Diagnostic Concordance Rate Research Articles

Assessment of the efficacy of early phase parameters by (123)I-MIBG dynamic imaging for distinguishing Lewy body-related diseases from Parkinson's syndrome.

The aim of this study was to assess the efficacy of early phase washout rate (early WR) and area under the time-activity curve (AUTAC) by (123)I-metaiodobenzylguanidine (MIBG) dynamic chest imaging for distinguishing Lewy body-related diseases (LBRD) from Parkinson's syndrome (PS) and reducing examination time. Sixty-two patients with suspected LBRD who underwent (123)I-MIBG dynamic imaging in early phase were retrospectively selected. The early WR and AUTAC were calculated from (123)I-MIBG dynamic data of the heart. We evaluated the relationships between proposed and conventional parameters by using Spearman's rank correlation coefficient. Differences in parameters between LBRD and PS groups were tested for statistical significance using the Mann-Whitney U test. The diagnostic performance of all parameters for distinguishing LBRD from PS was assessed in terms of receiver operating characteristic (ROC) analysis. Additionally, combination diagnostic performance and concordance rate between early phase parameters and late H/M ratio by kappa statistics were also assessed. The early WR and AUTAC showed a positive and negative correlation with conventional parameters. Both the early WR and AUTAC of LBRD group were significantly distinguishable from those of the PS group (p < 0.001). Area under the ROC curve of the early WR (0.98) was greater than that of AUTAC (0.91). The diagnostic performance of combination of the early phase parameters was 93 % sensitivity and 100 % specificity. Moreover, the early phase parameters showed excellent agreement with late H/M ratio (k = 0.93). The early WR and AUTAC showed high performance for distinguishing LBRD from PS, and the combination diagnosis with early H/M ratio and early WR contribute to improve the diagnostic performance. Thus, these parameters would be useful for reducing the examination time of myocardial (123)I-MIBG scintigraphy to diagnose LBRD.

Depression and suicidal behavior in adolescents: a multi-informant and multi-methods approach to diagnostic classification.

Background: Informant discrepancies have been reported between parent and adolescent measures of depressive disorders and suicidality. We aimed to examine the concordance between adolescent and parent ratings of depressive disorder using both clinical interview and questionnaire measures and assess multi-informant and multi-method approaches to classification.Method: Within the context of assessment of eligibility for a randomized clinical trial, 50 parent–adolescent pairs (mean age of adolescents = 15.0 years) were interviewed separately with a structured diagnostic interview for depression, the KID-SCID. Adolescent self-report and parent-report versions of the Strengths and Difficulties Questionnaire, the Short Mood and Feelings Questionnaire and the Depressive Experiences Questionnaire were also administered. We examined the diagnostic concordance rates of the parent vs. adolescent structured interview methods and the prediction of adolescent diagnosis via questionnaire methods.Results: Parent proxy reporting of adolescent depression and suicidal thoughts and behavior is not strongly concordant with adolescent report. Adolescent self-reported symptoms on depression scales provide a more accurate report of diagnosable adolescent depression than parent proxy reports of adolescent depressive symptoms. Adolescent self-report measures can be combined to improve the accuracy of classification. Parents tend to over report their adolescent’s depressive symptoms while under reporting their suicidal thoughts and behavior.Conclusion: Parent proxy report is clearly less reliable than the adolescent’s own report of their symptoms and subjective experiences, and could be considered inaccurate for research purposes. While parent report would still be sought clinically where an adolescent refuses to provide information, our findings suggest that parent reporting of adolescent suicidality should be interpreted with caution.

Diagnosis of small partial-thickness rotator cuff tears using vibro-acoustography.

