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Lin Q, Zhou Y, Shi S, Zhang Y, Yin S, Liu X, Peng Q, Huang S, Jiang Y, Cui C, She R, Xu J, Dong F. How much can AI see in early pregnancy: A multi-center study of fetus head characterization in week 10-14 in ultrasound using deep learning. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107170. [PMID: 36272307 DOI: 10.1016/j.cmpb.2022.107170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/22/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To investigate if artificial intelligence can identify fetus intracranial structures in pregnancy week 11-14; to provide an automated method of standard and non-standard sagittal view classification in obstetric ultrasound examination METHOD AND MATERIALS: We proposed a newly designed scheme based on deep learning (DL) - Fetus Framework to identify nine fetus intracranial structures: thalami, midbrain, palate, 4th ventricle, cisterna magna, nuchal translucency (NT), nasal tip, nasal skin, and nasal bone. Fetus Framework was trained and tested on a dataset of 1528 2D sagittal-view ultrasound images from 1519 females collected from Shenzhen People's Hospital. Results from Fetus Framework were further used for standard/non-standard (S-NS) plane classification, a key step for NT measurement and Down Syndrome assessment. S-NS classification was also tested with 156 images from the Longhua branch of Shenzhen People's Hospital. Sensitivity, specificity, and area under the curve (AUC) were evaluated for comparison among Fetus Framework, three classic DL models, and human experts with 1-, 3- and 5-year ultrasound training. Furthermore, 4 physicians with more than 5 years of experience conducted a reader study of diagnosing fetal malformation on a dataset of 316 standard images confirmed by the Fetus framework and another dataset of 316 standard images selected by physicians. Accuracy, sensitivity, specificity, precision, and F1-Score of physicians' diagnosis on both sets are compared. RESULTS Nine intracranial structures identified by Fetus Framework in validation are all consistent with that of senior radiologists. For S-NS sagittal view identification, Fetus Framework achieved an AUC of 0.996 (95%CI: 0.987, 1.000) in internal test, at par with classic DL models. In external test, FF reaches an AUC of 0.974 (95%CI: 0.952, 0.995), while ResNet-50 arrives at AUC∼0.883, 95% CI 0.828-0.939, Xception AUC∼0.890, 95% CI 0.834-0.946, and DenseNet-121 AUC∼0.894, 95% CI 0.839-0.949. For the internal test set, the sensitivity and specificity of the proposed framework are (0.905, 1), while the first-, third-, and fifth-year clinicians are (0.619, 0.986), (0.690, 0.958), and (0.798, 0.986), respectively. For the external test set, the sensitivity and specificity of FF is (0.989, 0.797), and first-, third-, and fifth-year clinicians are (0.533, 0.875), (0.609, 0.844), and (0.663, 0.781), respectively.On the fetal malformation classification task, all physicians achieved higher accuracy and F1-Score on Fetus selected standard images with statistical significance (p < 0.01). CONCLUSION We proposed a new deep learning-based Fetus Framework for identifying key fetus intracranial structures. The framework was tested on data from two different medical centers. The results show consistency and improvement from classic models and human experts in standard and non-standard sagittal view classification during pregnancy week 11-13+6. CLINICAL RELEVANCE/APPLICATION With further refinement in larger population, the proposed model can improve the efficiency and accuracy of early pregnancy test using ultrasound examination.
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Affiliation(s)
- Qi Lin
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yuli Zhou
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Siyuan Shi
- Illuminate, LLC, Shenzhen, Guangdong, China; Microport Prophecy, Shanghai, China
| | - Yujuan Zhang
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Shaoli Yin
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Xuye Liu
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Qihui Peng
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Shaoting Huang
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Yitao Jiang
- Illuminate, LLC, Shenzhen, Guangdong, China; Microport Prophecy, Shanghai, China
| | - Chen Cui
- Illuminate, LLC, Shenzhen, Guangdong, China; Microport Prophecy, Shanghai, China.
| | - Ruilian She
- Department of Obstetric, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China.
| | - Jinfeng Xu
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China.
| | - Fajin Dong
- Department of Ultrasound, Shenzhen People's Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China.
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Thornburg LL, Bromley B, Dugoff L, Platt LD, Fuchs KM, Norton ME, McIntosh J, Toland GJ, Cuckle H. United States' experience in nuchal translucency measurement: variation according to provider characteristics in over five million ultrasound examinations. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:732-737. [PMID: 33634915 DOI: 10.1002/uog.23621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/07/2021] [Accepted: 02/12/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The Nuchal Translucency Quality Review (NTQR) program has provided standardized education, credentialing and epidemiological monitoring of nuchal translucency (NT) measurements since 2005. Our aim was to review the effect on NT measurement of provider characteristics since the program's inception. METHODS We evaluated the distribution of NT measurements performed between January 2005 and December 2019, for each of the three primary performance indicators of NT measurement (NT median multiples of the median (MoM), SD of log10 NT MoM and slope of NT with respect to crown-rump length (CRL)) for all providers within the NTQR program with more than 30 paired NT/CRL results. Provider characteristics explored as potential sources of variability included: number of NT ultrasound examinations performed annually (annual scan volume of the provider), duration of participation in the NTQR program, initial credentialing by an alternative pathway, provider type (physician vs sonographer) and number of NT-credentialed providers within the practice (size of practice). Each of these provider characteristics was evaluated for its effect on NT median MoM and geometric mean of the NT median MoM weighted for the number of ultrasound scans, and multiple regression was performed across all variables to control for potential confounders. RESULTS Of 5 216 663 NT measurements from 9340 providers at 3319 sites, the majority (75%) of providers had an NT median MoM within the acceptable range of 0.9-1.1 and 85.5% had NT median MoM not statistically significantly outside this range. Provider characteristics associated with measurement within the expected range of performance included higher volume of NT scans performed annually, practice at a site with larger numbers of other NT-credentialed providers, longer duration of participation in the NTQR program and alternative initial credentialing pathway. CONCLUSIONS Annual scan volume, duration of participation in the NTQR program, alternative initial credentialing pathway and number of other NT-credentialed providers within the practice are all associated with outcome metrics indicating quality of performance. It is critical that providers participate in ongoing quality assessment of NT measurement to maintain consistency and precision. Ongoing assessment programs with continuous feedback and education are necessary to maintain quality care. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- L L Thornburg
