scholarly journals Predictive Value of Positive Margins in Diagnostic Biopsies of Dysplastic Nevi

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Jeffrey S. Dickman ◽  
Reem M. Haddad ◽  
Andrew Racette
Keyword(s):  
Predictive Value ◽  
Treatment Options ◽  
Histological Findings ◽  
Moderate Severity ◽  
Positive Margins ◽  
Dysplastic Nevi ◽  
Diagnostic Biopsy ◽  
Pathology Reports ◽  
Recurrent Nevus ◽  
Diagnostic Biopsies

Dysplastic nevi (DN) are common and controversial and the best choice for management of DN after diagnosis is not always clear. The presence of positive margins found on diagnostic biopsy is used by many dermatologists when deciding whether to re-excise these lesions. In order to quantify the predictive value of positive margins in diagnostic biopsies of DN, we performed a review and analysis of the concordance between the histological findings of biopsies and their subsequent excisions. A total of 122 pathology reports from diagnostic biopsies of DN with nevus cells present at the tissue margin were reviewed. Within this sample, 68 total postbiopsy excisions had been performed. The excisional pathology reports were reviewed for the presence of residual or recurrent nevus cells. Residual nevus cells were reported in 29 of 63 available excisional pathology reports illustrating a positive predictive value (PPV) of positive margins in diagnostic biopsies of DN of 46.0%. We present this value along with PPVs from the very few existing similar studies. The quantified predictive value of positive margins in diagnostic biopsies is useful information for providers who must make decisions regarding the best treatment options for patients with DN. The low PPV of positive margins lends further evidence that DN of moderate severity or less may simply be monitored.

Predictive value of margins in diagnostic biopsies of nonmelanoma skin cancers

2012 ◽  
Vol 67 (1) ◽  
pp. 122-127 ◽  
Author(s):  
Julie E. Jackson ◽  
Brent Kelly ◽  
Matthew Petitt ◽  
Tatsuo Uchida ◽  
Richard F. Wagner
Keyword(s):  
Predictive Value ◽  
Skin Cancers ◽  
Nonmelanoma Skin Cancers ◽  
Diagnostic Biopsies

The predictive value of MAP2K1/2 mutations for efficiency of immunotherapy in melanoma.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e21587-e21587
Author(s):  
Ting Ye ◽  
Jieying Zhang ◽  
Xinyi Liu ◽  
Mengmei Yang ◽  
Yuhan Zhou ◽  
...  
Keyword(s):  
Overall Survival ◽  
Predictive Value ◽  
Cox Regression ◽  
Treatment Options ◽  
Objective Response ◽  
Progression Free Survival ◽  
Driver Mutations ◽  
Cox Regression Analysis ◽  
Melanoma Patients ◽  
The Impact

e21587 Background: Immunotherapies targeting immune checkpoint receptors have become the cornerstone of systemic treatment options for malignant melanoma. The response to these immunotherapies may correlate with driver mutations. MAP2K1/2 genes are mutated in approximately 10% of melanomas, however, the impact of MAP2K1/2 gene alterations on the efficiency of immunotherapy has not been clarified. Methods: Six metastatic melanoma clinical cohorts treated with ICIs were included to investigate the association between clinical efficacy of immunotherapy and MAP2K1/2 mutations. Survival analyses were conducted in cohorts receiving two kinds of ICB agents, namely anti-CTLA-4 or anti-PD-1. RNA expression profiling from these cohorts and from the TCGA melanoma cohort were used to explore the potential mechanism related to immune activation. Results: In an independent anti-CTLA-4-treated cohort (n = 110), we found that MAP2K1/2 mutations are predictive of high objective response rate (17.6% vs 1.3%, p = 0.0185) and long progression-free survival [median OS, 49.2 months vs 8.3 months; hazard ratio (HR) = 0.37; 95% CI, 0.15–0.91; p = 0.0307] and overall survival (median PFS, 19.4 months vs 2.8 months; HR = 0.2; 95% CI, 0.05–0.83; p = 0.0262). This predictive value was further validated in a pooled anti-CTLA-4-treated cohort (n = 235) in terms of overall survival (median OS, 49.3 months vs 22.0 months; HR = 0.44; 95% CI, 0.22–0.91; p = 0.0255). However, no correlation between MAP2K1/2 mutations and overall survival was observed in the anti-PD-1-treated cohort (n = 285). Subgroup Cox regression analysis indicated that MAP2K-mutated patients receive less benefit from the anti-PD-1 monotherapy than from the anti-CTLA-4 treatment (median OS, 27.0 months vs 49.3 months; HR = 3.26; 95% CI, 1.18–9.02; p = 0.0225), which was contrary to the result obtained for the total population. Furthermore, transcriptome profiling analysis revealed that MAP2K-mutated tumors are enriched in CD8+ T cells, B cells, and neutrophil cells and also express high levels of CD33 and IL10, which might be the underlying mechanism for melanoma patients with MAP2K1/2-mutated benefit more from anti-CTLA-4 treatment. Conclusions: We identified mutations in MAP2K1/2 genes as the independent predictive factors for anti-CTLA-4 therapy in melanoma patients and found that anti-CTLA-4 treatment in patient harbouring MAP2K1/2 mutations might be more effective than the anti-PD-1 therapy.

