scholarly journals Molecular Markers for Bladder Cancer Screening, Early Diagnosis, and Surveillance: The WHO/ICUD Consensus

2014 ◽  
Vol 94 (1) ◽  
pp. 1-24 ◽  
Author(s):  
Bernd J. Schmitz-Dräger ◽  
Michael Droller ◽  
Vinata B. Lokeshwar ◽  
Yair Lotan ◽  
M''Liss A. Hudson ◽  
...  
Keyword(s):  
Decision Making ◽  
Bladder Cancer ◽  
Molecular Markers ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Urine Cytology ◽  
Added Value ◽  
Current Status ◽  
Low Grade ◽  
Screening And Surveillance

Due to the lack of disease-specific symptoms, diagnosis and follow-up of bladder cancer has remained a challenge to the urologic community. Cystoscopy, commonly accepted as a gold standard for the detection of bladder cancer, is invasive and relatively expensive, while urine cytology is of limited value specifically in low-grade disease. Over the last decades, numerous molecular assays for the diagnosis of urothelial cancer have been developed and investigated with regard to their clinical use. However, although all of these assays have been shown to have superior sensitivity as compared to urine cytology, none of them has been included in clinical guidelines. The key reason for this situation is that none of the assays has been included into clinical decision-making so far. We reviewed the current status and performance of modern molecular urine tests following systematic analysis of the value and limitations of commercially available assays. Despite considerable advances in recent years, the authors feel that at this stage the added value of molecular markers for the diagnosis of urothelial tumors has not yet been identified. Current data suggest that some of these markers may have the potential to play a role in screening and surveillance of bladder cancer. Well-designed protocols and prospective, controlled trials will be needed to provide the basis to determine whether integration of molecular markers into clinical decision-making will be of value in the future.

Quality specifications: self pleasure for clinical laboratories or added value for patient management?

2007 ◽  
Vol 45 (4) ◽  
Author(s):  
Mario Plebani
Keyword(s):  
Decision Making ◽  
Patient Management ◽  
Clinical Decision Making ◽  
Laboratory Data ◽  
Clinical Decision ◽  
Added Value ◽  
Internal Quality ◽  
Laboratory Services ◽  
Management Procedures ◽  
Quality Specifications

AbstractAnalytical quality specifications play a key role in assuring and continuously improving high-quality laboratory services. However, I believe, that there are two “missing links” in the effective management of quality specifications in the delivery of laboratory services. The first is the evidence that pre-analytical variation and related problems are not taken into great consideration by laboratory professionals. The second missing link is the communication of quality specifications to clinicians and other possible stakeholders. If quality specifications represent “the level of performance required to facilitate clinical decision-making”, they cannot be used only for internal quality management procedures but must be communicated to facilitate clinical reasoning, decision-making and patient management. A consensus should be achieved in the scientific community on these issues to assure better utilization of laboratory data and, ultimately, improved clinical outcomes.Clin Chem Lab Med 2007;45:462–6.

CytoProcessorTM: A New Cervical Cancer Screening System for Remote Diagnosis

2019 ◽  
Vol 63 (3) ◽  
pp. 215-223 ◽  
Author(s):  
Elizabeth Faris Crowell ◽  
Cyril Bazin ◽  
François Saunier ◽  
Romain Brixtel ◽  
Yann Caillot ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Imaging System ◽  
Virtual Slide ◽  
Clinical Decision ◽  
Diagnostic Sensitivity ◽  
Low Grade ◽  
Remote Diagnosis ◽  
Automated Screening ◽  
Screening Systems

