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Archives of Pathology & Laboratory... Sep 2018- Small lung biopsies (core needle biopsies and transbronchial biopsies) are the most common-and often the first-lung sample obtained when a radiologic abnormality is... (Review)
Review
CONTEXT
- Small lung biopsies (core needle biopsies and transbronchial biopsies) are the most common-and often the first-lung sample obtained when a radiologic abnormality is detected and tissue diagnosis is required. When a neoplastic diagnosis cannot be made but pathologic abnormalities are present, it is useful for pathologists to have a list ("menu") of specific nonneoplastic diagnoses that can be made in these samples.
OBJECTIVE
- To provide surgical pathologists and pathology trainees with menus of nonneoplastic entities that can be diagnosed in small lung biopsies, and to briefly describe and illustrate some of these entities as they appear in small lung biopsies.
DATA SOURCES
- Published literature and the authors' experience with small lung biopsies for diagnosis of nonneoplastic lung diseases.
CONCLUSIONS
- Although sampling error imposes some limitations, core needle biopsies and transbronchial lung biopsies can contribute to the diagnosis of a variety of nonneoplastic lung diseases and reduce the need for invasive surgical intervention.
Topics: Biopsy; Biopsy, Large-Core Needle; Bronchoscopy; Humans; Lung Diseases; Pathology, Surgical
PubMed: 30141992
DOI: 10.5858/arpa.2017-0558-RA -
Developmental Medicine and Child... May 2006We know how important it is to diagnose epilepsy correctly, but how to do so is surprisingly little validated. An inadequate history and misinterpretation of the...
We know how important it is to diagnose epilepsy correctly, but how to do so is surprisingly little validated. An inadequate history and misinterpretation of the electroencephalogram (EEG) are the major reasons 4 to 26% of children and adults in European studies are misdiagnosed with epilepsy. Error rates are not available for most countries, or for more precise diagnoses of seizure types, epilepsy syndrome, and cause.
Topics: Adult; Ambulatory Care; Child; Electroencephalography; Epilepsy; Humans; Videotape Recording
PubMed: 16608536
DOI: 10.1017/S0012162206000703 -
International Journal of Surgery... Apr 2017Acute appendicitis is the most common condition that presents with an acute abdomen needing emergency surgery. Despite this common presentation, correctly diagnosing... (Meta-Analysis)
Meta-Analysis Review
Acute appendicitis is the most common condition that presents with an acute abdomen needing emergency surgery. Despite this common presentation, correctly diagnosing appendicitis remains a challenge as clinical signs or positive blood results can be absent in 55% of the patients. The reported proportion of missed diagnoses of appendicitis ranges between 20% and 40%. A delay or mis-diagnosis of appendicitis can result in severe complications such as perforation, abscess formation, sepsis, and intra-abdominal adhesions. Literature has shown that patients who had a negative appendectomy suffer post-op complications and infections secondary to hospital stays; there have even been reported cases of fatality. It is therefore crucial that timely and accurate diagnosis of appendicitis is achieved to avoid complications of both non-operating as well as unnecessary surgical intervention. The aim of this review is to systematically report and analyse the latest evidence on the different approaches used in diagnosing appendicitis. We include discussions of clinical scoring systems, laboratory tests, latest innovative bio-markers and radiological imaging.
Topics: Acute Disease; Adult; Appendectomy; Appendicitis; Appendix; Biomarkers; Diagnosis, Differential; Female; Humans; Male; Sensitivity and Specificity
PubMed: 28279749
DOI: 10.1016/j.ijsu.2017.03.013 -
Head & Face Medicine Mar 2015Oral squamous cell carcinoma (OSCC) has a remarkably high incidence worldwide, and a fairly serious prognosis, encouraging further research into advanced technologies... (Review)
Review
BACKGROUND
Oral squamous cell carcinoma (OSCC) has a remarkably high incidence worldwide, and a fairly serious prognosis, encouraging further research into advanced technologies for noninvasive methods of making early diagnoses, ideally in primary care settings.
OBJECTIVES
Our purpose was to examine the validity of using advanced noninvasive technologies in diagnosis of OSCC by identifying and evaluating relevant published reports.
DATA SOURCE
MEDLINE, EMBASE, and CINAHL were searched to identify clinical trials and other information published between 1990 and 10 June 2014; the searches of MEDLINE and EMBASE were updated to November 2014.
STUDY SELECTION
Studies of noninvasive methods of diagnosing OSCC, including oral brush biopsy, optical biopsy, saliva-based oral cancer diagnosis, and others were included.
DATA EXTRACTION
Data were abstracted and evaluated in duplicate for possible relevance on two occasions at an interval of 2 months before being included or excluded.
