Cohen's Kappa Statistic Research Articles

Interreader agreement in evaluation of 68Ga-PSMA PET/CT at the time of initial staging: comparison of the three evaluation criteria in the pretreatment risk groups.

The aim of this study was to assess the interreader agreement in evaluation 68Ga-prostate-specific membrane antigen (PSMA) PET/CT according to three current criteria European association of nuclear medicine, PROMISE with miTNM, and PSMA-RADS in newly diagnosed prostate cancer (PC) patients. The images of 101 patients who had been diagnosed with PC and underwent 68Ga-PSMA PET/CT at the time of initial staging were evaluated according to the three interpretation criteria by two nuclear medicine specialists. Local tumor, pelvic lymph node metastasis and distant metastasis were evaluated separately. Abdominal lymph nodes, bone and visceral organ metastases were additionally evaluated as subregions of distant metastatic sites. Patients were evaluated in subgroups Gleason score ≥8 or prostate-specific antigen ≥20 ng/mL as the high-risk group (HR) and prostate-specific antigen ≤ 20 ng/mL and Gleason score <8 as the low-risk group (LR). To measure interreader agreement for each judgment site Cohen's Kappa statistic coefficient (κ) was calculated. All three criteria European association of nuclear medicine, PROMISE with miTNM and PSMA-RADS exhibit substantial and almost perfect agreement between the readers in all sites except for PSMA-RADS in bone and visceral metastasis (κ = 0.495, κ = 0.506, respectively). According to the risk groups, a remarkable difference in interreader agreement for bone metastasis for all three criteria (especially in PSMA-RADS) between the HR and LR patients was detected. In low-risk patients especially PSMA-RADS criteria leads to increased interreader reporting differences. While evaluating 68Ga-PSMA PET/CT images it should be considered that pretreatment risk levels of PC patients could affect the interreader agreement.

Comparing the diagnostic accuracy of rapid antigen detection tests to real time polymerase chain reaction in the diagnosis of SARS-CoV-2 infection: A systematic review and meta-analysis.

BackgroundTimely and accurate diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is crucial to reduce the risk of viral transmission. We investigated the diagnostic accuracy of rapid antigen detection tests (RADTs) in the diagnosis of SARS-CoV-2 infection.MethodsA systematic literature search was performed using Pubmed, Embase, and the Cochrane Central Register. The sensitivity, specificity, diagnostic odds ratio (DOR), and a hierarchical summary receiver-operating characteristic curve (HSROC) of RADTs were pooled using meta-analysis. We used commercial and laboratory-developed reverse transcriptase-polymerase chain reaction (RT-PCR) as reference standards.ResultsWe identified 24 studies comprising 14,188 patients. The overall pooled sensitivity, specificity, and DOR of RADTs for diagnosis of SARS-CoV-2 were 0.68 (95%CI, 0.59 – 0.76), 0.99 (95%CI, 0.99 – 1.00), and 426.70 (95% CI, 168.37 – 1081.65), respectively. RADTs and RT-PCR had moderate agreement with an estimated pooled Cohen's kappa statistic of 0.75 (95%CI, 0.74–0.77), and area under the HSROC of 0.98 (95%CI, 0.96 – 0.99). The pooled sensitivity of RADTs was significantly increased in subjects with viral load of Ct-value ≤25 or in those within 5 days after symptom onset than it was in subjects with lower viral loads or longer symptom duration.ConclusionsThe overall sensitivity of RADTs was inferior to that of the RT-PCR assay. The RADTs were more sensitive for samples of Ct-value ≤ 25 and might be suitable for subjects in the community within 5 days of symptom onset.

New Operative Reporting Standards: Where We Stand Now and Opportunities for Innovation.

The American College of Surgeons Commission on Cancer's (CoC) new operative standards for breast cancer, melanoma, and colon cancer surgeries will require that surgeons provide synoptic documentation of essential oncologic elements within operative reports. Prior to designing and implementing an electronic tool to support synoptic reporting, we evaluated current documentation practices at our institution to understand baseline concordance with these standards. Applicable procedures performed between 1 January 2018 and 31 December 2018 were included. Two independent reviewers evaluated sequential operative notes, up to a total of 100 notes, for documentation of required elements. Complete concordance (CC) was defined as explicit documentation of all required CoC elements. Mean percentage CC and surgeon-specific CC were calculated for each procedure. Interrater reliability was assessed via Cohen's kappa statistic. For sentinel lymph node biopsy, mean CC was 66% (n=100), with surgeon-specific CC ranging from 6 to 100%, and for axillary dissection, mean CC was 12% (n=89) and surgeon-specific CC ranged from 0 to 47%. The single surgeon performing melanoma wide local excision had a mean CC of 98% (n=100). For colon resections, mean CC was 69% (n=96) and surgeon-specific CC ranged from 39 to 94%. Kappa scores were 0.77, 0.78, -0.15, and 0.78, respectively. We identified heterogeneity in current documentation practices. In our cohort, rates of baseline concordance varied across surgeons and procedures. Currently, documentation elements are interspersed within the operative report, posing challenges to chart abstraction with resulting imperfect interrater reliability. This presents an exciting opportunity to innovate and improve compliance by introducing an electronic synoptic documentation tool.

