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Bruells, Christian S., Ashley J. Smuder, Lucy K. Reiss, et al. "Negative Pressure Ventilation and Positive Pressure Ventilation Promote Comparable Levels of Ventilator-induced Diaphragmatic Dysfunction in Rats." Anesthesiology 119, no. 3 (2013): 652–62. http://dx.doi.org/10.1097/aln.0b013e31829b3692.
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Abstract Background: Mechanical ventilation is a life-saving intervention for patients with respiratory failure. Unfortunately, a major complication associated with prolonged mechanical ventilation is ventilator-induced diaphragmatic atrophy and contractile dysfunction, termed ventilator-induced diaphragmatic dysfunction (VIDD). Emerging evidence suggests that positive pressure ventilation (PPV) promotes lung damage (ventilator-induced lung injury [VILI]), resulting in the release of signaling molecules that foster atrophic signaling in the diaphragm and the resultant VIDD. Although a recent report suggests that negative pressure ventilation (NPV) results in less VILI than PPV, it is unknown whether NPV can protect against VIDD. Therefore, the authors tested the hypothesis that compared with PPV, NPV will result in a lower level of VIDD. Methods: Adult rats were randomly assigned to one of three experimental groups (n = 8 each): (1) acutely anesthetized control (CON), (2) 12 h of PPV, and (3) 12 h of NPV. Dependent measures included indices of VILI, diaphragmatic muscle fiber cross-sectional area, diaphragm contractile properties, and the activity of key proteases in the diaphragm. Results: Our results reveal that no differences existed in the degree of VILI between PPV and NPV animals as evidenced by VILI histological scores (CON = 0.082 ± 0.001; PPV = 0.22 ± 0.04; NPV = 0.25 ± 0.02; mean ± SEM). Both PPV and NPV resulted in VIDD. Importantly, no differences existed between PPV and NPV animals in diaphragmatic fiber cross-sectional area, contractile properties, and the activation of proteases. Conclusion: These results demonstrate that NPV and PPV result in similar levels of VILI and that NPV and PPV promote comparable levels of VIDD in rats.
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Ben-Haim, Yakov, and Clifford C. Dacso. "Interpreting PPV and NPV of Diagnostic Tests with Uncertain Prevalence." Rambam Maimonides Medical Journal 15, no. 3 (2024): e0013. http://dx.doi.org/10.5041/rmmj.10527.
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Objective: Medical decision-making is often uncertain. The positive predictive value (PPV) and negative predictive value (NPV) are conditional probabilities characterizing diagnostic tests and assessing diagnostic interventions in clinical medicine and epidemiology. The PPV is the probability that a patient has a specified disease, given a positive test result for that disease. The NPV is the probability that a patient does not have the disease, given a negative test result for that disease. Both values depend on disease incidence or prevalence, which may be highly uncertain for unfamiliar diseases, epidemics, etc. Probability distributions for this uncertainty are usually unavailable. We develop a non-probabilistic method for interpreting PPV and NPV with uncertain prevalence. Methods: Uncertainty in PPV and NPV is managed with the non-probabilistic concept of robustness in info-gap theory. Robustness of PPV or NPV estimates is the greatest uncertainty (in prevalence) at which the estimate’s error is acceptable. Results: Four properties are demonstrated. Zeroing: best estimates of PPV or NPV have no robustness to uncertain prevalence; best estimates are unreliable for interpreting diagnostic tests. Trade-off: robustness increases as error increases; this trade-off identifies robustly reliable error in PPV or NPV. Preference reversal: sometimes sub-optimal PPV or NPV estimates are more robust to uncertain incidence or prevalence than optimal estimates, motivating reversal of preference from the putative optimum to the sub-optimal estimate. Trade-off between specificity and robustness to uncertainty: the robustness increases as test-specificity decreases. These four properties underlie the interpretation of PPV and NPV. Conclusions: The PPV and NPV assess diagnostic tests, but are sensitive to lack of knowledge that generates non-probabilistic uncertain prevalence and must be supplemented with robustness analysis. When uncertainties abound, as with unfamiliar diseases, assessing robustness is critical to avoiding erroneous decisions.
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Schnaiter, Johannes, Frank Roemer, Axel McKenna-Kuettner, et al. "Diagnostic Accuracy of an MRI Protocol of the Knee Accelerated Through Parallel Imaging in Correlation to Arthroscopy." RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren 190, no. 03 (2017): 265–72. http://dx.doi.org/10.1055/s-0043-119038.
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Purpose Parallel imaging allows for a considerable shortening of examination times. Limited data is available about the diagnostic accuracy of an accelerated knee MRI protocol based on parallel imaging evaluating all knee joint compartments in a large patient population compared to arthroscopy. Materials and Methods 162 consecutive patients with a knee MRI (1.5 T, Siemens Aera) and arthroscopy were included. The total MRI scan time was less than 9 minutes. Meniscus and cartilage injuries, cruciate ligament lesions, loose joint bodies and medial patellar plicae were evaluated. Sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV), as well as diagnostic accuracy were determined. Results For the medial meniscus, the values were: SE 97 %, SP 88 %, PPV 94 %, and NPV 94 %. For the lateral meniscus the values were: SE 77 %, SP 99 %, PPV 98 %, and NPV 89 %. For cartilage injuries the values were: SE 72 %, SP 80 %, PPV 86 %, and NPV 61 %. For the anterior cruciate ligament the values were: SE 90 %, SP 94 %, PPV 77 %, and NPV 98 %, while all values were 100 % for the posterior cruciate ligament. For loose bodies the values were: SE 48 %, SP 96 %, PPV 62 %, and NPV 93 %, and for the medial patellar plicae the values were: SE 57 %, SP 88 %, PPV 18 %, and NPV 98 %. Conclusion A knee MRI examination with parallel imaging and a scan time of less than 9 minutes delivers reliable results with high diagnostic accuracy. Key Points Citation Format
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Noll, Kyle, Israt Tasnim, Priscella Asman, et al. "NCOG-34. CORRESPONDENCE BETWEEN INTRAOPERATIVE GAMMA BAND ELECTROCORTICOGRAMS AND DIRECT ELECTRICAL STIMULATION ACROSS DIVERSE NAMING TASKS IN PATIENTS WITH LANGUAGE-ELOQUENT BRAIN TUMORS." Neuro-Oncology 26, Supplement_8 (2024): viii232. http://dx.doi.org/10.1093/neuonc/noae165.0916.
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Abstract BACKGROUND Few studies have examined concordance between intraoperative electrocorticography (ECoG) and direct electrical stimulation (DES) language mapping, especially across varied naming tasks. METHODS Twelve patients (Mdn age=59; 75% HGG) underwent awake craniotomy with ECoG and DES language mapping. Mapping utilized iPad stimulus presentation coupled to a 4x8 electrode array for both ECoG and DES. Time-frequency ECoG gamma band activity (Early and Late) was visualized for 3 naming paradigms (Object, Action, Auditory). Bipolar DES was also conducted for each task at each electrode pair. ECoG activations and DES hits were overlayed on preoperative MRI. DES hits represented ground truth for eloquence. ECoG accuracy was examined for each task with 3 different criteria: exact (identical electrodes for ECoG activation and DES hits), adjacent (ECoG <1cm of DES hits), and adjacent within a predefined peritumoral region of interest (<2 cm from boundaries). RESULTS 32 DES hits (40% Auditory, 32% Action, 28% Obj) were observed across patients. Exact ECoG-DES accuracy ranged from 78%-90% [Object: Sens=11%, Spec=91%, PPV=6%, NPV=95%; Action: Sens=40%, Spec=93%, PPV=24%, NPV=97%; Auditory: Sens=69%, Spec=78%, PPV=19%, NPV=78%]. Adjacent ECoG-DES accuracy ranged from 82%-91% [Object: Sens=33%, Spec=92%, PPV=18%, NPV=97%; Action: Sens=44%, Spec=93%, PPV=25%, NPV=97%; Auditory: Sens=91%, Spec=81%, PPV=37%, NPV=99%]. When restricted to the peritumoral region, adjacent ECoG-DES accuracy ranged from 94%-97% [Object: Sens=14%, Spec=99%, PPV=25%, NPV=97%; Action: Sens=25%, Spec=99%, PPV=25%, NPV=99%; Auditory: Sens=100%, Spec=94%, PPV=54%, NPV=100%]. For patients with DES hits (N=10), all had at least 1 task activation <1 cm of DES hits, with 7/10 having convergence of activations across at least 2 tasks. CONCLUSIONS Negative ECoG mapping is strongly predictive of non-eloquence confirmed by DES for all naming tasks. Additionally, gamma band activation elicited by auditory naming within the peritumoral region is strongly predictive of eloquence. Findings support task-based ECoG language mapping for prediction of eloquence and identification of targets for DES confirmation.
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Dargahi-Malamir, Mehrdad, Amin Amini, Seyed Hamid Borsi, Hooshmand Hosseininejad, and Heshmatollah Tavakol. "Evaluation of Diagnostic Value of Urinary Deep Stick in Differentiating Different Types of Exudative Pleural Effusions and Differentiating Exudative Pleural Effusions From Transudates." Journal of Pioneering Medical Science 13, no. 5 (2024): 45–51. http://dx.doi.org/10.61091/jpms202413508.
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Objective: Rapid diagnosis is one of the key factors in pleural effusion management. Dipstick has been suggested for use in other body fluids, while its role in pleural effusion has not yet been confirmed. This study was conducted with the aim of investigating the diagnostic value of dipstick in differentiating types of pleural effusion. Methods: This prospective study was conducted on 70 patients diagnosed with pleural effusion requiring thoracentesis in Ahvaz teaching hospitals in 2022. Microbiological and cytological laboratory tests were performed on pleural fluid samples. At the same time, pleural fluid samples were evaluated with a urine dipstick. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of dipstick parameters in differentiating types of pleural effusion were calculated in comparison with the standard diagnostic method. Results: The dipstick protein test had a sensitivity of 100%, specificity of 96.23%, PPV of 89.5%, and NPV of 100% for differentiating exudative from transudative effusions, and a sensitivity, specificity, PPV, and NPV of 40%, 100%, 100%, and 61.5%, respectively, in detecting infectious exudative effusions. Sensitivity, specificity, PPV, and NPV of the dipstick leukocyte esterase test in differentiating exudative from transudative effusions were 100%, 56.6%, 42.5%, and 100%, respectively, and in detecting different types of exudative effusions, sensitivity, specificity, PPV, and NPV were all 100%. The dipstick glucose test effectively differentiated exudative from transudative effusions (sensitivity, specificity, PPV, and NPV of 82.35%, 79.25%, 56.0%, and 93.3%, respectively) and detected infectious exudative effusions (sensitivity, 93.33%, specificity, 93.30%, PPV, 93.3%, NPV, 91.3%). Sensitivity, specificity, PPV, and NPV of the dipstick pH test in differentiating exudative from transudative effusions were 100%, 64.15%, 76.9%, and 100%, respectively, and for different types of exudative effusions were 86.67%, 65.22%, 76.5%, and 78.9%, respectively. Conclusion: The dipstick strip was effectively accurate in detecting transudative from exudative and infectious from noninfectious exudative effusions. Therefore, this accurate, rapid, easy-to-use, and inexpensive tool could be used to distinguish different types of pleural effusion at the bedside, which could be especially helpful in resource-limited settings.
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Begum, Wahida, Ahmed Hossain, Waziha A. Jahan, Mahbuba Shirin, M. Abdullah Yusuf, and Aftabun Nahar. "Comparing Predictive power of CT-scan Findings among the Malignant Hepatic Mass patients." Journal of Science Foundation 12, no. 1 (2015): 2–6. http://dx.doi.org/10.3329/jsf.v12i1.23457.
