Bone tumor radiograph review by pathologists prior to pathologic diagnosis: a receiver operator curve analysis of diagnostic utility.

1998 ◽  
Author(s):  
L J Layfield ◽  
J C Lenel ◽  
J R Crim ◽  
D Renfrew ◽  
W F Coulson ◽  
...  
Keyword(s):  
Bone Tumor ◽  
Curve Analysis ◽  
Diagnostic Utility ◽  
Receiver Operator Curve ◽  
Pathologic Diagnosis ◽  
Receiver Operator Curve Analysis ◽  
Operator Curve

scholarly journals Determining the Patient Acceptable Symptomatic State for Patients Undergoing Arthroscopic Partial Meniscectomy in the Knee

2017 ◽  
Vol 5 (3_suppl3) ◽  
pp. 2325967117S0012
Author(s):  
Thomas Zochowski ◽  
Tim Dwyer ◽  
Darrell Ogilvie-Harris ◽  
John S. Theodoropoulos ◽  
Daniel B. Whelan ◽  
...  
Keyword(s):  
Curve Analysis ◽  
Partial Meniscectomy ◽  
Consecutive Series ◽  
Receiver Operator Curve ◽  
Arthroscopic Partial Meniscectomy ◽  
Pain Subscale ◽  
Patient Reported ◽  
Receiver Operator Curve Analysis ◽  
Meniscal Pathology ◽  
Operator Curve

Objectives: Arthroscopic partial meniscectomy is one of the most commonly performed procedures in orthopaedic surgery. However, information on the threshold at which patients consider themselves to be well for patient reported outcome measures (PROMs) after this surgery remains limited. Our goal was to determine the patient acceptable symptomatic state (PASS) for the Knee Injury and Osteoarthritic Outcome Score (KOOS), the International Knee Documentation Committee (IKDC) Subjective Knee Form, the Western Ontario Meniscal Evaluation Tool (WOMET) and the Marx Activity Scale (MAS) in patients with knee meniscal pathology who treated with partial knee meniscectomy. Methods: A consecutive series of patients with knee meniscal pathology treated with arthroscopic partial meniscectomy plus or minus intra-articular debridement were eligible. Other inclusion criteria were: a Kellegren-Lawrence Grade of 0-2, and ligamentous integrity. The KOOS (0-100, 5 subscales), IKDC (0-100), WOMET (0-100) and MAS (0-16) were administered at baseline and 12 months postoperatively. An external anchor question at 1 year postoperatively was utilized to determine PASS values: “Taking into account all the activities you have during your daily life, your level of pain, and also your functional impairment, do you consider that your current state is satisfactory?” A receiver operator curve analysis was used to determine the PASS value at which patients considered their status to be satisfactory. Results: There were 115 patients (mean ± SD age, 53.8 ± 12.0 years), and 57.3% were male. Based on a receiver operator curve analysis, the PASS values - at which patients considered their status to be satisfactory - at 1 year after surgery were 43 (KOOS-symptoms subscale), 83 (KOOS-pain subscale), 84 (KOOS-functions of daily living subscale), 75 (KOOS-function, sport and recreational activity subscale), 56 (KOOS-quality of life subscale), 56 (IKDC), 61 (WOMET), 7 (MAS). The PASS threshold was not affected by baseline scores across the different instruments and there was no relationship between baseline score and likelihood of achieving the PASS. Age and sex were not significantly related to the odds of achieving the PASS for any of the PROMs. Conclusion: This is the first study to determine PASS in four commonly used knee-related PROMs in patients undergoing arthroscopic partial meniscectomy. The findings can allow researchers and clinicians to determine if partial meniscectomy is meaningful to patients and will be helpful for responder analysis in future trials related to knee arthroscopy and the treatment of meniscal pathology.

scholarly journals Evaluation of Bioinformatic Programmes for the Analysis of Variants within Splice Site Consensus Regions

2016 ◽  
Vol 2016 ◽  
pp. 1-10 ◽  
Author(s):  
Rongying Tang ◽  
Debra O. Prosser ◽  
Donald R. Love
Keyword(s):  
In Silico ◽  
Receiver Operator Curve ◽  
Consensus Guidelines ◽  
Diagnostic Use ◽  
Novel Variants ◽  
Receiver Operator Curve Analysis ◽  
Site Consensus ◽  
Splice Junctions ◽  
Selection Of ◽  
Operator Curve

