scholarly journals Convolutional Neural Network for Breast and Thyroid Nodules Diagnosis in Ultrasound Imaging

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Xiaowen Liang ◽  
Jinsui Yu ◽  
Jianyi Liao ◽  
Zhiyi Chen
Keyword(s):  
Predictive Value ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Diagnostic Efficiency ◽  
Clinical Value ◽  
Data Set ◽  
Multiple Organs ◽  
Significant Difference ◽  
Segmented Images ◽  
The Impact

Objective. The incidence of superficial organ diseases has increased rapidly in recent years. New methods such as computer-aided diagnosis (CAD) are widely used to improve diagnostic efficiency. Convolutional neural networks (CNNs) are one of the most popular methods, and further improvements of CNNs should be considered. This paper aims to develop a multiorgan CAD system based on CNNs for classifying both thyroid and breast nodules and investigate the impact of this system on the diagnostic efficiency of different preprocessing approaches. Methods. The training and validation sets comprised randomly selected thyroid and breast nodule images. The data were subgrouped into 4 models according to the different preprocessing methods (depending on segmentation and the classification method). A prospective data set was selected to verify the clinical value of the CNN model by comparison with ultrasound guidelines. Diagnostic efficiency was assessed based on receiver operating characteristic (ROC) curves. Results. Among the 4 models, the CNN model using segmented images for classification achieved the best result. For the validation set, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and area under the curve (AUC) of our CNN model were 84.9%, 69.0%, 62.5%, 88.2%, 75.0%, and 0.769, respectively. There was no statistically significant difference between the CNN model and the ultrasound guidelines. The combination of the two methods achieved superior diagnostic efficiency compared with their use individually. Conclusions. The study demonstrates the probability, feasibility, and clinical value of CAD in the ultrasound diagnosis of multiple organs. The use of segmented images and classification by the nature of the disease are the main factors responsible for the improvement of the CNN model. Moreover, the combination of the CNN model and ultrasound guidelines results in better diagnostic performance, which will contribute to the improved diagnostic efficiency of CAD systems.

Evaluation of the clot burden score (cbs) for acute ischemic stroke (ais) in intent-to-treat patients.

2019 ◽  
Vol 1 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Sarah Yaziz ◽  
Ahmad Sobri Muda ◽  
Wan Asyraf Wan Zaidi ◽  
Nik Azuan Nik Ismail
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Rank Correlation ◽  
Treatment Decision ◽  
Roc Curves ◽  
Significant Negative Correlation ◽  
Clot Burden

Background : The clot burden score (CBS) is a scoring system used in acute ischemic stroke (AIS) to predict patient outcome and guide treatment decision. However, CBS is not routinely practiced in many institutions. This study aimed to investigate the feasibility of CBS as a relevant predictor of good clinical outcome in AIS cases. Methods:  A retrospective data collection and review of AIS patients in a teaching hospital was done from June 2010 until June 2015. Patients were selected following the inclusion and exclusion criteria. These patients were followed up after 90 days of discharge. The Modified Rankin scale (mRS) was used to assess their outcome (functional status). Linear regression Spearman Rank correlation was performed between the CBS and mRS. The quality performance of the correlations was evaluated using Receiver operating characteristic (ROC) curves. Results: A total of 89 patients with AIS were analysed, 67.4% (n=60) male and 32.6% (n=29) female. Twenty-nine (29) patients (33.7%) had a CBS ?6, 6 patients (6.7%) had CBS <6, while 53 patients (59.6%) were deemed clot free. Ninety (90) days post insult, clinical assessment showed that 57 (67.6%) patients were functionally independent, 27 (30.3%) patients functionally dependent, and 5 (5.6%) patients were deceased. Data analysis reported a significant negative correlation (r= -0.611, p<0.001). ROC curves analysis showed an area under the curve of 0.81 at the cut-off point of 6.5. This showed that a CBS of more than 6 predicted a good mRS clinical outcome in AIS patients; with sensitivity of 98.2%, specificity of 53.1%, positive predictive value (PPV) of 76%, and negative predictive value (NPV) of 21%. Conclusion: CBS is a useful additional variable for the management of AIS cases, and should be incorporated into the routine radiological reporting for acute ischemic stroke (AIS) cases.

