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The British Journal of Radiology Feb 2023Incidental adrenal masses are among the most common incidental lesions detected on cross-sectional imaging. The majority are benign lesions, adenomas and myelolipomas... (Review)
Review
Incidental adrenal masses are among the most common incidental lesions detected on cross-sectional imaging. The majority are benign lesions, adenomas and myelolipomas being the most common. Simple cross-sectional imaging techniques using CT and MRI permit the characterization of over 80%, thereby requiring no further imaging. The remaining lesions are considered indeterminate. These lesions consist of benign and malignant lesions sharing imaging features. Further imaging and management of these indeterminate lesions should be guided by close collaboration between different specialists in an MDT setting. Advanced imaging options include dedicated adrenal scintigraphy, positron emission tomography CT, biopsy and surveillance. Biochemical and hormonal evaluation is also important to identify hyperfunctioning adrenal lesions. This review focuses on imaging features of benign and malignant adrenal masses used for characterization and suggests an imaging pathway for indeterminate adrenal masses.
Topics: Humans; Adrenal Gland Neoplasms; Tomography, X-Ray Computed; Adenoma; Magnetic Resonance Imaging; Biopsy
PubMed: 35543634
DOI: 10.1259/bjr.20220281 -
The Journal of Surgical Research Jan 2020In the management of indeterminate-depth burns (IDB), common challenges include the ability to predict time to healing and regenerative potential, risk of burn wound... (Review)
Review
In the management of indeterminate-depth burns (IDB), common challenges include the ability to predict time to healing and regenerative potential, risk of burn wound progression, and timing of excision. Several technologies exist to aid in determination of the depth of a burn injury, yet surgeons continue to rely on the naked eye-visual assessment-as the standard of care. Newer and improved imaging technologies are closing in on the goal of inexpensive, accurate, noninvasive modalities for depth determination. Likewise, management of IDB is becoming more sophisticated as newer wound healing technologies continue to be developed. By describing what is meant by "indeterminate" depth burns, and their associated challenges, we hope to stimulate interest in research to develop new therapies and management strategies. The ultimate goal is to treat IDB without the need for autografts.
Topics: Burns; Debridement; Disease Progression; Humans; Patient Selection; Severity of Illness Index; Skin; Skin Transplantation; Skin, Artificial; Standard of Care; Time Factors; Treatment Outcome; Uncertainty; Wound Healing
PubMed: 31421361
DOI: 10.1016/j.jss.2019.07.063 -
Clinical approach to indeterminate biliary strictures: Clinical presentation, diagnosis, and workup.World Journal of Gastroenterology Sep 2023Despite advances in cross-sectional imaging and endoscopic technology, bile duct strictures remain a challenging clinical entity. It is crucial to make an early... (Review)
Review
Despite advances in cross-sectional imaging and endoscopic technology, bile duct strictures remain a challenging clinical entity. It is crucial to make an early determination of benign or malignant nature of biliary strictures. Early diagnosis not only helps with further management but also minimizes mortality and morbidity associated with delayed diagnosis. Conventional imaging and endoscopic techniques, particularly endoscopic retrograde cholangiopancreatography (ERCP) and tissue sampling techniques play a key in establishing a diagnosis. Indeterminate biliary strictures (IDBSs) have no definite mass on imaging or absolute histopathological diagnosis and often warrant utilization of multiple diagnostics to ascertain an etiology. In this review, we discuss possible etiologies, clinical presentation, diagnosis, and management of IDBSs. Based on available data and expert opinion, we depict an evidence based diagnostic algorithm for management of IDBSs. Areas of focus include use of traditional tissue sampling techniques such as ERCP with brush cytology, intraductal biopsies, fluorescence hybridization and flow cytometry. We also describe the role of endoscopic ultrasound (EUS)-guided fine needle aspiration and biopsies, cholangioscopy, confocal laser endomicroscopy, and intraductal EUS in management of IDBSs.
