Specificity Of Ultrasonography Research Articles

Diagnostic Accuracy of Mammography and Ultrasonography Screening for Breast Cancer in Pregnant and Lactating Women

Breast cancer was of significant health concern affecting women worldwide. Objective: To assess diagnostic accuracy of mammography and ultrasonography in differentiating malignant and benign breast lesions in pregnant and lactating women. Methods: A cross sectional retrospective study was conducted at Radiology department of Shahida Islam Medical Complex, Lodhran from May 2023 to April 2024. A sample size of 242 females was calculated. Electronic medical records were reviewed for radiological examination including screening ultrasound and mammography. All those pregnant and lactating females on which ultrasound and mammograms were performed were included. SPSS version 23.0 was used for data analysis. Diagnostic accuracy of both ultrasound and mammography were calculated in terms of malignant or benign and sensitivity and specificity. Mann-Whitney U test was applied between mammography, ultrasonography and BI-RADS categories. Results: Of 242 females, 110 underwent mammography and 132 underwent ultrasound. Negative mammography was observed in 71 females in which at biopsy, 24 were benign. Negative ultrasound with only benign lesion was seen in 68 females and 10 of which were confirmed at biopsy. Specificity of ultrasonography was 100 %, sensitivity 85.7 %, positive predictive value of 100 % while negative predictive value of 25 %. Specificity of mammography was 100 %, sensitivity 92.3 %, positive predictive value of 100 % while negative predictive value of 42.8 % (p<0.001). Conclusions: Although both ultrasound and mammography were found to be specific, use of mammography was considered better in terms of sensitivity and diagnostic accuracy.

Diagnostic value of ultrasonography for injury of anterior talofibular ligament and anterior inferior tibiofibular ligament distal fascicle in patients with ankle fractures.

To explore the diagnostic value of ultrasonography for injuries of anterior talofibular ligament (ATFL) and anterior inferior tibiofibular ligament distal fascicle (ATiFL-DF) in patients with ankle fractures. Clinical data of 51 patients with ankle fractures who were clinically suspected of ligament injuries and underwent ankle ultrasonography examination and arthroscopy in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from April 2019 to March 2023 were retrospectively analyzed. Using arthroscopic results as the gold standard, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasonography in diagnosing ATFL and ATiFL-DF injuries were evaluated, and Kappa consistency test was performed. The sensitivity and specificity of ultrasonography in diagnosis of ATFL injury were 100.0% and 92.3%, with the PPV of 92.6% and NPV of 100.0%. Ultrasonography findings exhibited excellent concordance with arthroscopic results (kappa=0.849). The sensitivity and specificity of ultrasonography in diagnosis of ATiFL-DF injury was 86.7% and 33.3%, with the PPV of 90.7% and NPV of 25.0%. However, the consistency between ultrasonography and arthroscopic results was poor (kappa=0.168). Ultrasonography is reliable in assessing injuries of ATFL in patients with ankle fractures, but its specificity in diagnosing ATiFL-DF is poor. Therefore, ankle arthroscopy remains necessary for ankle fracture patients with negative findings of ATiFL-DF in ultrasonography.

The Diagnostic Utility of Biochemical Markers and Intestinal Ultrasound Compared with Endoscopy in Patients with Crohn's Disease and Ulcerative Colitis: A Systemic Review and Meta-Analysis.

