martina Wirtz
- Institute of Pharmaceutical Radiochemistry, Technical University of Munich, Garching, Germany
| | - Margret Schottelius
- Institute of Pharmaceutical Radiochemistry, Technical University of Munich, Garching, Germany
| | - Hans-Jürgen Wester
- Institute of Pharmaceutical Radiochemistry, Technical University of Munich, Garching, Germany
| | - Kristina Schwamborn
- Department of Pathology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Statistics and Epidemiology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Tobias Maurer
- Department of Urology, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
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25
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Morrison D, Bothun ED, Ying GS, Daniel E, Baumritter A, Quinn G. Impact of number and quality of retinal images in a telemedicine screening program for ROP: results from the e-ROP study. J AAPOS 2016; 20:481-485. [PMID: 27702612 PMCID: PMC5156479 DOI: 10.1016/j.jaapos.2016.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 06/28/2016] [Accepted: 08/05/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Telemedicine for the detection of retinopathy of prematurity (ROP) is becoming increasingly common; however, obtaining the required multiple retinal images from an infant can be challenging. This secondary analysis from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) study evaluated the detection of referral-warranted ROP (RW-ROP) by trained readers when a full set of 5 retinal images could not be obtained. METHODS A total of 7,905 image sets from 1,257 infants in the study were evaluated. Retinal location of images and image quality were recorded. Sensitivity and specificity of RW-ROP detection by trained readers were calculated by comparing findings in incomplete image sets to the findings on standard eye examination. RESULTS The majority of image sets contained all 5 retinal images (92.8%). The disk center view was the image most likely to be present and to be of acceptable image quality (96.8%). The nasal retina was the most difficult to obtain with acceptable image quality (83.4%). Sensitivity of detection of RW-ROP was 82.1% when 5 retinal images of acceptable quality were submitted for grading, 67.2% when 4 acceptable images were submitted, and 66.7% for 3 or fewer acceptable images (P = 0.02), with corresponding specificity of 82.2%, 89.0%, and 81.7% respectively (P < 0.0001). When images of any quality were evaluated, sensitivity was not increased (P = 0.74). CONCLUSIONS The likelihood of detecting RW-ROP by telemedicine screening is decreased when a full set of retinal images is not obtained.
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Affiliation(s)
- David Morrison
- Department of Ophthalmology and Visual Sciences, Vanderbilt Eye Institute, Nashville, Tennessee.
| | - Erick D Bothun
- Departments of Ophthalmology and Visual Neurosciences and Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Gui-Shuang Ying
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ebenezer Daniel
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Agnieshka Baumritter
- Division of Pediatric Ophthalmology, Children's Hospital of Philadelphia, Pennsylvania
| | - Graham Quinn
- Department of Ophthalmology, Scheie Eye Institute, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania; Division of Pediatric Ophthalmology, Children's Hospital of Philadelphia, Pennsylvania
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26
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Eiber M, Weirich G, Holzapfel K, Souvatzoglou M, Haller B, Rauscher I, Beer AJ, Wester HJ, Gschwend J, Schwaiger M, Maurer T. Simultaneous 68Ga-PSMA HBED-CC PET/MRI Improves the Localization of Primary Prostate Cancer. Eur Urol 2016; 70:829-836. [PMID: 26795686 DOI: 10.1016/j.eururo.2015.12.053] [Citation(s) in RCA: 396] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/29/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Ligands of the prostate-specific membrane antigen (PSMA) show promising results in positron emission tomography (PET) imaging of prostate cancer (PCa). OBJECTIVE To compare the diagnostic performance of simultaneous gallium 68 (68Ga)-PSMA HBED-CC PET/magnetic resonance imaging (MRI) for localization of primary PCa with multiparametric magnetic resonance imaging (mpMRI) and PET alone. DESIGN, SETTING, AND PARTICIPANTS We performed 68Ga-PSMA HBED-CC PET/MRI in 66 men with biopsy-proven PCa. INTERVENTION PET, mpMRI, and combined 68Ga-PSMA HBED-CC PET/MRI were independently evaluated using Prostate Imaging Reporting and Data System criteria or a 5-point Likert scale. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The prostate was divided into sextants for histopathology and coregistered with imaging. Diagnostic performance for localization of malignancy was calculated based on receiver operating characteristics analysis for each modality. Regional quantitative PET tracer uptake was recorded; uptake ratio was defined as the ratio of malignant to nonmalignant prostate tissue. RESULTS AND LIMITATIONS A total of 53 of 66 patients were eligible for analysis. mpMRI, PET, and PET/MRI detected cancer in 66% (35 of 53), 92% (49 of 53), and 98% (52 of 53) of the patients, respectively. Overall, 202 of 318 sextants (63.5%) contained cancer at pathologic examination. Simultaneous PET/MRI statistically outperformed mpMRI (area under the curve [AUC]: 0.88 vs 0.73; p<0.001) and PET imaging (AUC: 0.88 vs 0.83; p=0.002) for localization of PCa. Compared with mpMRI, PET imaging was more accurate (AUC: 0.83 vs 0.73; p=0.003). PET provided a high uptake ratio between malignant versus nonmalignant tissue (5.02 [range: 0.89-29.8]), but no significant correlation was observed between quantitative PET parameters and Gleason score or prostate-specific antigen value. CONCLUSIONS Simultaneous 68Ga-PSMA HBED-CC PET/MRI improves diagnostic accuracy for PCa localization both compared with mpMRI and with PET imaging alone. Further prospective studies are warranted to evaluate its potential (eg, for biopsy guidance). PATIENT SUMMARY We examined gallium 68 (68Ga)-prostate-specific membrane antigen (PSMA) HBED-CC positron emission tomography/magnetic resonance imaging (PET/MRI) for primary prostate cancer (PCa) and compared it with multiparametric MRI and PET alone. Our results indicate a higher diagnostic accuracy for 68Ga-PSMA HBED-CC PET/MRI that may help localize PCa.
