Diagnostic Test of Assessment of Bone Age in Girls with Idiopathic Precocious Puberty_Chinese Journal of Evidence-Based Medicine

Authors：

NING Gang ¹ , ZHOU Xiangping ² , WU Kangmin ³ , XIE Shuxiang ⁴ , XIANG Chengfa ³ , CHEN Xijian ¹

1.Dept. of Radiology; The Second West China Hospital; Sichuan University; Chengdu 610041; China2.Dept. of Radiology; West China Hospital; Sichuan University; Chengdu 610041; China3.Dept. of Pediatrics; West China Hospital; Sichuan University; Chengdu 610041; China4.Dept. of Reproductive Endocrinology; The Second West China Hospital; Sichuan University; Chengdu 610041; China;

Corresponding author：

Keywords：

Age determination by skeleton; Idiopathic precocious puberty; Diagnostic test; ROC curve

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Objective 　To explore the accuracy and practicability of bone age assessment for the diagnosis of idiopathic precocious puberty (IPP).
Methods 　According to the “Gold Standard”, we selected 55 girls with IPP for the study group, and 83 normal girls for the control group. We retrospectively analyzed the first left hand-wrist radiographs at the first visit. Bone ages were assessed by using a single-blind method according to the RUS (Radius Ulna and Short bones), carpale and 20 bones method (TW2). Each had 5 decision thresholds ( gt;97th percentile, gt;90th percentile, gt;75th percentile, gt;50th percentile and ≤50th percentile). The diagnostic values from RUS, carpale and 20 bones methods assessing bone age were analyzed to identify the best decision threshold.
Results 　① Both sensitivity and specificity of the four decision thresholds were relatively higher, including gt;90th percentile of RUS (sensitivity 0.836, specificity 0.916), gt;90th percentile of carpale (sensitivity 0.746, specificity 0.916), gt;90th and gt;75th percentile of 20 bone (sensitivity 0.746, specificity 0.964 and sensitivity 0.982, specificity 0.783, respectively). ② Area under receiver operator characteristic curve (AUR): AUR of RUS 0.939 ± 0.019 (95%CI 0.902 to 0.977), AUR of carpale 0.899 ± 0.028 (95%CI 0.845 to 0.954), AUR of 20 bone 0.958 ± 0.014 (95%CI 0.930 to 0.986). No significant difference was found (F=2.03, P=0.13). ③ Agreement assessment within-observer reliability was 89.28%, and between-observer reliability was 80.3% (Kappa 0.68, u=6.87, P＜0.01).
Conclusions 　RUS and 20 bones methods have high accuracy for the diagnosis of idiopathic precocious puberty. Considering sensitivity and specificity, we think that ＞90th percentile of RUS is the best decision threshold.

Citation： NING Gang,ZHOU Xiangping,WU Kangmin,XIE Shuxiang,XIANG Chengfa,CHEN Xijian. Diagnostic Test of Assessment of Bone Age in Girls with Idiopathic Precocious Puberty. Chinese Journal of Evidence-Based Medicine, 2004, 04(11): 759-765. doi: Copy

