Diagnostic Adequacy Research Articles

Diagnostic adequacy of surgeon‐performed ultrasound‐guided fine needle aspiration biopsy of thyroid nodules

Surgeon-performed ultrasonography (US) of thyroid nodules might serve as a potential therapeutic guide to designate accurate surgical or clinical intervention. To evaluate the diagnostic adequacy of surgeon-performed ultrasonography guided fine needle aspiration biopsy (FNAB) of thyroid nodules, the factors responsible for diagnostic adequacy and the impact of surgeon-performed US on treatment approach. Retrospective review of a single surgeon performed 621 US-guided FNABs without on-site cytological specimen assessment. Outside US findings were compared to the surgeon-performed US. Measured variables and outcomes for the study included diagnostic adequacy rates and the effects of detected differences between US reports on treatment variability. Diagnostic adequacy rate of surgeon-performed US-guided FNAB was determined to be 94.52% without on-site specimen evaluation by cytologist. Non-diagnostic specimens occurred in 34 of 621 (5.48%) nodules. The differences detected between the outside US and surgeon-performed US altered invasive treatment algorithm in 30 (5.47%) patients. FNAB was avoided for 15 (2.7%) patients. Total thyroidectomy became the preferred surgical option in 15 (2.7%) patients after the discovery of additional nodules in the contralateral lobe. Surgeon-performed US offers clear clinical benefits in terms of diagnostic yield of FNAB with providing valuable additional data that might alter surgical treatment approach.

Use of the mobile phone multimedia messaging service for teledermatology

We examined the feasibility of using mobile phone Multimedia Messaging Service (MMS) to send teledermatology referrals from a general practitioner to a dermatologist. Digital photographs of skin conditions in 40 consecutive patients were sent together with relevant clinical information to dermatologists at a university hospital. Two dermatologists separately assessed the MMS referrals. The suspected diagnosis, triage and management decisions were compared to those given after separate face-to-face (FTF) visits, and again after agreeing on a final clinical and/or histopathological diagnosis. Thirty-two patients (80%) were diagnosed with skin tumours and 8 patients (20%) with other skin conditions. Both dermatologists were able to make a correct diagnosis in 31 patients (78%) based solely on the MMS referral. They also provided adequate management recommendations for 98% of the patients. Adequate triage decisions after assessment of the MMS referrals were made for 34 (85%) and 38 (95%) patients by the two dermatologists. There was an inter-observer concordance of 68% for the teledermatology diagnosis, compared to 88% concordance after the separate FTF visits. The diagnostic accuracy and adequacy of the triage and management decisions achieved using MMS referrals were similar to those obtained with other store-and-forward teledermatology methods.

Adequacy of Low Dose Computed Tomography in Patients Presenting with Acute Urinary Colic

Noncontrast abdominal/pelvic CT is the current imaging standard for patients who present with acute urinary colic. Conventional CT, however, exposes the patient to significant amounts of ionizing radiation, which is cumulative when additional CTs are used to monitor stone migration, outcomes, etc. We sought to maintain diagnostic adequacy while decreasing our patients' radiation exposure from CT by using a reduced tube current, an abbreviated scanning area, and the use of coronal reformatted images. Between March 3, 2011 and October 31, 2011, 101 consecutive adult patients with suspected urinary colic were evaluated with a "low" dose CT. If the suspected calculus(i) was not seen, the patient underwent immediate conventional CT imaging customized to their body habitus. Radiation exposure for each patient was calculated using an established formula of dose length product and scan length. The effective total radiation dose was measured in millisieverts (mSv). Overall, 84 patients had an upper tract calculus(i) consistent with the clinical suspicion. Of these, 76 (90%) were adequately imaged with low dose and 8 (10%) with conventional noncontrast CTs. The mean effective radiation dose in the 76 low dose stone-positive CTs was 2.14 mSV (median 2.10 mSv). This was almost seven-fold lower than the mean conventional stone-positive CT dose of 14.5 mSv (median 13.1 mSv). Low dose noncontrast CT provided adequate imaging to guide optimal urologic management in the majority of our patients. This modality offered a significantly lower ionizing radiation dose and should be considered in patients who present with acute urinary colic.

