Fleiss Kappa Research Articles

Pediatric Hepatoblastoma After Neoadjuvant Chemotherapy: Diagnostic Performance of MR in Staging POSTTEXT and Vascular Involvement.

The assessment of resectability after neoadjuvant chemotherapy of hepatoblastoma is dependent on Post-Treatment EXTENT of Disease (POSTTEXT) staging and its annotation factors P (portal venous involvement) and V (hepatic venous/inferior vena cava [IVC] involvement), but MR performance in assessing them remains unclear. To assess the diagnostic performance of contrast-enhanced MR imaging for preoperative POSTTEXT staging and diagnosing vascular involvement in terms of annotation factors P and V in pediatric hepatoblastoma following neoadjuvant chemotherapy. Retrospective. Thirty-five consecutive patients (17 males, median age, 24 months; age range, 6-98 months) with proven hepatoblastoma underwent preoperative MR imaging following neoadjuvant chemotherapy. 3.0 T; T2-weighted imaging (T2WI), T2WI with fat suppression, diffusion weighted imaging, radial stack-of-the-star/Cartesian 3D Dixon T1-weighted gradient echo imaging. Three radiologists independently assessed the POSTTEXT stages and annotation factors P and V based on the 2017 PRE/POSTTEXT system. The sensitivities and specificities were calculated for 1) diagnosing each POSTTEXT stage; 2) discrimination of stages III and IV (advanced) from those stages I and II (non-advanced) hepatoblastomas; and 3) annotation factors P and V. The combination of pathologic findings and surgical records served as the reference standard. Sensitivity, specificity, Fleiss kappa test. The sensitivity and specificity ranges for discriminating advanced from non-advanced hepatoblastomas were 73.3%-80.0% and 80.0%-90.0%, respectively. For annotation factor P, they were 66.7%-100.0% and 90.6%, respectively. For factor V, they were 75.0% and 67.7%-83.9%, respectively. There was excellent, substantial, and moderate agreement on POSTTEXT staging (Fleiss kappa = 0.82), factors P (Fleiss kappa = 0.64), and factors V (Fleiss kappa = 0.60), respectively. MR POSTTEXT provides reliable discrimination between advanced and non-advanced tumors, and MR has moderate to excellent specificity at identifying portal venous and hepatic venous/IVC involvement. 3 TECHNICAL EFFICACY: Stage 3.

Interobserver Agreement on the Interpretation of Programmed Death-ligand 1 (PD-L1) Combined Positive Score (CPS) Among Gynecologic Pathologists.

The anti-programmed cell death (PD-1) checkpoint inhibitor pembrolizumab is approved for the treatment of cervical carcinoma with a programmed cell death-ligand 1 (PD-L1) Combined Positive Score (CPS) of ≥1. We assessed interobserver agreement in cervical carcinoma PD-L1 CPS to identify whether it may affect patient selection for immunotherapeutic candidacy. Twenty-nine cervical carcinomas were stained for PD-L1 (Dako 22C3), and slides were interpreted by 5 subspecialty-trained gynecologic pathologists with experience reading PD-L1 immunohistochemistry. Expression was scored using CPS and read out as positive (≥1) or negative (<1); in positive cases, a final score was assigned (1 to 100). There was consensus agreement across all 5 pathologists for 90% (26/29) (Fleiss Kappa value for interobserver agreement: 0.799). The 3 cases with disagreement were composed of 2 squamous cell carcinomas and 1 small cell carcinoma. Of the 26 with unanimous agreement, 88% (23/26) were positive and 12% (3/26) were negative. All (16/16) pure squamous cell carcinomas with full consensus were interpreted as positive, whereas tumors with glandular components were commonly consensus negative (33%, 3/9); this difference was significant ( P =0.037). Disagreements were attributable to low CPS versus negative reads (2 cases) and difficulty discerning glandular involvement from pushing invasion (1 case). In summary, experienced gynecologic pathologists showed substantial interobserver agreement in the interpretation of PD-L1 CPS at the Food and Drug Administration-approved treatment threshold, with the majority of tumors being classified as positive. Pure squamous histology was strongly associated with a consensus-positive read, whereas a subset of tumors with glandular differentiation was negative by all readers. Disagreements occurred in tumors with low versus negative CPS values and in the setting of limited invasion.

The Reliability and Accuracy of the Medial Malleolar Fracture Classification Based on 3D CT Reconstruction.

There is a new medial malleolar fracture classification based on 3D CT reconstruction. However, there is no study assessing the reliability and accuracy of the new classification system and comparison between the new and the classic classification. This study aimed to compare the reliability and accuracy of the medial malleolar fracture classification based on 3D CT reconstruction and the Herscovici classification system. We retrospectively analyzed the consecutive ankle fractures in our hospital from January 2013 to September 2020. Five inexperienced and five experienced orthopedic surgeons were included as observers to assess 68 cases with medial malleolar fractures. Ten evaluators classified the cases according to the two classification systems. The reference results of each case were made by the consensus of three senior trauma surgeons. The interobserver reliability, intraobserver reliability, and accuracy were evaluated at an interval of 6 weeks using Fleiss's kappa (κ) statistics. We found substantial interobserver and intraobserver reliability and 81.4% accuracy for the new classification, which was statistically superior to the Herscovici classification (P < 0.05). The reliability and accuracy of both classifications were similar in inexperienced and experienced groups, except for type III in the new classification. The interobserver reliability of type II was the best (P < 0.05), and the intraobserver reliability of IVc ranked the worst (P < 0.05) in the new classification. The reliability and accuracy of the new classification are superior to the Herscovici classification. Clinical experiences will not affect the assessment of both classification systems in most instances.

