Sensitivity and Specificity of Clinically Relevant Features on Fundus Photography, Optical Coherence Tomography, and Fluorescein Angiography to Diagnose Polypoidal Choroidal Vasculopathy

Abstract

Purpose : Indocyanine green angiography (ICG) is a gold standard to diagnose polypoidal choroidal vasculopathy (PCV) but invasive and not always available at clinical centers. This study explored sensitivity and specificity of clinically relevant features on fundus photography (FP), optical coherence tomography (OCT) and fluorescein angiography (FA) in diagnosing PCV without ICG.

Methods : With IRB approval, treatment-naïve eyes identified with serous/serosanguinous maculopathy that had FP, OCT, FA and ICG before treatment at Chiang Mai University Hospital between Jan 2013 and Dec 2016 were reviewed. De-identified images of each case were categorized into 3 sets (set A: FP; set B: OCT; set C: FA) and reviewed by 3 graders to confirm presence/absence of each feature, i.e., FP: subretinal orange nodule, large subretinal hemorrhage, notched/hemorrhagic pigment epithelial detachment (PED), peripapillary location, multifocal lesions, large drusen in fellow eye; OCT: multiple PED, sharply peaked PED, PED notch, hyperreflective ring beneath PED, double layer sign; FA: classic CNV, occult CNV, peripapillary location, multifocal lesions, expansile dot/smoke-stack leakage. In parallel, additional 2 graders reviewed images (including ICG) to confirm presence/absence of PCV in each case based on the EVEREST2 criteria. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under ROC curve (AUC) of PCV diagnosis were analyzed.

Results : Of 123 study eyes (119 subjects, 56% male, mean age±SD 57.5±12.5), definite diagnosis were 53% PCV, 37% CSC, 9% typical neovascular AMD. Features provided high AUC (≥0.8) were 1) FP: notched/hemorrhagic PED (0.76, 95%CI: 0.69-0.84), 2) OCT: PED notch (0.88, 95%CI: 0.82-0.93), 3) OCT: sharply peaked PED (0.84, 95%CI: 0.77-0.90), and 4) OCT: hyperreflective ring (0.84, 95%CI: 0.77-0.90). No features on FA reached AUC 0.8. When ≥2 of 4 highly suggestive signs presented, AUC increased to 0.93 (95%CI: 0.89-0.98) with 0.95 sensitivity (95%CI: 0.87-0.99), 0.95 specificity (95%CI: 0.82-0.97), 0.92 PPV (95%CI: 0.83-0.97), and 0.95 NPV (95%CI: 0.86-0.99).

Conclusions : These data suggest fundus photography and OCT can provide high sensitivity and specificity of PCV diagnosis especially when at least 2 of 4 highly suggestive signs are present.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.