An evaluation of concordance between head and neck advanced practice radiation therapist and radiation oncologists in toxicity assessment for nasopharyngeal carcinoma patients.

Weekly toxicity assessments for patients undergoing head and neck (HN) radiotherapy are essential to ensure that acute side effects are appropriately managed in order for patients to complete their treatment in a safe and timely manner. The incorporation of Advanced Practice Radiation Therapist (APRT) led treatment reviews has been reported for various subsites, but there is currently a lack of published literature regarding this role for patients with HN cancer. The purpose of this study is to assess the concordance of toxicity assessments performed during weekly radiotherapy treatment reviews for patients undergoing HN radiotherapy between the HN APRT and Radiation Oncologist (RO). Twenty-three patients with nasopharyngeal cancer (NPC) under the care of 3 ROs were recruited from June to December 2018; weekly assessments wereindependentlyperformed by HN APRT and ROs. The HN toxicity assessment was graded according to the Common Terminology Criteria for Advanced Events v4.0. Both assessors were blinded to each other's assessments. The percentage agreement of concordance and agreement level were interpreted by Cohen's Kappa statistic (κ), with the ROs' assessments deemed as the 'gold standard'. The overall concordance for all graded toxicity assessments between HN APRT and ROs was 78.4%. Xerostomia, dysgeusia, pharyngeal pain and dermatitis assessment were evaluated as 'Good' with agreement ranging from κ=0.608-0.640 between the HN APRT and ROs while dysphagia scored an 'Almost Perfect' agreement of κ=0.834. 'Moderate' agreement between the HN APRT and ROs was observed for oral pain and mucositis assessment. A scoring discrepancy of 1 and 2 grades was observed in 21.2% and 0.4% for these two toxicities. There was high concordance in scoring of acute toxicity between the HN APRT and ROs. The results support the continuing involvement of HN APRT in weekly assessments for NPC patients.

Superselective pseudocontinuous arterial spin labeling in patients with meningioma: utility in prediction of feeding arteries and preoperative embolization feasibility.

Superselective pseudocontinuous arterial spin labeling (ss-pCASL) is an MRI technique in which individual vessels are labeled to trace their perfusion territories. In this study, the authors assessed its merit in defining feeding vessels and gauging preoperative embolization feasibility for patients with meningioma, using digital subtraction angiography (DSA) as the reference method. Thirty-one consecutive patients with meningiomas were prospectively recruited, each undergoing DSA (and embolization, if feasible) before resection. All ss-pCASL imaging studies were performed 1 day prior to DSA. Two neuroradiologists independently reviewed ss-pCASL images, rating the contribution of each labeled vessel to tumor blood supply as none, minor, or major. Two neuroradiologists also gauged the feasibility of embolization in each patient, based on ss-pCASL images. Interobserver and intermodality agreement were determined using Cohen's kappa statistic. The diagnostic performance of ss-pCASL was assessed in terms of discerning tumor blood supply and the potential for embolization. Interobserver agreement in the rating of blood supply by ss-pCASL was very good (κ = 0.817, 95% CI 0.771-0.863), and intermodality agreement (consensus ss-pCASL readings vs DSA findings) was good (κ = 0.688, 95% CI 0.632-0.744). In delineating tumor blood supply, ss-pCASL showed high sensitivity (87.1%) and specificity (87.2%). The positive and negative predictive values for embolization feasibility were 85.2% and 100%, respectively. In patients with meningiomas, feeding vessels are reliably predicted by ss-pCASL. This noninvasive approach, involving no iodinated contrast or radiation exposure, is particularly beneficial if there are no prospects of embolization.