Combining b2500 diffusion-weighted imaging with BI-RADS improves the specificity of breast MRI

PurposeThe purpose of this study was to evaluate the diagnostic performance of visual assessment of diffusion-weighted images (DWI) obtained with a b value of 2500 s/mm2 in addition to a conventional magnetic resonance imaging (MRI) protocol to characterize breast lesions. Materials and methodsThis single-institution retrospective study included participants who underwent clinically indicated breast MRI and breast biopsy from May 2017 to February 2020. The examination included a conventional MRI protocol including DWI obtained with a b value of 50 s/mm2 (b50DWI) and a b value of 800 s/mm2 (b800DWI) and DWI obtained with a b value of 2500 s/mm2 (b2500DWI). Lesions were classified using Breast Imaging Reporting and Data Systems (BI-RADS) categories. Three independent radiologists assessed qualitatively the signal intensity within the breast lesions relative to breast parenchyma on b2500DW and b800DWI and measured the b50-b800-derived apparent diffusion coefficient (ADC) value. The diagnostic performances of BI-RADS, b2500DWI, b800DWI, ADC and of a model combining b2500DWI and BI-RADS were evaluated using receiver operating characteristic (ROC) curves analysis. ResultsA total of 260 patients with 212 malignant and 100 benign breast lesions were included. There were 259 women and one man with a median age of 53 years (Q1, Q3: 48, 66 years). b2500DWI was assessable in 97% of the lesions. Interobserver agreement for b2500DWI was substantial (Fleiss kappa = 0.77). b2500DWI yielded larger area under the ROC curve (AUC, 0.81) than ADC with a 1 × 10−3 mm2/s threshold (AUC, 0.58; P = 0.005) and than b800DWI (AUC, 0.57; P = 0.02). The AUC of the model combining b2500DWI and BI-RADS was 0.84 (95% CI: 0.79–0.88). Adding b2500DWI to BI-RADS resulted in a significant increase in specificity from 25% (95% CI: 17–35) to 73% (95% CI: 63–81) (P < 0.001) with a decrease in sensitivity from 100% (95% CI: 97–100) to 94% (95% CI: 90–97), (P < 0.001). ConclusionVisual assessment of b2500DWI has substantial interobserver agreement. Visual assessment of b2500DWI offers better diagnostic performance than ADC and b800DWI. Adding visual assessment of b2500DWI to BI-RADS improves the specificity of breast MRI and could avoid unnecessary biopsies.

Comparing Risk Assessment Between Payers and Providers: Inconsistent Agreement in Medical Comorbidity Records for Patients Undergoing Total Joint Arthroplasty

BackgroundThe proper risk adjustment for total hip arthroplasty (THA) and total knee arthroplasty (TKA) relies on an accurate assessment of comorbidity profiles by both the payer and the institution. The purpose of this study was to determine how strongly comorbidities tracked by our institution agreed with the same comorbidities reported by payers in patients undergoing THA and TKA. MethodsAll patients of a single payer undergoing primary THA and TKA at a single institution between January 5, 2021 and March 31, 2022 were included (n = 876). There were 8 commonly collected medical comorbidities obtained from institutional medical records and matched with patient records reported by the payer. Fleiss Kappa tests were used to determine agreement of payer data with institutional records. There were 4 medical risk calculations collected from our institutional records and compared with an insurance member risk score reported by the payer. ResultsComorbidities reported by the institution differed significantly from those reported by payers, with Kappa varying between 0.139 and 0.791 for THA, and 0.062 and 0.768 for TKA. Diabetes was the only condition to demonstrate strong agreement for both procedures (THA; k = 0.791, TKA; k = 0.768). The insurance member risk score demonstrates the closest association with total cost and surplus for THA regardless of insurance type and for TKA procedures paid for with private commercial insurance. ConclusionThere is a lack of agreement between medical comorbidities within payer and institutional records for both THA and TKA. These differences may put institutions at a disadvantage within value-based care models and when optimizing patients perioperatively.

The Influence of Computerized Tomography Imaging on Treatment of Periprosthetic Proximal Femur Fractures.