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | - B Bromley
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - L Dugoff
- Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
| | - L D Platt
- David Geffen School of Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
- Center for Fetal Medicine and Women's Ultrasound, Los Angeles, CA, USA
| | - K M Fuchs
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
| | - M E Norton
- Department of Obstetrics and Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - J McIntosh
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - G J Toland
- Perinatal Quality Foundation, Oklahoma City, OK, USA
| | - H Cuckle
- Tel Aviv University, Faculty of Medicine, Ramat Aviv, Israel
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Real-time quality control of nuchal translucency measurements using the exponentially weighted moving average chart. Taiwan J Obstet Gynecol 2021; 60:84-89. [PMID: 33495014 DOI: 10.1016/j.tjog.2020.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE The establishment of ongoing audits for first-trimester nuchal translucency (NT) measurements is of paramount importance. The exponentially weighted moving average (EWMA) chart has been published as an efficient tool for NT quality control with the advantages of being suitable for real-time long-term monitoring. This study aimed to assess the efficacy of real-time NT quality control using EWMA charts. MATERIALS AND METHODS This was an ongoing prospective study conducted from January 2011 to December 2017 at the Centre for Fetal Medicine Gennet in Prague. The quality of NT measurements was assessed using the NT retrospective distribution parameters and EWMA charts, and the results were presented to the sonographers during collective meetings. RESULTS Overall, 28,928 NT measurements obtained from six sonographers were eligible for the study. Looking at individual EWMA charts, we observed four main outcomes. First, there was a clear improvement in the performance of sonographers with initially poor performances. Second, the performance of sonographers with an initially satisfactory quality was maintained. Third, there was an observed deterioration of the performance without the audits. Last, the sonographers appreciated an unequivocal and straightforward graphical presentation of EWMA curves. CONCLUSION EWMA proved to be an efficient and suitable tool for real-time monitoring of NT quality and led to an overall improvement of the sonographers' performance.
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Badal B, Ballesteros A, Crespo M, Morell-Garcia D, Bauçà JM, Pastor M, Ruiz de Gopegui R, Martín I. Quality control of ultrasonography markers for Down's syndrome screening: a retrospective study by the laboratory. Diagnosis (Berl) 2021; 0:dx-2021-0007. [PMID: 34090321 DOI: 10.1515/dx-2021-0007] [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: 01/11/2021] [Accepted: 04/27/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Quality control of ultrasonography markers is necessary to ensure greater efficacy of prenatal aneuploidy screening. The aim of this study was to assess the quality of the crown-rump length (CRL) and nuchal translucence (NT) measurement accuracy by the laboratory according to quality indicators. METHODS Retrospective observational study on 4,908 single-foetus pregnant women who underwent prenatal aneuploidy screening in the first trimester of pregnancy. Euploid foetuses with CRL between 45 and 84 mm were included, while those with NT≥3.5 mm were excluded. CRL measurement was considered to be accurate if the median multiples of the median (MoM) for pregnancy-associated plasma protein A (PAPP-A) was between 0.90 and 1.10. Fifteen sonographers participated in the study, six of whom comprised the control group. Systematic error for a sonographer was considered when CRL measurement was greater than ±2 mm with respect to the control group. Quality for NT was assured by means of the WHIRI method and each sonographer cumulative sum control chart (CUSUM). RESULTS For CRL accuracy, five sonographers underestimated the measurements, while another four overestimated them, with no statistical differences. For smaller sized foetuses, all sonographers met the established specifications. Regarding NT control, three sonographers did not meet the quality criteria for the median MoM. All sonographers met the specifications for the logarithmic standard deviation of the NT MoM levels. Thirteen sonographers met the CUSUM specifications. CONCLUSIONS Evaluation of a quality control of ultrasonography parameters by laboratory professionals is necessary to avoid under- or overestimation tendencies for CRL and NT measurements. CUSUM is a useful tool for the immediate correction of errors in NT measurements.
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Affiliation(s)
- Blanca Badal
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Antonieta Ballesteros
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Miriam Crespo
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Daniel Morell-Garcia
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
- Institut de Recerca Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Josep Miquel Bauçà
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
- Institut de Recerca Sanitària de les Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Maria Pastor
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Rosa Ruiz de Gopegui
- Gynecology and Obstetrics Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Inmaculada Martín
- Laboratory Medicine Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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Granozio G, Napolitano R. Quality control of fetal biometric evaluation and Doppler ultrasound. Minerva Obstet Gynecol 2021; 73:415-422. [PMID: 33904693 DOI: 10.23736/s2724-606x.21.04795-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In recent years quality control in obstetric ultrasound has become recommended and an essential component of obstetric scanning. This is to minimize the inaccuracy and variability related to fetal measurements, to provide an effective quality assurance system to sonographers to certify their practice and decrease the impact of medical litigations. For a quality control system in obstetric ultrasound to be useful clinically, multiple strategies need to be employed: certified training, practical standardization exercise, image storing, qualitative and quantitative quality control. Qualitative quality control consists of the evaluation of images obtained for fetal biometry and Doppler scans using an objective score against predefined criteria. Quantitative quality control consists of analyzing quantitatively the performance of a sonographer and the impact on measurements values. Quantitative analysis could be performed either using estimates of intraobserver or interobserver reproducibility of plane acquisition and caliper placements.
