Predictive Value Of Negative Result Research Articles

A Comparative Evaluation of Multiparametric Magnetic Resonance Imaging and Micro-Ultrasound for the Detection of Clinically Significant Prostate Cancer in Patients with Prior Negative Biopsies.

The diagnostic process for prostate cancer after a negative biopsy is challenging. This study compares the diagnostic accuracy of micro-ultrasound (mUS) with multiparametric magnetic resonance imaging (mpMRI) for such cases. A retrospective cohort study was performed, targeting men with previous negative biopsies and using mUS and mpMRI to detect prostate cancer and clinically significant prostate cancer (csPCa). In our cohort of 1397 men, 304 had a history of negative biopsies. mUS was more sensitive than mpMRI, with better predictive value for negative results. Importantly, mUS was significantly associated with csPCa detection (adjusted odds ratio [aOR]: 6.58; 95% confidence interval [CI]: 1.15-37.8; p = 0.035). mUS may be preferable for diagnosing prostate cancer in previously biopsy-negative patients. However, the retrospective design of this study at a single institution suggests that further research across multiple centers is warranted.

Prognostic value of hyperuricemia in patients with heart failure

In patients with heart failure, hyperuricemia is often observed. The purpose of our study is to determine the relationship of serum uric acid with biochemical characteristics of heart failure and to determine its diagnostic and prognostic value for the outcome of the disease. Material and methods: the study was based on the results of the study of 117 patients with asymptomatic hyperuricemia who applied to the clinic from September 2019 to January 2022. We determined the relationship between serum uric acid and the characteristics of heart failure, using ROCK analysis we determined the sensitivity and specificity of uric acid for the outcome of heart failure. Results: Creatinine - r=0.478**, p=0.000 shows a reliable positive correlation with uric acid concentration; CRP - r=0.742**, p=0.000; BNP - r=0.599**, p=0.000, and eGFR - r=-0.184*, p=0.046 shows a reliable negative correlation; According to the degree of heart failure, the concentration of uric acid was distributed as follows: NYHAI - 5.48+0.94; NYHAII - 6.71+1.36; NYHAIII - 8.10+1.14; NYHA IV - 8.78+1.01 (F=29.24, p<0.0001). sensitivity - 00.810(95%CI: 0.709-0.911); specificity - 0.814(95%CI: 0.714-0.913); predictive value of negative result 0.814(95%CI:0.714-0.913); Prognostic value of a positive result - 0.810(95%CI:0.709-0.911); Diagnostic accuracy of the test - 0.812(95%CI:0.741-0.883). Conclusions: Serum uric acid values correlate with renal function and heart failure characteristics. The value of uric acid can be used as an additional test to predict the outcome of heart failure.

Diagnostic characteristics of serological tests for the detection of SARS-CoV-2 cases.

To study the diagnostic characteristics of test systems for detecting antibodies to SARS-Cov-2. We studied the diagnostic characteristics of two test systems for detecting antibodies to SARS-Cov-2, registered in the Russian Federation. The first test system is a kit for detecting total antibodies to SARS-Cov-2 using immunochemiluminescence analysis on the «Cobas e 411» analyzer («Roche Diagnostics», Germany). The second test system is a kit for detecting IgM and IgG to SARS-Cov-2 («Core Technology Co., Ltd», China) by immunochromatographic analysis. The biological material for the study was blood serum. We assessed: diagnostic sensitivity, diagnostic specificity, and predictive value of positive and negative results. In the test system for detecting total antibodies to SARS-CoV-2, using an IHLA, the diagnostic sensitivity and specificity were 100%; the predictive value of positive and negative results was 100%. In the test system for the detection of IgM and IgG to Sars-CoV-2, using IHA, diagnostic sensitivity for IgM and IgG were 100%; diagnostic specificity for IgM - 60%, for IgG - 72%; predictive value of a positive result for IgM - 60%, IgG - 68,18%; predictive value of negative results for IgM and IgG - 100%. The best diagnostic characteristics were found in the test system for the detection of total antibodies to SARS-Cov-2, which must be taken into account when deciding whether to purchase test systems for the detection of antibodies to SARS-Cov-2.