Topics: Humans; Constriction, Pathologic; In Situ Hybridization, Fluorescence; Cholestasis; Cholangiopancreatography, Endoscopic Retrograde; Biopsy
PubMed: 37901449
DOI: 10.3748/wjg.v29.i36.5198 -
Current Reviews in Musculoskeletal... Jun 2022The goal of this review is to provide an up to date understanding of the utility and limitations of the current tests utilized in the diagnosis of periprosthetic joint... (Review)
Review
PURPOSE OF REVIEW
The goal of this review is to provide an up to date understanding of the utility and limitations of the current tests utilized in the diagnosis of periprosthetic joint infection (PJI) in total knee and hip arthroplasty.
RECENT FINDINGS
Despite the growth in literature surrounding PJI diagnosis, there remains challenges in establishing a diagnosis of PJI. A combination of clinical, serum, and synovial tests and microbiologic and histologic examinations can yield a diagnosis in the majority of cases. Novel molecular and imaging studies may be beneficial for indeterminant cases. A number of emerging diagnostic tests have been proposed and may be incorporated into diagnostic algorithms in the future. Recently proposed stepwise diagnostic algorithms have shown high sensitivity and specificity. The diagnosis of PJI remains challenging due to a lack of tests that can definitively rule out infection. Diagnosis and investigations should occur in a stepwise fashion. There has been a plethora of new diagnostic tests introduced in attempts to improve the accuracy of diagnostic algorithms. The definition and algorithms for the diagnoses of PJI will continue to evolve as new techniques and tests are introduced.
PubMed: 35368214
DOI: 10.1007/s12178-022-09751-w -
Journal of Clinical Medicine Sep 2021We compared the results and differences of indeterminate rates between the QuantiFERON-TB Gold In-Tube (QFT-GIT) and QuantiFERON-TB Gold PLUS (QFT-PLUS) tests in...
We compared the results and differences of indeterminate rates between the QuantiFERON-TB Gold In-Tube (QFT-GIT) and QuantiFERON-TB Gold PLUS (QFT-PLUS) tests in patients with rheumatic diseases and analyzed the associated factors. Data of patients with rheumatic diseases who had undergone the QFT-GIT or QFT-PLUS test were used, and information regarding patient demographics, primary diagnosis, laboratory results, and medications was collected. Furthermore, indeterminate result rates of the patient cohort and healthy controls were also compared. A total of 177 (43.4%) and 231 (56.6%) patients had undergone QFT-GIT and QFT-PLUS tests, respectively. Among them, four (2.3%) and seven (3.0%) patients had indeterminate results, which did not differ between the QFT-GIT and QFT-PLUS groups. Indeterminate results were significantly higher among patients with rheumatic diseases than in healthy controls (2.7% vs. 0.2%, < 0.001). Multivariate logistic regression revealed that the lymphocyte count (hazard ratio (HR) 0.998, 95% confidence interval (CI) 0.997, 1.000; = 0.012) and albumin level (HR 0.366, 95% CI 0.150, 0.890; = 0.027) were predictive of indeterminate results. A lymphocyte count of ≤810/mm and an albumin level of ≤3.7 mg/dL were capable of discriminating between indeterminate and determinate results. The QFT-GIT and QFT-PLUS tests have comparable diagnostic performances in patients with rheumatic diseases. Decreased lymphocyte and albumin levels contribute to indeterminate results.
PubMed: 34640376
DOI: 10.3390/jcm10194357 -
Gland Surgery Aug 2019The indeterminate thyroid nodules diagnosed by fine-needle aspiration cytology (FNAC)represents a problem for both cytopathologists and clinicians. The former sometimes... (Review)
Review
The indeterminate thyroid nodules diagnosed by fine-needle aspiration cytology (FNAC)represents a problem for both cytopathologists and clinicians. The former sometimes use this diagnostic category as a sort of basket, putting in cases that they do not know exactly how to classify. The latter are faced with a highly variable risk of malignancy and consequently the management remains a challenge. On the histopathological side, the new WHO classification of tumors of the thyroid introduced the concept of tumors with uncertain and low malignant potential, and the concept of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), whose prognosis and management are still to be completely elucidated. While the risk of malignancy of the indeterminate diagnostic category has decreased due to the re-classification of certain types of papillary thyroid carcinomas of the follicular variant into a low malignant potential form (the NIFTP), cases diagnosed cytologically as indeterminate will probably increase in the future to avoid false positive diagnosis. Thus, the indeterminate thyroid diagnostic category still remains a challenge, both at the diagnostic level and for its management. The new version of the Bethesda system for reporting thyroid cytopathology suggests managing these patients with a repeat FNA, diagnostic lobectomy and/or molecular testing.