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Background: CT-scan is useful for the detection of hepatic mass. Objective: The purpose of the present study was to see the predictive values of CT scan in the diagnosis of malignant hepatic mass. Methodology: This cross sectional study was carried out in the Department of Radiology and Imaging at Mymensingh Medical College Hospital (MMCH), Mymensingh, Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Dhaka Medical College Hospital (DMCH), Dhaka during the period of 1st January 2006 to 31st December 2007. Patients admitted in the Department of Medicine and Department of Hepatobiliary of MMCH, BSMMU, and DMCH with the clinical diagnosis of fever, abdominal pain, anorexia, nausea/vomiting, loss of appetite, jaundice, weight loss and ascites were selected as study population. CT scan and histopathology were performed to all the patients. Result: A total number of 50 patients were recruited for this study.. The sensitivity for multiplicity was 71.4%, specificity was 63.6%, accuracy was 68%, PPV was 71.4% and NPV was 63.6%. The sensitivity for hypodensity as a sign of malignancy was 60.7%, specificity was 18.2%, accuracy was 42.0%, PPV was 48.6% and NPV was 26.7%. The sensitivity, specificity, PPV, NPV and accuracy of contrast enhancement were 100.0%, 22.7%, 62.2%, 100.0% and 66.0% respectively. Again the sensitivity, specificity, PPV, NPV and accuracy of detection of pressure effect on biliary apparatus by CT-scan were 100.0%, 22.7%, 62.2%, 100.0% and 66.0% respectively. Again the sensitivity, specificity, PPV, NPV and accuracy of detection of Lymphadenopathy by CT-scan were 35.7%, 95.5%, 90.9%, 53.8% and 62.0% respectively. The sensitivity, specificity, PPV, NPV and accuracy of detection of Portal vein invasion by CT-scan were 14.3%, 100.0%, 100.0%, 47.8% and 52.0% respectively. The sensitivity, specificity, PPV, NPV and accuracy of detection of hepatic vein invasion by CT-scan were 10.7%, 100.0%, 100.0%, 46.8% and 50.0% respectively. The sensitivity, specificity, PPV, NPV and accuracy of detection of inferior vena cava (IVC) invasion by CT-scan were 7.1%, 100.0%, 100.0%, 45.8% and 48.0% respectively. Conclusion: CT is a useful diagnostic tool for the detection of malignant hepatic masses.Journal of Science Foundation, 2014;12(1):2-6
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Henry, Jon C., Dennis Kiser, and Bhagwan Satiani. "A Critical Evaluation of Carotid Duplex Scanning in the Diagnosis of Significant Carotid Artery Occlusive Disease." Advances in Vascular Medicine 2015 (February 24, 2015): 1–6. http://dx.doi.org/10.1155/2015/905384.
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Carotid duplex (CD) scanning is the primary method of evaluating patients suspected of having extracranial carotid occlusive disease. It is incumbent on vascular laboratories (VL) to have internally validated criteria confirming overall accuracy, specificity (SP), sensitivity (SS), negative predictive value (NPV), and positive predictive value (PPV). Receiver operating characteristic (ROC) curves allow further analysis to update existing criteria. We correlated 127 internal carotid arteries studied by carotid duplex scanning and confirmatory modalities, which showed a SP of 83.3%, SS of 97.9%, NPV of 92.5%, PPV of 95%, and overall accuracy of 94.5% for >50% internal carotid artery stenosis. For >70% stenosis, SP was 88.8%, SS was 96.1%, NPV was 93.6%, PPV was 92.5%, and overall accuracy was 92.9%. ROC curves for the peak systolic velocities were used; for detecting a 50–69% stenosis range a sensitivity of 88%, specificity of 93%, NPV of 73%, and PPV of 97% were found. For detecting a 70–99% stenosis a sensitivity of 95%, specificity of 90%, NPV of 93%, and a PPV of 93% were found. All vascular laboratories must have a vigorous quality assurance program and must validate their own internal criteria or the recently promulgated consensus criteria for grading the severity of carotid stenosis by carotid duplex examination.
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Tailor, Imran K., Bilal Btoosh, Shaimaa Hamdy, et al. "Doublet Versus Triplet PET: Is END of Therapy PET Needed IF Interim PET Is Negative in Hodgkin'S or Diffuse Large B CELL Lymphoma?" Blood 128, no. 22 (2016): 5354. http://dx.doi.org/10.1182/blood.v128.22.5354.5354.
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Abstract Introduction: Baseline (PETb) and end of therapy (PETe) FDG PET is standard of care in the management of hodgkin's lymphoma (HL) and diffuse large B cell lymphoma (DLBCL). The role of interim PET (PETi) in HL is well established while its role in DLBCL is not well defined. We evaluated the utility of triPET (PETb, PETi and PETe ) in management of these two lymphomas. Methods: Retrospective review of PET archives revealed a total of 37 pts (HL=22, DLBCL=15). TriPET were acquired per accepted protocol. SUVmax and Deauville scores (DSc) were obtained from five target lesions, the average i.e. composite SUVmax & DSc were computed for each pt. Statistical analyses were performed with the composite maxSUV (cSUV) and Deauville scores (cDSc) (using EXCEL). Following statistics were performed (separately and combined in HL and DLBCL); mean+SD, PPV and NPV for complete response (CR) Vs. progressive disease (PD) on PETi using the following variables 1. cSUV and 2. cDSc and 3. delta change (DELT). Median progression free survival (PFS) was the clinical endpoint for response. Results: The mean PFS in our group was 17 and 15 months in HL and DLBCL respectively. Using cut off thresholds for intP to predict CR at cSUV<=2.0, , cDSC<=2.0 and DELT >=80%,. In HL: for cSUV- PPV 67%, NPV 95%; for DELT of cSUV PPV 100%, NPV 95%; for cDSC-PPV 30%, NPV 100%. In DLBCL: for cSUV- PPV 25%, NPV 100%; for DELT of cSUV PPV 33%, NPV 100%; for cDSC- PPV 50%, NPV 100%. Conclusion: The results from our series suggest that PETi has a role not only in HL but in DLBCL as well. Our modest cohort suggests that a negative PETi in DLBCL had a NPV of 100% across cSUV, cDSc and DELT, with regards to CR. Our data also suggests that PETe is not needed if PETi is -ve. While in HL subset, our results concur with results from other groups, this needs to be validated in a larger series. Disclosures No relevant conflicts of interest to declare.
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Baget-Bernaldiz, Marc, Romero-Aroca Pedro, Esther Santos-Blanco, et al. "Testing a Deep Learning Algorithm for Detection of Diabetic Retinopathy in a Spanish Diabetic Population and with MESSIDOR Database." Diagnostics 11, no. 8 (2021): 1385. http://dx.doi.org/10.3390/diagnostics11081385.
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Background: The aim of the present study was to test our deep learning algorithm (DLA) by reading the retinographies. Methods: We tested our DLA built on convolutional neural networks in 14,186 retinographies from our population and 1200 images extracted from MESSIDOR. The retinal images were graded both by the DLA and independently by four retina specialists. Results of the DLA were compared according to accuracy (ACC), sensitivity (S), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC), distinguishing between identification of any type of DR (any DR) and referable DR (RDR). Results: The results of testing the DLA for identifying any DR in our population were: ACC = 99.75, S = 97.92, SP = 99.91, PPV = 98.92, NPV = 99.82, and AUC = 0.983. When detecting RDR, the results were: ACC = 99.66, S = 96.7, SP = 99.92, PPV = 99.07, NPV = 99.71, and AUC = 0.988. The results of testing the DLA for identifying any DR with MESSIDOR were: ACC = 94.79, S = 97.32, SP = 94.57, PPV = 60.93, NPV = 99.75, and AUC = 0.959. When detecting RDR, the results were: ACC = 98.78, S = 94.64, SP = 99.14, PPV = 90.54, NPV = 99.53, and AUC = 0.968. Conclusions: Our DLA performed well, both in detecting any DR and in classifying those eyes with RDR in a sample of retinographies of type 2 DM patients in our population and the MESSIDOR database.
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Satish, Sanjana, Lohith K, Vinaya Manohara Gowda, Sriviruthi B, Prateek Parmeshwar Ugran, and Vishal S. Dharpur. "Role of transrectal ultrasound and MRI in the diagnosis and localisation of carcinoma prostate - A comparison of diagnostic efficacy of trus versus MRI." Panacea Journal of Medical Sciences 14, no. 1 (2024): 184–91. http://dx.doi.org/10.18231/j.pjms.2024.034.
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In this study, we wanted to correlate the findings of TRUS and MRI with regard to the diagnosis and localization of carcinoma prostate and local staging of carcinoma prostate. Our study included 43 men, with age ranging from 49 to 76 years. They underwent TRUS, MRI and TRUS guided twelve core biopsies after being suspected with prostate cancer based on high PSA values (greater than 4.0 ng /ml) or abnormal DRE findings. This study was conducted from April 2018 -June 2019. Imaging findings were confirmed with histopathology. TRUS used for the detection of malignancy had sensitivity, specificity, PPV and NPV as 69.70%, 80 %, 92% and 44.44 % respectively. The values were 63.16%, 83.33%, 75.00%, and 74.07% for the sensitivity, specificity, PPV and NPV of TRUS respectively for the detection of ECE. rnFor the detection of malignancy, the sensitivity, specificity, PPV and NPV of MRI was 87.88%, 70%, 90.63% and 63.64% respectively and 85.71%, 89.66%, 80.00% and 92.86% for the sensitivity, specificity, PPV and NPV of MRI respectively for detection of SVI. For detection of extracapsular extension (ECE), MRI had sensitivity, specificity, PPV and NPV of 78.95%, 83.33%, 78.95% and 83.33% respectively. When compared to TRUS, MRI is more useful in the diagnosis and accurate staging of prostate cancer. MRI can improve the false-negative biopsies resulting due to the inability of TRUS in detection of abnormal areas.
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Kleton, Michelle, Amy Manten, Iris Smits, Remco Rietveld, Wim A. M. Lucassen, and Ralf E. Harskamp. "Performance of risk scores for coronary artery disease: a retrospective cohort study of patients with chest pain in urgent primary care." BMJ Open 11, no. 12 (2021): e045387. http://dx.doi.org/10.1136/bmjopen-2020-045387.
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ObjectiveTo evaluate the diagnostic performance of the Marburg Heart Score (MHS), INTERCHEST, Gencer rule, Bruins Slot rule and compare these with unaided clinical judgement in patients with chest pain in urgent primary care.DesignRetrospective, cohort study.SettingRegional primary care facility responsible for out-of-hours primary care for a quarter-million people in the Netherlands.ParticipantsConsecutive patients aged ≥18 years who were evaluated for chest pain.Main outcome measuresDiscriminatory ability (C-statistic), sensitivity, specificity, positive and negative predictive values (PPV/NPV). The reference standard involved a composite endpoint of the occurrence of death, acute coronary syndrome or coronary revascularisation (=major adverse cardiac events; MACE) up to 6 weeks after initial contact.ResultsA total of 664 patients were included, of whom 4.8% (n=32) had a MACE event. C-statistics for MHS, INTERCHEST, Gencer and Bruins Slot rule were: 0.77 (95% CI 0.69 to 0.84), 0.85 (95% CI 0.78 to 0.92), 0.72 (95% CI 0.63 to 0.81) and 0.72 (95% CI 0.63 to 0.81), respectively. Optimal diagnostic accuracy was found for MHS ≥2 (sensitivity=81.3%, specificity=67.1%, PPV=11.1%, NPV=98.6%), INTERCHEST ≥2 (sensitivity=87.5%, specificity=78.8%, PPV=17.3%, NPV=99.1%), Gencer ≥2 (sensitivity=84.4%, specificity=37.8%, PPV=6.4%, NPV=98.0%) and Bruins Slot≥2 (sensitivity=90.6%, specificity=40.8%, PPV=7.2%, NPV=98.9%). Physicians referred 157 patients (23.6%) and missed 6 out of 32 MACEs (sensitivity=81.3%, specificity=79.3%, PPV=16.6%, NPV=98.8%). Using INTERCHEST with a referral threshold of ≥2 points, 4 MACEs would have been missed and 162 patients (24.4%) referred. The other risk scores resulted in far higher referral rates.ConclusionWhile available risk scores have reasonable to good discriminatory properties, they do not outperform unaided clinical judgment for evaluating chest pain in urgent primary care. Only the INTERCHEST score may slightly improve risk stratification.
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Gunawan, I. Made Kasmadi, Ida Bagus Budiarta, Tjokorda Gde Bagus Mahadewa, Ida Bagus Made Suryawisesa, I. Gusti Agung Bagus Krisna Wibawa, and Kadek Deddy Ariyanta. "Validity of Wagner, SINBAB, PEDIS, and WIFI Scoring Systems to Assess Risk of Amputation in Patients with Diabetic Foot Ulcers." JBN (Jurnal Bedah Nasional) 8, no. 2 (2024): 52. http://dx.doi.org/10.24843/jbn.2024.v08.i02.p04.
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Aim: This study aims to determine validity of the Wagner, SINBAD, PEDIS, and WIFI scoring systems in assessing the risk of amputation in patients with diabetic foot ulcers at Prof. dr. I.G.N.G. Ngoerah General Hospital, Denpasar. Methods: This research is an observational study of diagnostic tests with a cross-sectional design. The sample in this study was selected by consecutive sampling from 1 January 2022 to 31 December 2022 with total of 72 respondents.Results: Wagner score test obtained sensitivity 77.2%, specificity 80.0%, PPV 93.6%, NPV 48%, accuracy 77.7%, and RR 1.8. PEDIS score test results obtained sensitivity 82.5%, specificity 86.7%, PPV 95.9%, NPV 56.5%, accuracy 83.3%, and RR 2.2. The results of the SINBAD test score obtained sensitivity 78.9%, specificity 66.7%, PPV 90.0%, NPV 45.5%, accuracy 76.3%, and RR 1.6. WIFI score test obtained sensitivity 89.5%, specificity 66.7%, PPV 91.1%, NPV 62.5%, accuracy 84.7%, and RR 2.4. Conclusion: The WIFI score has better sensitivity and accuracy compared to score Wagner, SINBAD, and PEDIS so it is recommended to use the WIFI score to assess the risk of amputation in diabetic foot ulcer patients.