scholarly journals THU0433 TREATMENT WITH PEGLOTICASE IMPROVES HEPATIC FIBROSIS ESTIMATED BY FIBROSIS-4 INDEX IN SUBJECTS WITH CHRONIC REFRACTORY GOUT

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 454.1-454
Author(s):  
N. Schlesinger ◽  
A. Yeo ◽  
P. Lipsky
Keyword(s):  
Liver Disease ◽  
Linear Regression ◽  
Rank Order ◽  
Linear Regression Analysis ◽  
Area Under The Curve ◽  
Serum Urate ◽  
Complete Analysis ◽  
Alcoholic Fatty Liver ◽  
Significant Difference ◽  
The Impact

Background:Hyperuricemia is associated with non-alcoholic fatty liver disease (NAFLD)1,2, but the relationship to fibrosis remains uncertain3. Moreover, it is not known whether lowering serum urate will affect the course of NAFLD. The availability of data from two randomized trials of pegloticase, a pegylated recombinant mammalian uricase, that profoundly decreases serum urate afforded the opportunity to test the hypothesis that lowering urate might improve NAFLD.Objectives:To determine whether treatment of chronic refractory gout patients with pegloticase was associated with improvement in NAFLD determined by Fibrosis 4 index (Fib4).Methods:Databases from patients with chronic refractory gout who participated in two randomized 6 month clinical trials (RCTs) of pegloticase were analyzed4. Sub-sets who had persistent urate lowering to levels <1 mg/dL in response to biweekly pegloticase (Responders, n=36) were compared to those who received placebo (n=43). Since liver biopsy information was not available on these subjects, we relied on Fib4, a validated non-invasive estimate of liver fibrosis in a variety of liver diseases5,6calculated from measurements of AST, ALT, platelet count and age (Age x AST/platelets x √ALT). A Fib4 value of 1.3 is an indication that further evaluation of liver disease is warranted.Results:At baseline, the mean Fib4 values were 1.40 ± 0.86 in pegloticase responders and 1.04 ± 0.53 in subjects receiving placebo. As shown in figure 1, subjects receiving placebo exhibited a change of 0.26 ± 0.41 in the Fib4 score over the six months of the RCTs compared with 0.13 ± 0.62 in the pegloticase responders (p=0.048; by linear regression). When only the subjects with a Fib4 value > 1.3 were considered, a significant difference in the change in the Fib4 values over the 6 months of the trial between pegloticase responders and those receiving placebo was also observed (-0.15 ± 0.67 vs 0.37 ± 0.42, p=0.004, by linear regression). The correlations between serum urate area under the curve (AUC) over the 6 months of the trial and the change in Fib4 value was rs=0.33, p=0.0.0004 (Spearman rank-order correlation coefficient). Finally, multiple linear regression analysis indicated serum urate AUC (as a surrogate measure for group) is the main contributor to the change in Fib4 (p=0.018 by linear regression).Conclusion:The data are consistent with the conclusion that persistent lowering of serum urate had a significant impact on Fib4 levels, implying a possible effect on the course of NAFLD. The results support a more complete analysis involving biopsy examination of the impact of urate on liver inflammation and fibrosis.References:[1]Yang C et al. PlosOne2017; 12:e0177249[2]Jaruvongvanich V et al. Eur J Gastroenterol Hepatol 2017; 29:1031[3]Jaruvongvanich V et al. Eur J Gastroenterol Hepatol 2017; 29:694[4]Sundy JS, et al. JAMA. 2011; 306 (7):711-20[5]Sterling RK et al. Hepatol 2006; 43:1317[6]Shah AG et al. Clin Gastroenterol Hepatol 2009;7:1104Disclosure of Interests: :Naomi Schlesinger Grant/research support from: Pfizer, Amgen, Consultant of: Novartis, Horizon Therapeutics, Selecta Biosciences, Olatec, IFM Therapeutics, Mallinckrodt Pharmaceuticals, Anthony Yeo Employee of: Horizon Therapeutics, Peter Lipsky Consultant of: Horizon Therapeutics