CXCL-8 in Preoperative Colorectal Cancer Patients: Significance for Diagnosis and Cancer Progression.

Introduction. Since colorectal cancer (CRC) is the second most commonly diagnosed malignancy in Europe and third worldwide, novel biomarkers for diagnosing the disease are critically needed. Objectives. According to our knowledge, the present study is the first to evaluate the clinical usefulness of serum CXCL-8 (C-X-C motif chemokine 8) in the diagnosis and progression of CRC compared to classical tumor marker CEA (carcinoembryonic antigen) and marker of inflammation CRP (C-reactive protein). Patients and Methods. The study included 59 CRC patients and 46 healthy volunteers. Serum levels of selected proteins were measured using ELISA (enzyme-linked immunosorbent assay), CMIA (chemiluminescent microparticle immunoassay), and immunoturbidimetric methods. Results. Serum concentrations of CXCL-8, similarly to those of the classical tumor marker CEA and inflammatory state marker CRP, were significantly higher in CRC patients than in healthy controls. There were statistically significant differences in CXCL-8 concentrations between tumor stages, as established by the Kruskal–Wallis test and confirmed by the post hoc Dwass–Steele–Critchlow–Fligner test. CXCL-8 levels were also significantly elevated in CRC patients with distant metastases compared to patients in the subgroup without metastases. Diagnostic sensitivity, predictive values for negative results (NPV), and AUC (area under the Receiver Operating Characteristic Curve—ROC curve) of CXCL-8 were higher than those of CEA, while diagnostic specificity and predictive values for positive results (PPV) of CXCL-8 were higher than those of CRP. Conclusions. Our findings indicate greater utility of CXCL-8 in comparison to the classical tumor marker CEA in the diagnosis of CRC. Moreover, serum CXCL-8 might be a potential biomarker of colorectal cancer progression.

Оценка эффективности сцинтиграфии рецепторов соматостатина с 111In-октреотидом в диагностике нейроэндокринных опухолей

Purpose: Exploring methods to improve diagnosis of neuroendocrine tumors (NET) in different locations using somatostatin receptors scintigraphy with 111In-octreotide. Material and methods: The study included 125 patients with NET in different locations. Activity of injected 111In-octreotide was 200–250 MBq (effective dose – 0.054 mSv/MBq), which allows to carry out a planar study as and single photon emission computed tomography. The study was performed after 24 hours on intravenous injection of indicator on the combined SPECT/CT machine Symbia T2 (Siemens, Germany). Results: In the sample of patients, NET distribution by localization is indicated in Fig. 1. The results of the study with 111In-octreotide are presented in the form of scintigrams in the whole body scanning mode and in the form of single-photon emission computer tomograms combined with CT. To determine the effectiveness of scintigraphy with 111In-octreotide, after a visual evaluation of the scintigrams obtained, the number of positive and negative results of the study was calculated. A comparison was made with the data of other methods and the number of TP, TN, FP, and FN results was determined. Further, the characteristic parameters of the method studied were calculated to determine its effectiveness. The study of values of characteristic parameters showed that the sensitivity was 73 % (95 % CI: 63–83 %), specificity – 97 % (95 % CI: 88–100 %) accuracy is 79 % (95 % CI: 71–87 %). The value of the positive predictive value of 99 % (95 % CI: 94–100 %), the predictive value of negative results – 55 % (95 % CI: 40–70 %). While the study shows a high frequency of TP results, while the frequencies of the TN and FN results are not significantly different (the average frequency of the FN results falls within the confidence interval for the frequency of the TN results). The method has a high value of the prognostic value of the positive result, which gives the right to assert about the high probability of the presence of a neuroendocrine neoplasm in obtaining a positive result. In the present study, no FP results were obtained due to the presence of concomitant diseases, in which accumulation of used radiopharmaceutical is possible, since the data on the presence of such diseases were taken into account in the analysis of scintigrams. The data obtained in this paper are in good agreement with the data obtained by other authors, as well as early Russian publications. It is worth noting that the data of domestic authors were obtained on a small sample, without specifying confidence intervals; the injected activity was less than in this study. In addition, the possibility of obtaining more information than using classical imaging methods (for SPECT/CT, the tissue with the pathological accumulation of 111In-octreotide appeared to be intact on CT), allows us to recommend the method as a method of choice in the diagnosis of NET of different localization. Conclusions: The method of somatostatin receptors scintigraphy using domestic analogue of somatostatin in the diagnosis of NET has a high efficiency (efficiency of the method, calculated as the average value of the parameters of sensitivity and specificity of 85 % (95 % CI: 66–100 %).

