scholarly journals The Diagnostic Accuracy of Endometrial Sampling in Endometrial Hyperplasia

2017 ◽  
pp. 1
Author(s):  
Serdar Başaranoğlu ◽  
Elif Ağaçayak ◽  
Şafak Hatırnaz ◽  
Ayşegül Deregözü ◽  
Mustafa Acet ◽  
...  
Keyword(s):  
Predictive Value ◽  
Endometrial Hyperplasia ◽  
Treatment Options ◽  
Endometrial Biopsy ◽  
Predictive Values ◽  
Medicine Department ◽  
Endometrial Sampling ◽  
Pathologic Diagnosis ◽  
School Of Medicine ◽  
Sensitivity Specificity

<p><strong>Objective:</strong> Endometrial hyperplasia is a premalignant lesion characterized with hyperplastic changes in endometrial gland and stromal structures. Its incidence is not exactly known. This study evaluated the accuracy of endometrial sampling of the patients whose pathological results were endometrial hyperplasia and had undergone hysterectomy (paraffin sections).<br /><strong>Study Design:</strong> Patients that diagnosed with endometrial hyperplasia by endometrial biopsy and/or hysterectomy at Dicle University School of Medicine Department of Obstetrics and Gynecology between January 2006 and July 2014 were retrospectively evaluated. Sensitivity, specificity, and positive and negative predictive values of endometrial biopsy to predict postoperative hysterectomy result were calculated. Discrete results in endometrial sampling and hysterectomy were recorded separately. Statistical analyses were conducted with corresponding appropriate methods. <br /><strong>Results:</strong> Mean ages of pre and postmenopausal patients were 42.6±4.8 (28-50) and 57.7±7.7 (50-79) years, respectively. For the efficiency of endometrial sampling to predict definite pathologic diagnosis, sensitivity was 71.9%, specificity was 87.5%, positive predictive value was 79.3%, and negative predictive value was 82.3%. When the accuracy of endometrial sampling with the pathologic diagnosis was evaluated, 38 patients had accurate (47.5%), and 42 patients had discrete (52.5%) results.<br /><strong>Conclusion:</strong> The presence of atypia determines the treatment in patients with endometrial hyperplasia. Hysterectomy should not be the first option in endometrial hyperplasia patients without atypia, and medical treatment and curettage options should be considered. Experienced staff should perform and evaluate endometrial samplings. We consider that this will increase the success in diagnosis, and could change treatment options.</p>

scholarly journals Sensitivity, Specificity and Predictive Values of Cytological and Microbiological Findings of Endometrial Biopsy, Cytobrush and Low Volume Uterine Lavage in Relation to Endometrial Histology in Barren Mares

2020 ◽  
Vol 15 (04) ◽  
pp. 75-79
Author(s):  
Agnus Mathew ◽  
DM Patel ◽  
KK Hadiya
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Endometrial Biopsy ◽  
Microbial Culture ◽  
K Value ◽  
Predictive Values ◽  
Low Volume ◽  
Sensitivity Specificity ◽  
Uterine Lavage

This study was carried out on 10 infertile barren mares to evaluate the sensitivity, specificity, predictive values and agreement (kappa value) of cytological and microbiological findings of three diagnosing techniques of endometritis, viz., endometrial biopsy (EB), cytobrush (CB) and low volume uterine lavage (LVL) in relation to endometrial histology. When histological examinations from EB were used as “the best standard,” the sensitivity of cytology from EB, CB and LVL technique was 0.33, 0.50 and 0.50; specificity 0.75, 1.00 and 0.75; positive predictive value 0.66, 1.00 and 0.75, and negative predictive value was 0.42, 0.57 and 0.50, respectively. The sensitivity of bacteriology from EB, CB and LVL technique was 0.83, 0.83 and 1.00; the specificity was 0.75, 0.75 and 0.50; positive predictive value 0.83, 0.83 and 0.75, and the negative predictive value was 0.75, 0.75 and 1.00, respectively. In all the cases, the sensitivity of the bacteriology was found to be higher than the sensitivity of cytology. When the results of cytological and bacteriological examinations were combined, no any increase in the sensitivity was found. Bacteriology and cytology from CB showed the highest positive predictive value demonstrating that a positive result is an accurate indication of endometritis. Sensitivity values were always higher if smears were evaluated according to PMNs to epithelial cell ratio, and the highest values were observed in specimens collected from CB and LVL. The evaluation of cytological smears based on counting PMNs in relation to epithelial cells was a better method for diagnosis of endometritis than counting the number of PMNs per high power microscopic field (k value 0.07-0.47 vs. 0.00). The agreement of the diagnosis of endometritis between the three techniques of the collection was from fair to poor and between the different criteria adopted to evaluate smears was always poor. However, the agreement of the diagnosis of endometritis by the microbial culture was moderate between the three techniques of the collection (k value 0.55-0.58).