Vibro-acoustography is a new imaging technique based on the dynamic radiation force of ultrasound. The purpose of this study was to apply this new imaging technique to the diagnosis of small partial-thickness rotator cuff tears and to determine how small of tears could be detected with this imaging technique. Seven supraspinatus tendons excised from embalmed cadavers were used. Three different sizes of partial-thickness bursal-sided tears (1, 3, and 5 mm(3)) were created in each specimen. The intersection of two co-focused ultrasound beams of slightly different frequency was swept across the intended imaging area. The acoustic emission data were collected and used to form and display a vibro-acoustography image of the tendon. Vibro-acoustography images were read by two orthopedic surgeons. The rotator cuff tear could be detected by vibro-acoustography in all specimens. The diagnostic concordance rate was 90.5 % and the kappa coefficient value was 0.88, which resulted in a high concordance. The diagnostic concordance rate for the 1 mm tear was 71.3 %, which was low concordance (κ = 0.481), whereas that for the 3 and 5 mm tears was 100 %. We were able to detect a 3-mm tear by using vibro-acoustography. There is a possibility that this new imaging technique could become a useful imaging tool for the diagnosis of small partial-thickness rotator cuff tears.

Diagnostic concordance rate between histologic and cytologic specimens of endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer: A single institution experience.

The aspirates from endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) were examined using the tissue core and cytology. We assessed that the tissue core was a more reliable specimen and attempted to analyze how many discrepancies were found between the two specimens. We investigated diagnostic concordance rate between histology and cytology. From January 2011 to December 2011, a total of 267 consecutive patients with lung cancer, who underwent EBUS-TBNA, were included in this retrospective study. Of the 267 lung cancer patients, 207 (77.5%) were men. The median age was 65 years old. The most common pathologic type was adenocarcinoma (120, 44.9%), followed by squamous cell carcinoma (79, 29.6%). Among the 267 patients, 579 mediastinal and hilar lymph nodes were punctured. The right lower paratracheal (204, 35.2%) and subcarinal (172, 29.7%) lymph nodes were the most common nodal stations. Among the 579 lymph nodes, malignant cells were observed in 267 (46.1%) nodes, in either the histologic, cytologic or both slides: 209 in both histology and cytology, 37 in histology only, and 21 in cytology only slides. The diagnostic concordance rate between the tissue core and cytology was 90.0% (95% confidence interval CI, 87.1-92.2) (κ = 0.79). The diagnostic concordance rate between the histology and cytology of EBUS-TBNA in lung cancer was 90.0% (95% CI, 87.1-92.2) (κ = 0.79).

Evaluation of the URiSCAN Super Cassette ACR Semiquantitative Urine Dipstick for Microalbuminuria Screening

Microalbuminuria tests are used as screening tools for diseases, such as diabetic nephropathy, cardiovascular disease, and hypertension. The purpose of this study was to evaluate the utility of a newly introduced semiquantitative urine dipstick, URiSCAN Super cassette ACR (URiSuper-ACR [where ACR is albumin/creatinine ratio]; YD Diagnostics Corp., Korea), as a screening tool for microalbuminuria. Albumin and creatinine levels in randomly selected spot urine samples of 1,040 patients were semiquantitatively measured using URiSuper-ACR. Results using URiSuper-ACR system were compared to measurements obtained by quantitative analyzer. We also calculated diagnostic sensitivity, specificity, precision, linearity, and categorical concordance rates for the diagnosis of microalbumiuria using this system. Furthermore, we performed interference tests using standard controls to evaluate possible influence of various factors. URiSuper-ACR test showed 88.8% and 86.3% sensitivity and 90.1% and 93.8% specificity for albumin concentration and ACR, respectively. It also showed 91.1% and 92.6% positive predictive values and 87.6% and 88.5% negative predictive values, respectively. The concordance rate between URiSuper-ACR and quantitative method for albumin and creatinine concentration within the same category were 78.4% and 67.1%, respectively, and for the ±1 category were 98.8% and 99.5%, respectively. For ACR, an 80.0% concordance rate was seen within the same category. The within-run coefficients of variation (CVs) were 3.0∼15.4% and 5.2∼23.5% for albumin and creatinine, respectively, showing good linearity. In interference tests, no interference was observed except for cases with high specific gravity. URiSuper-ACR showed good diagnostic performance for the detection of microalbuminuria and may be a useful screening test in clinical laboratories.