Introduction Periprosthetic femur fractures (PPFF) are increasing in incidence and management of such injuries requires a specialized skill set combined with detailed knowledge of component design. To assist with planning, computed tomography (CT) can beusedpre-operatively to give a surgeon more information. No study to date has shown the utility of obtaining preoperative CT. The goal of this study is to show that CT is a useful diagnostic adjunct and report any differences in how subspecialties such as orthopedic traumatologists and arthroplasty surgeonsuse it. Methods Seventeen PPFF cases met our inclusion criteria.They were shown to six faculty, three trauma and three arthroplasty surgeons. They viewed the plain radiographs and then CTs. After each they filled out the same questionnaire that included their assessment of diagnosis and proposed treatment plan both before and after access to CT imaging. Fleiss and Cohen kappa were used to compare inter- and intra-observer reliability. Results The interobserver kappa values (k) in diagnosis were 0.348 pre- and 0.371 post-CT, while trauma and arthroplasty were 0.328 to 0.260 and 0.821 to 0.881 respectively. The interobserver reliability in treatment was 0.336 pre- and 0.254 post-CT, while trauma and arthroplasty were 0.323 to 0.288 and 0.688 to 0.519. For intraobserver the average k for diagnosis and treatment were 0.818 and 0.671. Broken down by subspecialty they were 0.874 and 0.831 and 0.762 and 0.510 for trauma and arthroplasty. There were 11 diagnostic and 24 treatment changes. Conclusion CT provides diagnostic changes 10% and treatment changes 24% of the time. However, it does not lead to greater agreement among the surgeons on either. Arthroplasty uses CT more to guide both their treatment and the diagnosis, and they agree more than trauma surgeons. Most of the treatment changes come from adding or removing a plate, and the most common diagnostic change was shared by A to B1 and B2 to B3. This suggests fracture extension and bone stock are better evaluated by CT.

Multilevel calibration procedure for the oral health national multicenter survey in primary teeth.

Early childhood caries (ECC) requires systematically collected and standardized data. To describe a novel multilevel calibration procedure in primary dentition. Calibration method involved two calibration levels: the first (L1 ) involved an interexaminer agreement between three main investigators, the group leaders (GLs) in the following level; the second level (L2 ) involved three groups of 11 paediatric dentists and interexaminer agreement assessment according to the GLs in each group. The study sample consisted of 650 primary teeth surfaces in eight children (mean age 6.56 ± 2.22 years). Surface-by-surface percent agreement, tooth-by-tooth percent agreement, Cohen's kappa, and Fleiss kappa statistics were used to calculate interexaminer reliability. Statistical analysis was performed with SPSS 27.0. Surface-by-surface percent agreement regarding ICDASepi-merged revealed almost perfect agreement (>90.00%) on both L1 and L2 . Kappa values and ranges showed good agreement at both L1 (overall κ = .95) and L2 (overall κ = .98) and almost perfect consistency was detected between GLs at L1 (>91.30%) and substantial agreement at L2 (>85.00%). All examiners at L2 showed almost perfect positive agreement (sensitivity = 96.77%-100%) when detecting the presence of dental plaque. The calibration procedure appeared feasible prior to organizing multicenter epidemiological oral health survey in large population groups of preschool children, with higher number of examiners.

Low agreement among patients and clinicians about urgency and safety to wait for assessment in primary care after hours medical care: results of cross-sectional matched surveys

BackgroundDiscordance between patient and clinician perceived urgency may drive “inappropriate” presentations to after-hours medical services. This paper investigates the level of agreement between patient and clinicians’ perceptions of urgency and safety to wait for an assessment at after-hours primary care services in the ACT.MethodsCross-sectional survey voluntarily completed by patients and then clinicians at after-hours medical services in May/June, 2019. Agreement between patients and clinicians is measured by Fleiss kappa. Agreement is presented overall, within specific categories of urgency and safety to wait, and by after-hours service type.Results888 matched records were available from the dataset. Overall inter-observer agreement between patients and clinicians on the urgency of presentations was slight (Fleiss kappa = 0.166; 95% CI 0.117–0.215, p < 0.001). Agreement within specific ratings of urgency ranged from very poor to fair. Overall inter-rater agreement on how long it would be safe to wait for assessment was fair (Fleiss kappa = 0.209; 95% CI 0.165–0.253, p < 0.001). Agreement within specific ratings ranged from poor to fair. By site type, agreement between patients and clinicians on urgency ranged from not significant to fair and agreement for safety to wait ranged from very poor to slight. Agreement on urgency of issue was more often reported among patients attending their usual health service or seeing their usual clinician compared to patients attending an unfamiliar health service or clinician (χ2(1) = 7.283, p = 0.007 and χ2(1) = 16.268, p < 0.001, respectively).ConclusionsLow levels of agreement between patients and clinicians on perceived urgency and safety to wait for issues to be assessed indicate potential inefficiency in primary care use after-hours. Agreement on urgency of issues was more common among patients attending a familiar health service or familiar clinician. Improving health literacy, particularly health system literacy, and supporting continuity of care may help to support patients to engage with the most appropriate level of care at the most appropriate time.