Background: Inflammatory bowel disease (IBD) consists of Crohn's disease (CD) and Ulcerative colitis (UC). The main goal of treatment is to obtain mucosal healing via endoscopy. More recently, intestinal ultrasounds, along with biochemical markers, have been increasingly popular as point-of-care testing to monitor treatment response. This systemic review and meta-analysis aimed to assess the diagnostic test performance of ultrasonography and biochemical markers (C-reactive protein and fecal calprotectin) compared with endoscopy for detecting inflammation in IBD. Methods: A comprehensive literature search was conducted using PubMed Medline, EMBASE, ScienceDirect, and CINAHL from 1 January 2018 to 1 January 2024. The included studies were prospective and retrospective observational studies, clinical trials, and cross-sectional studies investigating the diagnostic sensitivity and specificity of ultrasonography, biochemical markers, and endoscopy. Studies were selected based on the Preferred Reporting Items for Systematic Review and Meta-analysis Statement (PRISMA). Results: Of the 1035 studies retrieved, 16 met the inclusion criteria, and most of the included studies were prospective observational studies. Diagnostic test accuracy was conducted, and the pooled sensitivity and specificity of all the studies revealed that ultrasonography has the highest pooled sensitivity, at 85% (95% CI, 78 to 91%), and specificity, at 92% (95% CI, 86 to 96%), as compared with biochemical markers and endoscopy. More specifically, biochemical markers had a pooled sensitivity and specificity of 85% (95% CI, 81 to 87%) and 61% (95% CI, 58 to 64%), respectively, and endoscopy had 60% (95% CI, 52 to 68%) and 82% (95% CI, 76 to 87%), respectively. However, the results also show substantial heterogeneity in the studies because of various populations, protocols, and outcomes in the studies included. This was especially noted in the assessment of biochemical markers, in which a metaregression was performed showing a nonsignificant p-value of 0.8856 for the coefficient. Conclusions: IUS was found to have the highest pooled sensitivity and specificity of all the included studies for diagnosing inflammation in patients with CD and UC, and this, coupled with biochemical markers, can improve diagnostic utility.

Evaluation of high-frequency ultrasonography for diagnosis of carpal tunnel syndrome.

The aim of this study was to assess the sensitivity and specificity of ultrasonography in the diagnosis of carpal tunnel syndrome. The cross-sectional area of the median nerve at the carpal tunnel for a positive diagnosis had a sensitivity of ∼ 98.6% but a specificity of 60%. The measure of the difference in cross-sectional area of the median nerve at the carpal tunnel and at the level of pronator quadratus had much better sensitivity and specificity of 97.1% and 80%, respectively. Signs of nerve flattening, palmar bowing and increased nerve vascularity were valuable in confirming the diagnosis. A positive predictive value of ultrasonography was found to be > 95% and a negative predictive value was ∼ 66% for a diagnosis of carpal tunnel syndrome. Ultrasonography is, therefore, an effective diagnostic tool in this regard.

Comparison of Ultrasound and MRI in Detecting Breast Cancer: A Retrospective Study in Mumbai Hospitals, India

Introduction: Breast cancer is the most common cancer in women throughout the world. Early detection of breast cancer is very important to increase the chances of cure. Ultrasonography (USG) and magnetic resonance imaging (MRI) are two imaging methods commonly used to detect breast cancer. The aim of this study was to compare the accuracy of ultrasound and MRI in detecting breast cancer in female patients at Mumbai Hospital, India.
 Methods: A retrospective study was conducted on 2435 female patients who underwent ultrasound and MRI examinations at Mumbai Hospital, India between 2018 and 2023. Patient data was collected from electronic medical records and analyzed to compare the accuracy of ultrasound and MRI in detecting breast cancer.
 Results: The research results show that MRI is more accurate than ultrasound in detecting breast cancer. MRI sensitivity was 95.2%, while ultrasound sensitivity was 78.3%. The specificity of MRI was 98.7%, while the specificity of USG was 94.3%. The positive predictive value of MRI was 95.2%, while the positive predictive value of USG was 87.5%. The negative predictive value of MRI was 98.7%, while the negative predictive value of USG was 94.3%.
 Conclusion: MRI is recommended as the primary imaging method for detecting breast cancer in female patients. Ultrasound can be used as a complementary method to MRI.

Thyroid nodule diagnosis: A comparative analysis of ultrasonography and fine-needle aspiration cytology

Objectives: This paper aimed to investigate the association between Ultrasonography (USG) results and fine-needle aspiration cytology (FNAC) in the diagnosis of thyroid nodules (TNs) in private and public hospitals in Yemen. In addition, it aimed to determine the sensitivity, specificity of USG and FNAC in diagnosing thyroid nodules (TNs). Materials and Methods: The study utilized a retrospective comparative study design, analyzing medical records of patients diagnosed with TNs between June 01, 2022 and May 01, 2023, in four private and public hospitals in Yemen. USG and FNAC reports, along with demographic data were collected. The author categorized the USG findings based on the American Thyroid Association guidelines, while FNAC results were classified according to the Bethesda reporting system for thyroid cytopathology. Results: The study included 94 diverse participants with TNs. The average age was 39.96 years, with a majority of female participants (85.1%). The distribution of nodules revealed varying consistencies, sizes, and shapes. The association between USG and FNAC diagnoses showed a significant relationship (χ2 = 34.914, P < 0.001), with a high proportion of benign cases in both USG and FNAC results. Validity analysis demonstrated a sensitivity of 88.68% and a specificity of 70.73% for USG in diagnosing thyroid carcinoma. The positive predictive value was 79.66%, and the negative predictive value was 82.86%. The overall accuracy of USG compared to FNAC was 80.85%. Conclusion: This study shows USG’s potential as a diagnostic tool for TNs in Yemen. Insights improve understanding of TN diagnosis in Yemen’s healthcare settings.