The increasing diagnostic use of gene sequencing has led to an expanding dataset of novel variants that lie within consensus splice junctions. The challenge for diagnostic laboratories is the evaluation of these variants in order to determine if they affect splicing or are merely benign. A common evaluation strategy is to use in silico analysis, and it is here that a number of programmes are available online; however, currently, there are no consensus guidelines on the selection of programmes or protocols to interpret the prediction results. Using a collection of 222 pathogenic mutations and 50 benign polymorphisms, we evaluated the sensitivity and specificity of four in silico programmes in predicting the effect of each variant on splicing. The programmes comprised Human Splice Finder (HSF), Max Entropy Scan (MES), NNSplice, and ASSP. The MES and ASSP programmes gave the highest performance based on Receiver Operator Curve analysis, with an optimal cut-off of score reduction of 10%. The study also showed that the sensitivity of prediction is affected by the level of conservation of individual positions, with in silico predictions for variants at positions -4 and +7 within consensus splice sites being largely uninformative.

scholarly journals Co-Deregulated miRNA Signatures in Childhood Central Nervous System Tumors: In Search for Common Tumor miRNA-Related Mechanics

Cancers ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 3028
Author(s):  
George I. Lambrou ◽  
Apostolos Zaravinos ◽  
Maria Braoudaki
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Cns Tumors ◽  
Normal Brain ◽  
Cns Tumor ◽  
Different Types ◽  
Receiver Operator Curve Analysis ◽  
The Central Nervous System ◽  
Tumor Types ◽  
Operator Curve

Despite extensive experimentation on pediatric tumors of the central nervous system (CNS), related to both prognosis, diagnosis and treatment, the understanding of pathogenesis and etiology of the disease remains scarce. MicroRNAs are known to be involved in CNS tumor oncogenesis. We hypothesized that CNS tumors possess commonly deregulated miRNAs across different CNS tumor types. Aim: The current study aims to reveal the co-deregulated miRNAs across different types of pediatric CNS tumors. Materials: A total of 439 CNS tumor samples were collected from both in-house microarray experiments as well as data available in public databases. Diagnoses included medulloblastoma, astrocytoma, ependydoma, cortical dysplasia, glioblastoma, ATRT, germinoma, teratoma, yoc sac tumors, ocular tumors and retinoblastoma. Results: We found miRNAs that were globally up- or down-regulated in the majority of the CNS tumor samples. MiR-376B and miR-372 were co-upregulated, whereas miR-149, miR-214, miR-574, miR-595 and miR-765 among others, were co-downregulated across all CNS tumors. Receiver-operator curve analysis showed that miR-149, miR-214, miR-574, miR-595 and miR765 could distinguish between CNS tumors and normal brain tissue. Conclusions: Our approach could prove significant in the search for global miRNA targets for tumor diagnosis and therapy. To the best of our knowledge, there are no previous reports concerning the present approach.

scholarly journals Factors Associated With Intraoperative Conversion to Total Thyroidectomy in Benign Goiters

2019 ◽  
Vol 2 (1) ◽  
pp. 105-109
Author(s):  
Samuel Olatoke ◽  
Olayide Agodirin ◽  
Ganiyu Rahman ◽  
Benjamin Bolaji ◽  
Habeeb Olufemi
Keyword(s):  
Total Thyroidectomy ◽  
Nodular Goiter ◽  
Degenerative Changes ◽  
P Value ◽  
Receiver Operator Curve ◽  
Factors Associated ◽  
Patient Demographics ◽  
Partial Thyroidectomy ◽  
Intraoperative Conversion ◽  
Operator Curve

