Previous Diagnostic Procedures Research Articles

P1.03-050 Outcomes after the Decision to Biopsy: Results from a Nurse Practitioner Run Multidisciplinary Lung Cancer Screening Program

Lung cancer screening programs are increasing in popularity after results from the National Lung Screening Trial demonstrated improvement in mortality after screening with low dose computed tomography. Current guidelines recommend the availability of multidisciplinary care and evaluation; however, reported outcomes from multidisciplinary team decision making to proceed with diagnostic sampling in lung cancer screening remains sparse. A retrospective review of patients enrolled in the Swedish Cancer Institute Lung Cancer Screening Program from January 2013 to March 2016 was performed. The program is run by an independently practicing nurse practitioner, with a multidisciplinary team consisting of radiologists, interventional pulmonologists, and thoracic surgeons. Positive screening results (nodules >6mm) with the potential need to pursue diagnostic sampling were reviewed in a multidisciplinary fashion. Basic demographics and procedural outcomes after the decision to biopsy were obtained. A total of 516 patients were enrolled within the lung cancer screening program from 2013 – 2016. Nodule(s) >6mm were identified in 164 (31.8%) patients. Subsequently, 25 (4.8%) patients underwent some form of invasive testing. The mean age of this population was 66.2 (SD-6.7) years with 56% (14/25) being female and mean pack years of 50.8 (SD-19.5). Percutaneous needle aspiration (n=11), endoscopic sampling (n=10), and surgical biopsy/resection (n=4) were performed as the first invasive diagnostic procedure. The outcomes of this initial sampling were cancer (n=15), non-diagnostic (n=7), benign (n=2), and infection (n=1). Three patients without an initial diagnosis underwent additional non-surgical biopsy attempts. Overall, surgical resection was performed in twelve patients (6 after previous diagnostic procedure, 2 after previous non-diagnostic procedure, and 4 as initial procedure). Final outcomes were cancer (n=16), non-diagnostic procedure (n=4), non-caseating granulomatous inflammation (n=2), benign diagnosis after wedge resection (n=2), and infection (n=1). Within a nurse practitioner led, multidisciplinary, lung cancer screening program, a small proportion of patients undergo invasive diagnostic testing, despite a rather high prevalence of potentially actionable nodules. Within the NLST population receiving computed tomography, 6.1% underwent invasive testing with 43% undergoing testing that ultimately did not result in a cancer diagnosis. Within our multidisciplinary program, 4.8% underwent invasive testing with 36% undergoing testing not ultimately resulting in a cancer diagnosis. The utilization of multidisciplinary teams during the biopsy decision-making process may help decrease the number of non-diagnostic procedures. Further research is needed to help identify tools that improve patient selection for invasive testing in lung cancer screening programs.

Development and Application of Loop-Mediated Isothermal Amplification Assay for Rapid Detection of Fusarium Oxysporum f. Sp. lycopersici

A reliable and rapid pathogen detection protocol, for the first time, that utilizes colorimetric loop-mediated isothermal amplification (LAMP) was developed for detection of Fusarium oxysporum f. sp. lycopersici. In this regard, all six LAMP primers (i.e. F3, B3, FIP, BIP, LF and LB), together with PCR primers (F and R) were designed on the basis of the 28s ribosomal RNA gene (GenBank accession number: HM057281.1) of the fungi genome. Even though PCR and LAMP assays could successfully detect positive infected samples, considering the time, safety, cost and simplicity, the latter was overall superior. Furthermore, the results demonstrated that the LAMP assay was 100-fold sensitive and 4-fold faster compared to PCR. Interestingly, LAMP reaction could successfully detect Fusarium oxysporum f. sp. lycopersici without DNA purification (direct-LAMP). Meanwhile, among six visual dyes used to detect LAMP products, hydroxynaphthol blue, GeneFinderTM and SYBR Green I could produce long stable color change and brightness in a close tube-based approach, to prevent cross-contamination risk. Altogether, as LAMP is sensitive, cost effective, fairly user friendly, and also can generate more accurate results than previous diagnostic procedures, such as serological methods, PCR and other molecular methods, we accordingly propose this colorimetric assay as a highly reliable alternative fungi recognition system regarding Fusarium oxysporum f. sp. lycopersici recognition, and probably other fungi-based diseases.

