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Asian Pacific Journal of Cancer... Jun 2023Upper gastrointestinal malignancies are a major global health burden. Early diagnosis of upper gastrointestinal premalignant and malignant lesions is crucial for...
BACKGROUND
Upper gastrointestinal malignancies are a major global health burden. Early diagnosis of upper gastrointestinal premalignant and malignant lesions is crucial for improving prognosis and reducing morbidity and mortality. The purpose of this study was to investigate the diagnostic accuracy of confocal laser endomicroscopy (CLE) in detecting upper gastrointestinal premalignant and early malignant lesions in high-risk patients, as well as diagnosing patients with inconclusive white light endoscopy (WLE) and histopathology results.
METHODS
It was a cross-sectional study that included ninety (n = 90) high-risk patients with inconclusive diagnoses of upper gastrointestinal lesions on WLE and WLE-based biopsy histopathology. These patients underwent CLE, and the definitive diagnosis was confirmed using CLE and CLE-target biopsy histopathology. Diagnostic accuracy was determined by comparing the sensitivity, specificity, predictive values, and accuracy between the procedures.
RESULT
The mean patient age was 47.43 ± 11.18 years. CLE and target biopsy confirmed that 30 (33.3%) patients had normal histology, while 60 (66.7%) patients were diagnosed with gastritis, gastric intestinal metaplasia, high-grade dysplasia, adenocarcinoma, Barrett's esophagus, and squamous cell carcinoma of the esophagus. The results of CLE were superior to those of WLE in terms of diagnostic parameters. Additionally, CLE demonstrated nearly similar results in sensitivity (98.33%), specificity (100%), positive predictive value (100%), negative predictive value (96.77%), and accuracy (98.89%) when compared to CLE-target biopsy.
CONCLUSION
CLE showed higher diagnostic accuracy in differentiating normal, premalignant and malignant lesions. It effectively diagnosed patients who initially had inconclusive WLE and/or biopsy results. Furthermore, early detection of upper gastrointestinal premalignant or malignant lesions may improve prognosis and reduce morbidity and mortality.
Topics: Humans; Adult; Middle Aged; Cross-Sectional Studies; Microscopy, Confocal; Endoscopy; Gastrointestinal Neoplasms; Biopsy; Precancerous Conditions; Early Diagnosis; Lasers
PubMed: 37378923
DOI: 10.31557/APJCP.2023.24.6.1949 -
Urology Journal 2011To determine the value of color Doppler ultrasonography (CDUS) as a routine investigational method for diagnosis of scrotal pathologies. (Review)
Review
PURPOSE
To determine the value of color Doppler ultrasonography (CDUS) as a routine investigational method for diagnosis of scrotal pathologies.
MATERIALS AND METHODS
This prospective observational study (case series) was carried out over a period of 16 months on 122 patients in the age range of 13 to 70 years old, who presented with scrotal swellings. After adequate history taking and examination, CDUS was performed. The diagnosis of the surgeon and that of radiologist were compared with final outcome, which was based on course and outcome of the disease, fine needle aspiration cytology results, and operative findings.
RESULTS
The final diagnoses were epididymitis or epididymo-orchitis (46), hydrocele (26), varicocele (16), testicular malignancy (16), orchitis (6), testicular torsion (4), spermatic cord injury (2), hematocele (2), and pyocele (2). Color Doppler ultrasonography accurately diagnosed all cases of epididymitis or epididymo-orchitis, spermatic cord injury, testicular torsion, varicocele, and hydrocele (sensitivity 100% and specificity 100%). Of 16 subjects diagnosed as testicular malignancy on CDUS, only 14 were subsequently found to have malignancy. Two cases of orchitis were wrongly diagnosed as malignancy. Similarly, of 6 patients diagnosed as orchitis, 1 was found to have seminoma (sensitivity 87.5% and specificity 66.7%). Overall sensitivity of CDUS in diagnosing scrotal diseases was 98% while specificity was 66.7%.
CONCLUSION
Color Doppler ultrasonography is an excellent, a safe, and reliable method for evaluating patients with scrotal diseases. It aids in diagnosis of testicular tumors and reduces the number of unnecessary exploratory operations. It is especially important in conditions like testicular torsion where immediate diagnosis is required.
