WED 244 CSF cytology alone is unable to predict CNS neoplastic process

2018 ◽  
Vol 89 (10) ◽  
pp. A36.1-A36
Author(s):  
Osborne Alex ◽  
Hewamadduma Channa
Keyword(s):  
Diagnostic Value ◽  
Clinical Findings ◽  
Neurosurgical Procedures ◽  
Csf Cytology ◽  
Neoplastic Process ◽  
Detection And Diagnosis ◽  
Diagnostic Work ◽  
Low Sensitivity ◽  
Work Up ◽  
Cns Malignancy

Incidence of both primary and secondary central nervous system (CNS) malignancies are increasing, yet detection and diagnosis of which remains challenging. Neurological examination, CSF cytology and neuroimaging each offer diagnostic value, however, individually, each method has relatively low sensitivity. CSF cytology is often routinely requested as part of the diagnostic work-up. Therefore, we reviewed the value of CSF cytology in predicting CNS neoplastic process.We systematically analysed 296 patients who had had CSF cytology. All consecutive patients over the last 2 years were included. The 12 patients positive for CSF cytology were also found to have concurrent; clinical findings (92%), radiological findings (92%), or both (83%). In no patient CNS malignancy was identified by CSF cytology alone. Additionally, only 7 of the 12 CSF positive cases were collected by means of lumbar puncture, the rest were carried out during neurosurgical procedures.We conclude that if there is neither clinical findings nor abnormal neuroimaging, assessing CSF cytology does not contribute towards diagnosis of CNS malignancy. Yield of CSF cytology is high when both clinical and radiological evidence are present. Where neuroimaging is normal but suspicion remains, the low sensitivity of the CSF-cytology would make it a weak corroborator to exclude malignancy.

scholarly journals PET-PANC: multicentre prospective diagnostic accuracy and health economic analysis study of the impact of combined modality 18fluorine-2-fluoro-2-deoxy-d-glucose positron emission tomography with computed tomography scanning in the diagnosis and management of pancreatic cancer

2018 ◽  
Vol 22 (7) ◽  
pp. 1-114 ◽  
Author(s):  
Paula Ghaneh ◽  
Robert Hanson ◽  
Andrew Titman ◽  
Gill Lancaster ◽  
Catrin Plumpton ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pancreatic Cancer ◽  
Chronic Pancreatitis ◽  
Diagnostic Accuracy ◽  
Cost Effective ◽  
Diagnostic Value ◽  
Pet Ct ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Background Pancreatic cancer diagnosis and staging can be difficult in 10–20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer. Objective To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer. Design A multicentre prospective diagnostic accuracy and clinical value study of PET/CT in suspected pancreatic malignancy. Participants Patients with suspected pancreatic malignancy. Interventions All patients to undergo PET/CT following standard diagnostic work-up. Main outcome measures The primary outcome was the incremental diagnostic value of PET/CT in addition to standard diagnostic work-up with multidetector computed tomography (MDCT). Secondary outcomes were (1) changes in patients’ diagnosis, staging and management as a result of PET/CT; (2) changes in the costs and effectiveness of patient management as a result of PET/CT; (3) the incremental diagnostic value of PET/CT in chronic pancreatitis; (4) the identification of groups of patients who would benefit most from PET/CT; and (5) the incremental diagnostic value of PET/CT in other pancreatic tumours. Results Between 2011 and 2013, 589 patients with suspected pancreatic cancer underwent MDCT and PET/CT, with 550 patients having complete data and in-range PET/CT. Sensitivity and specificity for the diagnosis of pancreatic cancer were 88.5% and 70.6%, respectively, for MDCT and 92.7% and 75.8%, respectively, for PET/CT. The maximum standardised uptake value (SUVmax.) for a pancreatic cancer diagnosis was 7.5. PET/CT demonstrated a significant improvement in relative sensitivity (p = 0.01) and specificity (p = 0.023) compared with MDCT. Incremental likelihood ratios demonstrated that PET/CT significantly improved diagnostic accuracy in all scenarios (p < 0.0002). PET/CT correctly changed the staging of pancreatic cancer in 56 patients (p = 0.001). PET/CT influenced management in 250 (45%) patients. PET/CT stopped resection in 58 (20%) patients who were due to have surgery. The benefit of PET/CT was limited in patients with chronic pancreatitis or other pancreatic tumours. PET/CT was associated with a gain in quality-adjusted life-years of 0.0157 (95% confidence interval –0.0101 to 0.0430). In the base-case model PET/CT was seen to dominate MDCT alone and is thus highly likely to be cost-effective for the UK NHS. PET/CT was seen to be most cost-effective for the subgroup of patients with suspected pancreatic cancer who were thought to be resectable. Conclusion PET/CT provided a significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and significantly influenced the staging and management of patients. PET/CT had limited utility in chronic pancreatitis and other pancreatic tumours. PET/CT is likely to be cost-effective at current reimbursement rates for PET/CT to the UK NHS. This was not a randomised controlled trial and therefore we do not have any information from patients who would have undergone MDCT only for comparison. In addition, there were issues in estimating costs for PET/CT. Future work should evaluate the role of PET/CT in intraductal papillary mucinous neoplasm and prognosis and response to therapy in patients with pancreatic cancer. Study registration Current Controlled Trials ISRCTN73852054 and UKCRN 8166. Funding The National Institute for Health Research Health Technology Assessment programme.

