Positive Diagnostic Likelihood Ratio Research Articles

Assessing MRI Sensitivity and Specificity for Detecting Occult Nipple-Areolar Complex Malignancy in Nipple-Sparing Mastectomy Candidates: A Systematic Review and Meta-Analysis

Background: Approximately 8% of breast cancers originate within the central ducts near the nipple-areolar complex(NAC), which revealed higher rates of occult involvement than previously thought. Precise preoperative imaging to assess NAC and subjacent tumor involvement has become critical to identify candidates for nipple-sparing mastectomy(NSM) while ensuring oncological safety. The aim of our study is to determine whether MRI could be used for the detection of subtle neoplastic infiltration. Method: Electronic databases including PubMed, Scopus, Web of Science, and EMBASE were systematically searched to identify all relevant studies on diagnostic performance of Magnetic Resonance Imaging(MRI) in malignant extension to the nipple published before 2024. The keywords include MRI, NAC, breast cancer, NSM. True Positive(TP), True Negative(TN), False Positive(FP), False Negative(FN) were extracted for analysis. Finally, 5 articles were selected for our meta-analysis. STATA version 15 was used to analysis data. Result: Our meta-analysis showed a pooled sensitivity of 89%(95% CI: 81%-94%)with low heterogeneity(I2 = 17.51%), and a pooled specificity of 89% (95% CI: 71%-96%), with significant heterogeneity(I2 = 95.87%). The pooled positive diagnostic likelihood ratio(pDLR) was 7.81(95% CI: 2.82-21.61, I2 = 92.66%), and the negative diagnostic likelihood ratio(nDLR) was 0.12(95% CI: 0.07-0.22, I2 = 11.94%). Conclusion: Diagnostic MRI characteristics such as NAC enhancement, non-mass enhancement(NME) type, mass size (greater than 20 mm), and tumor-to-nipple distance(TND) were assocaited with the presence of NAC involement. Because of high diagnostic accuracy, MRI imaging can be used as a helpful tool for NAC diagnosis.

Abstract 6104: EDRN Lung Team Project 2 validation of molecular biomarkers for the early detection of lung cancer in the setting of indeterminate pulmonary nodules

Abstract Background: The goal of the Early Detection Research Network (EDRN) Lung Team Project #2 (LTP-2) is to establish a cohort (n= 300) of high-risk people with indeterminate pulmonary nodules (6mm-30mm) to clinically validate the diagnostic accuracy of existing molecular and imaging biomarkers discovered and analytically validated through the EDRN program. These biomarkers comprise signals measured in serum (glycan or cytokine), plasma (protein, miRNA, RNA, or methylated circulating tumor DNA), airway epithelial cells (RNA or DNA), nasal brush cells (RNA or DNA), and/or chest CT images. Methods: Eligible participants had an indeterminate nodule discovered incidentally or through low-dose CT screening within 14 months prior to enrollment and were aged 45-90 years, with 20 pack-years or more cigarette smoking history, free of lung cancer, and willing to provide blood, nasal brushing, and optionally bronchoscopic brush biopsy specimens. Baseline medical and demographic data were collected from each subject. Baseline and years 1 and 2 follow-up CT images were obtained. Each specimen at each respective site was labeled with a 2-D barcode provided by the DMCC and specimen information was entered into the Validation Study Information Management System (VSIMS) developed by the EDRN Data Management and Coordinating Center (DMCC). Aliquots of blinded specimens from selected cases and controls will be dispensed to each EDRN site for biomarker analysis. Analysis plan: Primary endpoint: The positive diagnostic likelihood ratio (DLR+) will be used to measure biomarker performance within values of DLR+ >= 2 or DLR- <= 0.5, a range considered clinically useful for any patients with indeterminate lung nodules. The sample size calculation targeted >80% power to test the null hypotheses that a) a positive biomarker does not alter risk across a range of specificities, and b) a negative biomarker does not alter risk across a range of sensitivities. The EDRN Data Management and Coordinating Center (DMCC) will unblind and complete analysis and report results. Exploratory endpoint: The diagnostic accuracy of combined biomarkers will be calculated using a logistic regression model with flexible functional forms. Results and Discussion: More than 300 subjects were enrolled into the LTP2 cohort including a sufficient number of cases and controls (cohort size n>300) to reach power according to calculated estimates. Chest CT images were collected and are in the process of transfer to a central database. Plasma specimens have been distributed to test sites. RNA and DNA extraction from NBC and AEC is in process and based on results thus far the specimen quality and quantity is more than sufficient from the number of subjects needed to reach power for the primary endpoint and to conduct the planned exploratory analyses. Citation Format: James C. Willey, Eric L. Grogan, Stephen A. Deppen, James G. Herman, Michael N. Kammer, Matthew B. Schabath, Lynn Sorbara, Harvey I. Pass, Jun-Chieh J. Tsay, Ziding Feng, Avrum Spira, Erin L. Crawford, Jackie Dahlgren, Steven M. Dubinett, Kimberly R. Rieger-Christ, Marc E. Lenburg. EDRN Lung Team Project 2 validation of molecular biomarkers for the early detection of lung cancer in the setting of indeterminate pulmonary nodules [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 6104.

