Biomedical Engineering Reference
In-Depth Information
Tabl e 9. 2
Sensitivity, specificity, and accuracy with DMR
value
Number
Marker
Sensitivity (%)
Specificity (%)
Accuracy (%)
Single
MUC1
0.25
66
83
68
EGFR
0.20
64
83
66
B7H3
0.11
68
67
68
HER2
0.24
64
100
68
Ki-67
0.10
68
67
68
EpCAM
0.21
59
67
60
Vimentin
0.08
59
67
60
CK18
0.06
73
50
70
p53
0.38
41
83
46
Dual
EpCam
CK18
(unweighted)
C
0.27
84
50
80
Triple
MUC1
C
HER2
1.23
95
67
92
C
EGFR (weighted)
Quad
MUC1
C
HER2
1.60
100
67
96
C
EGFR
C
EpCAM
(weighted)
Cutoff value for identification of malignancy. The value was determined from the point on a
receiver operating characteristic curve that has the minimal distance between the 0 % false negative
and the 100 % true positive
heterogeneity across samples, which reconfirmed the importance of multiple-marker
screening in cancer detection. Indeed, when analyzed for the diagnostic sensitivity,
specificity, and accuracy (Table
9.2
), a single marker showed accuracy of <70%.
The highest accuracy for cancer diagnosis with our cohort was obtained with
a quadruple marker combination (MUC1
C
EGFR
C
HER2
C
EpCAM, 96 % accu-
racy), followed closely by weighted triple markers (MUC1
HER2,92%
accuracy). Interestingly, the EpCAM and CK18 combination, which is routinely
used in detecting circulating tumor cells in peripheral blood, achieved an overall
diagnostic accuracy of 80 %, wherein high sensitivity (84 %) was offset by low
specificity (50 %).
The DMR results were also compared to those by standard-of-care methods.
Conventional cytology on FNA specimen was performed in 49 of 50 cases and
was diagnostic in 36 cases with 11 misdiagnoses (accuracy 74 %). Conventional
histology on all 50 biopsy samples correctly diagnosed 37 cases out of 45 diagnostic
samples (accuracy 84 %), with the remaining results nondiagnostic (5 cases). DMR
consistently outperformed the other methods, with 2 misdiagnoses in all 50 samples
(accuracy up to 96 %). Also note that DMR permitted fast detection (in less than
60 min for each patient), whereas the mean clinical turnaround time (from sample
submission to final report) was 3 days for cytology (1-8 days) and 4 days for surgical
pathology (1-11 days).
C
EGFR
C