DATA SYNTHESIS
This study identified 163 studies of noninvasive methods for diagnosing OSCC that met the inclusion criteria. These included six studies of oral brush biopsy, 42 of saliva-based oral diagnosis, and 115 of optical biopsy. Sixty nine of these studies were assessed by the modified version of the QUADAS instrument. Saliva-based oral cancer diagnosis and optical biopsy were found to be promising noninvasive methods for diagnosing OSCC.
LIMITATION
The strength of evidence was rated low for accuracy outcomes because the studies did not report important details required to assess the risk for bias.
CONCLUSIONS
It is clear that screening for and early detection of cancer and pre-cancerous lesions have the potential to reduce the morbidity and mortality of this disease. Advances in technologies for saliva-based oral diagnosis and optical biopsy are promising pathways for the future development of more effective noninvasive methods for diagnosing OSCC that are easy to perform clinically in primary care settings.
Topics: Biopsy; Carcinoma, Squamous Cell; Diagnostic Tests, Routine; Female; Humans; Male; Mouth Neoplasms; Physical Examination; Saliva; Visual Analog Scale
PubMed: 25889859
DOI: 10.1186/s13005-015-0063-z -
Annals of Oncology : Official Journal... Sep 2021Clinical management of soft tissue sarcoma (STS) is particularly challenging. Here, we used digital pathology and deep learning (DL) for diagnosis and prognosis...
BACKGROUND
Clinical management of soft tissue sarcoma (STS) is particularly challenging. Here, we used digital pathology and deep learning (DL) for diagnosis and prognosis prediction of STS.
PATIENTS AND METHODS
Our retrospective, multicenter study included a total of 506 histopathological slides from 291 patients with STS. The Cancer Genome Atlas cohort (240 patients) served as training and validation set. A second, multicenter cohort (51 patients) served as an additional test set. The use of the DL model (DLM) as a clinical decision support system was evaluated by nine pathologists with different levels of expertise. For prognosis prediction, 139 slides from 85 patients with leiomyosarcoma (LMS) were used. Area under the receiver operating characteristic (AUROC) and accuracy served as main outcome measures.
RESULTS
The DLM achieved a mean AUROC of 0.97 (±0.01) and an accuracy of 79.9% (±6.1%) in diagnosing the five most common STS subtypes. The DLM significantly improved the accuracy of the pathologists from 46.3% (±15.5%) to 87.1% (±11.1%). Furthermore, they were significantly faster and more certain in their diagnosis. In LMS, the mean AUROC in predicting the disease-specific survival status was 0.91 (±0.1) and the accuracy was 88.9% (±9.9%). Cox regression showed the DLM's prediction to be a significant independent prognostic factor (P = 0.008, hazard ratio 5.5, 95% confidence interval 1.56-19.7) in these patients, outperforming other risk factors.
CONCLUSIONS
DL can be used to accurately diagnose frequent subtypes of STS from conventional histopathological slides. It might be used for prognosis prediction in LMS, the most prevalent STS subtype in our cohort. It can also help pathologists to make faster and more accurate diagnoses. This could substantially improve the clinical management of STS patients.
Topics: Deep Learning; Humans; Prognosis; Retrospective Studies; Sarcoma; Soft Tissue Neoplasms
PubMed: 34139273
DOI: 10.1016/j.annonc.2021.06.007 -
Preferred diagnostic methods of pyriform sinus fistula in different situations: A systematic review.American Journal of Otolaryngology 2023Pyriform sinus fistula (PSF) diagnosis is often easily delayed and incorrect. Diagnostic values of modalities vary in different situations. The aim of this study was to... (Review)
Review
PURPOSE
Pyriform sinus fistula (PSF) diagnosis is often easily delayed and incorrect. Diagnostic values of modalities vary in different situations. The aim of this study was to recommend optimal schemes for diagnosing PSF at different ages and infection stages.
METHODS
A search of PubMed, Embase, Cochrane Library, and CBM databases was conducted to identify articles written in Chinese and English concerning PSF diagnosis using keywords: "pyriform sinus fistula", "diagnosis", and relevant synonymous terms. Quality assessment was performed using the Joanna Briggs Institute (JBI) levels of evidence and critical appraisal checklist tool.
RESULTS
111 studies describing 3692 patients were included. The highest true positive rate (TPR) of ultrasonography was 66.67 % in adult cases. Computed tomography (CT) yielded a good TPR (approximately 73 %) in both neonatal and adult patients, and contrast-enhanced CT (84.21 %) was better in adult patients. Most children cases could be accurately diagnosed by barium swallow (BS) examination which was significantly different in acute and non-infection stages (AIS, NIS). Magnetic resonance imaging (MRI) produced a nice TPR in fetal cases (69.23 %) and neonatal cases (54.44 %). Laryngoscopy was also affected by infection stages. TPR of gastroscopy (GS) was the highest in children (86.36 %) and adult cases (87.50 %).