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Affiliation(s)
- Matthias Eiber
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
| | - Gregor Weirich
- Department of Pathology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Konstantin Holzapfel
- Institute of Radiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Michael Souvatzoglou
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany; Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany
| | - Bernhard Haller
- Institute of Medical Statistics and Epidemiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany; Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany
| | - Hans-Jürgen Wester
- Pharmaceutical Radiochemistry, Technische Universität München, Garching, Germany
| | - Juergen Gschwend
- Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Tobias Maurer
- Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
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Rauscher I, Maurer T, Beer AJ, Graner FP, Haller B, Weirich G, Doherty A, Gschwend JE, Schwaiger M, Eiber M. Value of 68Ga-PSMA HBED-CC PET for the Assessment of Lymph Node Metastases in Prostate Cancer Patients with Biochemical Recurrence: Comparison with Histopathology After Salvage Lymphadenectomy. J Nucl Med 2016; 57:1713-1719. [PMID: 27261524 DOI: 10.2967/jnumed.116.173492] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/27/2016] [Indexed: 01/05/2023] Open
Abstract
The purpose of this study was to evaluate the accuracy of Glu-NH-CO-NH-Lys-(Ahx)-[68Ga(HBED-CC)] PET compared with morphologic imaging for the assessment of lymph node metastases (LNM) in patients with recurrent prostate cancer. METHODS Forty-eight patients (median age, 71 y; interquartile range, 66-74 y) with biochemical recurrence (median prostate-specific antigen level, 1.31 ng/mL; interquartile range, 0.75-2.55 ng/mL) who underwent 68Ga-prostate-specific membrane antigen (PSMA) HBED-CC PET/CT or PET/MR and salvage lymphadenectomy were retrospectively included. Institutional review board approval and written informed consent were obtained from all patients for the purpose of anonymized evaluation and publication of their data. Standardized predefined lymph node (LN) template fields (n = 10) were evaluated in 68Ga-PSMA HBED-CC PET and morphologic imaging for the presence of LNM using a 5-point-scale. Additionally, SUVmean/max and size of suspicious lesions were determined. Specificity of 68Ga-PSMA HBED-CC PET imaging for PET-positive LNs was defined by comparison to histopathology. The diagnostic accuracy of 68Ga-PSMA HBED-CC PET compared with morphologic imaging alone was assessed, and areas under the receiver-operating-characteristic curves are presented. RESULTS LNM were found histologically in 68 of 179 resected anatomic LN fields (38.0%). The specificity of 68Ga-PSMA HBED-CC PET and morphologic imaging was 97.3% and 99.1%, respectively. However, 68Ga-PSMA HBED-CC PET detected LNM in 53 of 68 histopathologically proven metastatic LN fields (77.9%) whereas morphologic imaging was positive in only 18 of 67 (26.9%). 68Ga-PSMA HBED-CC PET imaging performed significantly superior to morphologic imaging for detection of LNM (difference in the areas under the receiver-operating-characteristic curves, 0.139; 95% confidence interval, 0.063-0.214; P < 0.001). In 68Ga-PSMA HBED-CC PET, the mean size of PET-positive LN measured by CT or MRI was 8.3 ± 4.3 mm (range, 4-25 mm), and LNs, which were suspicious only in CT or MRI, presented with a mean size of 13.0 ± 4.9 mm (range, 8-25 mm). CONCLUSION 68Ga-PSMA HBED-CC PET imaging is a promising method for early detection of LNM in patients with biochemical recurrent prostate cancer. It is more accurate than morphologic imaging and thus might represent a valuable tool for guiding salvage lymphadenectomy.