Topics: Adolescent; Adult; Aged; Genital Diseases, Male; Humans; Male; Middle Aged; Prospective Studies; Scrotum; Ultrasonography, Doppler, Color; Young Adult
PubMed: 21404205
DOI: No ID Found -
Scientific Reports Dec 2022The accuracy of transbronchial lung cryobiopsy (TBLC) in each disease for pathological and multidisciplinary discussion (MDD) diagnosis is not yet established.
UNLABELLED
The accuracy of transbronchial lung cryobiopsy (TBLC) in each disease for pathological and multidisciplinary discussion (MDD) diagnosis is not yet established.
METHOD
We investigated 431 patients who were classified by MDD diagnosis and were grouped into the disease categories. For each category or disease, we used TBLC samples to calculate the sensitivities of the pathological diagnosis compared with MDD diagnoses. Further, we compared these sensitivities to pathological diagnoses with all clinical/radiological information.
RESULT
The sensitivity for diagnosing idiopathic interstitial pneumonia (IIPs) with TBLC was higher than connective tissue disease associated ILD (CTD-ILD). Idiopathic nonspecific interstitial pneumonia (iNSIP), fibrotic hypersensitivity pneumonitis, and some CTD-ILDs were diagnosed with lower sensitivities compared to IPF. The sensitivity of pathological diagnosis with all clinical/radiological information in IPF was higher than in iNSIP, but not significantly different from other diseases. The overall sensitivity of the pathological diagnosis with clinical/radiological information was 69.0%, significantly higher than without clinical/radiological information.
CONCLUSION
The sensitivity of pathological diagnosis with TBLC was low for some diseases except IPF. The addition of all clinical/radiological information increased the sensitivity of pathology diagnosis by TBLC, which was no less sensitive than IPF for all diseases except iNSIP.
Topics: Humans; Biopsy; Bronchoscopy; Lung Diseases, Interstitial; Lung; Idiopathic Interstitial Pneumonias
PubMed: 36543857
DOI: 10.1038/s41598-022-26510-6 -
JAMA Network Open Dec 2021The proposed MOLEM (Management of Lesion to Exclude Melanoma) schema is more clinically relevant than Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis...
IMPORTANCE
The proposed MOLEM (Management of Lesion to Exclude Melanoma) schema is more clinically relevant than Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis (MATH-Dx) for the management classification of melanocytic and nonmelanocytic lesions excised to exclude melanoma. A more standardized way of establishing diagnostic criteria will be crucial in the training of artificial intelligence (AI) algorithms.
OBJECTIVE
To examine pathologists' variability, reliability, and confidence in reporting melanocytic and nonmelanocytic lesions excised to exclude melanoma using the MOLEM schema in a population of higher-risk patients.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study enrolled higher-risk patients referred to a primary care skin clinic in New South Wales, Australia, between April 2019 and December 2019. Baseline demographic characteristics including age, sex, and related clinical details (eg, history of melanoma) were collected. Patients with lesions suspicious for melanoma assessed by a primary care physician underwent clinical evaluation, dermoscopy imaging, and subsequent excision biopsy of the suspected lesion(s). A total of 217 lesions removed and prepared by conventional histologic method and stained with hematoxylin-eosin were reviewed by up to 9 independent pathologists for diagnosis using the MOLEM reporting schema. Pathologists evaluating for MOLEM schema were masked to the original histopathologic diagnosis.
MAIN OUTCOMES AND MEASURES
Characteristics of the lesions were described and the concordance of cases per MOLEM class was assessed. Interrater agreement and the agreement between pathologists' ratings and the majority MOLEM diagnosis were calculated by Gwet AC1 with quadratic weighting applied. The diagnostic confidence of pathologists was then assessed.