Precision and impact of prenatal diagnosis of common arterial trunk

Outcomes of common arterial trunk (CAT) depend mainly on truncal valve function, coronary artery abnormalities and presence of interrupted aortic arch. Little is known about the precision and potential impact of prenatal diagnosis of CAT in the current era. Retrospective analysis of all prenatally diagnosed CAT patients with postnatal or fetopsy confirmation from 2011–2019 in a single tertiary center. Cohen's Kappa statistic was used to measure agreement for pre- and postnatal assessment of anatomic subtypes according to Van Praagh and of truncal valve function. Mortality and morbidity variables were compared. Eighty-four patients (62 live born with prenatal diagnosis/16 live born with postnatal diagnosis/6 terminations of pregnancy with fetopsy) met inclusion criteria. Diagnostic precision for prenatal diagnosis of CAT subtypes was moderate (Kappa κ = 0.43) with a pre- and postnatal discordance in 19%. Notably, no fetus had a prenatal diagnosis of CAT Type A3, and only half of patients with CAT Type A4 (8/17) were diagnosed prenatally. Fetal evaluation of truncal valve function underestimated the presence and severity of insufficiency (slight agreement; κ = 0.19). However, 4 of 5 postnatally confirmed significant stenoses were diagnosed prenatally (moderate agreement; κ = 0.38). There was no difference in postoperative mortality for CAT patients with or without prenatal diagnosis (P = 0.87). CAT patients with fetal diagnosis underwent earlier intervention (P ≤ 0.001), had shorter intubation time (P = 0.047) and shorter global hospital stay (P = 0.01). The precision of prenatal diagnosis of CAT has to be improved. Anatomic subtypes A3/A4 are largely underdiagnosed with potential negative impact on neonatal management. Truncal valve dysfunction appears difficult to assess, even if valve stenosis seems easier predictable than insufficiency. Prenatal diagnosis of CAT has no impact on postoperative mortality but tends to favorably influence morbidity.

Validity of Self-Reported Hepatitis C Virus Status Among Criminal Justice-Involved Persons Living With HIV

The prevalence of HIV/hepatitis C virus (HCV) coinfection among justice-involved persons is high. The validity of self-reported HCV status in this population has important public health implications, yet has not been studied. Justice-involved persons with HIV from Washington, DC, were enrolled in a study that investigated a mobile health intervention to support HIV treatment. Self-reported and laboratory-confirmed HCV status was compared. Among 103 participants, chronic HCV prevalence was 13%. Positive predictive value of self-reported positive chronic HCV status was low at 55%, and negative predictive value was 98%. Cohen's kappa statistic was 0.60 for agreement. Two women who reported negative HCV status were found to have HCV.

Cost-effective screening using a two-antibody panel for detecting mismatch repair deficiency in sporadic colorectal cancer.

BACKGROUNDThe microsatellite instability (MSI) test and immunohistochemistry (IHC) are widely used to screen DNA mismatch repair (MMR) deficiency in sporadic colorectal cancer (CRC). For IHC, a two-antibody panel of MLH1 and MSH2 or four-antibody panel of MLH1, MSH2, PMS2, and MSH6 are used. In general, MSI is known as a more accurate screening test than IHC.AIMTo compare two- and four-antibody panels of IHC in terms of accuracy and cost benefit on the basis of MSI testing for detecting MMR deficiency.METHODSWe retrospectively analyzed patients with CRC who underwent curative surgery between 2015 and 2017 at a tertiary referral center. Both IHC with four antibodies and MSI tests were routinely performed. The sensitivity and specificity of a four- and two types of two-antibody panels (PMS2/MSH6 and MLH1/MSH2) were compared on the basis of MSI testing for detecting MMR deficiency.RESULTSHigh-frequency MSI was found in 5.5% (n = 193) of the patients (n = 3486). The sensitivities of the four- and two types of two-antibody panels were 97.4%, 92.2%, and 87.6%, respectively. The specificities of the three types of panels did not differ significantly (99.6% for the four-antibody and PMS2/MSH6 panels, 99.7% for the MLH1/MSH2 panel). Based on Cohen's kappa statistic (κ), four- and two-antibody panels were in almost perfect agreement with the MSI test (κ > 0.9). The costs of the MSI test and the four- and two-antibody panels of IHC were approximately $200, $160, and $80, respectively.CONCLUSIONConsidering the cost of the four-antibody panel IHC compared to that of the two-antibody panel IHC, a two-antibody panel of PMS2/MSH6 might be the best choice in terms of balancing cost-effectiveness and accuracy.

Ambidirectional cohort study on the agreement of ultrasonography and surgery in the identification of parathyroid pathology, and predictors of postoperative hypocalcemia in 47 dogs undergoing parathyroidectomy due to primary hyperparathyroidism.