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Affiliation(s)
- Isabel Rauscher
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Tobias Maurer
- Department of Urology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany
| | - Frank-Philipp Graner
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Statistics and Epidemiology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Gregor Weirich
- Department of Pathology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany; and
| | - Alan Doherty
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
| | - Jürgen E Gschwend
- Department of Urology, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
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Maurer T, Gschwend JE, Rauscher I, Souvatzoglou M, Haller B, Weirich G, Wester HJ, Heck M, Kübler H, Beer AJ, Schwaiger M, Eiber M. Diagnostic Efficacy of (68)Gallium-PSMA Positron Emission Tomography Compared to Conventional Imaging for Lymph Node Staging of 130 Consecutive Patients with Intermediate to High Risk Prostate Cancer. J Urol 2015; 195:1436-1443. [PMID: 26682756 DOI: 10.1016/j.juro.2015.12.025] [Citation(s) in RCA: 541] [Impact Index Per Article: 60.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE Current standard imaging techniques are insufficient to reliably detect lymph node metastases in prostate cancer. Recently ligands of PSMA (prostate specific membrane antigen) were introduced in PET (positron emission tomography) of prostate cancer. Thus the aims of this retrospective analysis were to 1) investigate the diagnostic efficacy of (68)Ga-PSMA-PET imaging for lymph node staging in patients with prostate cancer scheduled for radical prostatectomy and 2) compare it to morphological imaging (computerized tomography and magnetic resonance tomography) with histopathological evaluation as the standard of reference. MATERIALS AND METHODS A total of 130 patients with intermediate to high risk prostate cancer were staged with (68)Ga-PSMA-PET/magnetic resonance tomography or PET/computerized tomography from December 2012 to November 2014 before radical prostatectomy and template pelvic lymph node dissection. Histopathological findings of resected tissue were statistically correlated with the results of (68)Ga-PSMA-PET and morphological imaging in a patient and template based manner. RESULTS Lymph node metastases were found in 41 of 130 patients (31.5%). On patient based analysis the sensitivity, specificity and accuracy of (68)Ga-PSMA-PET were 65.9%, 98.9% and 88.5%, and those of morphological imaging were 43.9%, 85.4% and 72.3%, respectively. Of 734 dissected lymph node templates 117 (15.9%) showed metastases. On template based analysis the sensitivity, specificity and accuracy of (68)Ga-PSMA-PET were 68.3%, 99.1% and 95.2%, and those of morphological imaging were 27.3%, 97.1% and 87.6%, respectively. On ROC analysis (68)Ga-PSMA-PET performed significantly better than morphological imaging alone on patient and template based analyses (p = 0.002 and <0.001, respectively). CONCLUSIONS In patients with intermediate to high risk prostate cancer preoperative lymph node staging with (68)Ga-PSMA-PET proved to be superior to standard routine imaging. Thus it has the potential to replace current standard imaging for this indication if confirmed by prospective studies.
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Affiliation(s)
- Tobias Maurer
- Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany.
| | - Jürgen E Gschwend
- Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Michael Souvatzoglou
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Statistics and Epidemiology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Gregor Weirich
- Institute of Pathology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Hans-Jürgen Wester
- Department of Pharmaceutical Radiochemistry, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Heck
- Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Hubert Kübler
- Department of Urology, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Ambros J Beer
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany; Department of Nuclear Medicine, University of Ulm, Ulm, Germany
| | - Markus Schwaiger
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
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Locoregional steroid injection prevents stricture formation after endoscopic submucosal dissection for esophageal cancer: a propensity score matching analysis. Surg Endosc 2015; 30:1441-9. [PMID: 26123341 DOI: 10.1007/s00464-015-4348-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Accepted: 06/15/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although endoscopic submucosal dissection (ESD) has become accepted for the treatment of superficial esophageal cancer, the incidence of stricture formation caused by ESD for widespread lesions is high and leads to a low quality of life. A few studies reported that locoregional steroid injections are useful for the prevention of such stricture formation compared with historical controls. We evaluated the efficacy of prophylactic locoregional steroid injections for stricture formation caused by ESD using quasi-randomized analysis. METHODS This matched case-control study included 461 superficial esophageal cancers from 305 patients who underwent ESD between 2006 and 2013. We used two methods of locoregional steroid injection to prevent stricture formation after ESD. A propensity score matching analysis was performed to reduce the effects of a selection bias for steroid injections and other potential confounding factors. In addition, generalized estimating equations were used to analyze repeated measures data. We compared the incidence of stricture formation with or without steroid injections. RESULTS Forty-two lesions were treated with locoregional steroid injection (dexamethasone/triamcinolone, 23/19) after ESD and esophageal stricture formation occurred in 36 lesions. Fifty-six lesions treated with or without steroid injections were matched after propensity score matching. Locoregional steroid injection reduced the incidence of stricture formation to 10.7% (3/28) of patients compared with 35.7% (10/28) in the control group (odds ratio 4.63, 95% confidence interval 1.11-19.25, p = 0.035). CONCLUSIONS Locoregional steroid injections could be efficient for the prevention of stricture formation after ESD for superficial esophageal cancer.
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Quinn GE, Ying GS, Daniel E, Hildebrand PL, Ells A, Baumritter A, Kemper AR, Schron EB, Wade K. Validity of a telemedicine system for the evaluation of acute-phase retinopathy of prematurity. JAMA Ophthalmol 2014; 132:1178-84. [PMID: 24970095 PMCID: PMC4861044 DOI: 10.1001/jamaophthalmol.2014.1604] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The present strategy to identify infants needing treatment for retinopathy of prematurity (ROP) requires repeated examinations of at-risk infants by physicians. However, less than 10% ultimately require treatment. Retinal imaging by nonphysicians with remote image interpretation by nonphysicians may provide a more efficient strategy. OBJECTIVE To evaluate the validity of a telemedicine system to identify infants who have sufficiently severe ROP to require evaluation by an ophthalmologist. DESIGN, SETTING, AND PARTICIPANTS An observational study of premature infants starting at 32 weeks' postmenstrual age was conducted. This study involved 1257 infants with birth weight less than 1251 g in neonatal intensive care units in 13 North American centers enrolled from May 25, 2011, through October 31, 2013. INTERVENTIONS Infants underwent regularly scheduled diagnostic examinations by an ophthalmologist and digital imaging by nonphysician staff using a wide-field digital camera. Ophthalmologists documented findings consistent with referral-warranted (RW) ROP (ie, zone I ROP, stage 3 ROP or worse, or plus disease). A standard 6-image set per eye was sent to a central server and graded by 2 trained, masked, nonphysician readers. A reading supervisor adjudicated disagreements. MAIN OUTCOMES AND MEASURES The validity of grading retinal image sets was based on the sensitivity and specificity for detecting RW-ROP compared with the criterion standard diagnostic examination. RESULTS A total of 1257 infants (mean birth weight, 864 g; mean gestational age, 27 weeks) underwent a median of 3 sessions of examinations and imaging. Diagnostic examination identified characteristics of RW-ROP in 18.2% of eyes (19.4% of infants). Remote grading of images of an eye at a single session had sensitivity of 81.9% (95% CI, 77.4-85.6) and specificity of 90.1% (95% CI, 87.9-91.8). When both eyes were considered for the presence of RW-ROP, as would routinely be done in a screening, the sensitivity was 90.0% (95% CI, 85.4-93.5), with specificity of 87.0% (95% CI, 84.0-89.5), negative predictive value of 97.3%, and positive predictive value of 62.5% at the observed RW-ROP rate of 19.4%. CONCLUSIONS AND RELEVANCE When compared with the criterion standard diagnostic examination, these results provide strong support for the validity of remote evaluation by trained nonphysician readers of digital retinal images taken by trained nonphysician imagers from infants at risk for RW-ROP. TRIAL REGISTRATION clinicaltrials.gov Identifier:NCT01264276.
