10-mm Threshold Research Articles

Detection of High-Risk Sessile Serrated Lesions: Multitarget Stool DNA Versus CT Colonography.

BACKGROUND. The serrated pathway for colorectal cancer (CRC) development is increasingly recognized. Sessile serrated lesions (SSLs) that are large (≥ 10 mm) and/or have dysplasia (i.e., high-risk SSLs) are at higher risk of progression to CRC. Detection of SSLs is challenging given their predominantly flat and right-sided location. The yield of noninvasive screening tests for detection of high-risk SSLs is unclear. OBJECTIVE. The aim of this study was to compare noninvasive screening detection of high-risk SSLs between the multitarget stool DNA (mt-sDNA) test and CT colonography (CTC). METHODS. This retrospective study included 7974 asymptomatic adults (4705 women, 3269 men; mean age, 60.0 years) who underwent CRC screening at a single center by mt-sDNA from 2014 to 2019 (n = 3987) or by CTC from 2009 to 2019 (n = 3987). Clinical interpretations of CTC examinations were recorded. Subsequent colonoscopy findings and histology of resected polyps were also recorded. Chi-square or two-sample t tests were used to compare results between mt-sDNA and CTC using 6-mm and 10-mm thresholds for test positivity. RESULTS. The overall colonoscopy referral rate for a positive screening test was 13.1% (522/3987) for mt-sDNA versus 12.2% (487/3987; p = .23) and 6.5% (260/3987; p < .001) for CTC at 6-mm and 10-mm thresholds, respectively. The PPV for high-risk SSLs was 5.5% (26/476) for mt-sDNA versus 14.4% (66/457; p < .001) and 25.9% (63/243; p < .001) for CTC at the 6-mm and 10-mm thresholds, respectively. The overall screening yield of high-risk SSLs was 0.7% (26/3987) for mt-sDNA versus 1.7% (66/3987; p < .001) and 1.6% (63/3987; p < .001) for CTC at 6-mm and 10-mm thresholds, respectively. CONCLUSION. CTC at 6-mm and 10-mm thresholds had significantly higher yield and PPV for high-risk SSLs compared with mt-sDNA. CLINICAL IMPACT. The significantly higher detection of high-risk SSLs by CTC than by mt-sDNA should be included in discussions with patients who decline colonoscopy and opt for noninvasive screening.

The reliability of tuberculin skin test in the diagnosis of latent tuberculosis infection in psoriasis patients: A case-control study.

Tuberculin skin test (TST), which is used in the diagnosis of latent tuberculosis infection, may cause Koebner's phenomenon and false-positive results in psoriasis patients. The purpose of this study is to compare TST with QuantiFERON-TB Gold Plus (QFT-plus) test in psoriasis patients and to determine the effects of psoriasis on TST results. Ninety-two psoriasis patients and 30 control subjects were included in the study. QFT-plus test, TST, and prick test to distinguish the increase of induration because of the skin trauma were performed on both groups. The demographics, risk factors for latent tuberculosis infection, BCG vaccination history, Koebner's history, psoriasis severity, and treatment history of the patients were recorded. The effects of these variables on test results were investigated by comparing those with control group. The criteria of National Tuberculosis Diagnosis and Treatment Guidelines were used in the evaluation of test results, and threshold value of positivity for TST was taken as 10 mm in BCG-vaccinated patients who are planned to start biological treatment. Prick test results were negative in the control group. There was no significant relation between the results of prick test and TST induration diameters in the patient group. Although TST positivity was significantly higher in patients (62%) compared with control group (33%), QFT-plus test results were not statistically different between two groups. Agreement between two tests was determined to be low in patient group with 48% (K = 0.1), and it was determined to be moderate with 77% in control group (K = 0.4). QFT-plus test was found to be negative in 46 of 57 TST-positive patients (80.7%) in patient group. It was determined in both groups that vaccination did not have any effect on test results. When threshold value was lowered to 5 mm in patient group without considering BCG reaction, the number of TST-positive patients increased from 57 to 65. Mean TST induration diameter was 10 mm and 14 mm in cases with mild and moderate to severe clinical manifestation, respectively (P = .04). However, no effect of disease period and treatment was determined on both test results. TST positivity was higher in psoriasis patients compared with control group. It was considered due to the increased reaction of the skin to mycobacterial antigens rather than the Koebner's response. Although TST results were not affected by BCG, it was concluded that a 10-mm threshold value of positivity was a suitable approach in order to reduce the number of patients receiving unnecessary preventive treatment in patients who are considered to initiate biologic agents. Furthermore, it was also concluded that QFT-plus test may be preferred in psoriasis patients since it is applied in vitro and its specificity is higher and not affected by disease severity.

