Use of Smartphones for the Detection of Uterine Cervical Cancer: A Systematic Review

Little is known regarding the usefulness of the smartphone in the detection of uterine cervical lesions or uterine cervical cancer. Therefore, we evaluated the usefulness of the smartphone in the detection of uterine cervical lesions and measured its diagnostic accuracy by comparing its findings with histological findings. We conducted a systematic review to identify studies on the usefulness of the smartphone in detecting uterine cervical lesions indexed in SCOPUS, MEDLINE/PubMed, Cochrane, OVID, Web of Science, and SciELO until November 2020. The risk of bias and applicability was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A total of 16 studies that evaluated the usefulness of the smartphone in the detection of uterine cervical lesions based on the images clicked after visual inspection with acetic acid (VIA), Lugol’s iodine (VILI), or VIA/VILI combination were included in the study. Five studies estimated diagnostic sensitivity and specificity, nine described diagnostic concordance, and five described the usefulness of mobile technology. Among the five first studies, the sensitivity ranged between 66.7% (95% confidence interval (CI); 30.0–90.3%) and 94.1% (95% CI; 81.6–98.3%), and the specificity ranged between 24.0% (95% CI; 9.0–45.0%) and 85.7% (95% CI; 76.7–91.6%). The risk of bias was low (20%), and the applicability was high. In conclusion, the smartphone images clicked after a VIA were found to be more sensitive than those following the VILI method or the VIA/VILI combination and naked-eye techniques in detecting uterine cervical lesions. Thus, a smartphone may be useful in the detection of uterine cervical lesions; however, its sensitivity and specificity are still limited.

Remote Skin Cancer Diagnosis: Adding Images to Electronic Referrals Is More Efficient Than Wait-Listing for a Nurse-Led Imaging Clinic

We undertook a retrospective comparison of two teledermatology pathways that provide diagnostic and management advice for suspected skin cancers, to evaluate the time from referral to diagnosis and its concordance with histology. Primary Care doctors could refer patients to either the Virtual Lesion Clinic (VLC), a nurse-led community teledermoscopy clinic or, more recently, to the Suspected Skin Cancer (SSC) pathway, which requires them to attach regional, close-up, and dermoscopic images. The primary objective of this study was to determine the comparative time course between the SSC pathway and VLC. Secondary objectives included comparative diagnostic concordance, skin lesion classification, and evaluation of missed skin lesions during subsequent follow-up. VLC referrals from July to December 2016 and 2020 were compared to SSC referrals from July to December 2020. 408 patients with 682 lesions in the VLC cohort were compared with 480 patients with 548 lesions from the 2020 SSC cohort, matched for age, sex, and ethnicity, including histology where available. Median time (SD) from referral to receipt of teledermatology advice was four (2.8) days and 50 (43.0) days for the SSC and VLC cohorts, respectively (p < 0.001). Diagnostic concordance between teledermatologist and histopathologist for benign versus malignant lesions was 70% for 114 lesions in the SSC cohort, comparable to the VLC cohort (71% of 122 lesions). Referrals from primary care, where skin lesions were imaged with variable devices and quality resulted in faster specialist advice with similar diagnostic performance compared to high-quality imaging at nurse-led specialist dermoscopy clinics.

HbA1c Screening for Diabetes in Patients with Acute Coronary Syndrome: A Worthwhile Test or a Pitfall?

Background: Diagnostic concordance between HbA1c and other glucose-based tests is imperfect, and data on this problem in acute coronary syndrome (ACS) are still lacking. The aim of this study was to identify undiagnosed glucose abnormalities in ACS patients, and to compare the effectiveness and consistency of the diagnostic screening based on HbA1c to the oral glucose tolerance test (OGTT). Methods: The study group consisted of 121 ACS patients, mean age 62.3 ± 11.6 years, without known glucose abnormalities. HbA1c, admission and fasting plasma glucose in the first days of hospitalization were assessed and referred to the results of OGTT performed two weeks after discharge. Results: OGTT identified normoglycemia in 45%, pre-diabetes in 39.4%, and diabetes in 15.6%, while HbA1c revealed these categories in 39.7%, 51.2%, and 9.1%, respectively. With an HbA1c cut-off ≥6.5% (48 mmol/mol) diagnostic for diabetes, the sensitivity of the method was 41%, while specificity was 98%, compared to the OGTT. The optimal HbA1c cut-off value at the crossing of sensitivity and specificity curves was 5.9%. The HbA1c value recommended for the diagnosis of pre-diabetes and optimal cut-off point were the same (5.7%). Conclusions: Using HbA1c without OGTT in an early but stable phase of ACS may result in a significant underdiagnosis of diabetes.