Factors affecting progression to permanent atrial fibrillation in an unselected population of patients with non-permanent form of atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V.L Malavasi ◽  
E Fantecchi ◽  
V Tordoni ◽  
L Melara ◽  
A Barbieri ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cox Regression ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Factors Affecting ◽  
Cox Proportional Hazard ◽  
Significant Difference ◽  
History Of ◽  
Unselected Population ◽  
Cox Proportional Hazard Regression

Abstract Background Natural history of atrial fibrillation (AF) shows a progression of arrhythmia from non-permanent to permanent AF. Permanent AF was found associated with a worse prognosis than non-permanent one. Aim To assess the factors associated with progression to permanent AF in an unselected population of AF patients with non-permanent AF. Methods In this prospective study we enrolled in- as well as out-patients with non-permanent AF and age ≥18 years, with at least one episode of ECG-documented AF within 1 year. The patients were followed-up at 1 month and every 6 months thereafter. Results Out of 523 patients, 314 (60%) were in non-permanent AF (80 [25.5%] paroxysmal AF, 165 [52.5%] persistent AF, 69 [2%] first diagnosed AF), mostly male (188, 59.9%), median age 71 years (IQ range 62–77), median CHA2DS2VASc 3 (1–4), median HATCH score 1 (1–2). After a median follow-up of 701 (IQ range 437–902) days, 66 patients (21%) showed permanent AF. CHA2DS2VASc and HATCH scores were incrementally associated to progression to permanent AF (CHA2DS2VASc χ2 p=0.001; HATCH χ2 p=0.017; p for trend CHA2DS2VASc &lt;0.001, HATCH p=0.001). At multivariable Cox proportional hazard regression the following variables were significantly associated with AF progression: age (hazard ratio [HR] 1.041; 95% CI: 1.004–1.079; p=0.028), at least moderate left atrial (LA) enlargement (&gt;42 ml/m2) (HR 2.092; 95% CI: 1.132–3.866; p=0.018), antiarrhythmics drugs after the enrollment (HR 0.087; 95% CI: 0.011–0.662; p=0.018), EHRA score &gt;2 (HR 0.351; 95% CI: 0.158–0.779; p=0.010) and Valvular HD (HR 2.161; 95% CI: 1.057–4.420; p=0.035). Adding LA dilation to HATCH score (HATCH-LA) and assigning 2 points based on multivariable Cox regression, HATCH-LA was statistically better in ROC curves in prediction of AF progression vs HATCH score (area under the curve 0.695 vs 0.636; DeLong p=0.0225). Survival-free curves on freedom from permanent AF using as discriminator HATCH-LA score ≤2 vs &gt;2 led to a statistically significant difference (χ2=16.080 p&lt;0.001), but the same was not found for HATCH score (χ2 =3.099; p=0.078). Conclusions In patients without permanent AF, progression of AF was independentely related to age, LA dilation, AF symptoms severity, antiarrhythmic drugs and Valvular HD. HATCH score predicted AF progression and adding to it LA dilation (at least moderate) improved patients stratification for the risk of evolution to permanent AF. Funding Acknowledgement Type of funding source: None

Predictive value of time-variant color-coded multiphase CT angiography (mCTA) regarding clinical outcome of acute ischemic stroke: in comparison with conventional mCTA and CT perfusion

2020 ◽  
pp. 028418512098177
Author(s):  
Yu Lin ◽  
Nannan Kang ◽  
Jianghe Kang ◽  
Shaomao Lv ◽  
Jinan Wang
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Ct Perfusion ◽  
Roc Curves ◽  
Multivariate Logistic Regression Model ◽  
Infarct Core ◽  
Predictive Values ◽  
Significant Difference ◽  
Core Volume

