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510(k) Data Aggregation
(90 days)
CardioPhase hsCRP is an in-vitro diagnostic reagent for the quantitative determination of C-reactive protein (CRP) in human serum, and heparin and EDTA plasma by means of particle enhanced immunonephelometry using the BN II and BN ProSpec® System. In acute phase response, increased levels of a number of plasma proteins, including C-reactive protein, is observed. Measurement of CRP is useful for the detection and evaluation of infection, tissue injury, inflammatory disorders and associated diseases. High sensitivity CRP (hsCRP) measurements may be used as an independent risk marker for the identification of individuals at risk for future cardiovascular disease. Measurements of hsCRP, when used in conjunction with traditional clinical laboratory evaluation of acute coronary syndromes, may be useful as an independent marker of prognosis for recurrent events, in patients with stable coronary disease or acute coronary syndromes.
The CardioPhase hsCRP assay is an in-vitro diagnostic reagent for the quantitative determination of Creactive protein (CRP) in human serum, and heparinized and EDTA plasma by means of particleenhanced immunoassay determination. The assay is traceable to the international standard ERM-DA474/IFCC. N Rheumatology Standard SL (cleared under K964527) is used for the establishment of reference curves for the immunonephelometric determination of C-reactive protein on the BN II and BN ProSpec® Systems. This calibrator consists of a mixture of human sera and elevated concentrations of CRP. The CardioPhase hsCRP reagent is a suspension of polystyrene (Latex) particles to which mouse monoclonal anti-human CRP antibodies (< 0.016 g/L) have been attached by covalent bonding. The reagent is a ready-to-use liquid containing preservatives. There are two product variants available. One variant (REF OQIY13) contains 3 x 2 mL vials / box, and the other variant (REF OQIY21) contains 5 x 5 mL vials / box. The assay's polystyrene particles coated with monoclonal antibodies specific to human CRP are aggregated when mixed with samples containing CRP. These aggregates scatter a beam of light passed through the sample. The intensity of the scattered light is proportional to the relevant protein in the sample. The result is evaluated by comparison with a standard of known concentration.
Here's a breakdown of the acceptance criteria and the study that proves the device meets them, based on the provided text:
1. Table of Acceptance Criteria and Reported Device Performance
The acceptance criteria for the method comparison study were that "Results from each lot of CardioPhase hsCRP met the predefined acceptance criteria." While the specific numerical acceptance criteria (e.g., maximum allowable bias) are not explicitly detailed in a table format within the provided text, the successful outcome is stated, and the resulting performance is presented as follows:
| Performance Metric | Lot 1 CardioPhase hsCRP | Lot 2 CardioPhase hsCRP | Lot 3 CardioPhase hsCRP |
|---|---|---|---|
| Sample Size (N) | 119 | 116 | 113 |
| Range | 5.523 – 197.746 mg/L | 5.378 – 199.150 mg/L | 5.501 – 199.503 mg/L |
| Regression Equation (y = mx + b) | y = 0.959x + 0.932 mg/L | y = 0.955x + 0.584 mg/L | y = 1.032x - 0.070 mg/L |
| Correlation Coefficient (r) | 0.994 | 0.996 | 0.994 |
| Coefficient of Determination (r²) | 0.989 | 0.991 | 0.989 |
| Observed Max Predicted Bias (for 10, 100, 150, 200 mg/L) | 5.2% (relative) | Not explicitly stated per lot, but given as overall maximum. | Not explicitly stated per lot, but given as overall maximum. |
| Overall Max Predicted Bias | 5.2% (relative) | 5.2% (relative) | 5.2% (relative) |
2. Sample Sizes Used for the Test Set and Data Provenance
- Sample Size:
- Lot 1: N = 119
- Lot 2: N = 116
- Lot 3: N = 113
- The total number of samples used in the method comparison study is the sum of these, which is 348.
- Data Provenance: The study was conducted at the "company site in Marburg, Germany." The samples used were "Native serum samples." The text does not explicitly state whether the samples were retrospective or prospective, but the phrasing "Native serum samples were measured" suggests they were existing samples at the time of the study rather than collected specifically for this study.
3. Number of Experts Used to Establish the Ground Truth for the Test Set and Their Qualifications
This information is not provided in the text. The study describes a method comparison between two quantitative laboratory assays (CardioPhase hsCRP and RCRP Flex reagent cartridge). For this type of in-vitro diagnostic device, the "ground truth" is typically defined by the reference method or the predicate device's measurement, not by human expert consensus or adjudication in the way it might be for image-based diagnostic AI.
4. Adjudication Method for the Test Set
Not applicable for this type of in-vitro diagnostic device and study design. The comparison is quantitative between two analytical methods, not involving human interpretation requiring adjudication.
5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done
No, a Multi-Reader Multi-Case (MRMC) comparative effectiveness study was not done. This type of study is typically performed for image analysis or other diagnostic tools where human interpretation is a key component. The CardioPhase hsCRP is an in-vitro diagnostic reagent for quantitative measurement, which does not involve human readers in the same way.
6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) Was Done
Yes, the study described is a standalone performance study of the CardioPhase hsCRP assay compared to a predicate device. It evaluates the device's ability to quantitatively determine C-reactive protein concentrations independently. No human-in-the-loop component is mentioned for the performance evaluation itself.
7. The Type of Ground Truth Used
The "ground truth" for this method comparison study was established by the predicate device, RCRP Flex® reagent cartridge, which runs on the Dimension clinical chemistry system. Both the proposed device (CardioPhase hsCRP) and the predicate device are traceable to the international standard ERM-DA474/IFCC for C-reactive protein measurements. Therefore, the predicate device's measurements serve as the reference for comparison, and that reference itself is traceable to an international standard.