scholarly journals Management of Neurosurgical Instruments and Patients Exposed to Creutzfeldt-Jakob Disease

2013 ◽  
Vol 34 (12) ◽  
pp. 1272-1280 ◽  
Author(s):  
Ermias D. Belay ◽  
Jennifer Blase ◽  
Lynne M. Sehulster ◽  
Ryan A. Maddox ◽  
Lawrence B. Schonberger
Keyword(s):  
Disease Control ◽  
Neurosurgical Procedures ◽  
Patient Exposure ◽  
Potential Exposure ◽  
Instrument Tracking ◽  
Control And Prevention ◽  
Jakob Disease ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Objective.To summarize the approaches used to manage exposure of patients to inadequately sterilized neurosurgical instruments contaminated as a result of Creutzfeldt-Jakob disease (CJD).Methods.Information on past CJD exposure incidents reported to the Centers for Disease Control and Prevention (CDC) was aggregated and summarized. In addition, inactivation studies were reviewed, and data from selected publications were provided for reference.Results.Nineteen incidents of patient exposure to potentially CJD-contaminated instruments were reported to the CDC, including 17 that involved intracranial procedures and 2 that involved ophthalmologic procedures. In more than 50% of incidents, the neurosurgical procedures were performed for diagnostic work up of the index patients. At least 12 of the hospitals had multiple neurosurgical sets, and the CJD-contaminated instruments could not be identified in 11 of 19 hospitals. In 12 of 15 hospitals with neurosurgical incidents, a decision was made to notify patients of their potential exposure.Conclusions.Neurosurgical instruments used for treatment of patients with suspected or diagnosed CJD or patients whose diagnosis is unclear should be promptly identified and sterilized using recommended CJD decontamination protocols. Inability to trace instruments complicates appropriate management of exposure incidents. The feasibility of instituting instrument tracking procedures should be considered.

scholarly journals Abdominal ultrasound in the diagnostic work-up of visceral leishmaniasis and for detection of complications of spleen aspiration

2021 ◽  
Vol 15 (2) ◽  
pp. e0009107
Author(s):  
Rezika Mohammed ◽  
Yonathan Gebrewold ◽  
Angela Schuster ◽  
Helina Fikre ◽  
Tigist Mekonnen ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Splenic Injury ◽  
Abdominal Ultrasound ◽  
Diagnostic Value ◽  
Treatment Center ◽  
Diagnostic Tools ◽  
Us Findings ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Introduction Abdominal ultrasound (US) is increasingly used in the diagnostic work-up of infectious diseases, but studies on its diagnostic value in visceral leishmaniasis (VL) are lacking. US could help to identify complications of spleen aspiration (SA). We aimed to assess the diagnostic value of US and the evolution of findings after VL treatment; the incidence and degree of splenic injury; and the pain perceived during SA. Methodology/result We conducted a cross-sectional prospective study at the Leishmaniasis Research and Treatment Center, Gondar, Ethiopia between Oct 2017 and Dec 2018. We enrolled VL suspects undergoing tissue aspiration; US were conducted before and after SA, and at the end of VL treatment. Splenic injury was graded using the American association of surgery trauma injury scale (grade 1–4). The pain perceived during SA was graded using a visual analogue scale. Out of 392 VL suspects, 192 (49%) were confirmed VL cases. The median age was 25 years (IQR 21–30). Massive splenomegaly and hepatomegaly were the most common US findings. Splenic nodules were seen in 3.7% of the 190 VL cases and 1.5% of the 197 non-VL cases. Ascites was more common in VL (16.4%) than in non-VL cases (9.1%). The frequency of US abnormalities decreased with treatment. None of the US findings had sufficient sensitivity and specificity to justify its use as a diagnostic test. US detected splenic injury in four of the 318 patients who had post-SA US. All four patients remained clinically stable. Pain was perceived as moderate or severe in 51% of patients. Conclusion The diagnostic value of abdominal US for VL was low but found useful to detect subclinical splenic injury. SA caries a risk of splenic injury and was perceived painful by most. Further research on less invasive diagnostic tools is needed.