Background Color-coded multiphase computed tomography angiography (mCTA) can provide time-variant blood flow information of collateral circulation for acute ischemic stroke (AIS). Purpose To compare the predictive values of color-coded mCTA, conventional mCTA, and CT perfusion (CTP) for the clinical outcomes of patients with AIS. Material and Methods Consecutive patients with anterior circulation AIS were retrospectively reviewed at our center. Baseline collateral scores of color-coded mCTA and conventional mCTA were assessed by a 6-point scale. The reliabilities between junior and senior observers were assessed by weighted Kappa coefficients. Receiver operating characteristic (ROC) curves and multivariate logistic regression model were applied to evaluate the predictive capabilities of color-coded mCTA and conventional mCTA scores, and CTP parameters (hypoperfusion and infarct core volume) for a favorable outcome of AIS. Results A total of 138 patients (including 70 cases of good outcomes) were included in our study. Patients with favorable prognoses were correlated with better collateral circulations on both color-coded and conventional mCTA, and smaller hypoperfusion and infarct core volume (all P < 0.05) on CTP. ROC curves revealed no significant difference between the predictive capability of color-coded and conventional mCTA ( P = 0.427). The predictive value of CTP parameters tended to be inferior to that of color-coded mCTA score (all P < 0.001). Both junior and senior observers had consistently excellent performances (κ = 0.89) when analyzing color-coded mCTA maps. Conclusion Color-coded mCTA provides prognostic information of patients with AIS equivalent to or better than that of conventional mCTA and CTP. Junior radiologists can reach high diagnostic accuracy when interpreting color-coded mCTA images.

scholarly journals Reanalysis and External Validation of a Decision Tree Model for Detecting Unrecognized Diabetes in Rural Chinese Individuals

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Zhong Xin ◽  
Lin Hua ◽  
Xu-Hong Wang ◽  
Dong Zhao ◽  
Cai-Guo Yu ◽  
...  
Keyword(s):  
Decision Tree ◽  
Predictive Value ◽  
Early Stage ◽  
Current Model ◽  
External Validation ◽  
Area Under The Curve ◽  
Decision Tree Model ◽  
Tree Model ◽  
Chinese Adult ◽  
Significant Difference

We reanalyzed previous data to develop a more simplified decision tree model as a screening tool for unrecognized diabetes, using basic information in Beijing community health records. Then, the model was validated in another rural town. Only three non-laboratory-based risk factors (age, BMI, and presence of hypertension) with fewer branches were used in the new model. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC) for detecting diabetes were calculated. The AUC values in internal and external validation groups were 0.708 and 0.629, respectively. Subjects with high risk of diabetes had significantly higher HOMA-IR, but no significant difference in HOMA-B was observed. This simple tool will help general practitioners and residents assess the risk of diabetes quickly and easily. This study also validates the strong associations of insulin resistance and early stage of diabetes, suggesting that more attention should be paid to the current model in rural Chinese adult populations.

scholarly journals Identification of the most specific markers to differentiate primary pulmonary carcinoma from metastatic gastrointestinal carcinoma to the lung

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Bachar Alabdullah ◽  
Amir Hadji-Ashrafy
Keyword(s):  
Gastrointestinal Tract ◽  
Predictive Value ◽  
Regression Models ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Multivariate Models ◽  
Gastrointestinal Carcinoma ◽  
Lung Tumours ◽  
Napsin A ◽  
Sensitivity Specificity

Abstract Background A number of biomarkers have the potential of differentiating between primary lung tumours and secondary lung tumours from the gastrointestinal tract, however, a standardised panel for that purpose does not exist yet. We aimed to identify the smallest panel that is most sensitive and specific at differentiating between primary lung tumours and secondary lung tumours from the gastrointestinal tract. Methods A total of 170 samples were collected, including 140 primary and 30 non-primary lung tumours and staining for CK7, Napsin-A, TTF1, CK20, CDX2, and SATB2 was performed via tissue microarray. The data was then analysed using univariate regression models and a combination of multivariate regression models and Receiver Operating Characteristic (ROC) curves. Results Univariate regression models confirmed the 6 biomarkers’ ability to independently predict the primary outcome (p < 0.001). Multivariate models of 2-biomarker combinations identified 11 combinations with statistically significant odds ratios (ORs) (p < 0.05), of which TTF1/CDX2 had the highest area under the curve (AUC) (0.983, 0.960–1.000 95% CI). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 75.7, 100, 100, and 37.5% respectively. Multivariate models of 3-biomarker combinations identified 4 combinations with statistically significant ORs (p < 0.05), of which CK7/CK20/SATB2 had the highest AUC (0.965, 0.930–1.000 95% CI). The sensitivity, specificity, PPV, and NPV were 85.1, 100, 100, and 41.7% respectively. Multivariate models of 4-biomarker combinations did not identify any combinations with statistically significant ORs (p < 0.05). Conclusions The analysis identified the combination of CK7/CK20/SATB2 to be the smallest panel with the highest sensitivity (85.1%) and specificity (100%) for predicting tumour origin with an ROC AUC of 0.965 (p < 0.001; SE: 0.018, 0.930–1.000 95% CI).