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Kicman, Aleksandra, Ewa Gacuta, Rafał Marecki, et al. "Diagnostic Utility of Metalloproteinases from Collagenase Group (MMP-1, MMP-8 and MMP-13) in Biochemical Diagnosis of Ovarian Carcinoma." Cancers 16, no. 23 (2024): 3969. http://dx.doi.org/10.3390/cancers16233969.
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Background: Ovarian carcinoma (OC) has an unfavorable prognosis due to lack of screening and an asymptomatic course. New diagnostic methods are being sought to enable earlier diagnosis of this condition. The purpose of this study was to determine the diagnostic utility of collagenases (MMP-1, MMP-8 and MMP-13) in the diagnosis of OC compared to HE4 and CA125 and the ROMA. Methods: The study group consisted of 120 patients with OC, the control group: 70 patients with benign ovarian lesions (BLs) and 50 healthy women (HS). MMP-1, MMP-8 and MMP-13 were determined by ELISA and HE4 and CA125 by CMIA. Results: OC patients had higher levels of MMP-1 and MMP-13 compared to the BL and HS groups. MMP-1 (SE: 81.66%; SP: 94%; PPV: 97.02%; NPV: 68.11%; AUC: 0.9625) and MMP-13 (SE: 77.50%; SP: 94%; PPV: 96.875%; NPV: 63.51%; AUC: 0.917) showed similar or higher diagnostic values to routine markers (HE4: SE:85%; SP: 92%; PPV: 96.22%; NPV: 71.875%; AUC: 0.943; CA125: SE: 80%; SP: 98%; PPV: 98.96%; NPV: 67.12%; AUC: 0.909) and the ROMA (SE: 90.83%; SP: 94%; PPV: 97.32%; NPV: 81.03%; AUC: 0.955). Performing combined analyses of individual MMPs and MMPs with ROMA was associated with further increases in diagnostic parameters. Conclusions: MMP-1 and MMP-13 have shown preliminary potential as diagnostic markers and auxiliary markers to ROMA in biochemical diagnosis of OC.
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SOEKERSI, HARI, and ERNY RAFIQAH. "Uji Diagnostik Utrasonografi Gray Scale Dibandingkan dengan Histopatologi pada Karsinoma Payudara Tipe Invasif di RSUP Dr. Hasan Sadikin, Bandung." Indonesian Journal of Cancer 10, no. 3 (2016): 87. http://dx.doi.org/10.33371/ijoc.v10i3.436.
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ABSTRACTGray scale ultrasonography (US) is the best choice modality for invasive breast carcinoma. Invasive breast carcinoma is the commonest breast carcinoma (65-80%) and grouped into malignant breast tumor that invade adjacent tissue with distant metastses. The important parameters in evaluating invasive breast carcinoma in US are inhomogenous hypoechoic texture, irregular, spiculated border and posterior accoustic shadowing. Gray scale US can also showed architectural distorsion. The sensitivity and spesificity of US in evaluating invasif breast carcinoma are 89,1 % ang 79,1%. Objective: to evaluating the diagnostic value of US in detection of invasive breast carcinoma which is confirmed by histopathology examination at Hasan Sadikin Hospital, Bandung. Methods: this research is a diagnostic research that evaluate sensitivity, spesificity, negative predictive value and positive predictive value of US in detecting invasive breast carcinoma, which is confirmed by histological examination. Samples taken by consecutive admission sampling on 23 subjects. Diagnostic evaluation result of gray scale US and histopathology in invasive breast carcinoma at RSUP Dr Hasan Sadikin Bandung shows characteristics including irregular margin and hipoechoic lesion (sensitivity 94,12%, specificity0,00%, PPV 72,7%, NPV 0,00%), inhomogenous texture (sensitivity 100%, specificity 16,67%, PPV 88,24%, NPV 100%), spiculated border (sensitivity 88,24%, specificity 66,67%, PPV 88,24%, NPV 66,67%), posterior acoustic shadow (sensitivity 100%, specificity 100%, PPV 100%, NPV 100%), and architectural distorsion (sensitivity 70,59%, specificity 66,67%, PPV 85,71%, NPV 44,44%). Gray scale US have a high sensitivity in diagnose invasive breast carcinoma that is confirmed with histopathology. Its specificity have a lower value compared with its sensitivity. ABSTRAKUltrasonografi (USG) gray scale merupakan modalitas pilihan yang tepat untuk karsinoma payudara tipe invasif. Karsinoma payudara tipe invasif merupakan karsinoma payudara yang paling sering (65%-80%) dan termasuk kelompok tumor ganas payudara yang menginvasi jaringan sekitar serta cenderung bermetastasis ke organ jauh. Parameter penting dalam menilai karsinoma payudara tipe invasif pada USG gray scale adalah gambaran hipoekhoik dengantekstur inhomogen, tepi ireguler, spikula, dan terdapat posterior accoustic shadowing. USG gray scale juga menunjukkan adanya distorsi jaringan. Nilai sensitivitas dan spesifisitas USG gray scale dalam menilai karsinoma payudara invasif sebesar 89,1% dan 79,1%. Tujuan penelitian ini adalah untuk mengetahui hasil uji diagnostik USG gray scale dalam mendeteksi karsinoma payudara tipe invasif yang dikonfirmasi oleh pemeriksaan histopatologi di Rumah Sakit Dr. Hasan Sadikin, Bandung. Metode penelitian yang digunakan adalah uji diagnostik yang menilai sensitivitas, spesifisitas, nilai prediksi negatif, dan nilai prediksi positif USG gray scale dalam mendeteksi karsinoma payudara invasif yang dikonfirmasi dengan hasil pemeriksaan histopatologi. Pengambilan sampel dilakukan secara consecutive admission sampling pada 23 subjek penelitian. Hasil uji diagnostik USG gray scale dengan histopatologi pada karsinomapayudara invasif di RSUP Dr. Hasan Sadikin Bandung menunjukkan karakteristik USG gray scale berupa batas/tepi ireguler dan lesi hipoekhoik (sensitivitas 94,12%; spesifisitas 0,00%; PPV 72,73%; NPV 0,00%), tekstur inhomogen (sensitivitas 100%, spesifisitas 16,67%; PPV 77,27%; NPV 100%), spikula (sensitivitas 88,24%; sensitifitas 66,67%; PPV 88,24% NPV66,67%), posterior accoustic shadow (sensitivitas 100%, sensitifitas 100%; PPV 100%; NPV 100%), dan distorsi jaringan (sensitivitas 70,59%; spesifisitas 66,67%; PPV 85,71%; NPV 44,44). Penelitian ini menyimpulkan bahwa USG gray scale memiliki nilai sensitivitas yang tinggi dalam mendiagnosis karsinoma payudara invasif yang dikonfirmasi dengan histopatologi. Nilai spesifisitas USG gray scale lebih rendah dibandingakan nilai sensitivitasnya.
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Scarvelis, Dimitrios, and Gail Rock. "Comparison of Antigen and Activation Assays with a Probability Scoring Model for the Diagnosis of Heparin Induced Thrombocytopenia." Blood 110, no. 11 (2007): 3215. http://dx.doi.org/10.1182/blood.v110.11.3215.3215.
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Background: Heparin induced thrombocytopenia (HIT) is a syndrome characterized by thrombocytopenia and an elevated risk of thrombosis. In the evaluation of patients with suspected HIT, laboratory testing is used to help differentiate between those patients who have HIT and those who do not and therefore do not require non-heparin anticoagulation. Laboratory tests include activation (serotonin release, heparin-induced platelet aggregation, ATP luminescence) and antigen (enzyme-linked immunoabsorbant assay (ELISA)) assays directed against the platelet factor 4-heparin or PF4/PVS complex. A pre-test scoring system (Warkentin 4T’s) has been derived to assess the probability of HIT which can be used in conjunction with laboratory testing in the evaluation for HIT. Objectives: To compare the activation assay used at The Ottawa Hospital (ATP luminescence) with the PF4 enhanced® ELISA and correlate results with clinical data. Methods: Patients undergoing HIT testing were identified. ELISA and activation assays were performed. Charts were reviewed in order to derive a 4T’s score and to assess response to therapeutic non-heparin anticoagulation (when administered). Correlation between ELISA, activation assay, 4T’s score and platelet response to alternative anticoagulation was determined. Sensitivity, specificity, PPV and NPV of laboratory tests or 4T’s scores were calculated depending on the measure chosen as the reference standard to diagnose HIT. Results: 111 patients undergoing HIT testing were evaluated. 41 and 43 were positive by ELISA (OD > 0.4) or activation assay respectively. 12 were positive only by ELISA (mean optical density (OD): 1.27) and 10 were positive by both activation assay and ELISA (mean OD: 2.28). Clinical information was available for 70 patients. 26 of these received therapeutic non-heparin anticoagulation as treatment for suspected HIT. Reference standard= activation assay: ELISA: Sens 95% (95% CI 73–99%), Spec 80% (66–89%), PPV 66% (46–81%), NPV 98% (86–100%). 4T’s (low vs. high score): Sens 85% (54–97%), Spec 95% (83–99%), PPV 85% (54–97%), NPV 95% (83–99%). ELISA OD > 1.5 + high 4T’s score: Sens 61% (36–82%), Spec 100% (56–100%), PPV 100% (68–100%), NPV 50% (24–76%). Reference standard= 4T’s score (high and low score only, excludes intermediate category): ELISA: Sens 85% (53–97%), Spec 77% (61–88%), PPV 52% (30–74%), NPV 94% (79–99%). Activation: Sens 85% (54–97%), Spec 95% (83–99%), PPV 85% (54–97%), NPV 95% (83–99%). Reference standard= “clear response to non-heparin anticoagulation” defined as significant platelet increase within 48 hours of start of therapy and no other explanation for platelet recovery: ELISA: Sens 100% (72–100%), Spec 54% (26–80%), PPV 68% (43–86%), NPV 100% (56–100%). Activation: Sens 85% (54–97%), Spec 69% (39–90%), PPV 73% (45–91%), NPV 82% (48–97%). 4T’s (low vs. high score): Sens 90% (54–99%), Spec 100% (60–100%), PPV 100% (63–100%), NPV 89% (51–99%). ELISA OD > 1.5 + 4T’s (low vs. high score): Sens 89% (51–99%), Spec 100% (56–100%), PPV 100% (60–100%), NPV 88% (47–99%). Conclusions: A high 4T’s score best predicts a clinical response to non-heparin therapeutic anticoagulation when HIT is suspected. ELISA OD > 1.5 does not add additional information in this respect. A negative ELISA and a low 4T’s score have comparable NPVs when an activation assay is the reference standard. Future trials should employ a clinical reference standard such as “clear response to non-heparin anticoagulation” when evaluating the operator characteristics of HIT assays.
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Natesan S., Rakesh, and Naren Kumar A. "Evaluation of validity of scoring systems in diagnosing acute appendicitis: a single centre prospective observational study." International Surgery Journal 9, no. 1 (2021): 23. http://dx.doi.org/10.18203/2349-2902.isj20214807.
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Background: Acute appendicitis is a very common cause of acute abdominal pain, requiring surgical intervention with a 7% life time risk. Various clinical scoring systems like Alvarado, appendicitis inflammatory response (AIR), Tzanaki scores enables risk stratification. In this study, we have validated the diagnostic accuracy of various scoring systems like Alvarado, Tzanaki and AIR scores. Methods: We conducted a prospective observational study for patients admitted in a tertiary care hospital. A total of 81 patients were selected based on the inclusion and exclusion criteria. A detailed clinical history, physical examination, relevant blood investigations and necessary imaging were done for all the patients. Using the above data, the probability of acute appendicitis is calculated using the Alvarado, Tzanaki and AIR scores. The various scores obtained were compared with the histopathological examination (HPE) reports (reference standard) and values like sensitivity, specificity, positive and negative predictive values (PPV and NPV) were calculated.Results: With regard to scores, Alvarado scores has a sensitivity 95.24%, specificity 77.78%, PPV of 93.75%, NPV of 82.35%. Tzanaki score has a sensitivity of 100%, specificity 23.5%, PPV of 83.12% and NPV of 100%. AIR score has a sensitivity of 95%, specificity of 66.67%, PPV of 89.06% and NPV of 82.35%. Conclusions: Alvarado score (cut off 7) has the best PPV (93.75%) and hence is the best scoring system to “rule in” a positive diagnosis. However, Tzanaki score (cut off 8) has the best NPV (100%) and hence is the best score to “rule out” a diagnosis of acute appendicitis.
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Taladriz-Sender, Irene, Gina Hernández-Osio, Paula Zapata-Cobo, et al. "An Inexpensive and Quick Method for Genotyping of HLA Variants Included in the Spanish Pharmacogenomic Portfolio of National Health System." International Journal of Molecular Sciences 25, no. 20 (2024): 11207. http://dx.doi.org/10.3390/ijms252011207.
