Difference In Diagnostic Yield Research Articles

Transbronchial Cryobiopsy Using the Ultrathin 1.1-mm Cryoprobe with Ultrathin Bronchoscopy under Radial Endobronchial Ultrasound Guidance for Diagnosis of Peripheral Pulmonary Lesions

Introduction: Today, the increasing number of incidentally detected peripheral pulmonary lesions (PPLs) within and outside lung cancer screening trials is a diagnostic challenge. This fact encourages further improvement of diagnostic procedures to increase the diagnostic yield of transbronchial biopsy, which has been shown to have a low complication rate. The purpose of this study was to evaluate the safety and feasibility of a new ultrathin 1.1 cryoprobe that can be placed through an ultrathin bronchoscope (UTB) using fluoroscopy and radial endobronchial ultrasonography (rEBUS) navigation for assessing PPLs. Methods: Thirty-five patients with PPL less than 4 cm in diameter were prospectively enrolled to receive transbronchial cryobiopsies (TBCBs) using the ultrathin 1.1-mm cryoprobe. Navigation to the PPL was accomplished with the UTB. Under rEBUS and fluoroscopy guidance up to 4 cryobiopsies were obtained. The sample sizes of the biopsies were compared to a historic collective derived from a 1.9-mm cryoprobe and standard forceps. The feasibility and safety of the procedure, the cumulative and overall diagnostic yield, and the cryobiopsy sizes were evaluated. Results: After detection with the rEBUS, TBCB was collected from 35 PPLs, establishing a diagnosis in 25 cases, corresponding to an overall diagnostic yield of 71.4%. There was no difference in diagnostic yield for PPL 2, which was significantly larger compared to the historic collective (p = 0.003). Six mild and four moderate bleeding events and 1 case of pneumothorax were observed. Conclusions: Using the ultrathin 1.1-mm cryoprobe combined with an UTB for rEBUS-guided TBCB of PPL is feasible and safe. This diagnostic approach improves bronchoscopic techniques for diagnosing peripheral lung lesions and may contribute to improve diagnosis of lung cancer even in small PPL.

Comparison of diagnostic outcomes, safety, and cost of Franseen-tip 19G versus 22G needles for endoscopic ultrasound-guided liver biopsies.

Background and study aims Favorable outcomes were noted with refinement in newer endoscopic ultrasound-guided liver biopsy (EUS-LB) needle tips. Still, the overall usefulness and benefit are yet to be well explored. Patients and methods This was a retrospective analysis of patients with EUS-LB (Franseen-tip 19G versus 22G FNB needle) over 2 years. EUS-LB was obtained in a one-pass, two-actuation, modified wet suction technique. Diagnostic yield, fragmentation rate, aggregate specimen length (AL), number of complete portal tracts (CPT), length of longest intact core (LIC), adverse events (AEs) (early), and cost of the procedure (1USD = 82 INR) were compared. Results Fifty-four patients (33 [61.1%], female) successfully underwent EUS-LB with a median age of 46 years (interquartile range [IQR] 34-54); the majority 32 (59.2%) underwent 19G biopsies. There was a significantly increased median (IQR) AL in the 19G compared with 22G (20 mm [19-21] vs. 15 [14-15], P < 0.001), respectively. Similarly, significantly lengthier median LIC and CPT were seen, respectively. A nonsignificant diagnostic yield was noted (100% vs. 90.9%, P = 0.082), respectively. The fragmentation rate was higher in 22G FNB needles (36.4% [95% CI 16-56] vs. 12.5% [95% CI 1-24], respectively; P = 0.038). Seven patients (12.9%) had mild AEs with no difference between groups. The average procedure cost with 19G was INR 63000 (768$), and with 22G needle was INR 54500 (664$). Conclusions The Franseen-tip 19G outperforms 22G with a significantly lower fragmentation rate, longer AL, LIC, and a higher number of CPT with a marginal increase in the procedure cost, without any difference in diagnostic yield and safety.

Endobronchial ultrasound (EBUS)-guided transbronchial miniforceps biopsy an urban center experience.

The role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in staging mediastinal and hilar lymph nodes in non-small cell lung cancer (NSCLC) is well established. However, evidence of its diagnostic utility in other pathologies-such as lymphoma-remains inadequate. This retrospective observational study aims to determine the diagnostic yield of EBUS-guided miniforceps biopsy (EBUS-MFB) compared to EBUS-TBNA in both malignant and nonmalignant conditions. We conducted a retrospective cross-sectional chart review of all adult patients referred for EBUS at our institution between January 2019 and December 2022. All patients who underwent both EBUS-TBNA and EBUS-MFB were included, with some patients also undergoing transbronchial cryobiopsy. Patients without pathology reports available were excluded. The combination of EBUS-MFB and EBUS-TBNA had the highest percentage of diagnostic results both in the overall cohort (34.4%) and in patients who did not undergo transbronchial cryobiopsy (46.2%). EBUS-MFB alone yielded more diagnostic results compared to EBUS-TBNA. Transbronchial cryobiopsy was the sampling method with the highest percentage of diagnostic results in the cryobiopsy group (64.5%). Statistical analysis revealed a significant difference in diagnostic yield between EBUS-MFB and EBUS-TBNA (P<0.001), with EBUS-MFB showing a higher diagnostic yield overall. EBUS-MFB had a significantly higher diagnostic yield than EBUS-TBNA in benign cases, in patients diagnosed with sarcoidosis, but not in malignant disease. Our study suggests that combining EBUS-MFB with EBUS-TBNA can improve the diagnostic yield, particularly in benign cases and sarcoidosis. These findings support the potential superiority of adding EBUS-MFB over EBUS-TBNA alone and highlight the need for further randomized control trials to validate these results. The retrospective nature of this study and certain limitations, such as the lack of adequate longer-term follow-up, selection and operator biases, and the absence of rapid on-site evaluation (ROSE) in some cases, should be considered when interpreting the results. Nonetheless, this study contributes to the growing evidence for the utility of EBUS-MFB in improving the diagnostic yield of EBUS procedures in specific clinical scenarios.