CT Enterography at 80 kVp With Adaptive Statistical Iterative Reconstruction Versus at 120 kVp With Standard Reconstruction: Image Quality, Diagnostic Adequacy, and Dose Reduction

The objective of our study was to evaluate the image quality and diagnostic adequacy of the following two CT enterography protocols in patients weighing less than 160 lb (72 kg): 80-kVp imaging with the adaptive statistical iterative reconstruction (ASIR) in comparison with 120-kVp imaging with the filtered back projection reconstruction. We retrospectively reviewed 133 CT enterography examinations of 127 patients weighing less than 160 lb, 64 80-kVp examinations, and 69 120-kVp examinations. Image quality for evaluation of the bowel wall, mesenteric vessels, and hepatic parenchyma and the overall image quality were graded on a scale of 1-5 (1 = poor, 2 = acceptable, 3 = good, 4 = very good, 5 = excellent). Diagnostic accuracy for the detection of inflammatory bowel disease was evaluated. The volume CT dose index (CTDI(vol)) was recorded and effective dose was calculated from scanner-generated dose-length product. There was a statistically significant decrease in the mean image quality scores for 80-kVp examinations compared with 120-kVp examinations for evaluation of the bowel wall (3.19 vs 3.70, respectively) and liver (3.12 vs 3.81) and for overall image quality (3.23 vs 3.68), but there was no significant decrease in score for evaluation of the mesenteric vessels (3.63 vs 3.67). None of the 80-kVp examinations was graded as poor, and all were considered to be of acceptable quality. Both techniques had comparable diagnostic accuracy for the detection of inflammatory bowel disease. Interobserver agreement was fair to moderate for qualitative image grading and was substantial for the detection of features of inflammatory bowel disease. The mean CTDI(vol) and effective dose for the 80-kVp examinations were 6.15 mGy and 4.60 mSv, respectively, and for the 120-kVp examinations, 20.79 mGy and 15.81 mSv. In patients weighing less than 160 lb, CT enterography examinations at 80 kVp with 30% ASIR produce diagnostically acceptable image quality with an average CTDI(vol) of 6.15 mGy and an average effective dose of 4.60 mSv.

Tu1561 The Performance of Pathology Trainees Compared to Non-Physician Cytotechnologists in the Assessment of EUS-FNA Specimen Adequacy

The Performance of Pathology Trainees Compared to NonPhysician Cytotechnologists in the Assessment of EUS-FNA Specimen Adequacy James L. Buxbaum*, Arthur W. Yan, Kavel H. Visrodia, Christianne J. Lane, Brett Quarto, Michael Y. Chan, Mehrdad Saliminejad Division of Gastrointestinal & Liver Diseases, Univ. of Southern California, Los Angeles, CA Background: The performance of rapid on-site evaluation (ROSE) of endoscopic ultrasound fine needle aspiration (EUS-FNA) samples by an attending cytopathologist to determine specimen adequacy has been shown to minimize additional procedures, optimize associated costs, and reduce complications. However, due to financial and manpower limitations, ROSE by an attending cytopathologists is not available at many centers and the realtime assessment of adequacy of EUS-FNA specimens is done by pathology trainees (resident or fellow) or cytotechnologists. The aim of this study is to compare the performance of pathology trainees and cytotechnologists in the determination of EUS-FNA specimen adequacy. Methods: A prospective database was developed in January 2010 following the establishment of two new academic ultrasound programs, one at Los Angeles County Hospital Medical Center (LAC), and the other at the USC Keck and Norris Hospitals (USC), a tertiary referral medical center. Among 365 consecutive patients, 221 anatomic targets were biopsied via EUS-FNA. EUS was performed at both centers by the same endosonographer and the same team of attending cytopathologists evaluated the samples after completion of the procedures. Real time adequacy of EUS-FNA samples at LAC was determined by pathology trainees, while at USC this was determined by non-physician cytotechnologists. The final assessment of the attending cytopathologist was the gold standard used to compare the performance of the trainees versus the cytotechnologists. Results: During the bedside evaluation all of the FNA samples were felt to be adequate at both institutions. However, final review of the samples by an attending pathologist determined that the adequacy of the specimens was 65.2% at LAC and 70.5% at USC (Table 1). There was no significant difference in the assessment of specimen adequacy by pathology trainees compared to experienced technologists (P 0.462). No difference in the performance of cytology trainees and the technicians was seen when the comparison was stratified by FNA target including pancreas masses, lymph nodes, or subepithelial lesions. Impression: These results suggest that there is no difference in the determination of diagnostic adequacy by a pathology trainee (resident or fellow) compared to an experienced non-physician cytology technician. Nonetheless, assessment of adequacy by both groups was suboptimal, which further underscores the need for an attending cytopathologist to determine the adequacy of EUS acquired fine needle aspirates in real-time. Other alternatives including telecytology, which allows for microscope images to be dynamically transmitted to a remotely located pathologist during EUS-FNA, are important considerations in health care systems where pathology resources are limited.