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The possibility of using the same genotyping technology (TaqMan) for all the genetic tests included in the new Spanish pharmacogenomics portfolio should enable the application of a multigenotyping platform to obtain a whole pharmacogenomics profile. However, HLA-typing is usually performed with other technologies and needs to be adapted to TaqMan assays. Our aim was to establish a set of TaqMan assays for correct typing of HLA-A*31:01, HLA-B*15:02, HLA-B*57:01, and HLA-B*58:01. Therefore, we searched for and selected SNVs described in different populations as surrogate markers for these HLA alleles, designed TaqMan assays, and tested in a set of samples with known HLA-A and HLA-B. HLA-A*31:01 was correctly typed with a combination of rs1061235 and rs17179220 (PPV 100%, 95% CI 84.6–100-%; NPV 100%, 95% CI 96.5–100.0%), HLA-B*15:02 with rs10484555 (PPV 100%, 95% CI 69.2–100.0%; NPV 100%, 95% CI 96.8–100.0%) and rs144012689 (PPV 100%, 95% CI 69.2–100.0%; NPV 100%, 95% CI 96.8–100.0%), and HLA-B*57:01 with rs2395029 (PPV 99.5%, 95% CI 72.9–99.3%; NPV 99.5%, 95% CI 98.3–100.0%). HLA-B*58:01 was typed using two allele-specific TaqMan probes mixed with a ß-Globin reference and treated as a genotyping assay (PPV 100.0%, 95% CI 81.5–100.0%; NPV 100%, 95% CI 96.8–100.0%). In conclusion, we demonstrated a clinically useful way to type HLA-A and HLA-B alleles included in the Spanish pharmacogenomics portfolio using TaqMan assays.
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Eulitt, Patrick, Ersan Altun, Arif Sheikh, et al. "Pilot study of [18F] fluorodexoyglucose positron emission tomography-magnetic resonance imaging (FDG-PET-MRI) for staging of muscle-invasive bladder cancer." Journal of Clinical Oncology 37, no. 15_suppl (2019): e16002-e16002. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e16002.
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e16002 Background: Standard of care imaging for staging MIBC is computed tomography (CT) abdomen and pelvis despite poor diagnostic accuracy. The addition of FDG-PET to evaluate biologic activity has been shown to improve detection of metastatic bladder cancer. Better soft tissue characterization with MRI may improve detection of local disease. We hypothesized that simultaneous acquisition of FDG-PET and MRI images (PET-MRI) would allow for more accurate preoperative staging in patients with MIBC. Methods: 21 patients with MIBC and planned radical cystectomy with lymph node dissection were enrolled. Four radiologists (2 senior, 2 junior) with expertise in MRI and PET independently reviewed MRI and FDG-PET scans, respectively, to determine: 1) extent of the primary bladder tumor; and 2) involvement of local lymph nodes and distant sites of disease. Combined radiologist reads were performed (senior MRI and junior PET and vice versa). Imaging results were compared to surgical pathology. Results: 18 patients were included in the final analysis (3 PET-MRI scans excluded due to technical pitfalls with image acquisition). Final pathology revealed 10 patients (56%) with muscle invasion and only 2 patients (11%) with lymph node involvement. Combined analyses of PET-MRI accurately detected the extent of the primary tumor (sensitivity 0.84, specificity 0.50, PPV 0.70, NPV 0.70), but was less accurate for the detection of lymph node involvement (sensitivity 0.00, specificity 1.00, no calculable PPV, NPV 0.91). Senior MRI radiologist had improved PPV and NPV for extent of primary tumor compared to junior MRI radiologist (PPV 0.71 vs 0.56, NPV 0.83 vs. 0.50), and senior PET radiologist had improved PPV with similar NPV for extent of primary tumor (PPV 1.00 vs 0.78, NPV 0.50 vs 0.55). No patient was determined to have distant metastatic disease. Conclusions: To our knowledge, this is the first study exploring the use of PET-MRI for staging MIBC. This novel imaging modality demonstrated promise in detecting the extent of the primary tumor. Further investigation of FDG-PET-MRI is needed to better determine its potential utility in staging MIBC.
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Ibrahim, Firuz, Michela Gabelloni, Lorenzo Faggioni, et al. "Are Semiquantitative Methods Superior to Deauville Scoring in the Monitoring Therapy Response for Pediatric Hodgkin Lymphoma?" Journal of Personalized Medicine 13, no. 3 (2023): 445. http://dx.doi.org/10.3390/jpm13030445.
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Tailoring treatment in patients with Hodgkin lymphoma (HL) is paramount to maximize outcomes while avoiding unnecessary toxicity. We aimed to compare the performance of SUVmax reduction (ΔSUVmax%) and the PET ratio (rPET) versus the Deauville score (DS) for assessing the chemotherapy response in pediatric HL patients undergoing 18F-FDG PET-CT. Fifty-two patients with biopsy-proven HL (aged 8–16 years) were enrolled at baseline, interim (after the second or third chemotherapy round) and post-therapy (on completion of first-line chemotherapy). Interim and post-therapy DS, ΔSUVmax% and rPET were compared as response predictors. Patients were classified as responders or non-responders based on a 24-month clinical follow-up. Interim DS showed a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of 100%, 80.4%, 100%, 40% and 82.7%, respectively, in predicting the therapy response. Post-therapy DS showed a sensitivity, specificity, PPV, NPV and accuracy of 66.7%, 97.8%, 95.7%, 80% and 94.2%, repsectively. Interim ΔSUVmax% showed a sensitivity, specificity, PPV, NPV and accuracy of 83.3%, 82.6%, 97.4%, 38.5% and 82.7%, respectively, with a 56.3% cutoff. Post-therapy ΔSUVmax% showed a sensitivity, specificity, PPV, NPV and accuracy of 83.3%, 84.8%, 97.5%, 41.7% and 84.6%, respectively, with a 76.8% cutoff. Compared to ΔSUVmax%, DS showed a significantly higher sensitivity, specificity (p < 0.05) and NPV (p < 0.01). The sensitivity, specificity, PPV, NPV and accuracy of rPET in predicting the therapy response at 24 months were 76.1%, 100%, 100%, 35.3% and 78.8%, respectively, with a cut-off of 1.31. DS and rPET showed comparable predictive performance (p > 0.58). In conclusion, DS is an easier method with better performance than ΔSUVmax% and rPET in predicting the chemotherapy response in pediatric HL patients.
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Poptani, Manoj, Ankit Soni, Shipra Sharma, and Sanjay Kumar. "Augmentation of modified Alvarado score with abdominal ultrasound in diagnosis of acute appendicitis." International Surgery Journal 7, no. 3 (2020): 853. http://dx.doi.org/10.18203/2349-2902.isj20200833.
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Background: Acute appendicitis is one of the commonest surgical emergencies. But confirming the diagnosis of acute appendicitis is still a subjective issue for clnicians. Modified Alvarado score is based on clinical and laboratory findings which is scored upto. Management of 5 to 7 modified Alvarado score came under equivocal. Either may be conservative or operative.Methods: We augmented the modified alvarado score with abdominal ultrasound in diagnosis of acute appendicitis.Results: Outcomes were evaluated in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and negative appendicectomy rate, results of our study are sensitivity 95.7%, specificity is 76.92%, PPV 93.75% and NPV 33.34%.Conclusions: Overall increased sensitivity, specificity, NPV and PPV of the augmented approach is useful for diagnosis of acute appendicitis which scored under 5-7 of modified alvarado scoring system.
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Sharma, Shipra, Ankit Soni, Sanjay Kumar, and Manoj Poptani. "Augmentation of modified Alvarado score with abdominal ultrasound in diagnosis of acute appendicitis." International Surgery Journal 8, no. 1 (2020): 111. http://dx.doi.org/10.18203/2349-2902.isj20205408.
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Background: Acute appendicitis is one of the commonest surgical emergencies. But confirming the diagnosis of acute appendicitis is still a subjective issue for clinicians. Modified Alvarado score is based on clinical and laboratory findings which is scored upto 9. Management of 5 to 7 modified Alvarado score came under equivocal. Either may be conservative or operative.Methods: We augmented the modified Alvarado score with abdominal ultrasound in diagnosis of acute appendicitis.Results: Outcomes were evaluated in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and negative appendicectomy rate, results of our study are sensitivity 95.7%, specificity is 76.92%, PPV 93.75% and NPV 33.34%.Conclusions: Overall increased sensitivity, specificity, NPV and PPV of the augmented approach is useful for diagnosis of acute appendicitis which scored under 5-7 of modified Alvarado scoring system.
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Bruner, L. H., G. J. Carr, J. W. Harbell, and R. D. Curren. "An investigation of new toxicity test method performance in validation studies: 3. sensitivity and specificity are not independent of prevalence or distribution of toxicity." Human & Experimental Toxicology 21, no. 6 (2002): 325–34. http://dx.doi.org/10.1191/0960327102ht254oa.
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Often, the only measures of toxicity test performance provided in validation studies are the contingent probability statistics (CPS) sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Sensitivity and specificity are generally used in preference to NPV and PPV since NPV and PPV are assumed to vary with changes in prevalence while sensitivity and specificity are assumed to be independent of changes in prevalence. The purpose of the studies reported here was to test whether or not sensitivity and specificity are actually independent of changes in prevalence. Results derived from these studies indicate that sensitivity and specificity vary significantly depending on the prevalence of toxic substances in the set of chemicals being tested. This means sensitivity and specificity should not always be considered constant indicators of toxicity test performance.
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Dong, Shou-Jin, Lu Wang, Pasquale Chitano, et al. "Lung resistance and elastance are different in ex vivo sheep lungs ventilated by positive and negative pressures." American Journal of Physiology-Lung Cellular and Molecular Physiology 322, no. 5 (2022): L673—L682. http://dx.doi.org/10.1152/ajplung.00464.2021.
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Lung resistance ( RL) and elastance ( EL) can be measured during positive or negative pressure ventilation. Whether the different modes of ventilation produce different RL and EL is still being debated. Although negative pressure ventilation (NPV) is more physiological, positive pressure ventilation (PPV) is more commonly used for treating respiratory failure. In the present study, we measured lung volume, airway diameter, and airway volume, as well as RL and EL with PPV and NPV in explanted sheep lungs. We found that lung volume under a static pressure, either positive or negative, was not different. However, RL and EL were significantly higher in NPV at high inflation pressures. Interestingly, diameters of smaller airways (diameters <3.5 mm) and total airway volume were significantly greater at high negative inflation pressures compared with those at high positive inflation pressures. This suggests that NPV is more effective in distending the peripheral airways, likely due to the fact that negative pressure is applied through the pleural membrane and reaches the central airways via the peripheral airways, whereas positive pressure is applied in the opposite direction. More distension of lung periphery could explain why RL is higher in NPV (vs. PPV), because the peripheral parenchyma is a major source of tissue resistance, which is a part of the RL that increases with pressure. This explanation is consistent with the finding that during high frequency ventilation (>1 Hz, where RL reflects airway resistance more than tissue resistance), the difference in RL between NPV and PPV disappeared.
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Niemann, Marcel, Ellen Otto, Karl F. Braun, et al. "Microbiological Advantages of Open Incisional Biopsies for the Diagnosis of Suspected Periprosthetic Joint Infections." Journal of Clinical Medicine 11, no. 10 (2022): 2730. http://dx.doi.org/10.3390/jcm11102730.
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Background: Periprosthetic joint infection (PJI) represents a serious complication following total hip (THA) and knee arthroplasty (TKA). When preoperative synovial fluid cultures remain inconclusive, open incisional joint biopsy (OIB) can support causative microorganism identification. Objective: This study investigates the potential benefit of OIB in THA and TKA patients with suspected PJI and ambigious diagnostic results following synovial fluid aspiration. Methods: We retrospectively assessed all patients treated from 2016 to 2020 with suspected PJI. Comparing the microbiology of OIB and the following revision surgery, we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the number needed to treat (NNT). Results: We examined the diagnostic validity of OIB in 38 patients (20 female) with a median age of 66.5 years. In THA patients (n = 10), sensitivity was 75%, specificity was 66.67%, PPV was 60%, NPV was 80%, and NNT was 2.5. In TKA patients (n = 28), sensitivity was 62.5%, specificity was 95.24%, PPV was 83.33%, NPV was 86.96%, and NNT was 1.42. Conclusions: Our results indicate that OIB represents an adequate diagnostic tool when previously assessed microbiological results remain inconclusive. Particularly in TKA patients, OIB showed an exceptionally high specificity, PPV, and NPV, whereas the predictive validity of the diagnosis of PJI in THA patients remained low.
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Flammia, Rocco Simone, Antonio Tufano, Luca Antonelli, et al. "Diagnostic Performance of Magnetic Resonance Imaging for Preoperative Local Staging of Penile Cancer: A Systematic Review and Meta-Analysis." Applied Sciences 11, no. 15 (2021): 7090. http://dx.doi.org/10.3390/app11157090.
