| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Department of Thoracic Surgery, Strasbourg University Hospital, 1 Place de l'Hôpital, Nouvel Hôpital Civil, Strasbourg, 670091 France
(Email: pierre-emmanuel.falcoz{at}wanadoo.fr).
In the present article, Cheng and associates [1] seek to address the interesting and currently debated question of the accurate diagnostic tests for myasthenia gravis (MG). Indeed, it contributes to a better understanding of the close relation between an accurate early diagnosis and optimum clinical benefit from thymectomy during the course of MG.
In an elegant cohort comparative study, the authors sought to analyze the protein spectra in MG patients. They performed a proteome-wide search for potential serum protein diagnostic markers for MG using surface-enhanced laser desorption/ionization time-of-flight (SELDI-TOF) techniques. To do this, they analyzed sera samples from 80 MG patients and 80 healthy individuals (controls). Two-thirds of these (56 MG patients and 56 controls) were used as a training set and analyzed to set up a decision tree, while samples from the remaining one-third of the population (24 MG patients and 24 controls) were used as a learning set for cross-validation.
The model was then evaluated by means of a bootstrap analysis. The results showed that the SELDI-TOF technique generated 101 proteins peaks in the cohort, and 39 of the peaks were statistically different between the MG and control groups. In the training set, the decision tree used 2 peaks as splitters, with a sensitivity of 100% and specificity of 89.3%. In the learning set, the sensitivity was 83.3% and specificity was 87.5%. The authors concluded that the SELDI-TOF technique useful to detect and identify potential serum biomarkers that can diagnose MG with high sensitivity and specificity.
One might ask why thoracic surgeons should be concerned by the findings of this rigorous study. Not only does it represent a very large series of patients, diagnosed and treated the same way over a short lapse of time, it also pinpoints a crucial issue concerning medical care: the identification of a subpopulation of patients who would not benefit from a given surgery, for whom surgery would thus be unnecessary. For instance, thymectomy is commonly recommended for all patients with generalized MG [2], whatever the rate of complete remission (frequently reported less than 50%) after long-term follow-up.
Cheng and colleagues [1] suggest another pathway for exploring MG management, and in the burgeoning field of serum biomarkers, has successfully "opened one door leading to ten more." Future works that use SELDI-TOF technology and assess follow-up may be the clue to altering the established decision of therapeutic indications and, thus, to performing thymectomy only if it appears to be necessary.
For now, Cheng and associates [1] are to be congratulated on their innovative contribution in this area. Their results will certainly prove to be most beneficial to the thoracic surgery community.
 |
References |
|---|
 Top References |
|---|
Related Article
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