RESULTS
A total of 197 patients were included in the study (102 [51.8%] male; 95 [48.2%] female); mean (SD) age was 64.2 (15.8) years (range, 24-93 years). Overall, 217 index lesions were assessed with a total of 1516 histological diagnoses. Of 1516 diagnoses, 677 (44.7%) were classified as MOLEM class I; 120 (7.9%) as MOLEM class II; 564 (37.2%) as MOLEM class III; 114 (7.5%) as MOLEM class IV; and 55 (3.6%) as MOLEM class V. Concordance rates per MOLEM class were 88.6% (class I), 50.8% (class II), 76.2% (class III), 77.2% (class IV), and 74.2% (class V). The quadratic weighted interrater agreement was 91.3%, with a Gwet AC1 coefficient of 0.76 (95% CI, 0.72-0.81). The quadratic weighted agreement between pathologists' ratings and majority MOLEM was 94.7%, with a Gwet AC1 coefficient of 0.86 (95% CI, 0.84-0.88). The confidence in diagnosis data showed a relatively high level of confidence (between 1.0 and 1.5) when diagnosing classes I (mean [SD], 1.3 [0.3]), IV (1.3 [0.3]) and V (1.1 [0.1]); while classes II (1.8 [0.2]) and III (1.5 [0.4]) were diagnosed with a lower level of pathologist confidence (≥1.5). The quadratic weighted interrater confidence rating agreement was 95.2%, with a Gwet AC1 coefficient of 0.92 (95% CI, 0.90-0.94) for the 1314 confidence ratings collected. The confidence agreement for each MOLEM class was 95.0% (class I), 93.5% (class II), 95.3% (class III), 96.5% (class IV), and 97.5% (class V).
CONCLUSIONS AND RELEVANCE
The proposed MOLEM schema better reflects clinical practice than the MPATH-Dx schema in lesions excised to exclude melanoma by combining diagnoses with similar prognostic outcomes for melanocytic and nonmelanocytic lesions into standardized classification categories. Pathologists' level of confidence appeared to follow the MOLEM schema diagnostic concordance trend, ie, atypical naevi and melanoma in situ diagnoses were the least agreed upon and the most challenging for pathologists to confidently diagnose.
Topics: Adult; Aged; Aged, 80 and over; Artificial Intelligence; Biopsy; Cohort Studies; Confidence Intervals; Female; Humans; Male; Melanoma; Middle Aged; New South Wales; Pathologists; Reproducibility of Results; Skin Neoplasms; Young Adult
PubMed: 34889949
DOI: 10.1001/jamanetworkopen.2021.34614 -
Journal of Andrology 2008Clinical examination of the scrotum remains the most commonly used technique to diagnose varicoceles. However, scrotal anatomy (eg, thick scrotum, scarring, hydrocele)... (Review)
Review
Clinical examination of the scrotum remains the most commonly used technique to diagnose varicoceles. However, scrotal anatomy (eg, thick scrotum, scarring, hydrocele) in some men may make physical examination alone unreliable. In these situations, imaging (eg, ultrasound, Doppler imaging, venography) may be used to diagnose a varicocele. The dilemma is that there are no widely accepted or used criteria to diagnose a varicocele based on imaging. This paper reviews the different imaging techniques used and the accuracy of each in diagnosing a varicocele.
Topics: Humans; Male; Valsalva Maneuver; Varicocele
PubMed: 18077824
DOI: 10.2164/jandrol.107.003467 -
MEDICC Review 2014Genetic testing uses advanced laboratory techniques to identify protein alterations, certain metabolites, chromosomes, or nucleic acids by which a genotype is determined...
Genetic testing uses advanced laboratory techniques to identify protein alterations, certain metabolites, chromosomes, or nucleic acids by which a genotype is determined or inferred. These tests provide insights into the molecular basis and physiopathology of genetic diseases, information which is critical for prevention, treatment and genetic counseling. Initiated in 1982, Cuba's National Program for Diagnosis, Management and Prevention of Birth Defects and Hereditary Diseases ensures availability of genetic tests to all Cubans who need them, free of charge, assisting physician-patient decisions. The tests may be used to confirm diagnoses, point to hereditary diseases and potential congenital problems during pregnancy or in pre-symptomatic stages, and diagnose carriers of recessive diseases.
Topics: Cuba; Diagnosis, Differential; Genetic Diseases, Inborn; Genetic Predisposition to Disease; Genetic Testing; Humans
PubMed: 25208125
DOI: 10.37757/MR2014.V16.N3-4.15 -
Gastrointestinal Endoscopy Dec 2023Data on how to teach endosonographers needle-based confocal laser endomicroscopy (nCLE)-guided histologic diagnosis of pancreatic cystic lesions (PCLs) are limited.... (Randomized Controlled Trial)
Randomized Controlled Trial
Structured training program on confocal laser endomicroscopy for pancreatic cystic lesions: a multicenter prospective study among early-career endosonographers (with video).