Impact of postoperative baseline MRI on diagnostic confidence and performance in detecting local recurrence of soft-tissue sarcoma of the limb

ObjectiveTo evaluate the impact of a postoperative baseline (PB) MRI on diagnostic confidence and performance in detecting local recurrence (LR) of soft-tissue sarcoma (STS) of the limb.Materials and methodsA total of 72 patients (8 with LR, 64 without LR) with primary STS of the limb were included. Routine follow-up MRI (1.5 T) at 6 and approximately 36 months (meanLR: 39.7 months; meanno LR: 34.9 months) after multimodal therapy or at time of LR were assessed by three independent readers using a 5-point Likert scale. Furthermore, the following imaging parameters were evaluated: presence of a mass, signal characteristics at T2- and T1-weighted imaging, contrast enhancement (CE), and in some of the cases signal intensity on the apparent diffusion coefficient (ADC). U-test, McNemar test, and ROC-analysis were applied. Interobserver reliability was calculated using Fleiss kappa statistics. A p value of 0.05 was considered statistically significant.ResultsThe presence of a PB MRI significantly improved diagnostic confidence in detecting LR of STS (p < 0.001) and slightly increased specificity (mean specificity without PE 74.1% and with presence of PB MRI 81.2%); however, not to a significant level. The presence of a mass showed highest diagnostic performance and highest interreader agreement (AUC [%]; κ: 73.1–83.6; 0.34) followed by T2-hyperintensity (50.8–66.7; 0.08), CE (52.4–62.5; 0.13), and T1-hypointensity (54.7–77.3; 0.23). ADC showed an AUC of 65.6–96.6% and a κ of 0.55.ConclusionThe presence of a PB MRI increases diagnostic confidence in detecting LR of STS of the limb.

The Reliability of Intraoperative Hip Arthrography in Cerebral Palsy Hip Reconstruction

Background: This study investigates surgeon interpretation of intraoperative hip arthrography after femoral osteotomy to guide decision-making regarding addition of concomitant pelvic osteotomy (PO) for Cerebral Palsy (CP) hip reconstruction.Methods: Ten orthopaedic surgeons reviewed preoperative radiographic images of 21 children with CP, undergoing hip reconstruction. Surgeons recorded if PO was indicated after 1) reviewing the preoperative radiographs. Raters who exhibited poor reliability (kappas <0.60) were excluded from arthrogram analysis. Agreement in decision-making was evaluated by estimating the concordance across six raters with respect to changing their recommendation after reviewing the arthrogram images by estimating Fleiss's kappa coefficient.Results: Intra-rater reliability for the three surgeons who conducted repeat evaluations was substantial to almost perfect (k=0.67, 0.86, 1.00). Pairwise inter-rater reliability for radiographic decision was moderate to almost perfect with kappa values ranging from 0.56 to 0.87. In 20 of 32 hip evaluations, at least 5 of 6 raters recommended PO after reviewing the radiograph, 64% of the cohort (122/192). However, upon reviewing the arthrogram images, only 45% (86/192) of reviewers recommended a PO. Attending surgeons changed their decisions away from PO in 35% of cases overall while fellows changed their decisions in only 7% of cases. Further radiographic characterization of the labrum position demonstrated substantial agreement (kappa=0.73; 95% CI=0.48-0.98) and almost perfect agreement regarding presence of dye pool (kappa=0.85; 95% CI=0.50-1.00).Conclusions: Interpretation of intraoperative hip arthrography to guide addition of PO in CP hip reconstruction is reliable with moderate agreement according to experience level and with substantial retest reliability.Level of Evidence: Level IVKey Concepts•Arthrograms can be helpful to determine hip stability during hip reconstruction in cerebral palsy patients.•The reliability of the interpretation of arthrograms is an important area of study.•Decision-making in neuromuscular hip reconstruction is not standardized across surgeons or institutions.

Reliability of a Novel Classification System for Thoracic Disc Herniations.

This is a cross-sectional survey. The aim was to assess the reliability of a proposed novel classification system for thoracic disc herniations (TDHs). TDHs are complex entities varying substantially in many factors, including size, location, and calcification. To date, no comprehensive system exists to categorize these lesions. Our proposed system classifies 5 types of TDHs using anatomic and clinical characteristics, with subtypes for calcification. Type 0 herniations are small (≤40% of spinal canal) TDHs without significant spinal cord or nerve root effacement; type 1 are small and paracentral; type 2 are small and central; type 3 are giant (>40% of spinal canal) and paracentral; and type 4 are giant and central. Patients with types 1 to 4 TDHs have correlative clinical and radiographic evidence of spinal cord compression. Twenty-one US spine surgeons with substantial TDH experience rated 10 illustrative cases to determine the system's reliability. Interobserver and intraobserver reliability were determined using the Fleiss kappa coefficient. Surgeons were also surveyed to obtain consensus on surgical approaches for the various TDH types. High agreement was found for the classification system, with 80% (range 62% to 95%) overall agreement and high interrater and intrarater reliability (kappa 0.604 [moderate to substantial agreement] and kappa 0.630 [substantial agreement], respectively). All surgeons reported nonoperative management of type 0 TDHs. For type 1 TDHs, most respondents (71%) preferred posterior approaches. For type 2 TDHs, responses were roughly equivalent for anterolateral and posterior options. For types 3 and 4 TDHs, most respondents (72% and 68%, respectively) preferred anterolateral approaches. This novel classification system can be used to reliably categorize TDHs, standardize description, and potentially guide the selection of surgical approach. Validation of this system with regard to treatment and clinical outcomes represents a line of future study.