Differences in diagnostic yield of invasive coronary function testing between high and low volume centres, in patients with angina and no obstructive coronary artery disease

Abstract Introduction Coronary angiograms for stable angina frequently show no obstructive coronary artery disease (ANOCA). A large proportion of ANOCA patients have underlying coronary vasomotor dysfunction. They can be divided into different endotype subgroups, according to their invasive coronary function test (CFT) results. A complete CFT in the studied cohort consists of both spasm provocation with acetylcholine as well as testing physiology of the microcirculation with adenosine and bolus thermodilution. There is a high prevalence of vasomotor dysfunction in our tertiary, high volume CFT centre where &amp;gt;100 CFT s are performed each year. No data is available yet on the prevalence in low volume centres. Purpose To compare CFT results of patients who underwent complete CFT in a high volume centre versus low volume centres. Methods We included all consecutive patients from the pilot version of a prospective national registry of coronary function tests in the Netherlands (NL-CFT) who underwent a complete standardized CFT between February 2019 and January 2023 (n=593). We compared CFT diagnosis (endotypes) in high versus low volume centres by acetylcholine spasm provocation and adenosine bolus thermodilution test results. A high volume CFT centre was defined as performing more than 100 CFT’s per year. Coronary microvascular dysfunction (CMD) was defined as a coronary flow reserve CFR &amp;lt;2 and/or index of microvascular resistance IMR ≥25. Coronary vasomotor dysfunction was present when epicardial or microvascular spasm was diagnosed, when CFR and/or IMR was abnormal, or when both parts of the CFT were abnormal. We expect to be able to present expanded data on approximately 1000 patients with complete CFTs around the ESC congress. Results Currently, 593 patients underwent complete CFT (83% female, mean age 60 ± 9.5 years). The high volume centre performed 307 (52%) of all CFTs in the studied period. The four low volume centres combined performed the other 286 (48%). A total of 461 (78%) of patients had coronary vasomotor dysfunction. Prevalence of coronary vasomotor dysfunction was significantly higher in a high volume centre compared to low volume centres (88% vs 66% p&amp;lt;0.001). Coronary spasm was present in 84% of CFTs in a high volume centre: 54% isolated and 30% combined with CMD. Isolated CMD was present in 4% and only 12% had a normal CFT. In low volume centres coronary spasm was present in 54% of patients: 36% isolated and 19% combined with CMD. Isolated CMD was present in 12% and 34% of all performed CFT’s was normal. Conclusions In this pilot data of NL-CFT, a large prospective registry, 593 patients underwent complete CFT. We show that the prevalence of coronary vasomotor dysfunction is significantly higher in a high volume CFT centre compared to low volume centres. Vasospasm is the predominant endotype, either isolated or combined with CMD. Nevertheless, prevalence of vasomotor dysfunction in low volume centres is still high and warrants attention.Distribution of endotypes

Abstract 16147: Racial and Ethnic Differences in the Diagnostic Yield of Cardiomyopathy, Aortopathy, and Arrhythmia Genetic Testing and Frequency of Family Variant Screening