BACKGROUND AND AIMS
Data on how to teach endosonographers needle-based confocal laser endomicroscopy (nCLE)-guided histologic diagnosis of pancreatic cystic lesions (PCLs) are limited. Hence, we developed and tested a structured educational program to train early-career endosonographers in nCLE-guided diagnosis of PCLs.
METHODS
Twenty-one early-career nCLE-naïve endosonographers watched a teaching module outlining nCLE criteria for diagnosing PCLs. Participants then reviewed 80 high-yield nCLE videos, recorded diagnoses, and received expert feedback (phase 1). Observers were then randomized to a refresher feedback session or self-learning at 4 weeks. Eight weeks after training, participants independently assessed the same 80 nCLE videos without feedback and provided histologic predictions (phase 2). Diagnostic performance of nCLE to differentiate mucinous versus nonmucinous PCLs and to diagnose specific subtypes were analyzed using histopathology as the criterion standard. Learning curves were determined using cumulative sum analysis.
RESULTS
Accuracy and diagnostic confidence for differentiating mucinous versus nonmucinous PCLs improved as endosonographers progressed through nCLE videos in phase 1 (P < .001). Similar trends were observed with the diagnosis of PCL subtypes. Most participants achieved competency interpreting nCLE, requiring a median of 38 assessments (range, 9-67). During phase 2, participants independently differentiated PCLs with high accuracy (89%), high confidence (83%), and substantial interobserver agreement (κ = .63). Accuracy for nCLE-guided PCL subtype diagnoses ranged from 82% to 96%. The learned nCLE skills did not deteriorate at 8 weeks and were not impacted by a refresher session.
CONCLUSIONS
We developed a practical, effective, and durable educational intervention to train early-career endosonographers in nCLE-guided diagnosis of PCLs.
Topics: Humans; Prospective Studies; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Microscopy, Confocal; Pancreatic Cyst; Lasers
PubMed: 37473969
DOI: 10.1016/j.gie.2023.07.019 -
Australian Family Physician Aug 2014Diagnosing cancer on the basis of a patient's symptoms and risk factors is a core role for general practice. Equally, as part of a cost-effective health system, GPs... (Review)
Review
BACKGROUND
Diagnosing cancer on the basis of a patient's symptoms and risk factors is a core role for general practice. Equally, as part of a cost-effective health system, GPs should avoid over-investigation or referral of patients who are very unlikely to have cancer. Diagnosing cancer in primary care is not straightforward because many of the symptoms of cancer have more common benign causes.
OBJECTIVE
The aim of this article is to review the use of risk tools for diagnosing cancer in primary care.
DISCUSSION
Certain cancers, such as lung, pancreas, ovary and myeloma, are particularly challenging to diagnose early. National guidelines exist to support identification of patients who are more likely to have an undiagnosed cancer but these list single symptoms as so-called 'red flags'. Validated risk tools, developed in general practice, exist that predict cancer diagnosis on the basis of patterns of symptoms and risk factors. These tools might prove useful in supporting cancer diagnosis in general practice and also reducing investigation of patients at very low risk of cancer.
Topics: Decision Support Techniques; General Practice; Humans; Neoplasms; Primary Health Care; Risk Factors; Symptom Assessment
PubMed: 25114983
DOI: No ID Found -
International Journal of Geriatric... Aug 2015Dementia is a common clinical presentation among older adults with Down syndrome. The presentation of dementia in Down syndrome differs compared with typical Alzheimer's...
OBJECTIVE
Dementia is a common clinical presentation among older adults with Down syndrome. The presentation of dementia in Down syndrome differs compared with typical Alzheimer's disease. The performance of manualised dementia criteria in the International Classification of Diseases (ICD)-10 and Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision (DSM-IV-TR) is uncertain in this population.We aimed to determine the concurrent validity and reliability of clinicians' diagnoses of dementia against ICD-10 and DSM-IV-TR diagnoses. Validity of clinical diagnoses were also explored by establishing the stability of diagnoses over time.
METHODS
We used clinical data from memory assessments of 85 people with Down syndrome, of whom 64 (75.3%) had a diagnosis of dementia. The cases of dementia were presented to expert raters who rated the case as dementia or no dementia using ICD-10 and DSM-IV-TR criteria and their own clinical judgement.