CONCLUSION
For fetal cases suspected of PSF, an MRI is recommended. MRI or CT is preferred for neonatal cases regardless of infection stages. Children and adult patients are advised to undergo GS during NIS or AIS, while BS is suggested for NIS. Contrast-enhanced CT can also diagnose adults with PSF in AIS.
Topics: Child; Infant, Newborn; Humans; Pyriform Sinus; Tomography, X-Ray Computed; Ultrasonography; Laryngoscopy; Fistula; Retrospective Studies
PubMed: 36584597
DOI: 10.1016/j.amjoto.2022.103747 -
Clinical Oral Investigations Mar 2013The aim of this overview is to consider the problems that may be associated with making a diagnosis of dentin hypersensitivity (DHS) and to provide a basis for... (Review)
Review
OBJECTIVES
The aim of this overview is to consider the problems that may be associated with making a diagnosis of dentin hypersensitivity (DHS) and to provide a basis for clinicians to effectively diagnose and manage this troublesome clinical condition.
MATERIALS AND METHODS
A PUBMED literature research was conducted by the author using the following MESH terms: ('diagnosis'[Subheading] OR 'diagnosis'[All Fields] OR 'diagnosis'[MeSH Terms]) AND ('therapy'[Subheading] OR 'therapy'[All Fields] OR 'treatment'[All Fields] OR 'therapeutics'[MeSH Terms] OR 'therapeutics'[All Fields]) AND ('dentin Sensitivity'[MeSH Terms] OR ('dentin'[All Fields] AND 'sensitivity'[All Fields]) OR 'dentin sensitivity'[All Fields]). Variations to the above MeSH terms using terms such as 'cervical', 'dentine' and 'hypersensitivity' as substitutes were also explored, but these searches failed to add any further information.
RESULTS
The literature search provided only limited data on specific papers relating to the clinical diagnosis of DHS by dental professionals. Evidence from these published studies would therefore indicate that clinicians are not routinely examining their patients for DHS or eliminating other possible causes of dental pain (differential diagnosis) prior to subsequent management and may rely on their patients' self-reporting of the problem. Furthermore, the findings of the Canadian Consensus Document (2003) would also suggest that clinicians are not confident of successfully treating DHS.
CONCLUSIONS
It is apparent from reviewing the published literature on the diagnosis of DHS that there are a number of outstanding issues that need to be resolved, for example, (1) is the condition under- or overestimated by dentists, (2) is the condition adequately diagnosed and successfully managed by dentists in daily practice, (3) is the impact of DHS on the quality of life of sufferers adequately diagnosed and treated and (4) is the condition adequately monitored by clinicians in daily practice. These and other questions arising from the workshop forum should be addressed in well-conducted epidemiological and clinical studies in order for clinicians to be confident in both identifying and diagnosing DHS and subsequent management that will either reduce or eliminate the impact of DHS on their patients' quality of life.
CLINICAL RELEVANCE
Clinicians should be made aware not only of the importance of identifying patients with DHS but also of the relevance of a correct diagnosis that may exclude any confounding factors from other oro-facial pain conditions prior to the successful management of the condition.
Topics: Dental Offices; Dentin Sensitivity; Diagnosis, Differential; Diagnosis, Oral; Humans; Quality of Life; Self Report
PubMed: 23296425
DOI: 10.1007/s00784-012-0911-1 -
European Radiology Aug 2022To evaluate the feasibility and accuracy of diagnosing acute heart failure (HF) with CT pulmonary angiography (CTPA) in emergency department patients.
OBJECTIVES
To evaluate the feasibility and accuracy of diagnosing acute heart failure (HF) with CT pulmonary angiography (CTPA) in emergency department patients.
METHODS
In this retrospective single-center study, we evaluated 150 emergency department patients (mean age 65 ± 17 years) undergoing CTPA with a fixed scan (100 kVp) and contrast media protocol (60 mL, 4 mL/s) who had no pulmonary embolism (PE). Patients were subdivided into training cohort (n = 100) and test cohort (n = 50). Three independent, blinded readers measured the attenuation in the right ventricle (RV) and left ventricle (LV) on axial images. The ratio (HU) and difference (HU) between RV and LV attenuation were calculated. Diagnosis of acute HF was made on the basis of clinical, laboratory, and echocardiography data. Optimal thresholds, sensitivity, and specificity were calculated using the area under the curve (AUC) from receiver operating characteristics analysis.