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Affiliation(s)
- Graham E Quinn
- Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Gui-shuang Ying
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ebenezer Daniel
- Department of Ophthalmology, Scheie Eye Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - P Lloyd Hildebrand
- Department of Ophthalmology, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Anna Ells
- University of Calgary, Calgary, Alberta, Canada
| | - Agnieshka Baumritter
- Division of Pediatric Ophthalmology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Alex R Kemper
- Program on Pediatric Health Services Research, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Eleanor B Schron
- Division of Extramural Research, National Institutes of Health, Bethesda, Maryland
| | - Kelly Wade
- Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Abstract
PURPOSE Detecting sight-threatening retinopathy of prematurity (ROP) relies on a diagnostic examination (DE) performed by an experienced ophthalmologist. An alternative may be a telemedicine system where retinal images of at-risk infants are graded by readers to determine features of ROP indicating the need for a DE. METHODS The multicenter Telemedicine Approaches to Evaluating Acute-phase ROP (e-ROP) Study is a cohort study of 2000 infants with birth weights <1251 g. At each visit, ophthalmologists perform DEs and non-physician imagers obtain iris and five retinal images with the disc positioned in the center, right, left, up and down. Images are uploaded to a secure server for grading by non-physician readers for the detection of plus disease, stage 3 ROP and/or zone I disease, any of which indicates "referral-warranted ROP" (RW-ROP). Images from all infants with RW-ROP and a random sample of infants without RW-ROP (based on DEs) are selected for grading. Gradings are compared to DEs to determine the validity and evaluate reliability, feasibility, safety, and cost-effectiveness of the telemedicine system. RESULTS e-ROP is conducted in 12 Clinical Centers in the US and Canada with Study Headquarters, the Data Coordinating Center and the Image Reading Center in Philadelphia and the ROP Data Center in Oklahoma City. A total of 27 study center coordinators, 34 ophthalmologists, 26 imagers, and 4 readers have been certified. All study data are submitted using a secure web-based system. CONCLUSION The design and findings of this study will be useful to conduct other ROP studies or evaluate telemedicine for other diseases.
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Weber U, Østergaard M, Lambert RGW, Pedersen SJ, Chan SM, Zubler V, Rufibach K, Zhao Z, Maksymowych WP. Candidate lesion-based criteria for defining a positive sacroiliac joint MRI in two cohorts of patients with axial spondyloarthritis. Ann Rheum Dis 2014; 74:1976-82. [DOI: 10.1136/annrheumdis-2014-205408] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 05/25/2014] [Indexed: 01/14/2023]
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Usefulness of non-magnifying narrow-band imaging in screening of early esophageal squamous cell carcinoma: a prospective comparative study using propensity score matching. Am J Gastroenterol 2014; 109:845-54. [PMID: 24751580 PMCID: PMC4050526 DOI: 10.1038/ajg.2014.94] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 03/12/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The usefulness of non-magnifying endoscopy with narrow-band imaging (NBI; NM-NBI) in the screening of early esophageal squamous cell carcinoma (SCC) and high-grade intraepithelial neoplasia (HGIN) remains unclear. Here, we aimed to compare NM-NBI and chromoendoscopy with iodine staining (CE-Iodine) in terms of the diagnostic performance, and to evaluate the usefulness of NM-NBI in detecting early esophageal SCC. METHODS We prospectively enrolled 202 consecutive patients (male/female=180/22; median age, 67 years) with high-risk factors for esophageal SCC. All patients received endoscopic examination with NM-NBI and CE-Iodine to screen for early esophageal SCC or HGIN. We conducted the examinations sequentially, and calculated the accuracy, sensitivity, and specificity through a per-lesion-based analysis. A propensity score matching analysis was performed to reduce the effects of selection bias, and we compared the respective outcomes according to NM-NBI and CE-Iodine after matching. RESULTS The accuracy, sensitivity, and specificity of NM-NBI were 77.0, 88.3, and 75.2%, respectively, and those for unstained areas by CE-Iodine were 68.0, 94.2, and 64.0, respectively. The accuracy and specificity of NM-NBI were superior to those of CE-Iodine (P=0.03 and P=0.01, respectively). However, the sensitivity did not significantly differ between NM-NBI and CE-Iodine (P=0.67). The accuracy and specificity of NM-NBI before matching were superior to those of CE-Iodine after matching (P=0.04 and P=0.03). CONCLUSIONS NM-NBI was useful and reliable for the diagnosis of esophageal SCC and can be a promising screening strategy for early esophageal SCC.