Determining the Stone Free Rate of Retrograde Intrarenal Surgery. Which Radiological Technique? RIRSearch Study Group

ObjectiveTo evaluate the sensitivity and specificity of ultrasonography and kidney ureter bladder radiography(KUB) for the determination of stone free status of retrograde intrarenal surgery(RIRS) according to different stone free status definitions. Materials and methodsThe patients who underwent RIRS between September 2021 and September 2022 were prospectively included in the study. All patients underwent a KUB radiography, urinary system ultrasonography and non-contrast abdominal tomography(NCCT) at the postoperative first month of the surgery. The sensitivity, specificity, negative predictive factor, and positive predictive factor of ultrasonography and KUB on evaluating the stone free rate were analyzed according to different stone free status definitions. ResultsA total of 178 patients were included in the study. The stone free rates according to stone free definitions as; residual stone<4mm,<2mm and no residual stone were 79.2%,64.0% and 56.7%,respectively. According to its definition as a residual stone<4mm, the sensitivity and specificity of ultrasonography were 64.9% and 84.3%,respectively. The sensitivity of ultrasonography was 57.1% and 52.5% as the definitions were residual stone<2 mm and no residual stone,respectively. Addition of KUB to USG slightly increased the sensitivity but did not change the specificity. ConclusionUltrasonography had high specificity but low sensitivity for evaluating stone free status after RIRS and addition of KUB did not increase the diagnostic efficacy. Although USG may be used in daily practice, it may overestimate the stone free status and NCCT must be used during the clinical trials to document the exact stone free rates of RIRS.

Comparison of Ultrasound-Guided Umbilical Venous Catheter Insertion with Blind Method: A Randomized Controlled Trial

Introduction: Ultrasonography (USG) can be used in neonates to manipulate and place the umbilical catheter in the correct position. Although chest radiograph (CXR) is the gold standard, a noninvasive method like USG without radiation exposure may be an alternative bedside armamentarium to the clinician. The purpose of the study was to evaluate whether USG-guided umbilical venous catheter (UVC) insertion is superior to the conventional method for the successful insertion of UVC. Method: The neonates born between 25 and 42 weeks of gestation requiring parenteral fluids and admission to neonatal intensive care unit (NICU) between September 2020 and November 2022 were randomized in two weight-based strata: ≤1,200 and >1,200 g. USG-guided UVC insertion was done in the intervention group and blind UVC insertion was done in the control group. Results: Out of 112 enrolled neonates, 58 were in the USG-guided group and 54 in the blind group. There was no significant difference in the failure rate between the intervention and control groups (20% versus 29% [RR: 0.69, 95% CI: 0.36–1.33]). The sensitivity and specificity of USG in locating tip position were 97 and 46.8%, respectively. The mean procedure time in USG and blind groups was 8.9 and 8.3 min, respectively (p value 0.56). Conclusion: USG does not reduce the failure rates during the insertion of umbilical catheters. However, being a safe, noninvasive procedure, it can be considered a rescue modality to CXR in NICUs equipped with portable USG for guiding UVC insertion.

The value of ultrasonography in predicting the outcomes of simple long bone fractures treated by closed intramedullary nail fixation

