Early Diagnosis Of Dysplasia Research Articles

OGC P31 On the role of Cytosponge for Barrett’s surveillance: assessment of viability and safety of this new technology

Abstract Background Barrett’s Oesophagus is a pre-malignant change where the normal stratified squamous epithelium is replaced by intestinal columnar epithelium. Current guidance produced by the British Society of Gastroenterologists describes 'gold-standard' surveillance as regular upper GI endoscopy with quadrantic biopsies for every 2cm length of Barrett’s oesophagus. The Covid pandemic led to significant delays in the Barrett's surveillance; as a result, many patients have fallen outside their maximum recommended surveillance interval. Cytosponge is a novel cytology sampling device which has a potential role in Barrett's surveillance though its use for this condition remains controversial. Methods All patients who were due for Barrett's surveillance in 2022 were identified and screened for suitability for Cytosponge, instead of endoscopy. Patients who were ineligible, or who declined Cytosponge, were sent for endoscopy. The remaining patients underwent a Cytosponge procedure as their primary Barrett's surveillance modality. Early clinical outcomes, patient satisfaction and cytology results were recorded. All patients have been followed up to determine if they have subsequently required endoscopy or had an early diagnosis of oesphago-gastric cancer. Results 193 patients (77%) were suitable for the Cytosponge test. 175 (90%) did not require endoscopy after Cytosponge. 18 patients (10%) had urgent endoscopy after Cytosponge; 9 patients had atypia on cytological analysis, 3 had aberrant p53 and 4 had dysplasia. Three patients had inadequate cytology. 2 of the patients with dysplasia had high-grade dysplasia confirmed on endoscopy; these were successfully treated with radiofrequency ablation. Median follow-up was 14 months (range, 10-22). No patients have been diagnosed with oesophago-gastric cancer so far; 8 patients (4%) were referred later for anaemia or weight loss. None of these patients had oesophago-gastric cancer. Conclusions These data suggest that Cytosponge can be a valuable first-line tool in surveillance of Barrett’s Oesophagus. Cytology results identified specific patients who required urgent endoscopy. No patients have had an early diagnosis of dysplasia or malignancy after a Cytosponge that was normal or showed intestinal metaplasia alone. Our findings suggest that Cytosponge should be integrated as an adjunct in Barrett’s surveillance, with clear benefits in safer and accurate monitoring of the condition without the risks of endoscopy.

1110 Terahertz spectroscopy: Pilot study of non-invasive early diagnosis of dysplasia and melanoma

1110 Terahertz spectroscopy: Pilot study of non-invasive early diagnosis of dysplasia and melanoma

Evaluation of role of cytodiagnostic techniques in detection of oral premalignant and malignant lesions: Study of 50 cases

Aims and Objectives: In this study, we studied cytomorphological features and determined the sensitivity and specificity of cytology specimens obtained with simple instruments like toothbrush (modified brush biopsy), wooden spatula and analyzed without computer-assisted analysis. Settings and Design: Fifty patients attending outpatient clinics who exhibited oral lesions suspicious of premalignancy or malignancy were enrolled. All patients underwent scrapping by wooden ice cream stick and an oral brush biopsy using a baby toothbrush. The specimens were analyzed manually in a double-blinded fashion. Histopathological confirmation by a scalpel biopsy was obtained whenever possible. Chi square test and Fischer exact 't' test was used for statistical analysis. Results: In our study, brush cytology was better (P < 0.05) than scrape cytology in the criteria of cellularity, abnormal cell group adequacy and detection of higher grade of dysplasia. Also, we found that increased N: C ratio, nuclear pleomorphism, nucleoli and presence of micronuclei were the parameters statistically significant in oral carcinoma as compared to high grade dysplasia. Sensitivity of detecting malignancy by cytodiagnosis was 76.47% and false negative rate of 23.53% was present in our study. Conclusions: Modified brush biopsy is relatively easy, non invasive, OPD procedure, particularly an effective tool for screening small innocuous lesions for dysplasia/ malignancy as each of their evaluation by cumbersome and painful scalpel biopsy procedure is often impractical. Early diagnosis of dysplasia/ malignancy helps patient to aim for curative treatment. Though cytomorphological difference between high grade dysplasia and carcinoma is not very distinct, certain features like high grade nuclear pleomorphism, presence of high frequency of micronuclei, tumor diathesis and bizarre shaped cells like tadpole, spindle shape etc. are the features which are more significantly associated with malignancy.