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Withanage N, de Leon A, Rudnisky C. Joint estimation of disease-specific sensitivities and specificities in reader-based multi-disease diagnostic studies of paired organs. J Appl Stat 2014. [DOI: 10.1080/02664763.2014.909790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- N. Withanage
- Department of Economics & Statistics, Sabaragamuwa University of Sri Lanka, Belihuloya, Sri Lanka
- Department of Mathematics & Statistics, University of Calgary, Calgary, Canada
| | - A.R. de Leon
- Department of Mathematics & Statistics, University of Calgary, Calgary, Canada
| | - C.J. Rudnisky
- Department of Ophthalmology, University of Alberta, Edmonton, Canada
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SHARPSTEN LUCIE, FAN JUANJUAN, BARR JOSEPHR, SU XIAOGANG, DEMIREL SHABAN, LEVINE RICHARDA. PREDICTING GLAUCOMA PROGRESSION USING DECISION TREES FOR CLUSTERED DATA BY GOODNESS OF SPLIT. INTERNATIONAL JOURNAL OF SEMANTIC COMPUTING 2013. [DOI: 10.1142/s1793351x13400072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Glaucoma is a chronic, progressive and potentially blinding condition. Predicting which patients will experience significant progression is recognized as a crucially needed development in the management of this disease. Application of the CART (Classification And Regression Trees) methodology has demonstrated that certain patterns of visual field findings may convey greater predictive information for glaucoma progression. However, the current standard classification tree method was developed for uncorrelated data. In this article a classification tree method is extended to correlated binary data. The robust Wald test statistic from generalized estimating equations (GEE) is used to measure the between-node difference while adjusting for correlation between the eyes of a patient. The proposed method is assessed through simulations conducted under a variety of model configurations and is used to analyze the perimetry and psychophysics in glaucoma (PPIG) study data. Employing an amalgamation algorithm from the result of a best-sized tree, each eye is classified to one of two prognosis categories (less likely, or more likely, to progress). Receiver operating characteristics (ROC) and area under the curve (AUC) indicate that the proposed method, applied to data from both eyes of the same patient, provides much improved prediction accuracy compared with application of standard CART method to the same PPIG data.
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Affiliation(s)
- LUCIE SHARPSTEN
- Computational Science Research Center, San Diego State University, San Diego, CA 92182, USA
| | - JUANJUAN FAN
- Department of Mathematics and Statistics, San Diego State University, San Diego, CA 92182, USA
| | - JOSEPH R. BARR
- SpecterMetrix, 16935 West Bernardo Drive, Suite 224, San Diego, CA 92127, USA
- Department of Mathematics and Statistics, San Diego State University, San Diego, CA 92182, USA
| | - XIAOGANG SU
- School of Nursing, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294, USA
| | - SHABAN DEMIREL
- Devers Eye Institute, Legacy Health System, Portland, OR 97232, USA
| | - RICHARD A. LEVINE
- Department of Mathematics and Statistics, San Diego State University, San Diego, CA 92182, USA
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Genders TSS, Spronk S, Stijnen T, Steyerberg EW, Lesaffre E, Hunink MGM. Methods for Calculating Sensitivity and Specificity of Clustered Data: A Tutorial. Radiology 2012; 265:910-6. [DOI: 10.1148/radiol.12120509] [Citation(s) in RCA: 176] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Meier R, Thürmel K, Moog P, Noël PB, Ahari C, Sievert M, Dorn F, Waldt S, Schaeffeler C, Golovko D, Haller B, Ganter C, Weckbach S, Woertler K, Rummeny EJ. Detection of synovitis in the hands of patients with rheumatologic disorders: Diagnostic performance of optical imaging in comparison with magnetic resonance imaging. ACTA ACUST UNITED AC 2012; 64:2489-98. [DOI: 10.1002/art.34467] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Maurer T, Souvatzoglou M, Kübler H, Opercan K, Schmidt S, Herrmann K, Stollfuss J, Weirich G, Haller B, Gschwend JE, Schwaiger M, Krause BJ, Treiber U. Diagnostic Efficacy of [11C]Choline Positron Emission Tomography/Computed Tomography Compared With Conventional Computed Tomography in Lymph Node Staging of Patients With Bladder Cancer Prior to Radical Cystectomy. Eur Urol 2012; 61:1031-8. [DOI: 10.1016/j.eururo.2011.12.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 12/05/2011] [Indexed: 01/09/2023]
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Qu Y, Hadgu A. A Model for Evaluating Sensitivity and Specificity for Correlated Diagnostic Tests in Efficacy Studies with an Imperfect Reference Test. J Am Stat Assoc 2012. [DOI: 10.1080/01621459.1998.10473748] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Muir SW, Berg K, Chesworth B, Klar N, Speechley M. Application of a Fall Screening Algorithm Stratified Fall Risk But Missed Preventive Opportunities in Community-Dwelling Older Adults. J Geriatr Phys Ther 2010. [DOI: 10.1519/jpt.0b013e3181ff23cc] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hu F, Schucany WR, Ahn C. Nonparametric Sample Size Estimation for Sensitivity and Specificity with Multiple Observations per Subject. DRUG INFORMATION JOURNAL 2010; 44:609-616. [PMID: 22114363 PMCID: PMC3221312 DOI: 10.1177/009286151004400508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We propose a sample size calculation approach for the estimation of sensitivity and specificity of diagnostic tests with multiple observations per subjects. Many diagnostic tests such as diagnostic imaging or periodontal tests are characterized by the presence of multiple observations for each subject. The number of observations frequently varies among subjects in diagnostic imaging experiments or periodontal studies. Nonparametric statistical methods for the analysis of clustered binary data have been recently developed by various authors. In this paper, we derive a sample size formula for sensitivity and specificity of diagnostic tests using the sign test while accounting for multiple observations per subjects. Application of the sample size formula for the design of a diagnostic test is discussed. Since the sample size formula is based on large sample theory, simulation studies are conducted to evaluate the finite sample performance of the proposed method. We compare the performance of the proposed sample size formula with that of the parametric sample size formula that assigns equal weight to each observation. Simulation studies show that the proposed sample size formula generally yields empirical powers closer to the nominal level than the parametric method. Simulation studies also show that the number of subjects required increases as the variability in the number of observations per subject increases and the intracluster correlation increases.