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Invasion of the tunica albuginea (TA) and/or urethra are key factors in determining the feasibility of organ-preserving surgery in penile cancer (PC). Magnetic resonance imaging (MRI) appeared to be a promising technique for preoperative local staging. We performed a systematic review (SR) and pooled meta-analysis to investigate the diagnostic performance of MRI in preoperative local staging of primary PC. An SR up to May 2021 was performed according to the PRISMA statement. The diagnostic performance of MRI was evaluated according to TA invasion, urethra invasion, and pT-stage ≥ 2. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) from eligible studies were pooled and summary receiver operating characteristic (SROC) curves were constructed. Overall, seven qualified studies were deemed suitable. Diagnostic performance of MRI showed an accuracy of 0.89 for TA invasion (sensitivity 0.78, PPV 0.79, specificity 0.91, and NPV 0.90); an accuracy of 0.88 for urethra invasion (sensitivity 0.65, PPV 0.46, specificity 0.86, and NPV 0.93); an accuracy of 0.90 for pT ≥ 2 (sensitivity 0.86, PPV 0.84, specificity 0.70, and NPV 0.73).Currently available evidence indicates that MRI might be a one-stop shop for local staging of primary PC and play a central role with regard to conservative surgical management.
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De Marchi, Armanda, Simona Pozza, Lorena Charrier, et al. "Small Subcutaneous Soft Tissue Tumors (<5 cm) Can Be Sarcomas and Contrast-Enhanced Ultrasound (CEUS) Is Useful to Identify Potentially Malignant Masses." International Journal of Environmental Research and Public Health 17, no. 23 (2020): 8868. http://dx.doi.org/10.3390/ijerph17238868.
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Subcutaneous masses smaller than 5 cm can be malignant, in contrast with the international guidelines. Ultrasound (US) and magnetic resonance imaging (MRI) are useful to distinguish a potentially malignant mass from the numerous benign soft tissue (ST) lesions. Contrast-enhanced ultrasound (CEUS) was applied in ST tumors, without distinguishing the subcutaneous from the deep lesions. We evaluated CEUS and MRI accuracy in comparison to histology in differentiating malignant from nonmalignant superficial ST masses, 50% smaller than 5 cm. Sensitivity, specificity, and positive and negative predictive values (PPV, NPV) with their 95% confidence intervals (CI) were calculated. Of malignant cases, 44.4% measured ≤5 cm. At univariate analysis, no statistically significant differences emerged between benign and malignant tumors in relation with clinical characteristics, except for relationship with the deep fascia (p = 0.048). MRI accuracy: sensitivity 52.8% (CI 37.0, 68.0), specificity 74.1% (CI 55.3, 86.8), PPV 73.1% (CI 53.9, 86.3), and NPV 54.1% (CI 38.4, 69.0). CEUS accuracy: sensitivity 75% (CI 58.9, 86.3), specificity 37% (CI 21.5, 55.8), PPV 61.4% (CI 46.6, 74.3), and NPV 52.6% (CI 31.7, 72.7). CEUS showed a sensitivity higher than MRI, whereas PPV and NPV were comparable. Also, masses measuring less than 5 cm can be malignant and referral criteria for centralization could be revised.
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Hassan, Nayera, Sahar El-Masry, Mohamed El Hussieny, et al. "Visceral Fat Cut-off Points for a Sample of Egyptian Adults." Open Access Macedonian Journal of Medical Sciences 1, no. 1 (2013): 6–11. http://dx.doi.org/10.3889/oamjms.2013.002.
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Objective: To determine appropriate visceral fat cut-off values using ultrasound (USVF); for obesity according to existing waist circumference (WC), waist/hip ratio (WHR) and BMI cut-off levels.Methods: 998 Egyptian adults, aged 25- 55 years, were studied in a cross-sectional survey for evaluation of “Visceral and Central Obesity as an Early Estimator for Obesity Health Riskâ€. Results:  Using WC as standard for classification of central obesity, cut-off points of USVF were found to be 6.5 cm for men and 5 cm for women; using ROC analysis; with 76 % sensitivity, 83% specificity, 1.06 PPV/NPV, and 81% accuracy for men, and with 77 % sensitivity, 76% specificity, 0.99 PPV/NPV, and 76% accuracy for women. Same cut-off points of USVF were detected using BMI as standard; with 71 % sensitivity, 77% specificity, 1.04 PPV/NPV, and 75% accuracy for men, and 74% sensitivity, 79% specificity, 1.03 PPV/NPV, and 77% accuracy for women. Even by using WHR as standard, these cut-offs increased 0.5 cm only for both men and women (7 and 5.5 cm respectively).Conclusion: The best cut-off points of visceral fat; using US in Egyptian adults; is 6.5 cm for men and 5 cm for women.en
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Vathanan, Veluppillai, and Nii Adjeidu Armar. "A Comparative Observational Study of the Use of Saline Uterine Hydrosonography for the Diagnosis and Assessment of Uterine Cavity Lesions in Women." International Journal of Reproductive Medicine 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/9317194.
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Aim of this study was to evaluate the performance of saline hydrosonography (HSGM) (also known as saline infusion sonography (SIS)) against transvaginal ultrasound scan (TVS) and hysteroscopy in the diagnosis of uterine cavity lesions. Diagnostic hysteroscopy with biopsy is considered as the “gold standard” to diagnose intrauterine abnormalities. The introduction of HSGM has improved the diagnostic capability of ultrasound. It is important to establish the efficacy and safety of HSGM before it is widely recommended for use. This retrospective observational data was collected from all 223 patients who underwent TVS, HSGM, and hysteroscopy as part of their gynaecological investigations from 1 January 2008 to 31 December 2010 at Central Middlesex Hospital, London.Endometrial Polyps. TVS: sensitivity 60.53%, specificity 97.06%, positive predictive value (PPV) 95.83%, and negative predictive value (NPV) 68.75% and HSGM: sensitivity 95%, specificity 97.14%, PPV 97.44%, and NPV 94.44%.Submucous Leiomyoma. TVS: sensitivity 57.14%, specificity 93.48%, PPV 84.21%, and NPV 78.18% and HSGM: sensitivity 96.55%, specificity 100.00%, PPV 100.00%, and NPV 97.92%. Diagnostic efficacy of HSGM is superior to TVS for the diagnosis of endometrial polyps and submucous fibroids. HSGM should be considered as an intermediate investigation after TVS to assess intracavity pathology and to confirm the diagnosis; hysteroscopy should become a therapeutic intervention.
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Abusheraida, Noora S. A., Asraa A. H. AlBaker, Asmaa S. A. Aljabri, et al. "Rapid Visual Detection of Methicillin-Resistant Staphylococcus aureus in Human Clinical Samples via Closed LAMP Assay Targeting mecA and spa Genes." Microorganisms 12, no. 1 (2024): 157. http://dx.doi.org/10.3390/microorganisms12010157.
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The emergence of antimicrobial resistance (AMR), particularly methicillin-resistant Staphylococcus aureus (MRSA), poses a significant global health threat as these bacteria increasingly become resistant to the most available therapeutic options. Thus, developing an efficient approach to rapidly screen MRSA directly from clinical specimens has become vital. In this study, we establish a closed-tube loop-mediated isothermal amplification (LAMP) method incorporating hydroxy-naphthol blue (HNB) colorimetric dye assay to directly detect MRSA from clinical samples based on the presence of mecA and spa genes. In total, 125 preidentified S. aureus isolates and 93 clinical samples containing S. aureus were sourced from the microbiology laboratory at Hamad General Hospital (HGH). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were computed based on conventional PCR. The assay demonstrated 100% specificity, 91.23% sensitivity, 0.90 Cohen Kappa (CK), 100% PPV, and 87.8% NPV for the clinical samples, while clinical isolates exhibited 100% specificity, 97% sensitivity, 0.926 CK, 100% PPV, and 88.89% NPV. Compared to cefoxitin disk diffusion, LAMP provided 100% specificity and sensitivity, 1.00 CK, and 100% for PPV and NPV. The study revealed that the closed-tube LAMP incorporating (HNB) dye is a rapid technique with a turnaround time of less than 1 h and high specificity and sensitivity.
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Bisoffi, Zeno, Elena Pomari, Michela Deiana, et al. "Sensitivity, Specificity and Predictive Values of Molecular and Serological Tests for COVID-19: A Longitudinal Study in Emergency Room." Diagnostics 10, no. 9 (2020): 669. http://dx.doi.org/10.3390/diagnostics10090669.
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Background: We assessed the sensitivity, specificity and positive and negative predictive value (PPV and NPV) of molecular and serological tests for the diagnosis of SARS-CoV-2 infection. Methods: A total of 346 patients were enrolled in the emergency room. We evaluated three Reverse Transcriptase-real time PCRs (RT-PCRs) including six different gene targets, five serologic rapid diagnostic tests (RDT) and one ELISA. The final classification of infected/non-infected patients was performed using Latent Class Analysis combined with clinical re-assessment of incongruous cases. Results: Out of these, 24.6% of patients were classified as infected. The molecular test RQ-SARS-nCoV-2 showed the highest performance with 91.8% sensitivity, 100% specificity, 100.0% PPV and 97.4% NPV respectively. Considering the single gene targets, S and RdRp of RQ-SARS-nCoV-2 had the highest sensitivity (94.1%). The in-house RdRp presented the lowest sensitivity (62.4%). The specificity ranged from 99.2% for in-house RdRp and N2 to 95.0% for E. The PPV ranged from 97.1% of N2 to 85.4% of E and the NPV from 98.1% of S to 89.0% of in-house RdRp. All serological tests had < 50% sensitivity and low PPV and NPV. VivaDiag IgM (RDT) had 98.5% specificity, with 84.0% PPV, but 24.7% sensitivity. Conclusion: Molecular tests for SARS-CoV-2 infection showed excellent specificity, but significant differences in sensitivity. Serological tests have limited utility in a clinical context.
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Wald, H. L., B. Bandle, A. Richard, and S. Min. "Accuracy of Electronic Surveillance of Catheter-Associated Urinary Tract Infection at an Academic Medical Center." Infection Control & Hospital Epidemiology 35, no. 6 (2014): 685–91. http://dx.doi.org/10.1086/676429.
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Objective.To develop and validate a methodology for electronic surveillance of catheter-associated urinary tract infections (CAUTIs).Design.Diagnostic accuracy study.Setting.A 425-bed university hospital.Subjects.A total of 1,695 unique inpatient encounters from November 2009 through November 2010 with a high clinical suspicion of CAUTI.Methods.An algorithm was developed to identify incident CAUTIs from electronic health records (EHRs) on the basis of the Centers for Disease Control and Prevention (CDC) surveillance definition. CAUTIs identified by electronic surveillance were compared with the reference standard of manual surveillance by infection preventionists. To determine diagnostic accuracy, we created 2 × 2 tables, one unadjusted and one adjusted for misclassification using chart review and case adjudication. Unadjusted and adjusted test statistics (percent agreement, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and κ) were calculated.Results.Electronic surveillance identified 64 CAUTIs compared with manual surveillance, which identified 19 CAUTIs for 97% agreement, 79% sensitivity, 97% sensitivity, 23% PPV, 100% NPV, and κ of .33. Compared with the reference standard adjusted for misclassification, which identified 55 CAUTIs, electronic surveillance had 98% agreement, 80% sensitivity, 99% specificity, 69% PPV, 99% NPV, and κ of .71.Conclusion.The electronic surveillance methodology had a high NPV and a low PPV compared with the reference standard, indicating a role of the electronic algorithm in screening data sets to exclude cases. However, the PPV markedly improved compared with the reference standard adjusted for misclassification, suggesting a future role in surveillance with improvements in EHRs.Infect Control Hosp Epidemiol 2014;35(6):685–691
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Wald, H. L., B. Bandle, A. Richard, and S. Min. "Accuracy of Electronic Surveillance of Catheter-Associated Urinary Tract Infection at an Academic Medical Center." Infection Control & Hospital Epidemiology 35, no. 06 (2014): 685–91. http://dx.doi.org/10.1086/529079.
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Objective.To develop and validate a methodology for electronic surveillance of catheter-associated urinary tract infections (CAUTIs).Design.Diagnostic accuracy study.Setting.A 425-bed university hospital.Subjects.A total of 1,695 unique inpatient encounters from November 2009 through November 2010 with a high clinical suspicion of CAUTI.Methods.An algorithm was developed to identify incident CAUTIs from electronic health records (EHRs) on the basis of the Centers for Disease Control and Prevention (CDC) surveillance definition. CAUTIs identified by electronic surveillance were compared with the reference standard of manual surveillance by infection preventionists. To determine diagnostic accuracy, we created 2 × 2 tables, one unadjusted and one adjusted for misclassification using chart review and case adjudication. Unadjusted and adjusted test statistics (percent agreement, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and κ) were calculated.Results.Electronic surveillance identified 64 CAUTIs compared with manual surveillance, which identified 19 CAUTIs for 97% agreement, 79% sensitivity, 97% sensitivity, 23% PPV, 100% NPV, and κ of .33. Compared with the reference standard adjusted for misclassification, which identified 55 CAUTIs, electronic surveillance had 98% agreement, 80% sensitivity, 99% specificity, 69% PPV, 99% NPV, and κ of .71.Conclusion.The electronic surveillance methodology had a high NPV and a low PPV compared with the reference standard, indicating a role of the electronic algorithm in screening data sets to exclude cases. However, the PPV markedly improved compared with the reference standard adjusted for misclassification, suggesting a future role in surveillance with improvements in EHRs.Infect Control Hosp Epidemiol2014;35(6):685–691
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Azevedo, Otávio Cansanção de, João Luiz Moreira Coutinho Azevedo, Albino Augusto Sorbello, Gustavo Peixoto Soares Miguel, Jorge Luis Wilson Junior, and Antônio Cláudio de Godoy. "Evaluation of tests performed to confirm the position of the Veress needle for creation of pneumoperitoneum in selected patients: a prospective clinical trial." Acta Cirurgica Brasileira 21, no. 6 (2006): 385–91. http://dx.doi.org/10.1590/s0102-86502006000600006.