PurposeUltrasonography has been used increasingly in orthopaedic practice credited to its low cost, easy accessibility, non-invasiveness, reproducibility, and safety from radiation. The purpose of this study was to test the validity and efficacy of ultrasonography as an adjunct in the assessment of fracture healing in long bones treated with intramedullary interlocking devices and its predictive value in determining the need for a secondary surgical procedure. MethodsThis was a descriptive longitudinal study of 40 skeletally mature patients who sustained long bone fractures of the tibia or femur treated using intramedullary interlocking nails. Patients with comminuted and segmental fracture patterns were excluded from the study. Each patient was evaluated at 6- and 12-week post-surgery using standard orthogonal radiographs and ultrasonography to assess fracture healing. Patients were then followed up until fracture union. Quantitative data was analyzed using frequency statistics and descriptive data with inferential statistics. ResultsUltrasonography predicted 87.5% union and 12.5% delayed or non-union as early as 6 weeks after surgery, while radiographs predicted 22.5% union as late as 3 months of follow-up. The sensitivity and specificity of ultrasonography in assessing fracture healing were 100% and 97.2%, respectively, with a positive predictive value of 80.0%. Vascular resistance index was less than 0.5 in all patients who developed delayed or non-union. ConclusionUltrasonography is able to predict fracture outcomes much earlier than standardized radiographs with comparable sensitivity and specificity. Vascular resistance index is an objective parameter in assessing callus quality and predicting fracture outcomes.

A Study to Evaluate the Efficacy of Ultrasonography as a Diagnostic Screening Tool in Maxillofacial Fractures: A Prospective Study.

The aim of the study was to estimate the diagnostic efficacy of high-resolution ultrasonography (USG) in the diagnosis of maxillofacial fractures. A descriptive diagnostic evaluation study was carried out on 30 patients with suspected maxillofacial fractures, out of which 26 were male (86.7%) and 4 were female (13.3%). After initial management, detailed clinical examinations were carried out and significant findings were noted. Computed tomography (CT) scans were performed in fracture-suspecting patients followed by USG examination which was done in a standardized pattern on both sides of the face. The result of USG was compared with the CT scan report. Based on CT findings, 65 sites were found to be fractured, and this was considered the gold standard. Ultrasonography detected 58 fractures at these 780 sites, of which 54 were true fractures, while 4 were false-positive results. However, USG was not able to detect eleven fractures. The overall sensitivity and specificity of USG were 83.1% and 99%, respectively. The positive and negative predictive values were 93% and 98%, respectively. According to our study, it may be concluded that USG may be recommended as a diagnostic screening tool to detect superficial maxillofacial fractures. Ultrasonography provides a safe, cost-effective, reliable, non-invasive, easily available, and portable imaging modality to screen for maxillofacial fractures.

Comparing Sensitivity and Specificity of Ultrasonography With Chest Radiography in Detecting Pneumothorax and Hemothorax in Chest Trauma Patients: A Cross-Sectional Diagnostic Study.

Background Thoracic trauma accounts for 20-25% of all traumas and is the third most frequent cause of death, after abdominal injury and head trauma. In the Emergency Department (ED), shifting an unstable patient to the X-ray room for detecting pneumothorax and hemothorax is always risky and bedside X-ray causes radiation exposure not only to the particular patient but also to the surrounding patients in a congested and busy ED. This can be avoided by using bedside ultrasonography (USG) as the initial imaging modality in chest trauma patients. Objective To compare the sensitivity and specificity of ultrasonography and chest radiography in detecting pneumothorax and hemothorax in chest trauma patients. Methods This cross-sectional diagnostic study was conducted for a period of one year at Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India, a tertiary care centre.All consecutive patients (n=255) with a suspected history of chest trauma were included in the study. The patients were evaluated bedside using USG by point of care ultrasonography trained emergency medicine physician and subsequently underwent chest radiography for documentation of pneumothorax and hemothorax. Sensitivity and specificity were calculated for ultrasonography and chest X-ray (CXR) compared with the composite gold standard (chest radiography and computed tomography thorax). Results Of the 255 patients, 89% were males. The mean age of the patients was 43.46 (standard deviation 16.3). Road traffic accident (RTA) was the most common mode of injury (81%). The median (interquartile range) time interval between injury and arrival at the hospital was four hours (2.5-7). About 16.1% of the patients had subcutaneous emphysema. About 88.2% of the patients were hemodynamically stable and 78% of the patients had associated other system injuries. The sensitivity and specificity of USG in detecting pneumothorax were 85.7% and 95.3% respectively and that of CXR were 71.4% and 100% respectively. Our study found that the sensitivity and specificity of USG in detecting hemothorax were 79% and 97.9% respectively and that of CXR were 62.9% and 100% respectively. Even in the subset of patients in whom a computed tomography scan was done, the sensitivity of USG was higher than that of CXR in detecting pneumothorax and hemothorax. The specificity of USG in detecting pneumothorax was the same as that of CXR and the specificity of USG in detecting hemothorax was higher than that of CXR in that subset of patients. Conclusion The sensitivities of USG in detecting pneumothorax and hemothorax were higher than that of CXR. The specificities of USG in detecting pneumothorax and hemothorax were comparable to that of CXR. Hence bedside USG performed by emergency physician during resuscitation helps in rapid diagnosis and early management of chest trauma patients.