High yield of same-session EUS-guided liver biopsy by 19-gauge FNA needle in patients undergoing EUS to exclude biliary obstruction

EUS-guided liver biopsy by Trucut yields variable specimen adequacy at high cost, limiting its utility. A modified EUS-guided technique with reliable adequacy could be a viable alternative to standard techniques in cost-effective clinical settings. To describe our experience with EUS-guided liver biopsy by 19-gauge FNA, non-Trucut, needle in a cost-effective setting: patients with abnormal liver test results of unclear etiology referred for EUS to exclude biliary obstruction in whom an unrevealing EUS would have prompted a next-step liver biopsy by the referring physician. Prospective case series. Tertiary-care teaching hospital. Consecutive patients with abnormal liver tests referred for EUS. EUS-guided liver biopsy by 19-gauge FNA needle (non-Trucut). Diagnostic yield, specimen adequacy, and complications. An adequate specimen was defined as a length of 15 mm or longer and 6 or more complete portal tracts (CPTs). Between July 2008 and July 2011, 22 of 31 consecutive patients meeting inclusion criteria underwent unrevealing EUS with same-session EUS-guided liver biopsy by 19-gauge FNA needle. A median of 2 FNA passes (range 1-3) yielded a median specimen length of 36.9 mm (range 2-184.6 mm) with a median of 9 CPTs (range 1-73 CPTs). EUS-guided liver biopsies yielded a histologic diagnosis and adequate specimens in 20 of 22 patients (91%). Expanded experience led to improved specimen adequacy. There were no complications. Small study size. EUS-guided liver biopsy by using a 19-gauge FNA needle appears to be feasible and safe and provides excellent diagnostic yield and specimen adequacy.

Intradepartmental variability in fine needle aspiration technique and cytological diagnostic adequacy rate in thyroid and neck masses

