Assessment of Lesions Detected at Mammographic Screening: Performance at First or Repeat Screening in the Florence Programme

1994 ◽  
Vol 1 (3) ◽  
pp. 188-192 ◽  
Author(s):  
Stefano Ciatto ◽  
Marco Rosselli Del Turco ◽  
Daniela Giorgi ◽  
Doralba Morrone ◽  
Sandra Catarzi ◽  
...  
Keyword(s):  
Diagnostic Procedures ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Mammographic Screening ◽  
Surgical Biopsy ◽  
Predictive Values ◽  
Screening Performance ◽  
The Cost ◽  
Benign Biopsy ◽  
Biopsy Rate

To evaluate the assessment criteria and the results achieved in the detection of breast lesions at mammographic screening. Review of cases assessed in the last screening round of Florence city (FC.- first screening round: 29 522 subjects) and Florence district (FD — repeat screening round: 13 268 subjects) programmes. Methods – Referral and biopsy rates, predictive values, and prevalence of cancers detected by screening were determined, as well as the frequency of the diagnostic procedures used at assessment, and their contribution to the final diagnosis according to the mammographic appearance of the suspected lesion. Assessment costs were estimated. Referral rate (FC 4.2%; FD 1.8%), referral positive predictive value (FC 18.7%; FD 28.3%), surgical biopsy rate (FC 0.96%; FD 0.6%), benign/malignant biopsy ratio (FC 0.20; FD 0.13), and prevalence of cancers detected by screening (FC 0.78%; FD 0.5%) were all within the European Community (EC) recommended standards for screening performance. The benign biopsy rate was considerably lower than that of recommended standards. The cost for each subject assessed was 179 000 Italian lire at the first and 116 000 lire at repeat screening. The cost for each subject screened that was attributable to assessment was 7600 lire at the first or 2100 lire at repeat screening. Limited referral rates and costs were achieved and the proportion of cancers detected by screening was high. The number of referrals was further reduced at repeat screening, and assessment had a limited impact on total screening costs. Detail or magnification mammography, palpation, sonography, and fine needle aspiration cytology all contributed to the final diagnosis and should be immediately available at the assessment clinic. The observed benign biopsy rate was particularly low and suggests that EC recommended standards should be modified.

scholarly journals Cost Effectiveness of Transbronchial Needle Aspiration

1999 ◽  
Vol 6 (4) ◽  
pp. 332-335 ◽  
Author(s):  
Jennifer A Crocket ◽  
Eric YL Wong ◽  
Dale C Lien ◽  
Khanh Gia Nguyen ◽  
Michelle R Chaput ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Effective ◽  
Diagnostic Procedures ◽  
Needle Aspiration ◽  
Benign Disease ◽  
University Hospital ◽  
High Yield ◽  
Transbronchial Needle Aspiration ◽  
Computed Tomographic ◽  
The Cost

OBJECTIVE: To evaluate the yield and cost effectiveness of transbronchial needle aspiration (TBNA) in the assessment of mediastinal and/or hilar lymphadenopathy.DESIGN: Retrospective study.SETTING: A university hospital.POPULATION STUDIED: Ninety-six patients referred for bronchoscopy with computed tomographic evidence of significant mediastinal or hilar adenopathy.RESULTS: Ninety-nine patient records were reviewed. Three patients had two separate bronchoscopy procedures. TBNA was positive in 42 patients (44%) and negative in 54 patients. Of the 42 patients with a positive aspirate, 40 had malignant cytology and two had cells consistent with benign disease. The positive TBNA result altered management in 22 of 40 patients with malignant disease and one of two patients with benign disease, thereby avoiding further diagnostic procedures. The cost of these subsequent procedures was estimated at $27,335. No complications related to TBNA were documented.CONCLUSIONS: TBNA is a high-yield, safe and cost effective procedure for the diagnosis and staging of bronchogenic cancer.