ObjectiveTo investigate (1a) agreement of ultrasonographic, surgical, and histopathologic findings in the diagnosis of a neoplastic etiology underlying primary hyperparathyroidism (PHPT), (1b) the ability of ultrasonographically determined parathyroid gland size to distinguish between malignant (carcinoma) and non‐malignant (hyperplasia, adenoma) pathology, and (2) variables associated with postoperative hypocalcemia in dogs undergoing surgical treatment of PHPT.Study DesignAmbidirectional cohort study.AnimalsForty‐seven client owned dogs with PHPT (34 retrospective; 13 prospective).MethodsData were extracted from medical records. Method agreements were explored using Cohen's Kappa statistic. A receiver operating characteristic curve (ROC) was used to determine a cut‐off separating parathyroid pathologies. Univariable and multivariable models assessed associations between postoperative hypocalcemia and potential risk factors.ResultsAgreement of ultrasound and surgery for number and side of affected glands was 31/47 (65.9%) and 34/47 (72.3%), respectively. In 37/47 (78.7%) cases, parathyroid tissue was correctly assessed as pathologic by the surgeon. An ultrasonographic cut‐off of ≥8.0 mm (ROC AUC = 0.82) best distinguished malignant from benign pathologies. Dogs with a preoperative serum ionized calcium (iCa) concentration ≥1.75 mEq/L had 7.5 times greater odds of becoming hypocalcemic postoperatively.ConclusionA fair agreement existed between ultrasonographic and surgical findings in dogs with PHPT. A parathyroid mass ≥8.0 mm on ultrasonographic examination was suggestive of malignancy, while dogs with a preoperative serum iCa concentration ≥1.75 mEq/L were at increased risk for postoperative hypocalcemia in this study.Clinical significanceThis study supports the use of bilateral cervical surgical exploration to identify abnormal parathyroid glands for the treatment of PHPT.

Evaluation of the use of paired modified Wright's and periodic acid Schiff stains to identify microbial aggregates on cytological smears of dogs with microbial otitis externa and suspected biofilm.

Micro-organisms associated with canine otitis externa (OE) may cause biofilm-associated infections (BAI). A key component of biofilm is microbial aggregate and extracellular polymeric substance (EPS). Periodic acid Schiff (PAS) can stain polysaccharide EPS in human otitis media with effusion, but this has not been tested in canine OE. There is no cytological definition for microbial aggregate, and definitive methods for identifying BAI in a clinical setting in canine OE have not been defined. To establish whether PAS stain can identify polysaccharide matrix on cytological smears; and to determine the reproducibility of identification of microbial aggregates within a discrete area of stained matrix, using paired modified Wright's and PAS-stained smears. Forty privately-owned dogs presenting to a dermatological referral practice. In this prospective, cross-sectional study, three investigators independently and blindly classified 40 paired modified Wright's-PAS slide sets into groups: aggregate-associated infection (AAI) and non-AAI (n=27); and control (n=13). Agreement between investigators for presence of AAI was measured using Fleiss' kappa statistic (FK). Agreement between investigators and dermatologists for presence of AAI upon cytological evaluation, and suspected BAI based on clinical examination, was measured using Cohen's kappa statistic. The matrix was confirmed to stain PAS-positive. Interinvestigator agreement for AAI was very good using PAS (0.82 FK) and fair using modified-Wright's (MW) (0.33 FK). Reproducible cytological features associated with AAI were the presence of: three or more distinct aggregates (0.76 FK); discrete areas of PAS-positive matrix (0.70 FK); and the presence of high-density material (0.70 FK) using PAS stain. PAS can stain the extracellular matrix on otic smears, and a novel protocol for reproducible identification of cytological features such as microbial aggregates has been established.