s / International Journal of Surgery 10 (2012) S1–S52 S35 ABSTRACTS unnecessary withholding of anticoagulant and antiplatelet medication with no statistically significant increase in complication rates (increased admission, DVT, PE, re-admission with bleeding following discharge). Conclusion: No guidelines currently exist within the literature on the management of antiplatelet or anticoagulant use in epistaxis patients; therefore this audit is significant in that respect. Current data from re-audit has shown favourable results and full results will be available for presentation in March 2012. 0237: WHAT IS THE VALUE OF A ‘ONE-STOP' CLINIC IN ASSESSING TWO WEEK WAIT NECK LUMP REFERRALS? Arunjit Takhar , Michael Jones , Ram Vaidhyanath , Peter Conboy , Tom Alun-Jones . Department of Otolaryngology, University Hospitals of Leicester NHS Trust, Leicester, UK; Department of Radiology, University Hospitals of Leicester NHS Trust, Leicester, UK Aim: To assess our surgeon and radiologist ‘one-stop' clinic compared to conventional head and neck clinic in the assessment of neck lumps. The ‘one-stop' service has provision for ultrasound examination and guided fine needle aspiration. Method: Retrospective analysis of all patients referred with a lump under the two week wait from 8th November 2010 31st January 2011. Results: A total of 72 new patients were seen, 26.4% of which were assessed in our ‘one-stop' service. The average time to diagnosis was 29.5 days in a standard head and neck clinic compared to 10.7 days in our onestop clinic (p1⁄40.003). The average number of outpatient appointments required tomake a diagnosis was 2.0 in the standard clinic compared to 1.5 in the ‘one-stop' service (p1⁄40.014). The longest time to cancerous diagnosis was 107 days in our standard clinic compared to 11 days in the 'one-stop' service. Conclusion: The ‘one-stop' model of assessing patients with neck lumps leads to significantly shortened time to diagnosis and fewer follow-up appointments providing mutual benefit to both patients and limited NHS resources. This has lead to a restructuring of our outpatient services with the objective that all neck lumps are assessed in a ‘one-stop' clinic. 0259: INTRADEPARTMENTALVARIABILITY IN FINE NEEDLE ASPIRATION TECHNIQUE AND CYTOLOGICAL DIAGNOSTIC ADEQUACY RATE IN THYROID AND NECK MASSES Vinay Varadarajan , Edward Ridyard . North West Higher Surgical Training Scheme, Manchester, UK; 2 The University of Manchester Medical School, Manchester, UK Aims: To assess variability in fine needle aspiration (FNA) technique and diagnostic adequacy rate amongst surgeons sampling thyroid and neck masses. Methods: A retrospective single-blinded analysis of all surgeons' FNA results was undertaken after consent. Sample adequacy was defined as enough cells to establish a firm cytological diagnosis. KolmogorovSmirnoff testing confirmed normal distribution in the data set. Results: A total data set of n1⁄470, represented the ten most recent FNA results of the seven surgeons included. Marked variability in technique existed amongst all surgeons. The diagnostic rate ranged from 80% to 30% with a departmental average of 52.7%. T-testing showed two surgeons achieved a significantly higher diagnostic rate (P1⁄40.007 and P1⁄40.045) and one surgeon had a significantly lower rate (P1⁄40.015) compared to the departmental average. The highest diagnostic rates were achieved using the same technique. Experience of surgeon was not a causal factor and correlation coefficient testing revealed no statistical difference between needle size (P1⁄40.348) and number of samples per patient (P1⁄40.348). Conclusions: There may exist a marked variability in FNA technique and success rate within a unit. Cytological adequacy rates are more dependent on technique rather than experience. We encourage others to monitor their FNA adequacy rates and technique. 0293: ENT EMERGENCY CLINIC ACTIVITY Jagdeep Virk, Behrad Elmiyeh, Arvind Singh. Northwick Park Hospital,

Pulmonary CT Angiography Protocol Adapted to the Hemodynamic Effects of Pregnancy

The purpose of this study was to compare the image quality of a standard pulmonary CT angiography (CTA) protocol with a pulmonary CTA protocol optimized for use in pregnant patients with suspected pulmonary embolism (PE). Forty-five consecutive pregnant patients with suspected PE were retrospectively included in the study: 25 patients (group A) underwent standard-protocol pulmonary CTA and 20 patients (group B) were imaged using a protocol modified for pregnancy. The modified protocol used a shallow inspiration breath-hold and a high concentration, high rate of injection, and high volume of contrast material. Objective image quality and subjective image quality were evaluated by measuring pulmonary arterial enhancement, determining whether there was transient interruption of the contrast bolus by unopacified blood from the inferior vena cava (IVC), and assessing diagnostic adequacy. Objective and subjective image quality were significantly better for group B-that is, for the group who underwent the CTA protocol optimized for pregnancy. Mean pulmonary arterial enhancement and the percentage of studies characterized as adequate for diagnosis were higher in group B than in group A: 321 ± 148 HU (SD) versus 178 ± 67 HU (p = 0.0001) and 90% versus 64% (p = 0.05), respectively. Transient interruption of contrast material by unopacified blood from the IVC was observed more frequently in group A (39%) than in group B (10%) (p = 0.05). A pulmonary CTA protocol optimized for pregnancy significantly improved image quality by increasing pulmonary arterial opacification, improving diagnostic adequacy, and decreasing transient interruption of the contrast bolus by unopacified blood from the IVC.

Relationship between implementation of the American Society of Clinical Oncology/College of American Pathologists guideline recommendations for breast core-needle biopsies and delay in therapy for patients with breast cancer.

