Gold Standard Histology Research Articles

Comparative Evaluation of 29 Commercial Helicobacter pylori Serological Kits

Serology is a noninvasive diagnostic method for the detection of Helicobacter pylori infection. Many commercial kits are now on the market. It is necessary to assess their performances to help the user to choose the most appropriate. The performances of 29 commercial serological tests detecting antibodies to Helicobacter pylori (17 enzyme-linked immunosorbent assay and 12 near-patient tests) were evaluated using sera from 108 patients prospectively selected from gastroenterology departments of five French hospital centers. These patients were infected (45) or uninfected (47) by H.pylori, or had doubtful results (16), according to the gold standard (culture or histology plus rapid urease test or urea breath test). The tests were evaluated by determining the usual parameters of performance: sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Two analyzes were performed including or not the 16 patients with doubtful infection as uninfected or not analyzed. Depending on the type of analysis, four or two of the 17 enzyme-linked immunosorbent assay tests presented excellent results with the five performance parameters >90%. Calculation of the Youden index allowed to show significantly better performances for one of the 4. Performances of the 12 near-patient tests were lower with accuracies <90% for all except one test. These data should help the users to choose the kit the most appropriate to their goals.

Evaluation of a new fluorescence quantitative PCR test for diagnosing Helicobacter pylori infection in children

BackgroundNumerous diagnostic tests are available to detect Helicobactor pylori (H. pylori). There has been no single test available to detect H. pylori infection reliably. We evaluated the accuracy of a new fluorescence quantitative PCR (fqPCR) for H. pylori detection in children.MethodsGastric biopsy specimens from 138 children with gastritis were sent for routine histology exam, rapid urease test (RUT) and fqPCR. 13C-urea breath test (13C-UBT) was carried out prior to endoscopic procedure. Gastric fluids and dental plaques were also collected for fqPCR analysis.Results38 children (27.5%) were considered positive for H. pylori infection by gold standard (concordant positive results on 2 or more tests). The remaining 100 children (72.5%) were considered negative for H. pylori. Gastric mucosa fqPCR not only detected all 38 H. pylori positive patients but also detected 8 (8%) of the 100 gold standard-negative children or 11 (10.7%) of the 103 routine histology-negative samples. Therefore, gastric mucosa fqPCR identified 46 children (33.3%) with H. pylori infection, significantly higher than gold standard or routine histology (P<0.01). Both gastric fluid and dental plaque fqPCR only detected 32 (23.2%) and 30 (21.7%) children with H. pylori infection respectively and was significantly less sensitive than mucosa fqPCR (P<0.05) but was as sensitive as non-invasive UBT.ConclusionsGastric mucosa fqPCR was more sensitive than routine histology, RUT, 13C-UBT alone or in combination to detect H. pylori infection in children with chronic gastritis. Either gastric fluid or dental plaque PCR is as reliable as 13C-UBT for H. pylori detection.

Proximal caries detection accuracy using intraoral bitewing radiography, extraoral bitewing radiography and panoramic radiography

To compare proximal caries detection using intraoral bitewing, extraoral bitewing and panoramic radiography. 80 extracted human premolar and molar teeth with and without proximal caries were used. Intraoral radiographs were taken with Kodak Insight film (Eastman Kodak Co., Rochester, NY) using the bitewing technique. Extraoral bitewing and panoramic images were obtained using a Planmeca Promax Digital Panoramic X-ray unit (Planmeca Inc., Helsinki, Finland). Images were evaluated by three observers twice. In total, 160 proximal surfaces were assessed. Intra- and interobserver kappa coefficients were calculated. Scores obtained from the three techniques were compared with the histological gold standard using receiver operating characteristic analysis. Az values for each image type, observer and reading were compared using z-tests, with a significance level of α = 0.05. Kappa coefficients ranged from 0.883 to 0.963 for the intraoral bitewing, from 0.715 to 0.893 for the extraoral bitewing, and from 0.659 to 0.884 for the panoramic radiography. Interobserver agreements for the first and second readings for the intraoral bitewing images were between 0.717 and 0.780, the extraoral bitewing readings were between 0.569 and 0.707, and the panoramic images were between 0.477 and 0.740. The Az values for both readings of all three observers were highest for the intraoral bitewing. Az values for the extraoral bitewing images were higher than those of the panoramic images without statistical significance (p > 0.05). Intraoral bitewing radiography was superior to extraoral bitewing and panoramic radiography in diagnosing proximal caries of premolar and molar teeth ex vivo. Similar intra- and interobserver coefficients were calculated for extraoral bitewing and panoramic radiography.