Background: Decision to undertake total thyroidectomy when gross inspection of the gland raises suspicion of widespread degenerative changes is often intraoperative. Knowing the factors associated with intraoperative conversion to total thyroidectomy may assist preoperative counselling. This study describes the probability of conversion to total thyroidectomy and factors associated with con-version among patients hitherto planned for partial thyroidectomy. Methods: We reviewed 191 records and extracted data on patient demographics, the pre-operative radiograph findings, the weight of excised gland and the operation performed. Descriptive and inferential statistics were performed. Receiver operator curve was used to assess for cut-off point. P-value was set at 0.05. Results: A total of 191 records was reviewed consisting of 181 females (94.8% 95% CI 90.6-97.5) and 10 males (5.2%, 95%CI 2.5-9.4). Only nodular goiters required conversion to total thyroidectomy. The over-all probability of total thyroidectomy was 11%(95% CI 7.0-16.3). The probability of total thyroidectomy in female was 10.5%(95% CI 6.4-16.9) while in male was 20%(95% CI2.5-55.6). The probability of total thyroidectomy in a female with nodular goiter was 8.1%(95% CI 4.8-13.5), compared to 28.6%(95% CI 3.7-71) in males. The risk of total thyroidectomy was associated with the weight of the excised gland. Conclusion: Only nodular goiters required intraoperative conversion to total thyroidecto-my and the probability of conversion was higher in males.

scholarly journals Differentiating combined pulmonary fibrosis and emphysema from pure emphysema: utility of late gadolinium-enhanced MRI

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Hannah Fleming ◽  
Simon M. Clifford ◽  
Aoife Haughey ◽  
Roisin MacDermott ◽  
Niall McVeigh ◽  
...  
Keyword(s):  
Pulmonary Fibrosis ◽  
Area Under The Curve ◽  
Resonance Imaging ◽  
High Resolution Computed Tomography ◽  
Antifibrotic Therapy ◽  
Control Subjects ◽  
Receiver Operator Curve Analysis ◽  
Healthy Control ◽  
Traction Bronchiectasis ◽  
Operator Curve

Abstract Background Differentiating combined pulmonary fibrosis with emphysema (CPFE) from pure emphysema can be challenging on high-resolution computed tomography (HRCT). This has antifibrotic therapy implications. Methods Twenty patients with suspected CPFE underwent late gadolinium-enhanced (LGE) thoracic magnetic resonance imaging (LGE-MRI) and HRCT. Data from twelve healthy control subjects from a previous study who underwent thoracic LGE-MRI were included for comparison. Quantitative LGE signal intensity (SI) was retrospectively compared in regions of fibrosis and emphysema in CPFE patients to similar lung regions in controls. Qualitative comparisons for the presence/extent of reticulation, honeycombing, and traction bronchiectasis between LGE-MRI and HRCT were assessed by two readers in consensus. Results There were significant quantitative differences in fibrosis SI compared to emphysema SI in CPFE patients (25.8, IQR 18.4–31.0 versus 5.3, IQR 5.0–8.1, p < 0.001). Significant differences were found between LGE-MRI and HRCT in the extent of reticulation (12.5, IQR 5.0–20.0 versus 25.0, IQR 15.0–26.3, p = 0.038) and honeycombing (5.0, IQR 0.0–10.0 versus 20.0, IQR 10.6–20.0, p = 0.001) but not traction bronchiectasis (10.0, IQR 5–15 versus 15.0, IQR 5–15, p = 0.878). Receiver operator curve analysis of fibrosis SI compared to similarly located regions in control subjects showed an area under the curve of 0.82 (p = 0.002). A SI cutoff of 19 yielded a sensitivity of 75% and specificity of 86% in differentiating fibrosis from similarly located regions in control subjects. Conclusion LGE-MRI can differentiate CPFE from pure emphysema and may be a useful adjunct test to HRCT in patients with suspected CPFE.

scholarly journals Comparing the Predictive Power of Preoperative Risk Assessment Tools to Best Predict Major Adverse Cardiac Events in Kidney Transplant Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Colin P. Dunn ◽  
Emmanuel U. Emeasoba ◽  
Ari J. Holtzman ◽  
Michael Hung ◽  
Joshua Kaminetsky ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Assessment Tools ◽  
Major Adverse Cardiac Events ◽  
Receiver Operator Curve ◽  
Cardiac Events ◽  
Preoperative Risk ◽  
Preoperative Risk Assessment ◽  
Transplant Patients ◽  
Adverse Cardiac Events ◽  
Operator Curve