Assessment of the scope, completeness, and consistency of various drug information resources related to COVID-19 medications in pregnancy and lactation

BackgroundDrug use in pregnancy and lactation is challenging. It becomes more challenging in pregnant and lactating women with certain critical clinical conditions such as COVID-19, because of inconsistent drug safety data. Therefore, we aimed to evaluate the various drug information resources for the scope, completeness, and consistency of the information related to COVID-19 medications in pregnancy and lactation.MethodsData related to COVID-19 medications from various drug information resources such as text references, subscription databases, and free online tools were used for the comparison. The congregated data were analyzed for scope, completeness, and consistency.ResultsScope scores were highest for Portable Electronic Physician Information Database (PEPID), Up-to-date, and drugs.com compared to other resources. The overall completeness scores were higher for Micromedex and drugs.com (p < 0.05 compared to all other resources). The inter-reliability analysis for overall components by Fleiss kappa among all the resources was found to be 'slight' (k < 0.20, p < 0.0001). The information related to the older drugs in most of the resources, provides in-depth details on various components such as pregnancy safety, clinical data related to lactation, the effect of the drug distribution into breast milk, reproductive potential/infertility risk and the pregnancy category/recommendations. However, the information related to these components for newer drugs was superficial and incomplete, with insufficient data and inconclusive evidence, which is a statistically significant observation. The strength of observer agreement for the various COVID-19 medications ranged from poor to fair and moderate for the various recommendation categories studied.ConclusionThis study reports discrepancies in the information related to pregnancy, lactation, drug level, reproductive risk, and pregnancy recommendations among the resources directing to refer to more than one resource for information about the safe and quality use of medications in this special population.The present study also emphasizes the need for development of comprehensive, evidence-based, and precise information guide that can promote safe and effective drug use in this special population.

Reliability of radiologists' first impression when interpreting a screening mammogram.

Previous studies showed that radiologists can detect the gist of an abnormality in a mammogram based on a half-second image presentation through global processing of screening mammograms. This study investigated the intra- and inter-observer reliability of the radiologists' initial impressions about the abnormality (or "gist signal"). It also examined if a subset of radiologists produced more reliable and accurate gist signals. Thirty-nine radiologists provided their initial impressions on two separate occasions, viewing each mammogram for half a second each time. The intra-class correlation (ICC) values showed poor to moderate intra-reader reliability. Only 13 radiologists had an ICC of 0.6 or above, which is considered the minimum standard for reliability, and only three radiologists had an ICC exceeding 0.7. The median value for the weighted Cohen's Kappa was 0.478 (interquartile range = 0.419-0.555). The Mann-Whitney U-test showed that the "Gist Experts", defined as those who outperformed others, had significantly higher ICC values (p = 0.002) and weighted Cohen's Kappa scores (p = 0.026). However, even for these experts, the intra-radiologist agreements were not strong, as an ICC of at least 0.75 indicates good reliability and the signal from none of the readers reached this level of reliability as determined by ICC values. The inter-reader reliability of the gist signal was poor, with an ICC score of 0.31 (CI = 0.26-0.37). The Fleiss Kappa score of 0.106 (CI = 0.105-0.106), indicating only slight inter-reader agreement, confirms the findings from the ICC analysis. The intra- and inter-reader reliability analysis showed that the radiologists' initial impressions are not reliable signals. In particular, the absence of an abnormal gist does not reliably signal a normal case, so radiologists should keep searching. This highlights the importance of "discovery scanning," or coarse screening to detect potential targets before ending the visual search.

Deep Learning Radiomics Model of Dynamic Contrast‐Enhanced MRI for Evaluating Vessels Encapsulating Tumor Clusters and Prognosis in Hepatocellular Carcinoma

Vessels encapsulating tumor cluster (VETC) is a critical prognostic factor and therapeutic predictor of hepatocellular carcinoma (HCC). However, noninvasive evaluation of VETC remains challenging. To develop and validate a deep learning radiomic (DLR) model of dynamic contrast-enhanced MRI (DCE-MRI) for the preoperative discrimination of VETC and prognosis of HCC. Retrospective. A total of 221 patients with histologically confirmed HCC and stratified this cohort into training set (n = 154) and time-independent validation set (n = 67). A 1.5 T and 3.0 T; DCE imaging with T1-weighted three-dimensional fast spoiled gradient echo. Histological specimens were used to evaluate VETC status. VETC+ cases had a visible pattern (≥5% tumor area), while cases without any pattern were VETC-. The regions of intratumor and peritumor were segmented manually in the arterial, portal-venous and delayed phase (AP, PP, and DP, respectively) of DCE-MRI and reproducibility of segmentation was evaluated. Deep neural network and machine learning (ML) classifiers (logistic regression, decision tree, random forest, SVM, KNN, and Bayes) were used to develop nine DLR, 54 ML and clinical-radiological (CR) models based on AP, PP, and DP of DCE-MRI for evaluating VETC status and association with recurrence. The Fleiss kappa, intraclass correlation coefficient, receiver operating characteristic curve, area under the curve (AUC), Delong test and Kaplan-Meier survival analysis. P value <0.05 was considered as statistical significance. Pathological VETC+ were confirmed in 68 patients (training set: 46, validation set: 22). In the validation set, DLR model based on peritumor PP (peri-PP) phase had the best performance (AUC: 0.844) in comparison to CR (AUC: 0.591) and ML (AUC: 0.672) models. Significant differences in recurrence rates between peri-PP DLR model-predicted VETC+ and VETC- status were found. The DLR model provides a noninvasive method to discriminate VETC status and prognosis of HCC patients preoperatively. 4. Stage 2.