Evaluation of YouTube as an information source for denture care

Statement of problemDenture cleaning is indispensable to the maintenance of good oral and systemic health for denture users. Nowadays people often consult YouTube about health-related topics, including denture care. However, the quality of the information about denture care presented on YouTube is unknown. PurposeThe purpose of this study was to evaluate the usefulness and quality of popular videos about denture care shared by different uploaders on YouTube and to evaluate the demographic characteristics of the videos. Material and methodsGoogle Trends showed that “denture cleaning” was the most searched keyword on the topic. This keyword was used to search YouTube videos. Of the 200 most-watched videos, 109 videos were selected for analysis. Included videos were analyzed for their demographic data, including number of views; number of likes, dislikes, and comments; days since upload; duration and number of subscribers; an 8-point usefulness score system, a global quality scale (GQS); video sources; target groups; and primary purposes of the videos. Statistical analyses were conducted by using the Kruskal-Wallis test, post hoc Mann-Whitney U test, Pearson chi-squared test, and Spearman correlation analysis, which was used to investigate the relationship among total content score, GQS score, and video demographics. Cohen kappa statistics was used to measure the reliability of the investigator’s evaluations of the videos (α=.05). ResultsBased on the usefulness score, 59.6% of the videos were classified as poor, 32.1% as moderate, and 8.2% as good. No statistically significant differences were found among usefulness scores according to the video demographics, except lower GQS score of poor content videos (P<.001). The overall mean ±standard deviation GQS score was 1.92 ±1.0 out of 5. Videos were primarily uploaded (38.5%) from commercial companies. No statistically significant difference was found between video sources and usefulness scores (P>.05). The number of videos with poor content was significantly higher than the number with moderate and good content among the videos primarily intended for the education of health professionals (P<.001). ConclusionsThe majority (59.6%) of YouTube videos on denture care received poor content quality ratings, independent of video demographics. Therefore, YouTube is not suitable as the only source of information on denture care. Dentists and prosthodontists should take more responsibility for enriching the content of video-sharing platforms because this content can affect the behavior of patients and their attitudes about denture care.

Reliability and validity of the Unified Classification System for postoperative periprosthetic femoral fractures around cemented polished taper-slip stems.

This aim of this study was to assess the reliability and validity of the Unified Classification System (UCS) for postoperative periprosthetic femoral fractures (PFFs) around cemented polished taper-slip (PTS) stems. Radiographs of 71 patients with a PFF admitted consecutively at two centres between 25 February 2012 and 19 May 2020 were collated by an independent investigator. Six observers (three hip consultants and three trainees) were familiarized with the UCS. Each PFF was classified on two separate occasions, with a mean time between assessments of 22.7 days (16 to 29). Interobserver reliability for more than two observers was assessed using percentage agreement and Fleiss' kappa statistic. Intraobserver reliability between two observers was calculated with Cohen kappa statistic. Validity was tested on surgically managed UCS type B PFFs where stem stability was documented in operation notes (n = 50). Validity was assessed using percentage agreement and Cohen kappa statistic between radiological assessment and intraoperative findings. Kappa statistics were interpreted using Landis and Koch criteria. All six observers were blinded to operation notes and postoperative radiographs. Interobserver reliability percentage agreement was 58.5% and the overall kappa value was 0.442 (moderate agreement). Lowest kappa values were seen for type B fractures (0.095 to 0.360). The mean intraobserver reliability kappa value was 0.672 (0.447 to 0.867), indicating substantial agreement. Validity percentage agreement was 65.7% and the mean kappa value was 0.300 (0.160 to 0.4400) indicating only fair agreement. This study demonstrates that the UCS is unsatisfactory for the classification of PFFs around PTS stems, and that it has considerably lower reliability and validity than previously described for other stem types. Radiological PTS stem loosening in the presence of PFF is poorly defined and formal intraoperative testing of stem stability is recommended. Cite this article: Bone Joint J2021;103-B(8):1339-1344.

Optimization of a Loop-Mediated Isothermal Amplification Assay as a Point-of-Care Tool for the Detection of Wuchereria bancrofti in Human Blood in Tana River Delta, Kenya.

Introduction Accurate detection of filarial parasites in humans and vectors is essential for the implementation and evaluation of Global and National Programs to eliminate lymphatic filariasis. Immunological methods to detect infection are available; however, cross-reactivity issues have been reported in most of them. Nucleic acid-based molecular assays offer high levels of specificity and sensitivity and can be used to detect the infections. Methods In this study, we evaluated loop-mediated isothermal amplification (LAMP) tests to amplify Wuchereria bancrofti DNA in patients' blood. The amplicons were tested by both pH-sensitive dyes for enhanced visual detection and agarose gel electrophoresis. A closed-tube LAMP assay was also evaluated. Cohen's Kappa statistics was used for statistical analysis of the assays. 125 patients consented for blood sampling which were used for clinical analysis of LAMP assays with the PCR method used as the “gold standard.” Results The sensitivity of the evaluated Wuchereria bancrofti LAMP was 92.3%, with a specificity of 97.3% and kappa statistics value of 0.84, which is in a strong agreement. Conclusion In this study, LAMP assays coupled with fluorescence dye detection have been found to be suitable for diagnosis and monitoring of Wuchereria bancrofti infections in the Kenyan population.