Can Computed Tomography Scan be Performed Effectively in the Diagnosis of Acute Appendicitis without the Added Morbidity of Rectal Contrast?

2008 ◽  
Vol 74 (10) ◽  
pp. 917-920 ◽  
Author(s):  
Daniel D. Dearing ◽  
Jamesa Recabaren ◽  
Magdi Alexander
Keyword(s):  
Acute Appendicitis ◽  
Predictive Value ◽  
Ct Scanning ◽  
Ct Scans ◽  
Negative Appendectomy ◽  
Suspected Appendicitis ◽  
Ct Examination ◽  
Preoperative Ct ◽  
Negative Appendectomy Rate ◽  
Pathology Reports

The highest degrees of accuracy have been demonstrated for CT scans using rectal contrast in diagnosing appendicitis. However, the administration of rectal contrast is associated with patient discomfort and rarely, rectosigmoid perforation (0.04%). Additionally, the commonly accepted negative appendectomy rate is around 16 per cent. We performed a retrospective review of radiology, operative, and pathology reports of consecutive patients undergoing appendectomy or CT examination for appendicitis during 2006. CT scans were performed without rectal contrast. The accuracy of each type of inpatient CT examination and negative appendectomy rates were determined. Two hundred and thirty-eight patients underwent appendectomy. One hundred and thirty-four appendectomy patients (56%) received a preoperative CT scan. The negative appendectomy rates were 6.3 per cent overall, 8.7 per cent without CT examination and 4.5 per cent with CT (P = 0.3). Two hundred and forty-five inpatient CT scans were performed for suspected appendicitis with a sensitivity of 90 per cent, specificity of 98 per cent, accuracy of 94 per cent, positive predictive value of 98 per cent, and negative predictive value of 91 per cent. CT scanning without rectal contrast is effective for the diagnosis of acute appendicitis making rectal contrast, with its attendant morbidity, unnecessary. The previously acceptable published negative appendectomy rate is higher than that found in current surgical practice likely due to preoperative CT scanning.

scholarly journals The role of hysteroscopy in diagnosis and treatment of postmenopausal bleeding

2013 ◽  
Vol 70 (8) ◽  
pp. 747-750 ◽  
Author(s):  
Sonja Pop-Trajkovic-Dinic ◽  
Aleksandar Ljubic ◽  
Vesna Kopitovic ◽  
Vladimir Antic ◽  
Snezana Stamenovic ◽  
...  
Keyword(s):  
Histological Examination ◽  
Predictive Value ◽  
Surgical Procedure ◽  
Diagnostic Procedure ◽  
Pathological Finding ◽  
Endometrial Biopsy ◽  
Postmenopausal Bleeding ◽  
Histological Findings ◽  
Minimally Invasive Surgical Procedure ◽  
Gynecology And Obstetrics