Evaluation and Comparison of Sensitivity and Specificity of Ultrasonography in Placenta Accreta Diagnosis in the Second and Third Trimesters.

Ultrasound is the selected technique for the detection of placenta accreta spectrum (PAS). This method can detect PAS in 80%-50% of cases. This study aimed to assess and compare the sensitivity and specificity of ultrasonography in the diagnosis of PAS after the first trimester. In this prospective study that was performed in 2020-2021 on 79 patients at high risk of PAS, all cases underwent ultrasonography in both 18-22 weeks of gestational age (GA) and 32-34 weeks of GA for evaluation of accreta. As per the risk factors, the delivery plan for all mothers was cesarean section. During the cesarean section, the placenta was examined for accreta, and if it was attached to the uterus, a diagnosis of placenta accreta was ascertained and a total abdominal hysterectomy was performed if the patient's bleeding was not controlled during the operation. The final diagnosis of PAS was made based on the pathology report. Ultrasound evaluation for PAS in 18-22 weeks of GA had 79.17% specificity, 51.61% sensitivity, 61.54% positive predictive value, and 71.70% negative predictive value. Ultrasound imaging for PAS in 32-34 weeks of GA had 60.8% specificity, 90% sensitivity, 62.52% positive predictive value, and 90.33% negative predictive value. It should be concluded that PAS is a critical condition and if the patient is diagnosed in the second or third trimester, special strategies should be applied.

Diagnosis and outcome following tenoscopic surgery of the digital flexor tendon sheath in German sports and pleasure horses.

Digital flexor tendon sheath (DFTS) pathology is an important cause of lameness in horses. The outcome after surgical treatment is variable and depends on the exact diagnosis. To (1) describe the prevalence of lesions associated with lameness caused by nonseptic DFTS tenosynovitis in a large population of German sports and pleasure horses; (2) determine the sensitivity and specificity of diagnostic imaging techniques for identifying lesions within the DFTS with tenoscopic diagnosis being the gold standard; (3) explore associations between tenoscopically diagnosed lesions and signalment, purpose, and limb affected; and (4) describe the outcome following DFTS tenoscopy with nonseptic DFTS tenosynovitis in this population. Retrospective case series. Medical records of horses admitted for tenoscopic surgery of nonseptic DFTS tenosynovitis between 2011 and 2020 were reviewed. Follow-up information was obtained via telephone contact. Sensitivity and specificity of ultrasonography and contrast tenography were determined using tenoscopic diagnosis as gold standard and univariable analysis was used to explore associations between signalment, case history, and tenoscopic diagnosis. Medical records from 131 horses were retrieved, of which 8 horses had bilateral disease and 6 horses were presented for tenoscopy on two separate occasions (3 for tenoscopy in the same limb, 3 in a different limb), thus, making a total of 145 limbs. Lesions were most commonly diagnosed in the deep (DDFT; n=55 limbs) and superficial (SDFT; n=55 limbs) digital flexor tendons. Manica flexoria (MF) lesions were detected in 44 limbs and palmar/plantar annular ligament (PAL) constriction in 99 limbs. In 36 limbs, only one structure within the DFTS was injured, whereas in 109 limbs a combination of lesions was noted, the most common being the combination of a SDFT lesion with PAL constriction. All affected limbs were examined with diagnostic ultrasonography; contrast tenography was performed in 86 limbs. For diagnosis of MF and DDFT tears, tenography was more sensitive (89% [confidence interval, CI: 65.4%-95.2%]; 72% [CI: 46.4%-89.3%], respectively) than specific (64% [CI: 52.5%-77.6%]; 53% [CI: 42.2%-73.3%], respectively) whereas ultrasonography was more specific (92% [CI: 84.5%-96.3%]; 92% [CI: 83.6%-96.0%]) with lower sensitivity (64% [CI: 47.7%-77.2%]; 54% [CI: 39.5%-67.9%]). For SDFT lesions, ultrasonography was highly specific (94% [CI: 86.9%-97.9%]) with lower sensitivity (66% [CI: 51.3%-77.4%]). Follow-up information following first surgery was obtained for 118 horses (132 limbs): 18 (15.3%) of 118 horses remained chronically lame, 40 (33.8%) performed at a reduced level and 60 (50.8%) performed at the same or higher level following rehabilitation after tenoscopy. Horses with DDFT lesions had the poorest outcomes with only 36.6% returning to the same or higher level of exercise. Retrospective analysis of clinical records and subjective outcome assessment based on owner follow-up with potential recall bias. Findings on diagnostic imaging are impacted by many factors including equipment quality and operator expertise and experience. Diagnostic imaging techniques were complimentary and contrast tenography was sensitive and ultrasonography was specific for the diagnosis of MF and DDFT lesions. Following tenoscopic surgery for nonseptic tenosynovitis of the DFTS, approximately half the cases were able to return to preinjury level of exercise.