A meta-analysis of urinary transferrin for early diagnosis of diabetic nephropathy

Abstract Objective To assess the diagnostic value of urinary transferrin (Tf) in early diabetic nephropathy (DN) to propose a more sensitive and noninvasive biomarker for screening and monitoring DN in clinical practice. Methods We searched 3 databases from their inception to May 2023, to identify studies investigating the diagnostic value of Tf in patients with DN. Meta-DiSc software, version 1.4, and Stata software, version 15.1 (StataCorp) were used to conduct a meta-analysis and evaluate the diagnostic accuracy of urine Tf levels for DN. Results The meta-analysis included 6 relevant studies investigating the diagnostic value of Tf level for DN. Urinary Tf as a diagnostic marker demonstrated a combined sensitivity of 0.82 (95% CI, 0.71-0.89) and specificity of 0.88 (0.84-0.92). the positive diagnostic likelihood ratio was 7.07 (4.57-10.93), the negative diagnostic likelihood ratio was 0.20 (0.12-0.35), and the diagnostic odds ratio was 34.49 (13.61-87.44). Also, the area under the receiver operating characteristic curve was 0.92 (0.89-0.94), indicating that urinary Tf has a decent discriminative ability in diagnosing DN. Conclusion Tf level is a valuable biological marker for early diagnosis and monitoring of DN in clinical practice. It has statistically significant predictive value for patients in the early phases of DN.

A systematic review of the applicability of emergency department assessment of chest pain score-accelerated diagnostic protocol for risk stratification of patients with chest pain.

The emergency department assessment of chest pain score-accelerated diagnostic protocol (EDACS-ADP) are commonly used for risk stratification in undifferentiated patients with acute chest pain. This systematic review aimed to investigate EDACS-ADP for risk stratification of emergency department (ED) patients with chest pain. The PubMed, Web of Science, Medline, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases were searched for related studies without restrictions on the publication year. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias, and Stata 16.0 was used to determine the combined sensitivity, specificity, positive diagnostic likelihood ratio (DLR), and negative DLR. Twelve studies comprising 14 290 patients were identified. Of these, 7537 (52.74%) patients were considered low risk, and 67 (0.89%) had major adverse cardiovascular events (MACE), including myocardial infarction, stroke, and cardiovascular death within 30 days of the patients' ED presentation. EDACS-ADP showed a combined sensitivity of 0.97 (95% confidence interval [CI]: 0.95-0.99); specificity, 0.58 (0.53-0.63); positive DLR, 2.34 (2.08-2.63); negative DLR, 0.04 (0.02-0.09); diagnostic odds ratio, 53.11 (26.45-106.63); and summary receiver operating characteristic area under the curve, 0.83 (0.79-0.86). Despite the large statistical heterogeneity of the results, EDACS-ADP identified a considerable number of low-risk patients for early discharge, with a specificity >50% and an incidence of MACE within 30-days of patients' ED presentation <1%. Thus, it is a useful tool with a potential for clinical application.

Development and Multicenter Case-Control Validation of Urinary Comprehensive Genomic Profiling for Urothelial Carcinoma Diagnosis, Surveillance, and Risk-Prediction.