scholarly journals Mid-arm and Chest Circumferences for Estimating Low Birthweight

2018 ◽  
Vol 33 (1-2) ◽  
pp. 24-31
Author(s):  
Achmad Surjono
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Low Birthweight ◽  
Newborn Infants ◽  
Roc Curves ◽  
Strong Correlations ◽  
Significant Difference ◽  
A Prospective Study

A prospective study was conducted to assess the diagnostic performance of mid-arm and chest circumferences on low birth weights in 1033 singleton newborn infants. The proportion of low birth weight was 11.7%. Strong correlations on birth weight (P<0.001) were found for mid-arm (r-0.85) and chest (r=0.86) circumferences. A mid-arm circumference of ≤9,5 cm was considered as cut-off level for low birth weight, with a sensitivity of 0.818, specificity 0.956 and positive predictive value 0. 712. Whereas that of chest circumference wa ≤29.5 cm with a sensitivity of 0. 785, specificity 0.895 and positive predictive value 0.497. Receiver operating characteristic (ROC) curves were used to compare their diagnostic accuracy. The area under these two ROC(± SE) were 0.954 ± 0.011 for mid-arm and 0.945 ± 0.012 for chest circumferences, respectively. Both areas showed significant differences with the area under chance line. No statistically significant difference was found between the area under ROC of mid-arm and chest circumferences. The results showed that mid-arm and chest circumferences as simple and reliable measurements can be used in estimating low birth weight, in areas where the accurate weighing of newborn infants is not feasible.

scholarly journals Investigating the impact of disease and health record duration on the eMERGE algorithm for rheumatoid arthritis

2020 ◽  
Vol 27 (4) ◽  
pp. 601-605
Author(s):  
Vanessa L Kronzer ◽  
Liwei Wang ◽  
Hongfang Liu ◽  
John M Davis ◽  
Jeffrey A Sparks ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Index Date ◽  
Model Performance ◽  
Area Under The Curve ◽  
Population Based ◽  
Health Record ◽  
The Impact

Abstract Objective The study sought to determine the dependence of the Electronic Medical Records and Genomics (eMERGE) rheumatoid arthritis (RA) algorithm on both RA and electronic health record (EHR) duration. Materials and Methods Using a population-based cohort from the Mayo Clinic Biobank, we identified 497 patients with at least 1 RA diagnosis code. RA case status was manually determined using validated criteria for RA. RA duration was defined as time from first RA code to the index date of biobank enrollment. To simulate EHR duration, various years of EHR lookback were applied, starting at the index date and going backward. Model performance was determined by sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve (AUC). Results The eMERGE algorithm performed well in this cohort, with overall sensitivity 53%, specificity 99%, positive predictive value 97%, negative predictive value 74%, and AUC 76%. Among patients with RA duration &lt;2 years, sensitivity and AUC were only 9% and 54%, respectively, but increased to 71% and 85% among patients with RA duration &gt;10 years. Longer EHR lookback also improved model performance up to a threshold of 10 years, in which sensitivity reached 52% and AUC 75%. However, optimal EHR lookback varied by RA duration; an EHR lookback of 3 years was best able to identify recently diagnosed RA cases. Conclusions eMERGE algorithm performance improves with longer RA duration as well as EHR duration up to 10 years, though shorter EHR lookback can improve identification of recently diagnosed RA cases.