26 Background: Recently the ASCO/CAP suggested new guideline recommendations for immunohistochemical (IHC) testing of biomarkers in breast cancer. An algorithm that relies on accurate, reproducible assay performance was proposed and preanalytical, analytical and postanalytical standards suggested. One such recommendation is to have appropriate internal controls when assessing hormone expression. In this retrospective study we evaluated 242 breast core biopsy specimens to assess the impact of the recently proposed ASCO/CAP guideline recommendations and its possible impact on routine daily practice. In addition, we explore the impact of blindly selecting a random core for potential future studies. Methods: A total 988 cores from 242 specimens corresponding to 224 patients diagnosed between 2008 and 2009 were examined. Each core was examined for the presence of normal glands, percentage of tumor involvement, biomarker status, and diagnostic adequacy. Results: Absence of normal glands was found on 61/242 specimens (25%). Of these, expression of ER, PR and HER2 was seen in 44 (72%), 28 (46%), and 21 specimens (35%) respectively. Negative staining for ER, PR and HER2 was observed in 7 specimens (12%). A total of 148 cores (15%) showed absence of tumor and 275 cores (28%) had <25% of tumor in them. 18 cores (2%) were insufficient for diagnosis due to either scant tumor present or crush artifact present. Conclusions: Although the presence of internal control glands is optimal, its presence may be unnecessary if proper IHC batch run controls are utilized and histologic/IHC concordance is performed. Tumor histology and IHC profile concordance is imperative specially in triple negative cases. The impact on patient health care of an “receptor uninterpretable” biopsy is yet to be determined, but likely would include assessment of the delay in care due to a repeat biopsy with procurement of additional tissue, additional heath care costs, and anxiety to the patient. Adequacy check using frozen section could be done to assess for the presence of tumor during the procedure.

Ultrasonography-Guided Fine-Needle Aspiration Biopsy of Cervical Lymphadenopathy: Comparison in the Diagnostic and Cytological Adequacy According to the Use of 21 and 23 Gauge Needles

Ultrasonography-Guided Fine-Needle Aspiration Biopsy of Cervical Lymphadenopathy: Comparison in the Diagnostic and Cytological Adequacy According to the Use of 21 and 23 Gauge Needles

Análisis del cumplimiento de la Guía Clínica del AUGE en pacientes con accidente cerebrovascular isquémico: la utilización de tecnología sanitaria de diagnóstico para prevención secundaria en un hospital público

Acute ischemic stroke in adults was given an Explicit Guarantee of diagnosis and treatment (GES) with Clinical Guidelines in 2007 as part of the on-going Chilean National Health Reform.To evaluate the adherence to official guidelines with regard to the use of diagnostic methods for patients with acute ischemic stroke during their stay in a public hospital.The study included a review of the medical records of 101 patients aged 70 ± 13 years (49 males and 52 females) diagnosed with acute ischemic stroke and discharged within August and September of 2008 and 2009 from a public hospital. Three trained observers independently determined the degree of dependency of patients at discharge using the Modified Rankin score. The completion of recommended diagnostic tests (electrocardiogram, carotid Doppler ultrasound and echocardiogram) as well as their overuse was evaluated.Ten patients died before discharge, 38% were discharged with and 52% were discharged without disabilities. Nineteen percent of patients with a Modified Rankin score of two or less (corresponding to a slight disability) had a complete diagnostic workup, compared with 87% of patients with a score of 3 to 5 (moderate to severe disability). In 27% of the patients, there was an overuse of diagnostic tests. No association between the diagnostic test use adequacy and year of discharge was observed.There exists a disparity between the recommended diagnostic testing and the actual tests completed among patients with acute ischemic stroke.