COMPARISON OF THE DIAGNOSTIC ACCURACY OF MAGNETIC RESONANCE IMAGING AND ULTRASOUND EXAMINATION FOR X-RAY NEGATIVE STAGE OF KNEE JOINTS OSTEOARTHRITIS

Purpose. To compare of the diagnostic accuracy of ultrasonography (US) with magnetic resonance imaging (MRI) as a reference in the assessment of pathological changes of the soft tissues at the X-ray negative stage of knee joint osteoarthritis (OA). Materials and methods. Nineteen patients with X-ray negative stage of knee OA diagnosed in 2015 underwent US and MRI of the knee joints. We estimated the sensitivity and specificity, positive and negative predictive values for pathological changes in 7 distinct anatomical areas on US comparing to MRI. Results. There were no false positive results. The findings of US and MRI coincided for the presence of an excess amount of free fluid in the joint cavity and suprapatellar bursa synovitis and the presence of Baker’s cyst, 15 (79%) and 4 (21%) patients, respectively. More o‡ en, false-negative results on US have been seen in assessing changes in the lateral meniscus and osteophytes: 2 (11%) diagnosed cases vs 15 (79%) for MRI, respectively. The degenerative changes in the medial meniscus were found in 10 (52.6%) on US compared to 15 (79%) for MRI, respectively. Method of US showed the low sensitivity in the detection of early pathological changes of the knee ligaments: sensitivity and predictive value of negative results accounted for the cruciate were 47% and 18%, for collateral ones only 24% and 13%, respectively. Conclusion. Ultrasound examination is highly effective in the diagnosis of synovitis, free fluid in the joint cavity and suprapatellar bursa and Baker’s cysts in patients with X-ray negative stage of knee OA. It helps to identify the group of patients with the highest risk of progression of OA. The method of ultrasound is significantly inferior to MRI in the diagnosis of early degenerative changes in ligaments, the menisci and cartilage of the joint.

O3-12-6 - Prognostic Significance of Procalcitonin in Small Cell Lung Cancer

Background: Procalcitonin (PCT) has been established as a sensitive and specific marker of sepsis and systemic bacterial infection. The increase of PCT in patients with neuroendocrine tumors has also been reported. In this study, we evaluated the diagnostic and prognostic value of PCT in small cell lung cancer (SCLC).Methods: We analyzed PCT levels in 23 patients with SCLC and 26 patients with advanced non-small cell lung cancer (NSCLC) before first-line chemotherapy.Results: The serum levels of PCT in SCLC patients were significantly higher than those in NSCLC patients (P < 0.0001). We use the serum PCT level of 0.05 ng/ml as the cut off value. Fourteen patients (61%) with SCLC had higher level of PCT than the cut off value. By contrast, only 2 patients (8%) with advanced NSCLC showed elevated levels of PCT. The sensitivity, specificity, efficiency, predictive value of positive results and predictive value of negative results to discriminate SCLC from NSCLC are 61%, 92%, 78%, 88% and 27%, respectively. No sign of infection was observed in SCLC patients with elevated level of PCT. There was no significant difference in PCT level between patients with limited disease-SCLC and those with extended disease-SCLC. In SCLC patients with elevated PCT, overall survival was significantly shorter than that in SCLC patients with normal PCT (11.1 months vs. 72.7 months, P = 0.0046). The CR rate in SCLC patients with elevated PCT was significantly lower than that in patients with normal PCT (17% vs. 63%, P = 0.0353).Conclusions: Our findings indicate that PCT is a prognostic biomarker in SCLC patients.