High-Resolution Gridded Daily Rainfall and Temperature for the Hawaiian Islands (1990–2014)

AbstractSpatially continuous data products are essential for a number of applications including climate and hydrologic modeling, weather prediction, and water resource management. In this work, a distance-weighted interpolation method used to map daily rainfall and temperature in Hawaii is described and assessed. New high-resolution (250 m) maps were developed for daily rainfall and daily maximum (Tmax) and minimum (Tmin) near-surface air temperature for the period 1990–2014. Maps were produced using climatologically aided interpolation, in which station anomalies were interpolated using an optimized inverse distance weighting approach and then combined with long-term means to produce daily gridded estimates. Leave-one-out cross validation was performed to assess the quality of the final daily grids. The median absolute prediction error for rainfall was 0.1 mm with an average overprediction (+0.6 mm) on days when total rainfall was less than 1 mm. On days with total rainfall greater than 1 mm, median absolute prediction errors were 2 mm and rainfall was typically underpredicted above the 10-mm threshold. For daily temperature, median absolute prediction errors were 3.1° and 2.8°C for Tmax and Tmin, respectively. On average, this method overpredicted Tmax (+1.1°C) and Tmin (+1.5°C), and errors varied considerably among stations. Errors for all variables exhibited significant seasonal variations. However, the annual range of errors was small. The methods presented here provide an effective approach for mapping daily weather fields in a topographically diverse region and improve on previous products in their spatial resolution, time period of coverage, and use of data.

CT Colonography Performance for the Detection of Polyps and Cancer in Adults ≥ 65 Years Old: Systematic Review and Meta-Analysis.

We sought to perform a systematic review and meta-analysis of published CT colonography (CTC) studies assessing lesion detection in senior-age (≥ 65 years old) cohorts. We conducted a systematic review of CTC studies published between January 1994 and August 2017 containing data on senior-age adults. The primary endpoint was the CTC-positive rate for large colorectal polyps (≥ 10 mm) and masses. Secondary endpoints included lesions ≥ 6 mm, proven advanced neoplasia, and colorectal cancer (CRC). Study authors were contacted for additional missing data. Random-effects and meta-regression analyses were used to generate pooled estimates and explore contributing factors. A total of 34 studies with 41,680 (18,798 senior-age) subjects were included. Pooled CTC-positive rates among senior-age patients using the 10-mm size threshold were significantly lower in cohorts of patients with no symptoms (8.2%; 95% CI, 6.0-11.1%) compared with cohorts of patients with positive fecal occult blood tests (32.8%; 95% CI, 15.4-56.7%) and other symptoms of CRC (14.0%; 95% CI, 12.0-16.1%). However, a uniformly high positive predictive value for advanced neoplasia at colonoscopy was seen for all senior-age cohorts using a 10-mm threshold (84.3%; 95% CI, 79.3-88.3%; I2 = 0.0) where such data were available. CTC sensitivity for CRC was 93.0% (95% CI, 89.0-95.0%) in senior-age patients compared with 92.0% (95% CI, 84.0-93.0%) in younger patients. Overall, CTC detection rates were higher in senior-age adults compared with younger adults. On average, one in every 12 senior-age adults without symptoms of CRC who underwent screening would be referred to colonoscopy using the 10-mm threshold, with a high yield for advanced neoplasia and high sensitivity for cancer detection. As expected, CTC-positive rates were higher in cohorts of patients 65 years old or older with symptoms of CRC. These results should help inform the Centers for Medicare & Medicaid Services regarding coverage determination of CTC screening for Medicare beneficiaries.