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PURPOSE: To evaluate tests performed to confirm the position of the Veress needle inserted into the left hypochondrium for creation of pneumoperitonium. METHODS: One hundred patients were submitted to laparoscopic procedure with left hypochondrium puncturing. Needle positioning tests were evaluated. The aspiration test was considered positive when organic material was aspirated; the injection test was considered positive when no increased resistance to liquid injection was observed; the recovery test was considered positive when the liquid injected was not recovered; the saline drop test was considered positive when drops of saline in the syringe disappeared quickly; the initial intraperitoneal pressure test was considered positive when pressure levels were £ 8 mmHg. A positive aspiration test indicated iatrogenic injury, whereas a positive result in any of the other tests indicated that the tip of the needle was correctly positioned in the peritoneal cavity. Sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) of the tests were calculated by correlating results considered true positives (a), false positives (b), false negatives (c) and true negatives (d), according to the formulas: SE = [a/(a + c)] x 100; SP = [d/(b + d)] x 100; PPV = [a/(a + b)] x 100; NPV = [d(c + d)] x 100. RESULTS: With regard to the aspiration test, SE and PPV were not applicable, SP was 100% and NPV was 100%. With regard to the injection test, SE was 0%, SP was 100%, PPV was inexistent and NPV was 90%. Both recovery and saline drop tests yielded the following results: SE was 50%, SP was 100%, PPV was 100% and NPV was 94.7%. The initial intraperitoneal pressure test yielded the following results: SE, SP, PPV and NPV were 100%. CONCLUSIONS: When inserting the Veress needle into the left hypochondrium, a negative aspiration test guarantees the absence of iatrogenic injury; the injection test is not reliable to determine incorrect needle positioning, but it accurately detects correct needle positioning; recovery and saline drop tests are not reliable to determine correct needle positioning, but they accurately detect incorrect needle positioning; the initial intraperitoneal pressure test is reliable to determine both correct and incorrect needle positioning, and proved to be the most reliable of the tests analyzed.
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Rapado, Inmaculada, Enriqueta Albizua, Rosa Ayala, et al. "Importance of JAK2 V617F Allele Burden in the Diagnosis of Myeloproliferative Diseases and Its Association to Age." Blood 110, no. 11 (2007): 4654. http://dx.doi.org/10.1182/blood.v110.11.4654.4654.
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Abstract The aim of this study is to compare the diagnostic value of several methods, with different sensitivities, to detect JAK2 V617F mutation. Three new methods based on Real Time PCR to detect JAK2 V617F mutation were employed. The first two, based on hybridization probes and Peptide Nucleic Acid Probe (PNA) specific for wild allele; and the third employing Allele Specific Oligonucleotide (ASO) primers for JAK2 V617F mutant allele and MGB TaqMan probe. Healthy subjects (n 149) and patients with Essential Thrombocythemia (ET) (n 63), Polycythemia Vera (PV) (n 31), Secondary Thrombocythosis (ST) (n 38), Secondary Erytrocythosis (SE) (n 35) and other haematological malignancies (n 72) were included in the study. Results. Validity test study for JAK2 617 using HP PCR showed: A-. For PV patients: Sensitivity (Se) was 87.1%, Specificity (Sp) 100%, Positive Predictive value (PPV) 100%, and Negative Predictive Value (NPV) 97.9%. B-. For ET patients: Se was 61.3%, Sp 100%, PPV 100%, and NPV 93.9%. With JAK2 617 PNA PCR: A.- For PV patients: Se was 93.6%, Sp 97.8%, PPV 87.9%, and NPV 98.9%. B. - For ET patients: Se was 71%, Sp 95.7%, PPV 73.3%, and NPV 95.2%. With JAK2 V671F ASO quantitative PCR (JAK2 617 ASO qPCR): A.- For PV patients: Se was 93.5%, Sp 98.5%, PPV 90.6%, and NPV 98.9%. B.-For ET patients: Se was 80.6%, Sp 95.9%, PPV 75.8%, and NPV 96.7%. Cutoff point of 1% was established by ROC curves as mutation burden to distinguish PV or ET versus secondary causes. Three healthy subjects were positive (2%, 3/149) by JAK2 617 PNA PCR method. With JAK2 617 ASO qPCR, 16 healthy subjects would be positive (10%) if cutoff burden established in 0.1%. Significant differences were obtained when comparing Myeloproliferative Disease (MPD) patients over 40 years (n 64) to patients under 40 (n 15). JAK2 V617F median allele burden was 18.41% and 7.26% respectivily (p=0.016). Conclusions: JAK2 617 HP and ASO qPCR are the best tests in differential diagnosis of Polyglobulias and Thrombocytosis. When JAK2 V617F allele burden is low, the best test for MPD diagnosis is JAK2 617 ASO qPCR. The number of JAK2 V617F mutated cells is higher in patients over 40, which leads to think that age may influence in tumour burden.
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Parikh, Aparna Raj, Emily E. Van Seventer, Genevieve Marie Boland, et al. "A plasma-only integrated genomic and epigenomic circulating tumor DNA (ctDNA) assay to inform recurrence risk in colorectal cancer (CRC)." Journal of Clinical Oncology 37, no. 15_suppl (2019): 3602. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.3602.
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3602 Background: ctDNA identifies patients (pts) at high risk for disease recurrence post CRC resection (post-op). Current ctDNA residual disease detection approaches assess only genomic alterations (alts) and rely on tissue sequencing to identify tumor-derived alts. We evaluated a plasma-only ctDNA assay to identify high risk pts. Methods: 72 CRC pts (surgery only = 42; adjuvant therapy (adj) = 30) had post-op and/or post-adj plasma samples (3-4mL). Extracted cfDNA (median 27 ng) was analyzed using a single-sample NGS test validated in early stage CRC that integrates assessment of genomic alts with epigenomic cancer signature (Guardant Health, CA). A variant classifier was applied to differentiate tumor-derived from non-tumor derived alts in a tumor tissue-uninformed approach. Results: In the surgery cohort, samples were collected a median of 31 days (d) post-op. 7/8 pts with post-op ctDNA detected (ctDNA+) recurred (PPV 88%; median time to recurrence (mTTR) 248d). The recurrence-free pt has < 180d follow-up. 7/34 pts without ctDNA detected (ctDNA-) recurred (NPV 79%; mTTR 333d). 1/1 Stage 0-II ctDNA+ pt recurred (PPV 100%; TTR 440d) while 1/20 ctDNA- recurred (NPV 95%; TTR 440d). 27 pts in the adj cohort had samples collected a median of 37d post-adj. 6/6 ctDNA+ pts recurred (PPV 100%, mTTR 239d). 4/21 ctDNA- pts recurred (NPV 81%, mTTR 466d). 2/2 ctDNA+ and 0/11 ctDNA- Stage III pts recurred (PPV, NPV 100%, mTTR 420d). All 3 post-op ctDNA+/post-adj ctDNA+ (ctDNA persistence) pts recurred. 1/2 post-op ctDNA+/post-adj ctDNA- (ctDNA clearance) pts is recurrence free (306d). 2 post-op ctDNA-/post-adj ctDNA+ pts recurred. In the entire cohort, ctDNA+ after standard therapy completion had a recurrence PPV 93%, NPV 80%, HR 11.29 (p < 0.0001). Conclusions: In post-op CRC, ctDNA detection utilizing a tumor-uninformed integrated genomic and epigenomic assay has high recurrence PPV and NPV following standard therapy completion. ctDNA identifies pts who may benefit from post-op adj therapy or additional/modified post-adj therapy. These findings demonstrate that ctDNA detection from a single post-op/post-adj plasma sample stratifies high/low risk pts and informs therapy decision making.
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Kumar, Vinod, Jeetendra S. Lodhi, Dhananjay Sabat, Rakesh Sehrawat, and Deepak Gupta. "Multidetector CT arthrography in shoulder instability and its comparison with MR arthrography and arthroscopy." International Journal of Research in Orthopaedics 3, no. 6 (2017): 1189. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20174712.
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<p class="abstract"><strong>Background:</strong> Purpose of this study was to compare diagnostic effectiveness of MDCT arthrography (MDCTA) in shoulder instability and pain in throwing and its comparison to MR arthrography (MRA) and arthroscopy taking arthroscopy as gold standard.</p><p class="abstract"><strong>Methods:</strong> 20 patients with history of recurrent shoulder dislocation in activity were included in this study. After detailed clinical examination, each patient underwent MDCT-MR arthrography in one sitting followed by diagnostic arthroscopy within 6 weeks. Results were compared with the help of statistician.<strong></strong></p><p class="abstract"><strong>Results:</strong> At arthroscopy, 10 Bankart’s lesions, 7 Hill Sachs lesion, 6 SLAP lesion, 1 ALPSA, 1 capsular laxity, 1 partial subscapularis tear and 1 supraspinatus fraying were visualized in 20 shoulders. For Bankart’s lesion MDCT has sensitivity 80%, specificity 100%, positive predictive value (PPV) 100% and negative predictive value (NPV) 83.3%. MRA has sensitivity of 90%, specificity 100%, PPV 100% and NPV 90.9%. For SLAP lesions sensitivity, specificity, PPV and NPV for MDCTA and MRA are 88.3%, 100%, 100%, 93.3%. For Hill-Sachs lesion; sensitivity, specificity, PPV and NPV for MDCTA are all 100% and for MRA they are 85.7%, 100%, 100%, 92.8% respectively. For ALPSA; sensitivity is 100%, specificity is 95%, PPV is 50% and NPV is 100% both for MDCTA and MRA. К value for MRA is 0.60 and for CTA is 0.55 suggesting moderate agreement.</p><p><strong>Conclusions:</strong> Considering availability, cost, time consumption, superior detection of bony lesions and comparable detection of soft tissue lesions; MDCTA can be used as single investigation of choice in shoulder instability pain.</p>
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PEYVASTEH, Mehran, Shahnam ASKARPOUR, Nasrollah OSTADIAN, Mohammad-Reza MOGHIMI, and Hazhir JAVAHERIZADEH. "DIAGNOSTIC ACCURACY OF BARIUM ENEMA FINDINGS IN HIRSCHSPRUNG'S DISEASE." ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) 29, no. 3 (2016): 155–58. http://dx.doi.org/10.1590/0102-6720201600030007.
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ABSTRACT Background: Hirschsprung's disease is the most common cause of pediatric intestinal obstruction. Contrast enema is used for evaluation of the patients with its diagnosis. Aim: To evaluate sensitivity, specificity, positive predictive value, and negative predictive value of radiologic findings for diagnosis of Hirschsprung in patients underwent barium enema. Methods: This cross sectional study was carried out in Imam Khomeini Hospital for one year starting from 2012, April. Sixty patients were enrolled. Inclusion criteria were: neonates with failure to pass meconium, abdominal distention, and refractory constipation who failed to respond with medical treatment. Transitional zone, delay in barium evacuation after 24 h, rectosigmoid index (maximum with of the rectum divided by maximum with of the sigmoid; abnormal if <1), and irregularity of mucosa (jejunization) were evaluated in barium enema. Biopsy was obtained at three locations apart above dentate line. PPV, NPV, specificity , and sensitivity was calculated for each finding. Results: Mean age of the cases with Hirschsprung's disease and without was 17.90±18.29 months and 17.8±18.34 months respectively (p=0.983). It was confirmed in 30 (M=20, F=10) of cases. Failure to pass meconium was found in 21(70%) cases. Sensitivity, specificity, PPV, and NPV were 90%, 80%, 81.8% and 88.8% respectively for transitional zone in barium enema. Sensitivity, specificity, PPV, and NPV were 76.7%, 83.3%, 78.1% and 82.1% respectively for rectosigmoid index .Sensitivity, specificity, PPV, and NPV were 46.7%, 100%, 100% and 65.2% respectively for irregular contraction detected in barium enema. Sensitivity, specificity, PPV, and NPV were 23.3%, 100%, 100% and 56.6% respectively for mucosal irregularity in barium enema. Conclusion: The most sensitive finding was transitional zone. The most specific findings were irregular contraction, mucosal irregularity, and followed by cobblestone appearance.