Diagnostic accuracy of cyst fluid amphiregulin in pancreatic cysts

BackgroundAccurate tests to diagnose adenocarcinoma and high-grade dysplasia among mucinous pancreatic cysts are clinically needed. This study evaluated the diagnostic utility of amphiregulin (AREG) as a pancreatic cyst fluid biomarker to differentiate non-mucinous, benign mucinous, and malignant mucinous cysts.MethodsA single-center retrospective study to evaluate AREG levels in pancreatic cyst fluid by ELISA from 33 patients with a histological gold standard was performed.ResultsAmong the cyst fluid samples, the median (IQR) AREG levels for non-mucinous (n = 6), benign mucinous (n = 15), and cancerous cysts (n = 15) were 85 pg/ml (47-168), 63 pg/ml (30-847), and 986 pg/ml (417-3160), respectively. A significant difference between benign mucinous and malignant mucinous cysts was observed (p = 0.025). AREG levels greater than 300 pg/ml possessed a diagnostic accuracy for cancer or high-grade dysplasia of 78% (sensitivity 83%, specificity 73%).ConclusionCyst fluid AREG levels are significantly higher in cancerous and high-grade dysplastic cysts compared to benign mucinous cysts. Thus AREG exhibits potential clinical utility in the evaluation of pancreatic cysts.

A Histological and Clinical Comparison of New and Conventional Integrated Backscatter Intravascular Ultrasound (IB-IVUS)

While the utilization of integrated backscatter intravascular ultrasound (IB-IVUS) for the quantitative in vivo assessment of coronary plaque continues to grow, the validity of IB-IVUS images obtained from newly developed and conventional systems remains uncertain. To assess the accuracy and reliability of a newly developed IB-IVUS system (VISIWAVE) as compared to the conventional system (Clearview), we compared quantitative IB-IVUS plaque characteristics in the 2 systems using 125 post-mortem specimens from 26 coronary arteries in 11 cadavers, as well as using 200 clinical plaques in 32 patients undergoing coronary intervention. The overall agreement between the histological and IB-IVUS diagnoses using VISIWAVE (Cohen's κ=0.82, 95%CI: 0.73-0.90) was similar to that using Clearview (Cohen's κ=0.80, 95%CI: 0.71-0.89). The 2 systems also demonstrated comparably high sensitivity and specificity. In the direct comparison, the overall agreement between IB-IVUS diagnoses using VISIWAVE and Clearview was also excellent (Cohen's κ=0.87, 95%CI: 0.78-0.95). In the clinical comparison, measured plaque dimensions were similar (VISIWAVE: 8.27±3.46 mm(2) vs. Clearview; 8.31±3.46 mm(2), P=0.44) and there was strong concordance between both greyscale and IB-IVUS parameters. There was close agreement of analyzed results in both systems when compared with the gold standard of histology. Both systems are able to reliably and accurately characterize coronary plaque and thereby make a valuable contribution to our understanding of atherosclerosis.

Letter by Knight et al Regarding Article, “Validation of In Vivo Magnetic Resonance Imaging Blood–Brain Barrier Permeability Measurements by Comparison With Gold Standard Histology”

To the Editor: We read with great interest the recent paper by Hoffmann et al1 on the validation of magnetic resonance imaging (MRI) measurements of blood-brain barrier (BBB) permeability. The authors reported that they measured changes in BBB permeability in rodent models of focal cerebral ischemia using MRI methods in conjunction with a Gd-based MRI contrast agent; they then validated these measures by comparing them with Cresyl violet histology and Evans Blue extravasation. The MRI-based estimates of vascular leakage were obtained using the Patlak graphical method to calculate the blood-to-brain transfer constant (Ki). In recent years, there has been a great deal of interest in the development of noninvasive imaging techniques capable of accurately measuring changes in acute BBB permeability after stroke to predict probability …

Detection of a Fatty Liver After Binge Drinking: Correlation of MR-spectroscopy, DECT, Biochemistry and Histology in a Rat Model