RESULTS
We found that clinician's judgement corresponded best with clinically diagnosed cases of dementia, identifying 84.4% cases of clinically diagnosed dementia at the time of diagnosis. ICD-10 criteria identified 70.3% cases, and DSM-IV-TR criteria identified 56.3% cases at the time of clinically diagnosed dementia. Over time, the proportion of cases meeting ICD-10 or DSM-IV-TR diagnoses increased, suggesting that experienced clinicians used their clinical knowledge of dementia presentation in Down syndrome to diagnose the disorder at an earlier stage than would have been possible had they relied on the classic description contained in the diagnostic systems.
CONCLUSIONS
Clinical diagnosis of dementia in Down syndrome is valid and reliable and can be used as the standard against which new criteria such as the DSM-5 are measured.
Topics: Adult; Aged; Dementia; Diagnostic and Statistical Manual of Mental Disorders; Down Syndrome; Female; Humans; International Classification of Diseases; Male; Middle Aged; Observer Variation; Psychiatric Status Rating Scales; Reproducibility of Results
PubMed: 25363568
DOI: 10.1002/gps.4228 -
Balkan Medical Journal Apr 2017Pathologic nipple discharge, which is a common reason for referral to the breast imaging service, refers to spontaneous or bloody nipple discharge that arises from a...
BACKGROUND
Pathologic nipple discharge, which is a common reason for referral to the breast imaging service, refers to spontaneous or bloody nipple discharge that arises from a single duct. The most common cause of nipple discharge is benign breast lesions, such as solitary intraductal papilloma and papillomatosis. Nevertheless, in rare cases, a malignant cause of nipple discharge can be found.
AIMS
To study the diagnostic value of ultrasonography, magnetic resonance imaging, and ductoscopy in patients with pathologic nipple discharge, compare their efficacy, and investigate the importance of magnetic resonance imaging in the diagnosis of intraductal pathologies.
STUDY DESIGN
Diagnostic accuracy study.
METHODS
Fifty patients with pathologic nipple discharge were evaluated by ultrasonography and magnetic resonance imaging. Of these, 44 ductoscopic investigations were made. The patients were classified according to magnetic resonance imaging, ultrasonography, and ductoscopy findings. A total of 25 patients, whose findings were reported as intraductal masses, underwent surgery oincluding endoscopic excision for two endoscopic excision. Findings were compared with the pathology results that were accepted as the gold standard in the description of the aetiology of nipple discharge. In addition, magnetic resonance imaging, ultrasonography and ductoscopy findings were analysed comparatively in patients who had no surgery.
RESULTS
Intraductal masses were reported in 26 patients, 20 of whom operated and established accurate diagnosis of 18 patients on magnetic resonance imaging. According to the ultrasonography, intraductal masses were identified in 22 patients, 17 of whom underwent surgery. Ultrasonography established accurate diagnoses in 15 patients. Intraductal mass was identified in 22 patients and ductoscopy established accurate diagnoses based on histopathologic results in 16 patients. The sensitivities of methods were 75% in ultrasonography, 90% in magnetic resonance imaging, and 94.6% in ductoscopy. The specificities were 66.7% in ultrasonography, 66.7% in magnetic resonance imaging, and 40% in ductoscopy. Intraductal papillomas were mostly observed as oval nodules with well-circumscribed smooth margins within dilated ducts and persistant in the dynamic analysis. Lesions that protruded into the lumen of the ducts, either solitary or multiple, were characteristic ductoscopy findings of our patients who were diagnosed as having papilloma/papillomatosis.
CONCLUSION
Magnetic resonance imaging and ductoscopy had no statistical superiority over each other, however they were superior to ultrasonography in the diagnosis of pathologic nipple discharge. Magnetic resonance imaging may be highly sensitive for diagnosing nipple discharge with new techniques and sequences and a non-invasive method that more advantageous for showing ductal tree visualization and is able to detect completely obstructed intraductal lesions.
Topics: Adolescent; Adult; Breast Diseases; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Nipple Discharge; Nipples; Reproducibility of Results; Ultrasonography
PubMed: 28418338
DOI: 10.4274/balkanmedj.2016.0184