Immunocapture Loop Mediated Isothermal Amplification for Rapid Detection of Tomato Yellow Leaf curl Virus (TYLCV) without DNA Extraction

To diminish the time required for some diagnostic assays including polymerase chain reaction (PCR), loopmediated isothermal amplification (LAMP; due to mainly DNA extraction step) and also DAS-ELISA into a minimum level, an innovative immunocapture LAMP (IC–LAMP) and immunocapture PCR (IC-PCR) protocol on the basis of Tomato Yellow Leaf curl Virus (TYLCV) genome were used and optimized. Even though DAS-ELISA, IC-PCR and IC–LAMP assays could successfully detect positive infected plant samples, considering the time, safety, sensitivity, cost, no need of DNA extraction and simplicity the last one was overall superior. The hydroxynaphthol blue could produce long stable colour change and brightness in a close tube-based approach to prevent cross-contamination risk. Altogether, as IC–LAMP is sensitive, cost effective, fairly user friendly and also can generate more accurate results than previous diagnostic procedures, we accordingly propose this assay as a highly reliable alternative viral recognition system regarding TYLCV recognition and probably other viral-based diseases.

Elevated factor VIII level and stroke in patients without traditional risk factors associated with cardiovascular diseases

IntroductionHemostasis is affected by interactions between physiological processes, including those connected with the coagulation system, whose essence is converting fibrinogen into fibrin. The role of factor VIII (FVIII) consists in activating factor X, which directly participates in the generation of thrombin, which is able to produce stable fibrin, which in turn forms blood clots. There are divergent opinions regarding the significance of high levels of FVIII in stroke pathogenesis.AimThe aim of our study was to evaluate FVIII activity in individuals with cryptogenic stroke in order to determine a potential relationship between it and cerebral ischemia.Material and methodsNine patients suffering with stroke were used in this study: six women and three men aged 49–63 years. In all of the patients, the presence of known and potential risk factors for stroke had been excluded during previous diagnostic procedures. These patients accounted for 1.2% of the 719 people who suffered a stroke and were hospitalized in 2011 at the Stroke Unit. FVIII activity was examined in each of the nine qualified subjects within 1–2 months of the occurrence of stroke (the first test) and repeated (the second test) in five patients with abnormal results obtained from the first examination.ResultsIncreased activity of FVIII was found in 5 out of 9 patients. In patients with abnormal results, elevated FVIII was found in follow-up examinations in the 8th–10th month following stroke. Hemodynamic abnormalities in carotid or cerebral artery (presence of thrombus) were found in 3 of the 5 patients with increased FVIII levels. In the first 24 hours following stroke the neurological state of patients with abnormal FVIII was worse than individuals with normal FVIII activity. The patients with abnormal FVIII levels were found to be more disabled in the examination of self-dependence on the 90th day after stroke.ConclusionWhen searching for the causes of stroke, it is worth examining the coagulation system, including FVIII concentration, the abnormality of which may play a significant part in brain ischemia. More research is needed to determine the relationship between abnormal FVIII activity and stroke.

Underdiagnosis of obstructive sleep apnoea syndrome in patients with type 2 diabetes in France: ENTRED 2007

AimThis study estimated the prevalence of symptoms evocative of obstructive sleep apneoa (OSA) in patients with type 2 diabetes and the proportion of those with evidence of a previous diagnosis or diagnostic procedure. MethodsIn ENTRED 2007, 8926 people reimbursed for at least three antidiabetic agents within the last 12 months were randomly selected, and 3894 answered a self-administered questionnaire. Symptoms evocative of OSA were defined as frequent snoring with excessive daytime sleepiness and/or witnessed sleep apneoa. Patients were considered to have evidence of a previous diagnostic procedure if they reported an OSA diagnosis or had a sleep recording done, or if a sleep recording was found in the hospital discharge or medical claims database, or if they were currently being treated with nocturnal ventilation. ResultsThe patients’ mean age was 66 years. Around 8.5% reported being diagnosed with OSA, 4.2% were treated with nocturnal ventilation and 16% had symptoms evocative of OSA. Being male, obesity, high blood pressure, insulin treatment, living with a partner, lower educational level and financial difficulties were all associated with symptoms suggestive of OSA. Overall, 13% had evidence of a previous diagnostic procedure, and the rate was 35% among those with symptoms evocative of OSA. ConclusionOSA is underdiagnosed in French diabetic patients, while the prevalence of symptoms is high. Only 13% of the study population and 35% of those with symptoms suggestive of OSA had benefited from a diagnostic procedure. It is of the utmost importance to better diagnose OSA in the diabetic population.