scholarly journals Accuracy of Preoperative Endometrial Sampling for the Detection of Endometrial Pathology: a Retrospective Study

2017 ◽  
pp. 23
Author(s):  
Keven P M Tali ◽  
Lilli M T Cole
Keyword(s):  
Endometrial Hyperplasia ◽  
Frozen Section ◽  
Medical Center ◽  
Abnormal Uterine Bleeding ◽  
Study Data ◽  
Endometrial Biopsy ◽  
Predictive Values ◽  
Endometrial Sampling ◽  
Test Result ◽  
Endometrial Pathology

Objective: To investigate the accuracy of endometrial sampling in the diagnosis of endometrial pathology and the need of intraoperative frozen section. Methods: One hundred forty women who underwent endometrial sampling followed by hysterectomy between 2011 and 2014 were included in this study. Data were retrieved from patient files and pathology archives in Department of Obstetrics and Gynecology, Jose R. Reyes Memorial Medical Center, Manila, Philippines. Results: There were 25 patients with malignancy but endometrial sampling detected only 22 of them. The endometrial sampling sensitivity and specificity for detecting cancer were 88% and 100%, respectively with negative and positive predictive values of 97.5% and 100%, respectively. In 3 patients, the endometrial sampling failed to detect malignancy; 1 patient had a preoperative diagnosis of complex hyperplasia with atypia, 1 patient had complex hyperplasia without atypia and 1 patient had adenofibroma. A total of eighty patients had benign findings. There were fifty-three cases with finding of proliferative endometrium and twenty-seven were secretory. Twenty-three (55.0%) and 11 (39.0%) cases were confirmed by the hysterectomy specimen, respectively. The sensitivity of endometrial sampling in detecting benign samples was 76.0% and the specificity reached up to 83.0%. The histopathology result of the other fourteen cases were reported of having atrophy, twelve cases were reported of having endometrial hyperplasia, four with basal endometrium, four with endometrial polyp and one with adenomyosis. Conclusion: Outpatient endometrial biopsy has a high overall accuracy in diagnosing endometrial cancer when the specimen obtained is sufficient. A positive test result is more accurate for ruling in disease than a negative test result is for ruling it out. However, the diagnosis should be confirmed by frozen section in patients with complex hyperplasia and adenofibroma. [Indones J Obstet Gynecol 2017; 5-1: 23-29] Keywords: abnormal uterine bleeding, endometrial hyperplasia, endometrial sampling, frozen section, pipelle

scholarly journals Foundational Statistical Principles in Medical Research: Sensitivity, Specificity, Positive Predictive Value, and Negative Predictive Value

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 503
Author(s):  
Thomas F. Monaghan ◽  
Syed N. Rahman ◽  
Christina W. Agudelo ◽  
Alan J. Wein ◽  
Jason M. Lazar ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Medical Literature ◽  
Disease Prevalence ◽  
Positive Test Result ◽  
Predictive Values ◽  
Sensitivity Specificity ◽  
Test Result ◽  
Test Probability

Sensitivity, which denotes the proportion of subjects correctly given a positive assignment out of all subjects who are actually positive for the outcome, indicates how well a test can classify subjects who truly have the outcome of interest. Specificity, which denotes the proportion of subjects correctly given a negative assignment out of all subjects who are actually negative for the outcome, indicates how well a test can classify subjects who truly do not have the outcome of interest. Positive predictive value reflects the proportion of subjects with a positive test result who truly have the outcome of interest. Negative predictive value reflects the proportion of subjects with a negative test result who truly do not have the outcome of interest. Sensitivity and specificity are inversely related, wherein one increases as the other decreases, but are generally considered stable for a given test, whereas positive and negative predictive values do inherently vary with pre-test probability (e.g., changes in population disease prevalence). This article will further detail the concepts of sensitivity, specificity, and predictive values using a recent real-world example from the medical literature.