Background: Current automated cervical cytology screening systems still heavily depend on manipulation of glass slides. We developed a new system called CytoProcessorTM (DATEXIM, Caen, France), which increases sensitivity and takes advantage of virtual slide technology to simplify the workflow and save worker time. We used an approach based on artificial intelligence to identify abnormal cells among the tens of thousands in a cervical preparation. Objectives: We set out to compare the diagnostic sensitivity and specificity of CytoProcessorTM and the ThinPrep Imaging System (HOLOGIC, Marlborough, MA, USA). Methods: A representative population of 1,352 cases was selected from the routine workflow in a private laboratory. Diagnoses were established using the ThinPrep Imaging System and CytoProcessorTM. All discordances were resolved by a consensus committee. Results: Compared to the ThinPrep Imaging System, CytoProcessorTM significantly improves diagnostic sensitivity without compromising specificity. The sensitivity of detection of “atypical squamous cells of undetermined significance (ASC-US) and more severe” and “low-grade squamous intraepithelial lesion and more severe” was significantly higher using CytoProcessorTM. Considering that cases with a truth diagnosis of ASC-US or more severe required clinical follow-up, 1.5% of the cases (21/1,360) would have been missed if the CytoProcessorTM diagnosis had been used for clinical decision-making. In contrast, 4% of the cases (54/1,360) were missed when the ThinPrep Imaging System diagnosis was used for clinical decision-making. There were 2.6 times fewer false negatives using CytoProcessorTM. The CytoProcessorTM workflow was 1.5 times faster in terms of worker time. Conclusions: CytoProcessorTM is the first of a new generation of automated screening systems, demonstrating improved sensitivity and yielding significant gains in processing time. In addition, the fully digital nature of slide presentation in CytoProcessorTM allows the remote diagnosis of Papanicolaou tests for the first time.

scholarly journals Differences in spatial distribution between WHO 2016 low-grade glioma molecular subgroups

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Maarten M J Wijnenga ◽  
Sebastian R van der Voort ◽  
Pim J French ◽  
Stefan Klein ◽  
Hendrikus J Dubbink ◽  
...  
Keyword(s):  
Decision Making ◽  
Spatial Distribution ◽  
Clinical Decision Making ◽  
Tumor Volume ◽  
Right Hemisphere ◽  
Clinical Decision ◽  
Low Grade Glioma ◽  
Low Grade ◽  
Wild Type ◽  
Significant Difference

Abstract Background Several studies reported a correlation between anatomic location and genetic background of low-grade gliomas (LGGs). As such, tumor location may contribute to presurgical clinical decision-making. Our purpose was to visualize and compare the spatial distribution of different WHO 2016 gliomas, frequently aberrated single genes and DNA copy number alterations within subgroups, and groups of postoperative tumor volume. Methods Adult grade II glioma patients (WHO 2016 classified) diagnosed between 2003 and 2016 were included. Tumor volume and location were assessed with semi-automatic software. All volumes of interest were mapped to a standard reference brain. Location heatmaps were created for each WHO 2016 glioma subgroup, frequently aberrated single genes and copy numbers (CNVs), as well as heatmaps according to groups of postoperative tumor volume. Differences between subgroups were determined using voxelwise permutation testing. Results A total of 110 IDH mutated astrocytoma patients, 92 IDH mutated and 1p19q co-deleted oligodendroglioma patients, and 22 IDH wild-type astrocytoma patients were included. We identified small regions in which specific molecular subtypes occurred more frequently. IDH-mutated LGGs were more frequently located in the frontal lobes and IDH wild-type tumors more frequently in the basal ganglia of the right hemisphere. We found no localizations of significant difference for single genes/CNVs in subgroups, except for loss of 9p in oligodendrogliomas with a predilection for the left parietal lobes. More extensive resections in LGG were associated with frontal locations. Conclusions WHO low-grade glioma subgroups show differences in spatial distribution. Our data may contribute to presurgical clinical decision-making in LGG patients.