Diagnostic concordance rates in the subtyping of basal cell carcinoma by different dermatopathologists

There are numerous subtypes of basal cell carcinoma (BCC). Defining the histopathologic subtype is an essential element in patient management, but there is little known data regarding interobserver precision in subtyping BCC. We studied interobserver variance between six board-certified dermatopathologists who subtyped 100 BCCs in a blinded fashion. We used kappa statistic to calculate the concordance in suggested subtype by different dermatopathologists. Provided diagnoses were then re-categorized into low-risk and high-risk phenotypes, and kappa statistic for concordance on high-risk BCC was determined. The overall κ statistic was 0.301, indicating fair agreement among the six observers. Superficial and fibroepithelial BCC had the highest individual kappa statistics. When subtypes were re-classified into a two-tier system of high-risk and low-risk phenotypes, there was substantial interobserver agreement on high-risk BCC with a κ statistic of 0.699. These results suggest only fair agreement among dermatopathologists on specific BCC subtypes, but substantial agreement on superficial, fibroepithelial and high-risk BCC growth patterns. A simplified classification system comprised of superficial, fibroepithelial, nodular and infiltrative subtypes would increase interobserver precision and facilitate clinical decision-making.

Abstract 4209: Genotypic agreement between histological specimen and preoperative cytology in small lung adenocarcinoma.

Abstract Background. Histological subtype and genotype is critical for making treatment decisions and improving patient outcomes in non-small cell lung cancer (NSCLC). Approximately 70% of lung cancers are diagnosed in advanced stages where small biopsies and cytological specimens are the only source of material for both diagnosis and genotyping. Patients with specific gene alterations in epidermal growth factor receptor (EGFR) or anaplastic lymphoma kinase (ALK) likely receive more benefit from EGFR TKI or ALK TKI therapy, respectively. Although, genotyping agreement from cytological and histological samples is critical, more investigational studies need to be explored to assess the concordance of genotype. Purpose. We performed a comparing investigation on concordance rate for pathological diagnosis and EGFR gene mutation status between surgical specimen and preoperative cytological specimen in small lung cancer. Additionally we reviewed immunohistochemical (IHC) staining with two different ALK specific antibodies. Materials and Methods. 55 patients who had surgically resected small (≦3cm) lung adenocarcinoma with known preoperative bronchial brushing cytology were examined retrospectively. IHC staining was conducted by mutation-specific antibodies using E746-A750 deletion and L858R for EGFR or 5A4 and D5F3 for ALK. DNA analysis was performed by PNA-RNA PCR clamp assay. Results. 1) Diagnostic concordance rate between cytological and histological specimen was 90.9%. Disagreement cases were included one case of squamous cell carcinoma, two cases of small cell carcinoma, one case of melanoma and one case of mucoepidermoid carcinoma by cytology. 2) In IHC positive for mutation-specific EGFR antibodies, the sensitivity was 83% in E746-A750 and 100% in L858R, respectively. In EGFR IHC positive cases, well to moderate differentiation were dominant. 3) In ALK IHC, one case was observed stronger cytoplasmic staining in D5F3 than 5A4. Furthermore, the cribriform pattern was observed in H&amp;E staining. Distinctive cytological feature was not observed. Conclusion. Our results showed that high genotype concordance rates of histology and cytology agreement in small lung adenocarcinoma. Citation Format: Noriko Hirai, Sasaki Takaaki, Yoshinori Minami, Masahiro Kitada, Naoyuki Miyokawa, Yoshinobu Ohsaki. Genotypic agreement between histological specimen and preoperative cytology in small lung adenocarcinoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4209. doi:10.1158/1538-7445.AM2013-4209

Utility of fluorescence in situ hybridization for the diagnosis of bladder urothelial carcinoma