Inter- and intra-rater reliability and accuracy of Sanders Skeletal Maturity Staging System when used by surgeons performing vertebral body tethering.

Pediatric orthopedic surgeons must accurately assess the skeletal stage of adolescent idiopathic scoliosis (AIS) patients for selection and timing of optimal treatment. Successful treatment using vertebral growth modulation is highly dependent on skeletal growth remaining. We sought to evaluate the current-state use of the Sanders Skeletal Maturity System (SSMS) in regard to precision and accuracy. We hypothesized that pediatric orthopedic surgeons currently use SSMS with moderate precision and accuracy. Eight practicing pediatric orthopedic surgeons who perform vertebral body tethering surgery without specific training in SSMS were asked to assign the SSMS stage for 34 de-identified hand radiographs from AIS patients. Precision was evaluated as inter-rater reliability, using both Krippendorff's α and Weighted Cohen's kappa statistics, and as intra-rater reliability, using only Weighted Cohen's kappa statistics. Surgeon accuracy was evaluated using Weighted Cohen's kappa statistics with comparison of surveyed surgeons' responses to the gold standard rating. Inter-rater reliability across the surveyed surgeons indicated moderate to substantial agreement using both statistical methods (α = 0.766, κ = 0.627) with the majority of discord occurring when assigning SSMS stages 2 through 4. The surveyed surgeons displayed substantial accuracy when compared to the gold standard (κ = 0.627) with the majority of inaccuracy involving the identification of stage 3B. When re-surveyed, the surgeons showed substantial intra-rater reliability (κ = 0.71) with increased inconsistencies when deciding between SSMS stage 3A and stage 3B. The current-state use of SSMS across pediatric orthopedic surgeons for evaluation of AIS patients displays adequate but imperfect precision and accuracy with difficulties delineating SSMS stages 2 through 4, which correlate with adolescent growth periods germane to scoliosis growth modulation surgery. Centralized assessment of hand-bone age may help ensure standardized reporting for non-fusion scoliosis research.

Agreement between Compass Fundus Perimeter New Grid and 10-2 Testing Protocols for Detecting Central Visual Field Defects

To evaluate the agreement between Compass New Grid (NG) and 10-2 test protocols for detecting early glaucomatous defects in the central 10 degrees of the visual field (CVFD). Cross-sectional study. A total of 123 eyes of 14 healthy individuals, 17 glaucoma suspects, and 32 glaucoma patients were enrolled. Subjects performed NG and 10-2 Compass automated perimetry testing within 1 week. For both test protocols, total deviation (TD) and pattern deviation (PD) plot CVFDs were defined by 3 contiguous points with probabilities of <5%, <2%, <2% or <5%, <1%, <1%. Cohen's Kappa statistic was used to assess agreement between NG and 10-2 for identifying CVFDs. The Spectralis GMPE Hood Glaucoma Report (investigational software version) macula deviation analysis obtained within 1 year was used for calculating sensitivities and specificities of test protocols. Protocols' agreement, sensitivity, and specificity. Fair to moderate agreement was observed between NG and 10-2 protocols for detecting presence of superior CVFDs on TD (k= 0.57) and PD (k= 0.26) plots and for detecting inferior CVFDs on TD (0.49) and PD (0.27) plots. With the use of OCT macula deviation maps, specificity for detecting CVFD was consistently higher with NG than 10-2 tests for TD plots of the superior hemifield (0.82 and 0.65), inferior hemifield (0.92 and 0.84), and PD plots of the superior hemifield (0.81 and 0.36) and inferior hemifield (0.86 and 0.52). Sensitivity of NG was consistently lower than TD plots of the superior hemifield (0.48 and 0.72), inferior hemifield (0.28 and 0.46), and PD plots of the superior hemifield (0.48 and 0.78) and inferior hemifield (0.20 and 0.52). By using pattern standard deviation (PSD) criterion, the mean PSD values for 10-2 and NG VF tests were 1.61 (95% confidence interval [CI], 1.26-1.96) and 1.81 (95% CI, 1.45-2.17) (P < 0.001), respectively. Although the Compass NG detected fewer CVFDs than the 10-2 test protocol, it did detect CVFDs that were not observed in the Compass 24-2 test in patients with early glaucoma. Therefore, NG may be particularly useful in clinical situations when higher specificity is desired or PSD criterion is used.