Background/Aim. Abnormal uterine bleeding is the most common problem which brings woman to the gynecologist during the postmenopausal period. The aim of this study was to define the significance of hysteroscopy as a diagnostic procedure for the evaluation of patients with postmenopausal bleeding, as well as to define it as a surgical procedure by which the cause of bleeding can be treated in most cases in the same sitting. Methods. The study involved 148 female patients referred to the Clinic for Gynecology and Obstetrics in Nis for postmenopausal bleeding in the period of 12 months. Hysteroscopy with endometrial biopsy were performed in all the patients. Biopsy materials were directed to histological examination, and the hysteroscopic and histological findings were compared afterwards. Polyps and submucous miomas were hysteroscopically removed in the same sitting and also directed to histological examination. Results. The success rate of the method was 95.1%, while complications occurred in 1.37% of the cases. The hysteroscopic findings were normal in almost 30% of the cases, and the most common pathological finding was endometrial polyp. The sensitivity of hysteroscopy in the detection of intrauterine pathology was 100%, the specificity 81%, the positive predictive value 92% and the negative predictive value 100%. In 69.7% of the patients the cause of bleeding was hysteroscopically removed. Hysteroscopy was performed in 58.1% of the patients in the same sitting, and in 11.6% of the patients after obtaining histological findings. Conclusion. Hysteroscopy is a safe, highly sensitive diagnostic procedure, thus being an ideal method for evaluation of patients with postmenopausal bleeding. The application of hysteroscopy with endometrial biopsy leads to accurate diagnosis. An adequate diagnosis is crucial for the selection of relevant treatment of postmenopausal bleeding and avoidance of unnecessary major surgical procedures. Except for being a diagnostic method hysteroscopy, is also an outpatient minimally invasive surgical procedure for treating the cause of bleeding in the majority of cases in the same sitting.

scholarly journals Negative predictive value of preoperative computed tomography in determining pathologic local invasion, nodal disease, and abdominal metastases in gastric cancer

2016 ◽  
Vol 23 (4) ◽  
pp. 273 ◽  
Author(s):  
D.J. Kagedan ◽  
F. Frankul ◽  
A. El-Sedfy ◽  
C. McGregor ◽  
M. Elmi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Population Level ◽  
Distant Metastases ◽  
Ct Imaging ◽  
Abdominal Ct ◽  
Curative Intent ◽  
Local Invasion ◽  
Pathology Reports

BackgroundBefore undergoing curative-intent resection of gastric adenocarcinoma (ga), most patients undergo abdominal computed tomography (ct) imaging to determine contraindications to resection (local invasion, distant metastases). However, the ability to detect contraindications is variable, and the literature is limited to single-institution studies. We sought to assess, on a population level, the clinical relevance of preoperative ct in evaluating the resectability of ga tumours in patients undergoing surgery.Methods In a provincial cancer registry, 2414 patients with ga diagnosed during 2005–2008 at 116 institutions were identified, and a primary chart review of radiology, operative, and pathology reports was performed for all patients. Preoperative abdominal ct reports were compared with intraoperative findings and final pathology reports (reference standard) to determine the negative predictive value (npv) of ct in assessing local invasion, nodal involvement, and intra-abdominal metastases.Results Among patients undergoing gastrectomy, the npv of ct imaging in detecting local invasion was 86.9% (n = 536). For nodal metastasis, the npv of ct was 43.3% (n = 450). Among patients undergoing surgical exploration, the npv of ct for intra-abdominal metastases was 52.3% (n = 407).Conclusions Preoperative abdominal ct imaging reported as negative is most accurate in determining local invasion and least accurate in nodal assessment. The poor npv of ct should be taken into account when selecting patients for staging laparoscopy.

Rate of Discordant Findings in Bilateral Temporal Artery Biopsy to Diagnose Giant Cell Arteritis

2009 ◽  
Vol 36 (4) ◽  
pp. 794-796 ◽  
Author(s):  
GABRIEL S. BREUER ◽  
GIDEON NESHER ◽  
RONIT NESHER
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Temporal Artery ◽  
Diagnostic Sensitivity ◽  
Temporal Artery Biopsy ◽  
Histological Findings ◽  
Discordance Rate ◽  
Pathology Reports ◽  
Positive Results

Objective.To determine to what extent performing simultaneous bilateral temporal artery biopsies might increase the diagnostic sensitivity in giant cell arteritis (GCA).Methods.In total 173 consecutive pathology reports of temporal artery biopsies were reviewed for histological findings by a single pathologist. The rate of discordance of biopsy results was calculated in patients with GCA.Results.Biopsies were performed bilaterally and simultaneously in 132 cases; 51 had positive results. In 38 the biopsy was positive on both sides (concordant results), while in 13 patients only one side was positive (discordant results), reaching a discordance rate of 13/51 = 0.255. Therefore 12.7% of the patients (one-half of the discordance rate) could have been misdiagnosed as biopsy-negative had a biopsy been done only unilaterally in those 51 cases.Conclusion.These data suggest that performing bilateral temporal artery biopsies increases the diagnostic sensitivity of the procedure by up to 12.7%, compared to unilateral biopsies.