Compliance with Chilean diagnostic guidelines among patients with ischemic stroke admitted to a public hospital

Acute ischemic stroke in adults was given an Explicit Guarantee of diagnosis and treatment (GES) with Clinical Guidelines in 2007 as part of the on-going Chilean National Health Reform. To evaluate the adherence to official guidelines with regard to the use of diagnostic methods for patients with acute ischemic stroke during their stay in a public hospital. The study included a review of the medical records of 101 patients aged 70 ± 13 years (49 males and 52 females) diagnosed with acute ischemic stroke and discharged within August and September of 2008 and 2009 from a public hospital. Three trained observers independently determined the degree of dependency of patients at discharge using the Modified Rankin score. The completion of recommended diagnostic tests (electrocardiogram, carotid Doppler ultrasound and echocardiogram) as well as their overuse was evaluated. Ten patients died before discharge, 38% were discharged with and 52% were discharged without disabilities. Nineteen percent of patients with a Modified Rankin score of two or less (corresponding to a slight disability) had a complete diagnostic workup, compared with 87% of patients with a score of 3 to 5 (moderate to severe disability). In 27% of the patients, there was an overuse of diagnostic tests. No association between the diagnostic test use adequacy and year of discharge was observed. There exists a disparity between the recommended diagnostic testing and the actual tests completed among patients with acute ischemic stroke.

Extreme musculo-skeletal ultrasound: training of non-physicians in the Arctic Circle

Abstract Objective The purpose of this study was to compare if non-physician, inexperienced ultrasound subjects can take quality diagnostic images after watching a brief educational video and using reference cue cards (autonomous group) versus taking ultrasound images with expert guidance using a satellite connection. Methods Six non-medical, inexperienced ultrasound subjects from a rural area (Arctic Circle) obtained ultrasound images of target anatomic regions using a portable ultrasound device after receiving expert-guided training or autonomous training (educational video and cue cards). Real-time expert guidance was provided using an audiovisual tele-ultrasound connection with direct ultrasound video compression which was relayed to a remote expert via a secure satellite connection. The resultant images from all studies were blindly reviewed by imaging experts for determination of diagnostic adequacy. Results All of the examinations were completed in <15 min. The blinded expert identified 85.1% of autonomously acquired images and 86.2% of the images obtained by expert guidance to be of diagnostic quality; there was no statistical difference between the two groups (P = 0.6653). Conclusion Non-physician, inexperienced subjects can quickly educate themselves to retrieve diagnostic quality ultrasound images whether they are being expert-guided or trained autonomously.

In Thyroid Fine-Needle Aspiration, Use of Bedside-Prepared Slides Significantly Increased Diagnostic Adequacy and Specimen Cellularity Relative to Solution-Based Samples

In the United States, the prevalence among adults of palpable thyroid nodules is 4%-7%, of which 5%-10% may represent thyroid carcinoma. Despite the success of fine-needle aspiration in reducing the need for thyroidectomy, aspirates are inadequate to render a diagnosis in 20% of cases. Minimizing nondiagnostic samples is an important goal in improving this technique. Our objective was to determine whether bedside-prepared slides improve diagnostic adequacy over standard solution-based samples. We further sought to determine the role of needle size. One hundred sixty-two patients were prospectively enrolled. For each, both bedside slides and standard cytology solutions were prepared; the order of preparation alternated from subject to subject. Needle size (21- or 25-gauge) also alternated from subject to subject. Slides were evaluated by pathologists blinded to needle size. The study took place in the endocrinology clinic at Boston Medical Center, the tertiary referral hospital of the Boston University School of Medicine. Key outcomes were diagnostic adequacy and specimen cellularity. Compared to standard solution-based samples, bedside slides provided more cellular specimens (p < 0.01) and fewer nondiagnostic samples (p = 0.016). When standard solution-based samples were used as the sole method of preparation, 21-gauge needles provided improved diagnostic adequacy. Bedside-prepared slides offer improved diagnostic adequacy and specimen cellularity over solution-based samples. The difference may be especially important when using smaller (25-gauge) needles to perform fine-needle aspiration. When solution-based samples are used, larger (21-gauge) needles provide more diagnostic specimens.