Objective To evaluate the clinical value of fluorescence in situ hybridization (FISH) method for diagnosis of bladder urothelial carcinoma.Methods Urine samples from 81 patients suspected of having bladder urothelial carcinoma were collected for immediate urine cytology and FISH analysis.All patients underwent cystoscopy for identification of bladder lesions.Urine samples from 8 patients with benign disease of urinary system werealso analyzed by means of FISH and cytology.The sensitivity and specificity of FISH were compared with cytology.Results 81 subjects of bladder urothelial carcinoma were verified with pathology,which included 34 non-muscle invasive carcinoma,14 cases with muscle invasive carcinoma,42 cases with high-grade carcinoma,and 24 cases with low-grade carcinoma.Residual cases included 12 verified benign disease of urinary system,and to serve as controls with 8 patients with benign disease of urinary system.The sensitivities of FISH,cytology and cystoscopy were 72.8％,27.2％ and 97.5％.The sensitivity of FISH was superior to cytology,but inferior to cystoscopy.The specificity and diagnostic concordance rate of FISH and cytology were 85.0％,100.0％ and 75.2％,41.6％,respectively.Conclusion FISH analysis as a non-invasive method has good sensitivity and specificity for diagnosing bladder urothelial carcinoma. Key words: Bladder neoplasms; Carcinoma; In situ hybridization, fluorescence; Urine cytology; Cystoscopy

Pitfalls of Rapid Onsite Evaluation (ROSE) Using Dynamic Telecytology

s S15 was to assess the pitfalls of rapid onsite evaluation with the use of dynamic telecytology. Materials and Methods: Diff Quick stained slides from 30 consecutive computed tomographyor endoscopyguided fine needle aspiration (FNA) cases that had required ROSE, were retrospectively evaluated via telecytology. Original diagnoses were kept blind to both, the operator (the cytotechnologist), and the remote consultant (cytopathologist). The same sets of cases were independently reviewed by two separate cytopathologists blinded to each other’s telecytology diagnostic impression. Cytotechnologist projected all cases and remote pathologist had the ability to request additional screening, better focus, higher power, etc, before making the final interpretation. Results: The specimen sites, original and telecytology diagnoses (Cytopathologist1 and Cytopathologist2) are listed in Table 1 and 2. Of the 30 cases (11 male, 19 female; age 14 93 years) evaluated by telecytology, lymph node EBUS FNA was the most common specimen. The diagnostic concordance rate was 95%. Two cases with discordant diagnosis are listed in Table 2. One was a mediastinal lymph node that was called small cell carcinoma (Cytopathologist1). The second was a paratracheal lymph node interpreted as non-small cell carcinoma (Cytopathologist2). Both cases had been originally diagnosed as reactive lymph nodes. Slides and telecytology pictures were reviewed after telecytology, with the aim to understand the reasons for the telecytology discrepancy. Table 1 Specimen sites Site Number of cases Lymph node (EBUS:16, US: 1) 17 Pancreas (CT: 6, EUS:2) 8 Lung (CT) 1 Omentum (CT) 1 Kidney (CT) 1 Liver (CT) 1 Bone (CT) 1 Total of cases 30 Table 2 Specimen, Diagnoses and Discrepancies Site Procedure Original Telecytology Telecytology Discrepancy diagnosis Diagnosis Cytopathologist1 Diagnosis Cytopathologist2 reason LN paratracheal EBUS Reactive Reactive Non-small cell carcinoma Reactive atypia of bronchial cells LN subcarinal EBUS Inadequate Non diagnostic Non diagnostic LN subcarinal EBUS Inadequate Non diagnostic Non diagnostic LN, R4 EBUS Granuloma Granuloma Granuloma LN, R4 EBUS Granuloma Granuloma Granuloma LN paratracheal EBUS Granuloma Granuloma Granuloma LN mediastinal EBUS Small cell carcinoma Reactive Small cell carcinoma Lymphocytes with crush artifact LN, R4 EBUS Small cell carcinoma Small cell carcinoma Small cell carcinoma LN mediastinal EBUS Reactive Reactive Reactive LN paratracheal EBUS Adenocarcinoma Adenocarcinoma Adenocarcinoma LN paratracheal EBUS Adenocarcinoma Adenocarcinoma Adenocarcinoma LN mediastinal EBUS Small cell carcinoma Small cell carcinoma Small cell carcinoma LN paratracheal EBUS Inadequate Inadequate Inadequate LN hilar EBUS Small cell carcinoma Small cell carcinoma Small cell carcinoma LN subcarinal EBUS Squamous cell ca Squamous cell ca Squamous cell ca LN hilar EBUS Granuloma Granuloma Granuloma LN right neck US Lymphoma Lymphoma Lymphoma Pancreas CT Pancreatic endocrine neoplasm Pancreatic endocrine neoplasm Pancreatic endocrine neoplasm Pancreas CT Adenocarcinoma Adenocarcinoma Adenocarcinoma Pancreas CT Adenocarcinoma Adenocarcinoma Adenocarcinoma Pancreas CT Adenocarcinoma Adenocarcinoma Adenocarcinoma Pancreas CT Adenocarcinoma Adenocarcinoma Adenocarcinoma Pancreas CT Adenocarcinoma Adenocarcinoma Adenocarcinoma Pancreas EUS Adenocarcinoma Adenocarcinoma Adenocarcinoma Pancreas EUS Adenocarcinoma Adenocarcinoma Adenocarcinoma Bone CT Metastatic Adenocarcinoma Metastatic Adenocarcinoma Metastatic Adenocarcinoma Omentum CT Endometroid Adenocarcinoma Endometroid Adenocarcinoma Endometroid Adenocarcinoma Lung CT Adenocarcinoma Adenocarcinoma Adenocarcinoma Liver CT Metastatic Adenocarcinoma Metastatic Adenocarcinoma Metastatic Adenocarcinoma Left kidney CT Renal Cell Carcinoma Renal Cell Carcinoma Renal Cell Carcinoma EBUS Z Endoscopic bronchial ultrasound; EUS Z Endoscopic ultrasound; USZ Ultrasound; CT Z Computed tomography; LNZ Lymph node. Conclusions: The pitfalls of rapid onsite evaluation by telecytology are similar to those found in conventional evaluation. EBUSFNAs of paratracheal nodes are more challenging. Reactive atypia of bronchial cells may be misinterpreted as adenocarcinoma when comparison with rest of the slide is suboptimal due to delayed projection of the frames screened, rendering a false-positive result. Also we need to be aware of the distinction between benign lymphocytes with crush artifact and small cell carcinoma.