8. The Sample Size for the Training Set
The text does not specify a separate training set or its sample size. The described "method comparison study" is focused on verifying the performance of the device for regulatory submission, using a test set of samples. For in-vitro diagnostic devices, "training sets" are usually relevant for developing the assay itself (e.g., optimizing reagent concentrations, reaction conditions), but this information is not typically detailed in a 510(k) summary with respect to a "training set" of patient data for algorithm development.
9. How the Ground Truth for the Training Set Was Established
As no specific "training set" of patient samples is described in the provided text in the context of algorithm development, this information is not applicable. The assay itself relies on a biochemical principle and calibration traceable to an international standard (ERM-DA474/IFCC), and the calibration is established using N Rheumatology Standard SL, which is traceable to Siemens internal Master Calibrator, which is in turn directly traceable to ERM-DA474/IFCC.
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(621 days)
N Latex FLC kappa and lambda are in-vitro diagnostic reagents for the quantitative determination of free light chains (FLC), type kappa or type lambda in human serum and EDTA-plasma. N Latex FLC kappa and lambda assays are used:
• as an aid in the diagnosis and monitoring of multiple myeloma (MM) on the BN Systems and Atellica® CH Analyzer,
• as an aid in the diagnosis of amyloidosis (AL) on the BN Systems and Atellica® CH Analyzer,
• as an aid in the evaluation of Monoclonal Gammopathy of Undetermined Significance (MGUS) on the BN Systems.
Results of FLC measurements should always be interpreted in conjunction with other laboratory and clinical findings.
The N Latex FLC (free light chain) assays are in vitro diagnostic reagents for the quantitative determination of free light chains, type kappa or type lambda, in human serum and EDTA plasma by means of particle-enhanced immunoassay determination. Used in conjunction with other clinical and laboratory findings, FLC measurements are used as an aid in the diagnosis and monitoring of multiple myeloma (MM), as an aid in the diagnosis of amyloidosis (AL) and on the BN Systems, as an aid in the evaluation of MGUS.
Polystyrene particles coated with antibodies to human free light chains, type kappa or lambda, are agglutinated when mixed with samples containing FLC. These aggregates scatter a beam of light passed through the sample. The intensity of the scattered light is proportional to the concentration of the respective protein in the sample. The result is evaluated by comparison with a standard of known concentration.
Here's an analysis of the acceptance criteria and the study that proves the device meets them, based on the provided text:
1. Table of Acceptance Criteria and Reported Device Performance
The acceptance criteria are implicitly defined by the concordance percentages achieved in various patient cohorts. The document does not explicitly state numerical thresholds as "acceptance criteria" but rather presents the performance results.
| Study Endpoint / Criteria | Reported Device Performance |
|---|---|
| MGUS Concordance (Overall): The ability of the device to correctly identify patients with MGUS based on FLC measurements. | 50.4% Concordance across 121 MGUS samples (89 Non-IgM, 21 IgM, 11 LC MGUS). |
| LC MGUS Concordance: The ability of the device to correctly identify patients with Light Chain MGUS (LC MGUS) based on an abnormal FLC-Ratio and elevated iFLC. | 90.9% Concordance across 11 LC MGUS samples when considering both criteria (abnormal FLC-Ratio and positive for iFLC elevation). 10 samples were positive for both criteria, and 1 for one criterion. |
| Polyclonal Immunostimulation Concordance: The ability of the device to correctly differentiate polyclonal immunostimulation from MGUS, yielding a low concordance for MGUS. | 90.2% Concordance across 102 polyclonal immunostimulation samples. (This implies a high agreement that these samples are not MGUS, aligning with the expected performance of a device aiding in MGUS evaluation by not falsely classifying non-MGUS as MGUS). |
| Agreement with Clinical Diagnosis for Stable MGUS: The device's ability to show stability in FLC measurements consistent with clinically stable MGUS. | 98.4% Agreement across 61 stable MGUS patients. Agreement was defined by: 1) κ/λ ratio within the reference interval of 0.53 - 1.51 at the last draw, AND 2) two consecutive assessments not showing a relative change of ≥ 25% for the involved free light chain (iFLC). |
| Agreement with Clinical Diagnosis for Progressive MGUS: The device's ability to show changes in FLC measurements consistent with progression from MGUS to MM. | 75.0% Agreement across 4 progressive MGUS patients. Agreement was defined by: 1) κ/λ ratio outside the reference interval of 0.53 - 1.51 at the time of clinical MM diagnosis, AND 2) two consecutive assessments showing a relative change of ≥ 25% for the involved light chain (iFLC). (Note: The small sample size here for progressive cases should be considered when interpreting this percentage). |
2. Sample Sizes Used for the Test Set and Data Provenance
- MGUS Concordance:
- Test Set Sample Size: 121 MGUS samples (89 Non-IgM, 21 IgM, 11 LC MGUS)
- Data Provenance: Not explicitly stated, but the study was described as a "multi-center study," suggesting samples were collected from various clinical sites. It is implied to be retrospective as they are described as "clinically defined samples" and patients with "diagnosed" MGUS or polyclonal immunostimulation.
- LC MGUS Concordance:
- Test Set Sample Size: 11 LC MGUS samples (subset of the 121 MGUS samples).
- Data Provenance: Same as above (multi-center, implied retrospective).
- Polyclonal Immunostimulation Concordance:
- Test Set Sample Size: 102 specimens.
- Data Provenance: Same as above (multi-center, implied retrospective).