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Affiliation(s)
- Giovanni Granozio
- Fetal Medicine Unit, University College London Hospitals, NHS Foundation Trust, London, UK
| | - Raffaele Napolitano
- Fetal Medicine Unit, University College London Hospitals, NHS Foundation Trust, London, UK - .,Elisabeth Garret Andersson Institute for Women's Health, University College London, London, UK
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Torrent A, Manrique G, Gómez-Castelló T, Baldrich E, Cahuana M, Manresa JM, Borrell A. Sonologist's characteristics related to a higher quality in fetal nuchal translucency measured in primary antenatal care centers. Prenat Diagn 2019; 39:934-939. [PMID: 31237971 DOI: 10.1002/pd.5512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the quality of nuchal translucency (NT) measurements in primary care and the sonologist's characteristics related with a higher quality. METHODS The median NT expressed in multiples of the median (MoM) was calculated for each sonologist of 14 participating antenatal primary care centers of the Catalan Institute of Health. A survey to the sonologists was used to establish variables related to higher-quality measurements. RESULTS The median NT MoM obtained in 16 448 NT measurements, performed by 102 sonologists, was 0.94 MoM. NT underestimation was observed in 46% of the sonologists. Underestimation were less frequent among professionals who performed more than 230 ultrasounds per year (26% vs 53%;p = .022), those who completed the online Fetal Medicine Foundation (FMF) course (22% vs 54%; p = .021), and those who were subject to periodic audits (24% vs 56%; p = .021). Underestimation rate decreased from 60%, to 33% and 14% with the increase of the years of experience from less than 5 years, to 6 to 15 years and more than 15 years of experience, respectively (p = .029). CONCLUSIONS Higher-quality measurements were demonstrated in sonologists who performed more ultrasounds per year, those with more years of scanning experience, those who completed the online FMF course, and those periodically audited.
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Affiliation(s)
- Anna Torrent
- Obstetrics and Gynecology Primary Care Center (ASSIR) Mollet, Institut Catala De La Salut, Barcelona, Spain.,GRASSIR Emerging Consolidated Research Group on Sexual and Reproductive Health, Institut de Recerca en Atencio Primaria Jordi Gol
| | - Gemma Manrique
- Obstetrics and Gynecology Primary Care Center (ASSIR) Mollet, Institut Catala De La Salut, Barcelona, Spain
| | - Teresa Gómez-Castelló
- Obstetrics and Gynecology Primary Care Center (ASSIR) Mataró, Institut Catala De La Salut, Barcelona, Spain
| | - Elisabeth Baldrich
- Obstetrics and Gynecology Primary Care Center (ASSIR) Sabadell, Institut Catala De La Salut, Barcelona, Spain
| | - Marc Cahuana
- GRASSIR Emerging Consolidated Research Group on Sexual and Reproductive Health, Institut de Recerca en Atencio Primaria Jordi Gol.,Obstetrics and Gynecology Primary Care Center (ASSIR) Sabadell, Institut Catala De La Salut, Barcelona, Spain
| | - Josep M Manresa
- Unitat Suport Recerca Metropolitana Nord, Institut de Recerca en Atencio Primaria IDIAPJGol, Sabadell, Spain.,Departament d'Infermeria, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain
| | - Antoni Borrell
- Department of Maternal-Fetal Medicine Barcelona, Institute Gynecology, Obstetrics and Neonatology, Hospital Clinic, Barcelona, Spain
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Nisbet D, Robertson A, Mannil B, Pincham V, Mclennan A. Quality management of nuchal translucency ultrasound measurement in Australia. Aust N Z J Obstet Gynaecol 2018; 59:54-58. [DOI: 10.1111/ajo.12792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/26/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Debbie Nisbet
- Pauline Gandel Women's Imaging Centre; Ultrasound Department; The Royal Women's Hospital; Parkville Victoria Australia
- Women's Ultrasound Melbourne; East Melbourne Victoria Australia
- Department of Medicine and Radiology; University of Melbourne; Melbourne Victoria Australia
| | - Ann Robertson
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists; East Melbourne Victoria Australia
| | - Blessy Mannil
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists; East Melbourne Victoria Australia
| | - Vanessa Pincham
- Sydney Ultrasound for Women; Sydney New South Wales Australia
| | - Andrew Mclennan
- Sydney Ultrasound for Women; Sydney New South Wales Australia
- Faculty of Medicine; Sydney University; Sydney New South Wales Australia
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Carroll S, Parange N. Nuchal translucency scans complicated by nuchal cord - Are we measuring correctly? SONOGRAPHY 2017. [DOI: 10.1002/sono.12096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sabria J, Guirado L, Miró I, Gómez-Roig MD, Borrell A. Crown-rump length audit plots with the use of operator-specific PAPP-A andβ-hCG median MoM. Prenat Diagn 2017; 37:229-234. [DOI: 10.1002/pd.4996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/10/2016] [Accepted: 12/15/2016] [Indexed: 01/09/2023]
Affiliation(s)
- Joan Sabria
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic); University of Barcelona; Barcelona Spain
- RETICS funded by the PN I + D + I 2008-2011 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), Ref. RD12/0026.; Spain
| | - Laura Guirado
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic); University of Barcelona; Barcelona Spain
| | - Isabel Miró
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic); University of Barcelona; Barcelona Spain
| | - Maria Dolors Gómez-Roig
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic); University of Barcelona; Barcelona Spain
- RETICS funded by the PN I + D + I 2008-2011 (Spain), ISCIII- Sub-Directorate General for Research Assessment and Promotion and the European Regional Development Fund (ERDF), Ref. RD12/0026.; Spain
| | - Antoni Borrell
- BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Sant Joan de Déu and Hospital Clínic); University of Barcelona; Barcelona Spain
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Control de calidad del cribado prenatal de aneuploidías. Control epidemiológico y control de calidad de la medición de la translucencia nucal: resultados de un hospital de tercer nivel durante un periodo de 3 años. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2016. [DOI: 10.1016/j.gine.2015.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Spaggiari E, Czerkiewicz I, Sault C, Dreux S, Galland A, Salomon LJ, Ville Y, Muller F. Impact of Including or Removing Nuchal Translucency Measurement on the Detection and False-Positive Rates of First-Trimester Down Syndrome Screening. Fetal Diagn Ther 2015; 40:214-218. [PMID: 26656919 DOI: 10.1159/000442198] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/26/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION First-trimester Down syndrome (DS) screening combining maternal age, serum markers (pregnancy-associated plasma protein-A and beta-human chorionic gonadotropin) and nuchal translucency (NT) gives an 85% detection rate for a 5% false-positive rate. These results largely depend on quality assessment of biochemical markers and of NT. In routine practice, despite an ultrasound quality control organization, NT images can be considered inadequate. The aim of the study was to evaluate the consequences for risk calculation when NT measurement is not taken into account. MATERIAL AND METHOD Comparison of detection and false-positive rates of first-trimester DS screening (PerkinElmer, Turku, Finland), with and without NT, based on a retrospective study of 117,126 patients including 274 trisomy 21-affected fetuses. NT was measured by more than 3,000 certified sonographers. RESULTS There was no significant difference in detection rates between the two strategies including or excluding NT measurement (86.7 vs. 81.8%). However, there was a significant difference in the false-positive rates (2.23 vs. 9.97%, p < 0.001). DISCUSSION Sonographers should be aware that removing NT from combined first-trimester screening would result in a 5-fold increase in false-positive rate to maintain the expected detection rates. This should be an incentive for maintaining quality in NT measurement.