Clinical utility of intraoperative Arterial Spin Labeling for resection control in brain tumor surgery at 3 T.

Resection control in brain tumor surgery can be achieved in real time with intraoperative MRI (iMRI). Arterial spin labeling (ASL), a technique that measures cerebral blood flow (CBF) noninvasively without the use of intravenous contrast agents, can be performed intraoperatively providing morpho-physiological information. This study aimed to evaluate the feasibility, image quality and potential to depict residual tumor of a pseudo-continuous-ASL (PCASL) sequence at 3T. 17 patients with brain tumors, primary (16) or metastatic (1), undergoing resection surgery with iMRI-monitoring were prospectively recruited (9 men, age:56±16.6 years). A PCASL sequence with long labeling duration (3000ms) and postlabeling delay (2000ms) was added to the conventional protocol that consisted of pre- and post-contrast 3D-T1-weighted (T1w) images, optional 3D-FLAIR, and diffusion. Three observers independently assessed image quality (4-point scale) of PCASL-derived CBF maps. In those with diagnostic quality (scores 2-4) they evaluated the presence of residual tumor using the conventional sequences first, and the CBF maps afterwards (3-point scale). Inter-observer agreement for image quality and the presence of residual tumor was assessed using Fleiss-kappa statistics. Intraoperative CBF-ratio of the surgical margins (i.e., perilesional CBF values normalized to contralateral gray matter CBF) was compared to preoperative CBF-ratio within the tumor (Wilcoxon's test). Diagnostic ASL image quality was observed in 94.1% of patients (inter-observer Fleiss-κ=0.76). PCASL showed additional foci suspicious of high-grade residual component in three patients, and a hyperperfused area extending outside the enhancing component in one patient. Interobserver agreement was almost perfect in the evaluation of residual tumor with the conventional sequences (Fleiss-κ=0.92) and substantial for PCASL (Fleiss-κ=0.80). No significant differences were found between pre and intraoperative CBF-ratios (p=0.578) in patients with residual tumor (n=7). iMRI-PCASL perfusion is feasible at 3T and is useful for the intraoperative assessment of residual tumor, providing in some cases additional information to the conventional sequences.

EASIER corpus: A lexical simplification resource for people with cognitive impairments.

Thanks to technologies such as the Internet and devices now available to people, we have increasingly greater access to larger quantities of information. However, people with ageing disabilities or intellectual disabilities, non-native speakers, and others have difficulties reading and understanding information. For this reason, it is essential to provide text simplification mechanisms when accessing information. Natural Language Processing methods can be applied to simplify textual content and improve understanding. These methods often use machine learning algorithms and models which require resources, such as corpora, to be trained and tested. This article presents the EASIER corpus, a resource that can be used to build lexical simplification methods to process Spanish domain-independent texts. The EASIER corpus is composed of 260 annotated documents with 8,155 words labelled as complex and 5,130 words with at least one proposed context-aware synonym associated. Expert linguists in easy-to-read and plain language guidelines have annotated the corpus based on their experience adapting texts for people with intellectual disabilities. Sixteen annotation guidelines that discriminate between complex and simple words have been defined to help other groups of experts to generate new annotations. Additionally, an inter-annotator agreement test was performed to validate the corpus, obtaining a Fleiss Kappa coefficient of 0.641. Furthermore, a qualitative evaluation was conducted with 45 users (including people with intellectual disabilities, elderly people, and a control audience). Complex word identification tasks achieved moderate results, but the synonyms proposed to replace complex words achieved almost perfect ratings. This resource has been integrated into the EASIER platform, a tool that helps people with cognitive impairments and intellectual disabilities to read and understand texts more easily.

A novel classification of osteotomized debridement based on the range of focus in treating active thoracolumbar tuberculosis: a multicenter study.