Introduction: Genetic testing for individuals with inherited cardiovascular conditions can guide treatment and aid in family screening. However, the diagnostic yield of pathogenic or likely pathogenic (P/LP) variants may differ by race and ethnicity because of a lack of diversity in population-based genomic databases. Methods: We evaluated the diagnostic yield (% tests with P/LP variants) of genetic testing for cardiomyopathy, aortopathy, and arrhythmia among probands undergoing testing at a large commercial laboratory (Invitae Corp.) from 9/2015-7/2022 for the most common racial and ethnic groups: Hispanic, Non-Hispanic (NH) Black, and NH White individuals. We used multivariable logistic regression to evaluate for differences in diagnostic yield by race and ethnicity adjusting for age, sex, payer, and number of genes tested. The ratio of the number of persons undergoing family variant testing (FVT) to the number with positive tests was determined, with Chi-square tests to evaluate for differences by group. Results: We identified 129,565 persons undergoing diagnostic genetic testing (n=9,157 Hispanic, n=16,287 NH Black, and n=78,740 NH White). Compared with White persons, the odds of a positive test were higher in Black and Hispanic persons for cardiomyopathy (OR 1.2, 95% CI 1.2-1.3, p &lt;0.001 and OR 1.3, 95% CI 1.2-1.4, p &lt;0.001, respectively) and aortopathy (OR 2.1, 95% CI 1.8-2.5, p &lt;0.001 and OR 1.9, 95% CI 1.7-2.2, p &lt;0.001, respectively), and higher for Hispanic persons for arrhythmia (OR 1.2, 95% CI 1.1-1.3, p &lt;0.001). The ratio of FVT to positive tests was significantly (p &lt; 0.001) lower for Black and Hispanic persons than White persons for cardiomyopathy (0.32, 1.19, and 1.51, respectively), aortopathy (0.77, 1.62, and 2.34, respectively), and arrhythmia (1.47, 2.23, and 3.33, respectively). Conclusion: Despite being underrepresented in population genomic databases, the diagnostic yield of genetic screening for cardiomyopathy and aortopathy was higher in Black and Hispanic persons compared with White individuals. The relative frequency of family variant testing was lower in Black and Hispanic than in White persons, indicating an opportunity to improve cascade screening in these groups.

Diagnostic Yield of Epilepsy-Genes Sequencing and Chromosomal Microarray in Pediatric Epilepsy

BackgroundAround 40% of individuals with epilepsy have an underlying identifiable genetic etiology. Common methods for epilepsy genetic testing are chromosomal microarray (CMA) and epilepsy-genes sequencing (EGS). Historically, CMA was the first-line test for patients with epilepsy, but recent studies have shown that EGS has a superior diagnostic yield. To further optimize testing algorithms for epilepsy, we compared these tests’ diagnostic yields and explored how they are influenced by age of onset and phenotype complexity. MethodsGenetic test results from a cohort of patients with epilepsy were used to determine the diagnostic yield of CMA (n = 366) versus EGS (n = 370) for genetic epilepsy etiologies. Further analysis examined the probability of diagnostic results based on age of seizure onset and patients’ phenotype complexity. ResultsFor patients who underwent CMA, causative variants were found in 28 of 366 cases (7.7%), and 60 of 366 patients (16.4%) had at least one variant of uncertain significance (VUS). For EGS, 65 of 370 (17.6%) cases had causative variants, whereas 155 of 370 (41.9%) had at least one VUS. EGS had a significantly higher diagnostic yield than CMA (odds ratio [OR] = 2.63, P < 0.001). This difference in diagnostic yield was further pronounced among patients with infantile seizure onset (OR = 4.69, P < 0.001) and patients with additional neurological findings (OR = 2.99, P < 0.001). ConclusionTo minimize the time and resources required to reach a diagnosis, clinicians and insurers alike should consider using EGS as an initial diagnostic tool.

Comparing the diagnostic adequacy of 25-Gauge fork-tip versus franseen versus reverse-bevel-type needles in EUS–guided tissue acquisition: A prospective randomized study with a retrospective control

ABSTRACT Background and Objectives EUS–guided fine-needle biopsy (FNB) is an established technique for the acquisition of tissue to diagnose lesions of the gastrointestinal tract and surrounding organs. Recently, newer-generation FNB needles have been introduced, including a second-generation reverse-bevel and the third-generation fork-tip and Franseen needles. We aimed to determine if there was any difference between these needles in terms of cytopathological diagnostic yield, sample cellularity, or sample bloodiness. Methods One hundred twenty-seven consecutive patients undergoing EUS–guided FNB of any solid lesion were randomized to use either a Franseen or fork-tip needle in a 1:1 ratio and were compared with 60 consecutive historical cases performed with reverse-bevel needles. Patient and procedure characteristics were recorded. Cases were reviewed by a blinded cytopathologist and graded based on cellularity and bloodiness. Overall diagnostic yield was calculated for each study arm. Results One hundred seventy-six cases were eligible for analysis, including 109 pancreatic masses, 24 lymphoid lesions, 17 subepithelial lesions, and 26 other lesions. The final diagnosis was malignancy in 127 cases (72%). EUS–guided FNB was diagnostic in 141 cases (80%) overall and in 89% of cases where malignancy was the final diagnosis. There was no difference in diagnostic yield, sample cellularity, or sample bloodiness between the different needle types. There was no difference in adverse events between groups. Conclusions EUS–guided FNB performed using 25-gauge Franseen, fork-tip, and reverse-bevel needles resulted in similar diagnostic yield, sample cellularity, and sample bloodiness. Our results may not be extrapolated to larger-caliber needles of the same design.