RESULTS
Fifty-nine of the 150 patients (40%) were diagnosed with acute HF. Attenuation measurements showed an almost perfect interobserver agreement (intraclass correlation coefficient: 0.986, 95%CI: 0.980-0.991). NT-pro BNP exhibited moderate correlations with HU (r = 0.50, p < 0.001) and HU (r = 0.50, p < 0.001). In the training cohort, HU (AUC: 0.89, 95%CI: 0.82-0.95) and HU (AUC: 0.88, 95%CI: 0.81-0.95) showed a very good performance to diagnose HF. Optimal cutoff values were 1.42 for HU (sensitivity 93%; specificity 75%) and 113 for HU (sensitivity 93%; specificity 73%). Applying these thresholds to the test cohort yielded a sensitivity of 89% and 89% and a specificity of 69% and 63% for HU and HU, respectively.
CONCLUSION
In emergency department patients undergoing CTPA and showing no PE, both HU and HU have a high sensitivity for diagnosing acute HF.
KEY POINTS
• Heart failure is a common differential diagnosis in patients undergoing CT pulmonary angiography. • In emergency department patients undergoing CT pulmonary angiography and showing no pulmonary embolism, attenuation differences of the left and right ventricle have a high sensitivity for diagnosing acute heart failure.
Topics: Aged; Aged, 80 and over; Angiography; Computed Tomography Angiography; Feasibility Studies; Heart Failure; Humans; Middle Aged; Pulmonary Embolism; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 35294585
DOI: 10.1007/s00330-022-08676-9 -
World Journal of Gastroenterology Jan 2020Coeliac disease (CD) is a complex condition resulting from an interplay between genetic and environmental factors. When diagnosing the condition, serological testing and... (Review)
Review
Coeliac disease (CD) is a complex condition resulting from an interplay between genetic and environmental factors. When diagnosing the condition, serological testing and genotyping are useful in excluding CD, although the gold standard of testing is currently histopathological examination of the small intestine. There are drawbacks associated with this form of testing however and because of this, novel forms of testing are currently under investigation. Before we develop completely novel tests though, it is important to ask whether or not we can simply use the data we gather from coeliac patients more effectively and build a more accurate snapshot of CD through statistical analysis of combined metrics. It is clear that not one single test can accurately diagnose CD and it is also clear that CD patients can no longer be defined by discrete classifications, the continuum of patient presentation needs to be recognised and correctly captured to improve diagnostic accuracy. This review will discuss the current diagnostics for CD and then outline novel diagnostics under investigation for the condition. Finally, improvements to current protocols will be discussed with the need for a holistic "snapshot" of CD using a number of metrics simultaneously.
Topics: Biopsy; Celiac Disease; Diagnosis, Differential; Diagnostic Techniques, Digestive System; Humans; Intestine, Small; Serologic Tests
PubMed: 31933510
DOI: 10.3748/wjg.v26.i1.1 -
Critical Care (London, England) 2008Early, accurate diagnosis is fundamental in the management of patients with ventilator-associated pneumonia (VAP). The aim of this qualitative review was to compare... (Review)
Review
INTRODUCTION
Early, accurate diagnosis is fundamental in the management of patients with ventilator-associated pneumonia (VAP). The aim of this qualitative review was to compare various criteria of diagnosing VAP in the intensive care unit (ICU) with a special emphasis on the value of clinical diagnosis, microbiological culture techniques, and biomarkers of host response.
METHODS
A MEDLINE search was performed using the keyword 'ventilator associated pneumonia' AND 'diagnosis'. Our search was limited to human studies published between January 1966 and June 2007. Only studies of at least 25 adult patients were included. Predefined variables were collected, including year of publication, study design (prospective/retrospective), number of patients included, and disease group.
RESULTS
Of 572 articles fulfilling the initial search criteria, 159 articles were chosen for detailed review of the full text. A total of 64 articles fulfilled the inclusion criteria and were included in our review. Clinical criteria, used in combination, may be helpful in diagnosing VAP, however, the considerable inter-observer variability and the moderate performance should be taken in account. Bacteriologic data do not increase the accuracy of diagnosis as compared to clinical diagnosis. Quantitative cultures obtained by different methods seem to be rather equivalent in diagnosing VAP. Blood cultures are relatively insensitive to diagnose pneumonia. The rapid availability of cytological data, including inflammatory cells and Gram stains, may be useful in initial therapeutic decisions in patients with suspected VAP. C-reactive protein, procalcitonin, and soluble triggering receptor expressed on myeloid cells are promising biomarkers in diagnosing VAP.
CONCLUSION
An integrated approach should be followed in diagnosing and treating patients with VAP, including early antibiotic therapy and subsequent rectification according to clinical response and results of bacteriologic cultures.
Topics: Biopsy; Bronchoalveolar Lavage Fluid; Colony Count, Microbial; Cross Infection; Humans; Intensive Care Units; Pneumonia, Bacterial; Radiography, Thoracic; Respiration, Artificial; Risk Factors
PubMed: 18426596
DOI: 10.1186/cc6877