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JAMA Otolaryngology-- Head & Neck... Sep 2019In the United States, the most used molecular test for the evaluation of cytologically indeterminate thyroid nodules is the Afirma gene expression classifier (GEC).
IMPORTANCE
In the United States, the most used molecular test for the evaluation of cytologically indeterminate thyroid nodules is the Afirma gene expression classifier (GEC).
OBJECTIVE
To evaluate the GEC's diagnostic performance through a novel approach to assess whether the findings of the initial validation study are consistent with the results of postmarketing studies.
DATA SOURCES
PubMed was systematically searched from inception through October 26, 2017, using the terms gene expression classifier or Afirma or GEC and thyroid.
STUDY SELECTION
Studies included were those in which the GEC diagnostic performance could be calculated on consecutively resected cytologically indeterminate thyroid nodules.
DATA EXTRACTION AND SYNTHESIS
Two observers independently assessed study eligibility and risk of bias using the quality assessment tool for observational cohort and cross-sectional studies of the National Heart, Lung, and Blood Institute. Summary data were extracted by a reviewer and reviewed independently by another. Study authors were contacted if missing data were needed. Data were pooled using a random-effects model. PRISMA and MOOSE guidelines were followed.
MAIN OUTCOMES AND MEASURES
Evaluation of the linear correlation between the benign call rate (BCR) and the positive predictive value (PPV).
RESULTS
Of the 137 retrieved titles, 19 (13.9%) were included, comprising a total of 2568 thyroid nodules. Based on a simulation using the sensitivity and specificity reported in the initial validation study, the observed BCR and PPV values in postmarketing studies would have to be explained by different underlying prevalence rates of cancer (15% vs 30%), which is an impossible event. Furthermore, the overall correlation between BCR and PPV for independent studies fell outside the PPV 95% CI of the initial validation study (95% CI, 0.17-0.32) at the BCR of pooled independent studies (0.45) and was just at the limit of the BCR 95% CI of the initial validation study (95% CI, 0.32-0.45) at the PPV of pooled independent studies (0.45). The diagnostic performance was statistically significantly better for atypia or follicular lesions of undetermined significance (diagnostic odds ratio [DOR], 5.67; 95% CI, 4.23-7.60) compared with follicular neoplasms (DOR, 2.24; 95% CI, 1.45-3.47).
CONCLUSIONS AND RELEVANCE
The findings suggest that the initial validation study cohort was not representative of the populations in whom the GEC has been used, calling into question its reported diagnostic performance, including its negative predictive value.
PubMed: 31318389
DOI: 10.1001/jamaoto.2019.1449 -
Medical Science Monitor : International... May 2019BACKGROUND Numerous studies have explored diagnosis of pulmonary nodules using perfusion computed tomography (CT); however, findings were not always consistent between... (Meta-Analysis)
Meta-Analysis
BACKGROUND Numerous studies have explored diagnosis of pulmonary nodules using perfusion computed tomography (CT); however, findings were not always consistent between studies. Th e present study aimed to summarize evidence on the diagnostic value of perfusion CT for distinguishing between lung cancer and benign lesions. MATERIAL AND METHODS We performed a systematic literature search on lung cancer and benign pulmonary lesions performed with perfusion CT. The searches were undertaken in English or Chinese language in Medline, PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Infrastructure database from Jan 2010 to Nov 2018. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) of blood volume (BV), blood flow (BF), mean transit time (MTT), and permeability surface (PS) were calculated using Review Manager 5.3. Publication bias, sensitivity, specificity, and the area under the curve (AUC) were calculated using Stata12.0. RESULTS Fourteen studies comprising 1032 malignant and 447 benign pulmonary lesions were analyzed. Lung cancer had higher BV, BF, MTT, and PS values than benign lesions. SMDs and 95% CIs of BV, BF, MTT, and PS were 2.29 (1.43, 3.16), 0.50 (0.14, 0.86), 0.55 (0.39, 0.72), and 1.21 (0.87, 1.56), respectively. AUC values of BV and PS were 0.92 (0.90, 0.94) and 0.83 (0.80, 0.86), respectively. CONCLUSIONS CT perfusion imaging is a valuable technique for the diagnosis of pulmonary nodules. Lung cancer had higher perfusion and permeability than benign lesions. The evidence suggests blood volume is the best surrogate marker for characterizing the blood supply, while permeability surface has a high specificity in quantifying the vascular permeability.