Black Patients Equally Benefit From Renal Genetics Evaluation but Substantial Barriers in Access Exist

Genetic testing is increasingly accessible to patients with kidney diseases. Racial disparities in renal genetics evaluations have not been investigated. A cohort of patients evaluated by the Cleveland Clinic Renal Genetics Clinic (RGC) from January 2019 to March 2022 was analyzed. Forty-eight Black patients, including 27 (56.3%) males, median age 34 (22-49) years and 232 White patients, including 76 (32.8%) males, median age 35 (21-53) years, were evaluated. Black patients were more likely to have end-stage kidney disease (ESKD) at the time of referral compared with White patients (23% vs. 7.3%, P= 0.004), more likely to be covered by Medicaid (46% vs. 15%, P< 0.001), and less likely to be covered by private insurance (35% vs. 66%, P< 0.001). Black patients were more likely to "no show" to scheduled appointment(s) or not submit specimens for genetic testing compared with White patients (24.1% vs. 6.7%, P= 0.0005). Genetic testing was completed in 35 Black patients. Of these, 37% had a positive result with 9 unique monogenic disorders and 1 chromosomal disorder diagnosed. Sixty-nine percent of Black patients with positive results received a new diagnosis or a change in diagnosis. Of these, 44% received a significant change in disease management. No differences in diagnostic yield and implications of management were noted between Black and White patients. Black patients equally benefit from renal genetics evaluation, but barriers to access exist. Steps must be taken to ensure equitable and early access for all patients. Further studies investigating specific interventions to improve access are needed.

Anesthesia care provider sedation versus conscious sedation for endoscopic ultrasound-guided tissue acquisition: a retrospective cohort study.

We aimed to study the effects of sedation on endoscopic ultrasound-guided tissue acquisition. We conducted a retrospective study evaluating the role of sedation in endoscopic ultrasound-guided tissue acquisition by comparing two groups: anesthesia care provider (ACP) sedation and endoscopist-directed conscious sedation (CS). Technical success was achieved in 219/233 (94.0%) in the ACP group and 114/136 (83.8%) in the CS group (p=0.0086). In multivariate analysis, the difference in technical success between the two groups was not significant (adjusted odds ratio [aOR], 0.5; 95% confidence interval [CI], 0.234-1.069; p=0.0738). A successful diagnostic yield was present in 146/196 (74.5%) in the ACP group and 66/106 (62.3%) in the CS group, respectively (p=0.0274). In multivariate analysis, the difference in diagnostic yield between the two groups was not significant (aOR, 0.643; 95% CI, 0.356-1.159; p=0.142). A total of 33 adverse events (AEs) were observed. The incidence of AEs was significantly lower in the CS group (5/33 CS vs. 28/33 ACP; OR, 0.281; 95% CI, 0.095-0.833; p=0.022). CS provided equivalent technical success and diagnostic yield for malignancy in endoscopic ultrasound-guided tissue acquisition. Increased AEs were associated with anesthesia for the endoscopic ultrasound-guided tissue acquisition.

Safety and Efficacy of CT-Guided Percutaneous Biopsy of Suspicious Subcentimeter Pelvic and Retroperitoneal Lymph Nodes Detected by 11C-Choline PET in Patients With Prostate Cancer.

BACKGROUND. In patients with prostate cancer, PET using targeted radiotracers can identify increased activity in small morphologically normal lymph nodes, facilitating earlier detection of metastatic disease. OBJECTIVE. The purpose of this article was to assess the efficacy and safety of CT-guided biopsy of suspicious pelvic and retroperitoneal lymph nodes measuring smaller than 1 cm detected by 11C-choline PET in patients with prostate cancer, with comparison with nodes measuring 1 cm or larger. METHODS. This retrospective study included patients with prostate cancer who underwent CT-guided percutaneous biopsy of suspicious pelvic or retroperitoneal lymph nodes detected by 11C-choline PET/CT or PET/MRI (performed because of a rising or elevated PSA level or known recurrent or metastatic disease) between June 1, 2012, and March 20, 2020. Patient, lymph node, and procedural characteristics, as well as biopsy outcomes and complications, were recorded. Biopsies of lymph nodes measuring smaller than 1 cm and of lymph nodes measuring 1 cm and larger were compared. RESULTS. A total of 269 patients (mean age, 68.7 ± 6.8 [SD] years) were included. A total of 156 patients underwent biopsy of lymph nodes measuring smaller than 1 cm (range, 3-9 mm); 113 patients underwent biopsy of lymph nodes measuring 1 cm or larger (range, 10-35 mm). Lymph nodes smaller than 1 cm and lymph nodes 1 cm and larger showed no significant difference in diagnostic yield (89.7% vs 92.9%; p = .40). Diagnostic yield was not significantly different between nodes smaller than 1 cm and nodes 1 cm and larger for any individual anatomic location within the pelvis or retroperitoneum (all p > .05). Malignant yield was lower for nodes smaller than 1 cm than for nodes 1 cm and larger (44.9% vs 63.7%; p = .003). The single biopsied 3-mm node had a nondiagnostic specimen. Diagnostic yield and malignant yield were 100.0% and 40.0%, respectively, for 4-mm nodes, and 95.5% and 45.5%, respectively, for 5-mm nodes. Patients with nodes smaller than 1 cm and nodes 1 cm and larger showed no significant difference in minor (12.8% vs 7.1%; p = .16) or major (0.6% vs 2.7%; p = .31) complication rate. CONCLUSION. The findings support the safety and efficacy of CT-guided biopsy of suspicious subcentimeter pelvic and retroperitoneal lymph nodes detected on 11C-choline PET in patients with prostate cancer. CLINICAL IMPACT. Earlier diagnosis of metastatic lymphadenopathy will impact prognostic assessment and management decisions in patients with recurrent prostate cancer.