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Affiliation(s)
- Emmanuel Spaggiari
- Department of Obstetrics and Maternal Fetal Medicine, Necker-Enfants Malades Hospital, AP-HP, Paris, France
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Liao KW, Tsai MS, Chang CH, Chien LC, Mao IF, Tsai YA, Chen ML. Do the Levels of Maternal Plasma Trace Elements Affect Fetal Nuchal Translucency Thickness? PLoS One 2015; 10:e0138145. [PMID: 26367380 PMCID: PMC4569564 DOI: 10.1371/journal.pone.0138145] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 08/25/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Fetal nuchal translucency (NT) thickness is an important marker for prenatal screening; however, studies focusing on the correlation between maternal trace element levels and NT thickness are limited. The aim of this study was to evaluate maternal trace element levels during the first trimester and to investigate the association between maternal trace element levels and fetal NT thickness. METHODS In total, 113 samples were obtained from singleton pregnant women. Maternal plasma samples were collected in the first trimester of gestation. Plasma trace element levels were measured using Inductively Coupled Plasma Mass Spectrometry (ICP-MS). Nuchal translucency thickness was measured using ultrasonography at 10-14 weeks of gestation. RESULTS We found that maternal plasma potassium (K) levels had a significant negative correlation with both NT (r = -0.230, p < 0.05) and NT Multiples of the Median (NT MoM) (r = -0.206, p < 0.05). After adjustment for potential confounders, log-transformed maternal plasma potassium levels in the first trimester were significantly associated with fetal NT (NT MoM: β = -0.68, p < 0.05; NT: β = -1.20, p < 0.01). Although not statistically significant, the As, Hg and Pb levels in maternal plasma were positively correlated with NT, and the Mg, Cu, Zn, Na and Ca levels were negatively correlated with NT. CONCLUSION Maternal plasma K levels during the first trimester appeared to be associated with NT thickness. The essential elements tended to decrease NT thickness, and non-essential elements tended to increase it.
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Affiliation(s)
- Kai-Wei Liao
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Ming-Song Tsai
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chia-Huang Chang
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Ling-Chu Chien
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - I-Fang Mao
- Department of Occupational Safety and Health, Chung Shan Medical University, Taichung, Taiwan
| | - Yen-An Tsai
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Mei-Lien Chen
- Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang Ming University, Taipei, Taiwan
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Cuckle H, Platt LD, Thornburg LL, Bromley B, Fuchs K, Abuhamad A, Benacerraf B, Copel JA, Depp R, D'Alton M, Goldberg J, O'Keeffe D, Spitz J, Toland G, Wapner R. Nuchal Translucency Quality Review (NTQR) program: first one and half million results. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:199-204. [PMID: 24753079 DOI: 10.1002/uog.13390] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 02/10/2014] [Accepted: 04/11/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the performance of first-trimester nuchal translucency (NT) measurement by providers (physician-sonologists and sonographers) within the Nuchal Translucency Quality Review (NTQR) program. METHODS After training and credentialing providers, the NTQR monitored performance of NT measurement by the extent to which an individual's median multiple of the normal median (MoM) for crown-rump length (CRL) was within the range 0.9-1.1 MoM of a published normal median curve. The SD of log10 MoM and regression slope of NT on CRL were also evaluated. We report the distribution between providers of these performance indicators and evaluate potential sources of variation. RESULTS Among the first 1.5 million scans in the NTQR program, performed between 2005 and 2011, there were 1 485 944 with CRL in the range 41-84 mm, from 4710 providers at 2150 ultrasound units. Among the 3463 providers with at least 30 scans in total, the median of the providers' median NT-MoMs was 0.913. Only 1901 (55%) had a median NT-MoM within the expected range; there were 89 above 1.1 MoM, 1046 at 0.8-0.9 MoM, 344 at 0.7-0.8 MoM and 83 below 0.7 MoM. There was a small increase in the median NT-MoM according to providers' length of time in the NTQR program and number of scans entered annually. On average, physician-sonologists had a higher median NT-MoM than did sonographers, as did those already credentialed before joining the program. The median provider SD was 0.093 and the median slope was 13.5%. SD correlated negatively with the median NT-MoM (r = -0.34) and positively with the slope (r = 0.22). CONCLUSION Even with extensive training, credentialing and monitoring, there remains considerable variability between NT providers. There was a general tendency towards under-measurement of NT compared with expected values, although more experienced providers had performance closer to that expected.