Assessment of Performance Ability of Three Diagnostic Methods for Detection of Potato Leafroll Virus (PLRV) Using Different Visualizing Systems

To diminish the time required for some diagnostic assays including reverse transcription PCR (RT-PCR), reverse transcription loop-mediated isothermal amplification (RT-LAMP; due to mainly RNA extraction step) and also DAS-ELISA into a minimum level, an innovative immunocapture RT-LAMP (IC-RT-LAMP) and immunocapture reverse transcription (IC/RT-PCR) protocol on the basis of Potato Leafroll virus (PLRV) genome were used and optimized. In this regard, all six IC-RT-LAMP primers (i.e. F3, B3, FIP, BIP, LF and LB) together with IC/RT-PCR primers were designed on the basis of the highly conserved sequence (ORF3) of coat protein gene (GenBank accession number: U73777) of PLRV genome. Even though DAS-ELISA, IC/RT-PCR and IC-RT-LAMP assays could successfully detect positive infected plant samples, considering the time, safety, sensitivity, cost and simplicity, the last one was overall superior. Meanwhile, among five different visual dyes to accurately detect IC-RT-LAMP products, both hydroxynaphthol blue and GeneFinder™ could produce long stable colour change and brightness in a close tube-based approach to prevent cross-contamination risk, concluded eventually as the best ones. Altogether, as IC-RT-LAMP is sensitive, cost-effective, fairly user friendly and also can generate more accurate results than previous diagnostic procedures, we accordingly propose this colorimetric assay as a highly reliable alternative viral recognition system regarding PLRV recognition and probably other viral-based diseases.

Diagnostic yield and safety of capsule endoscopy

the capsule endoscopy (CE), from his approval, has become a first line diagnostic procedure for the study of the small bowel disease. The aim of this study is to report our experience since the implantation of this technique in our hospital. retrospective review of the CE undertaken in Department of Endoscopy. There was gathered in every case the age, sex, motive of consultation, previous diagnostic procedures, capsule endoscopy findings and complication of the technique. One took to end a descriptive and analytical analysis. there was achieved a total of 416 explorations in 388 patients. The obscure gastrointestinal bleeding was the most frequent indication (83.30%) followed by suspected Crohn s disease (7.5%). Angiodisplasia was the endoscopic lesion more frequently detected (42.2%), especially, in patients with digestive bleeding of obscure origin (OR 3.13 p < 0.001), followed by the flebectasia (10.6%) and the ulcer suspicious of Crohn s disease (9.9%). The global diagnostic yield as for the detection of injuries was 77.34% with a case of "not defecation of the capsule" and therefore need of laparotomy. the capsule endoscopy is a technique consolidated and as his potential is known, his indications are extended. The obscure gastrointestinal bleeding is the most frequent indication and the angiodisplasia the most identified injury. Once known his diagnostic yield, larger studies are needed that assess the influence of capsule endoscopy on clinical outcoumes.

Charakterisierung von Lebertumoren durch kontrastverstärkte Sonographie und digitale Graustufenbestimmung

Ziel: Die Charakterisierung verschiedener Lebertumoren ist von therapeutischer und prognostischer Relevanz und war bereits Ziel diverser Studien. Die Sonographie bietet zwar die Möglichkeit, Lebertumoren ohne die Verwendung von Röntgenstrahlen zu detektieren, mit den bisherigen Techniken ist eine sichere Artdiagnose jedoch selten möglich. Ziel der Studie war die klinische Evaluierung der kontrastverstärkten Sonographie und der anschließenden quantitativen digitalen Bildanalyse bei Patienten mit fokalen Leberläsionen. Methodik: In einer prospektiven Studie wurde bei 50 Patienten mit computertomographisch (n = 47) oder magnetresonanztomographisch (n = 3) gesicherten Lebertumoren eine Sonographie des Oberbauchs in nativer Technik und in Phaseninversionstechnik mit intravenöser Gabe des schwefelhaltigen Ultraschallkontrastmittels SonoVue® durchgeführt. Zu festgelegten Zeitpunkten nach Kontrastmittelgabe wurde ein digitales Standbild gespeichert und für die jeweilige Läsion der Signalverlauf über die Zeit semiquantitativ ermittelt. Als Goldstandard dienten die Ergebnisse von Resektion (n = 17) und Punktionsergebnis (n = 19) sowie der weitere klinische Verlauf (n = 14). Ergebnisse: Während sich die korrekte artdiagnostische Zuordnung in der CT/MRT auf 78 % belief, konnte sie von 60 % in der nativen Sonographie auf 86 % nach kontrastverstärkter Sonographie gesteigert werden. Für die Tumorentitäten ergaben sich in der digitalen Graustufenbestimmung typische Kurvenverläufe, wobei sich die Zeitpunkte 20 s und 100 s p. i. für die Differenzierung einzelner Entitäten als optimal erwiesen. Schlussfolgerung: Die Quantifizierung der signalverstärkten Sonographie stellt eine Ergänzung der bisherigen Diagnostik von Lebertumoren und einen Schritt in Richtung einer untersucherunabhängigen Charakterisierung der Herde dar und sollte in weiteren Studien evaluiert werden.