- Evaluation of MGUS Patients (Stable Cohort):
- Test Set Sample Size: 61 patients.
- Data Provenance: Not explicitly stated, but patients were "initially diagnosed for MGUS" and "evaluated over different time periods" with "at least 4 sample draws at various time intervals," indicating a prospective or longitudinal study design over time.
- Evaluation of MGUS Patients (Progressive Cohort):
- Test Set Sample Size: 4 patients.
- Data Provenance: Same as above (prospective/longitudinal).
3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications
The document does not specify the number or qualifications of experts used to establish the ground truth for the test set. It refers to "clinically defined samples" and "clinical diagnosis," implying that the ground truth was based on a comprehensive clinical assessment, likely by medical professionals (e.g., oncologists, hematologists), but the details are not provided.
4. Adjudication Method for the Test Set
The document does not describe an adjudication method for establishing the ground truth of the test set (e.g., 2+1, 3+1). The ground truth appears to be based on pre-existing "clinical diagnosis" or "clinically defined samples."
5. Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study
- No, an MRMC comparative effectiveness study was not done. This device is an in-vitro diagnostic reagent, which provides quantitative measurements, not an imaging device that human readers interpret. Therefore, the concept of "human readers improve with AI vs without AI assistance" is not applicable in this context.
6. Standalone (Algorithm Only Without Human-in-the-Loop Performance) Study
- Yes, a standalone performance study was done. The studies described (concordance and evaluation of stable/progressive patients) assessed the performance of the N Latex FLC assays (the "device" or "algorithm" in this context) directly against clinical diagnoses and criteria. The results are reported as the "N Latex FLC κ/λ Ratio Concordance" and "N Latex FLC results," indicating an assessment of the device's output without direct human-in-the-loop interpretation of the assay results during the diagnostic process itself (though human interpretation of the FLC results in conjunction with other clinical findings is part of the intended use).
7. Type of Ground Truth Used
The ground truth used was expert consensus / clinical diagnosis / outcomes data.
- "Clinically defined samples" with diagnoses of MGUS or polyclonal immunostimulation.
- "Clinical diagnosis of MGUS" and "change in clinical diagnosis of MGUS to MM" for the stable and progressive cohorts, respectively. This implies that the ground truth was established by medical professionals using a combination of clinical findings, established diagnostic criteria, and other laboratory results, which could be considered a form of expert consensus or clinical outcomes.
8. Sample Size for the Training Set
The document does not report on a separate training set or its sample size. The performance data provided is for the evaluation of the device, implying the device was already developed. For an in-vitro diagnostic assay like this (which is a reagent test and analytical system), the "training" typically refers to the development and optimization of the assay's chemical and biological components, calibration, and establishment of analytical performance characteristics, rather than machine learning model training on a distinct labeled dataset. The document refers to prior submissions (K171742 and K182098) for "previously documented analytical and clinical studies," which likely covered the initial development and analytical validation.
9. How the Ground Truth for the Training Set Was Established
As no explicit "training set" for an AI/ML model is mentioned, this question is not directly applicable. For a traditional diagnostic assay, the "ground truth" during development involves rigorous analytical validation (e.g., using reference materials, spiked samples, and comparison to established methods) and initial clinical studies to define normal ranges and characteristic responses in different disease states. These would have been established through standard laboratory and clinical practices, likely involving certified reference materials, reference methods, and clinical expert assessment of patient samples.
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(158 days)
N Latex FLC kappa and lambda assays: In-vitro diagnostic reagents for the quantitative determination of free light chains (FLC), type kappa or type lambda, in human serum and EDTA plasma by means of particle-enhanced immunonephelometry using the BN Systems. FLC measurements are used as an aid in the diagnosis of multiple myeloma (MM) and amyloidosis (AL).
N FLC Supplementary Reagent: Supplementary reagent for the immunonephelometric determination of free light chains (FLC), type kappa and type lambda on BN Systems. A mixture of both supplementary reagents is used to suppress interference by rheumatoid factors and human anti-mouse antibodies (HAMA).
N FLC Standard SL: Establishment of reference curves for the determination of free light chains (FLC), type kappa and type lambda on the BN Systems.
N FLC Controls SL1 and SL2: The N FLC Controls SL1 and SL2 are for use as assayed accuracy controls in the determination of free light chains (FLC), type kappa and type lambda by immunonephelometry with the BN Systems.
The N Latex FLC (free light chain) assays are in vitro diagnostic reagents for the quantitative determination of free light chains, type kappa or type lambda, in human serum and EDTA plasma by means of particle-enhanced immunonephelometry using the BN™ II and BN ProSpec® Systems. Used in conjunction with other clinical and laboratory findings, FLC measurements are used as an aid in the diagnosis of multiple myeloma (MM) and amyloidosis (AL). Used in conjunction with the assay reagents, N FLC Standard SL is for use in the establishment of reference curves for the determination of free light chains, type kappa and type lambda on the BN™ II and BN ProSpec® Systems. The N FLC Control SL 1 and 2 products are for use as assayed accuracy controls and precision controls in the determination of free light chains, type kappa and type lambda by immunonephelometry with the BN™ II and BN ProSpec® Systems. The FLC test systems are based upon the principles of particle-enhanced immunonephelometry. Polystyrene particles coated with monoclonal antibodies to human free light chains, type kappa or lambda, respectively, are agglutinated when mixed with samples containing FLC. These aggregates scatter a beam of light passed through the sample. The intensity of the scattered light is proportional to the concentration of the respective protein in the sample. The result is evaluated by comparison with a standard of known concentration.
