REAPPRAISAL OF QUANTITATIVE ESOPHAGEAL SCINTIGRAPHY BY OPTIMIZING RESULTS WITH ROC ANALYSES

This study investigates whether systematic analyses of methodological issues contribute to improve and renew the diagnostic role of quantita te esophageal scintigraphy. Methods: Forty-seven patients with normal (n = 26) and pathologic (n = 21) esophageal function were studied with scintigraphy and manometry, using the latter findings as the gold sta ndard. Scintigraphic data were analyzed by receiver operator character istic (ROC) methods to: establish the optimal decision threshold for s ix different quantitative parameters, evaluate their inherent discrimi nation capacity and compare liquid compared with solid bolus data. Res ults: Quantitative parameters have shown remarkable differences in the ir potential to discriminate between normal and pathologic findings (p ercentage of emptying at definite time points > mean time > transit ti me > mean transit time > T-max). Sensitivity of 95% at a specificity o f 96% was the optimum obtained. At comparable specificity levels, soli d bolus studies generally demonstrated higher sensitivity than liquid bolus studies. Conclusion: The diagnostic performance of optimized eso phageal scintigraphy is close to that of manometry. Our findings do no t only renew the role of esophageal scintigraphy as an accurate screen ing test for esophageal motility disorders but also invalidate recent reservations about the diagnostic potential of this method.