The purpose of this study was to evaluate the possibility of detecting a fatty liver after binge drinking in an animal model using (1)H magnetic resonance spectroscopy ((1)H-MRS), dual-energy computed tomography (DECT), biochemistry, and the gold standard of histology. In 20 inbred female Lewis rats, an alcoholic fatty liver was induced; 20 rats served as controls. To simulate binge drinking, each rat was given a dose of 9.3 g/kg body weight 50% ethanol twice, with 24 hours between applications. Forty-eight hours after the first injection, DECT and (1)H-MRS were performed. Fat content as well as triglycerides were also determined histologically and biochemically, respectively. To assess specific liver enzymes, blood was drawn from the orbital venous plexus. In all 20 animals in the experimental group, fatty livers were detected using (1)H-MRS, DECT, and biochemical and histologic analysis. The spectroscopic fat/water ratio and the biochemical determination were highly correlated (r = 0.892, P < .05). A significant correlation was found between (1)H-MRS and histologic analysis (r = 0.941, P < .001). Also, a positive linear correlation was found between the dual-energy computed tomographic density of ΔHU and the biochemical (r = 0.751, P < .05) and histologic (r = 0.786, P < .001) analyses. Quantification of hepatic fat content on (1)H-MRS showed high correlation with histologic and biochemical steatosis determination. In comparison to DECT, it is more suitable to reflect the severity of acute fatty liver.

Validation of In Vivo Magnetic Resonance Imaging Blood–Brain Barrier Permeability Measurements by Comparison With Gold Standard Histology

We sought to validate the blood-brain barrier permeability measurements extracted from perfusion-weighted MRI through a relatively simple and frequently applied model, the Patlak model, by comparison with gold standard histology in a rat model of ischemic stroke. Eleven spontaneously hypertensive rats and 11 Wistar rats with unilateral 2-hour filament occlusion of the right middle cerebral artery underwent imaging during occlusion at 4 hours and 24 hours after reperfusion. Blood-brain barrier permeability was imaged by gradient echo imaging after the first pass of the contrast agent bolus and quantified by a Patlak analysis. Blood-brain barrier permeability was shown on histology by the extravasation of Evans blue on fluorescence microscopy sections matching location and orientation of MR images. Cresyl-violet staining was used to detect and characterize hemorrhage. Landmark-based elastic image registration allowed a region-by-region comparison of permeability imaging at 24 hours with Evans blue extravasation and hemorrhage as detected on histological slides obtained immediately after the 24-hour image set. Permeability values in the nonischemic tissue (marginal mean ± SE: 0.15 ± 0.019 mL/min 100 g) were significantly lower compared to all permeability values in regions of Evans blue extravasation or hemorrhage. Permeability values in regions of weak Evans blue extravasation (0.23 ± 0.016 mL/min 100 g) were significantly lower compared to permeability values of in regions of strong Evans blue extravasation (0.29 ± 0.020 mL/min 100 g) and macroscopic hemorrhage (0.35 ± 0.049 mL/min 100 g). Permeability values in regions of microscopic hemorrhage (0.26 ± 0.024 mL/min 100 g) only differed significantly from values in regions of nonischemic tissue (0.15 ± 0.019 mL/min 100 g). Areas of increased permeability measured in vivo by imaging coincide with blood-brain barrier disruption and hemorrhage observed on gold standard histology.

In situ imaging of lung alveoli with an optical coherence tomography needle probe

In situ imaging of alveoli and the smaller airways with optical coherence tomography (OCT) has significant potential in the assessment of lung disease. We present a minimally invasive imaging technique utilizing an OCT needle probe. The side-facing needle probe comprises miniaturized focusing optics consisting of no-core and GRIN fiber encased within a 23-gauge needle. 3D-OCT volumetric data sets were acquired by rotating and retracting the probe during imaging. The probe was used to image an intact, fresh (not fixed) sheep lung filled with normal saline, and the results validated against a histological gold standard. We present the first published images of alveoli acquired with an OCT needle probe and demonstrate the potential of this technique to visualize other anatomical features such as bifurcations of the bronchioles.