Ultrathin Bronchoscopy for the Diagnosis of Peripheral Pulmonary Lesions: A Meta-Analysis

Background: Ultrathin bronchoscopy (external diameter, ≤3.5 mm) is useful for the diagnosis of peripheral pulmonary lesions because of its good accessibility. Objectives: We performed a meta-analysis to investigate the diagnostic yield of ultrathin bronchoscopy for peripheral pulmonary lesions. Methods: We performed a systematic search of MEDLINE and EMBASE (from inception to May 2021), and meta-analysis was performed using R software. The diagnostic yield was evaluated by dividing the number of successful diagnoses by the total number of lesions, and subgroup analysis was performed to identify related factors. Results: Nineteen studies with a total of 1,977 peripheral pulmonary lesions were included. The pooled diagnostic yield of ultrathin bronchoscopy was 0.65 (95% confidence interval, 0.60–0.70). Significant heterogeneity was observed among studies (χ², 87.75; p < 0.01; I², 79.5%). In a subgroup analysis, ultrathin bronchoscopy with 1.2 mm channel size showed a diagnostic yield of 0.61 (95% confidence interval, 0.53–0.68), whereas ultrathin bronchoscopy with 1.7 mm channel size showed 0.70 (95% confidence interval, 0.66–0.74) (χ², 5.35; p = 0.02). In addition, there was a significant difference in diagnostic yield based on lesion size, histologic diagnosis (malignant vs. benign), bronchus sign, and lesion location from the hilum, whereas no significant difference was found based on lobar location. The overall complication rate of ultrathin bronchoscopy was 2.7% (pneumothorax, 1.1%). Conclusions: Ultrathin bronchoscopy is an excellent tool for peripheral pulmonary lesion diagnosis with a low complication rate. The diagnostic yield of ultrathin bronchoscopy was significantly higher with larger channel size, which might be attributed to the availability of radial endobronchial ultrasound.

Impact of COVID-19 pandemic healthcare restrictions on utilisation and diagnostic yield of outpatient transthoracic echocardiograms.

During the COVID-19 pandemic, Kentucky prohibited elective medical procedures from 3/18/2020-4/27/2020. We sought to determine if cessation of elective procedures in Kentucky during the COVID-19 pandemic resulted in a decrease in the proportion of rarely appropriate outpatient transthoracic echocardiograms interpreted at the open echocardiography lab at Norton Children's Hospital. A retrospective chart review was conducted comparing proportions of rarely appropriate outpatient paediatric transthoracic echocardiograms performed pre-COVID (3/21/2019-4/28/2019) and during COVID (3/19/2020-4/27/2020). Transthoracic echocardiogram indication was determined by chart review and echocardiogram reports. Indication appropriateness was evaluated using paediatric appropriate use criteria for initial outpatient transthoracic echocardiogram or CHD follow-up as applicable. Of transthoracic echocardiograms pre-COVID, 100 (37.7%) were rarely appropriate versus 18 (20.2%) during COVID. Pre-COVID, paediatric cardiologists tended to order fewer rarely appropriate transthoracic echocardiograms than paediatricians (35.9% versus 46.4%), although this difference was not statistically significant. Cardiologists ordered the majority of outpatient transthoracic echocardiograms during COVID (77/89, 86.5%), limiting the ability to compare transthoracic echocardiogram indications by provider type. There was no significant difference in diagnostic yield of initial outpatient transthoracic echocardiograms with (13.0%) abnormal studies pre-COVID versus 7 (15.5%) during COVID. While elective procedures were prohibited in Kentucky during the COVID-19 pandemic, a decrease in the proportion of rarely appropriate outpatient paediatric transthoracic echocardiograms was observed. There was no significant difference in diagnostic yield of initial outpatient transthoracic echocardiograms between time periods, suggesting that clinically significant echocardiogram findings were still detected despite more prudent utilisation of echocardiography during this time.

Helical CT versus intermittent CT fluoroscopic guidance for musculoskeletal needle biopsies: impact on radiation exposure, procedure time, diagnostic yield, and adverse events.

Image-guided percutaneous needle biopsies are essential in the workup of musculoskeletal (MSK) lesions. While helical CT (HCT) is well established, intermittent CT fluoroscopy (iCTF) is an increasingly used alternative. The purpose of this study is to establish whether differences in subject radiation exposure, procedure time, yield, or adverse events exist between HCT and iCTF guidance. This retrospective cohort study included consecutive MSK needle biopsies performed on a single-CT scanner over a 12-month period at a tertiary academic center. Subject demographics, radiation dose, and outcomes were abstracted from the medical record. Comparisons between the two cohorts were performed using Student's t-test for continuous data and using Fisher's exact test for categorical data and a two-tailed p value less than 0.05 was considered significant. Two hundred sixteen adults (115 (53.2%) females) with a mean age of 58.8 ± 18.4years, underwent 216 biopsies (109 (50.5%) HCT guided, 107 (49.5%) iCTF guided) between June 2017 and June 2018. Dose-length product (DLP) and volume CT dose index (CTDIvol) were significantly higher for the HCT cohort (HCT 698.9 ± 400.8 mGycm vs iCTF 312.8 ± 170.8 mGycm; p < 0.005 and HCT 19.1mGy ± 8.8 vs iCTF 6.9mGy ± 1.5, p < 0.001). No significant difference in diagnostic yield, procedure time, or adverse event rate was identified. For CT-guided MSK needle biopsies, iCTF decreases subject radiation dose compared to HCT without negatively affecting outcomes. iCTF should be strongly considered by radiologists performing MSK biopsies given the reduced patient radiation exposure.