Reliability of Color Doppler Ultrasound Imaging for the Assessment of Anterolateral Thigh Flap Perforators: A Prospective Study of 30 Perforators.

Diagnostic, II.

Colorectal Polyps: Stand-alone Performance of Computer-aided Detection in a Large Asymptomatic Screening Population

To evaluate stand-alone performance of computer-aided detection (CAD) for colorectal polyps of 6 mm or larger at computed tomographic (CT) colonography in a large asymptomatic screening cohort. In this retrospective, institutional review board-approved, HIPAA-compliant study, a CAD software system was applied to screening CT colonography in 1638 women and 1408 men (mean age, 56.9 years) evaluated at a single medical center between March 2006 and December 2008. All participants underwent cathartic preparation with stool tagging; electronic cleansing was not used. The reference standard consisted of interpretation by experienced radiologists in all cases. This interpretation was further refined for the subset of cases with positive findings by using subsequent colonoscopic or CT colonographic confirmation, as well as retrospective expert localization of polyps with CT colonography. This test set was not involved in training the CAD system. The Fisher exact test was used to evaluate significance; 95% confidence intervals (CIs) were obtained by using the exact method. Per-patient CAD sensitivities were 93.8% (350 of 373; 95% CI: 90.9%, 96.1%) and 96.5% (137 of 142; 95% CI: 92.0%, 98.8%) at 6- and 10-mm threshold sizes, respectively. Per-polyp CAD sensitivities for all polyps, regardless of histologic features, were 90.1% (547 of 607; 95% CI: 88.0%, 92.8%) and 96.0% (168 of 175; 95% CI: 91.9%, 98.4%) at 6- and 10-mm threshold sizes, respectively; CAD sensitivities for advanced neoplasia and cancer were 97.0% (128 of 132; 95% CI: 92.4%, 99.2%) and 100% (13 of 13; 95% CI: 79.4%, 100%), respectively. The mean and median false-positive rates were 4.7 and 3 per series, respectively (9.4 and 6 per patient). Among 373 patients with a positive finding at CT colonography, CAD marked an additional 15 polyps of 6 mm or larger, including four large polyps, that were missed at the prospective three-dimensional reading by an expert but were found at subsequent colonoscopy. Stand-alone CAD demonstrated excellent performance for polyp detection in a large screening population, with high sensitivity and an acceptable number of false-positive results.

CT Colonography: Performance and Program Outcome Measures in an Older Screening Population

To evaluate computed tomographic (CT) colonography performance and program outcome measures in an older cohort (65-79 years) of an established large-scale colorectal cancer screening program. This HIPAA-compliant study was approved by the institutional review board; informed consent waived. Retrospective analysis of the 65-79-year-old cohort (n = 577) from the University of Wisconsin CT colonography screening program (n = 5176) was undertaken. Performance and outcome measures including advanced neoplasia prevalence and colonoscopy referral, extracolonic finding, extracolonic work-up, and complication rates were obtained by using a CT colonography database and review of medical records. Comparisons between the older cohort and the general screening population were made by using the Student t, Pearson chi(2), and Fisher exact tests. A P value <or= .05 was considered to indicate a significant difference. With a 6-mm threshold for positivity, the overall referral rate to optical colonoscopy was 15.3% (88 of 577), leading to 277 polypectomies and the removal of 103 nondiminutive adenomas. For adenomas, the per-patient positivity rates were 10.9% (63 of 577) and 6.8% (39 of 577) at the 6- and 10-mm thresholds, respectively. The prevalence of advanced neoplasia was 7.6% (44 of 577). Fifty-four adenomas met advanced status, and five unsuspected cancers were detected. The advanced neoplasias identified were typically large, with a mean size of 21 mm. Potentially important extracolonic findings were seen in 15.4% (89 of 577) of patients, with a work-up rate of 7.8% (45 of 577). The majority of important extracolonic diagnoses were vascular aneurysms (n = 18). No major complications were encountered. CT colonography is a safe and effective screening modality for the older population.