Comparison of Hay’s Criteria with Nugent’s Scoring System for Diagnosis of Bacterial Vaginosis

Although Nugent's criterion is considered as the gold standard for the diagnosis of bacterial vaginosis (BV), the method requires an experienced slide reader and considerable time and skill. In this study, we compared the method of Hay and Ison with Nugent's scoring criteria. Vaginal specimens were collected from a total of 213 women, presenting with or without the symptoms of vaginitis. Diagnosis of BV was done using Nugent' and Hay's method. Sensitivity, specificity, and predictive values for positive and negative test were calculated for Hay's method using Nugent's method as the gold standard. We diagnosed 70 cases (32.86%) of BV by Nugent's method and 87 (40.85%) cases by the Hay's method. Sensitivity, specificity, predictive value of positive result, predictive value of negative result, and Kappa value when evaluating Hay's criteria using Nugent's criteria as the gold standard were ≥97.2%, ≥88.1%, ≥80.4%, ≥97.1%, and ≥0.830, respectively, when Hay's grade II and/or Nugent's intermediate score were considered either as negative or positive or excluded. Using Nugent score for the intermediate group is the most difficult. Hay's method shows good agreement with the gold standard method of Nugent et al. and can be used as an alternative to Nugent's criteria in busy tertiary care hospitals.

ICSH recommendations for identification, diagnostic value, and quantitation of schistocytes

Schistocytes are fragments of red blood cells (RBCs) produced by extrinsic mechanical damage within the circulation. The detection of schistocytes is an important morphological clue to the diagnosis of thrombotic microangiopathic anemia (TMA). Reporting criteria between different laboratories, however, are not uniform, owing to variability of shape and nature of fragments, as well as subjectivity and heterogeneity in their morphological assessment. Lack of standardization may lead to inconsistency or misdiagnosis, thereby affecting treatment and clinical outcome. The Schistocyte Working Group of the International Council for Standardization in Haematology (ICSH) has prepared specific recommendations to standardize schistocyte identification, enumeration, and reporting. They deal with the type of smear, method of counting, morphological description based on positive criteria (helmet cells, small, irregular triangular, or crescent-shaped cells, pointed projections, and lack of central pallor). A schistocyte count has a definite clinical value for the diagnosis of TMA in the absence of additional severe red cell shape abnormalities, with a confident threshold value of 1%. Automated counting of RBC fragments is also recommended by the ICSH Working Group as a useful complement to the microscope, according to the high predictive value of negative results, but worthy of further research and with limits in quantitation.

Analysis of leucocyte populations with the Coulter S-Plus STKR as a screening tool for haematological abnormalities

In two institutions at Rome and Florence we evaluated the clinical sensitivity of two Coulter STKR systems using the NCCLS standard H20-T for leucocyte differential count in a patient population with high prevalence of haematologic abnormalities. Reference ranges of normal leucocytes were obtained on 278 adult subjects. On a population of 455 patient specimens, 200 specimens (44%) were flagged by the STKR because of a distributional abnormality, and 122 (27%) because of a morphological abnormality. Percentage of subtotal agreements between the STKR and the reference manual differential count was 85.4%, with 67.5% full and 20.9% partial agreements. Eight specimens that showed a morphological abnormality with the reference manual differential count were classified as normal by the STKR, with a false normal rate of 6.6%. Analysis of the STKR performance for morphological abnormalities showed acceptable sensitivity (82.0%) and rather low specificity (71.5%), low predictive value of positive results (51.3), high predictive value of negative results (91.5%) and efficiency of 74.3%. The main problems of the STKR differential count were a high rate of false monocyte count, and the misidentification of eosinophilias and low-concentration abnormal cells.

