Matthew J Ebright1, Shih-Hon Li1, Evan Reynolds1, James F Burke1, Ben R Claytor1, Anna Grisold1, Mousumi Banerjee1, Brian C Callaghan2. 1. From the Health Services Research Program (M.J.E., J.F.B., B.R.C., B.C.C.), Department of Neurology, Department of Pathology (S.-H.L.), and Department of Biostatistics (E.R., M.B.), School of Public Health, University of Michigan; Veterans Affairs Healthcare System (J.F.B., B.C.C.), Ann Arbor, MI; and Department of Neurology (A.G.), Medical University of Vienna, Austria. 2. From the Health Services Research Program (M.J.E., J.F.B., B.R.C., B.C.C.), Department of Neurology, Department of Pathology (S.-H.L.), and Department of Biostatistics (E.R., M.B.), School of Public Health, University of Michigan; Veterans Affairs Healthcare System (J.F.B., B.C.C.), Ann Arbor, MI; and Department of Neurology (A.G.), Medical University of Vienna, Austria. bcallagh@med.umich.edu.
Abstract
OBJECTIVE: To determine the proportion of true and false positives from paraneoplastic panels and effects on downstream testing/treatment. METHODS: Using a retrospective cohort study design, we identified 500 consecutive patients with Mayo paraneoplastic autoantibody testing and performed chart abstraction. Paraneoplastic presentation types were categorized into probable, possible, and other by consensus. True positives were defined as a positive antibody titer with no other explanation found in addition to one of the following: syndrome known to be associated with the antibody, clinical improvement with treatment, and new malignancy. Comparisons of diagnostic testing and treatments between false and true positives were performed. Multivariable logistic regression was used to evaluate associations between patient-level factors and true positives. RESULTS: The mean (SD) age of the population was 55.4 (17.1) years, and 55.4% were female, with 1.3 (1.2) years of follow-up. Of the 500 tests, 87 (17.4%, 95% confidence interval [CI] 14.1%-20.7%) were positive and 62 (71.3%, 95% CI 61.8%-80.8%) of these were false positives. Of those with a possible/other presentation (n = 369), 2 (0.5%, 95% CI 0.0%-1.0%) were true positives. CT of the chest (30.7% vs 11.8%, p ≤ 0.01) was performed more often in false positives than true negatives. Probable presentation type (odds ratio [OR] 57.9, 95% CI 12.5-268.0) and outpatient setting (OR 8.7, 95% CI 2.4-31.8) were associated with true-positive results. CONCLUSION: Paraneoplastic tests result in a large proportion of false positives, particularly in those with clinical presentations that are not well established as paraneoplastic diseases. Future work should construct panels targeted to specific clinical presentations and ensure that tests are ordered in the appropriate clinical context.
OBJECTIVE: To determine the proportion of true and false positives from paraneoplastic panels and effects on downstream testing/treatment. METHODS: Using a retrospective cohort study design, we identified 500 consecutive patients with Mayo paraneoplastic autoantibody testing and performed chart abstraction. Paraneoplastic presentation types were categorized into probable, possible, and other by consensus. True positives were defined as a positive antibody titer with no other explanation found in addition to one of the following: syndrome known to be associated with the antibody, clinical improvement with treatment, and new malignancy. Comparisons of diagnostic testing and treatments between false and true positives were performed. Multivariable logistic regression was used to evaluate associations between patient-level factors and true positives. RESULTS: The mean (SD) age of the population was 55.4 (17.1) years, and 55.4% were female, with 1.3 (1.2) years of follow-up. Of the 500 tests, 87 (17.4%, 95% confidence interval [CI] 14.1%-20.7%) were positive and 62 (71.3%, 95% CI 61.8%-80.8%) of these were false positives. Of those with a possible/other presentation (n = 369), 2 (0.5%, 95% CI 0.0%-1.0%) were true positives. CT of the chest (30.7% vs 11.8%, p ≤ 0.01) was performed more often in false positives than true negatives. Probable presentation type (odds ratio [OR] 57.9, 95% CI 12.5-268.0) and outpatient setting (OR 8.7, 95% CI 2.4-31.8) were associated with true-positive results. CONCLUSION: Paraneoplastic tests result in a large proportion of false positives, particularly in those with clinical presentations that are not well established as paraneoplastic diseases. Future work should construct panels targeted to specific clinical presentations and ensure that tests are ordered in the appropriate clinical context.
Authors: Russell P Harris; Stacey L Sheridan; Carmen L Lewis; Colleen Barclay; Maihan B Vu; Christine E Kistler; Carol E Golin; Jessica T DeFrank; Noel T Brewer Journal: JAMA Intern Med Date: 2014-02-01 Impact factor: 21.873
Authors: Hesham Abboud; John Probasco; Sarosh R Irani; Beau Ances; David R Benavides; Michael Bradshaw; Paulo Pereira Christo; Russell C Dale; Mireya Fernandez-Fournier; Eoin P Flanagan; Avi Gadoth; Pravin George; Elena Grebenciucova; Adham Jammoul; Soon-Tae Lee; Yuebing Li; Marcelo Matiello; Anne Marie Morse; Alexander Rae-Grant; Galeno Rojas; Ian Rossman; Sarah Schmitt; Arun Venkatesan; Steven Vernino; Sean J Pittock; Maarten Titulaer Journal: J Neurol Neurosurg Psychiatry Date: 2021-03-01 Impact factor: 13.654
Authors: William J Mullally; David M Pilgrim; Peter Novak; Shibani S Mukerji; Haitham S Alabsi; David Systrom; Sadie P Marciano; Donna Felsenstein Journal: Ann Neurol Date: 2022-01-18 Impact factor: 11.274