Adrenal vein sampling: External validation of multinomial regression modelling and left adrenal vein‐to‐peripheral vein ratio to predict lateralization index without right adrenal vein sampling

• Published in: Clinical endocrinology (Oxford) 2020-12, Vol.93 (6), p.661-671
• Main Authors: Bouchard‐Bellavance, Roxanne, Perrault, Florence, Soulez, Gilles, Chagnon, Miguel, Kline, Gregory A., Bourdeau, Isabelle, Lacroix, André, So, Benny, Therasse, Eric
• Format: Article
• Language: English
• Subjects: adrenal vein sampling; aldosterone hypersecretion lateralization; Endocrine disorders; LAV/PV; multinomial regression modelling; primary aldosteronism; Sampling
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/cen.14295

Background Adrenal vein sampling (AVS) failure is mainly due to right adrenal vein unavailability. Multinomial regression modelling (MRM) and left adrenal vein‐to‐peripheral vein ratio (LAV/PV) were proposed to predict the lateralization index without the right AVS. Objective To assess external validity of MRM and LAV/PV to predict lateralization index when right adrenal vein sampling is missing. Design Diagnostic retrospective study. Patients Development and validation cohorts included AVS of 174 and 122 patients, respectively, from 2 different centres. Measurements Development and validation cohort data were used, respectively, for calibration and for validation of MRM and LAV/PV to predict the lateralization index without the right adrenal vein sampling. Sensitivity and specificity of MRM and LAV/PV were compared between both centres at different pre‐established specificity thresholds based on receiver operating characteristic curves generated from the development cohort data. Results At a specificity threshold of 95% set in the development cohort, specificity values exceeded 90% (range, 90.6%‐98.8%) for all verified MRM and LAV/PV models in the validation cohort. Corresponding sensitivities for MRM and LAV/PV, respectively, range from 54.1% to 83.7% and 32.8% to 88.4% for the development cohort compared to 33.3%‐87.5% and 2.8%‐79.2% for the validation cohort. Overall, diagnostic accuracy of both methods was higher to detect right (82.8%‐93.5%) than left (70.2%‐80.6%) lateralization index status in both centres. Conclusions Minimal changes in specificity from development to validation cohorts validate the use of MRM and LAV/PV to predict the lateralization index when the right AVS is missing. Both methods had better accuracy for right than left lateralization detection.