Diagnostic value of urinalysis combine with abdominal ultrasound in diagnosis of renal colic in Jordan

To assess the yield of both urinalysis and abdominal ultrasound in diagnosing renal colic and abdominal pain at King Hassein Medical Centre in Amman, Capital city of Jordan. Methods: Eight hundred and forty three successive patients presented to the emergency room at King Hussein Medical Centre Hospital between August 2004-March 2005 with abdominal pain and flank pain mimicking renal colic. All patients gave complete medical history, and underwent physical examination and urine analysis invesgation for pyuria, hematuria and/or crystalluria. Then they had abdominal ultrasound and 51 patients had plain abdominal radiograph. Urine analysis and abdominal ultrasound examinations were evaluated using 2 x 2 contingency table for sensitivity, specificity, positive and negative predictive values. (Mean age (±SD) was found to be 33.2 ± 11.66 years; (range 15-60). Male: Female ratio was (1.4:1).) There were 72 (8%) abnormal urinalysis (pyurea, hematuria) and 222 (26.3%) abnormal abdominal U/S. Sixty-nine (24.5%) cases were related to urinary tract and prostate. Nephrolithiasis dominated the ultrasonic findings (44.9%) followed by hydronephrosis (33.3%), small kidneys in 5.8%, prostate pathology, 4.3%, double kidneys, nephrectomy and renal cyst in 2.9% each. Adult polycystic kidney disease and horseshoe kidneys constituted (1.5%). Non-renal ultrasonic findings included gall bladder stones found in two patients, epigastric mass, intrapelvic mass in one female nd hepatosplenomegaly in one patient. Combined urine analysis and ultrasound had a sensitivity of 12% (95% CI: 4-19) and specificity of 92% (95% CI: 89-96). Positive predictive value was 33% (95% CI: 14-52). While combined ultrasound and kidney, urinary bladder had a sensitivity of 83% (95% CI: 62-104) and a specificity of 60% (95% 17-103). The predictive value for positive results was 83% (95% CI: 62-104) and the predictive value for negative results was 60% (95% CI: 17-103). Nephrolithiasis and hydronephrosis constutute the major causes of renal colic in Amman/Jordan. Keywords: renal colic, Amman-Jordan, ultrasound, urinalysis, sensitivity, specificity Mary Slessor Journal of Medicine Vol. 5 (1), 2005: 57-60

The Comparative Advantage of Plain Radiography in Diagnosis of Obstruction of the Small Intestine in Dogs

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Uriscreen, a rapid enzymatic urine screening test: useful predictor of significant bacteriuria in pregnancy

To establish the reliability of a new rapid enzymatic screening test, the Uriscreen, in the detection of significant bacteriuria in pregnancy. During a 6-month period, from July 1 to December 30, 1993, 313 consecutive pregnant patients were evaluated. Randomly voided, midstream, clean-catch urine specimens were used. Each sample was tested by routine laboratory culture and four rapid screening tests: the nitrite and leukocyte esterase dipstick, microscopic examination for pyuria, and the Uriscreen test. Results of the four rapid tests were compared with those of the urine culture. Twenty-four women (7.6%) had urine culture results indicating significant bacteriuria. The sensitivity of the nitrite test, the leukocyte esterase test, and a microscopic examination for pyuria was low (37, 52, and 56%, respectively). The Uriscreen test showed very high sensitivity (100%), lower specificity (81%), a high predictive value of negative results (100%), and a low positive predictive value (30%). The Uriscreen test is a reliable alternative to culture screening of all pregnant patients. A policy of performing a urine culture during pregnancy only on patients with a positive Uriscreen test will save as much as 80% of unnecessary cultures.

Positive thyroid cancer scintigraphy using technetium-99m methoxyisobutylisonitrile.

The aim of the study was to evaluate the possibility of detecting thyroid cancer recurrences without the need for withdrawal of thyroid suppressive treatment. Upper-body or whole-body scintigraphy was performed in a group of 200 patients evaluated for differentiated thyroid cancers in 1993 and 1994 using technetium-99m sestamibi. Scans were performed 20-30min following i.v. administration of 500MBq of 99mTc-methoxyisobutylisonitrile (MIBI). Bone and lung metastases were detected with very high sensitivity and specificity, with a very high predictive value of negative results and a somewhat lower predictive value of positive results. The sensitivity and specificity of findings in the neck were lower but the predictive value of negative results was high. Whole-body scans with 99mTc-MIBI are a useful tool in the follow-up of patients with differentiated thyroid cancer, for the detection of distant metastatic lesions.