Accuracy of diagnostic modalities in suspected appendicitis in King Saud Hospital, Unaizah,Qassim, Saudi Arabia-retrospective cohort study

ObjectiveTo retrospectively evaluate the accuracy of computed tomography (CT) ultrasonography (US) in the diagnosis of acute appendicitis, confirm the post-appendectomy result via histopathology, and compare the sensitivity and specificity of ultrasonography (US) to CT scans. MethodsA retrospective cohort -chart review of 244 patient who underwent CT and US for diagnosis of suspected acute appendicitis in single center -King Saud Hospital, Unaizah, Qassim Region, Saudi Arabia was performed. ResultAll study participants underwent CT scans as part of their diagnostic workup. Of the 244 patients, 240 (98.4%) returned with findings suggestive of acute appendicitis. Of the total number of participants, 203 were confirmed via US out of which only 30.0% of them had features on US scans suggestive of acute appendicitis. The majority of the patients did not have any complications (83.6%) ConclusionCT scan can be considered the best modality to diagnose acute appendicitis and its complications with sensitivity of 98% and specifty of 16.7 compared to US, which shows 100% specificity and 29% sensitivity.

Comparison of ultrasonography and computed tomography in detecting urolithiasis in a teaching hospital of Kaski district

Introduction: Urolithiasis is an increasing health problem worldwide including developing countries like Nepal. Ultrasonography and computed tomography of kidney, ureter and urinary bladder imaging modalities are used in detection of urolithiasis. This study was done to compare ultrasonography and computed tomography of kidney, ureter and urinary bladder findings for detection of urolithiasis. Methods: A cross-sectional study was conducted in Department of Radiology, Gandaki Medical College, Pokhara, Nepal from July to October, 2021 after obtaining ethical clearance from Institutional Review Committee of Gandaki Medical College. Total 92 patients who had urolithiasis in computed tomography and had ultrasound report available within one week were selected for the study. Demographic data of patients, location and side of calculi were recorded. The findings of ultrasonography and computed tomography were then compared. Similarly, sensitivity and specificity of ultrasonography were calculated. Results: Urolithiasis was more common in middle age groups i.e. 20 to 40 years (n= 57, 62.0%) and in males (n=56, 60.9%). Kidney was the commonest location detected by both ultrasonography (n=45, 48.9%) and computed tomography (n=44, 47.8%) with predominance in right side. Some of the calculi that were undetected by ultrasonography were easily confirmed by computed tomography in various locations. This was found to be statistically significant (p&lt;0.05). The sensitivity and specificity of ultrasonography in compared to computed tomography was 83.7% and 100% respectively. Conclusions: Ultrasonography has poor sensitivity and high specificity for detecting urolithiasis. Thus, computed tomography can be considered as better imaging modality as compared to ultrasonography for diagnosis of urolithiaisis.

Pediatric Appendicitis Score or Ultrasonography? In Search of a Better Diagnostic Tool in Indian Children with Lower Abdominal Pain.