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Shah, Santosh, Rajesh Poudel, and Sabir Miya. "Clinical Probability Assessment using Modified Wells Criteria and D-Dimer for Diagnosis of Lower Limb DVT." Medical Journal of Eastern Nepal 3, no. 2 (2024): 8–12. https://doi.org/10.3126/mjen.v3i2.73037.
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Background Deep vein thrombosis (DVT) is a frequent problem in ambulatory and hospitalized patients. It is linked to considerable illness and death related to post-thrombotic syndrome, pulmonary embolism (PE), and pulmonary hypertension secondary to chronic PE. The comparitively low prevalence of DVT leads to a significant number of negative initial ultrasound (US) examinations. A combination of clinical pretest probability assessment using Modified Wells Score (MWS) and D-Dimer testing and subsequent venous US is a good diagnostic approach. Methods This study is a drescriptive cross-sectional analysis on patients attending UCMS hospital with suspected DVT from September 2021 to March 2023 in order to evaluate the reliability of a combined approach of clinical assessment score (Modified Wells Score) followed by D-dimer test to exclude deep vein thrombosis. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Modified Wells Score and D-Dimer individually and in combination were noted as outcomes. Results The study was undertaken in 79 patients. Among the patients, 31 out of 79 (39.24%) were confirmed to have DVT (group one), while 48 patients (60.76%) were ruled out for DVT (group two). In individual Modified Wells Score both the sensitivity and PPV were found to be 77.4%, and both the specificity and NPV were found to be 85.4%. The individual D-dimer test sensitivity was 93.5% with a specificity of 87.5%, while PPV and NPV were 82.9% and 95.5%, respectively. In combined strategy the sensitivity, specificity, PPV and NPV for the likely group combined with D-dimer test results were 100%, 42.9%, 85.7% and 100% respectively. The sensitivity, specificity, PPV and NPV for unlikely group combined with D-dimer test results were 71.4%, 95.1%, 71.4% and 95.1% respectively. Conclusion Combination of Modified Well’s Criteria along with D-dimer level increases the sensitivity and Negative Predictive Value in DVT diagnosis in suspected cases.
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Mawla, Tamer S. A., Aliaa A. Elhameed, Areeg A. Y. Abdallah, and Osama M. Momtaz. "Validity of lung ultrasound FALLS-protocol in differentiating types of shock in critically ill patients." Research and Opinion in Anesthesia & Intensive Care 9, no. 4 (2022): 275–82. http://dx.doi.org/10.4103/roaic.roaic_28_22.
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Background Acute circulatory collapse is one of the most familiar challenges in ICUs. It is considered that artefacts generated by lung ultrasound (LUS) can help in diagnosis and management. FALLS-protocol using LUS is a tool proposed for the management of unexplained shock. Objectives To investigate the role of LUS FALLS-protocol in differentiating types of shock in critically ill patients. Patients and methods A total of 50 patients presented with undiagnosed shock. Fast bedside echocardiography and LUS FALLS-protocol were applied along with inferior vena cava diameter and collapsibility measurement. Results A total of 19 patients with septic shock on presentation had A profile in all of them and AB profile in three of them, and after resuscitation, they were transformed to B profile with 100% sensitivity, 90.5% specificity, 90.5% positive predictive value (PPV), and 100% negative predictive value (NPV). Overall, 16 patients with hypovolemic shock had A profile in all of them on presentation and after resuscitation, with 100% sensitivity, 94.1% specificity, 88.9% PPV, and 100% NPV. Moreover, eight patients with cardiogenic shock had B profile in all of them on presentation with 100% sensitivity, 95.2% specificity, 80% PPV, and 100% NPV; three patients with obstructive shock had A profile in all of them on presentation, with 100% sensitivity, 25.5% specificity, 7.9% PPV, and 100% NPV; and two patients with anaphylactic shock had A profile in all of them on presentation and transformed to B profile after resuscitation with 100% sensitivity, 50% specificity, 9.5% PPV, and 100% NPV. Our findings showed preference of FALLS-protocol than inferior vena cava diameter and collapsibility in directing fluid therapy. Conclusion Bedside chest ultrasound FALLS-protocol should be considered in the resuscitation pathways with a possible significant effect on patient management.
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Harskamp, Ralf E., Simone C. Laeven, Jelle CL Himmelreich, Wim A. M. Lucassen, and Henk C. P. M. van Weert. "Chest pain in general practice: a systematic review of prediction rules." BMJ Open 9, no. 2 (2019): e027081. http://dx.doi.org/10.1136/bmjopen-2018-027081.
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ObjectiveTo identify and assess the performance of clinical decision rules (CDR) for chest pain in general practice.DesignSystematic review of diagnostic studies.Data sourcesMedline/Pubmed, Embase/Ovid, CINAHL/EBSCO and Google Scholar up to October 2018.Study selectionStudies that assessed CDRs for intermittent-type chest pain and for rule out of acute coronary syndrome (ACS) applicable in general practice, thus not relying on advanced laboratory, computer or diagnostic testing.Review methodsReviewers identified studies, extracted data and assessed the quality of the evidence (using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2)), independently and in duplicate.ResultsEight studies comprising five CDRs met the inclusion criteria. Three CDRs are designed for rule out of coronary disease in intermittent-type chest pain (Gencer rule, Marburg Heart Score, INTERCHEST), and two for rule out of ACS (Grijseels rule, Bruins Slot rule). Studies that examined the Marburg Heart Score had the highest methodological quality with consistent sensitivity (86%–91%), specificity (61%–81%) and positive (23%–35%) and negative (97%–98%) predictive values (PPV and NPV). The diagnostic performance of Gencer (PPV: 20%–34%, NPV: 95%–99%) and INTERCHEST (PPV: 35%–43%, NPV: 96%–98%) appear comparable, but requires further validation. The Marburg Heart Score was more sensitive in detecting coronary disease than the clinical judgement of the general practitioner. The performance of CDRs that focused on rule out of ACS were: Grijseels rule (sensitivity: 91%, specificity: 37%, PPV: 57%, NPV: 82%) and Bruins Slot (sensitivity: 97%, specificity: 10%, PPV: 23%, NPV: 92%). Compared with clinical judgement, the Bruins Slot rule appeared to be safer than clinical judgement alone, but the study was limited in sample size.ConclusionsIn general practice, there is currently no clinical decision aid that can safely rule out ACS. For intermittent chest pain, several rules exist, of which the Marburg Heart Score has been most extensively tested and appears to outperform clinical judgement alone.
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Kumar, Maddala Surya, Varghese Zachariah K, and Chakravarthy Joel J. "Airway assessment: Predictors for difficult intubation – A prospective observational study." Indian Journal of Clinical Anaesthesia 10, no. 1 (2023): 11–20. http://dx.doi.org/10.18231/j.ijca.2023.003.
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Airway management remains an important challenge in the contemporary practice of anaesthesia and preoperative airway assessment facilitates appropriate preparation when difficulty with intubation or ventilation is anticipated prior to induction of anaesthesia.: Aim: To study the important predictors for difficult laryngeal intubation. To determine the predictors of difficult laryngeal intubation. Secondary: To determine the most significant predictor for difficult intubation and to determine the incidence of unanticipated difficult intubation.This single centre prospective observational study done in Bangalore Baptist hospital (after obtaining clearance from ethical committee) included adult patients posted for elective surgeries who received general anaesthesia. Patients of either gender in the 18 – 65 year age group, with an American Society of Anaesthesiologists physical status classification of I or II, who required endotracheal intubation for general anaesthesia. The sample size was 413 with confidence level 95%. In our study the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Mallampati class were found to be 75.8%, 78.06%, 37.90%, 94.80% respectively. The sensitivity, specificity, PPV and NPV of mouth opening were found to be 33.87%, 81.19%, 24.13%, 87.42% respectively. The sensitivity, specificity, PPV and NPV of upper lip bite test found to be 27.41%, 96.29%, 56.66%, 88.25% respectively. The sensitivity, specificity, PPV and NPV of neck extension found to be 54.83%, 92.59%, 56.66%, 92.06% respectively. The sensitivity, specificity, PPV and NPV of BMI found to be 53.22%, 75.49%, 27.73%, 90.13% respectively. The incidence of difficult intubation was 15%.:In conclusion, no single predictor is sufficient for prediction of difficult intubation on its own. All the studied bedside tests are poor to moderate predictors of difficult intubation. All the tests showed poor positive predictive values and high negative predictive values which suggests that they can be more useful predictors of easy intubation than difficult intubation.
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KHAN, A., N. MUMTAZ, AH MALIK, et al. "DIAGNOSTIC ACCURACY OF RIPASA SCORE FOR DIAGNOSING ACUTE APPENDICITIS KEEPING HISTOPATHOLOGY AS GOLD STANDARD." Biological and Clinical Sciences Research Journal 2023, no. 1 (2023): 567. http://dx.doi.org/10.54112/bcsrj.v2023i1.567.
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The objective of the study was to determine the diagnostic accuracy of the RIPASA score in diagnosing acute appendicitis using histopathology as the gold standard. The cross-sectional study was conducted at the General Surgery Department of Lady Reading Hospital, Peshawar, between 17-03-2020 and 16-092020. A total of 171 patients were enrolled in the study. Each patient underwent the RIPASA score, followed by an appendectomy. The appendix specimen obtained during the appendectomy was sent to the laboratory for histopathology. After receiving the histopathology study's objective, which was to determine the report, the results of histopathology, RIPASA score, and other information, including name, age, gender, and age group, were recorded. The age distribution in the sample varied from 15-65 years, with a mean age of 25.8±11.0 years. There were 114 males (66.7%) and 57 females (33.3%). The RIPASA score had a sensitivity of 94.9%, specificity of 64.2%, PPV of 96.7%, NPV of 52.9%, and accuracy of 92.4%. Stratification was also carried out for age and gender. Age 15-25 showed a sensitivity of 94%, specificity of 57.1%, PPV of 97.3%, NPV of 36.3%, and accuracy of 91.9%. Similarly, the age 26-65 group revealed a sensitivity of 97.5%, specificity of 71.4%, PPV of 65.1%, NPV of 83.3%, and accuracy of 93.6%. Stratification by gender showed a sensitivity of 94.2%, specificity of 66.6%, PPV of 97%, NPV of 50%, and accuracy of 92.1% for males, while for females, the sensitivity was 96.1%, specificity was 60%, PPV was 96.1%, NPV was 60%, and accuracy was 92.9%. In conclusion, the study suggests that the RIPASA scoring system is a good choice for doctors in the emergency department to aid in diagnosing acute appendicitis with good sensitivity, albeit with a slightly high profile and specificity, albeit with a bit low profile.
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Arad, Banafsheh, Abolfazl Mahyar, Mahmoud Vandaie, and Sonia Oveisi. "Prediction of Vesicoureteral Reflux by Ultrasonography and Renal Scan in Children." Global Pediatric Health 9 (January 2022): 2333794X2211078. http://dx.doi.org/10.1177/2333794x221107826.
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Background. In recent studies, renal ultrasonography and dimercapto-succinic acid (DMSA) scan have a role in predicting vesicoureteral reflux in children with febrile urinary tract infection (UTI). Materials and Methods. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were defined for ultrasonography and DMSA scan to predict vesicoureteral reflux in 70 children with febrile UTI. Results. Renal ultrasonography sensitivity, specificity, PPV, NPV, PLR, and NLR for vesicourethral reflux prediction was 0.57, 0, 1, 0, 0.57, and 0.47 and sensitivity, specificity, PPV, NPV, PLR, and NLR of DMSA scan for predicting vesicourethral reflux was 0.75, 0.9, 0.33, 0.98, 7.5, and 0.27, respectively. Conclusions. Ultrasonography cannot predict the presence of VUR, but DMSA scan has a good sensitivity in this context. Therefore, by observation of DMSA scan results, it can be decided whether to perform VCUG or not.
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Rai, Samarpit, Adnan Dervishi, Brittany Ewing O'Bryan, et al. "What is the accuracy of multi-parametric magnetic resonance imaging in predicting adverse pathology in patients undergoing radical prostatectomy?" Journal of Clinical Oncology 36, no. 6_suppl (2018): 139. http://dx.doi.org/10.1200/jco.2018.36.6_suppl.139.