Urinary comprehensive genomic profiling (uCGP) uses next-generation sequencing to identify mutations associated with urothelial carcinoma and has the potential to improve patient outcomes by noninvasively diagnosing disease, predicting grade and stage, and estimating recurrence risk. This is a multicenter case-control study using banked urine specimens collected from patients undergoing initial diagnosis/hematuria workup or urothelial carcinoma surveillance. A total of 581 samples were analyzed by uCGP: 333 for disease classification and grading algorithm development, and 248 for blinded validation. uCGP testing was done using the UroAmp platform, which identifies five classes of mutation: single-nucleotide variants, copy-number variants, small insertion-deletions, copy-neutral loss of heterozygosity, and aneuploidy. UroAmp algorithms predicting urothelial carcinoma tumor presence, grade, and recurrence risk were compared with cytology, cystoscopy, and pathology. uCGP algorithms had a validation sensitivity/specificity of 95%/90% for initial cancer diagnosis in patients with hematuria and demonstrated a negative predictive value (NPV) of 99%. A positive diagnostic likelihood ratio (DLR) of 9.2 and a negative DLR of 0.05 demonstrate the ability to risk-stratify patients presenting with hematuria. In surveillance patients, binary urothelial carcinoma classification demonstrated an NPV of 91%. uCGP recurrence-risk prediction significantly prognosticated future recurrence (hazard ratio, 6.2), whereas clinical risk factors did not. uCGP demonstrated positive predictive value (PPV) comparable with cytology (45% vs. 42%) with much higher sensitivity (79% vs. 25%). Finally, molecular grade predictions had a PPV of 88% and a specificity of 95%. uCGP enables noninvasive, accurate urothelial carcinoma diagnosis and risk stratification in both hematuria and urothelial carcinoma surveillance patients.

Evaluating the prognostic performance of bedside tests used for peripheral arterial disease diagnosis in the prediction of diabetic foot ulcer healing

IntroductionDiabetic foot ulceration (DFU) is a common and challenging complication of diabetes. Risk stratification can guide further management. We aim to evaluate the prognostic performance of bedside tests used for...

Use of diagnostic likelihood ratio of outcome to evaluate misclassification bias in the planning of database studies

BackgroundThe diagnostic likelihood ratio (DLR) and its utility are well-known in the field of medical diagnostic testing. However, its use has been limited in the context of an outcome validation study. We considered that wider recognition of the utility of DLR would enhance the practices surrounding database studies. This is particularly timely and important since the use of healthcare-related databases for pharmacoepidemiology research has greatly expanded in recent years. In this paper, we aimed to advance the use of DLR, focusing on the planning of a new database study.MethodsTheoretical frameworks were developed for an outcome validation study and a comparative cohort database study; these two were combined to form the overall relationship. Graphical presentations based on these relationships were used to examine the implications of validation study results on the planning of a database study. Additionally, novel uses of graphical presentations were explored using some examples.ResultsPositive DLR was identified as a pivotal parameter that connects the expected positive-predictive value (PPV) with the disease prevalence in the planned database study, where the positive DLR is equal to sensitivity/(1-specificity). Moreover, positive DLR emerged as a pivotal parameter that links the expected risk ratio with the disease risk of the control group in the planned database study. In one example, graphical presentations based on these relationships provided a transparent and informative summary of multiple validation study results. In another example, the potential use of a graphical presentation was demonstrated in selecting a range of positive DLR values that best represented the relevant validation studies.ConclusionsInclusion of the DLR in the results section of a validation study would benefit potential users of the study results. Furthermore, investigators planning a database study can utilize the DLR to their benefit. Wider recognition of the full utility of the DLR in the context of a validation study would contribute meaningfully to the promotion of good practice in planning, conducting, analyzing, and interpreting database studies.

Association between respiratory clinical signs and respiratory localization in dogs and cats with abnormal breathing patterns