Systematic review: distribution of advanced neoplasia according to polyp size at screening colonoscopy

The impact of not referring sub-centimetre polyps identified at CT colonography upon the efficacy of colorectal cancer screening remains uncertain. To determine the distribution of advanced neoplasia according to polyp size in a screening setting. Published studies reporting the distribution of advanced adenomas in asymptomatic screening cohorts according to polyp size were identified by MEDLINE and EMBASE searches. Predefined outputs were the screening rates of advanced adenomas represented by diminutive (< or =5 mm), small (6-9 mm), sub-centimetre (<10 mm) and large (> or =10 mm) polyp sizes. Data from four studies with 20 562 screening subjects met the primary inclusion criteria. Advanced adenomas were detected in 1155 (5.6%) subjects (95% CI = 5.3-5.9), corresponding to diminutive, small and large polyps in 4.6% (95% CI = 3.4-5.8), 7.9% (95% CI = 6.3-9.4) and 87.5% (95% CI = 86-89.4) of cases respectively. The frequency of advanced lesions among patients whose largest polyp was diminutive, small, sub-centimetre and large in size was 0.9%, 4.9%, 1.7% and 73.5% respectively. Based on this systematic review, a 6-mm polyp size threshold for polypectomy referral would identify over 95% of subjects with advanced adenomas, whereas a 10-mm threshold would identify 88% of cases.

Primary 2D Versus Primary 3D Polyp Detection at Screening CT Colonography

Disparate results from the existing large CT colonography (CTC) trials suggest that 2D polyp detection is less sensitive than 3D detection, but no direct evidence exists to support this claim. Our goal was to assess the sensitivity of primary 2D polyp detection with cases from the Department of Defense CTC screening trial and compare results with the primary 3D evaluation and previous 2D CTC trials. Ten radiologists, blinded to polyp findings, retrospectively interpreted 730 consecutive colonoscopy-proven CTC cases in asymptomatic adults using a primary 2D approach, with 3D reserved for problem solving. Primary 2D CTC performance was compared with the primary 3D CTC results from the original trial of 1,233 asymptomatic adults. The 10 2D reviewers were significantly more experienced in CTC interpretation (> 100 cases interpreted) than the six reviewers from the original 3D trial. Primary 2D CTC sensitivity for adenomas > or = 6 mm was 44.1% (56/127), compared with 85.7% (180/210) at 3D (p < 0.001). Sensitivity of 2D CTC for adenomas > or = 10 mm was 75.0% (27/36) compared with 92.2% (47/51) at 3D (p = 0.027). Similar sensitivity trends were seen for the by-patient analysis and for all polyps at the 6-mm and 10-mm thresholds. By-patient specificity for 2D evaluation at the 10-mm threshold was 98.1% (676/689), compared with 97.4% (1,131/1,161) at 3D evaluation (p = 0.336). Primary 2D CTC is less sensitive than primary 3D CTC for polyp detection in low-prevalence screening cohorts. The disappointing 2D sensitivity in this study was very similar to results obtained with primary 2D evaluation in previous CTC trials.

Water enema computed tomography: diagnostic tool in suspicion of colorectal tumor

The aim of this study was to assess the accuracy of water enema multi-row computed tomography for detecting clinically suspected colorectal tumor. A water enema multi-row computed tomography (WE-MR-CT) was performed in 128 consecutive patients (71 women, mean age 67.7 years) referred for suspicion of colorectal cancer. We defined at least one centimeter size of the lesion as the threshold of detection. The results of WE-MR-CT were compared with the diagnosis obtained by colonoscopy, pathology or clinical follow-up. The overall sensitivity and specificity of water enema multi-row CT in identifying patients with colorectal lesions were 95.5% and 93.5%, respectively. The negative predictive value was 98.8% for a 10-mm threshold lesion size. WE-MR-CT allowed identifying synchronous lesions in three cases. WE-MR-CT can accurately detect supracentimetric colorectal tumors. The performance of this technique should be further evaluated in prospective studies.