The provided text describes the Siemens N Latex FLC kappa and N Latex FLC lambda assays, along with their associated calibrators and controls. These devices are intended for the quantitative determination of free light chains (FLC) in human serum and EDTA plasma, used as an aid in diagnosing multiple myeloma (MM) and amyloidosis (AL).
Here's an analysis of the acceptance criteria and the study that proves the device meets them:
1. Table of Acceptance Criteria and Reported Device Performance
The acceptance criteria are generally implied by the performance characteristics presented in the study. For analytical performance, typical acceptance limits for precision (CV%), linearity, and interference are industry standards for IVD devices. For clinical performance, the reported sensitivity and specificity values against clinical diagnosis are the acceptance metrics.
| Acceptance Criteria Category | Specific Metric | Acceptance Criteria (Implied/Standard) | Reported Device Performance and Remarks |
|---|---|---|---|
| Analytical Performance | Precision (Total CV%) | Typically < 10-15% for clinical assays, varying by analyte concentration. CLSI EP05-A3 guidelines were followed. | FN II Instrument:- Kappa: Total CV% ranges from 3.45% (S1, 11.43 mg/L) to 4.55% (C1, 14.60 mg/L) to 3.81% (S3, 81.31 mg/L). Max 4.55%.- Lambda: Total CV% ranges from 5.60% (S1, 10.91 mg/L) to 6.61% (S2, 27.84 mg/L) to 6.89% (S3, 44.46 mg/L). Max 6.89%.BN ProSpec Instrument:- Kappa: Total CV% ranges from 5.24% (S1, 11.03 mg/L) to 5.58% (C2, 36.33 mg/L) to 7.68% (S3, 79.04 mg/L). Max 7.68%.- Lambda: Total CV% ranges from 3.22% (C1, 13.82 mg/L) to 4.71% (S3, 44.69 mg/L) to 4.28% (S1, 10.87 mg/L). Max 4.71%.Lot-to-Lot (BN II):- Kappa: Total CV% ranges from 4.00% (S2, 25.91 mg/L) to 6.35% (S1, 11.66 mg/L) to 5.58% (C2, 37.40 mg/L). Max 6.35%.- Lambda: Total CV% ranges from 6.19% (S2, 26.35 mg/L) to 9.44% (S3, 41.59 mg/L) to 8.54% (S1, 10.30 mg/L). Max 9.44%.Lot-to-Lot (BN ProSpec):- Kappa: Total CV% ranges from 5.23% (S2, 26.15 mg/L) to 7.87% (S1, 11.18 mg/L) to 7.39% (S3, 81.79 mg/L). Max 7.87%.- Lambda: Total CV% ranges from 4.47% (S2, 27.24 mg/L) to 7.97% (S1, 10.79 mg/L) to 7.59% (S3, 44.11 mg/L). Max 7.97%.All precision values are well within acceptable clinical laboratory ranges. |
| Measuring Range (Linearity) | Assays should be linear across their claimed measuring range. CLSI EP06-A guidelines were followed. | Kappa: Claimed 3.4 to 110 mg/L. Supported by linearity studies.Lambda: Claimed 1.9 to 60 mg/L. Supported by linearity studies. | |
| Limit of Quantitation (LoQ) | LoQ should demonstrate analytical performance (e.g., total error) at low concentrations. CLSI EP17-A2 guidelines were followed. | Kappa: 0.195 mg/L with a total error of 10.57%.Lambda: 0.532 mg/L with a total error of 10.01%. These values indicate acceptable performance at the lower end of the measuring range. | |
| High Dose Hook Effect (Antigen Excess) | No hook effect (false negatives) should be observed at high concentrations. | No hook effect observed up to 27,100 mg/L for FLC kappa and 57,300 mg/L for FLC lambda due to built-in pre-reaction protocols on BN II and BN ProSpec. Meets criteria. | |
| Specificity (Interference) | No significant interference from common endogenous and exogenous substances at specified concentrations. CLSI EP7-A2 guidelines were followed. | A variety of substances (e.g., Acetamidophenol, Heparin, Triglycerides, Hemoglobin, Bilirubin, RF, etc.) showed no interference up to high specified concentrations. Meets criteria. | |
| Clinical Performance | Sensitivity for Multiple Myeloma (MM) | High sensitivity is crucial for diagnostic aid. | 95.8 % (95 % Confidence Interval: 89.8 to 98.4 %). Very good sensitivity. |
| Specificity for Multiple Myeloma (MM) | High specificity is crucial for diagnostic aid. | 96.9 % (95 % Confidence Interval: 93.0 to 98.7 %). Very good specificity. | |
| Sensitivity for AL Amyloidosis (AL) | High sensitivity is crucial for diagnostic aid. | 83.1 % (95 % Confidence Interval: 73.7 to 89.7 %). Good sensitivity. | |
| Specificity for AL Amyloidosis (AL) | High specificity is crucial for diagnostic aid. | 96.9 % (95 % Confidence Interval: 93.0 to 98.7 %). Very good specificity. (Note: Specificity is the same as for MM, indicating the same non-diseased control group was used for both calculations). | |
| Method Comparison | Agreement Rate vs. Predicate Device for FLC kappa | High agreement rate is expected for substantial equivalence. | Overall agreement rate: (Value is missing from the table; it only shows the counts for each category. Based on the provided numbers, it's 102+23+6+11+3+1 / 152 = 146/152 = 96.05% agreement for Kappa based on the comparison method's categories, and 102/152 = 67.1% in the high range, 23/152 = 15.1% in the normal range, 6/152 = 3.9% in the low range. The table entries are counts in overlapping categories relative to the predicate's reference intervals, not a direct agreement percentage. The provided table does not explicitly state the "overall agreement rate" but shows cell counts, implying successful comparison.) |
| Agreement Rate vs. Predicate Device for FLC lambda | High agreement rate is expected for substantial equivalence. | Overall agreement rate: (Value is missing in the table, similar to kappa. Based on the provided numbers, it's 85+23+2+10+6+16 / 152 = 142/152 = 93.42% agreement for Lambda based on the comparison method's categories. The provided table does not explicitly state the "overall agreement rate".) |
2. Sample Size Used for the Test Set and Data Provenance
- Precision and Reproducibility:
- Sample Size: Serum samples were obtained from commercial sources. Three levels of serum specimens (S1-S3) and two levels of controls (C1, C2) were used. The exact number of individual patient samples aggregated into these pools is not specified, but the testing involved multiple replicates, runs, two instruments across three lots of reagents, suggesting extensive measurements.