Osteotomized debridement (OD) is increasingly used in the treatment of active thoracolumbar tuberculosis (TB). So far, no nomenclature has been established to describe the patterns of OD, and thus the surgical outcomes cannot be directly analyzed and compared among the patients treated with different extents of OD. The purpose of this study was to establish a reliable classification of OD for further study of spinal TB. This was a multicenter retrospective study. The proposed classification included 6 grades of OD based on sagittal range of vertebral body destruction: grade 0 involves single-level intervertebral disc and adjacent superficial endplates; grade 1 involves adjacent endplates and vertebral bodies, but no pedicle is involved; grade 2 involves adjacent endplates, vertebral bodies, and a lower or upper pedicle; grade 3 involves adjacent endplates, vertebral bodies, and both of lower and upper pedicles; grade 4 involves an entire vertebral body and an adjacent lower or upper pedicle; grade 5 involves two continuous entire vertebral bodies. Two hundred and five patients with active thoracolumbar TB who underwent OD surgery were included, and all ODs were classified. The reliability of this classification was evaluated twice by 10 readers, and Fleiss kappa coefficients were calculated. In the 205 patients, 208 ODs were performed. Grade 2 OD was the commonest type (98/208, 47.1%), followed by grade 1 (50/208, 24.0%), grade 3 (26/208, 12.5%), grade 0 (20/208, 9.6%), grade 4 (8/208, 3.8%), and grade 5 (6/208, 2.9%). The average accuracy of the two readings was 86.2% and 90.1%, respectively. The intra-rater reliability for the classification was "almost perfect agreement" with a Fleiss kappa coefficient average of 0.92. The inter-rater reliability was "almost perfect agreement" with a coefficient average of 0.89 for two readings. This classification proved to be intuitive and reliable. The graded OD provides a platform for preoperative evaluation and allows comparative analysis of clinical outcomes in different extents of OD.

Comparison of prognostic value of different metabolic response criteria determined by PET/CT in patients with metastatic breast cancer under CDK 4/6 inhibitor treatment

PurposeThis study evaluates the prognostic role of different [18F]FDG PET/CT metabolic response criteria in metastatic breast cancer (MBC) patients treated with cyclin-dependent kinase 4/6 inhibitors (CDK 4/6). Materials and methodsWe retrospectively evaluated the data of MBC patients treated with CDK 4/6 inhibitors who underwent an [18F]FDG PET/CT scan before starting and during treatment. [18F]FDG PET/CT response was assessed with the European Organization for Research and Treatment of Cancer (EORTC), PET Response Criteria in Solid Tumors (PERCIST), and whole-body total lesion glycolysis (WBTLG) criteria. Fleiss kappa was computed to assess the agreement between metabolic response criteria. The endpoint of the study was progression-free survival (PFS). PFS data were analyzed by the Kaplan–Meier method and compared using the log-rank test. ResultsThe study included sixteen MBC patients who received CDK 4/6 inhibitors therapy. According to PERCIST, partial metabolic response (PMR) was found in seven patients, stable metabolic disease (SMD) in seven patients, and progressive metabolic disease (PMD) in two patients. According to EORTC, PMR was detected in eight patients, SMD in seven patients, and PMD in one patient. According to WBTLG, PMR was found in 10 patients, SMD in four patients, and PMD in two patients. There was a fair agreement between the three criteria. While progression was detected in seven of the patients during follow-up, no progression was detected in nine of them. Kaplan–Meier analysis revealed that the responders according to WBTLG showed significantly longer PFS than non-responders. ConclusionTreatment response according to WBTLG criteria during treatment appears to be associated with prolonged PFS in patients treated with CDK 4/6 inhibitors for MBC.

Abstract 3373: Deep learning for circulating tumor cell (CTC) identification with the CELLSEARCH system: achieving top human-level performance

Abstract Background: Enumeration of CTCs in blood samples with the CELLSEARCH® system is a prognostic biomarker in metastatic breast, prostate and colorectal cancer (full intended use documents.cellsearchctc.com). Currently, the final CTC identification is performed by human reviewers through visual assessment, which is a time-consuming procedure that could be affected by subjective interpretations. Modern Artificial Intelligence (AI) methods can provide a solution by automating the process of CTC identification, thus eliminating subjectivity and producing faster and more reproducible results. We have recently presented an automated algorithm (for research use only) based on deep learning models for cell segmentation and classification which allows the automated identification of CTCs in CELLSEARCH® fluorescent images (Ansaloni et al., EACR 2022). The purpose of this study was to assess inter-rater variability among human reviewers and to compare the AI performance against them. Methods: Blood samples derived from metastatic cancer patients were processed with CELLTRACKS® AUTOPREP®. The AI algorithm was trained on fluorescent images of 7255 CTCs and 32876 non-CTC events (training set) acquired by CELLTRACKS ANALYZER II® (CTAII) from 90 breast, 122 prostate and 54 colorectal cancer samples. 10 human reviewers, qualified for CTC image analysis, performed blind labeling of a separate dataset independently (test set: 55 samples taken from 27 breast and 28 prostate cancer). We studied inter-rater agreement and variability using Fleiss Kappa and Coefficient of Variation (CV). The labels provided by 5 experienced reviewers (average experience ≅ 15 years) were used to generate the ground truth (GT) by majority voting. The CTC detection performance of the AI was ranked against the other 5 reviewers (average experience ≅ 5 years). Results: In the test dataset, 2990 out of 9554 events were identified as CTCs by the GT review on CTAII images. In the task of classifying each event as CTC or non-CTC, the inter-rater agreement among the 10 human reviewers measured by Fleiss Kappa was 0.85. These classification results provided the number of CTCs per patient counted by each reviewer. The inter-rater variability on the CTC enumeration among the 10 reviewers was evaluated for each sample (median CV = 17.9% and interquartile range = 17.6% , excluding 27 samples with mode = 0 CTC). Measured against the GT classification, the AI performance (accuracy = 94.7%; F1 = 91.6%) was at the top of the human reviewers’ ranking (accuracy = 92.4 - 93.6 - 93.8 - 94.0 - 95.8%; F1 = 86.8 - 89.2 - 89.2 - 89.5 - 93.1%). Conclusion: The AI algorithm reached top-ranking performance in CTC identification, surpassing 4 out of 5 expert reviewers. These results show the applicability of AI to cell classification to remove human subjectivity from the review process and to maximize standardization among different research centers. Citation Format: Luca Biasiolli, Pietro Ansaloni, Nicolò Gentili, Ramona Miserendino, Chiara Rossi, Giulio Signorini, Gianni Medoro. Deep learning for circulating tumor cell (CTC) identification with the CELLSEARCH system: achieving top human-level performance [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3373.