Charakterisierung von Lebertumoren durch kontrastverstärkte Sonographie und digitale Graustufenbestimmung

The characterization of different liver tumors is of therapeutic and prognostic relevance and has been the purpose of several studies. Although ultrasound offers the opportunity to detect hepatic tumors without ionizing radiation, its previous techniques did not lead toward a definitive differentiation of different tumor entities. The purpose of this study was the clinical evaluation of contrast enhanced ultrasound followed by quantitative digital analysis in patients with focal hepatic tumors. In a prospective study, 50 patients (18 females, 32 males, age 28 to 83 years, mean age 59.4 years) with liver tumors previously detected by CT (n = 47) or MRI (n = 3) were examined by ultrasound of the upper abdomen using conventional technique and phase inversion technique after intravenous application of sulfur-based contrast enhancer SonoVue. At scheduled intervals after application of the contrast enhancer, a digital image was stored and the characteristic signal course of each lesion determined semiquantitatively. The gold standard was either resection (n = 17), percutaneous needle biopsy (n = 19) or the clinical course (n = 14). While the percentage of tumors correctly characterized by CT/MRI amounted to 78 %, the percentage increased from 60 % using conventional ultrasound to 86 % using contrast enhanced ultrasound including grey-scale analysis. Typical graphs were achieved for different tumor entities on digital grey-scale analysis. The optimal intervals for the differentiation of particular entities were 20 and 100 seconds after injection. Quantification of contrast enhanced ultrasound is an addition to the previous diagnostic procedure in hepatic tumors. It offers the possibility of an investigator-independent characterization of lesions and should be evaluated in further studies.

Improved Estimate of the Magnetic Field in a Prominence

We present new results on the inversion of spectropolarimetric data of the He I D3 line in a prominence. These data were taken with the High Altitude Observatory Stokes II polarimeter on 1980 August 5. Full Stokes profiles in I, Q, U, and V were recorded at 13 locations of a prominence at the northeast limb. This prominence erupted 3 hr later, giving rise to the day of year 218 Solar Maximum Mission coronal transient. The data were originally analyzed in a paper by Querfeld et al. Here we analyze the data using the new inversion algorithm proposed by Lopez Ariste & Casini based on pattern recognition techniques. This method employs full Stokes profiles, and in tests on synthetic data, it proved to be much more precise than previous diagnostic procedures. When applied to the Stokes data of the prominence under study, it gives magnetic field strengths at least 2 times larger than previous estimates.

The method used to sample ulcers influences the diagnosis of cutaneous leishmaniasis

Before beginning treatment for cutaneous leishmaniasis, parasitological confirmation of the disease is required. The most commonly used diagnostic procedures are microscopy and culture of samples taken from the active edge of the lesion. In this study, we compared the sensitivity of previous diagnostic procedures with the polymerase chain reaction (PCR), using smears taken from the edge of the lesion and its centre. The sensitivity was greater with smears taken from the centre of the lesion, both for microscopical examination (85%) and for PCR (81%), compared to those obtained from the edge of the lesion (69% and 58% respectively). When PCR was carried out on biopsy material from the edge of the lesion the sensitivity was 63%.

Non-visualization of sentinel lymph node in patients with breast cancer.

Histological evaluation of the first draining lymph node (sentinel node) in the axilla of patients with breast cancer has dramatically altered the surgical approach to these patients, with sparing of the axilla if no tumour cells are identified. In a fraction of patients imaged after peri-tumoural injection of the breast, there is no visualization of the sentinel node. We retrospectively analysed the status of patients whose nodes were visualized and of patients whose nodes failed to visualize, to define the variables associated with non-visualization of the sentinel node. Seventy-four breast cancer patients were imaged following peri-tumoural injection of filtered 99Tc(m)-sulfur colloid, immediately and up to 5.5 h post-injection. The scintigraphic data were analysed with reference to the patient's age, histology, grade, site and size of tumour, previous diagnostic procedure and time interval to scan, using univariate analysis and a logistic regression model. A sentinel node was visualized in 53 of 74 women (72%). Comparison of patients with non-visualized versus visualized sentinel nodes disclosed no statistically significant univariate relation to age of the patients (P = 0.10), size of tumour (P = 0.46), site (P = 0.26), histology [invasive ductal carcinoma in 16 of 20 (80%) non-visualized cases, and in 43 of 53 (81%) visualized patients], prior excision biopsy (P = 0.36) and time interval to surgery (P = 0.29). Tumour grade was the only significant variable on univariate analysis (P = 0.03), though multivariate analysis showed that none of the independent parameters were statistically significant. In 39 patients with an upper outer quadrant tumour, the location of the sentinel node was not limited to the axilla and even crossed the midline of the breast. Our results show that none of the independent variables is associated with non-visualization of sentinel lymph node on preoperative lymphoscintigraphy of patients with breast cancer, though the tumour grade may have contributed to non-visualization of this node. The non-axillary drainage from upper outer quadrant tumours suggests the routine use of lymphoscintigraphy prior to axillary dissection.