scholarly journals Predictive Value of Pleural Cytology in the Diagnosis of Complicated Parapneumonic Effusions and Empyema Thoracis

2020 ◽  
Vol 2020 ◽  
pp. 1-5 ◽  
Author(s):  
John Ferguson ◽  
Michal Kazimir ◽  
Michael Gailey ◽  
Frank Moore ◽  
Earl Schott
Keyword(s):  
Logistic Regression ◽  
Pleural Fluid ◽  
Predictive Value ◽  
Interobserver Agreement ◽  
Empyema Thoracis ◽  
Cytologic Diagnosis ◽  
Wilcoxon Rank Sum Test ◽  
Sensitivity Specificity ◽  
Fluid Cytology

Introduction. Complicated parapneumonic effusions (CPE) are distinguished from uncomplicated parapneumonic effusions (UPE) by the ability to resolve without drainage. Determinants include pleural pH, pleural glucose, and pleural LDH, along with microbiologic cultures. Inflammation mediated by neutrophil chemotactic cytokines leads to fibrinous loculation of an effusion, and the degree of this inflammation may lead to a CPE. One role of the pathologist is to evaluate for the presence of malignancy in a pleural effusion; however, the ability of the pathologist to distinguish a CPE from UPE has not been evaluated. Materials and Methods. A single-center retrospective study was performed on pleural cytology specimens from 137 patients diagnosed with a parapneumonic effusion or empyema over a five-year interval. Pleural cytology was characterized as either uncomplicated or complicated by two pathologists based on cellular composition and the presence or absence of fibrinous exudate in the fluid. Cohen’s kappa was calculated for interobserver agreement. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of cytologic diagnoses were calculated. Determinants of cytologic accuracy were assessed using Wilcoxon rank sum test, unpaired t-test, and logistic regression. Results. Kappa interobserver agreement between pathologists was 0.753. Pleural fluid cytology sensitivity, specificity, PPV, and NPV for CPE/empyema were 76.0%, 95% CI [65.0, 84.9]; 50%, 95% CI [29.1, 70.9]; 83.3%, 95% CI [76.7, 88.4]; and 38.7%, 95% CI [26.5, 52.5], respectively. The presence of pleural bacteria, elevated pleural LDH, and reduced pleural pH were nonsignificant determinants of cytologic accuracy. Logistic regression was significant for the presence of pleural bacteria (p=0.03) in determining a successful cytologic diagnosis. Conclusion. Pleural cytology adds little value to traditional markers of distinguishing a UPE from CPE. Inflammation on pleural fluid cytology is suggestive of empyema or the presence of pleural fluid bacteria.

scholarly journals Correlation of colposcopy with biopsy in cases of abnormal cervical cytology

2019 ◽  
Vol 14 (1) ◽  
pp. 36-39
Author(s):  
Kirtipal Subedi
Keyword(s):  
Predictive Value ◽  
Prospective Observational Study ◽  
Accurate Diagnosis ◽  
Cervical Cytology ◽  
Histopathological Diagnosis ◽  
Cervical Biopsy ◽  
Abnormal Cervical Cytology ◽  
Disease Threshold ◽  
Sensitivity Specificity

Aims: This study aims to find out the role of colposcopy and its correlation with cervical biopsy in detection of pre malignant cervical lesion. Methodology: This is hospital based prospective observational study on 60 cases with abnormal cervical cytology reports conducted in the Department of Obstetrics and Gynecology, PMWH, Thapathali, Kathmandu. Colposcopy guided biopsies were done and findings noted. Results: Among 60 cases enrolled in the study the most common cervical cytology finding was ASCUS, LSIL, HSIL and ASC-H present in 46.6%, 31.6%, 15% and 6.6% respectively.  The colposcopy finding among these cases was normal, CIN1, CIN 2 and CIN 3 in 45%, 23.3%, 16.7% and 9% respectively. Among these cases the most common biopsy finding was normal, CIN 1, CIN 2, CIN 3 and squamous cell carcinoma in 55%, 18.3%, 8.3%, 15% and 3.3% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of colposcopy with CIN 1 as disease threshold was calculated to be 80.6%, 93.1%, 81.8% and 92.6% respectively. While evaluating the validity of colposcopy with histopathology, colposcopy seems to make an accurate diagnosis in 75% of cases, overestimating in 15% and underestimating in 8% of cases. Conclusions: There is a good correlation of colposcopy with histopathological diagnosis of cervical cancer. Keywords: colposcopy, cytology, diagnosis, premalignant  

scholarly journals Can CT Virtual Cystoscopy Replace Conventional Cystoscopy in Early Detection of Bladder Cancer?