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Affiliation(s)
- H Cuckle
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA
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Hynek M, Smetanová D, Stejskal D, Zvárová J. Exponentially weighted moving average chart as a suitable tool for nuchal translucency quality review. Prenat Diagn 2014; 34:367-76. [DOI: 10.1002/pd.4314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 12/30/2013] [Accepted: 12/31/2013] [Indexed: 12/30/2022]
Affiliation(s)
- Martin Hynek
- Gennet, Centre for Fetal Medicine and Reproductive Genetics; Prague Czech Republic
- Institute of Hygiene and Epidemiology, First Faculty of Medicine; Charles University; Prague Czech Republic
- Department of Gynecology and Obstetrics; Thomayer Hospital; Prague Czech Republic
| | - Dagmar Smetanová
- Gennet, Centre for Fetal Medicine and Reproductive Genetics; Prague Czech Republic
| | - David Stejskal
- Gennet, Centre for Fetal Medicine and Reproductive Genetics; Prague Czech Republic
| | - Jana Zvárová
- European Centre for Medical Informatics, Statistics and Epidemiology; Institute of Computer Science AS CR; Prague Czech Republic
- Institute of Hygiene and Epidemiology, First Faculty of Medicine; Charles University; Prague Czech Republic
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Salomon LJ, Porcher R, Socolov D, Lamrani H, Ville Y. Repeat measurements of nuchal translucency at 11-14 weeks of gestation: when do we need them? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:629-633. [PMID: 23576525 DOI: 10.1002/uog.12482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 02/21/2013] [Accepted: 03/01/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Previous studies have recommended that several repeat measurements of nuchal translucency (NT) be obtained to optimize sensitivity of the screening process. However, truncation is applied within the risk calculation for small NT measurements; therefore, repeating NT measurements in the lower range may be unnecessary. The aim of this study was to determine the optimal number of NT measurements and whether this is dependent on the initial value obtained. METHODS We simulated the expected distribution of sets of five repeat NT measurements and their corresponding likelihood ratios (LR) for a variety of crown-rump length (CRL) values at 11-14 weeks' gestation, based on the published mixture model for first-trimester NT measurements and on published data regarding NT measurement variability. The ratio between LR obtained from the highest and the initial measurement in each set were computed, with a ratio of 1 indicating that repeat measurements would have no effect on risk estimation. We calculated NT cut-offs below which a change in estimated LR would occur in fewer than 10% of cases if repeat measurements were obtained, and we tested this approach on a real first-trimester screening dataset. RESULTS The simulations performed indicated that repeating NT measurements when the first NT obtained ranged between ≤ 0.9 and ≤ 1.6 mm at CRLs of 45 and 84 mm, respectively, is not useful. When applied to a real dataset, our approach allowed avoiding repetition of measurements in 47/165 cases (28%). CONCLUSIONS Although there is some variability in NT measurements, repeat assessment is not useful to optimize screening performance for the smallest NT measurements due to lower truncation limits that are applied in risk calculation. Our study provides NT cut-off values, in relation to CRL, below which it appears that there is no need to repeat measurements once a good quality image has been obtained.
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Affiliation(s)
- L J Salomon
- Obstetrics and Maternal-Fetal Medicine, GHU Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France; Société Française pour l'Amélioration des Pratiques Echographiques (SFAPE), Paris, France
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Torrent Español A, Borrell Vilaseca A, Manresa Dominguez JM, Falguera Puig G. Control de calidad de la translucencia nucal. Experiencia en 6 centros del ámbito de primaria. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.pog.2012.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Hermann M, Fries N, Mangione R, Boukobza P, Ville Y, Salomon LJ. Nuchal translucency measurement: are qualitative and quantitative quality control processes related? Prenat Diagn 2013; 33:770-4. [DOI: 10.1002/pd.4121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 03/10/2013] [Accepted: 03/21/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Monika Hermann
- Department of Obstetrics and Gynecology; Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris; Paris France
- Société Française pour l'Amélioration des Pratiques Echographiques (SFAPE); Paris France
- Université Paris Descartes; Paris France
| | - Nicolas Fries
- Collège Français d'Echographie Fœtale (CFEF); France
| | | | | | - Yves Ville
- Department of Obstetrics and Gynecology; Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris; Paris France
- Société Française pour l'Amélioration des Pratiques Echographiques (SFAPE); Paris France
- Université Paris Descartes; Paris France
| | - Laurent J. Salomon
- Department of Obstetrics and Gynecology; Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris; Paris France
- Société Française pour l'Amélioration des Pratiques Echographiques (SFAPE); Paris France
- Université Paris Descartes; Paris France
- Collège Français d'Echographie Fœtale (CFEF); France
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Sabria J, Comas C, Barceló-Vidal C, Illa M, Echevarria M, Gomez-Roig MD, Borrell A. Cumulative sum plots and retrospective parameters in first-trimester ductus venosus quality assurance. Prenat Diagn 2013; 33:384-90. [PMID: 23494871 DOI: 10.1002/pd.4079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE This study aimed to evaluate the application of two quality assurance methods to the ductus venosus pulsatility index (DVPI), as a first-trimester aneuploidy marker, including retrospective assessment of distribution parameters and cumulative sum (CUSUM) plots. METHODS The DVPI was measured in 14 444 singleton fetuses at 11+0 to 13+6 weeks in two Fetal Medicine centers during a 4-year period. Sonologist-specific quality assurance distribution parameters, previously described for nuchal translucency, were assessed: the median multiples of the median (MoM), the logarithmic standard deviation of DVPI MoMs and the weekly DVPI percent decrease. Quality assurance results were compared between median MoMs and MoM-based CUSUM plots. RESULTS When sonologist-specific DVPI distribution parameters were retrospectively applied for quality assurance, a 1.0 median MoM, a 0.1 median logarithmic standard deviation and a 3.4 median weekly DVPI drop percentage were observed. CUSUM plots showed good agreement with 0.9-1.1 MoMs range for median MoM, in the assessment of sonologist-specific performances. CONCLUSION Retrospective and prospective DVPI quality assurance methods appear to be applicable to DVPI at 11+0 to 13+6 weeks. Its use should be encouraged if DVPI is to be added to first-trimester Down syndrome or cardiac defects screening.
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Affiliation(s)
- Joan Sabria
- Ultrasound Unit, Department of Obstetrics and Gynecology, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain
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Cuckle H, Maymon R. Role of second-trimester ultrasound in screening for Down syndrome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:241-244. [PMID: 23460191 DOI: 10.1002/uog.12397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- H Cuckle
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY, USA.