P1315PREDICTABILITY OF SONOGRAPHICALLY DETERMINED IMMEDIATE POST-OPERATIVE BLOODFLOW AND VEIN DIAMETER ON PRIMARY RADIOCEPHALIC FISTULA SHORT AND LONGTERM OUTCOMES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Claude Renaud ◽  
Desmond Ooi ◽  
Chuo Ren Leong
Keyword(s):  
Predictive Value ◽  
Cox Regression ◽  
Area Under The Curve ◽  
Primary Patency ◽  
Arterial Blood Flow ◽  
Secondary Patency ◽  
Arterial Blood ◽  
Linear Probe ◽  
Significant Difference ◽  
Esrd Patients

Abstract Background and Aims Vascular access (VA) guidelines recommend radio-cephalic (RC) over upper arm autogenous arteriovenous fistulas (AVF) as first line VA for hemodialysis in end stage renal disease (ESRD) patients. RCAVFs generally have inferior maturation and patency rates predicated on a lower feeding arterial blood flow (BF) and outflow vein calibre (VC). However studies on postoperative BF and VC as predictors of AVF outcomes, so far are confounded by their focus on early outcomes only, heterogeneity of AVFs studied, variable timing of assessment and use of non-standardised outcome definitions. Our aim was therefore to assess the accuracy and influence of immediate post-operative BF and VC on both early and longterm outcomes in a homogenous cohort of primary RCAVFs using standardised definitions and outcome measures as mandated by VA guidelines. Method This was a prospective study conducted in multi-ethnic Asian ESRD patients who had their primary RCAVFs created between October 2013 and October 2014 under regional anesthesia at Khoo Teck Puat hospital Singapore. All AVFs were assessed immediately after surgery for brachial artery BF and outflow VC using doppler ultrasound. A 10MHz linear probe and GE Logic e R7 machine were used exclusively by a single operator. Receiver operating characteristic (ROC) curves were generated to determine the optimal BF and VC cut-off for AVF maturation. Maturation was defined as BF&gt;600mL/min, VC&gt;6mm and vein depth &lt;6mm at 6 weeks post-op. An area under the curve (AUC)&gt; 0.7 was considered clinically significant. Kaplan–Meier analysis was used to evaluate the AVF primary and secondary patency based on best BF and VC cut-offs. Cox regression statistics was used to determine AVF hazard factors. Results Fifty-seven primary RCAVFs were created and included in the study. The baseline characteristics are shown in Table 1. Sonography- based non-assisted maturation at 6 weeks was 56%. ROC identified 410 mL/min and 42mm as the best BF and VC cut-off respectively to most accurately predict 6-week maturation. The sensitivity, specificity, positive predictive value and negative predictive value were 75%, 61%, 44% and 86% for BF at 410 mL/min and 69%, 61%, 41% and 83% for VC at 42mm respectively. Survival analysis (Fig. 1 and 2) showed that AVFs with VC≥42 mm compared to &lt;42mm had significantly greater 6 months, 1-year, 2-year and 4-year primary and secondary patency rates. There was no significant difference in patency rates between AVFs with BF≥410 and &lt;410mL/min. Cox proportional regression hazard analysis showed that diabetes (HR 2.26, CI 1.02-4.99, p= 0.04) and maturation (HR 0.47, 95% CJ 0.24-0.89, p=0.02) as significant contributed to the variability of primary patency. Only VC (HR 0.28, 95% CI 0.13-0.063, p=0.002) impacted significantly towards secondary patency. Conclusion An immediate post-op BF≥410mL/min and VC≥42mm can predict early RCAVF outcome in the form of nonassisted maturation, but only VC accurately impact on longterm AVF survival. VA surveillance efforts should therefore target RCAVFs with post-op VC &lt;42mm for timely intervention and maintenance of longterm patency.