Shape-Sensing Robotic-Assisted Bronchoscopy vs Digital Tomosynthesis-Corrected Electromagnetic Navigation Bronchoscopy: A Comparative Cohort Study of Diagnostic Performance

Electromagnetic navigational bronchoscopy has been the dominant bronchoscopic technology for targeting small peripheral lesions and now includes digital tomosynthesis-electromagnetic navigational bronchoscopy (DT-ENB), allowing near-real-time intraprocedural nodule visualization. Shape-sensing robotic-assisted bronchoscopy (ssRAB), with improved catheter stability and articulation recently became available. Although the diagnostic performance of these two methods seems higher than that of legacy systems, data remain limited. We sought to compare the diagnostic yield of these two novel platforms after their introduction at our institution. Does the diagnostic yield of ssRAB differ significantly from that of DT-ENB in patients undergoing biopsy of peripheral pulmonary lesions (PPLs)? This retrospective comparative cohort study analyzed prospectively collected data on consecutive procedures performed with DT-ENB and ssRAB in their first 6months of use at our institution. Biopsies were considered diagnostic if histopathologic analysis revealed malignancy or specific benign features that readily explained the presence of a PPL. Nonspecific inflammation, normal lung or airway, and atypia not diagnostic of malignancy were considered nondiagnostic. SSRAB was used to biopsy 143 PPLs in 133 patients and DT-ENB was used to biopsy 197 PPLs in 170 patients. Diagnostic yield was 77%for ssRAB (110 of 143 PPLs) and 80%(158 of 197 PPLs) for DT-ENB (OR, 0.8; 95%CI, 0.5-1.4; P= .4). Median lesion diameters were 17 and 19mm, respectively. No difference in diagnostic yield was found after adjustment for lesion size, bronchus sign, peripheral vsmiddle third location, and sex. Pneumothorax complicated 1.5%of ssRAB and 1.8%of DT-ENB procedures (P= .86). SSRAB and DT-ENB showed comparable diagnostic yields and safety profiles in this comparative cohort study.

Diagnostic yield of a multi-strategy genetic testing procedure in a nationwide cohort of 728 patients with infantile spasms in China

ObjectiveInfantile spasms (IS) is a common epilepsy syndrome in infancy. Genetically based birth defects are among the many causes of infantile spasms. Genetic diagnosis can reveal the etiology of IS and guide treatment strategies and genetic counseling, but significant challenges surround the choice of appropriate genetic diagnostic strategies to improve the diagnostic yield in IS. MethodsFor a cohort of Chinese patients with IS, appropriate genetic testing methods were selected according to etiological classification. Methods included karyotyping, copy number variation detection, single-gene sequencing, targeted sequencing panel, and whole-exome sequencing. ResultsA total of 728 children with IS from fifteen provinces and municipalities in China from June 2015 to October 2020 were recruited in the study. Among them, 436 were males (59.9%). The median age was 9.46 months. The diagnostic yield of our study was 31.5% (185/587). The top five causative genes were TSC2 (n = 91), STXBP1 (n = 21), TSC1 (n = 15), SCN2A (n = 6), and CDKL5 (n = 6). The genetic diagnostic yield was 100% in Down syndrome (n = 1), neurofibromatosis (n = 2), and methylmalonic acidemia (n = 2), 83.5% in tuberous sclerosis complex (n = 127), and 16.7% in unsolved infantile spasms (n = 442). Different genetic testing methods for different etiologies show large differences in diagnostic yields. ConclusionThis study demonstrates that appropriate genetic testing procedures for different phenotypes can ensure a high diagnostic yield.

