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Cui HW. et al., 2019: Predicting shockwave lithotripsy outcome for urolithiasis using clinical and stone computed tomography texture analysis variables

Cui HW, Silva MD, Mills AW, North BV, Turney BW.
Oxford Stone Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
University of Lisbon, Faculty of Sciences, Lisbon, Portugal.
Exploristics Ltd., Belfast, United Kingdom.
Oxford Stone Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.

Abstract

We aimed to develop and evaluate a statistical model, which included known pre-treatment factors and new computed tomography texture analysis (CTTA) variables, for its ability to predict the likelihood of a successful outcome after extracorporeal shockwave lithotripsy (SWL) treatment for renal and ureteric stones. Up to half of patients undergoing SWL may fail treatment. Better prediction of which cases will likely succeed SWL will help patients to make an informed decision on the most effective treatment modality for their stone. 19 pre-treatment factors for SWL success, including 6 CTTA variables, were collected from 459 SWL cases at a single centre. Univariate and multivariable analyses were performed by independent statisticians to predict the probability of a stone free (both with and without residual fragments) outcome after SWL. A multivariable model had an overall accuracy of 66% on Receiver Operator Curve (ROC) analysis to predict for successful SWL outcome. The variables most frequently chosen for the model were those which represented stone size. Although previous studies have suggested SWL can be reliably predicted using pre-treatment factors and that analysis of CT stone images may improve outcome prediction, the results from this study have not produced a useful model for SWL outcome prediction.
Sci Rep. 2019 Oct 11;9(1):14674. doi: 10.1038/s41598-019-51026-x. FREE ARTICLE

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Comments 1

Peter Alken on Friday, April 17 2020 08:30

Another very good study in the last quarter of 2019: It’s so good to read the results of a well done study and well written paper not hiding but showing negative results.
Publications on CTTA-analysis in ESWL application have previously been reviewed (1,2). The Oxford Stone Group has now moved from in-vitro studies (1) to retrospective clinical work and failed to show relevant information for the clinical CTTA-application.

Besides from this I did not know and was surprised to read in the introduction that “recent evidence review conducted as part of the National Institute of Health and Care Excellence (NICE) guidelines on renal and ureteric stones concluded that there was only small benefit of ureteroscopy for stone removal over SWL for ureteric stones less than 10 mm; and that the clinical and cost effectiveness between SWL and ureteroscopy for renal stones less than 10 mm favoured SWL as the first line treatment choice” (3)

1. Cui HW et al, 2017: CT Texture Analysis of Ex Vivo Renal Stones Predicts Ease of Fragmentation with Shockwave Lithotripsy. J Endourol. 2017 Jun 5. doi: 10.1089/end.2017.0084
2. Xun Y et al., 2018: Single extracorporeal shock-wave lithotripsy for proximal ureter stones: Can CT texture analysis technique help predict the therapeutic effect? Eur J Radiol. 2018 Oct;107:84-89. doi: 10.1016/j.ejrad.2018.08.018.
3. National Institute for Health and Care Excellence. Surgical Treatments Intervention Evidence Review. NICE Guideline NG118
(2019).

Another very good study in the last quarter of 2019: It’s so good to read the results of a well done study and well written paper not hiding but showing negative results. Publications on CTTA-analysis in ESWL application have previously been reviewed (1,2). The Oxford Stone Group has now moved from in-vitro studies (1) to retrospective clinical work and failed to show relevant information for the clinical CTTA-application. Besides from this I did not know and was surprised to read in the introduction that “recent evidence review conducted as part of the National Institute of Health and Care Excellence (NICE) guidelines on renal and ureteric stones concluded that there was only small benefit of ureteroscopy for stone removal over SWL for ureteric stones less than 10 mm; and that the clinical and cost effectiveness between SWL and ureteroscopy for renal stones less than 10 mm favoured SWL as the first line treatment choice” (3) 1. Cui HW et al, 2017: CT Texture Analysis of Ex Vivo Renal Stones Predicts Ease of Fragmentation with Shockwave Lithotripsy. J Endourol. 2017 Jun 5. doi: 10.1089/end.2017.0084 2. Xun Y et al., 2018: Single extracorporeal shock-wave lithotripsy for proximal ureter stones: Can CT texture analysis technique help predict the therapeutic effect? Eur J Radiol. 2018 Oct;107:84-89. doi: 10.1016/j.ejrad.2018.08.018. 3. National Institute for Health and Care Excellence. Surgical Treatments Intervention Evidence Review. NICE Guideline NG118 (2019).
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