- Data Provenance: Not explicitly stated, but likely from a laboratory setting. No indication of retrospective/prospective or country of origin for these pooled specimens.
- Measuring Range (Linearity and LoQ):
- Sample Size: A test specimen for linearity was diluted to 9 levels. Serum and EDTA plasma specimens from four healthy donors from Sanquin Blood Bank (one donor each for kappa EDTA plasma and serum and one donor each for lambda EDTA plasma and serum) were used.
- For LoQ, five individual serum samples with very low concentrations of FLC kappa and five for FLC lambda were used.
- Data Provenance: Fresh human serum and EDTA plasma. Sanquin Blood Bank is a Dutch organization, suggesting the data provenance is European (Netherlands).
- High Dose Hook Effect:
- Sample Size: Serum samples with high concentrations of FLC kappa and FLC lambda were used. The number of samples is not specified.
- Data Provenance: Not specified.
- Specificity (Interference):
- Sample Size: Not explicitly stated how many samples or replicates were used for each interferent, but the study implies testing against various concentrations for each listed substance.
- Data Provenance: Not specified.
- Expected Values / Reference Interval:
- Sample Size: 201 apparently healthy subjects.
- Data Provenance: US-population. This was a prospective study to establish reference intervals.
- Clinical Sensitivity and Specificity:
- Sample Size: A total of 342 samples. This included:
- 96 samples from Multiple Myeloma patients.
- 83 samples from AL Amyloidosis patients.
- 163 samples from non-myeloma patients with various clinical conditions (24 polyclonal immunoglobulin stimulation, 16 Chronic Kidney Disease (CKD), and 123 other clinical conditions).
- Data Provenance: Not explicitly stated, but these are patient samples. The type of study (retrospective/prospective) is not mentioned for this section, but it's common for such validation sets to be carefully curated retrospective collections.
- Sample Size: A total of 342 samples. This included:
- Method Comparison with Predicate Device:
- Sample Size: 152 serum samples from patients with monoclonal gammopathy.
- Data Provenance: Patients with monoclonal gammopathy. Not specified if retrospective or prospective or country of origin.
3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of Those Experts
The document does not specify the number or qualifications of experts used to establish the "ground truth" for the test set in the conventional sense of a diagnostic imaging or pathology study.
- For the clinical sensitivity and specificity study: The "ground truth" was established by "Clinical Diagnosis of Multiple Myeloma" and "Clinical Diagnosis of Amyloidosis." This implies diagnosis made by clinicians based on established diagnostic criteria, which would involve multiple medical professionals (e.g., oncologists, hematologists, nephrologists, pathologists) but these are not explicitly qualified or counted in this document.
- For analytical studies (precision, linearity, LoQ, interference): The "ground truth" is typically defined by the known concentrations or characteristics of the reagents/samples used and verified by established analytical methods, not by human expert opinion.
4. Adjudication Method for the Test Set
Not applicable for this type of in-vitro diagnostic device study. Adjudication methods like 2+1 or 3+1 are typically used in imaging studies where multiple readers interpret images, and a consensus or majority vote establishes ground truth. In this case, "ground truth" for the clinical study is based on a clinical diagnosis, which is a broader process.
5. If a Multi Reader Multi Case (MRMC) Comparative Effectiveness Study was Done
No, an MRMC comparative effectiveness study was not done. This type of study is relevant for comparing human reader performance with and without AI assistance, typically in medical imaging. The N Latex FLC assays are IVD assays that provide quantitative measurements, not interpretations by human readers that would be augmented by AI.
6. If a Standalone (i.e. algorithm only without human-in-the-loop performance) was Done
Yes, the studies described are for the standalone performance of the N Latex FLC assays. These are automated laboratory tests where the device (the assay and instrument system) performs the measurement and outputs a quantitative result. There isn't a "human-in-the-loop" for the interpretation of the raw signal data, though a clinician then interprets the numerical FLC results in the context of other clinical findings. The performance metrics (precision, linearity, LoQ, sensitivity, specificity) reflect the algorithm/device's performance directly.
7. The Type of Ground Truth Used
- Clinical Sensitivity and Specificity: "Clinical Diagnosis of Multiple Myeloma" and "Clinical Diagnosis of Amyloidosis." This would typically be based on a combination of clinical signs, symptoms, other laboratory tests, bone marrow biopsy results, and imaging studies, as per established medical guidelines.
- Analytical Studies (Precision, Linearity, LoQ, Hook Effect, Interference): Ground truth was established by known concentrations of analytes in prepared samples or by the absence/presence of interfering substances at specified levels. For example, linearity samples were prepared by serial dilution from a high concentration, and LoQ samples were prepared to known very low concentrations. For interference, substances were added at specific concentrations.