1.	［1］Mo ZH, Su X. Sex premature in girls[A]. In: Liao EY, Chao CS, editor-in-chief. Endocrinology[M]. Beijing: People,s Medical Publishing House, 2001. p.1 191-1 201.
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11.	［6］Swets JA. Measuring the accuracy of diagnostic systems[J].Science,1988; 240: 1 285.
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13.	［8］Ye YY, eds. The methodologies of scorers and atlases measuring skeletal age in children and adolescents: introduction and application[M]. Changsha: Hunan Science and Technology Publishing House; 1994.p.145-177.
14.	叶义言, 主编. 儿童青少年骨龄的评分法图谱及应用[M]. 长沙: 湖南科技出版版; 1994. p.145～177.
15.	［9］Ning G, Wu KM, Li KM, Liao FL, Li XS, Zhou XP. The software of assessment of skeletal maturity and prediction of adult height: the value of clinical applicacation in pediatrics[J]. Journal of West China University of Medical Sciences, 2002; 33(2): 302.
16.	宁刚, 吴康敏, 李开明, 廖芳丽, 李学胜, 周翔平. 骨龄测定及成年身高预测软件在儿科临床的应用价值[J].华西医科大学学报, 2002; 33(2): 302.
17.	［10］Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve[J]. Radiology, 1982; 143: 29.
18.	［11］Lee PA. Central Precocious Puberty: An overview of diagnosis, treatment, and outcome[J]. Metab Clin North Am, 1999; 28(4): 901.
19.	［12］Salardi S, Cacciari E, Mainetti B. Outcome of premature thelarche: relation to puberty and final height[J]. Arch Dis Child, 1998; 79(2): 173.
20.	［13］Du ML, Kong QY, Cai W, Guo NQ, Huang XQ. Correlation between ovarian and uterine morphology by ultrasonography and serum levels of LH, FSH, and E2 in girls with idiopathic true precocious puberty. Chinese Journal of Endocrinology and Metabolism, 1995; 11(1): 22.
21.	杜敏联, 孔秋英, 蔡文, 郭念群, 黄兴强. 特发性真性性早熟女孩超声显示的子宫和卵巢形态改变与血清LH、FSH和E2的关系[J]. 中华内分泌代谢杂志, 1995; 11(1): 22.
22.	［14］Juul A, Fisker S, Scheike F. Serum levels of growth hormone binding protein in children with normal and precocious puberty: relation to age, gender, body composition and gonadal steroids[J]. Clin Endocrinol, 2000; 52(2): 165.
23.	［15］Della MT, Setian N, Damiani D. Premature thelarche: identification of clinical and laboratory data for the diagnosis of precocious puberty[J]. Rev Hosp Clin Fac Med Sao Paulo, 2002; 57(2): 49.
24.	［16］Sun J, Chen F, Zheng KE. The application of receiver operating characteristic (ROC) curve analysis in radiology[J]. Chin J Radiol, 2001; 35(8): 574.
25.	孙军, 陈峰, 郑凯尔. ROC曲线分析在放射学中的应用[J]. 中华放射学杂志, 2001; 35(8): 574.
26.	［17］Yip WM, Pang SY, Yim WS, Kwok CS. ROC cure analysis of lesion detectability on phantoms: comparison of digital spot mammography with conventional spot mammography[J]. BJR, 2001; 74: 621.
27.	［18］Metz CE. ROC methodology in radiologic imaging[J]. Invest Radiol,1986; 21(9): 720.