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Sachin Abrol ◽  
Ankush Jairath ◽  
Sanika Ganpule ◽  
Arvind Ganpule ◽  
Shashikant Mishra ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Early Detection ◽  
Predictive Value ◽  
Bladder Tumor ◽  
Urothelial Cancer ◽  
Routine Clinical Practice ◽  
Bladder Tumors ◽  
Virtual Cystoscopy ◽  
Sensitivity Specificity

Aim. To correlate findings of conventional cystoscopy with CT virtual cystoscopy (CTVC) in detecting bladder tumors and to evaluate accuracy of virtual cystoscopy in early detection of bladder cancer.Material and Method. From June 2013 to June 2014, 50 patients (46 males, four females) with history and investigations suggestive of urothelial cancer, with mean age 62.76 ± 10.45 years, underwent CTVC by a radiologist as per protocol and subsequently underwent conventional cystoscopy (CPE) the same day or the next day. One urologist and one radiologist, blinded to the findings of conventional cystoscopy, independently interpreted the images, and any discrepant readings were resolved with consensus.Result. CTVC detected 23 out of 25 patients with bladder tumor(s) correctly. Two patients were falsely detected as negative while two were falsely labeled as positive in CTVC. Virtual and conventional cystoscopy were comparable in detection of tumor growth in urinary bladder. The sensitivity, specificity, positive predictive value, and negative predictive value of virtual cystoscopy were 92% each.Conclusion. CTVC correlates closely with the findings of conventional cystoscopy. Bladder should be adequately distended and devoid of urine at the time of procedure. However, more studies are required to define the role of virtual cystoscopy in routine clinical practice.

Diagnostic evaluation of immune checkpoint inhibitor (CPI) colitis: The role of CT scan.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 821-821
Author(s):  
Sienna Durbin ◽  
Meghan Mooradian ◽  
Leyre Zubiri ◽  
Ian Matthew Allen ◽  
Florian Fintelmann ◽  
...  
Keyword(s):  
Ct Scan ◽  
Predictive Value ◽  
Gold Standard ◽  
Invasive Procedure ◽  
Primary Objective ◽  
Lower Endoscopy ◽  
Grade 3 ◽  
Sensitivity Specificity ◽  
Tumor Types

821 Background: CPI therapy has expanded rapidly in recent years and represents a major advancement in the treatment of many cancers, including hepatocellular carcinoma, gastric cancer, and colon cancer. However, these therapies are associated with significant toxicities. CPI colitis is one of the most common toxicities and can be fatal, especially when not diagnosed and treated promptly. The current gold standard for diagnosis is endoscopy with biopsy, an invasive procedure that is resource- and time-intensive. CT has emerged as a possible alternative. The primary objective of this study is to identify the diagnostic performance of CT in the evaluation of CPI colitis. Methods: With IRB approval, we conducted a retrospective cohort study of patients who received CPI therapy between 2009-2019 across a single healthcare system. Patients were included if they underwent both abdominal CT and upper/lower endoscopy with biopsy within 72 hours of each other. We reviewed the electronic medical record to identify possible cases of colitis based on either CT or pathology. All cases were labeled as either true positive or false positive based on pathology. We examined clinical characteristics, including CTCAE grade and treatment received. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CT for diagnosing CPI colitis when compared to the gold standard of tissue diagnosis. Results: Of the 4,474 patients screened, 141 met inclusion criteria. Average age was 63 years (23 – 91); 43% were male. Most common tumor types were melanoma (36%) and NSCLC (20%). Seventy-four percent of patients were treated with anti-PD-1/PD-L1 monotherapy. Forty percent had signs of colitis on CT scan and 59% had biopsy-proven CPI colitis. Sensitivity and specificity of CT were 51% and 74%, respectively. PPV of CT was 74% and NPV was 51%. Of those with confirmed CPI colitis, 78% had symptoms that were classified as grade 3 or above. Seventy-three percent received IV steroids and 38% received infliximab. Conclusions: CT demonstrates moderate specificity and PPV and remains an important diagnostic test but does not replace endoscopy/biopsy in the evaluation of CPI colitis.

scholarly journals Diagnostic Role of Pediatric Appendicitis Score (PAS) in Appendicitis of Children