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Affiliation(s)
- Fan Hu
- Department of Statistical Science, Southern Methodist University, Dallas, TX
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de Leon AR, Soo A, Bonzo DC, Rudnisky CJ. Joint Estimation of Diagnostic Accuracy Measures for Paired Organs - Application in Ophthalmology. Biom J 2009; 51:837-50. [DOI: 10.1002/bimj.200800123] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Kremer P, Fardanesh M, Ding R, Pritsch M, Zoubaa S, Frei E. Intraoperative fluorescence staining of malignant brain tumors using 5-aminofluorescein-labeled albumin. Neurosurgery 2009; 64:ons53-60; discussion ons60-1. [PMID: 19240573 DOI: 10.1227/01.neu.0000335787.17029.67] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The newly developed conjugate 5-aminofluorescein (AFL)-human serum albumin (HSA) was investigated in a clinical trial for fluorescence-guided surgery of malignant brain tumors to assess its efficacy and tolerability. METHODS AFL, covalently linked to human serum albumin at a molar ratio of 1:1, was administered intravenously 0.5 to 4 days before surgery at 0.5 or 1.0 mg/kg of body weight to 13 patients aged 38 to 71 years who were suspected of having malignant gliomas. Fluorescence guidance using a 488-nm argon laser was performed during surgery at will. The extent of tumor resection was verified by early postoperative magnetic resonance imaging. Fluorescent and nonfluorescent samples were collected for neuropathology. Blood samples for laboratory and pharmacokinetic analyses were taken over the course of 4 weeks. RESULTS Fluorescence staining of tumor tissue was bright in 11 patients (84%), resulting in complete resection of fluorescent tumor tissue in 9 patients (69%). In 2 patients, residual fluorescent tumor tissue was also confirmed by magnetic resonance imaging. Neither bleaching nor penetration of AFL-HSA into the surrounding brain edema or into necrotic tissue was seen. The agreement between fluorescence and histopathology in tumor samples and samples of the tumor border was 83.3%. There were no toxic side effects. The quality of fluorescence was independent of the dose administered. The optimal time for surgery is between 1 and 4 days after AFL-HSA administration. CONCLUSION Tumor fluorescence using AFL-HSA made fluorescence-guided brain tumor resection possible, demonstrating that albumin is a suitable carrier system for selective targeting of aminofluorescein into malignant gliomas.
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Affiliation(s)
- Paul Kremer
- Department of Neurosurgery, Kopfklinikum, University of Heidelberg, Heidelberg, Germany.
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Weustink AC, Hunink MGM, van Dijke CF, Renken NS, Krestin GP, Oosterhuis JW. Minimally invasive autopsy: an alternative to conventional autopsy? Radiology 2009; 250:897-904. [PMID: 19244053 DOI: 10.1148/radiol.2503080421] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE To determine the diagnostic performance of minimally invasive autopsy (MIA) for detection of causes of death and to investigate the feasibility of MIA as an alternative to conventional autopsy (CA) in the clinical setting. MATERIALS AND METHODS The institutional review board approved the MIA procedure and study, and informed consent was obtained for all deceased patients from relatives. Thirty deceased patients (19 men, 11 women; age range, 46-79 years), for whom family permission for CA on medical grounds had already been obtained, underwent additional evaluation with MIA prior to CA. MIA consisted of whole-body 16-section computed tomography (CT) and 1.5-T magnetic resonance (MR) imaging, followed by ultrasonography-guided 12-gauge needle biopsy of heart, both lungs, liver, both kidneys, and spleen. Percentage agreement between MIA and CA on cause of death was evaluated. Sensitivity and corresponding 95% confidence intervals (CIs) of MIA for detection of overall (major plus minor) findings, with CA as the reference standard, were calculated. Specificity was calculated for overall findings. Sensitivity analysis was performed to explore the effect of the clustered nature of the data. RESULTS In 23 patients (77%), MIA and CA were in agreement on the cause of death. Sensitivity of MIA for detection of overall findings and detection of major findings was 93% (95% CI: 90%, 96%) and 94% (95% CI: 87%, 97%), respectively. Specificity was 99% (95% CI: 98%, 99%) for detection of overall findings. MIA failed to demonstrate acute myocardial infarction as the cause of death in four patients. Sensitivity analysis indicated a negligible correlation between observations within each patient. CT was superior to MR for detection of pneumothorax and calcifications. MR was superior to CT for detection of brain abnormalities and pulmonary embolus. With biopsy only, detection of disease in 55 organs was possible, which included 27 major findings. CONCLUSION MIA is a feasible procedure with high diagnostic performance for detection of common causes of death such as pneumonia and sepsis; MIA failed to demonstrate cardiac diseases, such as acute myocardial infarction and endocarditis, as underlying cause of death. SUPPLEMENTAL MATERIAL http://radiology.rsnajnls.org/cgi/content/full/250/3/897//DC1.