MP21-18 MISCONCEPTIONS ABOUT WOMEN WITH RECURRENT URINARY TRACT INFECTION IN YOUTUBE EDUCATIONAL VIDEOS; INCONGRUENCE WITH AUA GUIDELINES - HEALTH EQUITY FINDINGS

You have accessJournal of UrologyCME1 Apr 2023MP21-18 MISCONCEPTIONS ABOUT WOMEN WITH RECURRENT URINARY TRACT INFECTION IN YOUTUBE EDUCATIONAL VIDEOS; INCONGRUENCE WITH AUA GUIDELINES - HEALTH EQUITY FINDINGS Mostafa Bondok, Lynn stothers, Andrew Macnab, Vancouver, Canada, Mohamed Bandok, Calgary, Canada, A. Lenore Ackerman, Emma Dixon, Marcia Trochez, Kelsey Petersen, and Rishika Selvakumar Mostafa BondokMostafa Bondok More articles by this author , Lynn stothers Lynn stothers More articles by this author , Andrew MacnabAndrew Macnab More articles by this author , Vancouver Vancouver More articles by this author , Canada Canada More articles by this author , Mohamed BandokMohamed Bandok More articles by this author , Calgary Calgary More articles by this author , Canada Canada More articles by this author , A. Lenore AckermanA. Lenore Ackerman More articles by this author , Emma DixonEmma Dixon More articles by this author , Marcia TrochezMarcia Trochez More articles by this author , Kelsey PetersenKelsey Petersen More articles by this author , and Rishika SelvakumarRishika Selvakumar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003246.18AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Stigmatization of health illness is a threat to health equity. Although case control studies demonstrate that commonly suggested hygiene practices do not decrease the incidence of urinary tract infection (UTI) in women, many patient-education sources promote this misconception, & in doing so risk stigmatizing women with UTIs as ‘dirty’ or ‘unclean’. Objective: To document the quality, veracity, & comprehensiveness of recurrent UTI (rUTI) information on YouTube to increase health care workers’ (HCWs) awareness of UTI-related content online, & to identify deficits in understanding, clarify misconceptions & reduce stigmatization risk. METHODS: High-traffic topic search terms were curated by Google Trends to extract 200, of which 45 met inclusion criteria. 5 independent reviewers used a standardized questionnaire based on the AUA rUTI guidelines to assess definition of UTI, marketing content, prophylaxis/prevention strategies, & antibiotic use/stewardship. Statistics: Fleiss kappa (K) assessed Inter-rater reliability (IRR). RESULTS: High variability and incongruency from guideline definitions of UTI (Table 1); the most common prophylactic strategy discussed Cranberry; only 55% discussed increasing fluid intake. Table 2 illustrates commonly recommended hygiene practices: including front to back wiping (25%) K=0.71. 33% promoted other non-evidence-based hygiene practices including expression of uncleanliness of women. CONCLUSIONS: Misleading information for women seeking education on UTI through YouTube is high. Misinformation on hygiene practices is unproductive, & several videos captured HCWs claiming that rUTI results from poor female hygiene practices, creating a health equity concern for women experiencing UTIs. These findings alert HCWs on the need to provide evidence-based recommendations by consulting practice guidelines, such as those provided by the AUA. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e293 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mostafa Bondok More articles by this author Lynn stothers More articles by this author Andrew Macnab More articles by this author Vancouver More articles by this author Canada More articles by this author Mohamed Bandok More articles by this author Calgary More articles by this author Canada More articles by this author A. Lenore Ackerman More articles by this author Emma Dixon More articles by this author Marcia Trochez More articles by this author Kelsey Petersen More articles by this author Rishika Selvakumar More articles by this author Expand All Advertisement PDF downloadLoading ...