Personalised management of women with cervical abnormalities using a clinical decision support scoring system

Kyrgiou, Maria; Pouliakis, Abraham; Panayiotides, John; Margari, Niki; Bountris, Panagiotis; Valasoulis, George; Paraskevaidi, Maria; Bilirakis, Evripidis; Nasioutziki, Maria; Loufopoulos, Aristotelis; Haritou, Maria; Koutsouris, Dimitrios; Karakitsos, Petros; Paraskevaidis, Evangelos

doi:10.1016/j.ygyno.2015.12.032

Cited by 35 publications

(25 citation statements)

References 26 publications

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“…Newer markers such as mRNA or p16/Ki67 immunostaining have more recently shown promising results claiming an equal sensitivity to that of the DNA test but improved specificity in this setting . Further combination of novel biomarkers and Clinical Decision Support Scoring Systems (DSSS) that will create user‐friendly tools have the potential to further improve the management of this population …”

Section: Discussionmentioning

confidence: 99%

Immediate referral to colposcopy versus cytological surveillance for low‐grade cervical cytological abnormalities in the absence of HPV test: A systematic review and a meta‐analysis of the literature

Kyrgiou

Kalliala

Mitra

et al. 2016

Intl Journal of Cancer

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We performed a systematic review and meta-analysis to explore the optimum management strategy for women with atypical squamous cells of undetermined significance (ASCUS/borderline) or low-grade squamous intra-epithelial lesions (LSIL/mild dyskaryosis) cytological abnormalities at primary screening in the absence of HPV DNA test. We searched MEDLINE, EMBASE and CENTRAL and included randomised controlled trials comparing immediate colposcopy to cytological surveillance in women with ASCUS/LSIL. The outcomes of interest were occurrence of different histological grades of cervical intraepithelial neoplasia (CIN) and default rates during follow-up. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using a random-effect model and with inverse variance weighting. Interstudy heterogeneity was assessed using I 2 statistics. Six RCTs were included. Immediate colposcopy significantly increased detection of unimportant abnormalities as opposed to repeat cytology (koilocytosis: 32 vs. 21%, RR: 1.49, 95% CI 5 1.17-1.90); CIN1: 21 vs. 8%, RR: 2.58, 95% CI 5 1.69-3.94). Although immediate colposcopy detected CIN2, CIN21, and CIN31 earlier than cytology, the differences were no longer observed at 24 months (CIN31: 10.3 vs.11.9%, RR: 1.02, 95% CI 5 0.53-1.97), with significant interstudy heterogeneity (p < 0.001, I 2 5 93%). Default risk was significantly higher for repeat cytology (6 months: 6.3 vs. 13.3%, RR: 3.85, 95% CI 5 1.27-11.63; 12 months: 6.3 vs. 14.8%, RR: 6.39, 95% CI 5 1. 24 months: 0.9 vs. 16.1%, RR: 19.1,. Detection of CIN21 for cytological surveillance over two years is similar to that of immediate colposcopy, although patients may default. Colposcopy may be first choice when good compliance is not assured, but may increase detection of insignificant lesions. This emphasizes the need for a reflex triage test to distinguish women who need diagnostic work-up from those who can return to routine recall.

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Section: Discussionmentioning

confidence: 99%

Immediate referral to colposcopy versus cytological surveillance for low‐grade cervical cytological abnormalities in the absence of HPV test: A systematic review and a meta‐analysis of the literature

Kyrgiou

Kalliala

Mitra

et al. 2016

Intl Journal of Cancer

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“…Kyrgiou et al [75] tried to develop a clinical decision support scoring system (DSSS) based on artificial neural networks (ANN), which was first introduced by McCullogh and Pitts in 1943, for personalized management of women with cervical abnormalities. They collected data of liquid-based cytology, HPV-related biomarkers (E6&E7 mRNA and p16INK4a) and colposcopic findings from 2,267 women with or without cervical abnormalities.…”