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139 Background: Few studies have examined the accuracy of preoperative multi-parametric magnetic resonance imaging (MP-MRI) in predicting adverse pathological features in patients undergoing radical prostatectomy (RP) for localized prostate cancer (PCa). Methods: We retrospectively analyzed the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of preoperative MP-MRI for adverse pathologic features [extracapsular extension (ECE), seminal vesicle invasion (SVI), lymph node involvement (LNI) and high Gleason score) on postoperative pathologic staging after RP in 30 patients with localized PCa . Results: The median age and preoperative PSA were 62.5 years and 8.5 ng/mL, respectively.17 patients had ECE, 5 had SVI, 5 had LNI, and 15 had high risk Gleason score (4+3, tertiary pattern 5, 4+4 or higher). The sensitivity, specificity, PPV and NPV of MP-MRI for ECE was 64.71% (95%CI 38.33 - 65.79), 92.31% (95% CI 63.97 - 99.81), 91.67% (95% CI 61.52 - 99.79), and 66.67% (95% CI 40.89 - 86.96) respectively. For the detection of SVI on MP-MRI, the sensitivity, specificity, PPV, and NPV were 60% (95% CI 14.66 - 94.73), 96% (95% CI 76.95 - 99.90), 75% (95% CI 19.41 - 99.37), and 92.31% (95% CI 74.87 - 99.05) respectively. For the detection of LNI, the sensitivity of MP-MRI was 100% (95% CI 47.82 - 100), specificity was 96% (95% CI 79.65 - 99.90), PPV was 83.33% (95% CI 35.88 - 99.58), NPV was 100% (95% CI 85.75 - 100). For detection of of high risk Gleason score the sensitivity of MP-MRI was 94.44% (95% CI 72.71 - 99.86), specificity was 66.67% (95% CI 34.89 - 90.08), PPV was 80.95% (95% CI 58.09 - 94.55), and NPV was 88.89% (95% CI 51.75 - 99.72). Conclusions: MP-MRI has a reasonable sensitivity, specificity, and NPV for the preoperative detection of adverse pathologic features at prostatectomy. This could provide assistance in the selection of patients appropriate for Active Surveillance as well as in the preoperative counseling regarding multimodality treatment for PCa.
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Ladika Davidovic, Blazenka, Dubravka Muzina Misic, and Ivan Samija. "Peritoneal interleukin-6 and tumor necrosis factor-alpha as markers for early detection of anastomotic dehiscence following surgery for colorectal cancer." Molecular and experimental biology in medicine 2, no. 2 (2019): 28–32. http://dx.doi.org/10.33602/mebm.2.2.5.
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Anastomotic dehiscence is one of the most serious complications following surgery for colorectal cancer, and early detection of anastomotic dehiscence is critical to minimize mortality and morbidity. The aim of this study was to determine the value of peritoneal interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) as markers for preclinical detection of anastomosis dehiscence following colorectal surgery. Concentrations of IL-6 and TNF-α were measured in drain fluid obtained from 58 patients on days 1 to 4 following surgery for colorectal cancer. Five out of 58 patients developed anastomosis dehiscence. Patients who developed anastomosis dehiscence had significantly higher concentration of IL-6 on day 1 after surgery, and TNF-α on day 1, 2 and 4 after surgery. Interleukin-6 on day 1 was predictive for anastomosis dehiscence with specificity of 83%, sensitivity of 80%, positive predictive value (PPV) of 31% and negative predictive value (NPV) of 98%. TNF-α was predictive for anastomosis dehiscence on day 1 (specificity 92%, sensitivity 80%, PPV 50%, NPV 98%), day 2 (specificity 94%, sensitivity 80%, PPV 57%, NPV 98%), and day 4 (specificity 83%, sensitivity 100%, PPV 27%, NPV 100%). Our study indicates the potential use of peritoneal cytokines IL-6 and TNF-α as additional diagnostic tool for early detection of anastomosis dehiscence following colorectal surgery.
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Putri Wirawati1, I. A., Aryati Aryati, and A. A. Wiradewi Lestari. "ROLE OF IMMATURE/TOTAL NEUTROPHIL RATIO, LEUKOCYTE COUNT AND PROCALCITONIN IN DIAGNOSING NEONATAL SEPSIS." INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY 24, no. 2 (2018): 169. http://dx.doi.org/10.24293/ijcpml.v24i2.1319.
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Neonatal sepsis is a clinical syndrome of systemic disease, accompanied by bacteremia that occurs during infants in the first month of life. A late diagnosis might increase mortality. The presence of bacteria growth in blood cultures is a definitive diagnosis. Unfortunately, culture results are usually obtained of a long time. The study aimed to analyze sensitivity and specificity of the manual I/T ratio, automatic I/T ratio, leukocyte count and procalcitonin (PCT) to diagnose neonatal sepsis. This study used a cross-sectional design, from the NICU room in Sanglah General Hospital, Denpasar. There were 59 patients who met the study criteria. Along with blood culture as the gold standard in determining diagnosis of sepsis and with I/T ratio cut-off of 0.2, the sensitivity of manual I/T ratio was 69.2%, specificity 83.9%, PPV 63.9%, NPV 87% and likelihood ratio was 3.06. While the sensitivity of automatic I/T ratio was 47.6%, specificity 85.8%, PPV 55.1%, NPV 81.4% and likelihood ratio was 2.25. Based on the normal range of leukocyte count (9.1 - 34 x 103/μl), sensitivity of leukocyte count was 59%, specificity 71.5%, PPV 46.7%, NPV 80.9% and likelihood ratio was 1.59. With PCT cut-off 0.5 ng/mL, the obtained sensitivity of PCT was 64.3%, specificity 85.8%, PPV 64.3%, NPV 85.8% and likelihood ratio was 3.13.
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Carnero Contentti, Edgar, Vanessa Daccach Marques, Ibis Soto de Castillo, et al. "Brain and spinal MRI features distinguishing MS from different AQP4 antibody serostatus NMOSD at disease onset in a cohort of Latin American patients." Multiple Sclerosis Journal 26, no. 8 (2019): 945–54. http://dx.doi.org/10.1177/1352458519849517.
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Objective: We aimed to evaluate magnetic resonance imaging (MRI) previously used criteria (Matthews’s criteria, MC) for differentiating multiple sclerosis (MS) from neuromyelitis optica spectrum disorders (NMOSD) in Caucasian and non-Caucasian populations (Argentina, Brazil and Venezuela) with positive (P-NMOSD), negative (N-NMOSD), and unknown (U-NMOSD) aquaporin-4 antibody serostatus at disease onset and to assess the added diagnostic value of spinal cord MRI in these populations. Methods: We reviewed medical records, and MRIs were assessed by two blinded evaluators and were scored using MC. Short-segment transverse myelitis (STM) was added as a new criterion. MC sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. Results: We included 282 patients (MS = 188 and NMOSD = 94). MC applied to the entire cohort showed 97.8% sensitivity, 82.9% specificity, 92.0% PPV, and 95.1% NPV for differentiating MS from NMOSD. A subanalysis applied only to non-Caucasian (MS = 89 and NMOSD = 47) showed 100% sensitivity, 80.8% specificity, 90.8% PPV, and 100% NPV. Similar sensitivity, specificity, PPV, and NPV of MC for MS versus P-NMOSD ( n = 55), N-NMOSD ( n = 28), and U-NMOSD ( n = 21) were observed. Conclusion: MC distinguished MS from NMOSD of all serostatus in a Latin American cohort that included non-Caucasian populations. Addition of STM to MC did not raise the accuracy significantly.
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Zhu, Xueli, Yi Cao, Ruidie Li, Mingxia Zhu, and Xin Chen. "Diagnostic performance of mammography and magnetic resonance imaging for evaluating mammographically visible breast masses." Journal of International Medical Research 49, no. 9 (2021): 030006052097309. http://dx.doi.org/10.1177/0300060520973092.
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Objective We compared the diagnostic values of mammography and magnetic resonance imaging (MRI) for evaluating breast masses. Methods We retrospectively analyzed mammography, MRI, and histopathological data for 377 patients with breast masses on mammography, including 73 benign and 304 malignant masses. Results The sensitivities and negative predictive values (NPVs) were significantly higher for MRI compared with mammography for detecting breast cancer (98.4% vs. 89.8% and 87.8% vs. 46.6%, respectively). The specificity and positive predictive values (PPV) were similar for both techniques. Compared with mammography alone, mammography plus MRI improved the specificity (67.1% vs. 37.0%) and PPV (91.8% vs. 85.6%), but there was no significant difference in sensitivity or NPV. Compared with MRI alone, the combination significantly improved the specificity (67.1% vs. 49.3%), but the sensitivity (88.5% vs. 98.4%) and NPV (58.3% vs. 87.8%) were reduced, and the PPV was similar in both groups. There was no significant difference between mammography and MRI in terms of sensitivity or specificity among 81 patients with breast masses with calcification. Conclusion Breast MRI improved the sensitivity and NPV for breast cancer detection. Combining MRI and mammography improved the specificity and PPV, but MRI offered no advantage in patients with breast masses with calcification.
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Conduit, Ciara, Michael S. Hofman, Jeremy Howard Lewin, Guy C. Toner, and Ben Tran. "Clinical utility of FDG PET-CT in stage 1 and advanced testicular seminoma." Journal of Clinical Oncology 39, no. 15_suppl (2021): 5027. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.5027.
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5027 Background: Testicular seminoma is highly curable; however, treatments can cause long-term morbidity in survivors. Following chemotherapy for advanced seminoma, positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose together with computerised tomography (PET-CT) can identify patients with residual masses who do not need additional treatment. Its role in detecting recurrence during active surveillance, particularly in patients with small indeterminate masses, is unknown. We assessed the clinical utility of PET-CT in testicular seminoma undergoing active surveillance for stage 1 disease and following curative-intent treatment for advanced disease. Methods: An institutional database was interrogated to identify patients with testicular seminoma who underwent PET-CT between 2000-2020. Demographic, clinicopathological, PET-CT findings and outcome data were retrieved. The positive predictive value (PPV) of PET-CT for correctly identifying disease recurrence was calculated, with disease recurrence (true positive) defined as progressive radiological change, response to treatment or histological confirmation. Negative predictive value (NPV) was calculated for correctly identifying non-recurrence (true negative) at 24-months post PET-CT. Results: We identified 193 PET-CT in 181 stage 1 patients. Of these, 18 (10%) PET-CT were positive, with all correctly diagnosing recurrence, PPV 100%. Of the 138 negative PET-CT with at least 24 months follow up, 5 recurrences developed, NPV 96%. In the subset of PET-CT conducted for suspicion of recurrence in stage 1 patients (n = 71: abnormal imaging n = 65, elevated markers n = 4, other clinical suspicion n = 2), 16 (23%) PET-CT were positive, with all correctly diagnosing recurrence, PPV 100%. In this subset, the NPV is 93% at 24 months (3 recurrences in 44 negative PET-CT). We also identified 154 PET-CT in 77 post-treatment, advanced stage patients. Of these, 69 (45%) PET-CT were positive, with 51 correctly diagnosing recurrence, PPV 74%. Of the 66 negative PET-CT with at least 24 months follow up, 5 recurrences developed, NPV 92%. In the subset of PET-CT performed for suspicion of recurrence following treatment for advanced disease (n = 61: abnormal imaging n = 49, elevated markers n = 5, other clinical suspicion n = 7), 41 (67%) PET-CT were positive, with 36 correctly diagnosing recurrence, PPV 88%. In this subset, the NPV is 94% at 24 months (1 recurrence in 17 negative PET-CT). Conclusions: At our centre, PET-CT has a very high PPV for recurrence, particularly in stage 1 disease, and a very high NPV for non-recurrence in all disease settings. In the subset of PET-CT performed for suspicion of recurrence, PPV is > 88% and NPV is > 93%. The role of PET-CT should be considered in patients with suspicion of recurrence where it may prevent over-treatment in up to 70% patients in stage 1 or 30% in advanced disease.
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Rio, Purwati Pole, Hariadi Hariawan, Dyah Wulan Anggrahini, Anggoro Budi Hartopo, and Lucia Kris Dinarti. "The Accuracy of Combined Electrocardiogram Criteria to Diagnose Right Atrial Enlargement in Adults With Uncorrected Secundum Atrial Septal Defect." Clinical Medicine Insights: Cardiology 13 (January 2019): 117954681986994. http://dx.doi.org/10.1177/1179546819869948.
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Background: Right atrium (RA) enlargement in uncorrected atrial septal defect (ASD) is due to chronic volume overload. Several electrocardiogram (ECG) criteria had been proposed for screening RA enlargement. This study aimed to compare the accuracy of ECG criteria in detecting RA enlargement in adults with uncorrected ASD. Methods: This was a cross-sectional study involving 120 adults with uncorrected secundum ASD. The subjects underwent ECG examination, transthoracic echocardiography, and right heart catheterization. An RA enlargement was determined with RA volume index by transthoracic echocardiography. Various ECG and combined ECG criteria were evaluated. Statistical analysis was performed to analyze the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV). Results: An RA enlargement was detected in 64.2% subjects. The P wave height > 2.5 mm in lead II criterion had the best specificity (100%) and PPV (100%), but low sensitivity (19%) and accuracy (48%). The combined 2 ECG criteria (QRS axis > 90°, R/S ratio > 1 in V1) had 82% sensitivity, 56% specificity, 73% accuracy, 77% PPV, and 63% NPV. The combined 3 ECG criteria (QRS axis > 90°, R/S ratio > 1 in V1, and P wave height > 1.5 mm in V2) had 35% sensitivity, 86% specificity, 53% accuracy, 82% PPV, and 43% NPV. Conclusions: The combined 2 ECG criteria (QRS axis > 90° and R/S ratio > 1 in V1) had increased sensitivity, better accuracy, and more balance of PPV and NPV as compared with P wave > 2.5 mm in II criterion and combined 3 ECG criteria to diagnose RA enlargement in adults with uncorrected ASD.