Teledermatology: A Tool for Nurse Practitioner Practice?

Teledermatology is the practice of dermatology from a distance and can be used in several ways. This emerging technology has the potential to impact the current health care delivery system and provide dermatology care to a greater number of patients in underserved areas. Current research shows that the diagnostic concordance rates and accuracy rates are high, but there are also limitations with teledermatology use. Nurse practitioners have the potential to become active participants in the practice of teledermatology and ensure the provision of dermatology services to underserved populations.

Virtual microscopy using whole-slide imaging as an enabler for teledermatopathology: A paired consultant validation study

Background: There is a need for telemedicine, particularly in countries with large geographical areas and widely scattered low-density communities as is the case of the Canadian system, particularly if equality of care is to be achieved or the difference gap is to be narrowed between urban centers and more peripheral communities. Aims: 1. To validate teledermatopathology as a diagnostic tool in under-serviced areas; 2. To test its utilization in inflammatory and melanocytic lesions; 3. To compare the impact of 20× (0.5 μm/pixel) and 40× (0.25 μm/pixel) scans on the diagnostic accuracy. Materials and Methods: A total of 103 dermatopathology cases divided into three arms were evaluated by two pathologists and results compared.The first arm consisted of 79 consecutive routine cases (n=79).The second arm consisted of 12 inflammatory skin biopsies (n=12) and the third arm consisted of 12 melanocytic lesions (n=12). Diagnosis concordance was used to evaluate the first arm. Whereas concordance of preset objective findings were used to evaluate the second and third arms. Results: The diagnostic concordance rate for the first arm was 96%.The concordance rates of the objective findings for the second and third arms were 100%. The image quality was deemed superior to light microscopy for 40× scans. Conclusion: The current scanners produce high-resolution images that are adequate for evaluation of a variety of cases of different complexities.