Comparison of the Predictive Value of MRD and PVA Score in Pediatric ALL.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1520-1520
Author(s):  
Anja Troeger ◽  
Gabriele Escherich ◽  
Udo zur Stadt ◽  
M. L Den Boer ◽  
Rob Pieters ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Correlation Coefficient ◽  
Predictive Value ◽  
Genetic Alterations ◽  
Relevant Parameter ◽  
Response To Chemotherapy ◽  
Significant Difference ◽  
The Impact

Abstract Early identification of patients (pts) at risk for relapse allows for development of risk-adapted treatment strategies, thus steadily improving the outcome in pediatric acute lymphoblastic leukemia (ALL). Besides classic prognostic factors such as age, initial leukocyte count (WBC), genetic alterations and the immune phenotype, the so called PVA Score, summarizing the in vitro resistance of blasts against prednisone, vincristine and asparaginase, has been applied for treatment stratification in the CoALL protocol, a German multicenter study for children with ALL. Over the past years it has become increasingly clear that the in vivo response to chemotherapy assessed by detection of residual malignant cells (MRD) by PCR technique can be predictive of prognosis. Here we compare for the first time the relevance of in vitro (PVA Score) and in vivo (MRD) treatment response in a large cohort of 275 children with ALL, age 1–17 years, uniformly treated according to the CoALL protocols 05–92 to 07–03. Children with B cell precursor ALL (BCP-ALL) and T-ALL were analyzed separately. Bone marrow samples of 160 children with BCP-ALL and of 115 T-ALL pts diagnosed between 1992–2005 were prospectively assessed for PVA Score at diagnosis and MRD levels at day (d) 15, 29 and 43 after informed consent was obtained from the parents or legal guardians at the time of enrolment. Of note, 7 of the BCP-ALL and 14 of the T-ALL pts with late morphological response were excluded from analysis. Overall median MRD levels in BCP-ALL pts (MRDd15: 6×10e-4; MRDd29: 2×10e-5) were one log lower than in T-ALL (MRDd15: 9×10e-3; MRDd29: 3×10e-4). We detected no association between PVA Score and MRD level in BCP-ALL (correlation coefficient: r=0.15; p=0.15) and only a weak correlation in T-ALL pts (correlation coefficient: r=0.43; p=0.0003). When assessing the impact of the PVA Score on relapse free survival (RFS), in BCP-ALL only score 3+4 (good response) vs. 8+9 (poor response) was prognostically relevant (RFS 0.86±0.05 vs. 0.59±0.12; p=0.03), whereas in T-ALL no significant difference between these subgroups was found (RFS 0.71±0.1 vs. 0.68±0.1; p=0.62). In multivariate analysis PVA Score 3+4 vs. 8+9 remained the most relevant parameter for RFS in BCP-ALL (p=0.05) when compared to age and initial WBC. However, MRD levels were of even higher predictive power, especially at later time points: MRD negativity at d29 in BCP-ALL identified pts with significantly superior RFS (RFS MRD neg.: 0.9±0.05 vs. pos.: 0.7±0.05; p=0.003) and low MRD levels indicated a favorable outcome in T-ALL (RFS MRD &lt;10e-3: 0.89±0.05 vs. MRD &gt;10e-3: 0.68±0.07; p=0.001). Moreover, both BCP-ALL and T-ALL pts characterized by MRD levels &gt;10e-3 on d43 exhibited a poor outcome (RFS BCP-ALL: 0.42±0.17; RFS T-ALL: 0.47±0.14). MRD remained an independent marker in multivariate analysis including initial WBC and age, both in BCP- (MRDd29: p=0.006; MRDd43: p=0.001) and T-ALL (MRDd29: p=0.003; MRDd43: p=0.015). By multivariate analysis, in T-ALL low MRD levels on d29 predicted superior RFS independently from the PVA Score (MRD: p=0.002 vs. PVA: p=0.09), whereas in BPC-ALL these parameters were not completely independent from each other at that early time point (MRD: p= 0.059 vs. PVA: p= 0.063) but became independent at d43 (MRD: p= 0.018 vs. PVA: p= 0.253). While the predictive value of the PVA Score was limited to BCP-ALL, MRD was an independent prognostic marker for both BCP- and T-ALL and reliably identified pts at low and high risk for relapse.

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