Prediction of progression to MIBC for pT1 bladder cancer: Development of a clinical decision-making tool

2017 ◽  
Vol 16 (11) ◽  
pp. e2937
Author(s):  
M. Abufaraj ◽  
D. D’Andrea ◽  
R. Ristl ◽  
B. Foerster ◽  
C. Seitz ◽  
...  
Keyword(s):  
Decision Making ◽  
Bladder Cancer ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Cancer Development ◽  
Decision Making Tool

Considerations on implementing diagnostic markers into clinical decision making in bladder cancer

2010 ◽  
Vol 28 (4) ◽  
pp. 441-448 ◽  
Author(s):  
Yair Lotan ◽  
Shahrokh F. Shariat ◽  
Bernd J. Schmitz-Dräger ◽  
Marta Sanchez-Carbayo ◽  
Feliksas Jankevicius ◽  
...  
Keyword(s):  
Decision Making ◽  
Bladder Cancer ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Diagnostic Markers

scholarly journals Sensitivity and Specificity in Urine Bladder Cancer Markers – Is it that Simple?

2021 ◽  
pp. 1-4
Author(s):  
Florian Roghmann ◽  
Peter J. Goebell ◽  
Lars Dyrskjøt ◽  
Bas W.G. van Rhijn ◽  
Heiko U. Käfferlein ◽  
...  
Keyword(s):  
Decision Making ◽  
Bladder Cancer ◽  
Clinical Decision Making ◽  
Prospective Trial ◽  
Clinical Decision ◽  
The Past ◽  
Large Numbers ◽  
Urine Bladder ◽  
Level 1 ◽  
Current Guidelines

Marker research and, in particular urine bladder cancer marker research throughout the past three decades, devours enormous scientific resources in terms of manpower (not to mention time spent on reviewing and editorial efforts) and financial resources finally generating large numbers of manuscripts without affecting clinical decision making. This is mirrored by the fact that current guidelines do not recommend marker use due to missing level 1 evidence. Although we recognize the problems and obstacles, the authors of this commentary feel that the time has come to abandon the current procedures and move on to prospective trial designs implementing marker results into clinical decision making. Our thoughts and concerns are summarized in this comment.

scholarly journals Impact of the revised WHO classification of diffuse low-grade glioma on clinical decision making: A case report

2017 ◽  
Vol 8 (1) ◽  
pp. 223 ◽  
Author(s):  
TimA. M. Bouwens van der Vlis ◽  
Ann Hoeben ◽  
JanC Beckervordersandforth ◽  
Linda Ackermans ◽  
DaniëlleB. P. Eekers ◽  
...  
Keyword(s):  
Decision Making ◽  
Case Report ◽  
Who Classification ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Low Grade Glioma ◽  
Low Grade

scholarly journals Study Progress of Noninvasive Imaging and Radiomics for Decoding the Phenotypes and Recurrence Risk of Bladder Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Xiaopan Xu ◽  
Huanjun Wang ◽  
Yan Guo ◽  
Xi Zhang ◽  
Baojuan Li ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Clinical Decision Making ◽  
Early Stage ◽  
Image Interpretation ◽  
Region Of Interest ◽  
Urinary Bladder Cancer ◽  
Clinical Decision ◽  
Recurrence Risk ◽  
Low Grade ◽  
Precise Diagnosis

Urinary bladder cancer (BCa) is a highly prevalent disease among aged males. Precise diagnosis of tumor phenotypes and recurrence risk is of vital importance in the clinical management of BCa. Although imaging modalities such as CT and multiparametric MRI have played an essential role in the noninvasive diagnosis and prognosis of BCa, radiomics has also shown great potential in the precise diagnosis of BCa and preoperative prediction of the recurrence risk. Radiomics-empowered image interpretation can amplify the differences in tumor heterogeneity between different phenotypes, i.e., high-grade vs. low-grade, early-stage vs. advanced-stage, and nonmuscle-invasive vs. muscle-invasive. With a multimodal radiomics strategy, the recurrence risk of BCa can be preoperatively predicted, providing critical information for the clinical decision making. We thus reviewed the rapid progress in the field of medical imaging empowered by the radiomics for decoding the phenotype and recurrence risk of BCa during the past 20 years, summarizing the entire pipeline of the radiomics strategy for the definition of BCa phenotype and recurrence risk including region of interest definition, radiomics feature extraction, tumor phenotype prediction and recurrence risk stratification. We particularly focus on current pitfalls, challenges and opportunities to promote massive clinical applications of radiomics pipeline in the near future.

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