scholarly journals Diagnostic value of lymphopaenia and elevated serum ACE in patients with uveitis

2020 ◽  
pp. bjophthalmol-2020-316563
Author(s):  
Philippine Cotte ◽  
Pierre Pradat ◽  
Laurent Kodjikian ◽  
Yvan Jamilloux ◽  
Pascal Seve
Keyword(s):  
Retrospective Study ◽  
Predictive Value ◽  
Elevated Serum ◽  
Diagnostic Value ◽  
Granulomatous Uveitis ◽  
Registration Number ◽  
The Mean ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

AimTo evaluate the diagnostic worth of elevated serum ACE (sACE) and lymphopaenia, singly or combined, in diagnosing sarcoid uveitis.MethodsMonocentric retrospective study, on a cohort of 996 adult patients referred to our department between March 2001 and December 2018 for a diagnostic work-up of uveitis. The sensitivity (SE), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) of the two biomarkers were calculated in different contexts.ResultsEight hundred and sixty-eight patient cases were reviewed. The mean age at uveitis onset was 49.4 (±18.6) years. Of them, 144 patients had a diagnosis of sarcoid uveitis. An elevated sACE had SE of 45.8%, Sp of 88.8%, PPV of 44.9% and NPV of 89.2% in diagnosing sarcoid uveitis. For lymphopaenia, SE was 15.3%, Sp was 96.7%, PPV was 47.8% and NPV was 85.2%. For the combination of elevated sACE and lymphopaenia, SE was 18.9%, Sp was 99.0%, PPV was 73.9% and NPV was 89.5%. The value of this combination varied according to patient age at diagnosis plus anatomoclinical entities: for patients aged ≤50 years, SE was 31.3%, Sp was 99.7%, PPV was 90.9% and NPV was 94.3%. For granulomatous uveitis, SE was 26.2%, Sp was 97.3%, PPV was 73.3% and NPV was 82.5%.ConclusionA combination of elevated serum ACE and lymphopaenia more convincingly suggests sarcoid uveitis than these investigational tests used alone, especially in patients with granulomatous uveitis, while a lack of these markers corresponds to a high NPV.Trial registration numberNCT03863782.

Clinical usefulness of D-dimer testing in cancer patients with suspected pulmonary embolism

2006 ◽  
Vol 95 (04) ◽  
pp. 715-719 ◽  
Author(s):  
Grégoire Le Gal ◽  
Sylvain De Lucia ◽  
Pierre-Marie Roy ◽  
Guy Meyer ◽  
Drahomir Aujesky ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cancer Patients ◽  
Diagnostic Value ◽  
Clinical Usefulness ◽  
Limited Data ◽  
Suspected Pulmonary Embolism ◽  
Diagnostic Work ◽  
Work Up ◽  
D Dimer ◽  
Rule Out

SummaryLimited data are available about the diagnostic value of D-dimer testing in cancer patients with clinically suspected pulmonary embolism (PE).Therefore, we evaluated i) the safety and clinical usefulness of an ELISA D-dimer test to rule out PE in cancer patients compared with non-cancer patients and ii) whether adopting a higher D-dimer cut-off value might increase the usefulness of D-dimer in cancer patients. We analysed data from two outcome studies which enrolled 1,721 consecutive patients presenting in the emergency department with clinically suspected PE. Presence of an active malignancy was abstracted from the database. All patients underwent a sequential diagnostic work-up including an ELISA D-dimer test and a 3-month followup. Sensitivity and predictive value (NPV) were 100% in both cancer and non-cancer patients. PE was ruled out by a negative D-dimer test in 494/1,554 (32%) patients without cancer, and in 18/164 (11%) patients witha malignancy. At cut-off values varying from 500 to 900 µg/l, the sensitivity was unchanged (100%, 95% CI: 93% to 100%) and the specificity increased from 16% (95% CI:11% to 24%) to 30% (95% CI:22% to 39%).The 3-month thromboembolic risk was 0% (95 % CI: 0% to 18%) in cancer patients witha negative D-dimer test. ELISA D-dimer appears safe to rule out pulmonary embolism in cancer patients but it is negative in only one of ten patients at the usual cut-off value. Increasing the cut-off value of D-dimer in cancer patients might increase the test’s clinical usefulness.

scholarly journals The diagnostic value of the neurological examination in coma of unknown etiology