Background. Patients undergoing kidney transplantation have increased risk of adverse cardiovascular events due to histories of hypertension, end-stage renal disease, and dialysis. As such, they are especially in need of accurate preoperative risk assessment. Methods. We compared three different risk assessment models for their ability to predict major adverse cardiac events at 30 days and 1 year after transplant. These were the PORT model, the RCRI model, and the Gupta model. We used a method based on generalized U-statistics to determine statistically significant improvements in the area under the receiver operator curve (AUC), based on a common major adverse cardiac event (MACE) definition. For the top-performing model, we added new covariates into multivariable logistic regression in an attempt to create further improvement in the AUC. Results. The AUCs for MACE at 30 days and 1 year were 0.645 and 0.650 (PORT), 0.633 and 0.661 (RCRI), and finally 0.489 and 0.557 (Gupta), respectively. The PORT model performed significantly better than the Gupta model at 1 year (p=0.039). When the sensitivity was set to 95%, PORT had a significantly higher specificity of 0.227 compared to RCRI’s 0.071 (p=0.009) and Gupta’s 0.08 (p=0.017). Our additional covariates increased the receiver operator curve from 0.664 to 0.703, but this did not reach statistical significance (p=0.278). Conclusions. Of the three calculators, PORT performed best when the sensitivity was set at a clinically relevant level. This is likely due to the unique variables the PORT model uses, which are specific to transplant patients.

scholarly journals Plasma Free Cortisol in States of Normal and Altered Binding Globulins: Implications for Adrenal Insufficiency Diagnosis

2019 ◽  
Vol 104 (10) ◽  
pp. 4827-4836 ◽  
Author(s):  
Laura E Dichtel ◽  
Melanie Schorr ◽  
Claudia Loures de Assis ◽  
Elizabeth M Rao ◽  
Jessica K Sims ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Outcome Measure ◽  
Cross Sectional ◽  
Free Cortisol ◽  
Receiver Operator Curve Analysis ◽  
Liquid Chromatography Tandem Mass ◽  
Healthy Control ◽  
Low Cortisol ◽  
The Relationship ◽  
Operator Curve

Abstract Context Accurate diagnosis of adrenal insufficiency is critical because there are risks associated with overdiagnosis and underdiagnosis. Data using liquid chromatography tandem mass spectrometry (LC/MS/MS) free cortisol (FC) assays in states of high or low cortisol-binding globulin (CBG) levels, including cirrhosis, critical illness, and oral estrogen use, are needed. Design Cross-sectional. Objective Determine the relationship between CBG and albumin as well as total cortisol (TC) and FC in states of normal and abnormal CBG. Establish the FC level by LC/MS/MS that best predicts TC of <18 μg/dL (497 nmol/L) (standard adrenal insufficiency diagnostic cutoff) in healthy individuals. Subjects This study included a total of 338 subjects in four groups: healthy control (HC) subjects (n = 243), patients with cirrhosis (n = 38), intensive care unit patients (ICU) (n = 26), and oral contraceptive (OCP) users (n = 31). Main Outcome Measure(s) FC and TC by LC/MS/MS, albumin by spectrophotometry, and CBG by ELISA. Results TC correlated with FC in the ICU (R = 0.91), HC (R = 0.90), cirrhosis (R = 0.86), and OCP (R = 0.70) groups (all P < 0.0001). In receiver operator curve analysis in the HC group, FC of 0.9 μg/dL (24.8 nmol/L) predicted TC of <18 μg/dL (497 nmol/L; 98% sensitivity, 91% specificity; AUC, 0.98; P < 0.0001). Decreasing the cutoff to 0.7 μg/dL led to a small decrease in sensitivity (92%) with similar specificity (91%). Conclusions A cutoff FC of <0.9 μg/dL (25 nmol/L) in this LC/MS/MS assay predicts TC of <18 μg/dL (497 nmol/L) with excellent sensitivity and specificity. This FC cutoff may be helpful in ruling out adrenal insufficiency in patients with binding globulin derangements.

scholarly journals Extubation Success Prediction in a Multicentric Cohort of Patients with Severe Brain Injury