Evaluation of large airway specimens obtained by transbronchial lung cryobiopsy in diffuse parenchymal lung diseases

BackgroundThe difference in diagnostic yield between surgical lung biopsy and transbronchial lung cryobiopsy (TBLC) in diffuse parenchymal lung diseases (DPLD) has been reported to be due to differences in the rate of interpathologist agreement, specimen size, and specimen adequacy. In TBLC, the specimens containing large airway components are generally believed as inadequate specimens for histological evaluation, but the detailed characteristics of TBLC specimens including the large airway and the impact on histological diagnostic rates of DPLD have not been investigated.MethodsWe retrospectively reviewed the specimen characteristics of patients with DPLD who underwent TBLC.ResultsBetween February 2018 and January 2020, 74 patients and 177 specimens were included. There were 85 (48.0%) large airway specimens (LAS) that contained bronchial gland or bronchial cartilage. The ideal specimen ratio was significantly lower in the LAS-positive group than that in the LAS-negative group (5.8% vs. 45.6%), and the proportion of bronchioles, alveoli, and perilobular area were similarly lower in the LAS-positive group. The presence of traction bronchiectasis and diaphragm overlap sign on high-resolution computed tomography (HRCT) were also significantly higher in the LAS-positive group than those in the LAS-negative group. We observed a statistically significant trend in histological diagnostic yield (40.7% in LAS positive group; 60.8% in LAS positive and negative group; 91.6% in LAS negative group) (Cochran-Armitage trend test).ConclusionLAS is a specimen often collected in TBLC and contains a low percentage of bronchioles, alveoli, and perilobular area. Since the histological diagnostic yield tends to be higher in cases that do not contain LAS, it may be important to determine the biopsy site that reduces the frequency of LAS collection by referring to the HRCT findings in TBLC.

Telecytology versus in-room cytopathologist for EUS-guided FNA or fine-needle biopsy sampling of solid pancreatic lesions

Rapid on-site-evaluation (ROSE) with an in-room cytopathologist (ROSE-P) has been shown to improve the diagnostic yield of specimens obtained from patients undergoing EUS-guided FNA or fine-needle biopsy sampling (EUS-FNAB) of pancreatic lesions. Recently, there has been an increased interest and use of ROSE using telecytology (ROSE-T) to optimize clinical workflows and to address social distancing mandates created during the coronavirus disease 2019 pandemic. The purpose of this study was to compare diagnostic outcomes of ROSE-P and ROSE-T. A single-center cohort study of patients who underwent EUS-FNAB of solid pancreatic lesions with ROSE was conducted. The primary outcome was overall diagnostic yield of cancer. All patients who underwent EUS-FNAB were entered into a prospectively maintained database. Statistical analyses were performed using descriptive statistics and univariate analysis. There were 165 patients in each arm. There was no difference in diagnostic yield between ROSE-P and ROSE-T (96.4% vs 94.5%, P= .428). ROSE-T was associated with an increased use of 22-gauge needles (P= .006) and more needle passes (P< .001). No significant differences were found in age, gender, lesion size, needle type, procedure times, or adverse events between the 2 groups (P< .05 for all). More pancreatic tail lesions were sampled in the ROSE-P group (P< .001). ROSE-T was not associated with any difference in final histologic diagnosis for EUS-FNAB of solid pancreatic masses. This has important implications for optimizing clinical workflows.

S1076 Anesthesia Care Provider Sedation (ACPS) Is Superior to Conscious Sedation (CS) for Successful Diagnostic Tissue Acquisition in Endoscopic Ultrasound Fine Needle Aspiration and/or Biopsy (EUS FNA/B)

Introduction: EUS-FNA/B is frequently used for diagnosis of suspicious intestinal, subepithelial, and extraintestinal lesions. Our study aimed to evaluate the role of sedation in the diagnostic yield of EUS-FNA/B of suspicious lesions in the mediastinum, abdomen and pelvis. Given frequent use and experience of CS with diagnostic EUS at our institution, we hypothesized that the diagnostic yield of EUS-FNA/B would be equivalent for both sedation groups. Methods: A retrospective, single-center, cohort study was conducted including patients aged >18 years old who received EUS-FNA/B at our institution from 9/2018 – 5/2021 for further evaluation of suspicious lesions. Relevant baseline variables were collected for both groups. The primary endpoint was EUS diagnostic yield of neoplastic lesions. Successful cytologic diagnosis was defined by positive or suspicious results. Unsuccessful cytological results were defined by unsatisfactory, indeterminate, or false negative results. Secondary endpoint was adverse events (AEs). AEs were recorded for EUS only (EUS/ERCP patients were excluded from AE tally due to possible confounding). Baseline statistical comparison was done using the Chi-square test and Wilcoxon two sample tests. Univariate and multivariate logistic regression analysis was conducted to further evaluate primary and secondary outcomes. All statistical analyses were performed utilizing SAS Software (version 9.4; SAS Institute Inc. Cary, NC, USA). Results: 369 patients met initial inclusion criteria. 67 cases with confirmed or suspected benign lesions were eliminated from analysis. Successful FNA/B was present in 146/196 (74.5%) of patients in the ACPS group and 66/106 (62.3%) in the CS group, (p = 0.0274). Upon multivariate logistic regression controlling for lesion size, location, needle size, number of passes, and presence of ROSE, the difference in diagnostic yield between the CS and GA groups remained statistically significant (adjusted odds ratio [95% CI]: 0.558 [0.315 - 0.987], P = 0.0451) (Table). Adverse events (AEs) occurred more frequently in the ACPS group. This difference was sustained on multivariate analysis controlling for BMI, age, and ASA class. Conclusion: ACPS is associated with improved diagnostic yield when performing EUS-FNA/B for suspicious lesions in the mediastinum, abdomen, and pelvis. AEs occur more frequently in ACPS albeit most AEs are mild and associated with general anesthesia. Table 1. - Descriptive Analysis of demographics, Univariate/Multivariate logistic regression analysis, and Adverse Events Demographics Type of sedation P value Anesthesia Conscious Sedation N(number of patients) % N % Gender 0.07 Male 110 47.21 51 37.5 Female 123 52.79 85 62.5 ASA Class < 0.001 1 5 2.15 8 5.88 2 45 19.31 63 46.32 3 169 72.53 65 47.79 4 14 6.01 . . Location 0.001 Thoracic 1 0.43 1 0.74 Abdominal (non-pancreas) 26 11.16 22 16.18 Pelvic 3 1.29 2 1.47 pancreas ampulla/uncinate/head 130 55.79 42 30.88 neck/body/tail pancreas 50 21.46 46 33.82 SEL 22 9.44 22 16.18 Cytologic Result 0.007 Unsatisfactory specimen 14 6.01 22 16.18 Negative for malignancy 43 18.45 33 24.26 Atypical/Indeterminate 30 12.88 15 11.03 Suspicious for malignancy 10 4.29 3 2.21 Positive for malignancy 136 58.37 63 46.32 FNB < 0.001 N 140 60.09 115 84.56 Y 93 39.91 21 15.44 Univariate and Multivariate logistic regression analysis Univariate logistic regression (Crude effect) Unit OR 95% Confidence Limits p-Value Type of sedation (CS vs Anesthesia) 1 0.565 0.34 0.938 0.0274 Adjusted Effect Unit OR 95% Confidence Limits Column1 p-Value Type of sedation CS vs Anesthesia 1 0.558 0.315 0.987 0.0451 Location Others vs (pancreas ampulla/uncinate/head) 1 0.46 0.2 1.063 0.0691 Number of needle passed 1 1.473 1.191 1.822 0.0004 Categories of Adverse Events Type of Sedation CS Anesthesia Severity GA MAC Mild 3 14 2 Moderate 1 5 0 Severe 0 3 0 Fatal 0 0 0 Total 4 22 2 **Total of 28 adverse events.

