[Comparison among three standards of TW2 to skeletal age determination in children with central precocious puberty]

Area of Science:

• Pediatric Endocrinology
• Radiology
• Growth and Development

Background:

• Central precocious puberty (CPP) requires accurate skeletal age assessment for timely diagnosis and treatment.
• The TW2 (Tanner-Whitehouse II) method is a standard for skeletal age estimation, with variations in different regions.

Purpose of the Study:

• To evaluate the diagnostic accuracy of the English, Chinese (TW2-CHN), and Japanese (TW2-JP) standards of the TW2 method for skeletal age assessment in children with CPP.
• To determine optimal thresholds for these standards to improve diagnostic sensitivity and specificity.

Main Methods:

• Retrospective analysis of left hand-wrist X-ray radiographs from 61 children with confirmed CPP and 67 controls.
• Skeletal ages were assessed independently by two doctors using TW2, TW2-CHN, and TW2-JP standards.
• Receiver Operating Characteristic (ROC) curve analysis was used to compare the diagnostic performance of the three standards.

Main Results:

• High inter-rater reliability (kappa = 0.776) was observed in skeletal age assessments.
• No significant differences in the areas under the ROC curves were found among the three TW2 standards.
• Optimal diagnostic thresholds were identified: TW2 (d ≥ 1.15 years), TW2-CHN (d ≥ 1.25 years), and TW2-JP (d ≥ 0.65 years) for improved sensitivity and specificity.

Conclusions:

• The TW2, TW2-CHN, and TW2-JP standards offer valuable diagnostic utility for skeletal age assessment in children with CPP.
• The TW2-CHN standard demonstrates the highest diagnostic value specifically for Chinese children.