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Canick J. Prenatal screening for trisomy 21: recent advances and guidelines. Clin Chem Lab Med 2012; 50:1003-8. [DOI: 10.1515/cclm.2011.671] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Gabriel CC, Echevarria M, Rodríguez I, Serra B. Analysis of quality of nuchal translucency measurements: its role in prenatal diagnosis. ScientificWorldJournal 2011; 2012:482832. [PMID: 22649294 PMCID: PMC3353280 DOI: 10.1100/2012/482832] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 12/08/2011] [Indexed: 11/17/2022] Open
Abstract
Objective. Quantitative analysis of the quality of nuchal translucency (NT) measurements. Methods. First-trimester combined screening for Down syndrome was performed to all pregnant women attended in our Department from October 2003 to November 2009. NT was measured according to the Fetal Medicine Foundation (FMF) criteria by 20 trained obstetricians. The performance of NT measurements was retrospectively analyzed with regard to several quality control standards. Accuracy according to experience, professional profile, crown rump length (CRL) values, and FMF certification was statistically tested. Results. A total of 14978 NT measurements were assessed. (1) The mean operator-specific median NT-MoM values was 0,98. (2) Mean percentage of cases >95th and <5th centiles were 5,0% and 4,2%, respectively. (3) Logarithmic mean and SD of the NT MoM values were 0,00 and 0,13, respectively. (4) The DR for trisomy 21 at screening time was 90,7% for a FPR of 6,7% for standard screening strategy. (5) According to Cumulative SUM (CUSUM) figures, the performance was more acceptable in FMF-certified operators. Conclusion. Overall, quality standards show optimal NT measurements in our unit. Operator experience, a dedicated profile to fetal medicine, CRL over 60 mm, and FMF certification have a significant positive impact on the quality standards.
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Affiliation(s)
- Carmen Comas Gabriel
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Institut Universitari Dexeus, Gran Vía Carles III 71-75, 08028 Barcelona, Spain.
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Koster MPH, Wortelboer EJ, Stoutenbeek P, Visser GHA, Schielen PCJI. Modeling Down syndrome screening performance using first-trimester serum markers. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 38:134-139. [PMID: 21800388 DOI: 10.1002/uog.8881] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To evaluate the modeled predictive value of three current screening markers (pregnancy-associated plasma protein-A (PAPP-A), free β-human chorionic gonadotropin (free β-hCG), and nuchal translucency (NT)) and four potential screening markers (a disintegrin and metalloprotease 12 (ADAM12), total hCG, placental protein 13 (PP13), and placental growth factor (PlGF)) for Down syndrome using different screening strategies. METHODS All markers were measured in stored first-trimester serum of 151 Down syndrome cases and 847 controls. All marker levels were expressed as gestational age-specific multiples of the median (MoMs) and comparisons were made using the Mann-Whitney U-test. Detection rates (DRs) for fixed false-positive rates (FPRs) were modeled using different screening strategies. RESULTS Significantly different median MoMs for Down syndrome cases compared to controls were found for PAPP-A (0.49 vs. 1.00; P < 0.0001), free β-hCG (1.70 vs. 1.01; P < 0.0001), ADAM12 (0.89 vs. 1.00; P < 0.0001), total hCG (1.28 vs. 1.00; P < 0.0001), PlGF (0.80 vs. 1.00; P < 0.0001) and NT (1.74 vs. 1.01; P < 0.0001). The lower PP13 MoM in Down syndrome cases (0.91 vs. 1.00) was not statistically significant (P = 0.061). Adding the four new markers to the current screening strategy (i.e. first-trimester combined test) led to an increase in DR from 77% to 80% at a 5% FPR. The modeled application of a two-sample screening strategy (with some markers assessed early and others later in the first trimester) increased the DR to 89%. In a two-step contingent screening model, using an intermediate risk range of 1 in 100 to 1 in 2000 at biochemical screening (using all markers), the overall DR was 77%, but it was predicted that only 33% of women would require referral for NT measurement. CONCLUSIONS First-trimester Down syndrome screening may be improved by adding new markers to the current screening test and by applying different screening strategies. The application of a two-sample screening model resulted in the highest predicted DR, but this should be confirmed in population-based prospective studies.
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Affiliation(s)
- M P H Koster
- Laboratory for Infectious Diseases and Screening, National Institute for Public Health and Environment (RIVM), Bilthoven, The Netherlands.
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Sabrià J, Barceló-Vidal C, Arigita M, Jimenez JM, Puerto B, Borrell A. The CUSUM test applied in prospective nuchal translucency quality review. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:582-587. [PMID: 21520314 DOI: 10.1002/uog.8860] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To design a cumulative sum (CUSUM) test for prospective nuchal translucency (NT) measurement quality review that is as stringent as the retrospective quality review methods based on distribution parameters currently in use. METHODS The database including all fetal NT measurements obtained during a 2-year period in a single center was reviewed, and measurements obtained by sonologists who measured fewer than 100 cases were excluded. The NT distribution parameters proposed by The Fetal Medicine Foundation (FMF) and the Women & Infants Hospital of Rhode Island (WIHRI) were assessed in the whole NT series and in sonologist-specific distributions. A previously described CUSUM model was adapted to fulfil our objective. RESULTS Two thousand four hundred and seventy-five NT measurements were obtained by seven sonologists during the study period (January 2007-December 2008). In the assessment of sonologist-specific NT distributions, two sonologists fulfilled all the FMF and WIHRI criteria, one showed NT overestimation and four failed due to NT underestimation. Our new CUSUM test model, based on multiples of the median deviations, showed good agreement with the FMF and WIHRI methods in the assessment of sonologist-specific performance. CONCLUSIONS Our CUSUM test model showed close agreement with the retrospective quality review methods based on distribution parameters currently in use, but with the advantage that it can be applied prospectively, allowing for earlier correction of deviations from target performance.
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Affiliation(s)
- J Sabrià
- Department of Obstetrics and Gynecology, Hospital Sant Joan de Déu, Barcelona, Catalonia, Spain.
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Salomon LJ, Porcher R, Stirnemann JJ, Bernard JP, Ville Y. Likelihood ratio-based quality control for nuchal translucency measurements at 11-14 weeks of gestation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2011; 37:576-581. [PMID: 20814879 DOI: 10.1002/uog.8811] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/20/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To develop a quantitative quality control process of nuchal translucency (NT) measurement at 11-14 weeks of gestation based on the mixture model, characterized by analysis of the corresponding distribution of the likelihood ratio (LR). METHODS Based on the published mixture model for NT measurement in the first trimester, we simulated the expected distribution of NT and the corresponding LR. This approach was then tested for the quality control of 15 048 NT measurements performed by four operators trained and certified by The Fetal Medicine Foundation. The new quality control approach based on LR was compared with existing processes based on NT plots, multiples of the median (MoMs) and analysis of the 95(th) centile. RESULTS Each operator contributed 2176-4730 examinations. Median, 5(th) and 95(th) centile of NT values ranged from 1.4 to 1.6, 1.0 to 1.0 and 2.2 to 2.6 mm, respectively. Median of NT-MoM values ranged from 0.83 to 0.95. Analysis of the distribution of NT measurements confirmed departure from the assumptions of the delta-NT and NT-MoM models. Analysis of LR distributions demonstrated a significant difference between observed and expected distributions for all operators (P < 10(-4) ). CONCLUSION An LR-based quality control process is feasible at 11-14 weeks of gestation. Because it is more sensitive to measurement bias around the critical area of the 95(th) centile, its use should be encouraged.
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Affiliation(s)
- L J Salomon
- Obstetrics and Maternal-Fetal Medicine, GHU Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France.
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Estrategias para mejorar el cribado de síndrome de Down: experiencia en el Instituto Dexeus (Barcelona). ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.diapre.2010.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sahota DS, Chen M, Leung TY, Chan LW, Fung TY, Ting YH, Lau TK. Assessment of sonographer nuchal translucency measurement performance – central tendency and dispersion. J Matern Fetal Neonatal Med 2011; 24:812-6. [DOI: 10.3109/14767058.2010.531310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Echevarria M, Comas C, Serra B, Rodríguez I, Sabrià J. Analysis of Quality of Nuchal Translucency Measurements. ACTA ACUST UNITED AC 2011. [DOI: 10.5005/jp-journals-10009-1187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
ABSTRACT
Objective
Quantitative analysis of the quality of nuchal translucency (NT) measurements.
Methods
This is a retrospective single-center study. NT was measured according to the Fetal Medicine Foundation (FMF) criteria by 20 trained obstetricians (October 2003-November 2009). The performance of NT measurements was analyzed with regard to several quality control standards. Accuracy according to experience, professional profile, crown-rump length (CRL) values and FMF certification was statistically tested.
Results
A total of 14,978 NT measurements were assessed. (1) The mean operator-specific median NT-MoM values was 0.98. (2) Mean percentage of cases >95th and <5th percentiles were 5.0 and 4.2% respectively. (3) Logarithmic mean and SD of the NT-MoM values were 0.00 and 0.13 respectively. (4) The DR for trisomy 21 at screening time was 90.7% for a FPR of 6.7% for standard screening strategy. (5) According to cumulative SUM (CUSUM) figures, the performance was more acceptable in FMF-certified operators. Operator experience, exclusive dedication to FM, FMF certification and a range of CRL values > 60 mm had a statistical impact improving these standards.
Conclusion
Overall quality standards show optimal NT measurements in our unit. Experience a dedicated profile to fetal medicine ultrasound, CRL over 60 mm and FMF certification has a significant positive impact on the quality standards.
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Palomaki GE, Knight GJ, Lambert-Messerlian G, Canick JA, Haddow JE. Four years' experience with an interlaboratory comparison program involving first-trimester markers of Down syndrome. Arch Pathol Lab Med 2010; 134:1685-91. [PMID: 21043823 DOI: 10.5858/2009-0670-oar.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT We initiated a voluntary, self-funded interlaboratory comparison program in the fall of 2005 because no proficiency testing program was available to laboratories in North America offering first-trimester, combined serum and ultrasound, Down syndrome screening. Objectives.-To evaluate the first 4 years of the interlaboratory comparison program against stated goals, to identify areas of concern, and to create new initiatives as indicated. DESIGN Five serum samples are distributed 3 times a year to be tested for pregnancy-associated plasma protein A, human chorionic gonadotropin or its β subunit, and dimeric inhibin-A; participants convert these results into multiples of the median. Patient histories include nuchal translucency information that enables the calculation of the risk of Down syndrome. Also included are educational components linked to interlaboratory comparison program results. Assessment of integrated (first- and second-trimester markers) risks is accomplished by having participants combine interlaboratory comparison program results with their results from a second-trimester proficiency testing program administered by the College of American Pathologists. RESULTS The precision profile for pregnancy-associated plasma protein A shows decreasing coefficients of variation with increasing pregnancy-associated plasma protein A concentrations and multiples of the median (25% to 11% and 30% to 15%, respectively). In contrast, coefficients of variation are a relatively constant 12% throughout the entire range of human chorionic gonadotropin results. On a logarithmic scale, the median coefficient of variation of the risk of Down syndrome is 9%. CONCLUSIONS Participants in the interlaboratory comparison program reliably measure analytes, compute multiples of the median, and calculate consistent Down syndrome risks. Assays for the measurement of pregnancy-associated plasma protein A are not standardized and are less precise than those for human chorionic gonadotropin. Participants calculate reliable median equations given sonographer-specific sets of paired crown-rump length and nuchal translucency measurements.
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Affiliation(s)
- Glenn E Palomaki
- Department of Pathology and Laboratory Medicine, Brown University, Providence, RI02903, USA.
