Adrenal vein sampling may not be a gold-standard diagnostic test in primary aldosteronism: final diagnosis depends upon which interpretation rule is used
Adrenal vein sampling may not be a gold-standard diagnostic test in primary aldosteronism: final diagnosis depends upon which interpretation rule is used
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DOI：
10.1007/s11255-008-9441-9
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发表时间：
2008-12-01
影响因子：
2
通讯作者：
Pasieka, Janice L.
中科院分区：
文献类型：
--
作者：
Kline, Gregory A.;Harvey, Adrian;Pasieka, Janice L.
肾上腺静脉采样 (AVS) 被认为是证明原发性醛固酮增多症中单侧醛固酮过多的金标准测试，但尚未有任何单一的 AVS 解释方法经过外部验证。根据使用的 AVS 解释规则，单侧与双侧醛固酮过多的最终诊断可能存在显着的观察者间差异。对 63 名原发性醛固酮增多症患者进行 AVS 和 40 例后续肾上腺切除术的回顾性图表审查推测为单侧醛固酮增多症。根据文献中发表的各种解释标准对 AVS 的数据进行了回顾性重新分析。使用 40 名接受手术的受试者，病理学和临床结果定义了醛固酮增多症亚型的最终诊断，这些受试者的 AVS 结果用于估计 AVS 解释的各种方法的真实敏感性和特异性。不同的 AVS 解释规则之间存在诊断差异。 13% 至 77% 的 AVS 尝试中证实肾上腺静脉导管插入成功。 AVS 的敏感性为 47% 至 100%，特异性为 55-100%。只有 17% 的案例能够按照所有解释标准进行统一分类。使用生化导管放置标准和 ACTH 输注提高了定义为成功并显示偏侧化的 AVS 结果的比例。我们通过使用文献中建议的不同解释 AVS 结果的系统发现最终诊断存在很大差异，这表明 AVS 可能并不总是被视为金标准诊断测试。
Adrenal vein sampling (AVS) is considered the gold-standard test to demonstrate unilateral aldosterone excess in primary aldosteronism, yet no single approach to interpretation of AVS has been externally validated.There may be significant inter-observer variability in the final diagnosis of unilateral vs. bilateral aldosterone excess depending on which AVS interpretation rule is used.Retrospective chart review of 63 subjects with primary aldosteronism undergoing AVS and 40 subsequent adrenalectomies for presumed unilateral aldosteronism. The data from the AVS were retrospectively re-analyzed according to a variety of interpretation criteria published in the literature. Using 40 subjects undergoing surgery, pathology and clinical outcomes defined the final diagnosis of aldosteronism subtype, and these subjects' AVS results were used to estimate the true sensitivity and specificity of the various approaches to AVS interpretation.Diagnostic discrepancies exist between the different AVS interpretation rules. Successful adrenal vein catheterization was confirmed in between 13% and 77% of AVS attempts. Sensitivity of AVS ranged from 47% to 100% and specificity 55-100%. Only 17% of all cases would be categorized uniformly by all interpretation criteria. Use of biochemical catheter placement criteria and ACTH infusion improved the proportions of AVS results defined as successful and showing lateralization.We found substantial variabilty in final diagnosis by using different systems of interpreting AVS results as suggested in the literature This suggests AVS may not always be considered a gold-standard diagnostic test.