To prospectively assess the performance of pediatric appendicitis score (PAS) in diagnosing acute appendicitis in the children with lower abdominal pain and correlated with ultrasound findings; and to assess the impact of the PAS on clinical outcome and its efficacy in differentiating between complicated and uncomplicated appendicitis. A prospective study was done which included cases of lower abdominal pain. Appendectomy was done for PAS ≥ 6, and diagnosis was confirmed on histopathology. A receiver operator characteristic (ROC) curve was created to assess the PAS performance. The sensitivity, specificity, and accuracy of ultrasonography in diagnosing appendicitis were assessed, and analysis of agreement between ultrasonography and PAS score was done by kappa statistics. Of 260 cases with lower abdominal pain, 205 were suspected of having appendicitis. One hundred fifty-nine had PAS ≥ 6. There were 2/159 (1.26%) cases of negative appendectomies and 2/46 (4.34%) cases of missed appendicitis. The mean PAS was significantly higher in patients with appendicitis than in those without appendicitis. The area under the ROC curve was 0.9925. Sensitivity, specificity, and positive and negative predictive value of PAS were 98.74%, 95.65%, 95.7% and 95.65%, respectively. Complicated appendicitis had significantly more PAS, fever, and cough tenderness than uncomplicated appendicitis. The sensitivity and specificity of ultrasonography were 86.79% and 17.39%, respectively. Agreement between ultrasonography-proven appendicitis and PAS-dependent appendicitis was weak. PAS has high efficacy in diagnosing acute appendicitis. Clinical outcome was more favorable with the use of PAS. Ultrasonography should be used judiciously and in combination with clinical judgment.

Diagnostic Accuracy of FNAC and Ultrasonography in Salivary Gland Lesions in Comparison with Histopathology

Introduction: Modern era demands for early and accurate diagnosis. Fine Needle Aspiration Cytology (FNAC) and Ultrasonography (USG) are two such diagnostic modalities which have gained importance in recent years due to their rapid, repeatable and precision properties. Aim: To study the accuracy of FNAC and USG in diagnosing salivary gland lesions in comparison with histopathology and to study the expression of p63 and Cytokeratin 7 (CK7) Immunohistochemical (IHC) markers in malignant salivary gland tumours. Materials and Methods: A cross-sectional study was conducted on 106 cases who presented with salivary gland lesions possessing USG reports and underwent FNAC and surgical specimens received in Cytopathology and Histopathology Department, Government Medical College Thiruvananthapuram, Kerala, India during one year period (February 2017-January 2018). In each case FNAC was performed and slides were stained with Papanicolaou and Giemsa, surgical specimens were grossed, histopathological features studied under microscope and tumours classified according to World Health Organisation (WHO) Classification of Salivary gland Tumours 2017. Diagnosis on USG and FNAC were compared with histopathological diagnosis. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), diagnostic accuracy, concordance and discordance was calculated by Statistical Package for the Social Sciences (SPSS) software 24.0 version. p63 and CK7 IHC markers were done only in malignant salivary gland tumours. Results: In the present study majority of lesions i.e. 82 cases (77.4%) were seen predominantly in parotid gland and pleomorphic adenoma was the most commonest lesion and neoplasm overall with 50 cases (47.2%). Most common malignant neoplasm was mucoepidermoid carcinoma (four cases, 3.8%). USG and FNAC had high diagnostic accuracy of 89.6% and 97.2% in comparison to histopathology in diagnosing salivary gland lesions. Conclusion: High sensitivity and specificity of USG and FNAC makes them most acclaimed preoperative diagnostic modality for salivary gland lesions, but histopathology remains gold standard. Subtyping of malignant and cystic lesions were difficult in USG and cytology

Hepatic echinococcosis: difficulties in diagnosis at the early stages of progression and with complications (literature review)

To demonstrate the possible difficulties in the diagnosis of hepatic echinococcosis, that a specialist in ultrasound diagnostics and a radiologist may encounter in everyday practice, russian and foreign literature as well as our own experience have been reviewed. With high accuracy and specificity of ultrasonography in the differential diagnosis of echinococcal cysts, incorrect interpretation is possible in the presence of mural hemorrhages and (or) hemorrhagic clots in a nonparasitic cyst, which aren’t also visible in ultrasonography and can imitate elements of the chitinous membrane. The degree of prevalence of the process, the exclusion of damage to the lungs and other organs of the abdominal cavity are important. In such cases CT scan is the most convenient and accurate diagnostic method due to its high spatial and temporal resolution, standardization and availability. In the most difficult cases the capabilities of MRI are used in the comparison of diffusion-weighted images and apparent diffusion coefficient, which also makes it possible to diagnose cystic neoplasms. Ultrasonography is a diagnostic technology that is still the most commonly used to differentiate cavity structures; however, all dubious clinical observations should be further examined by using CT or MRI.