Comparative evaluation of a latex agglutination test for the detection and presumptive serogroup identification of Salmonella spp.

The Wellcolex Colour Salmonella Test (WCST) is a rapid latex agglutination test designed to detect Salmonella antigens in stool enrichment broth cultures or from plate cultures. As the reagents are mixtures of suspensions of red, blue, and green latex particles, serogroup identification can be achieved in a single test. The results of the WCST using overnight selenite broth cultures were compared with standard culture results. A total of 702 stool samples were evaluated in this study. Thirty-nine Salmonella strains (5.5%) were isolated while 50 positive results were obtained with the WCST reagents. In 14 other cases, the latex test could not be interpreted because of doubtful agglutination. Excluding these cases, the specificity of the WCST was 98% and the percentage agreement between the WCST and teh culture rsults was 98%. The predictive value of a positive test was 78%. Of particular note, the predictive value for negative results was 100% showing that the WCST can be used to effectively predict those samples which do not need further workup. The color change (red, blue, green) is easy to observe and can identify 6 serogroups (A–E and G). We conclude that the WCST provides a simple and rapid procedure for detection and presumptive serogroup identification of Salmonella spp. in enrichment broths.

Comparison of an enzyme immuno assay (Antigenz Chlamydia) with cell culture for the detection of genital chlamydial infection in high and low risk populations.

To evaluate a new enzyme immuno assay, Antigenz Chlamydia, for the detection of chlamydial antigen in urogenital samples using cell culture as the gold standard for comparison and direct immuno fluorescence to aid resolving the discrepancies. 212 men and 303 women attending an STD clinic and 404 women of child bearing age attending gynaecological clinics. Sensitivity, specificity, predictive value of positive result and predictive value of negative result of the new test were 77.6%, 99.0%, 94.3%, and 95.7% respectively in the high risk population with a prevalence of 16.5%. In the low risk population the figures were 84.2%, 94.5%, 43.2% and 99.2% respectively with a prevalence of 4.7%. Antigenz Chlamydia is an easy and quick test to perform. The test is suitable for use in high risk and low risk populations provided all positive samples are confirmed.

The acute response of left ventricular filling dynamics to intravenous verapamil predicts the changes in exercise tolerance after oral verapamil therapy in patients with hypertrophic cardiomyopathy.

We studied the correlation between changes in left ventricular filling dynamics induced by acute intravenous administration of verapamil and the changes in exercise tolerance induced by oral administration of the agent in 30 patients with hypertrophic cardiomyopathy. Diastolic cardiac function was measured by means of a nuclear stethoscope before and 10 min after intravenous administration of verapamil, 0.15 mg.kg-1 over 2 min. Treadmill exercise tests using a modified Bruce protocol were performed before the initiation of oral verapamil treatment and after 4 weeks of oral therapy at a dose of 320-360 mg.day-1 (mean +/- SD 332 +/- 17 mg.day-1). Peak filling rate (PFR) increased in 21 patients, 18 of whom (86%) also had an increase in exercise duration, PFR showed no increase in nine patients, eight of whom (89%) had no change in exercise duration (sensitivity 95%, specificity 73%, predictive value of the positive result 86%, predictive value of the negative result 89%). Acute changes in time from the beginning of rapid filling to PFR (t-PFR) and in left ventricular end-diastolic volume (EDV) were less useful in predicting improvement in exercise tolerance. In 19 patients the changes in PFR and EDV paralleled. Twelve of the 13 patients (92%) with an increase in both parameters also had an increase in exercise duration, whereas all six in whom these parameters were reduced showed no increase in exercise duration (sensitivity 100%, specificity 86%, predictive value of positive results 92%, and predictive value of negative results 100%).(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitative assessment of transient left ventricular asynergy in coronary artery disease

