Abstract：
A nomogram for predicting the diagnosis of lower urinary tract obstruction (LUTO) based on an antenatal ultrasound index generated from a Bayesian Meta-regression analysis has been in development and noted with superior diagnostic accuracy compared to the keyhole sign (KHS). We aim to assess the accuracy of the nomogram in expanded diagnostic utilization to predict LUTO.
The validation of the nomogram for expanded diagnostic utilization was based on data from a prospective institutional antenatal clinic database between January 2020 and June 2022. Diagnostic accuracy indices were determined for confirmed postnatal diagnosis of LUTO or prune belly syndrome (PBS). Receiver operating characteristics (ROC) curves were generated to compare the area under the curve (AUC) of the nomogram versus KHS.
Based on 84 male fetuses with antenatal ultrasound of moderate-severe hydronephrosis (PUV n = 15, PBS n = 4), the KHS had 26.3% (95%CI 9.1-51.2) sensitivity and 100% (95%CI 94.4%-100%) specificity, with 14 false-negatives. The nomogram showed a 84.2 (95%CI 60.4%-96.6%) sensitivity and 95.4 (95%CI 87.1%-99%) specificity with three false-positives. The nomogram also had a superior AUC compared to KHS (0.98 vs. 0.63).
The nomogram can be used as a valuable tool to trigger further postnatal screening and provide individualized risk assessments to families during prenatal counseling.
The validation of the nomogram for expanded diagnostic utilization was based on data from a prospective institutional antenatal clinic database between January 2020 and June 2022. Diagnostic accuracy indices were determined for confirmed postnatal diagnosis of LUTO or prune belly syndrome (PBS). Receiver operating characteristics (ROC) curves were generated to compare the area under the curve (AUC) of the nomogram versus KHS.
Based on 84 male fetuses with antenatal ultrasound of moderate-severe hydronephrosis (PUV n = 15, PBS n = 4), the KHS had 26.3% (95%CI 9.1-51.2) sensitivity and 100% (95%CI 94.4%-100%) specificity, with 14 false-negatives. The nomogram showed a 84.2 (95%CI 60.4%-96.6%) sensitivity and 95.4 (95%CI 87.1%-99%) specificity with three false-positives. The nomogram also had a superior AUC compared to KHS (0.98 vs. 0.63).
The nomogram can be used as a valuable tool to trigger further postnatal screening and provide individualized risk assessments to families during prenatal counseling.
摘要：
背景：基于贝叶斯Meta回归分析生成的产前超声指标，用于预测下尿路梗阻（LUTO）诊断的列线图已经在开发中，并且与锁孔征（KHS）相比具有更高的诊断准确性。我们旨在评估列线图在预测LUTO的扩展诊断利用率中的准确性。
方法：扩大诊断利用的列线图的验证是基于2020年1月至2022年6月的前瞻性机构产前临床数据库的数据。确定诊断准确性指数，以确认产后诊断为LUTO或修剪腹部综合征（PBS）。产生受试者工作特征(ROC)曲线以比较列线图与KHS的曲线下面积(AUC)。
结果：基于84例男性胎儿产前超声检查中重度肾积水（PUVn=15，PBSn=4），KHS的敏感性为26.3%(95CI9.1-51.2)，特异性为100%(95CI94.4-100%)，14个假阴性。列线图显示84.2（95CI60.4-96.6%）的敏感性和95.4（95CI87.1-99%）的特异性，三个假阳性。与KHS相比,列线图也具有优异的AUC(0.98vs0.63)。
结论：列线图可作为一种有价值的工具，用于进一步进行产后筛查，并在产前咨询期间为家庭提供个性化的风险评估。本文受版权保护。保留所有权利。
方法：扩大诊断利用的列线图的验证是基于2020年1月至2022年6月的前瞻性机构产前临床数据库的数据。确定诊断准确性指数，以确认产后诊断为LUTO或修剪腹部综合征（PBS）。产生受试者工作特征(ROC)曲线以比较列线图与KHS的曲线下面积(AUC)。
结果：基于84例男性胎儿产前超声检查中重度肾积水（PUVn=15，PBSn=4），KHS的敏感性为26.3%(95CI9.1-51.2)，特异性为100%(95CI94.4-100%)，14个假阴性。列线图显示84.2（95CI60.4-96.6%）的敏感性和95.4（95CI87.1-99%）的特异性，三个假阳性。与KHS相比,列线图也具有优异的AUC(0.98vs0.63)。
结论：列线图可作为一种有价值的工具，用于进一步进行产后筛查，并在产前咨询期间为家庭提供个性化的风险评估。本文受版权保护。保留所有权利。