scholarly journals Value and Diagnostic Efficacy of Fetal Morphology Assessment Using Ultrasound in A Poor-Resource Setting

Diagnostics ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. 109 ◽  
Author(s):  
Ukweh ◽  
Ugbem ◽  
Okeke ◽  
Ekpo
Keyword(s):  
Predictive Value ◽  
Performance Metrics ◽  
Area Under The Curve ◽  
Youden Index ◽  
Likelihood Ratios ◽  
Diagnostic Efficacy ◽  
Predictive Values ◽  
Resource Setting ◽  
Post Test ◽  
Sensitivity Specificity

Background: Ultrasound is operator-dependent, and its value and efficacy in fetal morphology assessment in a low-resource setting is poorly understood. We assessed the value and efficacy of fetal morphology ultrasound assessment in a Nigerian setting. Materials and Methods: We surveyed fetal morphology ultrasound performed across five facilities and followed-up each fetus to ascertain the outcome. Fetuses were surveyed in the second trimester (18th–22nd weeks) using the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) guideline. Clinical and surgical reports were used as references to assess the diagnostic efficacy of ultrasound in livebirths, and autopsy reports to confirm anomalies in terminated pregnancies, spontaneous abortions, intrauterine fetal deaths, and still births. We calculated sensitivity, specificity, positive and negative predictive values, Area under the curve (AUC), Youden index, likelihood ratios, and post-test probabilities. Results: In total, 6520 fetuses of women aged 15–46 years (mean = 31.7 years) were surveyed. The overall sensitivity, specificity, and AUC were 77.1 (95% CI: 68–84.6), 99.5 (95% CI: 99.3–99.7), and 88.3 (95% CI: 83.7–92.2), respectively. Other performance metrics were: positive predictive value, 72.4 (95% CI: 64.7–79.0), negative predictive value, 99.6 (95% CI: 99.5–99.7), and Youden index (77.1%). Abnormality prevalence was 1.67% (95% CI: 1.37–2.01), and the positive and negative likelihood ratios were 254 (95% CI: 107.7–221.4) and 0.23 (95% CI: 0.16–0.33), respectively. The post-test probability for positive test was 72% (95% CI: 65–79). Conclusion: Fetal morphology assessment is valuable in a poor economics setting, however, the variation in the diagnostic efficacy across facilities and the limitations associated with the detection of circulatory system anomalies need to be addressed.

scholarly journals Prediction of preeclampsia using a combination of serum micro RNA-210 and uterine artery Doppler ultrasound

2021 ◽  
Vol 104 (3) ◽  
pp. 003685042110368
Author(s):  
Ananya Trongpisutsak ◽  
Vorapong Phupong
Keyword(s):  
Pregnant Women ◽  
Doppler Ultrasound ◽  
Predictive Value ◽  
Early Onset ◽  
Uterine Artery ◽  
Micro Rna ◽  
Predictive Values ◽  
Uterine Artery Doppler ◽  
Early Onset Preeclampsia ◽  
Sensitivity Specificity

The objective was to determine whether a combination of serum micro RNA-210 level and uterine artery Doppler can predict preeclampsia in pregnant women at 16–24 weeks gestation. A prospective observational study conducted in singleton pregnant women at 16–24 weeks of gestation who had prenatal care at the King Chulalongkorn Memorial Hospital, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand between 2017 and 2018. Uterine artery Doppler ultrasound and blood testing for serum micro RNA-210 were performed. Pregnancy outcomes were recorded. Optimal cut-off for uterine artery pulsatility index (PI) and serum micro RNA-210 were obtained to calculate the predictive values for preeclampsia. Data from 443 participants were analyzed. Twenty-two cases developed preeclampsia (5.0%) and seven of these preeclamptic cases had early-onset preeclampsia (1.6%). Pregnant women with preeclampsia had higher mean PI of the uterine artery (1.34 ± 0.52 vs 0.98 ± 0.28, p = 0.004), higher detection rates of diastolic notching (45.5% vs 11.2%, p < 0.001), and lower median serum micro RNA-210 level (22.86 vs 795.78, p < 0.001) than pregnant women without preeclampsia. Using abnormal serum micro RNA-210 level, abnormal mean PI or uterine artery diastolic notches to predict for preeclampsia, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 95.5%, 54.9%, 10.0%, and 99.6%, respectively. For early-onset preeclampsia prediction, the sensitivity, specificity, PPV, and NPV were 100.0%, 53.2%, 3.3%, and 100.0%, respectively. This study demonstrated that a combination of serum micro RNA-210 and uterine artery Doppler is effective in predicting preeclampsia in the second trimester.