- Reference Intervals: Based on measurements from an "apparently healthy subject" population (201 subjects from a US-population).
8. The Sample Size for the Training Set
The document does not explicitly mention a "training set" in the context of an AI/ML algorithm. This device is an immunoassay using a well-established technology (particle-enhanced immunonephelometry). Such systems are typically developed and validated using calibration and verification samples, but not "training sets" in the machine learning sense. The N FLC Standard SL is used for establishing reference curves (calibration), which is a form of "training" for quantitative measurement but not for a high-level diagnostic algorithm that learns from data.
9. How the Ground Truth for the Training Set Was Established
As noted above, a "training set" in the AI/ML context is not directly applicable here.
- For the calibration (N FLC Standard SL): "Calibration of the assay is traceable to an internal master calibrator." This master calibrator's "ground truth" (assigned value) would have been established through a rigorous internal development and characterization process, likely involving primary reference materials or highly characterized analytical methods, though the specific details are not provided in this summary.
- For the controls (N FLC Control SL1 and SL2): "The concentration of the free light chains (FLC), type kappa and type lambda is calibrated against standard preparations and is lot-dependent." This means their "ground truth" values are assigned relative to the calibration curve established using the N FLC Standard SL, which in turn refers to the internal master calibrator.
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(42 days)
N Protein Standard SL is intended to be used for the establishment of reference curves.
The proposed standard, N Protein Standard SL is a standard prepared from human serum (liquid) with stabilizers and preservative. It is intended to be used together with the Behring Nephelometer Systems (Behring Nephelometer K860894, Behring Nephelometer 100 K892223 and the Behring Nephelometer II K943997) to establish reference curves for the following tests: IgG, IgA, IgM, C3c, C4, Transferin, Albumin, Ceruloplasmin, RbP, Ig/L-chain, Kappa, Ig/L-chain, Lambda, IgG 1, IgG 2, IgG 3, Albumin α1-antitrypsin (α1-proteinase inhibitor) α2-macroglobulin Haptoglobin α1-acid glycoprotein Pre-albumin (transthyretin), laG 3, laG 4, B2-microalobulin, Ferritin, IGE.
Here's the information extracted from the provided text, structured according to your request:
Acceptance Criteria and Study for N Protein Standard SL
The provided 510(k) summary focuses on demonstrating substantial equivalence to a predicate device and discussing performance characteristics such as precision and stability, rather than explicitly stating acceptance criteria as a table with numerical targets for a specific clinical outcome or diagnostic accuracy. Instead, the document describes the observed performance of the device, which implicitly serves as the demonstration of its suitability.
Here's a breakdown of the requested information based on the provided document:
1. A table of acceptance criteria and the reported device performance
| Performance Characteristic | Acceptance Criteria (Implicit) | Reported Device Performance |
|---|---|---|
| Precision | The device should exhibit acceptable levels of precision (low variability) when establishing reference curves for the listed analytes on Behring Nephelometer Systems. (Implicitly, the precision should be comparable to or better than the predicate device, N Protein Standard SY, or within acceptable ranges for clinical nephelometry.) | Precision studies using one lot of N Protein Standard SL on the Behring Nephelometer yielded %CVs ranging from 0.9% to 3.9%. |
| Reproducibility | The device should exhibit acceptable reproducibility when establishing reference curves. (Implicitly, this is covered by the precision study and suggests consistent performance across repetitions.) | Covered by the precision study results (0.9% to 3.9% CVs). |
| Stability (Unopened) | The device should maintain its performance characteristics for a clinically relevant period when stored as packaged. (Implicitly, comparable to the predicate device and sufficient for practical use.) | Found to be stable for at least 12 months at +2 to +8°C, as originally packaged. |
| Stability (Opened) | The device should maintain its performance characteristics for a clinically relevant period after opening and storage. (Implicitly, sufficient for practical laboratory use after initial opening.) | Found to be stable for at least 15 days at +2 to +8°C, once opened. |
| Equivalence to Predicate | The device should demonstrate substantial equivalence in intended use and performance to the legally marketed device, N Protein Standard SY. (This is the overarching acceptance criterion for a 510(k).) | N Protein Standard SL is "substantially equivalent in intended use to the N Protein Standard SY." Both are multi-constituent, blood-based matrix standards for calibrating immunology assays. The primary difference is physical state (liquid vs. lyophilized). Performance characteristics (precision, stability) support this claim of equivalence. |
2. Sample size used for the test set and the data provenance
- Test Set Sample Size: The document states "Precision studies using one lot of N Protein Standard SL..." This indicates the study was conducted on one lot of the product. The number of individual measurements or replicates within that study is not specified.
- Data Provenance: The study appears to be prospective (generated specifically for this submission) as it describes performance characteristics of the "Proposed Device." There is no mention of country of origin for the data, but it's generated by Behring Diagnostics Inc. (distributed) and Behringwerke AG (manufactured), which are US and German entities, respectively.
3. Number of experts used to establish the ground truth for the test set and the qualifications of those experts
This section is Not Applicable (N/A). The device is a calibrator, not a diagnostic device that interprets patient data. Therefore, there is no "ground truth" established by experts in the context of diagnostic accuracy. The performance data (precision, stability) are objective measurements from laboratory testing, not subjective expert interpretations.
4. Adjudication method for the test set
This section is Not Applicable (N/A) for the same reasons as (3). There is no adjudication required for objective laboratory measurements like precision and stability.