The diagnostic values of respiratory signs have been under-investigated in pets. The study aim was to explore commonly assumed associations between respiratory signs and disease localization in pets with abnormal breathing patterns (ABP). Dogs and cats with ABP presenting to three hospitals were included if investigations permitted disease localization. Hypothesized associations between respiratory signs and disease location were evaluated via mixed-effects logistic regression. Sensitivity, specificity, and positive diagnostic likelihood ratio were calculated.One-hundred and fifteen dogs and 49 cats with ABP were recruited. Confirmed associations included: inspiratory effort with extra-thoracic airway disease (odds ratio [OR], 9.1; 95% confidence interval [95% CI] 3.0–27.2); expiratory effort with intra-thoracic airway disease (OR, 6.5; 95% CI, 2.3–18.1); paradoxical breathing and attenuation of heart/lung sounds with pleural space disease (paradoxical breathing: OR, 4.5; 95% CI 1.7–12.1; sound attenuation: OR, 11.5; 95% CI 4.0–33.3); decreased nasal airflow and stertor with nasal/pharyngeal disease (nasal airflow: OR, 26.2; 95% CI 8.1–84.8; stertor: OR, 155.2; 95% CI 24.9–968.8); stridor with laryngeal or tracheal disease (laryngeal disease: OR, 39.9; 95% CI 7.6–209.0; tracheal disease: OR, 32.4; 95% CI 4.2–248.0); tracheal sensitivity with bronchial disease (OR, 3.8; 95% CI 1.5–9.6); crackles with pulmonary or bronchial disease (pulmonary disease: OR, 5.4; 95% CI 2.1–13.8; bronchial disease: OR, 3.9; 95% CI 1.6–9.8); and goose honking with tracheal disease (all dogs with goose honking had tracheal involvement). Select respiratory signs provide guidance to localize and prioritize causes of the underlying respiratory disease in pets, allowing targeted interventions in animals with ABP.

Can 18F-FDG PET/CT predict EGFR status in patients with non-small cell lung cancer? A systematic review and meta-analysis

ObjectivesThis study aimed to explore the diagnostic significance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT for predicting the presence of epidermal growth factor receptor (EGFR) mutations in patients with non-small...

The Factor Structure of the Mood Disorder Questionnaire in Tunisian Patients.

Background:The Mood Disorder Questionnaire (MDQ) is a frequently used screening tool for the early detection of Bipolar Disorder (BD), which is often unrecognized or misdiagnosed at its onset. In this study, data from Tunisia has been used to evaluate the psychometric properties of the Arabic MDQ.Methods:The sample included 151 patients with a current major depressive episode. The Arabic adapted version of the Structured Clinical Interview for DSM-IV-TR was used to formulate a diagnosis, yielding 62 patients with BD and 89 with unipolar Major Depressive Disorder (MDD). Principal component analysis with parallel analysis was used to establish the spontaneous distribution of the 13 core items of the MDQ. Confirmatory Factor Analysis (CFA) was used to check the available factor models. Receiver Operating Characteristic (ROC) analysis was used to assess the capacity of the MDQ to distinguish patients with BD from those with MDD.Results:Cronbach’s α in the sample was 0.80 (95%CI: 0.75 to 0.85). Ordinal α was 0.88. Parallel analysis suggested two main components, which explained 59% of variance in the data. CFA found a good fit for the existing unidimensional, the two-factor, and the three-factor models. ROC analysis showed that at a threshold of 7, the MDQ was able to distinguish patients with BD from those with MDD with extraordinary negative predictive value (0.92) and a positive diagnostic likelihood ratio of 3.8.Conclusion:The Arabic version of the MDQ showed good measurement properties in terms of reliability, factorial validity and discriminative properties.

Validation of the diabetes screening tools proposed by the American Diabetes Association in an aging Chinese population.

AimDiabetes is a serious global health problem. A simple and effective screening tool should have substantial public health benefit. We investigated the performance of the latest American Diabetes Association diabetes screening methods in our aging Chinese population.MethodsSubjects without diabetes who returned for the 4th Hong Kong Cardiovascular Risk Factors Prevalence Study in 2010–2012 were evaluated for the probability of having diabetes with reference to the age- and body mass index-based screening criteria (screening criteria) and the diabetes risk test (risk test), and the conclusion drawn was compared to their measured glycaemic status. Diabetes was defined by fasting glucose ≥ 7 mmol/L or 2-hour post oral glucose tolerance test glucose ≥ 11.1 mmol/L.Results1415 subjects, aged 58.1±10.2, were evaluated. 95 (6.7%) had diabetes. The risk test showed good accuracy (area under the receiver operating curve 0.725) in screening for diabetes with an optimal cut-off score of five. Compared to the screening criteria, the risk test had significantly better specificity (0.57 vs. 0.41, p<0.001), positive predictive value (0.12 vs. 0.09, p<0.001) and positive diagnostic likelihood ratio (1.85 vs. 1.37, p<0.001). To diagnose one case of diabetes, fewer subjects (11 vs. 18) needed to be tested for blood glucose if the risk test was adopted.ConclusionThe risk test appears to be a more effective screening tool in our population. It is simple to use and can be adopted as a public health strategy for identifying people with undiagnosed diabetes for early intervention.