Real time decision support system for diagnosis of rare cancers, trained in parallel, on a graphics processing unit

In the present study a new strategy is introduced for designing and developing of an efficient dynamic Decision Support System (DSS) for supporting rare cancers decision making. The proposed DSS operates on a Graphics Processing Unit (GPU) and it is capable of adjusting its design in real time based on user-defined clinical questions in contrast to standard CPU implementations that are limited by processing and memory constrains. The core of the proposed DSS was a Probabilistic Neural Network classifier and was evaluated on 140 rare brain cancer cases, regarding its ability to predict tumors' malignancy, using a panel of 20 morphological and textural features Generalization was estimated using an external 10-fold cross-validation. The proposed GPU-based DSS achieved significantly higher training speed, outperforming the CPU-based system by a factor that ranged from 267 to 288 times. System design was optimized using a combination of 4 textural and morphological features with 78.6% overall accuracy, whereas system generalization was 73.8%±3.2%. By exploiting the inherently parallel architecture of a consumer level GPU, the proposed approach enables real time, optimal design of a DSS for any user-defined clinical question for improving diagnostic assessments, prognostic relevance and concordance rates for rare cancers in clinical practice.

Clinical Usefulness of Multiplex PCR Lateral Flow in MRSA Detection: A Novel, Rapid Genetic Testing Method

Methicillin-resistant Staphylococcus aureus (MRSA) with exogenous cassette DNA containing the methicillin-resistant gene mecA (SCCmec) poses a problem as a drug-resistant bacterium responsible for hospital- and community-acquired infections. The frequency of MRSA detection has recently been increasing rapidly in Japan, and SCCmec has also been classified more diversely into types I–V. A rapid test is essential for early diagnosis and treatment of MRSA infections, but detection by conventional methods requires at least two days. The newly developed multiplex PCR lateral flow method allows specific amplification of femA to detect S. aureus, mecA to detect SCCmec, and kdpC to detect SCCmec type II; moreover, PCR products can be evaluated visually in about 3 h. In the present study, we developed a PCR lateral flow method for MRSA using this method and investigated its clinical usefulness in the detection of MRSA. The results showed a diagnostic concordance rate of 91.7% for MRSA and methicillin-susceptible S. aureus between bacteriological examination and PCR lateral flow, and a high level of specificity in PCR lateral flow. In addition, a higher detection rate for S. aureus using the same sample was observed for PCR lateral flow (70.2%) than for bacteriological tests (48.6%). The above results show that PCR lateral flow for MRSA detection has high sensitivity, specificity, and speed, and its clinical application as a method for early diagnosis of MRSA infections appears to be feasible.

Clinical significance of multi-slice spiral CT angiography in radical resection of gastric cancer

To explore the clinical significance of preoperative abdominal multi-slice spiral CT angiography (MSCTA) in radical resection of gastric cancer. One hundred and three patients with gastric cancer were divided into two groups according to their desires. Group I( included 57 patients who underwent preoperative MSCTA and group II( included 46 patients who underwent surgery without preoperative MSCTA. All these patients were operated by the same surgical team. Six patients(10.5%) with abnormal gastric artery in group I( were discovered. The diagnostic concordance rate between MSCTA and intraoperative findings was 100% in group I( in the locations and alignments of main perigastric vessels and their relationship with cancer lesions. Operative time in group I( was shorter than that in group II( [(206 ± 23) min vs. (257 ± 32) min, P=0.044]. Operative time [(190 ± 50) min] of patients with abnormal gastric artery of group I( was shorter than that [(255 ± 62) min] of patients with abnormal gastric artery discovered during operation of group II( (P=0.048). However there were no differences in blood loss, extent of lymph node dissection, complication rate, length of hospital stay, and hospitalization cost between the two groups(P>0.05). Preoperative MSCTA is beneficial to the evaluation of vascular structure of the cancer and the adjacent tissues, which may reduce postoperative complications.