Comparison of ultrasonography and radiography with arthroscopy for diagnosis of dorsoproximal osteochondral fragmentation of the proximal phalanx in 56 Thoroughbred racehorses.

Osteochondral fragmentation of the proximal phalanx (DPP1 fragment) is a common finding in the racehorse. Whilst radiographic assessment has been reported to lack diagnostic sensitivity, ultrasonographic examination has been documented to be extremely sensitive for identification of bone fragments in the metacarpophalangeal joint. To determine the sensitivity and specificity of ultrasonography as an imaging modality for diagnosis of DPP1 fragmentation and to compare it with radiography in the Thoroughbred racehorse. Retrospective cohort study. Medical records (radiographs and ultrasonographic examinations) of 56 Thoroughbred racehorses in training (average age 26.4months [SD ±5.9]) with a history of forelimb fetlock joint effusion and arthroscopically confirmed DPP1 fragmentation were evaluated. Inter-observer agreement was calculated between three blinded reviewers for both ultrasonographic and radiographic findings. Median values were used for statistical analyses. Ultrasonographic and radiographic identification of DPP1 fragmentation was considered correct if in agreement with arthroscopic findings. The McNemar test was used to compare correct proportions between radiography and ultrasonography. Analyses were performed to evaluate correct identification of presence of fragment(s), location of fragment(s) and presence and location of fragment(s) within the joints, with values P<.05 considered significant. Eighty-one fetlock joints from 56 Thoroughbreds were evaluated. In total, 99 individual DPP1 fragments were confirmed arthroscopically. Ultrasonography was shown to have high levels of sensitivity (94%, 95% CI 89%-99%) and specificity (97%, 95% CI 92%-100%) for identification of DPP1 fragments, with transverse ultrasonographic images being more sensitive than sagittal ultrasonography (P=.001). Ultrasonography was also shown in this population to have significantly greater sensitivity than radiography (47%, 95% CI 37%-56%) (P<.001). Ultrasonography is an extremely sensitive and specific imaging modality for evaluation of DPP1 fragmentation, with transverse ultrasonographic imaging being the most sensitive technique. Radiographic evaluation was less sensitive than ultrasonography in this study.

Accuracy of Pretreatment Ultrasonography Assessment of Intra-Abdominal Spread in Epithelial Ovarian Cancer: A Prospective Study.

The aim of this study was to test the accuracy of ultrasonography performed by gynecological oncologists for the preoperative assessment of epithelial ovarian cancer (EOC) spread in the pelvis and abdominal cavity. A prospective, observational cohort study was performed at a single tertiary cancer care unit. Patients with suspected EOC were recruited and underwent comprehensive transvaginal and abdominal ultrasonography performed by a gynecological oncologist. Sixteen intra-abdominal localizations and parameters were assessed using ultrasonography and compared with surgical-pathological status (reference standard). Sensitivity, specificity, positive and negative predictive values, and overall accuracy were calculated. Differences were analyzed using Fisher’s exact and chi-square tests. Ultimately, we included 132 patients (median age 62 years), of whom 67% were in stage IIIC–IVB and 72% had serous cancer. Overall prediction accuracies for the involvement of the omentum, small bowel mesentery root, and frozen pelvis, and detecting ascites were >90%. Detecting the involvement of the pelvis peritoneum, liver and spleen hilum, and rectosigmoid colon, and predictions of disease stage and residual disease had overall accuracies of 80–90%. The lowest accuracy was for involvement of the abdominal peritoneum (69%) and diaphragm peritoneum (right 71%; left 75%) and surgical complexity prediction (77%). Stratification of results by presence or absence of ascites revealed significantly higher specificity of ultrasonography (clinically meaningful) for assessments of the abdominal/pelvic peritoneum, spleen hilum, and rectum wall, if there were ascites. A gynecological oncologist, experienced in surgery and sonology, performing comprehensive ultrasonography on patients with EOC can accurately detect intraperitoneal lesions and recognize critical disease manifestations and predict stage, surgical complexity, and residual disease, which allow accurate qualification of patients for primary debulking surgery or neoadjuvant chemotherapy.