A novel algorithm for the non-invasive detection of bladder outlet obstruction in men with lower urinary tract symptoms

ObjectiveTo determine the ability of bladder wall thickness (BWT) in combination with non-invasive variables to distinguish patients with bladder outlet obstruction (BOO). Patients and methodsPatients completed the International Prostate Symptom Score (IPSS) questionnaire and prostate size was measured by transrectal ultrasonography (US). Pressure-flow studies were performed to determine the urodynamic diagnosis. BWT was measured at 250-mL bladder filling using transabdominal US. Recursive partition analysis (RPA) recursively partitions data for relating independent variable(s) to a dependent variable creating a tree of partitions. It finds a set of cuts of the dependent variable(s) that best predict the independent variable, by searching all possible cuts until the desired fit is reached. RPA was used to test the ability of the combined data of BWT, maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), IPSS, and prostate size to predict BOO. ResultsIn all, 72 patients were included in the final analysis. The median BWT, voided volumes, PVR, mean Qmax, and IPSS were significantly higher in patients who had an Abrams/Griffiths (A/G) number of >40 (55 patients) compared to those with an A/G number of ≤40 (17 patients). RPA revealed that the combination of BWT and Qmax gave a correct classification in 61 of the 72 patients (85%), with 92% sensitivity and 65% specificity, 87% positive predictive value, and 76% negative predictive value (NPV) for BOO (area under the curve 0.85). The positive diagnostic likelihood ratio of this reclassification fit was 2.6. ConclusionsIt was possible to combine BWT with Qmax to create a new algorithm that could be used as a screening tool for BOO in men with lower urinary tract symptoms.

Significance of Serum Pepsinogens as a Biomarker for Gastric Cancer and Atrophic Gastritis Screening: A Systematic Review and Meta-Analysis.

BackgroundHuman pepsinogens are considered promising serological biomarkers for the screening of atrophic gastritis (AG) and gastric cancer (GC). However, there has been controversy in the literature with respect to the validity of serum pepsinogen (SPG) for the detection of GC and AG. Consequently, we conducted a systematic review and meta-analysis to assess the diagnostic accuracy of SPG in GC and AG detection.MethodsWe searched PubMed, Embase, and the Chinese National Knowledge Infrastructure (CNKI) for correlative original studies published up to September 30, 2014. The summary sensitivity, specificity, positive diagnostic likelihood ratio (DLR+), negative diagnostic likelihood ratio (DLR-), area under the summary receiver operating characteristic curve (AUC) and diagnostic odds ratio (DOR) were used to evaluate SPG in GC and AG screening based on bivariate random effects models. The inter-study heterogeneity was evaluated by the I2 statistics and publication bias was assessed using Begg and Mazumdar’s test. Meta-regression and subgroup analyses were performed to explore study heterogeneity.ResultsIn total, 31 studies involving 1,520 GC patients and 2,265 AG patients were included in the meta-analysis. The summary sensitivity, specificity, DLR+, DLR-, AUC and DOR for GC screening using SPG were 0.69 (95% CI: 0.60–0.76), 0.73 (95% CI: 0.62–0.82), 2.57 (95% CI: 1.82–3.62), and 0.43 (95% CI: 0.34–0.54), 0.76 (95% CI: 0.72–0.80) and 6.01 (95% CI: 3.69–9.79), respectively. For AG screening, the summary sensitivity, specificity, DLR+, DLR-, AUC and DOR were 0.69 (95% CI: 0.55–0.80), 0.88 (95% CI: 0.77–0.94), 5.80 (95% CI: 3.06–10.99), and 0.35 (95% CI: 0.24–0.51), 0.85 (95% CI: 0.82–0.88) and 16.50 (95% CI: 8.18–33.28), respectively. In subgroup analysis, the use of combination of concentration of PGI and the ratio of PGI:PGII as measurement of SPG for GC screening yielded sensitivity of 0.70 (95% CI: 0.66–0.75), specificity of 0.79 (95% CI: 0.79–0.80), DOR of 6.92 (95% CI: 4.36–11.00), and AUC of 0.78 (95% CI: 0.72–0.81), while the use of concentration of PGI yielded sensitivity of 0.55 (95% CI: 0.51–0.60), specificity of 0.79 (95% CI: 0.76–0.82), DOR of 6.88 (95% CI: 2.30–20.60), and AUC of 0.77 (95% CI: 0.73–0.92). For AG screening, the use of ratio of PGI:PGII as measurement of SPG yielded sensitivity of 0.69 (95% CI: 0.52–0.83), specificity of 0.84 (95% CI: 0.68–0.93), DOR of 11.51 (95% CI: 6.14–21.56), and AUC of 0.83 (95% CI: 0.80–0.86), the use of combination of concentration of PGI and the ratio of PGI:PGII yield sensitivity of 0.79 (95% CI: 0.72–0.85), specificity of 0.89 (95% CI: 0.85–0.93), DOR of 24.64 (95% CI: 6.95–87.37), and AUC of 0.87 (95% CI: 0.81–0.92), concurrently, the use of concentration of PGI yield sensitivity of 0.46 (95% CI: 0.38–0.54), specificity of 0.93 (95% CI: 0.91–0.95), DOR of 19.86 (95% CI: 0.86–456.91), and AUC of 0.86 (95% CI: 0.52–1.00).ConclusionSPG has great potential as a noninvasive, population-based screening tool in GC and AG screening. In addition, given the potential publication bias and high heterogeneity of the included studies, further high quality studies are required in the future.