The Effectiveness of SilverIn SituHybridization in Patients with Breast Cancer: A Systematic Review

Purpose: The purpose of this study was to evaluate silver in situ hybridization (SISH) as an effective test to identify HER2 gene amplification in patients with breast cancer. Methods: A systematic literature review was used to evaluate the effectiveness of SISH. The literature review covered from October 27, 2009 to December 1, 2009, and eight domestic databases including KoreaMed and foreign databases including Ovid-MEDLINE, EMBASE, and Cochrane Library were used. Keywords, such as ‘silver in situ hybridization’ and ‘SISH’, were used to search 63 documents. Ten studies regarding the evaluation of diagnostics were included in the final evaluation. The Scottish Intercollegiate Guidelines Network (SIGN) tool was used by two evaluators to independently evaluate the quality of the ten studies. Results: A total of ten studies (nine diagnostic evaluation studies and one correlation study) were identified to evaluate SISH. The effectiveness of this test was evaluated based on diagnostic accuracy, concordance rate, and correlation with fluorescence in situ hybridization (FISH) results. The sensitivity of SISH was 0.81-1.00, and the specificity was 0.82-1.00. The positive predictive value was 0.95-1.00, negative predictive value was 0.81-1.00, and the test accuracy was 0.90-1.00. The concordance rate of SISH was 87.0-100% and two studies reported a correlation with FISH results. The body of evidence as a whole suggests a Grade D for SISH. Conclusion: SISH is a safe and useful test in patients with breast cancer and at least grade D evidence based on existing positive studies.

Mobile teledermatology in the developing world: Implications of a feasibility study on 30 Egyptian patients with common skin diseases

The expansion of store-and-forward teledermatology into underserved regions of the world has long been hampered by the requirement for computers with Internet connectivity. To our knowledge, this study is one of the first to demonstrate the feasibility of teledermatology using newer-generation mobile telephones with specialized software and wireless connectivity to overcome this requirement in a developing country. We sought to demonstrate that mobile telephones may be used on the African continent to submit both patient history and clinical photographs wirelessly to remote expert dermatologists, and to assess whether these data are diagnostically reliable. Thirty patients with common skin diseases in Cairo, Egypt, were given a diagnosis by face-to-face consultation. They were then given a diagnosis independently by local senior dermatologists using teleconsultation with a software-enabled mobile telephone containing a 5-megapixel camera. Diagnostic concordance rates between face-to-face and teleconsultation were tabulated. Diagnostic agreement between face-to-face consultation and the two local senior dermatologists performing independent evaluation by teleconsultation was achieved in 23 of 30 (77%) and in 22 of 30 (73%) cases, respectively, with a global mean of 75%. Limited sample size and interobserver variability are limitations. Mobile teledermatology is a technically feasible and diagnostically reliable method of amplifying access to dermatologic expertise in poorer regions of the globe where access to computers with Internet connectivity is unreliable or insufficient.

Diagnostic Accuracy and Image Quality Using a USB Digital Eyepiece Camera for Telecytology—Georgian Experience

this study is aimed at evaluating the effectiveness of digital images for telecytology diagnosis and compares it with routine cytology diagnostic under the conditions of Georgia. gynecological cytology cases (n = 420) were taken from the clinical laboratory. Cases were diagnosed routinely by one of four certified cytologists who provided cytology diagnoses. Digital images were obtained on all cases and were evaluated as computer images by a panel of cytologists. there was 94% concordance in average between routine versus digital images diagnostic. Intracytologists concordance averaged 95.5%. Image sharpness and quality were rated "good" and "excellent" in 97% cases. With respect to image color, 96% of the images were rated as "excellent" or "good." digital images for cytology diagnostic are of adequate quality, with diagnostic concordance rates.