2021 ◽  
Author(s):  
Wolf U. Schmidt ◽  
M. Lutz ◽  
C. J. Ploner ◽  
M. Braun
Keyword(s):  
Emergency Department ◽  
Brain Damage ◽  
Neurological Examination ◽  
Clinical Pathways ◽  
Diagnostic Value ◽  
Clinical Findings ◽  
Neurological Deficits ◽  
Unknown Etiology ◽  
Diagnostic Reliability ◽  
Work Up

Abstract Background Identifying the cause of non-traumatic coma in the emergency department is challenging. The clinical neurological examination is the most readily available tool to detect focal neurological deficits as indicators for cerebral causes of coma. Previously proposed clinical pathways have granted the interpretation of clinical findings a pivotal role in the diagnostic work-up. We aimed to identify the actual diagnostic reliability of the neurological examination with regard to identifying acute brain damage. Methods Eight hundred and fifty-three patients with coma of unknown etiology (CUE) were examined neurologically in the emergency department following a predefined routine. Coma-explaining pathologies were identified retrospectively and grouped into primary brain pathology with proof of acute brain damage and other causes without proof of acute structural pathology. Sensitivity, specificity and percentage of correct predictions of different examination protocols were calculated using contingency tables and binary logistic regression models. Results The full neurological examination was 74% sensitive and 60% specific to detect acute structural brain damage underlying CUE. Sensitivity and specificity were higher in non-sedated patients (87/61%) compared to sedated patients (64%/59%). A shortened four-item examination protocol focusing on pupils, gaze and pyramidal tract signs was only slightly less sensitive (67%) and more specific (65%). Conclusions Due to limited diagnostic reliability of the physical examination, the absence of focal neurological signs in acutely comatose patients should not defer from a complete work-up including brain imaging. In an emergency, a concise neurological examination should thus serve as one part of a multimodal diagnostic approach to CUE.

Clinically Driven Diagnostic Antifungal Approach in Neutropenic Patients: A Prospective Feasibility Study

2010 ◽  
Vol 28 (4) ◽  
pp. 667-674 ◽  
Author(s):  
Corrado Girmenia ◽  
Alessandra Micozzi ◽  
Giuseppe Gentile ◽  
Stefania Santilli ◽  
Eva Arleo ◽  
...  
Keyword(s):  
Empirical Therapy ◽  
Clinical Findings ◽  
Neutropenic Fever ◽  
Diagnostic Strategy ◽  
Neutropenic Patients ◽  
Diagnostic Work ◽  
Clinical Conditions ◽  
Work Up ◽  
Diagnostic Work Up

Purpose Preemptive strategies in neutropenic patients based on serum galactomannan (GM) –guided triggering of diagnostic work-up may be time-consuming and expensive when applied to the entire population. We have assessed the feasibility of a clinically driven diagnostic strategy without GM screening. Patients and Methods Patients with neutropenic fever underwent a baseline diagnostic work-up (BDWU; three blood cultures and other examinations as indicated). An intensive diagnostic work-up (IDWU; GM for 3 days, chest computed tomography and other examinations as indicated) was reserved for patients with 4 days of persisting or relapsing fever or with other clinical findings possibly related to an invasive fungal diseaser (IFD). Antifungal therapy was administered to patients diagnosed with IFD and empirically (negative IDWU) only to those with persisting neutropenic fever and worsening clinical conditions. Results Of 220 neutropenia episodes, fever occurred in 159 cases and recurred in 28 cases. Overall, 49 IFDs were diagnosed (two by BDWU and 47 by IDWU) during 48 episodes (21.8%). Diagnostic-driven therapy was administered to 48 patients with IFDs; one patient with zygomycosis died without treatment. Only one patient received empirical therapy. IDWU was required in 40% of neutropenia episodes, and only 1.4 mean blood samples per neutropenia episode were tested for GM. Our strategy allowed a 43% reduction in antifungal treatments compared with a standard empirical approach. At 3-month follow-up, 63% of patients with IFD survived, and no undetected IFDs were found. Conclusion A clinically driven diagnostic approach in selected neutropenia episodes offered effective antifungal control and reduced the exposure to unnecessary antifungal treatment.

scholarly journals Diagnostic value of a panel of tumor markers as a part of a diagnostic work-up for ascites of unknown etiology

2012 ◽  
Vol 02 (03) ◽  
pp. 93-100
Author(s):  
Soha Saoud Abdelmoniem ◽  
Eman Mosad Zaki ◽  
Hala Mostafa Imam ◽  
Hosny Badrawy ◽  
Sanaa Ali ◽  
...  
Keyword(s):  
Tumor Markers ◽  
Diagnostic Value ◽  
Unknown Etiology ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up
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