scholarly journals Clinical Performance of the Spot Vision Photo Screener before and after Induction of Cycloplegia in Children

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Konuralp Yakar
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Clinical Performance ◽  
High Specificity ◽  
Screening Criteria ◽  
Predictive Values ◽  
Before And After ◽  
Sensitivity Specificity ◽  
Vision Screener

Aim. To compare the clinical performance of the Spot Vision Screener used to detect amblyopia risk factors (ARFs) in children before and after induction of cycloplegia; the children were referred because they met the screening criteria of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Methods. The Spot Vision Screener and a standard autorefractometer were used to examine 200 eyes of 100 children aged 3–10 years, before and after cycloplegia induction, in terms of ARFs. Sensitivity, specificity, and positive and negative predictive values for the detection of significant refractive errors were measured using the AAPOS referral criteria. It was explored that Spot Screener data were affected by cycloplegia. The extent of agreement between cycloplegic/noncycloplegic photoscreening data and cycloplegic autorefraction measurements was assessed using Wilcoxon and Spearman correlation analyses. Results. The Spot’s sensitivity was improved from 60.9% to 85.3% and specificity from 94.9% to 87.4% with cycloplegia compared to cycloplegic standard autorefractometer results. The positive predictive value of Spot was 75.7%, and the negative predictive value was 90.4% without cycloplegia. With cycloplegia, the positive predictive value of Spot was 63.6% and the negative predictive value was 95.8%. Conclusions. The Spot Screener afforded moderate sensitivity and high specificity prior to cycloplegia. The sensitivity and negative predictive value improved after induction of cycloplegia. Examiners should be aware of the effects of cycloplegia on their findings.

scholarly journals An assessment of chromosomal alterations detected by fluorescence in situ hybridisation in pancreatobiliary tract malignancy

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Xiaohong Pu ◽  
Hongwei Zheng ◽  
Xin Yang ◽  
Qing Ye ◽  
Zhiwen Fan ◽  
...  
Keyword(s):  
Predictive Value ◽  
In Situ Hybridisation ◽  
False Negative ◽  
Chinese Patients ◽  
Fluorescence In Situ Hybridisation ◽  
Predictive Values ◽  
Formalin Fixed Paraffin Embedded ◽  
9P21 Locus ◽  
Sensitivity Specificity

Abstract Background Using fluorescence in situ hybridisation (FISH) to detect any gain of chromosomes 3, 7, or 17 and loss of the 9p21 locus has been proven to be sensitive in the diagnosis of pancreatobiliary tumors. However, both genetic and environmental factors contribute to the pathogenesis of pancreatobiliary tumors. Therefore, it is unknown whether this method is suitable for Chinese patients with pancreatobiliary tumors. This study aims to compare the sensitivity, specificity, predictive values and accuracy of cytology, ERCP/MRCP and FISH based on Chinese patients with pancreatobiliary tumors,and to analyze differences between brushing-based and formalin-fixed paraffin-embedded (FFPE)-based FISH. Methods A total of 66 brush cytology specimens obtained during ERCP were detected by FISH and cytology test respectively to compare the sensitivity, specificity, predictive values and accuracy. Besides, FFPE-based FISH was performed on 46 corresponding paraffin sections of pancreatobiliary tumors obtained by surgical resection. Results Our findings demonstrate that FISH greatly improves diagnostic sensitivity and negative predictive value compared to ERCP/MRCP and cytology without much reduction in specificity and positive predictive value. However, our results also indicate that FFPE-based FISH could not effectively identify the false-negative of brushing-based FISH. Conclusions We believe that FISH can effectively distinguish true positive and false positive results of cytological or radiological suspicions of malignancy. However, FFPE-based FISH still does not precisely recognize the false-negative of brushing-based FISH. Both cytology-based and PPFE-based FISH had limitation in some specimens.

