Invasive Diagnostic Procedures Research Articles

Diagnostic yield of bone marrow aspiration in paediatric primary immune thrombocytopenia: impact of evolution and adherence to medical guidelines over the last 25years.

BMA at presentation did not significantly alter the diagnosis in our cohort of patients with an initial suspicion of ITP, although the procedure was decisive in diagnosing 2 cases of acquired aplastic anaemia during the subsequent course of the disease. Regarding the number of aspirations performed, our findings show that increased physician compliance with current guidelines reduced the rate of unnecessary BMAs. • BMA is a supplementary test for the diagnosis of ITP. • The usefulness of this invasive diagnostic procedure is not clearly stated in current guidelines. • Adjustments to scientific guidelines have led to a reduction in the number of BMAs performed on our patients with suspected ITP in the last 27years. • While the risks and benefits of BMA at the time of diagnosis are unclear in patients with suspected ITP, the procedure does not contribute significant information to support the diagnosis.

STUDY OF PHYSIOLOGICAL AND BIOCHEMICAL VARIATIONS IN POPULATION GROUPS UNDERGOING ACUTE OR CHRONIC STRESS

Objective: Stress arises from derangements of personal and professional activities. The basic reason is changes in lifestyle and psychosocial adaptations. Life becomes demanding, complicated, mechanical, and devoid of health. In today’s modern world, occupational stress has become the major factor for loss of health and peacefulness of mind. Methods: This is an observational descriptive study which was conducted in a group of 84 people between 25 and 60 years of age to study the association of acute stress on salivary amylase level and effect of chronic stress on lipid profile, glycosylated hemoglobin and certain inflammatory markers in people representing different forms of stress. Three groups of the population were studied. Group 1 (n=20) - Patients undergoing any elective surgery (abdominal/genitourinary) or an invasive diagnostic procedure (upper GI endoscopy, lymph node biopsy) Group 2 (n=32) – High/middle socio-economic male or female working for ≥8 h/day with or without stress. Group 3 (n=32) – Low socioeconomic male or female earning <100 Rs/day with or without stress. Salivary alpha-amylase and chromogranin A (CgA) levels are good markers of stress. Results: There was increased levels of cortisol (p<0.0001), alpha amylase (p<0.01), and decreased levels of CgA (p<0.001) pre-procedure period as a marker of acute stress. In the chronic stress group of low income as well as high-income status, glycosylated hemoglobin, and blood lipid profile in both males and females were significantly deranged. Plasma malondialdehyde (MDA) levels and interleukin (IL)-1 and IL-2 were significantly raised in both groups. Serum ferritin level was low in the low socioeconomic group but normal in the high socioeconomic group. Conclusion: Salivary amylase level was raised in acute stress and there is a direct correlation of chronic stress with high low-density lipoprotein/ high-density lipoprotein ratio, raised glycosylated Hemoglobin, serum MDA, IL-1, 2 levels irrespective of economic group.

Diagnostic value of microbial cell-free DNA sequencing for suspected invasive fungal infections: a retrospective multicenter cohort study

Abstract Background An early diagnosis and treatment of invasive fungal disease(IFD) is associated with improved outcome, but the moderate sensitivity of non-invasive diagnostic tests makes this challenging. Invasive diagnostic procedures like bronchoalveolar lavage(BAL) have a higher yield but are not without risk. The detection and sequencing of microbial cell-free DNA(mcfDNA) may facilitate a non-invasive diagnosis. Materials In a prospective observational study, we collected plasma in the 120 hours preceding or following a BAL in patients with hematological malignancies suspected for a pulmonary IFD. The EORTC/MSGERC2020 criteria were used for IFD classification. Sequencing was performed by Karius(Redwood City, California) using their Karius Test® (KT) on plasma and a ‘research use only test'(RUO-KT) on BAL fluid if available. Cases with a probable/proven IFD were identified based on standard diagnostic tests on serum and BAL (microscopy, PCR, GM, culture) and used to calculate the sensitivity, specificity and additional diagnostic value of the KT. Results Of 106 patients enrolled, 39 (37%) had a proven/probable invasive aspergillosis (IA), 7 (7%) a non-Aspergillus IFD and 4 (4%) a mixed IFD. The KT detected fungal mcfDNA in 29 (28%) patients. Compared with usual diagnostic tests, the sensitivity and specificity were 44.0%(95%CI:31.2–57.7%) and 96.6%(95%CI:88.5–99.1%). Sensitivity of the KT was higher in non-Aspergillus IFD (Mucorales:2/3, Pneumocystis jirovecii:3/5). On BAL, the sensitivity was 72.2% (95%CI:62.1–96.3%) and specificity 83.3%(95%CI:49.1–87.5%). Conclusions Sequencing of mcfDNA may facilitate a non-invasive diagnosis of IFD in particular non-Aspergillus IFD. However, on plasma and similar to currently available diagnostics, it cannot be used as a “rule-out” test.