PubMed: 31475096
DOI: 10.21037/gs.2018.12.06 -
Journal of Clinical & Translational... Dec 2021Oral glucose tolerance testing (OGTT) is the primary method to screen for and diagnose cystic fibrosis-related diabetes (CFRD). Diagnostic thresholds as currently...
Oral glucose tolerance testing (OGTT) is the primary method to screen for and diagnose cystic fibrosis-related diabetes (CFRD). Diagnostic thresholds as currently defined are based on microvascular complications seen in type 2 diabetes. Abnormal glucose tolerance (AGT) refers to OGTT glucose elevations outside the normal range and encompasses both impaired and indeterminate glucose tolerance. Current guidelines define impaired glucose tolerance (IGT) as a 2-hour glucose of 140-199 mg/dL (7.8-11 mmol/L) and indeterminate glucose tolerance (INDET) as any mid-OGTT glucose ≥ 200 mg/dL (11.1 mmol/L) with a normal fasting and 2 h glucose. There is growing evidence that AGT also has associations with CF-centered outcomes including pulmonary decline, hospitalizations, and weight loss. Here we aim to review the historical emergence of glucose tolerance testing, review relevance to risk stratification for CFRD, discuss alternate cutoffs for identifying AGT earlier, and highlight the need for larger, future studies to inform our understanding of the implications of IGT and INDET on CF health.
PubMed: 34868882
DOI: 10.1016/j.jcte.2021.100275 -
PloS One 2020Indeterminate HIV test results are common, but little is known about the evolution of indeterminate serology and its sociodemographic and behavioral correlates. We...
BACKGROUND
Indeterminate HIV test results are common, but little is known about the evolution of indeterminate serology and its sociodemographic and behavioral correlates. We assessed future HIV serological outcomes for individuals with indeterminate results and associated factors in Rakai, Uganda.
METHODS
115,944 serological results, defined by two enzyme immunoassay (EIAs), among 39,440 individuals aged 15-49 years in the Rakai Community Cohort Study were assessed. Indeterminate results were defined as contradictory EIAs. Modified Poisson regression models with generalized estimating equations were used to assess prevalence ratios (PRs) of subsequent HIV serological outcomes and factors associated with HIV indeterminate results.
RESULTS
The prevalence of HIV serologically indeterminate results was 4.9%. Indeterminate results were less likely among women than men (adjPR 0.76, 95% CI 0.71,0.81), in unmarried participants than married participants (adjPR 0.92, 95% CI 0.85,99), and in individuals with primary (adjPR 0.90, 95% CI 0.80,1.02), secondary (adjPR 0.83, 95% CI 0.73,0.96) and post-secondary (adjPR 0.75, 95% CI 0.60,0.94) education, relative to no education. The proportions of persons with indeterminate results progressing to HIV positive, negative or indeterminate results in subsequent visits was 5%, 71% and 24%, respectively.
CONCLUSION
HIV serologically indeterminate results were associated with gender and marital status. HIV surveillance programs should develop a protocol for reporting individuals with mixed or persistently indeterminate HIV results on multiple follow-up visits. Most indeterminate results became HIV-negative over time, but follow-up is still needed to detect positive serologies.
Topics: AIDS Serodiagnosis; Adolescent; Adult; Female; Follow-Up Studies; HIV; HIV Infections; Humans; Longitudinal Studies; Male; Marriage; Middle Aged; Prevalence; Risk Factors; Uganda; Young Adult
PubMed: 32845933
DOI: 10.1371/journal.pone.0237633 -
Frontiers in Endocrinology 2022Fine needle aspiration (FNA) is the procedure of choice in the evaluation of thyroid nodules. Nodules with indeterminate cytological categories, Bethesda III and IV,...