Topics: Adult; Aged; Aged, 80 and over; Area Under Curve; China; Female; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Perfusion; Perfusion Imaging; Publication Bias; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 31077263
DOI: 10.12659/MSM.914206 -
Pulmonary Circulation 2019Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal disease process in which pulmonary hypertension (PH) develops in the setting of malignancy. The purpose of...
Pulmonary tumor thrombotic microangiopathy (PTTM) is a fatal disease process in which pulmonary hypertension (PH) develops in the setting of malignancy. The purpose of this study is to present a detailed analysis of cases of PTTM reported in literature in the hopes of achieving more ante-mortem diagnoses. We conducted a systematic review of currently published and available cases of PTTM by searching the term "pulmonary tumor thrombotic microangiopathy" on the Pubmed.gov database. Seventy-nine publications were included consisting of 160 unique cases of PTTM. The most commonly reported malignancy was gastric adenocarcinoma (94 cases, 59%). Cough and dyspnea were reported in 61 (85%) and 102 (94%) cases, respectively. Hypoxemia was reported in 96 cases (95%). Elevation in D-dimer was noted in 36 cases (95%), presence of anemia in 32 cases (84%), and thrombocytopenia in 30 cases (77%). Common findings on chest computed tomography (CT) included ground-glass opacities (GGO) in 28 cases (82%) and nodules in 24 cases (86%). PH on echocardiography was noted in 59 cases (89%) with an average right ventricular systolic pressure of 71 mmHg. Common features of PTTM that are reported across the published literature include presence of dyspnea and cough, hypoxemia, with abnormal CT findings of GGO, nodules, and mediastinal/hilar lymphadenopathy, and PH. PTTM is a universally fatal disease process and this analysis provides a detailed examination of all the available published data that may help clinicians establish an earlier diagnosis of PTTM.
PubMed: 31032740
DOI: 10.1177/2045894019851000 -
Journal of Maxillofacial and Oral... Jun 2019Dirofilariasis is an endemic disease in tropical and subtropical countries caused by about 40 different species of dirofilari. Dirofilariasis of the oral cavity is... (Review)
Review
BACKGROUND
Dirofilariasis is an endemic disease in tropical and subtropical countries caused by about 40 different species of dirofilari. Dirofilariasis of the oral cavity is extremely rare and is usually seen as mucosal or submucosal nodules. We also present a case of dirofilariasis of the mandibular third molar region submucosally in a 26 year old male patient.
PURPOSE
To identify, enlist and analyze the cases of dirofilariasis in maxillofacial region reported worldwide so as to understand the clinical presentation and encourage the consideration of helminthic infections as a possible differential diagnosis in maxillofacial swellings.
METHODS
Two authors KC and SK independently searched the electronic database of PUBMED, OVID, Google Scholar and manual search from other sources. A general search strategy was planned and anatomic areas of interest identified. The search was made within a bracket of 1 month by the independent authors KC and SK who assessed titles, abstracts and full texts of articles based on the decided keywords. The final selection of articles was screened for the cases that were reported in the maxillofacial region including the age, gender, site of occurrence and region of the world reported in. A geographic distribution of the reported cases was tabulated.
RESULTS
A total number of 265, 97, 1327, 3 articles were identified by PubMed, Ovid, GoogleScholar and manual search respectively. The final articles were manually searched for duplicates and filtered according to the inclusion/exclusion criteria which led to a final list of 58 unique articles that were included in the study. In total 99 cases were identified.
CONCLUSION
Although intraoral dirofilarial infections are extremely uncommon, it should be considered in the differential diagnosis of an intraoral or facial swelling that does not completely respond to routine therapy especially in patients from endemic areas.
PubMed: 30996536
DOI: 10.1007/s12663-018-1139-7 -
Diagnostics (Basel, Switzerland) Mar 2019The aim of this study was to provide an overview of the literature available on machine learning (ML) algorithms applied to the Lung Image Database Consortium Image... (Review)
Review
The aim of this study was to provide an overview of the literature available on machine learning (ML) algorithms applied to the Lung Image Database Consortium Image Collection (LIDC-IDRI) database as a tool for the optimization of detecting lung nodules in thoracic CT scans. This systematic review was compiled according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Only original research articles concerning algorithms applied to the LIDC-IDRI database were included. The initial search yielded 1972 publications after removing duplicates, and 41 of these articles were included in this study. The articles were divided into two subcategories describing their overall architecture. The majority of feature-based algorithms achieved an accuracy >90% compared to the deep learning (DL) algorithms that achieved an accuracy in the range of 82.2%⁻97.6%. In conclusion, ML and DL algorithms are able to detect lung nodules with a high level of accuracy, sensitivity, and specificity using ML, when applied to an annotated archive of CT scans of the lung. However, there is no consensus on the method applied to determine the efficiency of ML algorithms.