3D Telomere Dynamics In Hodgkin's Lymphoma

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 745-745 ◽  
Author(s):  
Hans Knecht ◽  
Narisorn Kongruttanachok ◽  
Bassem Sawan ◽  
Zelda Lichtensztejn ◽  
Daniel Lichtensztejn ◽  
...  
Keyword(s):  
Cancer Biology ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Refractory Disease ◽  
Mixed Cellularity ◽  
Nodular Sclerosis ◽  
Diagnostic Biopsy ◽  
Relapse Group ◽  
Telomere Dynamics ◽  
Diagnostic Biopsies

Abstract Abstract 745 Introduction: Innovative 3D telomere q-FISH allows a mechanistic understanding of the transition from the mononuclear Hodgkin (H) to the multinuclear Reed-Sternberg (RS) cell in in Hodgkin's lymphoma (HL) derived cell lines and diagnostic patient biopsies (Leukemia. 2009; 23:565-573). In RS-cells the telomere protecting shelterin complex appears to be disrupted and deregulation of DNA repair mechanisms is observed. These changes occur in both, classical EBV negative and EBV-associated, LMP1 expressing HL (Lab Invest. 2010; 90:611-619). However, it is not known whether the 3D telomere profile at diagnostic biopsy is different in patients entering rapid remission after initiation of standard chemotherapy (ABVD) compared to that-one of patients with relapsing or refractory disease. In order to answer this question we analyzed by 3D telomere q-FISH diagnostic biopsies of HL patients entering rapid complete remission and compared them to diagnostic biopsies of patients with relapsing or refractory disease. Patients and methods: Rapid remission group (after 1–4 cycles of ABVD): 7 diagnostic biopsies of 7 patients, 19–57 years old, 5 male, 3 LMP1 expressing, 4 nodular sclerosis subtype, 3 mixed cellularity subtype, stages IA, IIA, IIIA × 2, IIIB x2, IVA. Relapse group: 7 diagnostic biopsies of 4 patients, 40–77 years old, 2 male, 1 LMP1 expressing, 3 nodular sclerosis subtype, 1 mixed cellularity subtype, stages IIA bulky, IIIB × 2, IVB; first remission after 6–8 cycles of ABVD in 3 patients, 1 patient died from progressive disease after 11 months. 3D telomere q-FISH was performed as described (Lab Invest. 2010; 90:611-619) and statistical analysis was performed using nested or two-way analysis of variance. Results: Bi- or multinuclear RS-cells of all patients from both groups showed a significant increase of very short telomeres and telomere aggregates when compared to the mononuclear precursor H-cells. However, most importantly, all diagnostic biopsies of the relapse group contained a very high percentage of very small telomeres, including so-called “t-stumps”, in both, H-cells (76,8 ± 11,8%) and RS-cells (87,9 ± 7,3%). Compared to the percentage of very small telomeres identified in both, H-cells (33,7 ± 9,4%) and RS-cells (54,6 ± 15,0%) of the rapid remission group, this increase is highly significant (p <0.001). Moreover, analogous findings are observed for the number of telomere aggregates. In the relapse group the average numbers of telomere aggregates per cell were 4,3 ± 2,4 aggregates per H-cell and 5,4 ± 3.0 aggregates per RS-cell, compared to 1,2 ± 0,7 aggregates per H-cell and 3,3 ± 1,1 aggregates per RS-cell in the rapid remission group. Discussion: The 3D nuclear telomere organization of H- and RS- cells in diagnostic biopsies of relapsing or refractory HL is characterized by both, H- and RS-cells with abundant “t-stumps” and numerous telomere aggregates. Very short telomeres, including t-stumps, and telomere aggregates, both, are characteristics of aggressiveness in cancer biology (Mol Cell. 2007;28:315-327; J Cell Biochem. 2010; 109:1095-1102). Thus, H- and RS-cells of refractory or relapsing HL show significant differences in the 3D telomere dynamics already at first, diagnostic biopsy when compared to H- and RS-cells of HL entering rapid remissions. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Acute Abdomen—A Clinical Presentation of MIS-C in Children