Which model of small bowel capsule endoscopy has a better diagnostic yield? A systematic review and meta-analysis.

Small-bowel capsule endoscopy (SBCE) is a safe and efficient method for diagnosis of small-bowel diseases. Since its development, different models have appeared. The aim of this study was to analyze which of the different models of SBCE has the best diagnostic yield. Extensive medical literature research was reviewed, using MESH terms, searching studies comparing different SBCE types. We analyzed the diagnostic yield of all the comparisons and when there were 2 or more studies that compared the same model of SBCEs, a meta-analysis was performed. Ten eligible studies including 1065 SBCEs procedures were identified. The main indication was occult gastrointestinal bleeding in 9/10 studies. Two of them included anemia, chronic diarrhea and/or chronic abdominal pain. The indication in one article was celiac disease. In 9 studies, different types of SBCEs (MiroCam, Endocapsule, OMOM and CapsoCam) were compared with PillCam (SB, SB2 and SB3). Three studies compared MiroCam vs PillCam and CapsoCam vs PillCam, while two studies contrast Endocapsule vs PillCam. None of the SBCEs show superiority over PillCam [OR 0.78 (95%CI;0.60-1.01)]. One study compared SBCEs other than Pillcam (MiroCam vs Endocapsule). Nine studies did not find statistical differences between SBCEs, one showed better diagnostic yield of Mirocam compared with PillCam SB3 (p=0.02). The difference between these SBCE was not replayed in the metaanalysis [OR 0.77 (95%CI;0.49-1.21)]. Despite the appearance of new SBCE models, there are no differences in diagnostic yield; therefore, SBCE endoscopist's performance should be based on experience and availability.

Diagnostic Yield of Serial Pancreatic Juice Aspiration Cytologic Examination With Brush Cytology for Pancreatic Ductal Stenosis

Serial pancreatic-juice aspiration cytologic examination (SPACE) is useful for diagnosis of pancreatic ductal stenosis. This study investigates the utility of adding brush cytology to SPACE during the same procedure. We retrospectively analyzed consecutive patients who underwent SPACE with brush cytology for pancreatic ductal stenosis between February 2014 and July 2020 in our hospital. Thirty-four patients were included. Eleven had lesions in the pancreatic head lesions, and 23 had lesions in the pancreatic body or tail. Malignancies were found in 22 patients. Endoscopic ultrasound, computed tomography, and magnetic resonance imaging showed distal pancreatic duct dilation in 81.8% to 90.6% of cases, with a sensitivity of 63.0% to 65.5%. The sensitivity and diagnostic accuracy of SPACE, brush cytology, and SPACE with brush cytology were 63.6%, 50.0%, and 77.3% (P = 0.19) and 73.5%, 67.6%, and 82.4% (P = 0.42), respectively. No significant differences in diagnostic yield were observed for either pancreatic head lesions or pancreatic body/tail lesions. Post-endoscopic retrograde cholangiopancreatography pancreatitis was observed in 4 cases (11.8%). The utility of adding brush cytology to SPACE was limited.