2016 ◽  
Vol 6 (1) ◽  
pp. 16-19
Author(s):  
Susankar Kumar Mondal ◽  
AKM Zahid Hossain ◽  
Mizanur Rahman ◽  
Gazi Zahirul Hasan ◽  
Kaniz Hasina ◽  
...  
Keyword(s):  
Predictive Value ◽  
Age Group ◽  
Good Tool ◽  
Suspected Appendicitis ◽  
Diagnostic Role ◽  
Group 5 ◽  
Negative Appendicectomy ◽  
Sensitivity Specificity ◽  
Appendicitis Score

Appendicitis is one of the most common causes of acute abdominal pain in pediatrics and is the most common indication for emergency abdominal surgery in childhood. The diagnosis of pediatric appendicitis remains challenging. To evaluate the role of pediatric appendicitis score (PAS) in the diagnosis of appendicitis of children.Methods: In this study, 200 suspected appendicitis patients attended in four private hospitals in old Dhaka city over a period of about 34 months from January 2011 to May 2014 were selected as study subjects. Patient age, sex and each of the eight PAS components were collected. Children who had PAS less than six were discharged and contacted by telephone upto 1 month to verify final outcome. Rest of the children with PAS equal or more than 6 were underwent appendectomy.Results: Two hundred patients were assessed in this study. Out of them 67 (33.5%) children had appendicitis and 76 (38.0%) children had PAS equal or more than 6. In appendicitis children, maximum (85.3%) children were in age group 10- 16 years and 10 (14.7%) patients were in age group 5-9 years.Male (73.5%) were predominant than female (26.5%) in appendicitis children. Migration of pain, nausea and anorexia were in 43 (63.2%), 45 (66.2%) and 48 (70.6%) appendicitis children respectively. Fever, cough/percussion tenderness and tenderness in RLQ were in 37 (54.4%), 52 (76.5%) and 59 (86.8%) appendicitis children respectively. Leukocytosis andneutophilia were present in 42 (61.8%) and 46 (67.6%) appendicitis children respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy rate of PAS were 80.6%, 83.5%, 71.1%, 89.5% and 82.5% respectively.Conclusion: Paediatric Appendicitis Score is a good tool but not good enough for diagnosis of paediatirc appedicitis. It cannot be recommended for diagnosis of paediatric appendicitis because its negative appendicectomy rate as well as wrongly discharged rate is high.J. Paediatr. Surg. Bangladesh 6(1): 16-19, 2015 (Jan)

scholarly journals Role of ultrasound guided fine needle aspiration cytology of right hypochondrial masses

2017 ◽  
Vol 5 (12) ◽  
pp. 5312
Author(s):  
Nidhi Verma ◽  
. Neetu ◽  
S. P. Sharma ◽  
Preeti Singh ◽  
Anuj Kumar
Keyword(s):  
Fine Needle Aspiration ◽  
Predictive Value ◽  
Single Case ◽  
Needle Aspiration ◽  
Primary Hepatocellular Carcinoma ◽  
Ultrasound Guided ◽  
Fine Needle ◽  
Abdominal Masses ◽  
Sensitivity Specificity

Background: Patients having right hypochondrial intra-abdominal masses are commonly encountered in clinical practice. The study was done to know the role of ultrasound guided fine needle aspiration in diagnosing right hypochondrial masses and its most common cause.Methods: 112 cases were collected from department of surgery, SVBP hospital meerut. FNAC was done using 22-23 G disposable lumbar puncture needle with trochar fitted with 20 ml syringe, introduced under radiological guidance and aspiration is done under negative pressure. Smears were stained with Leishman’s stain, May Grunwald Geimsa (MGG) and Papnicolou stain.Results: Out of total 112 cases, 12 cases excluded from study as only blood was aspirated. Therefore, out of 100 cases, 83% (83/100) cases were malignant, 7% (7/100) benign and 10% (10/100) inconclusive/ due to low cellularity. Among the malignant masses, majority 52 (52.0%) cases were of liver secondaries followed by 24 (24.0%) cases of adenocarcinoma gall bladder, 5 (5.0%) cases of primary hepatocellular carcinoma (HCC) and single case (1%), each of cholangiocarcinoma GB and squamous cell carcinoma GB. Among the benign lesions, 3 (3.0%) cases of liver abscess, 2 (2.0%) cases of hydatid disease followed by single case (1.0%) of hepatic adenoma and cysticercosis liver. In this study, overall accuracy of USG guided FNAC was 96.66%. Sensitivity, specificity, positive predictive value, negative predictive value and efficacy of USG guided FNAC in right hypochondrial masses were 96.66%, 100%, 100%, 66.67% and 96.87% respectively.Conclusions: USG guided FNAC is simple, quick, safe, reliable and economical tool without any significant complication in diagnosing right hypochondrial masses.