Pre-treatment serum lactate dehydrogenase and alkaline phosphatase as predictors of metastases in extremity osteosarcoma

BackgroundThe prognosis of patients with metastatic osteosarcoma remains poor. However, the chance of survival can be improved by surgical resection of all metastases. In this study we investigate the value of serum alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) in predicting the presence of metastatic disease at time of diagnosis. MethodsSixty-one patients with histologically confirmed conventional osteosarcoma of the extremity were included in the study. Only 19.7% of cases presented without evidence of systemic spread of the disease. Pre-treatment serum ALP and LDH were analysed in patients with and without skeletal or pulmonary metastases. ResultsSerum LDH and ALP levels were not significantly different in patients with or without pulmonary metastases (p=0.88 and p=0.47, respectively). The serum LDH and ALP levels did however differ significantly in patients with or without skeletal metastases (p<0.001 and p=0.02, respectively). The optimal breakpoint for serum LDH as a marker of skeletal metastases was 849 IU/L (AUC 0.839; Sensitivity=0.88; Specificity=0.73). LDH >454 IU/L equated to 100% sensitivity for detected bone metastases (positive diagnostic likelihood ratio (DLR)=1.32). With a cut-off of 76 IU/L a sensitivity of 100% was reached for serum ALP predicting the presence of skeletal metastases (positive DLR=1.1). In a multivariate analysis both LDH ≥850 IU/L (odds ratio [OR]=9; 95% confidence interval (CI) 1.8–44.3) and ALP ≥280 IU/L (OR=10.3; 95% CI 2.1–50.5) were predictive of skeletal metastases. LDH however lost its significance in a multivariate model which included pre-treatment tumour volume. ConclusionIn cases of osteosarcoma with LDH >850 IU/L and/or ALP >280 IU/L it may be prudent to consider more sensitive staging investigations for detection of skeletal metastases. Further research is required to determine the value and the most sensitive cut-off points of serum ALP and LDH in the prediction of skeletal metastases.

Prospective Comparison of Multi-Detector Computed Tomographic Angiography with Digital Subtraction Angiography for the Diagnosis of Intracranial Aneurysms in Patients with Acute Non-Traumatic Subarachnoid Hemorrhage