2021 ◽  
Author(s):  
Emrah Gün ◽  
Tanıl Kendirli ◽  
Edin Botan ◽  
Berrin Demir ◽  
Ergun Ergün ◽  
...  
Keyword(s):  
Acute Abdomen ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Clinical Course ◽  
Treatment Options ◽  
Pediatric Intensive Care ◽  
Multiple Organ ◽  
Multiple Organ Dysfunction ◽  
Pathology Reports ◽  
Inflammatory Syndrome

Abstract Objective Multisystemic inflammatory syndrome in children (MIS-C) is characterized by persistent fever, systemic hyperinflammation, and multiple-organ dysfunction. There are a few reports about MIS-C presenting with acute abdomen. The aim of this study is to demonstrate the clinical characteristics and treatment options for MIS-C-related acute abdomen and appendicitis. Methods This was a retrospective study conducted between April 2020 and October 2020 in our pediatric intensive care unit in Turkey. Patients between the ages of 1 month and 18 years who presented with acute abdomen and were ultimately diagnosed with MIS-C were included. Results Seven patients with a median age of 12.5 (interquartile range 10.5–13) years were enrolled. Four were females. The most frequent symptoms were fever, abdominal pain, and vomiting. Three patients had involvement of the appendix that required surgical intervention. All pathology reports were compatible with appendicitis. The other patients also had an acute abdomen. One patient had malignant hyperthermia during induction of anesthesia, so surgery was postponed and medical management was commenced. The clinical picture regressed with immunomodulation. All patients were treated with intravenous immunoglobulin and steroids. Four patients with acute abdomens improved with immunomodulation, and surgery was not needed. Conclusion MIS-C may present with an acute abdomen. Immunomodulation should be considered instead of surgery if the clinical course is not complicated.

scholarly journals The Diagnostic Accuracy of Endometrial Sampling in Endometrial Hyperplasia

2017 ◽  
pp. 1
Author(s):  
Serdar Başaranoğlu ◽  
Elif Ağaçayak ◽  
Şafak Hatırnaz ◽  
Ayşegül Deregözü ◽  
Mustafa Acet ◽  
...  
Keyword(s):  
Predictive Value ◽  
Endometrial Hyperplasia ◽  
Treatment Options ◽  
Endometrial Biopsy ◽  
Predictive Values ◽  
Medicine Department ◽  
Endometrial Sampling ◽  
Pathologic Diagnosis ◽  
School Of Medicine ◽  
Sensitivity Specificity

<p><strong>Objective:</strong> Endometrial hyperplasia is a premalignant lesion characterized with hyperplastic changes in endometrial gland and stromal structures. Its incidence is not exactly known. This study evaluated the accuracy of endometrial sampling of the patients whose pathological results were endometrial hyperplasia and had undergone hysterectomy (paraffin sections).<br /><strong>Study Design:</strong> Patients that diagnosed with endometrial hyperplasia by endometrial biopsy and/or hysterectomy at Dicle University School of Medicine Department of Obstetrics and Gynecology between January 2006 and July 2014 were retrospectively evaluated. Sensitivity, specificity, and positive and negative predictive values of endometrial biopsy to predict postoperative hysterectomy result were calculated. Discrete results in endometrial sampling and hysterectomy were recorded separately. Statistical analyses were conducted with corresponding appropriate methods. <br /><strong>Results:</strong> Mean ages of pre and postmenopausal patients were 42.6±4.8 (28-50) and 57.7±7.7 (50-79) years, respectively. For the efficiency of endometrial sampling to predict definite pathologic diagnosis, sensitivity was 71.9%, specificity was 87.5%, positive predictive value was 79.3%, and negative predictive value was 82.3%. When the accuracy of endometrial sampling with the pathologic diagnosis was evaluated, 38 patients had accurate (47.5%), and 42 patients had discrete (52.5%) results.<br /><strong>Conclusion:</strong> The presence of atypia determines the treatment in patients with endometrial hyperplasia. Hysterectomy should not be the first option in endometrial hyperplasia patients without atypia, and medical treatment and curettage options should be considered. Experienced staff should perform and evaluate endometrial samplings. We consider that this will increase the success in diagnosis, and could change treatment options.</p>

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