Relative efficacy of different MRI signs in diagnosing active Crohn's disease, compared against a histological gold standard

There has been growing interest in the use of MRI in assessing Crohn's disease because of its lack of ionising radiation. Many MRI signs have been described in the literature, but their relative utility is unknown. The MRIs of the bowel performed at 1.5 Tesla were blindly reviewed on 26 patients with recent histology (surgery and/or colonoscopy and their associated reports) according to a dedicated pro forma. Each patient's bowel was divided into nine segments. Each segment was assessed as to the presence or absence of 15 MRI signs described in the literature: abnormal gadolinium enhancement (both subjective and objective), wall oedema, fat oedema, fat proliferation, nodal enlargement, free fluid, wall nodularity, serosal blurring, mural thickening >4 mm, stricture, multi-segmental disease, fistula, abscess and layered contrast enhancement. The results were compared against a histological gold standard with a six-point scale of disease severity. MRI correctly identified all 15 patients with at least established mucosal disease, and three of eight with only mild mucosal disease. Combining these results, a positive MRI correlated highly with at least early mucosal disease (positive predictive value 95%), while the presence of established mucosal disease was unlikely if MRI was negative (negative predictive value 100%). The MRI signs found to be the most sensitive for detecting active Crohn's disease were those related to the bowel wall, namely, wall thickening, nodularity, contrast enhancement and oedema. The most specific signs were the presence of multi-segmental disease, layered contrast enhancement and complications (fistula and abscess).

Sensitivity and specificity of the human papillomavirus identification test

When the sensitivity of a test such as the Pap smear is determined, both positive and negative results should be submitted to the gold standard of histology. If this is not done, the sensitivity will be unrealistically high. The human papillomavirus (HPV) test has not been adequately investigated in this way. In this letter I report a preliminary study in which the HPV test was evaluated against histology in all cases.

Diagnostic accuracy of different imaging modalities in detection of proximal caries

The purpose of this study was to assess the in vitro diagnostic ability of visual inspection, film, charge-coupled device (CCD) sensor, photostimulable phosphor (PSP) sensor and cone beam CT in the detection of proximal caries in posterior teeth compared with the histological gold standard. Visual inspection, film, CCD, PSP and cone beam CT images were used to detect proximal caries in the mesial and distal surfaces of 138 teeth (276 surfaces). Visual inspection and evaluation of all intraoral digital and conventional radiographs and cone beam CT images were performed twice by three oral radiologists. Weighted kappa coefficients were calculated to assess intra- and interobserver agreement for each image set, and scores were compared with the histological gold standard using receiver operating characteristic (ROC) analysis to evaluate diagnostic ability. Intraobserver kappa coefficients calculated for each observer for each method of detecting caries ranged from 0.739 to 0.928. Strong interobserver agreement ranging from 0.631 to 0.811 was found for all detection methods. The highest Az values for all three observers were obtained with the cone beam CT images; however, differences between detection methods were not statistically significant (P > 0.05). Visual inspection, film, CCD, PSP plates and cone beam CT performed similarly in the detection of proximal caries.

Endoscopic Ultrasound, Secretin Endoscopic Pancreatic Function Test, and Histology: Correlation in Chronic Pancreatitis

Endoscopic ultrasound (EUS) and hormone-stimulated pancreatic function tests are considered useful, and possibly complementary, in the diagnosis of early chronic pancreatitis (CP). Few past studies have compared either methods with a histological gold standard. The aims were to assess correlations of EUS score and endoscopic pancreatic function test (ePFT) results with the degree of histological fibrosis, as well as the sensitivity of each method for detecting fibrosis. This was a retrospective study of patients who underwent EUS, ePFT, or both within 12 months of pancreatic resection or wedge biopsy. EUS scoring was performed using 9 standard criteria, with ≥4 considered abnormal. An ePFT peak bicarbonate concentration <80 mM was considered abnormal. Surgical specimens were reviewed in a blinded manner by an expert pancreatic pathologist and assigned a fibrosis score from 0 to 12. Correlations of the EUS score and ePFT peak bicarbonate with the fibrosis score are reported using the Spearman correlation coefficient. Sensitivity and specificity was calculated for each method against the histological gold standard (fibrosis score ≥2). Twenty-five patients were included. The fibrosis score significantly correlated with the EUS score (r=0.72; 95% confidence interval (CI)=0.43, 0.87; P<0.001) and the ePFT peak bicarbonate (r=-0.57; 95% CI=-0.81, -0.10; P=0.016). EUS had a sensitivity of 84% (95% CI=69, 100) and specificity of 100% (95% CI=40, 100) compared with histology. The ePFT had a sensitivity of 86% (95% CI=67, 100) and specificity of 67% (95% CI=13, 100). When both modalities were combined, the sensitivity increased to 100% (95% CI=63, 100). Both EUS and ePFT are useful tests in the diagnosis of CP. Combining EUS with ePFT may improve the sensitivity for detection of early fibrosis.