Clinical Implications of Endoscopically Suspected Eosinophilic Esophagitis

We aimed to determine the concordance rate and clinical predictors of eosinophilic esophagitis (EoE) in patients with endoscopically suspected eosinophilic esophagitis (ESEoE) findings. From June 2006 to December 2009 in Gangnam Severance Hospital, we prospectively enrolled the patients of "endoscopically suspected eosinophilic esophagitis (ESEoE)", and then we retrospectively reviewed and analyzed clinical features and endoscopic findings. We found 17 patients of ESEoE, and 5 of them were finally confirmed as an EoE by histology (diagnostic concordance rate 29.4%). We added two more patients previously diagnosed as EoE and compared patients of EoE＋ (n=7) with EoE- (n=12). Mean age was 56.0 (range 36-70) and 51.0 (range 36-68) years old, respectively. In EoE＋ group, there were 5 males and 2 females and 6 males and 6 females in EoE- group. The symptoms of EoE＋ patients were dysphagia (n=5), food impaction (n=3), foreign body sensation in esophagus (n=2), chest pain (n=1), and heartburn (n=1). EoE- patients complained food impaction (n=5), heartburn (n=4), chest pain (n=2), foreign body sensation in esophagus (n=2), and dysphagia (n=1). The endoscopic findings of EoE＋ patients were furrows (n=6), rings (n=5), exudates or nodules (n=3), and friability (n=1). EoE- patients showed rings (n=10) and furrows(n=7). Univariative analysis showed that 'a symptom of dysphagia', 'presence of exudates or nodules', 'more than 2 suggestive endoscopic findings' were significantly different between two groups. In ESEoE, diagnostic concordance rate was 29.4%. In addition, 'symptom of dysphagia', 'exudates or nodules', '≥ endoscopic findings' are more suggestive of EoE in ESEoE patients.

Etiology and Clinical Course of Abdominal Pain in Senior Patients: A Prospective, Multicenter Study

The authors describe the epidemiology and clinical course of older persons examined in emergency departments (EDs) for abdominal pain. This was a prospective, multicenter, observational study of older persons (>or=60 years) examined in participating EDs for nontraumatic abdominal pain. Medical records were reviewed for demographics, ED diagnoses, findings of radiographic imaging, disposition, operative procedures, length of hospitalization, and final diagnoses. Patients were interviewed at 2 weeks to determine clinical course, final diagnoses, and mortality status. The authors compared ED diagnoses with final diagnoses, reporting the percentage change in aggregate and for the 12 most common diagnoses. Of 360 patients (mean age, 73.2+/- 8.8 years; 66% women; 51% white) who met selection criteria, 209 (58%) were admitted to the hospital and 63 (18%) required surgery or an invasive procedure. For patients with complete follow-up information (n=337), 37 (11%) had repeated ED visits and 23 (7%) were readmitted to the hospital. The case-fatality rate was 5%. Leading causes of abdominal pain were nonspecific (14.8%), urinary tract infection (8.6%), bowel obstruction (8%), gastroenteritis (6.8%), and diverticulitis (6.5%). The ED and final diagnoses matched 82% of the time. Older patients had higher mortality rates (odds ratio, 4.4; 95% confidence interval, 1.4--14) and lower diagnostic concordance rates (76% vs 87%; p=.01). Study limitations include inability to enroll all eligible persons and possible inaccuracies in participant-reported follow-up interviews. Abdominal pain in older patients should be investigated thoroughly as, in this study, nearly 60% of patients were hospitalized, 20% underwent operative or invasive procedures, 10% had return ED visits, and 5% died within a 2-week follow-up period.

A Preliminary Diagnosis Service Provides Prospective Blinded Dual-Review of All General Surgical Pathology Cases in an Academic Practice

Quality assurance of diagnostic accuracy in surgical pathology is an important part of a pathologist's total quality management program. At our academic institution, the quality of diagnostic accuracy is monitored via dual-review of every general surgical pathology case, which accounts for nearly 20,000 cases per year. This comprehensive dual-review is achieved by operating a preliminary diagnosis service, staffed by a senior or board eligible resident. Analysis of a portion of our dual-review data (6300 cases) demonstrates an overall diagnostic concordance rate of 95.4% and a clinical major discrepancy rate of 0.29% between the preliminary diagnosis and staff pathologist diagnosis, comparable to other published rates. The incorporation of a preliminary diagnosis service into our academic surgical pathology practice has proven to be beneficial with regard to quality assurance and resident education. Other academic institutions may similarly benefit from the addition of such a service.