scholarly journals “A Four-Leaf Clover” Sign for Rapid Identification of Coagulase-Negative Staphylococci by Gram Staining From Positive Blood Culture: A Cross-Sectional Study

2020 ◽  
Author(s):  
Takahiro Matsuo ◽  
Kuniyoshi Hayashi ◽  
Aki Sakurai ◽  
Masumi Suzuki Shimizu ◽  
Masaya Morimoto ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Blood Culture ◽  
Positive Predictive Value ◽  
Positive Blood Culture ◽  
Predictive Value ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococci ◽  
Gram Staining ◽  
Sensitivity Specificity

Abstract Background: Coagulase-negative staphylococci (CoNS) are one of the most common contaminant microorganisms isolated from blood cultures. Few studies exploring the use of Gram staining to distinguish between Staphylococcus aureus (SA) and CoNS have been reported. Here, this study aimed to explore whether morphological features of Gram staining could identify SA or CoNS.Methods: This study was conducted at St. Luke’s International Hospital from November 2016 to September 2017. The positive blood cultures for which the Gram staining showed gram-positive cocci (GPC) in clusters were included in our study. The direct smear of Gram staining obtained from positive blood culture bottles were examined within 24 hours of positivity. We have identified and characterized the following two signs: “four-leaf clover (FLC)” if 4 GPC gathered like a planar four-leaf clover and “grapes” if the GPC gathered like grapes in a three-dimensional form. The number of fields with FLC and grapes signs in 10 fields per slide with ×1,000 power was counted, and the results in a total of 20 fields with ×1,000 power were combined. We performed a logistic regression analysis to assess whether these signs could serve as factors distinguishing between SA and CoNS. The predictive ability of these signs was evaluated based on the sensitivity, specificity, positive predictive value, and negative predictive value for CoNS via receiver operating curve analysis.Results: In total, 106 blood cultures for which Gram staining showed GPC in clusters were examined; 46 (43%) were SA, and 60 (57%) were CoNS samples. The result of multivariate logistic regression analysis showed that the FLC sign was a statistically significant marker of CoNS with an odds ratio of 1.31 (95 % confidential interval (CI): 1.07–1.61, p<0.05). In aerobic bottles, sensitivity, specificity, positive predictive value, and negative predictive value for CoNS were 0.67, 0.91, 0.92, and 0.65, respectively, and the value of area under the curve was 0.79 (95% CI: 0.67–0.91).Conclusions: To our knowledge, this is the first study to show that the FLC could be a rapid and useful indicator to identify CoNS in aerobic bottles. Thus, the presence of FLC sings could help clinicians to suspect the possibility of CoNS before the final identification by cultures.

scholarly journals Elastography for the Diagnosis of High-Suspicion Thyroid Nodules Based on the 2015 American Thyroid Association Guidelines: A Multicenter Study

2020 ◽  
Author(s):  
Hairu Li ◽  
Yulan Peng ◽  
Yan Wang ◽  
Hong Ai ◽  
Xiaodong Zhou ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Reference Method ◽  
Final Analysis ◽  
American Thyroid Association ◽  
Diagnostic Efficiency ◽  
Sensitivity Specificity

Abstract Background: An accurate diagnosis for high-suspicion nodules based on the 2015 American Thyroid Association (ATA) guidelines would reduce unnecessary invasive examinations. Elastography is a useful tool for discriminating benign and malignant thyroid nodules. The aim of this study is to investigate the diagnostic efficiency of elastography for high-suspicion thyroid nodules based on the 2015 ATA guidelines in the Chinese population.Methods: Thyroid nodules with high-suspicion characteristics based on the 2015 ATA guidelines were subjected to conventional ultrasound (US) and ultrasound strain elastography (USE) examinations at 12 hospitals from 4 geographic regions across China. Cytology/histology of thyroid nodules was used as a reference method. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic performance of the elasticity score (ES) and strain ratio (SR). Logistic regression analysis was used to determine the predictors of malignancy.Results: Overall, a total of 1445 thyroid nodules (834 malignant, 611 benign) from 12 centers were included in the final analysis. The areas under the curve of the ES and SR were 0.828 and 0.732, respectively. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the ES were 92.4%, 60.7%, 79.0%, 76.3% and 85.5%, respectively, and those of the SR were 81.1%, 50.1%, 68.9%, 65.9% and 67.9%, respectively. The combination of the Thyroid Imaging Reporting and Data System (TI-RADS) and ES led to a significant increase in the sensitivity and NPV (97.1% and 91.9%, respectively) compared with the TI-RADS alone. Logistic regression analysis showed that microcalcifications (OR=5.290), taller than wide (OR=12.710), irregular margins (OR=10.117), extrathyroidal extension (ETE; OR=6.412), the ES (OR=3.741) and the SR (OR=1.083) were independent predictors of malignant thyroid nodules. The sensitivity, specificity, accuracy, PPV and NPV of the ES were all superior in nodules ≥1 cm than in those <1 cm (95.0% vs 90.4%, 68.8% vs 56.8%, 85.9% vs 74.4%, 85.2% vs 69.9%, and 87.8% vs 84.2%, respectively).Conclusions: Elastography combined with the ES is a valuable tool for the assessment of high-suspicion thyroid nodules based on the 2015 ATA guidelines, especially in nodules ≥1 cm.