18F-FDG PET/CT in the characterization and surgical decision concerning adrenal masses: a prospective multicentre evaluation

This prospective multicentre study assesses the usefulness of FDG PET/CT in characterizing and making the therapeutic decision concerning adrenal tumours that are suspicious or indeterminate in nature after conventional examinations (CE). Seventy-eight patients (37 men, 41 women, 81 adrenal lesions) underwent FDG PET/CT after CE including CT scan, biological tests and optionally (131)I-metaiodobenzylguanidine (MIBG) and/or (131)I-norcholesterol scans. FDG adrenal uptake exceeding that of the liver was considered positive. PET results were not decisive. Surgery was discussed when at least one of the following criteria was found during CE: size >3 cm, spontaneous attenuation value >10 HU, heterogeneous aspect, abnormal MIBG or norcholesterol scan or hormonal hypersecretion. Following the gold standard (histology analysis or >or=9 months follow-up), 49 lesions potentially qualified for surgery (malignant = 27, benign secreting = 22) and 32 benign non-secreting lesions did not. PET was negative in 97% of non-surgical lesions and positive in 73% of potentially surgical ones which included all the malignant lesions, except 3 renal cell metastases, and 12 of 22 benign secreting lesions. The negative predictive value for malignancy was 93% (41/44) and positive predictive value for detecting surgical lesions was 97% (36/37). A high FDG uptake (maximum standardized uptake value >or= 10) was highly predictive of malignancy. Adrenal FDG uptake is a good indicator of malignancy and/or of secreting lesions and should lead one to discuss surgery. If there is no prior history of poorly FDG-avid cancer, the absence of FDG uptake should avoid unnecessary removal of benign adrenal lesions.

Validation of a Monoclonal Stool Antigen Test for Diagnosing Helicobacter pylori Infection in Young Children

The monoclonal stool antigen test for diagnosing Helicobacter pylori infection in children has been tested in developed countries, showing sensitivity and specificity higher than 90%. However, its accuracy in young children from developing countries is not well established. The aim of the study was to determine the accuracy of the monoclonal stool antigen test for diagnosing H pylori infection in children up to 7 years old. Two hundred seventy-six patients (53.6% female; ages 0.35-6.99 years) were evaluated. Gold standard positive culture or positive histology and rapid urease tests were performed. The test (Amplified IDEIATM Hp StAR) was done according to the manufacturer's instructions. Results were expressed as optical density (OD) and an OD more than or equal to 0.190 was considered positive. Additionally, a receiver operating characteristic curve was used to find the best cutoff. The monoclonal stool antigen test for diagnosing H pylori infection showed 100% sensitivity (95% confidence interval [CI] 92.7%-100%) and 76.2% specificity (95% CI 70.1%-81.4%), considering the manufacturer's cutoff. After setting a new cutoff with the receiver operating characteristic curve (OD = 0.400), sensitivity remained 100% (95% CI 92.7%-100%), but the specificity improved to 97.7% (95% CI 94.7%-99%). At ages up to 2 years, sensitivity was 100% (95% CI 43.8%-100%) and specificity was 100% (95% CI 92.4%-100%); at ages 2 to 4 years, 100% (95% CI 80.6%-100%) and 97.6% (95% CI 96%-99.2%); at ages older than 4 years, 100% (95% CI 88.6%-100%) and 96.6% (95% CI 94.7%-98%), respectively. The monoclonal stool antigen test is accurate for diagnosing H pylori in children younger than 7 years old, but it must be locally validated in order to find the best cutoff for each population.