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Koster MPH, Pennings JLA, Imholz S, Rodenburg W, Visser GHA, de Vries A, Schielen PCJI. Bead-based multiplexed immunoassays to identify new biomarkers in maternal serum to improve first trimester Down syndrome screening. Prenat Diagn 2009; 29:857-62. [PMID: 19488973 DOI: 10.1002/pd.2294] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To identify new discriminative biomarkers for Down syndrome (DS) pregnancies using a bead-based multiplexed immunoassay, and to use the newly identified biomarkers to construct a prediction model for non-invasive DS screening. METHODS Maternal serum samples of 14 DS pregnancies and 15 matched controls were analyzed with a bead-based multiplexed immunoassay containing immunoassays for 90 different analytes. Potential biomarkers were selected on the basis of concentration fold ratios between DS and control samples. For these markers and the current screening markers (pregnancy-associated plasma protein-A, PAPP-A; free beta subunit of human chorion gonadotrophin (fbeta-hCG) and nuchal translucency) prediction values were obtained and used to calculate detection rates (DR) at a 5% false positive rate. RESULTS Seven potential biomarkers of which the fold ratio exceeded 1.3 or -1.3 were selected for further analysis. All 14 DS cases in this study were detected using the combination of all currently used and newly identified markers. The modelled DR for all markers extrapolated to the general pregnant population was 82.5%, compared to a modelled DR of 56.2% for the current screening markers. CONCLUSION This study demonstrates the possibility of improving the performance of the current first-trimester DS screening by addition of new biomarkers, which were identified using bead-based multiplexed immunoassays.
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Affiliation(s)
- M P H Koster
- Laboratory for Infectious Diseases and Screening, National Institute for Public Health and the Environment (RIVM), 3720 BA Bilthoven, The Netherlands.
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Technical standards and guidelines: Prenatal screening for Down syndrome that includes first-trimester biochemistry and/or ultrasound measurements. Genet Med 2009; 11:669-81. [DOI: 10.1097/gim.0b013e3181ad5246] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Koster MPH, Wortelboer EJ, Engels MAJ, Stoutenbeek PH, Elvers LH, Visser GHA, Schielen PCJI. Quality of nuchal translucency measurements in The Netherlands: a quantitative analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:136-141. [PMID: 19562664 DOI: 10.1002/uog.6398] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The Dutch Centre for Population Research has specified quality demands for nuchal translucency (NT) measurement in The Netherlands. We performed an analysis of the quality of NT measurement in 2005-2006 and its influence on screening performance. METHODS This was a retrospective study of records of NT measurements (n = 27,738) obtained between January 2005 and December 2006 retrieved from the Dutch National Institute for Public Health and the Environment (RIVM). The performance of each individual operator was analyzed with regard to the quality standards, which involved calculation of operator-specific median NT-multiples of the median (MoM) values. For the entire population of operators, a curve was determined describing the relationship between crown-rump length and NT. Detection rates (DR) and false-positive rates (FPR) for Down syndrome were modeled with this new curve and compared to those originally obtained using previously published reference data. RESULTS Only 22% of all operators met the quality requirement of performing more than 150 NT measurements per year. However, no relationship was found between the number of measurements per operator and their median NT-MoM. The mean of all operator-specific median NT-MoM values was 0.94 (target value 1.0). Overall, operators with The Fetal Medicine Foundation certificate measured a significantly higher median NT-MoM (mean of operator-specific medians, 0.98) as compared to the non-certified operators (0.92). During the study period, the monthly median NT-MoM of all operators rose steadily, from 0.86 in January 2005 to 0.96 in December 2006. Recalculation of the risk for Down syndrome after adjusting the reference NT medians using our own data led to a modeled 4% increase in DR at a 5% FPR. CONCLUSION Improved monitoring of NT measurement put into effect during the study period seems to have led to an improvement in the accuracy of measurements. Strict quality demands, continued monitoring and scrupulous evaluation of individual operators is likely to lead to an even better performance.
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Affiliation(s)
- M P H Koster
- National Institute for Public Health and the Environment, Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, Bilthoven, The Netherlands.
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D'Alton ME, Cleary-Goldman J, Lambert-Messerlian G, Ball RH, Nyberg DA, Comstock CH, Bukowski R, Berkowitz RL, Dar P, Dugoff L, Craigo SD, Timor IE, Carr SR, Wolfe HM, Dukes K, Canick JA, Malone FD. Maintaining quality assurance for sonographic nuchal translucency measurement: lessons from the FASTER Trial. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:142-146. [PMID: 19173241 DOI: 10.1002/uog.6265] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate nuchal translucency measurement quality assurance techniques in a large-scale study. METHODS From 1999 to 2001, unselected patients with singleton gestations between 10 + 3 weeks and 13 + 6 weeks were recruited from 15 centers. Sonographic nuchal translucency measurement was performed by trained technicians. Four levels of quality assurance were employed: (1) a standardized protocol utilized by each sonographer; (2) local-image review by a second sonographer; (3) central-image scoring by a single physician; and (4) epidemiological monitoring of all accepted nuchal translucency measurements cross-sectionally and over time. RESULTS Detailed quality assessment was available for 37 018 patients. Nuchal translucency measurement was successful in 96.3% of women. Local reviewers rejected 0.8% of images, and the single central physician reviewer rejected a further 2.9%. Multivariate analysis indicated that higher body mass index, earlier gestational age and transvaginal probe use were predictors of failure of nuchal translucency measurement and central image rejection (P = 0.001). Epidemiological monitoring identified a drift in measurements over time. CONCLUSION Despite initial training and continuous image review, changes in nuchal translucency measurements occur over time. To maintain screening accuracy, ongoing quality assessment is needed.
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Borrell A. Promises and pitfalls of first trimester sonographic markers in the detection of fetal aneuploidy. Prenat Diagn 2008; 29:62-8. [DOI: 10.1002/pd.2182] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Prenatal screening for serious congenital heart defects using nuchal translucency: a meta-analysis. Prenat Diagn 2008; 28:1094-104. [DOI: 10.1002/pd.2124] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Wax JR, Pinette MG. Nuchal translucency quality monitoring holes in the safety net. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:1539-1542. [PMID: 18946091 DOI: 10.7863/jum.2008.27.11.1539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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