Diagnostic performance of a CT-based scoring system for diagnosis of anastomotic leakage after esophagectomy: comparison with subjective CT assessmentReportar como inadecuado




Diagnostic performance of a CT-based scoring system for diagnosis of anastomotic leakage after esophagectomy: comparison with subjective CT assessment - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

European Radiology

pp 1–9

First Online: 29 March 2017Received: 05 October 2016Revised: 20 January 2017Accepted: 13 March 2017

Abstract

ObjectiveTo develop a CT-based prediction score for anastomotic leakage after esophagectomy and compare it to subjective CT interpretation.

MethodsConsecutive patients who underwent a CT scan for a clinical suspicion of anastomotic leakage after esophagectomy with cervical anastomosis between 2003 and 2014 were analyzed. The CT scans were systematically re-evaluated by two radiologists for the presence of specific CT findings and presence of an anastomotic leak. Also, the original CT interpretations were acquired. These results were compared to patients with and without a clinical confirmed leak.

ResultsOut of 122 patients that underwent CT for a clinical suspicion of anastomotic leakage; 54 had a confirmed leak. In multivariable analysis, anastomotic leakage was associated with mediastinal fluid OR = 3.4, esophagogastric wall discontinuity OR = 4.9, mediastinal air OR = 6.6, and a fistula OR = 7.2. Based on these criteria, a prediction score was developed resulting in an area-under-the-curve AUC of 0.86, sensitivity of 80%, and specificity of 84%. The original interpretation and the systematic subjective CT assessment by two radiologists resulted in AUCs of 0.68 and 0.75 with sensitivities of 52% and 69%, and specificities of 84% and 82%, respectively.

ConclusionThis CT-based score may provide improved diagnostic performance for diagnosis of anastomotic leakage after esophagectomy.

Key Points• A CT-based score provides improved diagnostic performance for diagnosis of anastomotic leakage.

• Leakage associations include mediastinal fluid, mediastinal air, wall discontinuity, and fistula.

• A scoring system yields superior diagnostic accuracy compared to subjective CT assessment.

• Radiologists may suggest presence of anastomotic leakage based on a prediction score.

KeywordsEsophagectomy Anastomotic leakage Prediction score Computed tomography Esophageal cancer AbbreviationsALP-scoreanastomotic leakage prediction score

AUCarea-under-the-curve

CIconfidence interval

CTcomputed tomography

CRPC-reactive protein

NRInet reclassification index

ORodds ratio

WBCWhite blood cell count

Maarten S. van Leeuwen and Richard van Hillegersberg contributed equally to this work.

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Autor: Lucas Goense - Pauline M. C. Stassen - Frank J. Wessels - Peter S. N. van Rossum - Jelle P. Ruurda - Maarten S. van L

Fuente: https://link.springer.com/







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