Method of diagnosis of pancreatic adenocarcinoma: A Nova Scotia experience.
Bibliographic record
Abstract
252 Background: The gold standard for the diagnosis of pancreatic adenocarcinoma involves pathologic confirmation, as identified in consensus guidelines. Little is known about the care of patients with pancreatic cancer in Nova Scotia. This retrospective study intends to clarify the methods utilized in Nova Scotia to diagnose pancreatic adenocarcinoma and identify variables associated with pathologic confirmation of diagnosis. Methods: A provincial database, involving patients diagnosed with unresectable pancreatic adenocarcinoma between January 1, 2011 and December 31, 2014, was created as identified by the surveillance and epidemiology unit of the program of care for cancer. Pearson chi-square was used to determine significant differences between groups and logistic regression was used to identify those variables associated with a specific pathologic diagnosis. Results: Of the 264 patients identified, most were diagnosed by a combination of imaging and an elevated CA 19-9 level (n = 120, 45.5%) and 24.2% (n = 64) by imaging alone. Significant predictors of diagnosis by imaging alone included i) age 65 or more vs less than 65 (n = 55, 31.3% vs n = 9, 10.2%; p = 0.001), and ii) living in areas served by community hospitals (rather than a tertiary care centre) (n = 46, 28.6% vs n = 18, 17.5%; p = 0.014). A pathologic diagnosis was attempted (non-diagnostic or positive) in 40.2% of patients (n = 106), and a pathologic diagnosis was actually obtained in 30.3% of patients (n = 80). Patients were significantly less likely to have an attempted pathologic diagnosis if they were over 65 (OR = 1.95, 95% CI 1.13 – 3.38), female (OR = 1.78, 95% CI 1.05 – 3.01), or resided in a community with a tertiary care centre (OR = 2.02, 95% CI = 1.17 – 3.49). Conclusions: A significant majority of patients in Nova Scotia were diagnosed with pancreatic adenocarcinoma without pathological confirmation, and nearly a quarter of these patients were diagnosed on the basis of imaging alone. The lack of pathologic diagnosis does not conform to consensus guidelines of management of pancreatic cancer and suggests that more work needs to be done to improve care for these patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".