PubMed: 30866425
DOI: 10.3390/diagnostics9010029 -
Cancer Management and Research 2019NIMA-related kinase 2 (NEK2) has been reported to be overexpressed in various types of cancer and correlated with poor prognosis. The role(s) of NEK2 in cancer, however,...
OBJECTIVE
NIMA-related kinase 2 (NEK2) has been reported to be overexpressed in various types of cancer and correlated with poor prognosis. The role(s) of NEK2 in cancer, however, is still uncertain. The aim of this study was to evaluate the prognostic value of NEK2 in human tumors.
METHODS
A comprehensive literature search was performed for PubMed, Embase, Web of Science, and CNKI databases, and eligible studies were included based on the inclusion and exclusion criteria. A meta-analysis of the included studies was then carried out.
RESULTS
Fifteen studies with 3,280 cancer patients were included in the present meta-analysis. All publications were of moderate to high quality, and had no significant heterogeneity ( , =0.03) or publication bias was discovered. The results showed that a high NEK2 level was associated with shorter overall survival (OS) in patients with various types of cancers (pooled HR=1.72, 95% CI 1.49-2.00, <0.00001). However, the disease-free survival (DFS) had no significant association with NEK2 level (HR=1.13, 95% CI: 0.29-4.38, =0.85). In the subgroup analyses, high NEK2 level was correlated with an increased risk of poor OS in patients with hepatocellular carcinoma (HR=1.62, 95% CI: 1.25-2.10, =0.02) and lung cancer (HR=2.18, 95% CI: 1.40-3.38, =0.0005). However, other factors, including sample size, follow-up period, HR estimation method, and country, also affect the association between NEK2 expression and OS. Analysis of clinicopathological parameters further showed that increased NEK2 level was correlated with younger age, male gender, better tumor differentiation, and lower number of tumor nodules.
CONCLUSION
The results of this study indicated that increased expression of NEK2 was associated with unfavorable survival of cancer patients and that NEK2 could be used as a prognostic predictor for cancers.
PubMed: 30655697
DOI: 10.2147/CMAR.S188347 -
Jornal Brasileiro de Pneumologia :... Apr 2018The objective of this systematic review was to select articles including chest X-ray or chest CT findings in patients who developed pulmonary tuberculosis following...
The objective of this systematic review was to select articles including chest X-ray or chest CT findings in patients who developed pulmonary tuberculosis following solid organ transplantation (lung, kidney, or liver). The following search terms were used: "tuberculosis"; "transplants"; "transplantation"; "mycobacterium"; and "lung". The databases used in this review were PubMed and the Brazilian Biblioteca Virtual em Saúde (Virtual Health Library). We selected articles in English, Portuguese, or Spanish, regardless of the year of publication, that met the selection criteria in their title, abstract, or body of text. Articles with no data on chest CT or chest X-ray findings were excluded, as were those not related to solid organ transplantation or pulmonary tuberculosis. We selected 29 articles involving a collective total of 219 patients. The largest samples were in studies conducted in Brazil and South Korea (78 and 35 patients, respectively). The imaging findings were subdivided into five common patterns. The imaging findings varied depending on the transplanted organ in these patients. In liver and lung transplant recipients, the most common pattern was the classic one for pulmonary tuberculosis (cavitation and "tree-in-bud" nodules), which is similar to the findings for pulmonary tuberculosis in the general population. The proportion of cases showing a miliary pattern and lymph node enlargement, which is most similar to the pattern seen in patients coinfected with tuberculosis and HIV, was highest among the kidney transplant recipients. Further studies evaluating clinical data, such as immunosuppression regimens, are needed in order to improve understanding of the distribution of these imaging patterns in this population.