Artificial intelligence- image learning and its applications in neurooncology: a review.

Image learning involves using artificial intelligence (AI) to analyse radiological images. Various machine and deeplearning- based techniques have been employed to process images and extract relevant features. These can later be used to detect tumours early and predict their survival based on their grading and classification. Radiomics is now also used to predict genetic mutations and differentiate between tumour progression and treatment-related side effects. These were once completely dependent on invasive procedures like biopsy and histopathology. The use and feasibility of these techniques are now widely being explored in neurooncology to devise more accurate management plans and limit morbidity and mortality. Hence, the future of oncology lies in the exploration of AI-based image learning techniques, which can be applied to formulate management plans based on less invasive diagnostic techniques, earlier detection of tumours, and prediction of prognosis based on radiomic features. In this review, we discuss some of these applications of image learning in current medical dynamics.

Role of nuclear medicine assessing patients with suspected coronary artery disease

Nuclear medicine is a critical component in the field of cardiology as it provides diagnostic and prognostic insights that are essential for the effective management of heart disease. Both single photon emission computed tomography (SPECT) and positron emission tomography (PET) play a significant role in assessing the likelihood of ischemic heart disease based on pre-test probabilities. Both SPECT and PET should be integrated into the clinical pathway according to the patient’s individual risk profile, symptoms, and initial test results. The guidelines recommend using these imaging modalities to refine risk stratification, particularly in intermediate-risk patients, and to guide further invasive diagnostic or therapeutic procedures based on the imaging findings.

Physical examination, magnetic resonance imaging and the arthroscopy of the shoulder: a correlation of diagnostic tests

Background: Shoulder pathology is the third cause of consultation for musculoskeletal disorders; it is a cause of disability and economic losses. The gold standard for its diagnosis and treatment is arthroscopy. However, arthroscopy is an invasive diagnostic technique. Therefore, clinical and imaging methods may be useful as diagnostic techniques before considering arthroscopy. Nevertheless, these non-surgical diagnostic methods may present a poor correlation in diagnostic accuracy when compared to the arthroscopic diagnostic method in the context of shoulder pathology. Methods: A retrospective study including 123 patients who presented shoulder complains, underwent physical examination and a shoulder magnetic resonance imaging (MRI) study prior to a shoulder arthroscopy. A clinical correlation was made using the kappa index, sensitivity and specificity of the clinical and imaging tests were also calculated. Results: The correlation between arthroscopy and the clinical assessment showed a kappa index of 0.25 for rotator cuff injuries, 0.41 biceps pathology, 0.51 sub acromial impingement, 0.51 acromioclavicular arthrosis, 0.28 for SLAP injury. MRI diagnostic method showed a kappa correlation of 0.24 for rotator cuff injuries, 0.59 biceps pathology, 0.39 sub acromial impingement, 0.46 acromioclavicular arthrosis and 0.34 for superior labral anterior posterior (SLAP) injury. Conclusions: After comparing arthroscopy with clinical assessment and the MRI diagnostic method we found that clinical assessment is useful to diagnose biceps pathologies, subacromial impingement, and acromioclavicular arthrosis. On the other hand, MRI studies and diagnosis made by a radiologist showed to be a valuable tool for the diagnosis of biceps pathology and acromioclavicular arthrosis.

Serum Amyloid A as a non-invasive predictive biomarker of mucosal healing in ulcerative colitis patients

Ulcerative colitis is a chronic immune-mediated inflammatory condition of large intestine that is frequently associated with inflammation of the rectum but often extends proximally to involve other areas of the colon. The ultimate target of therapy is complete healing in the form of clinical remission, complete endoscopic and histological healing, and transmural healing for which endoscopy is mandatory. Colonoscopy may not always be applicable due to possible complications in active ulcerative colitis. Therefore, non-invasive biomarkers are needed to avoid the disadvantageous complications of invasive diagnostic procedures. The aim of this study was to evaluate the role of serum Amyloid-A (SAA) as a non-invasive predictive biomarker of mucosal healing in comparison to different laboratory biomarkers, and endoscopic activity scores. The study included 100 ulcerative colitis patients classified into two groups: 50 patients in clinical, and biochemical remission and 50 patients in activity. Complete blood picture, C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, and SAA were measured and recorded, colonoscopies with histopathological examination were done for all patients. SAA levels were significantly higher in patients with active ulcerative colitis than in clinical remission patients (p <0.001). In clinical, remission patients without full mucosal healing, SAA was positively correlated with endoscopic disease activity represented with Mayo score, Mayo endoscopic sub-score and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) (p< 0.001). However, there was no significant correlation between SAA and endoscopic scores among the activity patients’ group. The cut off value of SAA for determining disease activity was > 5.199 µg/ml with 100 % sensitivity, specificity of 92 %, and accuracy of 99.6%. In conclusion, SAA can be used for prediction of mucosal healing in ulcerative colitis remission patients despite not being superior to fecal calprotectin. However, it was unable to differentiate between the different disease activities or extents.

SPR and Double Resonance LPG Biosensors for Helicobacter pylori BabA Antigen Detection.

Given the medical and social significance of Helicobacter pylori infection, timely and reliable diagnosis of the disease is required. The traditional invasive and non-invasive conventional diagnostic techniques have several limitations. Recently, opportunities for new diagnostic methods have appeared based on the recent advance in the study of H. pylori outer membrane proteins and their identified receptors. In the present study we assess the way in which outer membrane protein-cell receptor reactions are applicable in establishing a reliable diagnosis. Herein, as well as in other previous studies of ours, we explore the reliability of the binding reaction between the best characterized H. pylori adhesin BabA and its receptor, the blood antigen Leb. For the purpose we developed surface plasmon resonance (SPR) and double resonance long period grating (DR LPG) biosensors based on the BabA-Leb binding reaction for diagnosing H. pylori infection. In SPR detection, the sensitivity was estimated at 3000 CFU/mL-a much higher sensitivity than that of the RUT test. The DR LPG biosensor proved to be superior in terms of accuracy and sensitivity-concentrations as low as 102 CFU/mL were detected.

Head and neck cancer of unknown primary: unveiling primary tumor sites through machine learning on DNA methylation profiles

BackgroundThe unknown tissue of origin in head and neck cancer of unknown primary (hnCUP) leads to invasive diagnostic procedures and unspecific and potentially inefficient treatment options for patients. The most common histologic subtype, squamous cell carcinoma, can stem from various tumor primary sites, including the oral cavity, oropharynx, larynx, head and neck skin, lungs, and esophagus. DNA methylation profiles are highly tissue-specific and have been successfully used to classify tissue origin. We therefore developed a support vector machine (SVM) classifier trained with publicly available DNA methylation profiles of commonly cervically metastasizing squamous cell carcinomas (n = 1103) in order to identify the primary tissue of origin of our own cohort of squamous cell hnCUP patient’s samples (n = 28). Methylation analysis was performed with Infinium MethylationEPIC v1.0 BeadChip by Illumina.ResultsThe SVM algorithm achieved the highest overall accuracy of tested classifiers, with 87%. Squamous cell hnCUP samples on DNA methylation level resembled squamous cell carcinomas commonly metastasizing into cervical lymph nodes. The most frequently predicted cancer localization was the oral cavity in 11 cases (39%), followed by the oropharynx and larynx (both 7, 25%), skin (2, 7%), and esophagus (1, 4%). These frequencies concord with the expected distribution of lymph node metastases in epidemiological studies.ConclusionsOn DNA methylation level, hnCUP is comparable to primary tumor tissue cancer types that commonly metastasize to cervical lymph nodes. Our SVM-based classifier can accurately predict these cancers’ tissues of origin and could significantly reduce the invasiveness of hnCUP diagnostics and enable a more precise therapy after clinical validation.

Abstract 4906: Biopsy free virtual histology to discriminate benign from malignant squamous neoplasms

Abstract Reflectance confocal microscopy (RCM) is a noninvasive optical imaging modality that allows for cellular-level resolution, in vivo images of skin without performing a traditional skin biopsy. RCM image interpretation currently requires specialized training to interpret the grayscale output images that are difficult to correlate with tissue pathology. Here, we use a deep learning-based framework that uses a convolutional neural network to transform grayscale output images into virtually-stained hematoxylin and eosin (H&E)-like images allowing for the visualization of various skin layers, including the epidermis, dermal-epidermal junction, and superficial dermis layers. To train the deep-learning framework, a stack of a minimum of 7 time-lapsed, successive RCM images of excised tissue were obtained from epidermis to dermis 1.52 microns apart to a depth of 60.96 microns using the Vivascope 3000. The tissue was embedded in agarose tissue and a curette was used to create a tunnel through which drops of 50% acetic acid was used to stain cell nuclei. These acetic acid-stained images were used as “ground truth” to train a deep convolutional neural network using a conditional generative adversarial network (GAN)-based machine learning algorithm to digitally convert the images into GAN-based H&E-stained digital images. We used the already trained machine learning algorithm and retrained the algorithm with new samples to include squamous neoplasms. Through further training and refinement of the algorithm, high-resolution, histological quality images can be obtained to aid in earlier diagnosis and treatment of cutaneous neoplasms. The overall goal of obtaining biopsy-free virtual histology images with this technology can be used to provide real-time outputs of virtually-stained H&E skin lesions, thus decreasing the need for invasive diagnostic procedures and enabling greater uptake of the technology by the medical community. Citation Format: Nelly Kokikian, Rachel Wahhab, Jingxi Li, Stephanie Martin, David P. Beynet, Aydogan Ozcan, Phillip Scumpia. Biopsy free virtual histology to discriminate benign from malignant squamous neoplasms [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4906.

Combined gray scale ultrasonography and doppler diagnostic tools with strain elastography in assessment of inflammatory bowel disease in pediatrics patients.

Intestinal changes in inflammatory bowel disease (IBD) are frequently observed on ultrasound. Invasive diagnostic procedures are often employed to differentiate between the main types of IBD and detect complications. Ultrasound Strain Elastography (SE) is a promising non-invasive technique for detecting intestinal changes and assessing inflammatory activity in pediatric IBD. This research aims to evaluate the diagnostic performance of conventional ultrasound, color Doppler, and SE in assessing inflammatory bowel disease in pediatric patients, both separately and in combination as additional tools. Forty patients (18 females and 22 males) initially diagnosed with IBD through clinical and endoscopic biopsy, along with 20 healthy controls, underwent conventional ultrasound, color Doppler, SE, and laboratory evaluations, including CBC, ESR, CRP, Fecal calprotectin, and assessment of IBD activity using PIBDAI. Conventional ultrasound, color Doppler, and SE significantly contributed to detecting disease activity and intestinal changes in IBD (p < 0.001; 95% CI 0.79-1.100), demonstrating better sensitivity in combination compared to each method individually. The combined approach showed 100% sensitivity, 84% specificity, 78.6% precision (Positive Predictive Value), 100% Negative Predictive Value, and an overall accuracy of 92%. The addition of Color Doppler and SE parameters to grayscale ultrasound provides diagnostic value comparable to endoscopy, histopathology, and laboratory markers in detecting inflammatory activity and intestinal changes in IBD. This combined approach can help avoid unnecessary invasive techniques for follow-up.

SST: a snore shifted-window transformer method for potential obstructive sleep apnea patient diagnosis

Objective. Obstructive sleep apnea (OSA) is a high-incidence disease that is seriously harmful and potentially dangerous. The objective of this study was to develop a noncontact sleep audio signal-based method for diagnosing potential OSA patients, aiming to provide a more convenient diagnostic approach compared to the traditional polysomnography (PSG) testing. Approach. The study employed a shifted window transformer model to detect snoring audio signals from whole-night sleep audio. First, a snoring detection model was trained on large-scale audio datasets. Subsequently, the deep feature statistical metrics of the detected snore audio were used to train a random forest classifier for OSA patient diagnosis. Main results. Using a self-collected dataset of 305 potential OSA patients, the proposed snore shifted-window transformer method (SST) achieved an accuracy of 85.9%, a sensitivity of 85.3%, and a precision of 85.6% in OSA patient classification. These values surpassed the state-of-the-art method by 9.7%, 10.7%, and 7.9%, respectively. Significance. The experimental results demonstrated that SST significantly improved the noncontact audio-based OSA diagnosis performance. The study’s findings suggest a promising self-diagnosis method for potential OSA patients, potentially reducing the need for invasive and inconvenient diagnostic procedures.

The Validity of Computed Tomography Guided Lung Tru- cut Biopsies in Achieving Accurate Tissue Results

Objective: This study aims to assess the efficacy of CT-guided true-cut biopsy as a less invasive and cost-effective diagnostic technique for peripherally placed lung lesions.&#x0D; &#x0D; Methods: fourty patients with solitary lung nodule were involved in this study, true cut biopsies under Ct guide was taken then processed for routine H&amp;E staining.&#x0D; &#x0D; Results: different pathological features can be identified with different pathological features giving primary diagnostic screening for lung cancer&#x0D; &#x0D; Conclusion: CT guided thoracic lesion biopsy is very efficient, cost-effective and less invasive technique when compared with the thoracic surgery

Complications Subsequent to Urinary Tract Stent Placement: An Overview Focusing on the Imaging of Cancer Patients.

Ureteral involvement by a tumor is common, and both partial and complete obstructions can result in symptoms that are distressing and debilitating, especially in cancer patients for whom the resection of the primary tumor is not considered an option. Maintaining ureteric patency in these patients is a challenge. In addition, in cases where a patient has undergone nephroureterectomy due to primary transitional cell cancer, it becomes necessary to decompress the urinary tract to preserve the contralateral kidney from irreversible damage. This is possibly due to ureteral stenting, both retrograde and anterograde, and percutaneous nephrostomy (PCN). Since imaging plays an important role in the routine monitoring of stents, their more and more increasing use requires radiologists to be familiar with these devices, their correct position, their potential complications, and their consequences. The aim of this review is to offer a comprehensive review of the imaging features of some urinary stents and to show the complications encountered in cancer patients as a direct consequence of an invasive diagnostic or therapeutic procedure. Specifically, we focus on ureteral stents and PCN.

Real-life practice of reflectance confocal microscopy in France: A prospective multicenter study

BackgroundStudies demonstrating the potential utility of reflectance confocal microscopy (RCM) have been performed under experimental conditions. ObjectiveTo provide an overview of RCM practice in real-life. MethodsA multicenter, prospective study carried out in 10 university dermatology departments in France. Results0verall, 410 patients were enrolled. Half of the patients (48%) were referred by private-practice dermatologists. They were referred for diagnosis (84.9%) or pre-surgical mapping (13%). For diagnosis, the lesions were located on the face (62%), arms and legs (14.9%), and trunk (13,6%), and pre-surgical mapping was almost exclusively on the face (90.9%). Among those referred for diagnosis, the main indication was suspicion of a skin tumor (92.8%). Of these,50.6% were spared biopsies after RCM. When RCM indicated surgery, histology revealed malignant lesions in 72.7% of cases. The correlation between RCM and histopathology was high, with a correlation rate of 82.76% and a kappa coefficient of 0.73 (0.63; 0.82). Limitations: This study was performed in the settings of French tertiary referral hospitals. Conclusion: This study shows that in real-life RCM can be integrated into the workflow of a public private network, which enables a less invasive diagnostic procedure for patients.