scholarly journals Elastography for the Diagnosis of High-Suspicion Thyroid Nodules Based on the 2015 American Thyroid Association Guidelines: A Multicenter Study

2020 ◽  
Author(s):  
Hairu Li ◽  
Yulan Peng ◽  
Yan Wang ◽  
Hong Ai ◽  
Xiaodong Zhou ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Predictive Value ◽  
Thyroid Nodules ◽  
Reference Method ◽  
Final Analysis ◽  
American Thyroid Association ◽  
Diagnostic Efficiency ◽  
Sensitivity Specificity

Abstract Background: An accurate diagnosis for high-suspicion nodules based on the 2015 American Thyroid Association (ATA) guidelines would reduce unnecessary invasive examinations. Elastography is a useful tool for discriminating benign and malignant thyroid nodules.Aims: To investigate the diagnostic efficiency of elastography for high-suspicion thyroid nodules based on the 2015 ATA guidelines in the Chinese population.Materials and Methods: Thyroid nodules with high-suspicion characteristics based on the 2015 ATA guidelines were subjected to conventional ultrasound (US) and ultrasound strain elastography (USE) examinations at 12 hospitals from 4 geographic regions across China. Cytology/histology of thyroid nodules was used as a reference method. Receiver operating characteristic (ROC) curves were plotted to evaluate the diagnostic performance of the elasticity score (ES) and strain ratio (SR). Logistic regression analysis was used to determine the predictors of malignancy.Results: Overall, a total of 1445 thyroid nodules (834 malignant, 611 benign) from 12 centers were included in the final analysis. The areas under the curve of the ES and SR were 0.828 and 0.732, respectively. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of the ES were 92.4%, 60.7%, 79.0%, 76.3% and 85.5%, respectively, and those of the SR were 81.1%, 50.1%, 68.9%, 65.9% and 67.9%, respectively. The combination of the Thyroid Imaging Reporting and Data System (TI-RADS) and ES led to a significant increase in the sensitivity and NPV (97.1% and 91.9%, respectively) compared with the TI-RADS alone. Logistic regression analysis showed that microcalcifications (OR=5.290), taller than wide (OR=12.710), irregular margins (OR=10.117), extrathyroidal extension (ETE; OR=6.412), the ES (OR=3.741) and the SR (OR=1.083) were independent predictors of malignant thyroid nodules. The sensitivity, specificity, accuracy, PPV and NPV of the ES were all superior in nodules ≥1 cm than in those <1 cm (95.0% vs 90.4%, 68.8% vs 56.8%, 85.9% vs 74.4%, 85.2% vs 69.9%, and 87.8% vs 84.2%, respectively).Conclusions: Elastography combined with the ES is a valuable tool for the assessment of high-suspicion thyroid nodules based on the 2015 ATA guidelines, especially in nodules ≥1 cm.

An Investigation of the Aetiology of Chronic Headache. The Role of Headache Models

1984 ◽  
Vol 145 (6) ◽  
pp. 665-666 ◽  
Author(s):  
Ira Daniel Turkat ◽  
Andrzej R. Kuczmierczyk ◽  
Henry E. Adams
Keyword(s):  
Predictive Value ◽  
Chronic Headache ◽  
Family Members ◽  
Sensitivity Specificity

SummaryHeadache sufferers (n = 30) reported significantly more immediate family members with headache, compared to controls (n = 22). Sensitivity, specificity, and efficiency analyses revealed that knowledge of family headache history has predictive value. The results are consistent with findings with other pain disorders.

Sign in / Sign up

Export Citation Format

Share Document