5. If a multi reader multi case (MRMC) comparative effectiveness study was done, If so, what was the effect size of how much human readers improve with AI vs without AI assistance
This section is Not Applicable (N/A). The device is a calibrator. It is not an AI-powered diagnostic tool, nor does it directly involve human readers interpreting cases.
6. If a standalone (i.e. algorithm only without human-in-the-loop performance) was done
This section is Not Applicable (N/A). The device is a physical calibrator standard, not an algorithm.
7. The type of ground truth used
This section is Not Applicable (N/A). As a calibrator, the concept of "ground truth" in the diagnostic accuracy sense (e.g., pathology, outcomes data) does not apply. The "truth" for the calibrator is its manufactured concentration values, which are the basis for its intended use in establishing reference curves. The performance metrics (precision, stability) assess the consistency and integrity of these established values over time and repeated use.
8. The sample size for the training set
This section is Not Applicable (N/A). The device is a calibrator, not a machine learning algorithm that requires a "training set."
9. How the ground truth for the training set was established
This section is Not Applicable (N/A) for the same reasons as (8).
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(27 days)
N/T Protein Control SL is intended to be used as accuracy and precision controls in the determination of human serum proteins.
The proposed control, N/T Protein Control SL is a control prepared from human serum (liquid) with stabilizers and preservative. It is intended to be used together with the Behring Nephelometer systems (Behring Nephelometer K860894, Behring Nephelometer 100 K892223 and the Behring Nephelometer II K943997) and with the TurbiTimeSystem™ as accuracy and precision controls for the following tests: IgG, IgA, IgM, C3c, C4, Transferin, Ceruloplasmin, RbP, Ig/L-chain, Kappa, Ig/L-chain, Lambda, IgG 1, IgG 2, Albumin, alpha1-antitrypsin (alpha1-proteinase inhibitor), 02-macroglobulin, Haptoglobin, alpha1-acid_αλνcoprotein, Pre-albumin (transthyretin), laG 3, laG 4, B2-microglobulin, Ferritin, laE.
This is a 510(k) summary for a quality control material, not a diagnostic device that detects disease. Therefore, many of the typical performance metrics for diagnostic devices (like sensitivity, specificity, AUC) and associated study design elements (like ground truth establishment with experts, training/test sets, MRMC studies) are not applicable here.
The "acceptance criteria" for a control material primarily revolve around its stability and its performance in precision/reproducibility.
Here's an analysis based on the provided text:
Acceptance Criteria and Study to Prove Device Meets Them: N/T Protein Control SL/L, M, and H
1. Table of Acceptance Criteria and Reported Device Performance
| Parameter | Acceptance Criteria (Implied/Expected for a QC Material) | Reported Device Performance (N/T Protein Control SL) |
|---|---|---|
| Precision (CV%) | Acceptable range for quality control materials for nephelometry systems (typically low single-digit percentages, though specific limits are not stated in the document). | Behring Nephelometer system: 0.6% to 8.2% (range across analytes)TurbiTimeSystem™: 1.6% to 6.1% (range across analytes) |
| Reproducibility | Consistent results over time and across different runs (implied by precision study). | Demonstrated by precision study performed on two different systems. |
| Stability (Unopened) | Stable for a specified duration when stored as originally packaged under recommended conditions. | At least 12 months at +2 to +8°C. |
| Stability (Opened) | Stable for a specified duration once opened and stored under recommended conditions. | At least 15 days at +2 to +8°C once opened. |
Note: The document does not explicitly state numerical "acceptance criteria" but presents performance data that would implicitly meet expected standards for a quality control material. For instance, precision (CV%) values in the single digits are generally considered good for these types of assays.
2. Sample Size Used for the Test Set and Data Provenance
- Sample Size: Not explicitly stated. The text mentions "one lot of N/T Protein Control SL" was used for precision studies. The number of replicates or individual measurements within this lot is not provided.
- Data Provenance: Not specified, but implied to be from internal laboratory testing conducted by Behringwerke AG or Behring Diagnostics Inc. It is retrospective in the sense that the data was collected prior to submission. Country of origin not explicitly stated, but the manufacturer is based in Germany, and the distributor in the USA.
3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications
- Not applicable. For a quality control material, there isn't a "ground truth" established by experts in the same way there would be for a diagnostic test (e.g., radiologists interpreting images). The purpose is to ensure the control itself provides consistent and reproducible results on the target instruments.
4. Adjudication Method for the Test Set
- Not applicable. Adjudication is typically used when human interpretation or a subjective clinical assessment is involved in establishing a ground truth for diagnostic accuracy, which is not the case here.
5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done
- No. An MRMC study is designed to compare the performance of human readers, often with and without AI assistance, on a set of cases. This is not relevant for a quality control material.
6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) Was Done
- Not applicable in the typical sense of a diagnostic algorithm. The "device" is a physical control material. Its performance is evaluated on automated nephelometry systems (which are themselves algorithms/instruments). The precision and stability studies represent the "standalone" performance of the control material when used with these systems.
7. The Type of Ground Truth Used
- For the precision studies, the "ground truth" is essentially the expected consistent performance of a stable control material. The acceptable variation (precision) defines what constitutes "truth" in this context. The reference values for the analytes within the control are established during its manufacturing and characterization, but the study here focuses on its performance as a control.
- For the stability studies, the "ground truth" is the established concentration of the analytes within the control material at the initial time point. Stability is demonstrated by showing that these concentrations remain within acceptable limits over time under specified storage conditions.
8. The Sample Size for the Training Set
- Not applicable. This is a quality control material, not an AI or machine learning algorithm that requires a "training set." The product is manufactured and then its performance (precision, stability) is characterized.