Abnormal MRI findings of the orbital or visual pathways in patients with severe COVID-19: Observations from the French multicenter COVID-19 cohort

ObjectivesCOVID-19 is a multisystemic disease. Ophthalmological abnormalities are relatively rare among COVID-19-infected patients. The aim of our study was to report orbital and visual pathways MRI findings in a nationwide multicenter cohort of patients with severe COVID-19. MethodsThis IRB-approved retrospective multi-center study included participants presenting with severe COVID-19, who underwent brain MRI from March 4th to May 1st 2020. Two neuroradiologists (“blinded”), blinded to all data, individually analyzed morphological MRIs focusing on the orbits and the visual pathways. A second consensus reading session was performed in the case of disagreement between both readers. Clinical and ophthalmological data were compared to MRI findings. Descriptive statistical analysis and interobserver agreement for MRI reading using non-weighted Cohen kappa statistics were performed. Results129 participants (43 [33%] women and 86 [67%] men, mean age 63 ± 14 years) were included in the study. 17/129 (13%) patients had abnormal MRI findings of the orbit or visual pathways. 11/17 (65%) patients had a FLAIR-WI hyperintense optic disc. 6/17 (35%) patients had abnormal signal of at least one of the visual pathway structures: 6/6 (100%) of the optic nerve, 1/6 (17%) of the optic chiasm, 2/6 (33%) of the optic tract and 1/6 (17%) of the optic radiations. ConclusionsOur study showed that a substantial number of patients with severe COVID-19 presented with abnormal MRI findings of the orbit or visual pathways, which might lead to potentially severe visual impairment.

Interexaminer Agreement in the Radiologic Identification of Apical Periodontitis/Rarefying Osteitis in the National Dental Practice-Based Research Network PREDICT Endodontic Study

IntroductionPeriapical images are routinely made in endodontics to support diagnosis and treatment decisions, but conventional imaging may not readily demonstrate inflammatory changes. This study aims to quantify disagreement in the radiologic interpretation of apical periodontitis/rarefying osteitis between 2 expert examiners and to determine if differences exist based on anatomic location. MethodsWe used 1717 pretreatment periapical images made before orthograde endodontic treatment as part of the Predicting Outcomes of Root Canal Treatment (PREDICT) study conducted within the National Dental Practice-Based Research Network. Periapical changes were assessed independently by 2 board-certified specialists, an oral and maxillofacial radiologist and an endodontist, blinded to other clinical information. If the examiners disagreed about whether a diagnosis of apical periodontitis/rarefying osteitis was justified, an adjudication was made by a third examiner. ResultsThe overall prevalence of this radiologic diagnosis in the periapical images was 55%, and interexaminer agreement measured with the Cohen kappa statistic was calculated to be 0.56 (95% confidence interval, 0.52–0.60). Diagnostic disagreements between the 2 examiners occurred for 377 teeth (22%), with disagreements more frequent for jaw location (P = .038) and tooth type (P = .021). Differences between root number (P = .058) and jaw location and tooth groups (P = .069) were found not to be statistically significant. ConclusionsThe variability of diagnostic disagreements across anatomic location and tooth type may reflect the inability of periapical images to reveal bone changes masked by the complexity and density of overlying anatomic structures, a limitation that could potentially be overcome with the use of 3-dimensional imaging.

Intra-Individual Variability in Self-Reported Use of Non-Steroidal Anti-Inflammatory and Analgesic Medicines Depending on Mode of Data Collection - Observations from the Population Study of Women in Gothenburg, Sweden.

BackgroundSelf-report by questionnaire is one of the main methods to collect data on drug utilization. There are several modes of data collection by questionnaire, differing in the way of delivering the questionnaire to respondents and in the administration of the questions, both influencing the recall and participation rates. The aim of this study was to compare different modes of data collection for self-reported use of non-steroidal anti-inflammatory (NSAIDs) and analgesic medicines.MethodsData on 573 women (38 or 50 years) were retrieved from the Population Study of Women in Gothenburg. Data on medicine use were collected using two different modes: (1) a self-administered questionnaire with closed-ended medicine-specific questions; and (2) an interviewer-administered questionnaire with open-ended questions. Cohen’s kappa statistics were applied to assess the agreement of the two modes.ResultsThe proportion of participants that reported use of NSAIDs and analgesics was higher with the self-administered questionnaire compared with the interviewer-administered questionnaire (69.3% vs 58.5%, p <0.001). The overall agreement between the two modes of data collection was fair (Ⱪ=0.27), ranging from none for antimigraine preparations to fair (Ⱪ=0.36) for NSAIDs. A higher proportion of the participants aged 38 years reported use of NSAIDs and analgesics compared with the 50-year olds. In the regression model using data from the self-administered questionnaire, all four categories of bodily pain were significant predictors for use of NSAIDs and analgesics. The most severe reported bodily pain was the only significant predictor in the model using data from the interviewer-administered questionnaire.ConclusionThis study showed that use of a self-administered questionnaire with closed-ended medicine-specific questions identified more users of NSAIDs and analgesic medicines compared with an interviewer-administered questionnaire with open-ended questions. Reported use according to the self-administered questionnaire was also more strongly associated with experienced pain.

Abstract 90: Feasibility and Acceptability of Smartphone-Based Cervical Cancer Screening among HIV-Positive Women in Western Kenya

Abstract Purpose: Adjunct cervical cancer screening methods, including cervicography, are under evaluation to improve the accuracy of HPV-based screening in low- and middle-income countries (LMICs). We evaluated the feasibility and acceptability of smartphone-based cervicography among HPV-positive women living with HIV (WLWH) in Western Kenya. Methods: HPV-positive WLWH age 25-49 years enrolled in a clinical trial (NCT04191967) had digital images of the cervix taken using a smartphone by a nonphysician provider following visual inspection with acetic acid (VIA). All participants had colposcopy-directed biopsy prior to treatment. A questionnaire was administered to assess acceptability of cervicography. Cervical images were evaluated by three off-site colposcopists for quality, diagnostic utility, and assigned a presumed diagnosis. We determined the proportion of images rated as low, medium, or high quality, the interobserver agreement using Cohen's Kappa statistic, and the colposcopist's sensitivity and specificity for diagnosis of cervical intraepithelial neoplasia grade 2 or worse (CIN2+) compared with histopathology. Results: One hundred and sixty-four HPV-positive WLWH underwent cervicography during the study period. Mean age was 37.3 years. The vast majority of women, 99.4%, were comfortable having an image of their cervix taken as part of screening. Images from the first 94 participants were evaluated by off-site colposcopists, with a majority (70.9%) rated as high quality, and 86.9% of sufficient quality for diagnosis. Off-site colposcopists had a sensitivity ranging from 21.4% (95% CI 0.06-0.43) to 35.7% (95% CI 0.26-0.46), and specificity between 85.5% (95% CI 0.81-0.90) to 94.9% (95% CI 0.92-0.98) for diagnosis of CIN2+ compared to histopathology. Conclusion: Cervicography by a nonphysician provider as an adjunct to HPV-based screening among WLWH in an LMIC setting is feasible and acceptable. However, low sensitivity for diagnosis of CIN2+ from cervical images by off-site expert colposcopists highlights the limitations of cervicography and need for a better triage test in this population. Citation Format: Chemtai Mungo, Cyrillus Ogollah, Jennifer Ambaka, Magdalene Randa, Anagha Guliam, Craig Cohen. Feasibility and Acceptability of Smartphone-Based Cervical Cancer Screening among HIV-Positive Women in Western Kenya [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 90.

Interobserver and Intraobserver Reliability of the Enneking Classification in Plain Radiographic Staging of Benign Bone Tumors of the Extremities in Patients Seen at the Philippine General Hospital

Objective. To determine the interobserver and intraobserver reliabilities of the Enneking Classification system in staging benign bone tumors.&#x0D; Methods. Photographs of traditional plain radiographs of 65 histologically benign tumors from the PGH Department of Orthopedics Tumor Registry were used in the study. Nine Orthopedic surgeons (three consultants, one fellow, and five senior residents) staged the tumors using the Enneking Classification based on radiographic tumor-host margins. The photographs were sent to the surgeons twice (batch 1 and 2), three months apart, for staging. The Fleiss and Cohen kappa statistics were used to determine interobserver and intraobserver reliabilities, respectively. This is a pilot study.&#x0D; Results. There was only fair interobserver reliability of the Enneking Classification staging with Fleiss kappa of 0.38 and 0.26 for batches 1 and 2, respectively. Also, there was only moderate intraobserver reliability (Cohen kappa 0.48) for the staging. Moreover, there was also a relatively low intraobserver percent agreement (67%) among raters. In both reliabilities, the consultants/fellow group consistently showed better interobserver and intraobserver reliabilities compared to the residents.&#x0D; Conclusion. The Enneking Classification in staging benign bone tumors had relatively low interobserver and intraobserver reliabilities. There was also a tendency of experienced orthopedic tumor consultants and senior residents to stage the same radiograph differently upon repeat testing.