Maria Pia Giannoccaro1, Matteo Paolucci2, Corrado Zenesini2, Vitantonio Di Stasi2, Vincenzo Donadio2, Patrizia Avoni2, Rocco Liguori2. 1. From the Dipartimento di Scienze Biomediche e Neuromotorie (M.P.G., P.A., R.L.), Università di Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (M.P.G., C.Z., V.D.S., V.D., P.A., R.L.); UO Neurosonologia e Cefalee (M.P.), Università Campus Bio-Medico, Rome; and UO Neurologia (M.P.), Ospedale M. Bufalini, Cesena, AUSL Romagna, Italy. mpgiannoccaro@gmail.com. 2. From the Dipartimento di Scienze Biomediche e Neuromotorie (M.P.G., P.A., R.L.), Università di Bologna; IRCCS Istituto delle Scienze Neurologiche di Bologna (M.P.G., C.Z., V.D.S., V.D., P.A., R.L.); UO Neurosonologia e Cefalee (M.P.), Università Campus Bio-Medico, Rome; and UO Neurologia (M.P.), Ospedale M. Bufalini, Cesena, AUSL Romagna, Italy.
Abstract
OBJECTIVE: To compare the diagnostic accuracy of ice pack test (IPT) and single-fiber EMG (SF-EMG) in patients with suspected ocular myasthenia (OM) presenting with ptosis. METHODS: We studied consecutive patients referred for the clinical suspicion of OM. Patients underwent IPT and stimulated SF-EMG on the orbicularis oculi muscle. Receiver operating characteristic curve analysis was performed to determine the accuracy of IPT, SF-EMG, and their combination. RESULTS: We included 155 patients, 102 with OM and 53 with other diagnosis (OD). The IPT had a sensitivity of 86% (95% confidence interval [CI] 79-93) and a specificity of 79% (95% CI 68-90). SF-EMG showed a sensitivity of 94% (95% CI 89-98) and a specificity of 79% (95% CI 68-90). Overall, IPT and SF-EMG showed discordant results in 30 cases, 16 OM and 14 OD. The combination of IPT and SF-EMG, using the positivity of at least one test for OM diagnosis, increased the sensitivity to 98% (95% CI 95-100), reducing the specificity to 66% (95% CI 53-78), whereas using the positivity of both tests, we obtained a sensitivity of 82% (95% CI 75-90) and a specificity of 92% (95% CI 85-99). The negativity of both tests had a 94% (95% CI 87-100) negative predictive value. Comparison of the areas under the curve showed no differences in the diagnostic accuracy of IPT, SF-EMG, and their combinations. CONCLUSIONS: IPT and SF-EMG have similar diagnostic accuracy in patients with OM presenting with ptosis. The negativity of both tests strongly suggests another diagnosis. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that both the IPT and SF-EMG accurately identify patients with OM.
OBJECTIVE: To compare the diagnostic accuracy of ice pack test (IPT) and single-fiber EMG (SF-EMG) in patients with suspected ocular myasthenia (OM) presenting with ptosis. METHODS: We studied consecutive patients referred for the clinical suspicion of OM. Patients underwent IPT and stimulated SF-EMG on the orbicularis oculi muscle. Receiver operating characteristic curve analysis was performed to determine the accuracy of IPT, SF-EMG, and their combination. RESULTS: We included 155 patients, 102 with OM and 53 with other diagnosis (OD). The IPT had a sensitivity of 86% (95% confidence interval [CI] 79-93) and a specificity of 79% (95% CI 68-90). SF-EMG showed a sensitivity of 94% (95% CI 89-98) and a specificity of 79% (95% CI 68-90). Overall, IPT and SF-EMG showed discordant results in 30 cases, 16 OM and 14 OD. The combination of IPT and SF-EMG, using the positivity of at least one test for OM diagnosis, increased the sensitivity to 98% (95% CI 95-100), reducing the specificity to 66% (95% CI 53-78), whereas using the positivity of both tests, we obtained a sensitivity of 82% (95% CI 75-90) and a specificity of 92% (95% CI 85-99). The negativity of both tests had a 94% (95% CI 87-100) negative predictive value. Comparison of the areas under the curve showed no differences in the diagnostic accuracy of IPT, SF-EMG, and their combinations. CONCLUSIONS:IPT and SF-EMG have similar diagnostic accuracy in patients with OM presenting with ptosis. The negativity of both tests strongly suggests another diagnosis. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that both the IPT and SF-EMG accurately identify patients with OM.
Authors: Bart K Chwalisz; James Hillis; Amanda C Guidon; Leeann B Burton; Teilo H Schaller; Anthony A Amato; Allison Betof Warner; Priscilla K Brastianos; Tracey A Cho; Stacey L Clardy; Justine V Cohen; Jorg Dietrich; Michael Dougan; Christopher T Doughty; Divyanshu Dubey; Jeffrey M Gelfand; Jeffrey T Guptill; Douglas B Johnson; Vern C Juel; Robert Kadish; Noah Kolb; Nicole R LeBoeuf; Jenny Linnoila; Andrew L Mammen; Maria Martinez-Lage; Meghan J Mooradian; Jarushka Naidoo; Tomas G Neilan; David A Reardon; Krista M Rubin; Bianca D Santomasso; Ryan J Sullivan; Nancy Wang; Karin Woodman; Leyre Zubiri; William C Louv; Kerry L Reynolds Journal: J Immunother Cancer Date: 2021-07 Impact factor: 13.751