Computer-aided classification of colorectal polyps based on vascular patterns: a pilot study

Recent studies have shown that narrow-band imaging (NBI) is a powerful diagnostic tool for differentiating between neoplastic and nonneoplastic colorectal polyps. The aim of the present study was to develop and evaluate a computer-based method for automated classification of colorectal polyps on the basis of vascularization features. In a prospective pilot study with 128 patients who were undergoing zoom NBI colonoscopy, 209 detected polyps were visualized and subsequently removed for histological analysis. The proposed computer-based method consists of image preprocessing, vessel segmentation, feature extraction, and classification. The results of the automated classification were compared to those of human observers blinded to the histological gold standard. Consensus decision between the human observers resulted in a sensitivity of 93.8 % and a specificity of 85.7 %. A "safe" decision, i. e., classifying polyps as neoplastic in cases when there was interobserver discrepancy, yielded a sensitivity of 96.9 % and a specificity of 71.4 %. The overall correct classification rates were 91.9 % for the consensus decision and 90.9 % for the safe decision. With ideal settings the computer-based approach achieved a sensitivity of approximately 90 % and a specificity of approximately 70 %, while the overall correct classification rate was 85.3 %. The computer-based classification showed a specificity of 61.2 % when a sensitivity of 93.8 % was selected, and a 53.1 % specificity with a sensitivity of 96.9 %. Automated classification of colonic polyps on the basis of NBI vascularization features is feasible, but classification by observers is still superior. Further research is needed to clarify whether the performance of the automated classification system can be improved.

How reliable are 40 MHz IVUS and 64-slice MDCT in characterizing coronary plaque composition? An ex vivo study with histopathological comparison

The present study investigated whether IVUS could serve as a reliable reference in validating MDCT characterization of coronary plaque against a histological gold standard. Twenty-one specimens were postmortem human coronary arteries. Coronary cross-sections were imaged by 40 MHz IVUS and by 64-slice MDCT and characterized histologically as presenting calcified, fibrous or lipid-rich plaques. Plaque composition was analyzed visually and intra-plaque MDCT attenuation was measured in Hounsfield Units (HU). 83 atherosclerotic plaques were identified. IVUS failed to characterize calcified plaque accurately, with a positive predictive value (ppv) of 75% versus 100% for MDCT. Lipid-rich plaque was even less accurately characterized, with ppv of 60 and 68% for IVUS and MDCT respectively. Mean MDCT attenuation was 966 +/- 473 HU for calcified plaque, 83 +/- 35 HU for fibrous plaque and 70.92 HU +/- 41 HU for lipid-rich plaque. No significant difference in mean MDCT attenuation was found between fibrous and lipid-rich plaques (P = 0.276). In vivo validation of MDCT against an IVUS reference thus appears to be an unsuitable and unreliable approach: 40 MHz IVUS suffers from acoustic ambiguities in plaque characterization, and 64-slice MDCT fails to analyze plaque morphology and components accurately.

Comparison of Current EUS Criteria to the Proposed “Rosemont Criteria” in Patients with An Established Diagnosis of Chronic Pancreatitis

Introduction: EUS has been proposed as the most accurate test to diagnose CP, and ≥4 criteria are accepted as diagnostic. This assigns equal importance to all endoscopic changes. The Rosemont criteria were proposed to be a more reliable grading system for CP. Aim: Compare the previous EUS criteria and the newly proposed Rosemont criteria in patients with established CP. Methods: The endoscopy database was searched from 2006 to 2008 for patients with an established diagnosis of CP who had a EUS. The current EUS criteria were: parenchymal lobularity, hyperechoic foci, hyperechoic strands, cysts, main pancreas duct (MPD) dilatation, MPR irregularity, hyperechoic duct walls, visible side branches and calcifications. More than 4 of these criteria were considered diagnostic for CP. The Rosemont criteria were: Major A: hyperechoic foci with shadowing or MPD calculi; Major B: lobularity with honeycombing; Minor: cysts, dilated duct >3.5 mm, irregular PD contour, dilated side branches > 1 mm, hyperechoic duct wall, strands, non-shadowing hyperechoic foci, lobularity with non-contiguous lobules and where categorized as most consistent, suggestive, or indeterminate for chronic pancreatitis. The diagnosis of CP was established by combining clinical criteria (exocrine and/or endocrine insufficiency), with imaging (CT and/or MRI in all), ERCP (Cambridge III or IV in 6), and histology (pancreatectomy 1, tail resection 1, Beger resection 2, Whipple resection 3). Results: We evaluated 23 patients (M=17, F=6) with a mean age of 51.3 years. The etiology of CP was idiopathic (11), alcohol (10), hypertriglyceridemia (2). Seventeen patients had ≥ 4 current EUS criteria, and 18/23 fulfilled major Rosemont criteria for CP. The sensitivity of the current EUS criteria was 79%, and 82% using Rosemont criteria. PPV was 74% and 78%, respectively. In patients with histologically confirmed CP (n=7) the sensitivity of EUS was 88% for current and 100% for Rosemont criteria, respectively. The PPV was 86% for current criteria and 100% for Rosemont criteria. Conclusions: The diagnosis of CP is difficult to establish and the actual performance of diagnostic tests is speculative because tissue is usually not obtained. In an attempt to normalize EUS criteria for CP the Rosemont criteria establish more restrictive parameters for the diagnosis of CP. In a group of patients with established CP the current EUS criteria and the newly proposed Rosemont criteria were equally efficacious at establishing the diagnosis of CP. Overall sensitivity increased for both when compared to the gold standard of histology. Performance of the criteria in patients with less severe disease needs to be studied.