2017 ◽  
Vol 127 (2) ◽  
pp. 338-346 ◽  
Author(s):  
Karim Asehnoune ◽  
Philippe Seguin ◽  
Sigismond Lasocki ◽  
Antoine Roquilly ◽  
Adrien Delater ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Brain Injury ◽  
Unit Length ◽  
Extubation Failure ◽  
Receiver Operator Curve ◽  
Severe Brain Injury ◽  
University Hospitals ◽  
Operator Curve ◽  
Successful Extubation

Abstract Background Patients with brain injury are at high risk of extubation failure. Methods We conducted a prospective observational cohort study in four intensive care units of three university hospitals. The aim of the study was to create a score that could predict extubation success in patients with brain injury. Results A total of 437 consecutive patients with brain injury were included, and 338 patients (77.3%) displayed successful extubation. In the multivariate analysis, four features were associated with success the day of extubation: age less than 40 yr, visual pursuit, swallowing attempts, and a Glasgow coma score greater than 10. In the score, each item counted as one. A score of 3 or greater was associated with 90% extubation success. The area under the receiver–operator curve was 0.75 (95% CI, 0.69 to 0.81). After internal validation by bootstrap, the area under the receiver–operator curve was 0.73 (95% CI, 0.68 to 0.79). Extubation success was significantly associated with shorter duration of mechanical ventilation (11 [95% CI, 5 to 17 days] vs. 22 days [95% CI, 13 to 29 days]; P &lt; 0.0001), shorter intensive care unit length of stay (15 [95% CI, 9 to 23 days] vs. 27 days [95% CI, 21 to 36 days]; P &lt; 0.0001), and lower in-intensive care unit mortality (4 [1.2%] vs. 11 [11.1%]; P &lt; 0.0001). Conclusions Our score exploring both airway functions and neurologic status may increase the probability of successful extubation in patients with severe brain injury.

scholarly journals Machine Learning Applied to Electronic Health Records: Identification of Chemotherapy Patients at High Risk for Preventable Emergency Department Visits and Hospital Admissions

2021 ◽  
pp. 1106-1126
Author(s):  
Dylan J. Peterson ◽  
Nicolai P. Ostberg ◽  
Douglas W. Blayney ◽  
James D. Brooks ◽  
Tina Hernandez-Boussard
Keyword(s):  
Machine Learning ◽  
At Risk ◽  
Emergency Department ◽  
Emergency Department Visits ◽  
Test Model ◽  
Receiver Operator Curve ◽  
Patients At Risk ◽  
Electronic Health ◽  
Chemotherapy Patients ◽  
Operator Curve

PURPOSE Acute care use (ACU) is a major driver of oncologic costs and is penalized by a Centers for Medicare & Medicaid Services quality measure, OP-35. Targeted interventions reduce preventable ACU; however, identifying which patients might benefit remains challenging. Prior predictive models have made use of a limited subset of the data in the electronic health record (EHR). We aimed to predict risk of preventable ACU after starting chemotherapy using machine learning (ML) algorithms trained on comprehensive EHR data. METHODS Chemotherapy patients treated at an academic institution and affiliated community care sites between January 2013 and July 2019 who met inclusion criteria for OP-35 were identified. Preventable ACU was defined using OP-35 criteria. Structured EHR data generated before chemotherapy treatment were obtained. ML models were trained to predict risk for ACU after starting chemotherapy using 80% of the cohort. The remaining 20% were used to test model performance by the area under the receiver operator curve. RESULTS Eight thousand four hundred thirty-nine patients were included, of whom 35% had preventable ACU within 180 days of starting chemotherapy. Our primary model classified patients at risk for preventable ACU with an area under the receiver operator curve of 0.783 (95% CI, 0.761 to 0.806). Performance was better for identifying admissions than emergency department visits. Key variables included prior hospitalizations, cancer stage, race, laboratory values, and a diagnosis of depression. Analyses showed limited benefit from including patient-reported outcome data and indicated inequities in outcomes and risk modeling for Black and Medicaid patients. CONCLUSION Dense EHR data can identify patients at risk for ACU using ML with promising accuracy. These models have potential to improve cancer care outcomes, patient experience, and costs by allowing for targeted, preventative interventions.

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