1. ［1］Mo ZH, Su X. Sex premature in girls[A]. In: Liao EY, Chao CS, editor-in-chief. Endocrinology[M]. Beijing: People,s Medical Publishing House, 2001. p.1 191-1 201.
2. 莫朝晖, 苏欣. 女性性早熟[A]. 见: 廖二元, 超楚生主编. 内分泌学[M]. 北京: 人民卫生出版社; 2001 .p.1 191～1 201.
3. ［2］Zhu J, Zhou JP. The current diagnosis and treatment of idiopathic central precocious puberty[J]. Progress in Obsterics and Gynecology, 2000; 9(1): 47.
4. 朱瑾, 周剑萍. 特发性真性性早熟的诊治现状[J]. 现代妇产科进展, 2000; 9(1): 47.
5. ［3］Sun YY, Li HL. Idiopathic central precocious puberty: the pathogenesis and diagnosis[J]. Foreign Medical Sciences: Section of Pediatrics, 2002; 29(2): 97.
6. 孙跃玉, 李海浪. 特发性中枢性性早熟的发病机制及其诊断[J]. 国外医学儿科学分册, 2002; 29(2): 97.
7. ［4］Wang JS. The application and clinical value of diagnostic test[M]. In: Wang JL, editor-in-chief. Clinical Epidemiology: scientific design, measurement and assessment. 2nd ed. Shanghai: Shanghai Science and Technology Publishing House, 2001.p.261-272.
8. 王觉生. 诊断性试验的应用及其临床意义[M]. 见: 王家良主编. 临床流行病学--临床科研设计、衡量与评价. 第2版. 上海: 上海科技出版社; 2001. p.261～272.
9. ［5］Xu YY, Yu CH, Chen YP, Fang JG. The research design and analysis of diagnostic and screening test[M]. In: Fang JG, eds. Medical Statistics and Computer Experiments. 2nd ed. Shanghai: Shanghai Science and Technology Publishing House, 2003:327-344.
10. 徐勇勇, 宇传华, 陈平雁, 方积乾. 诊断和筛查试验的研究设计与分析[M]. 见: 方积乾主编, 医学统计学与电脑实验. 第2版. 上海: 上海科技出版社; 2003. p.327～344.
11. ［6］Swets JA. Measuring the accuracy of diagnostic systems[J].Science,1988; 240: 1 285.
12. ［7］Tanner JM, Whitehouse RH, Cameron N, Marshall WA, Healy MJR, Goldstein H. Assessment of skeletal maturity and prediction of adult height (TW2 method)[M]. 2nd eds, London: Acad press, 1983.p.50-88.
13. ［8］Ye YY, eds. The methodologies of scorers and atlases measuring skeletal age in children and adolescents: introduction and application[M]. Changsha: Hunan Science and Technology Publishing House; 1994.p.145-177.
14. 叶义言, 主编. 儿童青少年骨龄的评分法图谱及应用[M]. 长沙: 湖南科技出版版; 1994. p.145～177.
15. ［9］Ning G, Wu KM, Li KM, Liao FL, Li XS, Zhou XP. The software of assessment of skeletal maturity and prediction of adult height: the value of clinical applicacation in pediatrics[J]. Journal of West China University of Medical Sciences, 2002; 33(2): 302.
16. 宁刚, 吴康敏, 李开明, 廖芳丽, 李学胜, 周翔平. 骨龄测定及成年身高预测软件在儿科临床的应用价值[J].华西医科大学学报, 2002; 33(2): 302.
17. ［10］Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve[J]. Radiology, 1982; 143: 29.
18. ［11］Lee PA. Central Precocious Puberty: An overview of diagnosis, treatment, and outcome[J]. Metab Clin North Am, 1999; 28(4): 901.
19. ［12］Salardi S, Cacciari E, Mainetti B. Outcome of premature thelarche: relation to puberty and final height[J]. Arch Dis Child, 1998; 79(2): 173.
20. ［13］Du ML, Kong QY, Cai W, Guo NQ, Huang XQ. Correlation between ovarian and uterine morphology by ultrasonography and serum levels of LH, FSH, and E2 in girls with idiopathic true precocious puberty. Chinese Journal of Endocrinology and Metabolism, 1995; 11(1): 22.
21. 杜敏联, 孔秋英, 蔡文, 郭念群, 黄兴强. 特发性真性性早熟女孩超声显示的子宫和卵巢形态改变与血清LH、FSH和E2的关系[J]. 中华内分泌代谢杂志, 1995; 11(1): 22.
22. ［14］Juul A, Fisker S, Scheike F. Serum levels of growth hormone binding protein in children with normal and precocious puberty: relation to age, gender, body composition and gonadal steroids[J]. Clin Endocrinol, 2000; 52(2): 165.
23. ［15］Della MT, Setian N, Damiani D. Premature thelarche: identification of clinical and laboratory data for the diagnosis of precocious puberty[J]. Rev Hosp Clin Fac Med Sao Paulo, 2002; 57(2): 49.
24. ［16］Sun J, Chen F, Zheng KE. The application of receiver operating characteristic (ROC) curve analysis in radiology[J]. Chin J Radiol, 2001; 35(8): 574.
25. 孙军, 陈峰, 郑凯尔. ROC曲线分析在放射学中的应用[J]. 中华放射学杂志, 2001; 35(8): 574.
26. ［17］Yip WM, Pang SY, Yim WS, Kwok CS. ROC cure analysis of lesion detectability on phantoms: comparison of digital spot mammography with conventional spot mammography[J]. BJR, 2001; 74: 621.
27. ［18］Metz CE. ROC methodology in radiologic imaging[J]. Invest Radiol,1986; 21(9): 720.

Chinese Journal of Evidence-Based Medicine

Diagnostic Test of Assessment of Bone Age in Girls with Idiopathic Precocious Puberty

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