Magnetic Resonance Imaging in the Diagnosis of Glomus Tumours of the Hand

2005 ◽  
Vol 30 (5) ◽  
pp. 535-540 ◽  
Author(s):  
M. M. AL-QATTAN ◽  
A. AL-NAMLA ◽  
A. AL-THUNAYAN ◽  
F. AL-SUBHI ◽  
A. F. EL-SHAYEB
Keyword(s):  
Predictive Value ◽  
Final Diagnosis ◽  
Senior Author ◽  
Glomus Tumour ◽  
Resonance Imaging ◽  
Predictive Values ◽  
Final Histological Diagnosis ◽  
Sensitivity Specificity ◽  
The Cost ◽  
Negative Imaging

This paper studies the sensitivity, specificity and predictive values of MRI in the diagnosis of glomus tumours of the hand and investigates the final diagnosis and outcome in cases with false positive or negative imaging tests. A total of 42 cases with the clinical diagnosis of a glomus tumour were included in the study. All patients underwent MRI and the results of MRI were correlated with the final histological diagnosis of the excised lesion. MRI had a sensitivity of 90%, a specificity of 50%, a positive predictive value of 97% and a negative predictive value of 20%. The four cases in which the MRI was negative all proved histologically to be glomus tumours. All four tumours were small (2–3 mm in diameter) and the lack of delineation of the lesions by MRI was attributed to their small size. Despite negative MRIs, surgical exploration identified the glomus tumours. Based on the results of the current study and the cost of MRI, the senior author has stopped ordering pre-operative MRIs in patients clinically diagnosed with a glomus tumour.

scholarly journals Liver and splenic sarcoidosis: Diagnostic procedures

2004 ◽  
Vol 57 (9-10) ◽  
pp. 462-466 ◽  
Author(s):  
Vesna Skodric-Trifunovic ◽  
Violeta Vucinic ◽  
Radoje Colovic ◽  
Jelica Videnovic-Ivanov ◽  
Vladimir Zugic ◽  
...  
Keyword(s):  
Diagnostic Procedure ◽  
Diagnostic Procedures ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Pulmonary Diseases ◽  
Important Criterion ◽  
Chronic Patients ◽  
Significant Parameter ◽  
Abdominal Organs ◽  
Clinical Center

Introduction Clinical studies indicate involvement of the liver and spleen in approximately 20-30% of patients affected with sarcoidosis and their detection should be based on a standardized diagnostic procedure. Diagnostic procedures Ultrasonography is a reliable and safe method to assess changes related to size and structure of the affected organs that are pathognomonic for sarcoidosis. Further evaluation may include computerized tomography or magnetic resonance, while percutaneous needle aspiration biopsy or laparoscopy may also be applied when indicated. The most important criterion used for final diagnosis is pathohistological evidence of epithelioid noncaseating granuloma in bioptic material along with already established sarcoidosis of the lungs or some other organ. Material and methods The study on the incidence of liver and spleen sarcoidosis included a group of 130 patients affected with sarcoidosis hospitalized at the Institute of Pulmonary Diseases and Tuberculosis, Clinical Center of Serbia, over the period 2002-2003. Results The analysis evidenced that 31.5% of sarcoidosis patients had pathognomonic echographic findings of abdominal organs: splenomegaly (13%), hepatomegaly (10.8%) and hepatosplenomegaly (7.7%). Three patients underwent surgical treatment of liver and spleen sarcoidosis. Conclusion Pathognomonic findings of liver and spleen sarcoidosis were evidenced in approximately one third of sarcoidosis cases and they represented a significant parameter for further therapy, particularly in chronic patients.

scholarly journals Diagnostic yield of transbronchial needle aspiration for lymphoma

2016 ◽  
Vol 22 (3) ◽  
pp. 67
Author(s):  
B Sonnekus ◽  
J Steenkamp ◽  
M Louw ◽  
C F N Koegelenberg
Keyword(s):  
Predictive Value ◽  
Diagnostic Yield ◽  
Cost Effective ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Tracheobronchial Tree ◽  
Transbronchial Needle Aspiration ◽  
Predictive Values ◽  
Hilar Adenopathy ◽  
Sensitivity Specificity