Ultrasonography-Guided Fine Needle Aspiration Cytology of Cervical Lymphadenopathy: Comparative Study of the Cytological Adequacy Using of 21- and 23-Gauge Needles

the cytological analysis of each slide and compared the cytological adequacy of US-FNAC for cervical lymphadenopathy in the two groups. Results: We performed US-FNACs on 58 cervical lymph nodes from 29 patients, with a cytological adequacy of 69.0%. The number of adequate cytological results was 19 (65.5%) in group A and 21 (72.4%) in group B, and the diagnostic adequacy did not differ significantly between the two groups (Mann-Whitney test, p = 0.574). Conclusion: There was no statistically significant difference in the cytological adequacy of US-FNAC for cervical lymphadenopathy according using of 21 and 23 gauge needles.

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in a Geographical Region With Endemic Histoplasmosis Infection

In a geographical area with high prevalence of calcific granulomatous inflammation, calcified lymph nodes may affect the diagnostic adequacy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The objective of this study was to describe the diagnostic performance of EBUS-TBNA in a region endemic of histoplasmosis related granulomatous inflammation. A retrospective review was done for all patients referred for EBUS-TBNA over a 7-month period at 2 institutions. Computed tomographic (CT) chest studies were reviewed in a blinded manner by 2 radiologists. In parallel, CT images from 100 unselected sequential control patients were reviewed. Cytologic analysis of EBUS-TBNA aspirates was compared with a reference standard of definitive pathologic tissue diagnosis or a composite of ≥6-month clinical follow-up. The prevalence of calcified lymph nodes in the 100 control patients was 56%. All 61 patients undergoing EBUS-TBNA were included. In total, 97 lymph nodes (mean size=13.8 mm) and 7 masses were biopsied. Definitive lymph node sampling was achieved in 51 of 61 patients (83%). The sensitivity, specificity, and positive and negative predictive values of EBUS-TBNA for malignancy (primary lung cancer staging, restaging, and reevaluation after cancer therapy, small cell lung cancer, lymphoma, and metastatic cancer) were 81%, 100%, 100%, and 84% respectively. On pre-EBUS CT chest scan, 60.6% had nodal calcification. The prevalence of cancer was not different in those with and without nodal calcification (49%). There was no difference in frequency of definitive lymph node sampling in those patients with or without nodal calcification. In a geographical area with endemic histoplasmosis-related nodal calcification, there was no evidence of nodal calcification affecting the frequency of EBUS-TBNA definitive lymph node sampling.

Tissue issues: Clinical and research implications of diagnostic biopsy practices

Abstract Tissue Issues for Researchers: Why the pathologist does NOT want to give you human tumor tissue...and how to get it anyway. Or: Why you should befriend a pathologist. Overview: More research should be done using human tumor tissue.This is very hard for many logistical, organizational, and sociological reasons.Befriend a pathologist. Involve them early during the design phase. Fund their time.So you want some human tumor tissue...Tissue banks exist, with well-annotated tumor samples, sometimes with clinical follow up information.This tissue is either frozen or paraffin embedded.Tissue arrays are available, which are very efficient and allow for good QC because one can cut a section and actually see what cells are there, and then punch out a corresponding core of tissue from the block to use for experiment.Expensive, not necessarily tailored to your experiment, and not fresh tissue. Fresh tissue: No, we don't want to give you any...Pathologists control tissue in a hospital setting, where most cancer surgeries take place.Biopsies are hard won tiny fragments of people — we have to bully the other doctors into getting us enough in the first place.Resections usually provide lots of tissue but it takes a bunch of extra time and judgment to collect them fresh and carefully annotate them for you, and place them in special media and make sure they get picked up and handled promptly. How do we get the tissue to make the diagnosis? From whom do we get it? Diagnostic adequacy rate of sampling procedures is related to type of biopsy.Research samples are considered second priority after adequate diagnostic material is obtained. Suggestions for optimizing your chances of getting some.