Background Rupture of intracranial aneurysms and malformations are the main causes of spontaneous subarachnoid hemorrhage (SAH). Multi-detector computed tomography angiography (CTA) and intra-arterial digital subtraction angiography (DSA) are used to evaluate cerebrovascular structures and to detect such abnormalities with an intention to treat them. Objective The aim of the present study was to compare CTA and DSA findings in the detection of a cerebral aneurysm in patients with acute non-traumatic SAH and to depict the diagnostic value of CTA. Methods During the last 3 years 52 patients with non-traumatic SAH were prospectively studied. Four patients underwent only 16-slice multi-detector CTA and 48 patients underwent both CTA and DSA in an acute setting. Aneurysm morphologic information on CTA was compared to DSA, which is considered the gold standard imaging technique. Results The sensitivity of CTA per aneurysm was 97.9% (95% confidence intervals-CI 0.83-1), the specificity 100% (CI 0.50-0.99), the positive diagnostic likelihood ratio 0 and the negative diagnostic likelihood ratio 0.02. DSA successfully depicted 47 aneurysms in 40 patients from our study group. One aneurysm was missed on CTA (2 mm) which retrospectively was identified. In 8 patients with SAH no aneurysm was detected by either CTA or DSA. Conclusion 16-slice multi-detector CTA can be successfully used as a first choice imaging tool in the diagnostic algorithm of non-traumatic SAH and efficiently guide the therapeutic strategy.

Diagnostic value of urine prostate cancer antigen 3 test using a cutoff value of 35 μg/L in patients with prostate cancer.

The aim of this study is to explore the diagnostic role of urine prostate cancer antigen 3 (PCA3) in detecting prostate cancer (PCa) through a systematic review and meta-analysis. Relevant research studies aiming at the application of urine PCA3 level in PCa diagnosis were searched in PubMed, Embase, Chinese Biomedical Database (CBM), Chinese National Knowledge Infrastructure (CNKI), VIP, and Wan Fang databases independently, which were published up to May 8, 2014. The pooled sensitivity, specificity, positive diagnostic likelihood ratio (DLR+), negative diagnostic likelihood ratio (DLR-), diagnostic odds ratio, and the area under the summary receiver operating characteristic were used to evaluate the value of urine PCA3 in diagnosis of PCa by using the Meta-DiSc and STATA 12.0 statistical software. Sixteen research studies with a total 2,457 PCa patients and 4,236 control individuals were included in this meta-analysis. Overall, the results showed sensitivity and specificity of urine PCA3 in the diagnosis of PCa was 0.57 (95 % CI = 0.55-0.59), and 0.71 (95 % CI = 0.70-0.73), respectively. The DLR + and PLR - in the diagnosis of PCa were 2.12 (95 % CI = 1.89-2.38), and 0.55 (95 % CI = 0. 50-0.61), respectively. The pooled diagnostic odds ratio was 3.93 (95 % CI = 3.28-4.72). The area under the curve (AUCs) and *Q index estimate were 0.7118 and 0.6623, respectively. Urine PCA3 is a potential biomarker for the diagnosis of PCa. However, further well-designed studies with large samples will be needed to confirm the results got from present meta-analysis.

Antibiotic screening of urine culture as a tool for interal quality audit

Microbiologic culture of urine is an important component in the diagnosis of urinary tract infections (UTI). However, confounding factors like the patient's current history of antibiotic usage can affect the interpretation of urine culture results. This study was undertaken to find out the occurrence of unreported antibiotic consumption prior to urine culture and its clinical consequences. In this descriptive study conducted from February to August 2013, we tested consecutive urine specimens for the presence of antibiotics with a modified urine antibacterial substance assay (UABA) and compared the results obtained with the accuracy of antibiotic data entry on the accompanying request forms. In addition, the consequences of culturing urine specimens with incomplete antibiotic history received in the laboratory were investigated. Out of 2,040 urine specimens, 721 (35.34 per cent) were UABA positive. Comparison of antibiotic screening of urine with antibiotic data entry from request forms showed 1,299 (63.68 per cent) true-negative, 38 (1.86 per cent) true- positive, 20 (0.98 per cent) false-negative, and 683 (33.48 per cent) false-positive results. The sensitivity and specificity of this test were 65.52 per cent and 65.54 per cent, respectively. The positive and negative predictive values were 5.27 per cent and 98.48 per cent, respectively. The UABA had a positive diagnostic likelihood ratio of 1.901. This internal audit demonstrates how the accurate history of current antibiotic usage in the request forms impacts the interpretation of urine culture results.