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Affiliation(s)
- Annick C Weustink
- Department of Radiology, Erasmus University Medical Center Rotterdam, Dr Molewaterplein 40, 3000 CA Rotterdam, The Netherlands.
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Hanigan MH, Dela Cruz BL, Thompson DM, Farmer KC, Medina PJ. Use of prescription and nonprescription medications and supplements by cancer patients during chemotherapy: questionnaire validation. J Oncol Pharm Pract 2009; 14:123-30. [PMID: 18719067 DOI: 10.1177/1078155208090624] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cancer patients take medications for coexisting disease and self-medicate with over-the-counter drugs (OTCs). A complete analysis of the use of prescription drugs, OTCs, and supplements during cancer treatment has never been done. METHODS The study developed and validated a self-administered questionnaire on the use of concomitant medications by patients undergoing treatment with chemotherapy. The questionnaire listed 510 prescription medications, OTCs, and supplements (including vitamins, minerals, and herbs). Fifty-two subjects completed the questionnaire while visiting the infusion clinic to receive chemotherapy. On a subsequent visit the subjects brought their medications to the clinic and a pharmacist reviewed their completed questionnaire. RESULTS Ninety-six percent of the subjects reported taking prescription medications within 3 days prior to chemotherapy, 71% reported taking OTCs and 69% reported use of supplements. The subjects took an average of 5.5 (range 0-13) prescription drugs, 2.2 (0-20) OTCs, and 1.9 (0-11) supplements. Twenty-one drugs were each taken by at least 10% of the subjects. Acetaminophen was taken by 59.6% of the subjects. One subject reported taking five acetaminophen-containing drugs. The questionnaire's sensitivity was 92.0%, specificity 99.9%. CONCLUSION Within 3 days prior to chemotherapy, subjects took an average of 9.6 concomitant medications, many of which alter drug metabolism and or disposition. In clinical trials, multivariate analysis of all concomitant medications could add to clinically relevant data to identify drug interactions that negate or potentiate the efficacy of cancer treatment regimens. In some instances, apparent resistance of tumors to chemotherapy may be the result of drug interactions.
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Affiliation(s)
- Marie H Hanigan
- Department of Cell Biology, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA.
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Saadat E, Jobke B, Chu B, Lu Y, Cheng J, Li X, Ries MD, Majumdar S, Link TM. Diagnostic performance of in vivo 3-T MRI for articular cartilage abnormalities in human osteoarthritic knees using histology as standard of reference. Eur Radiol 2008; 18:2292-302. [PMID: 18491096 DOI: 10.1007/s00330-008-0989-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Revised: 02/22/2008] [Accepted: 03/22/2008] [Indexed: 10/22/2022]
Abstract
The purpose of this study was (1) to evaluate the sensitivity, specificity and accuracy of sagittal in vivo 3-T intermediate-weighted fast spin-echo (iwFSE) sequences in the assessment of knee cartilage pathologies using histology as the reference standard in patients undergoing total knee replacement, and (2) to correlate MR imaging findings typically associated with osteoarthritis such as bone marrow edema pattern (BMEP) and cartilage swelling with histological findings. Tibial plateaus and femoral condyles of eight knees of seven patients were resected during surgery, and sagittal histological sections were prepared for histology. Preoperative MRI findings were compared to the corresponding region in histological sections for thickness, surface integrity and signal pattern of cartilage, and histological findings in areas of BMEP and swelling were documented. The overall sensitivity, specificity and accuracy were 72%, 69% and 70% for thickness, 69%, 74% and 73% for surface and 36%, 62% and 45% for intracartilaginous signal pattern. For all cases of BMEP on MRI subchondral ingrowth of fibrovascular tissue and increased bone remodeling were observed. MRI using fat-saturated iwFSE sequences showed good performance in assessing cartilage thickness and surface lesions, while signal changes of cartilage were not suited to characterize the severity of cartilage degeneration as validated by histology.