The purpose of this study was to determine the diagnostic value of quantitative two-dimensional echocardiography during transesophageal atrial pacing in assessing the presence and severity of coronary artery disease. Apical four- and two-chamber views were registered at rest and at different pacing rates. Computerized quantitative evaluation of left ventricle wall motion was performed. On the basis of left ventricle wall motion analysis data of 22 individuals with no coronary pathology, as assessed by angiography and with negative exercise ECG and transesophageal atrial pacing ECG test, nomograms for assessment of wall motion abnormalities and for calculation of asynergy area as a measure of wall motion abnormality extent were obtained. The method revealed new transient wall motion abnormalities during pacing or exacerbation of old ones present at rest in 83 of the 89 patients with angiographically proven coronary artery stenosis greater than or equal to 70% and in 3 of the 32 controls with no changes in their coronary angiograms. Thus, it showed high sensitivity (93%), specificity (91%), predictive value of positive result (96%), predictive value of negative result (83%), and efficiency of the test (93%). These values appeared to be higher than those calculated for transesophageal atrial pacing ECG, recorded simultaneously with echocardiographic images (81, 87, 95, 62, and 83%, respectively) and for exercise ECG test which was performed in 66 coronary patients and in 29 controls (68, 86, 92, 54, and 74%, respectively). The extent of pacing-induced left ventricular regional wall motion abnormalities appeared to be directly correlated to the extent of coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Utility of frozen-section evaluation of lymph nodes in the staging of bronchogenic carcinoma at mediastinoscopy and thoracotomy

We conducted a retrospective analysis of the utility of frozen-section diagnoses in determining lymph node status at mediastinoscopy in 122 consecutive patients with bronchogenic carcinoma. Thirty-five of 122 patients had one or more lymph nodes with frozen-section evaluation positive for metastatic carcinoma. Subsequent nodal sections not in the original frozen-section study revealed metastatic carcinoma in two additional patients. The false-negative rate was 1.6%. Sensitivity was 94.6%. Predictive value of negative frozen-section evaluation results was 97.7%. Because there were no false-positive frozen-section results, specificity and predictive value for positive results of frozen-section evaluation were 100%. The statuses of individual lymph nodes from these 122 patients were also evaluated. Six hundred twenty lymph nodes were sampled from the mediastinum at mediastinoscopy. Frozen-sections in 47 lymph nodes were positive. Subsequent nodal sections not in the original frozen-sections examination revealed metastatic carcinoma in four additional lymph nodes. The false-negative rate was 0.6%. Sensitivity was 92.2%. Predictive value of negative results from frozen-section evaluation was 99.3%. Because there were no false-positive frozen-section results, specificity and predictive value for positive results of frozen-section examination were 100%. We conclude that frozen-section evaluation of lymph nodes at mediastinoscopy reliably indicates lymph node status, thus enabling the physician to decide whether to proceed to thoracotomy. Thus staging of the carcinoma and definitive surgery can be accomplished during a single anesthetic procedure. Combining mediastinoscopy and thoracotomy with frozen-section diagnostic control also reduces both the length and cost of hospitalization.

Fine-needle aspiration of breast lesions: role and accuracy in a review of 7,495 cases.

In the past 10 years, 7,495 cytological breast fine-needle aspirations (FNAs) were performed (4,756 FNAs of solid nodes and 2,739 of cystic nodes). Of these, 2,099 cases underwent surgery; 650 (31%) had histologically proven carcinoma. Sensitivity was 83.9%, specificity was 99.5%, the predictive value for negative results was 93.2% and for positive results was 98.6%, and the accuracy was 94.6%. Inadequate (13.3%) and doubtful samples (8.1%) were excluded from calculation. False-negative results (82 cases) mainly resulted from sampling errors. False suspicious results (six cases) lessened with increasing experience in breast pathology and with the application of strict diagnostic criteria, but most likely they will never reach zero. Frozen-section diagnosis could be bypassed only in selected cases. Guidelines on the role of FNA in management of solid breast lesions are given. FNA deserves further evaluation in diagnosing early stages of breast carcinoma: sensitivity was 7.5% in 57 carcinomas in situ, 67.5% in 55 minimally invasive carcinoma, and 92.7% in 538 nonminimally invasive carcinomas.