Comparison of diagnostic accuracy of transvaginal ultrasound with laparoscopy in the management of patients with adnexal masses

PurposeThe aims of this study was (a) to compare the diagnostic accuracy of ultrasound examination with laparoscopic findings and both with the gold standard (histology) in the management of benign ovarian lesions, and (b) to assess the feasibility of laparoscopy in their diagnosis and management.MethodsProspective, comparative study (Canadian Task Force Classification II-2). A total of 117 women 15–59 years old were examined at outpatient department and had transvaginal ultrasound assessment. Ninety-eight women (three postmenopausal) with 105 cystic ovarian lesions met inclusion criteria and underwent operative laparoscopy. Histology was performed in all cases.ResultsAlthough laparoscopy showed an overall higher performance compared to transvaginal ultrasound, statistically significant difference was found only in the detection of endometriomas compared to ultrasound (P = 0.004 for sensitivity and P = 0.046 for specificity).ConclusionLaparoscopy exhibits higher diagnostic accuracy, especially in endometriomas, compared to transvaginal scan. Laparoscopic diagnosis appears to be safe and accurate. Conservative laparoscopic management of benign adnexal masses is safe and with low morbidity.

Comparison of validity of DIAGNOdent with conventional methods for detection of occlusal caries in primary molars using the histological gold standard: An in vivo study

This study was conducted to compare the in vivo effectiveness of DIAGNOdent with other conventional methods (visual, tactile and bitewing radiographs) for the detection of occlusal caries in primary molars. Another objective of the study was to calculate new cut-off limits for the detection of caries by DIAGNOdent in primary teeth. Eighty-four primary molars in 52 children (aged 8-12 years), which were indicated for extraction, were selected and evaluated for dental caries using DIAGNOdent, visual and tactile examination and bitewing radiographs. Histological examination of the sections, prepared subsequent to extraction of the teeth, served as the gold standard for comparison of the above-mentioned methods. When considering enamel caries, values obtained for sensitivity, specificity and accuracy were 48.15, 100 and 49.40% for visual examination, 48.15, 100.00 and 49.40% for tactile examination, 49.38, 50.00 and 49.40% for bitewing radiographs, 85.19, 50.00 and 84.34% for DIAGNOdent scores interpreted according to manufacturer's cut-off limits and 81.48, 100.00 and 81.93% for DIAGNOdent scores interpreted according to newly formulated cut-off limits, respectively. At dentin caries cut-off levels, the values of sensitivity, specificity and accuracy for visual examination were 52.78, 89.36 and 73.49%; 50.00, 91.49 and 73.49% for tactile examination; 30.56, 82.98 and 60.24% for bitewing radiographs; 72.22, 76.60 and 74.70% for DIAGNOdent scores when interpreted according to manufacturer's cut-off limits and 77.48, 74.47 and 75.90%, respectively, for the DIAGNOdent scores when interpreted according to the newly formulated cut-off limits. DIAGNOdent showed higher sensitivity and accuracy as compared with other conventional methods for detection of enamel caries, whereas for detection of dentinal caries, even though the sensitivity was high, accuracy of the DIAGNOdent device was similar to other conventional caries diagnostic methods.