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Affiliation(s)
- Ehsan Saadat
- School of Medicine and Department of Radiology, University of California San Francisco, San Francisco, CA, USA
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Pugliese F, Mollet NR, Hunink MGM, Cademartiri F, Nieman K, van Domburg RT, Meijboom WB, Van Mieghem C, Weustink AC, Dijkshoorn ML, de Feyter PJ, Krestin GP. Diagnostic Performance of Coronary CT Angiography by Using Different Generations of Multisection Scanners: Single-Center Experience. Radiology 2008; 246:384-93. [DOI: 10.1148/radiol.2462070113] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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de Leon AR, Guo M, Rudnisky CJ, Singh G. A likelihood approach to estimating sensitivity and specificity for binocular data: application in ophthalmology. Stat Med 2007; 26:3300-14. [PMID: 17211837 DOI: 10.1002/sim.2791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Binocular data typically arise in ophthalmology where pairs of eyes are evaluated, through some diagnostic procedure, for the presence of certain diseases or pathologies. Treating eyes as independent and adopting the usual approach in estimating the sensitivity and specificity of a diagnostic test ignores the correlation between eyes. This may consequently yield incorrect estimates, especially of the standard errors. The paper proposes a likelihood-based method of accounting for the correlations between eyes and estimating sensitivity and specificity using a model for binocular or paired binary outcomes. Estimation of model parameters via maximum likelihood is outlined and approximate tests are provided. The efficiency of the estimates is assessed in a simulation study. An extension of the methodology to the case of several diagnostic tests, or the same test measured on several occasions, which arises in multi-reader studies, is given. A further extension to the case of multiple diseases is outlined as well. Data from a study on diabetic retinopathy are analysed to illustrate the methodology.
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Affiliation(s)
- A R de Leon
- Department of Mathematics and Statistics, University of Calgary, Alta., Canada T2N 1N4.
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Muhlebach MS, Miller MB, Moore C, Wedd JP, Drake AF, Leigh MW. Are lower airway or throat cultures predictive of sinus bacteriology in cystic fibrosis? Pediatr Pulmonol 2006; 41:445-51. [PMID: 16547960 DOI: 10.1002/ppul.20396] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The choice of antibiotics for sinusitis in children with cystic fibrosis (CF) is empirical or based on lower airway cultures, because sinus cultures are difficult to obtain. The aim of this study was to identify the main organisms cultured from CF children with chronic sinusitis, and to evaluate the concordance of concomitant sinus, oropharyngeal swab (OP), and bronchoalveolar lavage fluid (BALF) cultures. OP and BALF cultures were done preoperatively, and sinus cultures were obtained during clinically indicated sinus surgery. The genetic identity of the bacteria was compared if the same organisms were present in upper and lower airway cultures. In total, 45 paired sinus-BALF cultures from 31 patients were included. Twenty-four of these had matched OP cultures. The mean age of patients was 9.5 +/- 4.3 years, and 19 patients were DeltaF508 homozygous. Bacterial sinus infection was present in 96%, caused by S. aureus (49%), P. aeruginosa (42%), and H. influenzae (22%). The diagnostic accuracy of BALF or OP cultures was low in predicting sinus infection, particularly at younger ages. Positive and negative predictive values (PPV and NPV) of BALF for P. aeruginosa infection were 65% and 67%, and for S. aureus, 76% and 63%, respectively. Predictive values for OP cultures were similar. Bacterial species were the same in sinus and OP or BALF samples of 12 patients of these bacteria 83% showed genetic identity. We conclude that S. aureus is an important pathogen in pediatric CF sinusitis, and that BALF or oropharyngeal cultures are poor predictors for organisms present in the sinuses.
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Kühl HP, Lipke CSA, Krombach GA, Katoh M, Battenberg TF, Nowak B, Heussen N, Buecker A, Schaefer WM. Assessment of reversible myocardial dysfunction in chronic ischaemic heart disease: comparison of contrast-enhanced cardiovascular magnetic resonance and a combined positron emission tomography-single photon emission computed tomography imaging protocol. Eur Heart J 2006; 27:846-53. [PMID: 16434414 DOI: 10.1093/eurheartj/ehi747] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIMS The aim of the study was to compare, in patients with chronic ischaemic cardiomyopathy, contrast-enhanced cardiovascular magnetic resonance (ce-CMR) imaging and a combined (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) and (99m)Tc-sestamibi single-photon emission computed tomography (SPECT) protocols for the prediction of functional recovery after revascularization, as assessed by cine CMR. METHODS AND RESULTS Twenty-nine patients with ischaemic cardiomyopathy (ejection fraction 32 +/- 10%) were investigated with ce-CMR and PET/SPECT. For the assessment of global and regional functions, cine CMR was performed at baseline and at 6 months follow-up. For ce-CMR, the segmental extent of hyperenhancement (SEH) was quantitated, and for PET/SPECT, different viability categories were defined according to a validated quantitative protocol. Functional improvement was related to the SEH by ce-CMR, as well as to the viability categories by PET/SPECT. Sensitivity and specificity for the prediction of functional recovery at follow-up was 97 and 68% for ce-CMR and 87 and 76% for PET/SPECT. The positive predictive value was identical for both techniques (73%). However, ce-CMR achieved a higher negative predictive value (93 vs. 77%, respectively), indicating that ce-CMR may be superior to PET/SPECT for the identification of segments unlikely to recover function after revascularization. Both methods had a similar yield in the prediction of global functional improvement. CONCLUSION ce-CMR is comparable with a PET/SPECT imaging protocol for the prediction of regional and global functional improvement after revascularization. However, ce-CMR may be superior to nuclear imaging for the identification of segments that are unlikely to recover function at follow-up.
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Affiliation(s)
- Harald P Kühl
- Medical Clinic I, University Hospital, RWTH Aachen University, Germany.
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