Topics: Humans; Immunocompetence; Incidental Findings; Kidney Transplantation; Liver Transplantation; Lung Transplantation; Radiography, Thoracic; Tomography, X-Ray Computed; Tuberculosis, Pulmonary
PubMed: 29791554
DOI: 10.1590/s1806-37562017000000459 -
The British Journal of Radiology Jan 2018Lung cancer is the leading cause of cancer mortality worldwide. Treatment pathways include regular cross-sectional imaging, generating large data sets which present... (Review)
Review
Lung cancer is the leading cause of cancer mortality worldwide. Treatment pathways include regular cross-sectional imaging, generating large data sets which present intriguing possibilities for exploitation beyond standard visual interpretation. This additional data mining has been termed "radiomics" and includes semantic and agnostic approaches. Textural analysis (TA) is an example of the latter, and uses a range of mathematically derived features to describe an image or region of an image. Often TA is used to describe a suspected or known tumour. TA is an attractive tool as large existing image sets can be submitted to diverse techniques for data processing, presentation, interpretation and hypothesis testing with annotated clinical outcomes. There is a growing anthology of published data using different TA techniques to differentiate between benign and malignant lung nodules, differentiate tissue subtypes of lung cancer, prognosticate and predict outcome and treatment response, as well as predict treatment side effects and potentially aid radiotherapy planning. The aim of this systematic review is to summarize the current published data and understand the potential future role of TA in managing lung cancer.
Topics: Carcinoma, Non-Small-Cell Lung; Humans; Image Interpretation, Computer-Assisted; Lung Neoplasms; Positron Emission Tomography Computed Tomography; Tomography, X-Ray Computed
PubMed: 28869399
DOI: 10.1259/bjr.20170267 -
European Journal of Nuclear Medicine... Nov 2017Positron-emission tomography can be useful in oncology for diagnosis, (re)staging, determining prognosis, and response assessment. However, partial-volume effects hamper... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Positron-emission tomography can be useful in oncology for diagnosis, (re)staging, determining prognosis, and response assessment. However, partial-volume effects hamper accurate quantification of lesions <2-3× the PET system's spatial resolution, and the clinical impact of this is not evident. This systematic review provides an up-to-date overview of studies investigating the impact of partial-volume correction (PVC) in oncological PET studies.
METHODS
We searched in PubMed and Embase databases according to the PRISMA statement, including studies from inception till May 9, 2016. Two reviewers independently screened all abstracts and eligible full-text articles and performed quality assessment according to QUADAS-2 and QUIPS criteria. For a set of similar diagnostic studies, we statistically pooled the results using bivariate meta-regression.
RESULTS
Thirty-one studies were eligible for inclusion. Overall, study quality was good. For diagnosis and nodal staging, PVC yielded a strong trend of increased sensitivity at expense of specificity. Meta-analysis of six studies investigating diagnosis of pulmonary nodules (679 lesions) showed no significant change in diagnostic accuracy after PVC (p = 0.222). Prognostication was not improved for non-small cell lung cancer and esophageal cancer, whereas it did improve for head and neck cancer. Response assessment was not improved by PVC for (locally advanced) breast cancer or rectal cancer, and it worsened in metastatic colorectal cancer.
CONCLUSIONS
The accumulated evidence to date does not support routine application of PVC in standard clinical PET practice. Consensus on the preferred PVC methodology in oncological PET should be reached. Partial-volume-corrected data should be used as adjuncts to, but not yet replacement for, uncorrected data.
Topics: Humans; Neoplasm Staging; Neoplasms; Positron-Emission Tomography
PubMed: 28776088
DOI: 10.1007/s00259-017-3775-4 -
Jornal Brasileiro de Pneumologia :... 2017The objective of this systematic review was to characterize chest CT findings in patients with dysphagia and pulmonary aspiration, identifying the characteristics and... (Review)
Review
The objective of this systematic review was to characterize chest CT findings in patients with dysphagia and pulmonary aspiration, identifying the characteristics and the methods used. The studies were selected from among those indexed in the Brazilian Virtual Library of Health, LILACS, Indice Bibliográfico Español de Ciencias de la Salud, Medline, Cochrane Library, SciELO, and PubMed databases. The search was carried out between June and July of 2016. Five articles were included and reviewed, all of them carried out in the last five years, published in English, and coming from different countries. The sample size in the selected studies ranged from 43 to 56 patients, with a predominance of adult and elderly subjects. The tomographic findings in patients with dysphagia-related aspiration were varied, including bronchiectasis, bronchial wall thickening, pulmonary nodules, consolidations, pleural effusion, ground-glass attenuation, atelectasis, septal thickening, fibrosis, and air trapping. Evidence suggests that chest CT findings in patients with aspiration are diverse. In this review, it was not possible to establish a consensus that could characterize a pattern of pulmonary aspiration in patients with dysphagia, further studies of the topic being needed.
Topics: Deglutition Disorders; Humans; Pneumonia, Aspiration; Tomography, X-Ray Computed
PubMed: 28767772
DOI: 10.1590/S1806-37562016000000273