Ultrasound‐guided needle aspiration: Impact of immediate cytologic review

To compare the diagnostic adequacy of ultrasound-guided fine-needle aspiration biopsy (USFNA) of the head and neck with immediate on-site microscopic evaluation and feedback by a cytopathologist (IMMEDIATE) versus delayed examination without immediate feedback (DELAYED). Retrospective chart review of office-based USFNA performed in both IMMEDIATE and DELAYED settings by the same otolaryngologist. A total of 199 USFNA procedures in the head and neck were performed by one practitioner. Of these procedures, 137 biopsies were performed in the DELAYED setting, whereas 62 biopsies were performed in the IMMEDIATE setting. Cytopathology reports were reviewed for diagnostic conclusions as well as adequacy of biopsies. The results from both settings were compared using Pearson χ2 test. The ability to obtain a diagnosis from USFNA was 73.0% in the DELAYED group as compared with 90.3% in the IMMEDIATE group. The rate of adequate cells on biopsy was 89.1% in the DELAYED group as compared with 96.8% in the IMMEDIATE group. There was a statistically significant difference between observed and expected diagnostic rates (χ(2)[1] = 7.568, P = .006) and a trend toward a significant difference between the observed and expected adequacy rates (χ(2)[1] = 3.259, P = .071) when IMMEDIATE evaluation by a cytopathologist was performed. An immediate microscopic evaluation of USFNA specimens to confirm adequacy of sampling is strongly recommended. Diagnostic conclusions were increased when an evaluation of the specimen was performed at the time of biopsy. The specimen adequacy rate tended to increase with an immediate cytopathologic assessment. Laryngoscope, 2010.

Coronary angiogram video compression for remote browsing and archiving applications

In this paper, we propose a H.264/AVC based compression technique adapted to coronary angiograms. H.264/AVC coder has proven to use the most advanced and accurate motion compensation process, but, at the cost of high computational complexity. On the other hand, analysis of coronary X-ray images reveals large areas containing no diagnostically important information. Our contribution is to exploit the energy characteristics in slice equal size regions to determine the regions with relevant information content, to be encoded using the H.264 coding paradigm. The others regions, are compressed using fixed block motion compensation and conventional hard-decision quantization. Experiments have shown that at the same bitrate, this procedure reduces the H.264 coder computing time of about 25% while attaining the same visual quality. A subjective assessment, based on the consensus approach leads to a compression ratio of 30:1 which insures both a diagnostic adequacy and a sufficient compression in regards to storage and transmission requirements.

Diffuse Reflection Spectroscopy: An Alternative to Autofluorescence Spectroscopy in Tongue Cancer Detection

Laser-induced autofluorescence (LIAF) and diffuse reflection spectroscopy (DRS) are two emerging noninvasive optical tools that have shown immense potential to detect oral cavity pre-cancer. In a recent study, we have used spectral ratio reference standards (SRRS) of LIAF intensity ratios F500/F635, F500/F685, and F500/F705 for grading of tissues belonging to sites other than dorsal side of tongue (DST), lateral side of tongue (LST), and vermillion border of lip (VBL) that exhibited similar spectral shape for normal and abnormal tissues. This led to dismal diagnostic accuracies, and for the three LIAF-SRRS, normal tissue values were often misclassified as squamous cell carcinoma (SCC), which means that the true negatives were being wrongly identified as true positives. This study examines the applicability of the site-specific diffuse reflection spectral intensity ratio (R545/R575) of the oxygenated hemoglobin bands to classify different DST lesions and compares the results obtained with those obtained using LIAF-SRRS. DRS-SRRS of R545/R575 differentiated benign hyperplastic DST tissues from normal tissue with a sensitivity of 86% and specificity of 80%, which were indistinguishable using LIAF-SRRS. Further, in distinguishing hyperplastic tissues from premalignant dysplastic lesions, DRS-SRRS gave a sensitivity of 90% and a specificity of 86%, as compared to sensitivity of 89% and specificity of 72% shown by the three LIAF-SRRS together. The diagnostic accuracy and statistical adequacy of the two techniques were assessed by receiver operating characteristic curve (ROC-Curve) analysis. Three LIAF ratios gave a low overall ROC area under curve (ROC-AUCs) of 0.521, whereas the DR ratio (R545/R575) has shown an improved accuracy of 0.970 in differentiating different tissue types. While distinguishing hyperplastic from dysplastic tissues, the DR ratio gave a higher discrimination accuracy of 0.9. Based on these findings, it can be concluded that the DRS-SRRS technique by virtue of its low cost and higher diagnostic accuracies could be a viable alternate to LIAF-SRRS for in vivo screening of tongue pre-cancers and grading of different tissue types.