Systematic tissue collection during clinical breast biopsy is feasible, safe and enables high-content translational analyses

Systematic collection of fresh tissues for research at the time of diagnostic image-guided breast biopsy has the potential to fuel a wide variety of innovative studies. Here we report the initial experience, including safety, feasibility, and laboratory proof-of-principle, with the collection and analysis of research specimens obtained via breast core needle biopsy immediately following routine clinical biopsy at a single institution over a 14-month period. Patients underwent one or two additional core biopsies following collection of all necessary clinical specimens. In total, 395 patients were approached and 270 consented to the research study, yielding a 68.4% consent rate. Among consenting patients, 238 lesions were biopsied for research, resulting in 446 research specimens collected. No immediate complications were observed. Representative research core specimens showed high diagnostic concordance with clinical core biopsies. Flow cytometry demonstrated consistent recovery of hundreds to thousands of viable cells per research core. Among a group of HER2 + tumor research specimens, HER2 assessment by flow cytometry correlated highly with immunohistochemistry (IHC) staining, and in addition revealed extensive inter- and intra-tumoral variation in HER2 levels of potential clinical relevance. Suitability for single-cell transcriptomic analysis was demonstrated for a triple-negative tumor core biopsy, revealing substantial cellular diversity in the tumor immune microenvironment, including a prognostically relevant T cell subpopulation. Thus, collection of fresh tissues for research purposes at the time of diagnostic breast biopsy is safe, feasible and efficient, and may provide a high-yield mechanism to generate a rich tissue repository for a wide variety of cross-disciplinary research.

Diagnostic and Translational Utility of the Secondary Traumatic Stress Clinical Algorithm (STS-CA)

Objective: Current tools available to assess secondary traumatic stress (STS) do not account for whether the symptoms are functionally related to indirect trauma, determine functional impairment caused by the STS symptoms, and/or consider the duration of the disturbance. This prevents delineation of various expressions of traumatic stress related to indirect trauma that may constitute the phenomenon of STS. The STS Clinical Algorithm (STS-CA) was developed to make these distinctions, so that interventions can be tailored to need. This study investigates the following: (1) the diagnostic concordance between the STS-CA findings and scores on the Secondary Traumatic Stress Scale (STSS); (2) reasons for diagnostic discrepancies between the STS-CA and the STSS assessments. Method: Three trained interviewers used the STS-CA to guide the determination of clinical outcome ( N = 181) in a diverse group of helping professionals. Results: There was 100% agreement between the CAPS and the STS-CA, and fair agreement (κ =.426, p = .000) between the STS-CA and the STSS. The STS-CA demonstrated more sensitivity in classifying positive cases, and specificity in delineating those with atypical cluster presentations or little to no functional impairment that prohibited a post-traumatic stress disorder diagnosis than the STSS. Implications: Effective treatment of STS requires proper identification and the delivery of protocols that are tailored to the unique ways that STS manifests. This study provides some insights into the utility of the STS-CA in guiding this process and creates STS categories to organize and classify intervention strategies.

Diagnostic Concordance between Optical Coherence Tomography and Histological Investigations for Immune-Mediated Desquamative Gingivitis: Observational Study

Desquamative gingivitis (DG) denotes a heterogeneous immune-mediated disease for which early diagnosis represents a great challenge. The main aim of this study is to validate diagnostic concordance between specific Optical Coherence Tomography (OTC) patterns for DG related to oral Lichen Planus (OLP), Pemphigus Vulgaris (PV), and Mucous Membrane Pemphigoid (MMP) and definitive histological diagnosis. Forty-three patients with suspected immune-mediated DGs, were progressively recruited. Before biopsy, an OCT preliminary evaluation was performed using specific pre-determined OCT diagnostic patterns (i.e., morphology and localization of blisters, status of the basal membrane, epithelial thickness, presence/absence of acantholytic cells into blister and/or inflammatory infiltrate) related to OLP, PV and MMP. After histological confirmation, OCT and histological diagnoses were compared. Using pre-determined patterns, OCT diagnoses of DGs were: 22 (51%) OLP, of which 11 (26%) were with the bullous variant, 4 (9%) PV and 6 (14%) MMP. The same diagnoses were found by histological investigations (with the main OCT discriminatory potential for the bullous variant of OLP). The concordance between the two diagnostic methods was confirmed by the Fisher exact test (p-value < 0.01). These specific OCT patterns show a diagnostic reliability in 100% of the cases investigated, suggesting their accuracy to support the complex diagnosis and management of immune-mediated DGs.