An external validation of a novel predictive algorithm for male nipple areolar positioning: an improvement to current practice through a multicenter endeavor.

IF 1 4区医学 Q3 ORTHOPEDICS

Journal of Plastic Surgery and Hand Surgery Pub Date : 2023-02-01 DOI:10.1080/2000656X.2021.1994982

Floyd W Timmermans, Laure Ruyssinck, Sterre E Mokken, Marlon Buncamper, Kevin M Veen, Margriet G Mullender, Karel E Y Claes, Mark-Bram Bouman, Stanislas Monstrey, Timotheus C van de Grift

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引用次数: 1

Abstract

The correct positioning of nipple-areolar complexes (NAC) during gender-affirming mastectomies remains a particular challenge. Recently, a Dutch two-step algorithm was proposed predicting the most ideal NAC-position derived from a large cisgender male cohort. We aimed to externally validate this algorithm in a Belgian cohort. The Belgian validation cohort consisted of cisgender men. Based on patient-specific anthropometry, the algorithm predicts nipple-nipple distance (NN) and sternal-notch-to-nipple distance (SNN). Predictions were externally validated using the performance measures: R²-value, means squared error (MSE) and mean absolute percentage error (MAPE). Additionally, data were collected from a Belgian and Dutch cohort of transgender men having undergone mastectomy with free nipple grafts. The observed and predicted NN and SNN were compared and the inter-center variability was assessed. A total of 51 Belgian cisgender and 25 transgender men were included, as well as 150 Dutch cisgender and 96 transgender men. Respectively, the performance measures (R²-value, MSE and MAPE) for NN were 0.315, 2.35 (95%CI:0-6.9), 4.9% (95%CI:3.8-6.1) and 0.423, 1.51 (95%CI:0-4.02), 4.73%(95%CI:3.7-5.7) for SNN. When applying the algorithm to both transgender cohorts, the predicted SNN was larger in both Dutch (17.1_measured(±1.7) vs. 18.7_predicted(±1.4), p= <0.001) and Belgian (16.2_measured(±1.8) vs. 18.4_predicted(±1.5), p= <0.001) cohorts, whereas NN was too long in the Belgian (22.0_measured(±2.6) vs. 21.2_predicted(±1.6), p = 0.025) and too short in the Dutch cohort (19.8_measured(±1.8) vs. 20.7_predicted(±1.9), p = 0.001). Both models performed well in external validation. This indicates that this two-step algorithm provides a reproducible and accurate clinical tool in determining the most ideal patient-tailored NAC-position in transgender men seeking gender-affirming chest surgery.

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一种新的男性乳头乳晕定位预测算法的外部验证:通过多中心努力对当前实践的改进。

在性别确认乳房切除术中，乳头-乳晕复合物(NAC)的正确定位仍然是一个特别的挑战。最近，荷兰人提出了一种两步算法，从一个大型顺性别男性队列中预测最理想的nac位置。我们的目标是在比利时队列中外部验证该算法。比利时验证队列由顺性别男性组成。基于患者特异性人体测量，该算法预测乳头-乳头距离(NN)和胸骨-缺口-乳头距离(SNN)。预测使用性能指标进行外部验证:r2值、均方误差(MSE)和平均绝对百分比误差(MAPE)。此外，我们还收集了来自比利时和荷兰的一组变性男性的数据，这些男性接受了乳房切除术和游离乳头移植。比较了观测和预测的NN和SNN，并评估了中心间变异性。调查对象包括51名比利时顺性男性和25名跨性别男性，以及150名荷兰顺性男性和96名跨性别男性。神经网络的性能指标(r2值，MSE和MAPE)分别为0.315,2.35 (95%CI:0-6.9)， 4.9% (95%CI:3.8-6.1)， SNN的性能指标为0.423,1.51 (95%CI:0-4.02)， 4.73%(95%CI:3.7-5.7)。当将该算法应用于两个跨性别队列时，荷兰人的预测SNN都较大(17.1实测(±1.7)vs. 18.7预测(±1.4)，p=实测(±1.8)vs. 18.4预测(±1.5)，p=实测(±2.6)vs. 21.2预测(±1.6)，p= 0.025)，荷兰人的预测SNN过短(19.8实测(±1.8)vs. 20.7预测(±1.9)，p= 0.001)。两种模型在外部验证中均表现良好。这表明，该两步算法为寻求性别确认胸部手术的跨性别男性确定最理想的患者定制nac位置提供了一种可重复且准确的临床工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Plastic Surgery and Hand Surgery ORTHOPEDICS-SURGERY

CiteScore

2.10

自引率

0.00%

发文量

108

审稿时长

6-12 weeks

期刊介绍： The purpose of the Journal of Plastic Surgery and Hand Surgery is to serve as an international forum for plastic surgery, hand surgery and related research. Interest is focused on original articles on basic research and clinical evaluation. The scope of the journal comprises: • Articles concerning operative methods and follow-up studies • Research articles on subjects related to plastic and hand surgery • Articles on cranio-maxillofacial surgery, including cleft lip and palate surgery. Extended issues are published occasionally, dealing with special topics such as microvascular surgery, craniofacial surgery, or burns. Supplements, usually doctoral theses, may also be published. The journal is published for the Acta Chirurgica Scandinavica society and sponsored by the Key Foundation, Sweden. The journal was previously published as Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery.