Rate Of Missed Cancers Research Articles

A comprehensive comparative assessment of eight risk stratification systems for thyroid nodules in the elderly population.

This study aims to investigate the diagnostic value of eight risk stratification systems (RSSs) for thyroid nodules in the elderly and explore the reasons in comparison with a younger group. Cases of thyroid nodules that underwent ultrasound examination with thyroidectomy or fine-needle aspiration (FNA) at our hospital between August 2013 and March 2023 were collected. The patients were categorized into two groups: an elderly group (aged ≥60) and a younger group (aged <60). Eight RSSs were applied to evaluate these nodules respectively. The malignant rate in the elderly group was significantly lower than that in the younger group (28.2% vs. 49.6%, P=0.000). There were statistically significant differences in nodule diameter, multiplicity, composition, echogenicity, orientation, margin, and echogenic foci between the elderly and younger groups (P<0.05). Among the eight RSSs evaluated in elderly adults, the artificial intelligence-based Thyroid Imaging Reporting and Data System (AI TIRADS) demonstrated the highest overall diagnostic efficacy, but with relatively high unnecessary FNA rate (UFR) and missed cancer rate (MCR) of 55.0% and 51.3%, respectively. By modifying the size thresholds, the new AI TI-RADS achieved the lowest UFR and MCR while maintaining nearly the lowest FNA rate (FNAR) among all the RSSs (P=0.172, 0.162, compared to the ACR and original AI, respectively, but P<0.05 compared to the other six RSSs). Among the eight RSS systems, AI demonstrated higher diagnostic efficacy in the elderly population. However, the size thresholds for FNA needed to be adjusted.

Intelligent Information Retrieval for Reducing Missed Cancer and Improving the Healthcare System

This study presents an intelligent information retrieval system that will effectively extract useful information from breast cancer datasets and utilized that information to build a classification model. The proposed model will reduce the missed cancer rate by providing a comprehensive decision support to the radiologist. The model is built on two datasets, Wisconsin Breast Cancer Dataset (WBCD) and 365 free text mammography reports from a hospital. Effective pre-processing techniques including filling missing values with regression, an effective Natural Language Processing (NLP) Parser is developed to handle free text mammography reports, balancing the dataset with Synthetic Minority Oversampling (SMOTE) was applied to prepare the dataset for learning. Most relevant features were selected with the help of filter method and tf-idf scores. K-NN and SGD classifiers are optimized with optimum value of k for K-NN and hyper tuning the SGD parameters with grid search technique.

Sensitivity and missed cancer rate in the symptomatic breast clinic-A retrospective cohort study of 40323 patients.

Symptomatic presentations account for the majority of invasive breast cancer diagnoses. While the National Health Service Breast Screening Programme is subjected to strict quality control, no such system for performance monitoring exists in the symptomatic clinic. We assess the sensitivity of cancer detection and missed cancer rate for symptomatic breast patients to benchmark future outcome measures. A retrospective cohort study of patients attending the symptomatic breast clinic between October 2013 and October 2018 was performed. Patients with new cancer diagnoses were identified and screened for those who had presented to the department within the 3years prior to their diagnosis. From this, the sensitivity and missed cancer rate were calculated. About 40323 patients were seen over the 5-year study period. About 2155 new cancers were diagnosed, with 2033 identified at their initial clinic attendance. A further 122 patients had cancer diagnosed on a subsequent appointment, of which 23 patients were considered to have had a delay in diagnosis. The sensitivity of the one-stop symptomatic breast clinic was therefore 99.0%, and the missed cancer rate was 0.06% over 5years. The missed cancer rate reported in this study is favorable compared to the outcomes reported in the National Health Service Breast Screening Programme and superior to the only other study reporting outcomes on a much smaller cohort. The unit in question therefore is performing exceptionally against current standards and sets a benchmark against which future performance can be measured.

PTU-040 How Should Miss Rates for Cancer and Large Polyps Be Monitored at A Local Level? Retrospective Analysis of Repeat Colonoscopies at a District General Hospital

Introduction Caecal intubation and adenoma detection rates are key performance indicators (KPI) used to assess the quality of colonoscopy. Post-colonoscopy colorectal cancer (PCCRC) rates have recently been suggested as an additional KPI. Most studies estimate PCCRC rates by identifying the proportion of patients with diagnosed colorectal cancer (CRC) who have had a colonoscopy within 3 years of their diagnosis. This is labour intensive requiring evaluation of ≥2 databases. We describe a simplified method for estimating PCCRC rates. Aim To estimate the PCCRC rate using data from the endoscopy database alone. To identify all patients who had ≥2 colonoscopies over a 3 year period and those with CRC at the latest colonoscopy. To estimate the miss rate for larger (>20 mm) polyps. Methods We identified all patients on our endoscopy database (Adam, Fujifilm) who had a colonoscopy from 2010–12 and had a repeat colonoscopy within the next 3 years. We merged initial colonoscopy data with data of those patients found to have CRC and used conditional formatting to flag up duplicate procedures. Patients found to have CRCs or polyps >20 mm in the repeat procedure, not noted at their initial endoscopy, were identified. This data was used to calculate a ‘miss rate’ for these lesions. Results Between 2010 and 2012, 4961 colonoscopies were performed. In total 192 cancers were identified during this period. 237, 150, 225 and 128 repeat colonoscopies were performed within the same year and at 1, 2 and 3 years respectively. Of the 150 repeat procedures performed the following calendar year, indications included polyp surveillance (78), post-operative cancer surveillance (20), HNPCC or FAP (15), family history of CRC (8), anaemia (7), altered bowel habit (6) and other (16). In this group, 42 had polyps >20 mm and 6 had cancers. 3 of the cancers were in the ascending colon and the remaining three were missed at sites reported to have been examined in the previous study. This resulted in a missed polyp rate of 38.6%, a ‘missed cancer rate’ at one year of 6/150 patients (4%) and an overall ‘missed cancer rate’ of 0.12% or 1 in 827 colonoscopies. 2 cancers were found in patients who had a repeat colonoscopy after 2 years, both in the ascending colon. There were no missed cancers on repeat colonoscopy within the same calendar year or at three years. Conclusion Data readily obtainable from the endoscopy reporting system can be used to determine the rate of missed cancers. Our results are similar to that reported in other studies employing more complex and time-consuming methodology. This alternative approach can be used by units to confirm their local PCCRC rate, large polyp miss rates and potentially identify endoscopists whose miss rates are unacceptably high. Disclosure of Interest None Declared

Underestimation of malignancy in biopsy-proven cases of stromal fibrosis.

To determine the rate of underestimation of malignancy in patients with biopsy-proven stromal fibrosis. Following institutional review board approval, we retrospectively reviewed the charts of patients with biopsy-proven stromal fibrosis who underwent percutaneous breast biopsy in the 5-year period between 1 January 2005 and 31 December 2009. The medical records and the histopathology in patients who underwent repeat biopsy and/or surgical excision at the site of stromal fibrosis within 2 years were reviewed. Interval stability for up to 2 years was documented in patients who did not undergo additional biopsy or surgical excision. An upgrade was defined as any patient with biopsy-proven stromal fibrosis or fibroadenoma with evidence of malignancy at the site of biopsy within 2 years. 365 cases of stromal fibrosis were identified, of which 25 (7%) were upgraded to in situ or invasive malignancy on repeat biopsy or surgical excision. 7 were upgraded to ductal carcinoma in situ and 18 were upgraded to invasive cancer. Of the upgraded cases, 8 out of 24 (32%) were considered concordant with a benign diagnosis. The false-negative rate, that is, cases of stromal fibrosis concordant with benignity, but with subsequent upgrade, comprised 2% of all cases. In biopsy-proven cases of stromal fibrosis, there is a 7% upgrade to malignancy. We recommend that all instances of stromal fibrosis with radiology-pathology discordance undergo repeat biopsy or surgical excision. Cases that demonstrate radiology-pathology concordance can be safely categorized as a Breast Imaging Reporting and Data System 3 (BI-RADS® 3) lesion with a 6-month follow-up, owing to a false-negative rate for missed cancer of 2%. We now recommend that concordant cases of stromal fibrosis be categorized as BI-RADS 3 with a short-term follow-up, as this results in a missed cancer rate of 2%.

Magnetic Resonance Imaging-Guided Prostate Biopsy: Institutional Analysis and Systematic Review

To evaluate the detection rate of prostate cancer (PCa) after magnetic resonance-guided biopsy (MRGB); to monitor the patient cohort with negative MRGB results and to compare our own results with other reports in the current literature. A group of 41 patients was included in this IRB-approved study and subjected to combined MRI and MRGB. MRGB was performed in a closed 1.5 T MR unit and the needle was inserted rectally. The follow-up period ranged between 12 and 62 months (mean 3.1 years). To compare the results with the literature, a systematic literature search was performed. Eighteen publications were evaluated. The cancer-suspicious regions were punctured successfully in all cases. PCa was detected in eleven patients (26.9 %) who were all clinically significant. MRGB showed a benign histology in the remaining 30 patients. In the follow-up (mean 3.1 years) of patients with benign histology, no new PCa was diagnosed. The missed cancer rate during follow-up was 0.0 % in our study. MRGB is effective for the detection of clinically significant cancer, and this is in accordance with the recent literature. In the follow-up of patients with benign histology, no new PCa was discovered. Although the probability of developing PCa after negative MRGB is very low, active surveillance is reasonable.

PWE-042 Colonoscopy Quality Measures: Experience from a Welsh Bowel Cancer Screening Centre

IntroductionThe NHS Bowel Cancer Screening Programme (BCSP) in England has demonstrated high quality colonoscopy [1]. Bowel Cancer Screening in Wales began in October 2008. We report results of first 3...