Ultrasound for the diagnosis of gout—the value of gout lesions as defined by the Outcome Measures in Rheumatology ultrasound group

Rheumatology ◽  
2020 ◽  
Vol 60 (1) ◽  
pp. 239-249
Author(s):  
Sara Nysom Christiansen ◽  
Mikkel Østergaard ◽  
Ole Slot ◽  
Viktoria Fana ◽  
Lene Terslev
Keyword(s):  
Outcome Measures ◽  
Predictive Value ◽  
Reference Standards ◽  
Secondary Outcome ◽  
Predictive Values ◽  
Ultrasound Findings ◽  
Ultrasound Assessment ◽  
Sensitivity Specificity ◽  
Ultrasound Group ◽  
Msu Crystals

Abstract Objective To evaluate ultrasound for diagnosing gout using consensus-based Outcome Measures in Rheumatology ultrasound definitions of gout lesions. Methods Ultrasound was performed in patients with clinically suspected gout. Joints (28) and tendons (26) were binarily evaluated for the Outcome Measures in Rheumatology gout lesions—double contour (DC), tophus, aggregates and erosions. Ultrasound assessment was compared with two reference standards: (i) presence of MSU crystals in joint/tophus aspirate (primary outcome) and (ii) ACR/EULAR 2015 gout classification criteria (secondary outcome). Both reference standards were evaluated by rheumatologists blinded to ultrasound findings. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of each ultrasound lesion against both reference standards were determined. Results Eighty-two patients (70 men), mean age 62.4 (range 19–88) years, were included. Fifty-seven patients were MSU-positive whereas 25 patients were MSU-negative (no MSU crystals: 23; aspiration unsuccessful: 2). Of these 25 patients, three patients were classified as ACR/EULAR-positive (i.e. totally 60 ACR/EULAR-positive patients). All ultrasound lesions had high sensitivities for gout (0.77–0.95). DC and tophus showed high specificities (0.88–0.95), positive predictive values (0.94–0.98) and accuracies (0.82–0.84) when both reference standards were used. In contrast, low specificities were found for aggregates and erosions (0.32–0.59). Ultrasound of MTP joints for DC or tophus, knee joint for DC and peroneus tendons for tophus was sufficient to identify all MSU-positive patients with ultrasound signs of gout at any location. Conclusion Ultrasound-visualized DC and tophus, as defined by the Outcome Measures in Rheumatology ultrasound group, show high specificities, positive predictive values and accuracies for diagnosing gout and are therefore valid tools in clinical practice.

Interpretations of the dial test should be reconsidered. A diagnostic accuracy study reporting sensitivity, specificity, predictive values and likelihood ratios

2018 ◽  
Vol 3 (4) ◽  
pp. 198-204
Author(s):  
Richard Norris ◽  
Christian Kopkow ◽  
Michael James McNicholas
Keyword(s):  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Knee Ligament ◽  
Predictive Values ◽  
Medial Knee ◽  
Sensitivity Specificity ◽  
Dial Test

ObjectivesTo determine the accuracy of the dial test, used alone and in combination with additional clinical tests, in the diagnosis of an isolated posterolateral corner (PLC) injury, combined PLC-posterior cruciate ligament (PCL) injury or medial knee injury.MethodsA retrospective analysis of consecutive patients who underwent arthroscopic and/or open knee ligament reconstruction surgery was conducted. The dial test was performed in an outpatient’s clinic as part of a routine knee examination. Examination under anaesthetic and intraoperative findings were used as the reference standard test to determine the diagnostic accuracy of the dial test used alone and in combination with other PCL and medial knee tests. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR−) were calculated with corresponding 95% CI.ResultsData from 87 patients were available and included in the data analysis. For an isolated PLC injury, the dial test sensitivity and specificity were 0.20 (95% CI 0.08 to 0.39) and 1.00 (95% CI 0.92 to 1.00). The PPV and NPV were 1.00 (95% CI 0.52 to 1.00) and 0.70 (95% CI 0.59 to 0.80). LR+ and LR− of the dial test detecting isolated PLC injury were infinity (95% CI calculation not possible, infinity) and 0.80 (95% CI 0.41 to 1.57). The diagnostic accuracy of the dial test, when used alone and in combination with other PCL and medial knee tests, was also calculated for combined PLC-PCL and medial knee injuries.ConclusionA negative dial test at 30° of knee flexion can rule out a PLC injury, while a test that is positive at 30° and negative at 90° indicates a PLC injury, without concomitant injury to the PCL or medial knee ligaments. A positive test at both 30° and 90° can indicate isolated PLC, combined PLC-PCL or medial ligament injuries, and other knee examination findings are required to differentially diagnose these injury patterns.Level of evidenceII.

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