Genetic testing for fetal loss of heterozygosity using single nucleotide polymorphism array and whole-exome sequencing

The study explored the clinical significance of fetal loss of heterozygosity (LOH) identified by single-nucleotide polymorphism array (SNP array). We retrospectively reviewed data from pregnant women who underwent invasive diagnostic procedures at prenatal diagnosis centers in southeastern China from December 2016 to December 2021. SNP array was performed by the Affymetrix CytoScan 750 K array platform. Fetuses with LOH were further identified by parental verification, MS-MLPA, and/or trio whole-exome sequencing (trio-WES). The genetic results, fetal clinical manifestations, and perinatal outcome were analyzed. Of 11,062 fetuses, 106 (0.96%) had LOH exhibiting a neutral copy number, 88 (83.0%) had LOH in a single chromosome, whereas 18 (17.0%) had multiple LOHs on different chromosomes. Sixty-six fetuses had ultrasound anomalies (UAs), most frequently fetal growth restriction (18/66 (27.3%)). Parental SNP array verification was performed in 21 cases and trio-WES in 21 cases. Twelve cases had clinically relevant uniparental disomy, five had pathogenic variants, four had likely pathogenic variants, six had variants of unknown significance, and eight had identity by descent. The rate of adverse pregnancy outcomes in fetuses with LOH and UAs (24/66 (36.4%)) was higher than in those without UAs (6/40 (15.0%)) (p < 0.05). LOH is not uncommon. Molecular genetic testing techniques, including parental SNP array verification, trio-WES, methylation-specific multiplex ligation-dependent probe amplification, regular and systematic ultrasonic monitoring, and placental study, can accurately assess the prognosis and guide the management of the affected pregnancy.

Pneumocystis jirovecii pneumonia in people living with HIV: a review.

SUMMARYPneumocystis jirovecii is a ubiquitous opportunistic fungus that can cause life-threatening pneumonia. People with HIV (PWH) who have low CD4 counts are one of the populations at the greatest risk of Pneumocystis jirovecii pneumonia (PCP). While guidelines have approached the diagnosis, prophylaxis, and management of PCP, the numerous studies of PCP in PWH are dominated by the 1980s and 1990s. As such, most studies have included younger male populations, despite PCP affecting both sexes and a broad age range. Many studies have been small and observational in nature, with an overall lack of randomized controlled trials. In many jurisdictions, and especially in low- and middle-income countries, the diagnosis can be challenging due to lack of access to advanced and/or invasive diagnostics. Worldwide, most patients will be treated with 21 days of high-dose trimethoprim sulfamethoxazole, although both the dose and the duration are primarily based on historical practice. Whether treatment with a lower dose is as effective and less toxic is gaining interest based on observational studies. Similarly, a 21-day tapering regimen of prednisone is used for patients with more severe disease, yet other doses, other steroids, or shorter durations of treatment with corticosteroids have not been evaluated. Now with the widespread availability of antiretroviral therapy, improved and less invasive PCP diagnostic techniques, and interest in novel treatment strategies, this review consolidates the scientific body of literature on the diagnosis and management of PCP in PWH, as well as identifies areas in need of more study and thoughtfully designed clinical trials.

Recent Advances in Metallic Nanostructures-Assisted Biosensors for Medical Diagnosis and Therapy.

The field of nanotechnology has witnessed remarkable progress in recent years, particularly in its application to medical diagnosis and therapy. Metallic nanostructures-assisted biosensors have emerged as a powerful and versatile platform, offering unprecedented opportunities for sensitive, specific, and minimally invasive diagnostic techniques, as well as innovative therapeutic interventions. These biosensors exploit the molecular interactions occurring between biomolecules, such as antibodies, enzymes, aptamers, or nucleic acids, and metallic surfaces to induce observable alterations in multiple physical attributes, encompassing electrical, optical, colorimetric, and electrochemical signals. These interactions yield measurable data concerning the existence and concentration of particular biomolecules. The inherent characteristics of metal nanostructures, such as conductivity, plasmon resonance, and catalytic activity, serve to amplify both sensitivity and specificity in these biosensors. This review provides an in-depth exploration of the latest advancements in metallic nanostructures-assisted biosensors, highlighting their transformative impact on medical science and envisioning their potential in shaping the future of personalized healthcare.

Quantitative EEG in the Differential Diagnosis of Dementia Subtypes.