Automated preoperative assessment of endothelial dysfunction and risk stratification for perioperative myocardial injury in patients undergoing non-cardiac surgery

BackgroundMyocardial injury after non-cardiac surgery (MINS) is a common complication with associated serious morbidity and mortality. Endothelial dysfunction might play an important role in MINS, and its rapid assessment could provide a novel method of risk stratification before surgery. MethodsWe studied 238 subjects scheduled to undergo intermediate or high-risk surgery in a two-centre prospective study to determine whether preoperative endothelial dysfunction identified by a reactive hyperaemia'peripheral arterial tonometry (RH-PAT) index could provide effective risk stratification for MINS, defined as serum troponin ≥0.04 μg litre−1, within 3 postoperative days. ResultsThe primary outcome occurred in 35 subjects (14.7%). Endothelial dysfunction was defined as an RH-PAT index of ≤1.22. Adjusted for age, Lee index and a composite measure of the extent of surgery, endothelial dysfunction was associated with MINS [odds ratio 10.1, 95% confidence interval (CI) 3.3–30.9, P=0.001] and increased time to discharge from hospital after surgery (hazard ratio 0.39, 95% CI 0.23–0.65, P=0.001). Endothelial dysfunction identified MINS with a sensitivity of 31%, a specificity of 96%, and a positive diagnostic likelihood ratio of 8.0. Risk classification for MINS was improved by the addition of RH-PAT-defined endothelial dysfunction to the Lee index (c-statistic increased from 0.69 to 0.77; integrated discrimination improvement 0.11, P=0.003). However, prognostic utility varied widely between sites. ConclusionsFor patients undergoing non-cardiac surgery, non-invasive assessment of endothelial function might enhance preoperative risk stratification for perioperative myocardial injury. However, unexplained large inter-site variation in prognostic utility could limit widespread application and needs to be further understood.

The diagnostic value of monoclonal gastric cancer 7 antigen: a systematic review with meta-analysis

The aim of this study is to explore the clinical characteristic and the diagnostic role of MG7-Ag in detecting gastric cancer (GC) through a systematic review and meta-analysis. Relevant manuscripts aiming at the application of serum MG7-Ag level in GC diagnosis were searched in PubMed, Embase, Chinese National Knowledge Infrastructure, VIP, and Wan Fang Data independently,which were published between January 1, 1980 and February 28, 2013. The pooled sensitivity, specificity,positive diagnostic likelihood ratio (DLR+), negative diagnostic likelihood ratio (DLR-), diagnostic odds ratio,and the area under the summary receiver operating characteristic(AUC) were used to evaluate the value of serum MG7-Ag in diagnosis of GC by using the Meta-DiSc and STATA 11.0 statistical software. 410 manuscripts were retrieved, and 7 manuscripts of high quality including 652 patients were of high quality in this meta-analysis. Overall,the pooled sensitivity, specificity, DLR+, DLR-, and AUC were 0.73 (95 % CI 0.63-0.82), 0.91 (95 % CI 0.84-0.94), 8.59 (95 % CI 5.62-13.11), 0.29 (95 % CI 0.21-0.42), and 0.92 (95 % CI 0.89-0.94), respectively. MG7-Ag is a potential biomarker for the diagnosis of GC.However, more studies are needed to confirm the standard criteria.

¿Se puede conocer el tamaño del adenocarcinoma de endometrio con histeroscopia?

ObjectiveThe aim of this study was to assess the value of hysteroscopy in determining tumoral size in endometrial adenocarcinoma. Material and methodsWe carried out a prospective cohort study of 34 patients with suspected endometrial adenocarcinoma who underwent outpatient hysteroscopy in Hospital Donostia. Tumors were classified as larger or smaller than 2cm, or diffuse. These classifications were compared with subsequent histopathological results. ResultsIn our series, 85.29% (95% CI 68.1-94.4) of tumors were>2cm. Hysteroscopy correctly classified 79.41% of the lesions (95% CI 61.5-90.6). The sensitivity of hysteroscopy in correctly classifying tumors>2cm was 86.21% (95% CI 67.4-95.4), but specificity was only 40% (CI 95% 7.2-82.9).The positive diagnostic likelihood ratio was 89.29% (95% CI 70.6-97.1%). The chance of having a tumor>2cm was multiplied by 1.44 if hysteroscopy classified it as such (95% CI 0.62-2.98), and by 0.34 if it did not (95% CI 0.08-1.41). The negative likelihood ratio was 33.33% (95% CI 6-75.8%). ConclusionHysteroscopy has a high positive predictive value in diagnosing tumors larger than 2cm or with diffuse involvement of the uterine cavity. This procedure does not involve additional costs or complications to the diagnostic protocol for endometrial cancer and can be highly useful in surgical planning.