BACKGROUND
Fine needle aspiration (FNA) is the procedure of choice in the evaluation of thyroid nodules. Nodules with indeterminate cytological categories, Bethesda III and IV, pose challenges in clinical practice and are frequently submitted to diagnostic surgery. CytoFoam Core (CFCS) uses an absorbent foam device inserted into the needle hub to collect the cytological sample aspirated during FNA. Specimen is formalin-fixed and paraffin-embedded.
AIM OF THE STUDY
Assessing diagnostic efficacy of CFCS, compared to traditional cytology, in re-evaluating thyroid nodules classified as Bethesda III, using post-surgical histology as reference standard.
METHOD
Retrospective study on 89 patients with a first indeterminate cytological report who were referred to the Department of Endocrinology of Regina Apostolorum Hospital (Albano L. Rome, Italy) for a second FNA. FNA was performed after at least one month under ultrasound guidance with a 23G needle according to the established procedure. During the second procedure, both traditional cytological (TC) smears and a single-pass CFCS specimen were obtained for each patient. On CFCS samples immunocytochemical staining for Galectin-3, HBME-1, and CK-19 was also performed. 51 patients eventually underwent surgery, and their histological diagnoses were compared to the TC and CFCS reports. Four parameters were evaluated: inadequacy rate, rate of persistent indeterminate (Bethesda III and IV) reports, rate of malignancy in persistently indeterminate nodules, and rate of cancer in lesions cytologically classified as malignant.
RESULTS
Non-diagnostic samples were 6 (11.8%) in TC vs 3 (5.9%) in CFCS (p=0.4). Persistent indeterminate samples were 31 (60.8%) in TC vs 19 (37.2%) in CFCS (p=0.01). Rate of malignancy in persistently indeterminate nodules was 8/19 (42.1%) in CFCS vs 9/31 (29%) in TC group (p=0.3). Nine/51 (17.6%) samples were classified as benign by TC vs 21/51 (41.2%) samples by CFCS (p<0.01). All nodules resulted benign at post-surgical evaluation. Five/51 (9.8%) samples were classified as suspicious for malignancy/malignant in TC group against 8/51 (15.7%) samples in CFCS (p=0.5). Post-surgical evaluation confirmed malignancy in all these cases.
CONCLUSION
CFCS demonstrated greater diagnostic accuracy than TC in repeat FNA assessment of cytologically indeterminate nodules. CFCS increased the conclusive diagnosis rate and decreased the number of cytologically indeterminate cases.
Topics: Humans; Thyroid Nodule; Retrospective Studies; Thyroid Neoplasms; Biopsy, Fine-Needle; Cytodiagnosis
PubMed: 36531453
DOI: 10.3389/fendo.2022.1078019 -
Horticulture Research Jul 2021Cucumber (Cucumis sativus L.) is an important vegetable crop species with great economic value. Shoot architecture determines the visual appearance of plants and has a... (Review)
Review
Cucumber (Cucumis sativus L.) is an important vegetable crop species with great economic value. Shoot architecture determines the visual appearance of plants and has a strong impact on crop management and yield. Unlike most model plant species, cucumber undergoes vegetative growth and reproductive growth simultaneously, in which leaves are produced from the shoot apical meristem and flowers are generated from leaf axils, during the majority of its life, a feature representative of the Cucurbitaceae family. Despite substantial advances achieved in understanding the regulation of plant form in Arabidopsis thaliana, rice, and maize, our understanding of the mechanisms controlling shoot architecture in Cucurbitaceae crop species is still limited. In this review, we focus on recent progress on elucidating the genetic regulatory pathways underlying the determinant/indeterminant growth habit, leaf shape, branch outgrowth, tendril identity, and vine length determination in cucumber. We also discuss the potential of applying biotechnology tools and resources for the generation of ideal plant types with desired architectural features to improve cucumber productivity and cultivation efficiency.
PubMed: 34193859
DOI: 10.1038/s41438-021-00577-0