Most neurodegenerative dementias present with substantial overlap in clinical features. Therefore, differential diagnosis is often a challenging task necessitating costly and sometimes invasive diagnostic procedures. A promising, non-invasive and cost-effective method is the widely available electroencephalography (EEG). Twenty-three subjects with Alzheimer's disease (AD), 28 subjects with dementia with Lewy bodies (DLB), 15 subjects with frontotemporal dementias (FTDs), and 22 healthy controls (HC) were enrolled. Nineteen channel computerized EEG recordings were acquired. Mean relative powers were calculated using the standard frequency bands. Theta/alpha ratio (TAR), theta/beta ratio (TBR), a spectral index of (alpha + beta)/(theta + delta) and an alpha reactivity index (alpha in eyes-open condition/alpha in eyes-closed condition) were also calculated. Receiver operating characteristic (ROC) analyses were performed to assess diagnostic accuracy. For the comparison of EEG measures across groups, we performed a multivariate ANOVA followed by univariate ANOVAs controlling for the effects of age, with post hoc tests. Theta power and TBR were increased in DLB compared to other groups. Alpha power was decreased in DLB compared to HC and FTD; and in AD compared to FTD. Beta power was decreased in DLB compared to AD and HC. Furthermore, regional analyses demonstrated a unique pattern of theta power increase in DLB; affecting frontal, central, parietal, occipital, and temporal regions. In AD, theta power increased compared to HC in parietal, occipital, and right temporal regions. TAR was increased in DLB compared to other groups; and in AD compared to HC. Finally, alpha reactivity index was higher in DLB compared to HC and FTD. In AD, EEG slowing was associated with cognitive impairment, while in DLB, this was associated with higher DLB characteristics. In the ROC analyses to distinguish DLB from FTD and AD, measures of EEG slowing yielded high area under curve values, with good specificities. Also, decreased alpha reactivity could distinguish DLB from FTD with good specificity. EEG slowing in DLB showed a diffuse pattern compared to AD, where a posterior and temporal slowing predominated. We showed that EEG slowing was satisfactory in distinguishing DLB patients from AD and FTD patients. Notably, this slowing was a characteristic finding in DLB patients, even at early stages, while it paralleled disease progression in AD. Furthermore, EEG slowing in DLB showed a diffuse pattern compared to AD, where a posterior and temporal slowing predominated. These findings align with the previous evidence of the diencephalic dysfunction in DLB.

Health State Utilities Associated with False-Positive Cancer Screening Results.

Early cancer detection can significantly improve patient outcomes and reduce mortality rates. Novel cancer screening approaches, including multi-cancer early detection tests, have been developed. Cost-utility analyses will be needed to examine their value, and these models require health state utilities. The purpose of this study was to estimate the disutility (i.e., decrease in health state utility) associated with false-positive cancer screening results. In composite time trade-off interviews using a 1-year time horizon, UK general population participants valued 10 health state vignettes describing cancer screening with true-negative or false-positive results. Each false-positive vignette described a common diagnostic pathway following a false-positive result suggesting lung, colorectal, breast, or pancreatic cancer. Every pathway ended with a negative result (no cancer detected). The disutility of each false positive was calculated as the difference between the true-negative and each false-positive health state, and because of the 1-year time horizon, each disutility can be interpreted as a quality-adjusted life-year decrement associated with each type of false-positive experience. A total of 203 participants completed interviews (49.8% male; mean age = 42.0 years). The mean (SD) utility for the health state describing a true-negative result was 0.958 (0.065). Utilities for false-positive health states ranged from 0.847 (0.145) to 0.932 (0.059). Disutilities for false positives ranged from -0.031 to -0.111 (-0.041 to -0.111 for lung cancer; -0.079 for colorectal cancer; -0.031 to -0.067 for breast cancer; -0.048 to -0.088 for pancreatic cancer). All false-positive results were associated with a disutility. Greater disutility was associated with more invasive follow-up diagnostic procedures, longer duration of uncertainty regarding the eventual diagnosis, and perceived severity of the suspected cancer type. Utility values estimated in this study would be useful for economic modeling examining the value of cancer screening procedures.