Skeletal dysplasias: A radiographic approach and review of common non-lethal skeletal dysplasias.

Skeletal dysplasias are not uncommon entities and a radiologist is likely to encounter a suspected case of dysplasia in his practice. The correct and early diagnosis of dysplasia is important for management of complications and for future genetic counselling. While there is an exhaustive classification system on dysplasias, it is important to be familiar with the radiological features of common dysplasias. In this article, we enumerate a radiographic approach to skeletal dysplasias, describe the essential as well as differentiating features of common non-lethal skeletal dysplasias and conclude by presenting working algorithms to either definitively diagnose a particular dysplasia or suggest the most likely differential diagnoses to the referring clinician and thus direct further workup of the patient.

Early diagnosis and treatment of DDH:a sonographic approach

This study reviews the data regarding clinical and ultrasound (US) examinations, collected during an 11-year period, in a DDH dedicated outpatient clinic. The material was analysed in order to verify the importance of US hip examination and Ortolani's test for early DDH diagnosis, to select dysplastic, unstable hips, to identify the role of the labrum in DDH, and to analyse the treatment strategy. Of the 21709 newborns (43418 hips) examined with US and Ortolani's manoeuvre for DDH diagnosis, 431 patients (356 F; 75 M; average age 42+/-33 days) had 574 unstable, dysplastic hips (1.32%). The hips identified according to Graf's classification were: 298 type D, 252 type IIIa, 4 type IIIb, 20 type IV. In 73.09% of the patients, no risk factors were identified; 18.56% had positive family history for DDH, 5.57% had breech presentation, 2.78% had both risk factors. Only 10.63% had a positive Ortolani's test. The diagnosis was made in 21.5% of cases by the 2nd week of life, in 52.9% between the 2nd-8th week, and in 25.5% after the 8th week. Unstable dislocated hips were treated, after reduction with or without sedation, by applying a cast; dysplastic hips were treated using a Gekeler splint. No open reductions or reconstruction surgery were needed. The labrum was always positioned on top of the femoral head, never inverted, and it was not an obstacle to closed reduction. Neither the Ortolani's sign, nor the risk factors are sure signs for the early diagnosis of DDH and its instability. Only US examination permits an early diagnosis of dysplasia and instability of the hip.

Early Diagnosis and Treatment of DDH: A Sonographic Approach

This study reviews the data regarding clinical and ultrasound (US) examinations, collected during an 11-year period, in a DDH dedicated outpatient clinic. The material was analysed in order to verify the importance of US hip examination and Ortolani's test for early DDH diagnosis, to select dysplastic, unstable hips, to identify the role of the labrum in DDH, and to analyse the treatment strategy Of the 21709 newborns (43418 hips) examined with US and Ortolani's manoeuvre for DDH diagnosis, 431 patients (356 F; 75 M; average age 42 ± 33 days) had 574 unstable, dysplastic hips (1.32%). The hips identified according to Grafs classification were: 298 type D, 252 type IIIa, 4 type IIIb, 20 type IV. In 73.09% of the patients, no risk factors were identified; 18.56% had positive family history for DDH, 5.57% had breech presentation, 2.78% had both risk factors. Only 10.63% had a positive Ortolani's test. The diagnosis was made in 21.5% of cases by the 2nd week of life, in 52.9% between the 2nd-8th week, and in 25.5% after the 8th week. Unstable dislocated hips were treated, after reduction with or without sedation, by applying a cast; dysplastic hips were treated using a Gekeler splint. No open reductions or reconstruction surgery were needed. The labrum was always positioned on top of the femoral head, never inverted, and it was not an obstacle to closed reduction. Neither the Ortolani's sign, nor the risk factors are sure signs for the early diagnosis of DDH and its instability. Only US examination permits an early diagnosis of dysplasia and instability of the hip.