How valuable is the Cunningham panel in PANS Pandas?
- Sensitivity 15 to 60%
- Specificity 28 to 92%
- PPV 7-40%
- NPV 44 to 74%
Positive predictive value - The PPV of a test is a proportion that is useful to clinicians since it answers the question: ‘How likely is it that this patient has the disease given that the test result is positive?’ In this case 7-40%
Negative predictive value The NPV of a test answers the question: ‘How likely is it that this patient does not have the disease given that the test result is negative?’ In this case 44 to 74%.
To me, this data suggests that a negative test does not rule out PANS/PANDAS and a positive test is NOT diagnostic. Is the panel better than a coin flip in this clinical scenario?
As a comparison, estimates of mammography sensitivity range from 75% to 90% with specificity
from 90% to 95%. The positive predictive value of mammography for breast
cancer ranges from 20% in women under age 50 to 60% to 80% in women age
50-69. (https://cdn.ymaws.com/acpm.site-ym.com/resource/resmgr/policy-files/polstmt_breast.pdf)
I am interested in learn more about how this test is used clinically.
JR
J Neuroimmunol. 2017 Nov 15;312:31-37. doi: 10.1016/j.jneuroim.2017.09.002. Epub 2017 Sep 9.
Biomarkers for diagnosis of Pediatric Acute Neuropsychiatric Syndrome (PANS) - Sensitivity and specificity of the Cunningham Panel.
Erratum in
Abstract
OBJECTIVE:
Pediatric Acute Neuropsychiatric Syndrome (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are conditions marked by sudden onset of obsessive-compulsive disorder (OCD), tics, or avoidant/restrictive food intake in combination with multiple psychiatric symptoms. A diagnosis of PANS or PANDAS may be supported by the Cunningham Panel, a commercially available set of immunologic assays currently in clinical use. However, the relationship between Cunningham Panel results and patient symptoms remains unclear. This study was done to assess the diagnostic accuracy of the Cunningham Panel in patients with suspected PANS or PANDAS.
METHOD:
All Swedish patients who had taken the Cunningham Panel prior to June 2014 (n=154) were invited and 53 patients participated in the study. Based on comprehensive psychiatric assessment (the reference standard of diagnosis), subjects were classified as PANS, PANDAS, or neither. Prior Cunningham Panel test results were collected from patient records, and new blood samples were similarly analyzed within the scope of this study. In addition, results were compared to healthy controls (n=21) and a test-retest reliability analysis was performed.
RESULTS:
Sensitivities of individual biomarkers in the Cunningham Panel ranged from 15 to 60%, and specificities from 28 to 92%. Positive predictive values ranged from 17 to 40%, and negative predictive values from 44 to 74%. A majority of the healthy controls had pathological Cunningham Panel results and test-retest reliability proved insufficient.
CONCLUSION:
Clinical use of the Cunningham Panel in diagnosing PANS or PANDAS is not supported by this study.
Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.
KEYWORDS:
Antibodies; Biomarkers; Calcium/calmodulin kinase II; Obsessive-compulsive disorder; PANDAS; PANS; Sensitivity and specificity
- PMID:
- 28919236
- DOI:
- 10.1016/j.jneuroim.2017.09.002
- [Indexed for MEDLINE]
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