Section: Applying Ai To Make Personalized Cancer Therapy Realmentioning

confidence: 99%

Major clinical research advances in gynecologic cancer in 2016: 10-year special edition

Suh

Kim

et al. 2017

J Gynecol Oncol

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In 2016, 13 topics were selected as major research advances in gynecologic oncology. For ovarian cancer, study results supporting previous ones regarding surgical preventive strategies were reported. There were several targeted agents that showed comparable responses in phase III trials, including niraparib, cediranib, and nintedanib. On the contrary to our expectations, dose-dense weekly chemotherapy regimen failed to prove superior survival outcomes compared with conventional triweekly regimen. Single-agent non-platinum treatment to prolong platinum-free-interval in patients with recurrent, partially platinum-sensitive ovarian cancer did not improve and even worsened overall survival (OS). For cervical cancer, we reviewed robust evidences of larger-scaled population-based study and cost-effectiveness of nonavalent vaccine for expanding human papillomavirus (HPV) vaccine coverage. Standard of care treatment of locally advanced cervical cancer (LACC) was briefly reviewed. For uterine corpus cancer, new findings about appropriate surgical wait time from diagnosis to surgery were reported. Advantages of minimally invasive surgery over conventional laparotomy were reconfirmed. There were 5 new gene regions that increase the risk of developing endometrial cancer. Regarding radiation therapy, Post-Operative Radiation Therapy in Endometrial Cancer (PORTEC)-3 quality of life (QOL) data were released and higher local control rate of image-guided adaptive brachytherapy was reported in LACC. In addition, 4 general oncology topics followed: chemotherapy at the end-of-life, immunotherapy with reengineering T-cells, actualization of precision medicine, and artificial intelligence (AI) to make personalized cancer therapy real. For breast cancer, adaptively randomized trials, extending aromatase inhibitor therapy, and ribociclib and palbociclib were introduced.

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“…Computational algorithms and their implementation in machine learning logic would be a feasible approach. Such algorithms and artificial intelligences are already used in pathology and diagnostic processes [43][44][45]. In medical education, it would be especially valuable to add the process of analyses itself to the final results, including the intermediate calculations.…”

Section: Discussionmentioning

confidence: 99%

Regression analyses of questionnaires in bedside teaching

et al. 2020

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Background Students’ ratings of bedside teaching courses are difficult to evaluate and to comprehend. Validated systematic analyses of influences on students’ perception and valuation of bedside teaching can serve as the basis for targeted improvements. Methods Six hundred seventy-two observations were conducted in different surgical departments. Survey items covered the categories teacher’s performance, student’s self-perception and organizational structures. Relevant factors for the student overall rating were identified by multivariable linear regression after exclusion of variable correlations > 0.500. The main target for intervention was identified by the 15% worst overall ratings via multivariable logistic regression. Results According to the students the success of bedside teaching depended on their active participation and the teacher’s explanations of pathophysiology. Further items are both relevant to the overall rating and a possible negative perception of the session. In comparison, negative perception of courses (worst 15%) is influenced by fewer variables than overall rating. Variables that appear in both calculations show slight differences in their weighing for their respective endpoints. Conclusion Relevant factors for overall rating and negative perception in bedside teaching can be identified by regression analyses of survey data. Analyses provide the basis for targeted improvement.

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Personalised management of women with cervical abnormalities using a clinical decision support scoring system

Cited by 35 publications

References 26 publications

Immediate referral to colposcopy versus cytological surveillance for low‐grade cervical cytological abnormalities in the absence of HPV test: A systematic review and a meta‐analysis of the literature

Immediate referral to colposcopy versus cytological surveillance for low‐grade cervical cytological abnormalities in the absence of HPV test: A systematic review and a meta‐analysis of the literature

Major clinical research advances in gynecologic cancer in 2016: 10-year special edition

Regression analyses of questionnaires in bedside teaching

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