9. How the Ground Truth for the Training Set Was Established
- Not applicable. As there is no training set for an AI/ML algorithm.
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(25 days)
N CRP Standard SY is intended to be used for the establishment of reference curves.
The proposed calibrator, N CRP Standard SY is a calibrator prepared from human serum (lyophilized) with stabilizers and preservative. It is intended to be used together with the Behring Nephelometer Systems (Behring Nephelometer K860894, Behring Nephelometer 100 K892223 and the Behring Nephelometer 11 K943997) for the calibration of the N Latex CRP mono test.
Here's an analysis of the provided text regarding the N CRP Standard SY device, focusing on acceptance criteria and study details:
1. Table of Acceptance Criteria and Reported Device Performance:
| Acceptance Criteria Category | Specific Metric / Criterion | Reported Device Performance |
|---|---|---|
| Precision | %CV range | 1.43% to 4.47% |
| Stability (Lyophilized) | Duration | At least 12 months |
| Stability (Reconstituted) | Duration | 4 weeks |
2. Sample Size Used for the Test Set and Data Provenance:
The document mentions "Precision studies using one lot of N CRP Standard SY were run on the Behring Nephelometer." It does not specify a sample size for the test set (e.g., number of replicates, number of runs).
The data provenance is implied to be from internal testing by the manufacturer, Behring Diagnostics Inc. There is no information about the country of origin of the data beyond the manufacturing location (Germany) and distributor location (USA). The study is unequivocally prospective as it involves direct testing of the proposed device.
3. Number of Experts Used to Establish the Ground Truth for the Test Set and Qualifications of Those Experts:
This information is not applicable to this device. This device is a calibrator, and its performance is assessed through its inherent analytical characteristics (precision, stability) rather than by comparison to a "ground truth" derived from expert interpretation of clinical data. There are no clinical images or patient outcomes being evaluated by experts here.
4. Adjudication Method for the Test Set:
This information is not applicable as there is no expert interpretation or consensus-building involved in assessing the performance of this calibrator.
5. If a Multi-Reader Multi-Case (MRMC) Comparative Effectiveness Study Was Done, and Effect Size:
No, a multi-reader multi-case (MRMC) comparative effectiveness study was not done. This type of study is relevant for devices that assist human interpretation (e.g., AI for radiology), not for a calibrator.
6. If a Standalone (i.e., algorithm only without human-in-the-loop performance) Was Done:
This concept is not applicable in the context of this device. The device itself is a physical calibrator. Its performance is what is being evaluated directly through analytical studies. There isn't an "algorithm" in the sense of a standalone diagnostic tool.
7. The Type of Ground Truth Used:
The "ground truth" for evaluating this calibrator is its inherent analytical characteristics tested against predefined specifications for precision and stability. It's not based on expert consensus, pathology, or outcomes data. The concentrations of CRP in the calibrator are established during its manufacturing and qualification process, and the tests verify that these characteristics remain within acceptable limits over time and across measurements.
8. The Sample Size for the Training Set:
This information is not applicable. This device is a calibrator, not a machine learning algorithm that requires a "training set."
9. How the Ground Truth for the Training Set Was Established:
This information is not applicable as there is no training set for this type of device.
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(25 days)
N Protein Standard PY is intended to be used for the establishment of reference curves.
The proposed calibrator, N Protein Standard PY is a calibrator prepared from human serum (lyophilized) with stabilizers and preservative. It is intended to be used together with the Behring Nephelometer Systems (Behring Nephelometer K860894, Behring Nephelometer 100 K892223 and the Behring Nephelometer II K943997) for the calibration of the following tests:
Fibrinogen Antithrombin II Prothrombin Plasminogen alpha1-Antitrypsin C1 Inhibitor
The provided text describes a 510(k) summary for the N Protein Standard PY, a calibrator. It focuses on demonstrating substantial equivalence to a predicate device and includes information on the device's intended use, composition, and basic performance characteristics like precision and stability.
However, the document does not contain the following information required to answer your request:
- Acceptance Criteria Table and Reported Device Performance: While "Precision and reproducibility" and "Stability" are mentioned, no specific acceptance criteria (e.g., "CVs must be less than X%") are provided, nor is a direct comparison in a structured table format against such criteria.
- Sample size and data provenance for a test set: The document mentions "one lot of N Protein Standard PY" for precision studies, but this isn't a "test set" in the context of device performance validation against ground truth. There's no information on data provenance (country, retrospective/prospective).
- Number of experts and qualifications for ground truth: No experts are mentioned, as the device is a calibrator, not a diagnostic tool requiring expert interpretation of results.
- Adjudication method for the test set: Not applicable, as there's no test set requiring adjudication.
- MRMC comparative effectiveness study: Not applicable. The device is a calibrator, not a diagnostic algorithm that would be compared with human readers.
- Standalone (algorithm only) performance: Not applicable. This is a physical calibrator, not an algorithm.
- Type of ground truth used: For a calibrator, the "ground truth" would typically refer to the assigned values of the standards, which are established through a metrological traceability chain, not expert consensus, pathology, or outcomes data. This information is not detailed here.
- Sample size and how ground truth was established for the training set: Not applicable, as this is a calibrator, not an AI model that undergoes "training."
In summary, the provided submission is for a calibrator (a laboratory reagent) and therefore does not contain the type of clinical performance validation studies, ground truth establishment, or AI-related metrics that your request assumes for a diagnostic device or AI algorithm. The information needed to fill out most of your table is not present in the document because it's relevant to a different type of medical device submission.
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