<p>Background. Transbronchial needle aspiration (TBNA) is a minimally invasive bronchoscopic technique that is cost-effective and safe for diagnosing mediastinal and hilar adenopathy in lung cancer, other malignancies, sarcoidosis and infectious processes such as tuberculosis. Few studies have analysed the sensitivity, specificity and predictive values of TBNA for diagnosing lymphoma.</p><p>Objective. To evaluate the diagnostic yield of TBNA for diagnosing mediastinal and hilar adenopathy in suspected lymphoma.</p><p>Methods. We performed a retrospective analysis of collected data of patients with mediastinal and hilar adenopathy adjacent to the tracheobronchial tree detected by thoracic computed tomography, who underwent TBNA at Tygerberg Hospital between July 2010 and June 2013. We included 25 patients with suspected or proven lymphoma. Histology was used as the gold standard.</p><p>Results. Adequate samples for cytological evaluation were obtained for 22 (88%) patients. Cytological diagnosis was possible for 8 (32%). For 17 (68%) who could not be diagnosed by TBNA alone, histology provided final diagnosis. Rapid on-site examination (ROSE) was performed in 23 (92%). In 17/23 (74%) cases, these had similar results to formal cytology. Only 4 (16%) had flow cytometry requested. Twelve (48%) had lymphoma confirmed on histology. TBNA cytology had 100% specificity and positive predictive value for suspicion of lymphoma. Sensitivity was 33% and negative predictive value 62%.</p><p>Conclusion. TBNA is an appropriate first-line diagnostic procedure in evaluating mediastinal and hilar lymphadenopathy in suspected lymphoma. Biopsy should be the immediate second-line procedure when ROSE/cytology is suspicious of lymphoma or shows atypical cells. Patients with negative TBNA cytology, but high clinical or radiological suspicion of lymphoma, should be further investigated.</p>

The Challenge of Mediastinal Staging

2011 ◽  
Vol 07 (01) ◽  
pp. 31 ◽  
Author(s):  
Loris Ceron ◽  
Lucio Michieletto ◽  
Andrea Zamperlin ◽  
Laura Mancino ◽  
◽  
...  
Keyword(s):  
Imaging Techniques ◽  
Diagnostic Procedures ◽  
Cancer Staging ◽  
Needle Aspiration ◽  
Nodal Metastasis ◽  
Endobronchial Ultrasound ◽  
Transbronchial Needle Aspiration ◽  
Predictive Values ◽  
Mediastinal Staging ◽  
Positron Emission

Lung cancer staging is a crucial step in both correct prognosis and therapy. Mediastinal staging in particular is usually accomplished using imaging techniques such as computed tomography and 18F–glucose positron-emission tomography, minimally invasive techniques, i.e. transbronchial needle aspiration with or without ultrasound guidance (endobronchial ultrasound) and transoesophageal ultrasound-guided fine needle aspiration and surgical procedures, i.e. mediastinoscopy, thoracoscopy. Each of these techniques has its own sensitivities, specificities and predictive values that must be thoroughly considered within the staging route, with the aim of achieving the best result with the least resource consumption and the least discomfort to the patient; the correct evaluation of a negative result on the basis of its predictive value is essential as well. In this article we suggest a mathematical model that can predict the probability of nodal metastasis after a certain number of diagnostic procedures has been performed, providing an objective way of evaluating whether a patient is fit for surgery or, conversely, whether further investigations are required.

scholarly journals Role of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of space occupying lesions of the pancreas

2014 ◽  
Vol 05 (03) ◽  
pp. 110-113 ◽  
Author(s):  
S. Palaniappan ◽  
M. A. Arvind ◽  
Jothimani Dinesh ◽  
Srinivas Melpakam ◽  
Srinivasan Vijaya ◽  
...  
Keyword(s):  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Definitive Diagnosis ◽  
Benign Lesions ◽  
Ultrasound Guided ◽  
Predictive Values ◽  
Fine Needle

Abstract Introduction: Space occupying lesions (SOLs) of the pancreas are commonly encountered in day to day practice either as an incidental finding or during evaluation of symptomatic patients. The aim of the present study was to compare the final diagnosis at follow-up with diagnosis made at computed tomography (CT)/magnetic resonance imaging (MRI) and endoscopic ultrasound (EUS). Materials and Methods: Retrospective analysis of EUS data of 131 patients referred for tissue diagnosis of SOL in pancreas was done. The lesions were classified as malignant, benign, and nonneoplastic by both CT/MRI and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in conjunction with clinical presentation, biochemical parameters, and tumor markers. Follow-up cases with a final diagnosis alone were included for the comparative analysis. Statistical Analysis: Chi-square test, sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) for CT/MRI and EUS-FNA were computed against the follow-up data. Results: Of the 131, there were 78 males (59.5%). The median age of presentation was 48 years (range: 11–82 years. Follow-up information on the final diagnosis was available for 54 patients. Confirmed diagnosis at follow-up was malignant lesion in 18, benign in 13 and 23 with a nonneoplastic lesion. When EUS-FNA outcome was compared with the definitive diagnosis of the 54 patients, it had a higher sensitivity for malignant (66.7% vs. 61.1%) and nonneoplastic lesions (78.3% vs. 73.9%) and was similar to CT/MRI for benign lesions (76.9% for both). EUS-FNA had a higher specificity (87.8% vs. 80.5%) with a good PPV for benign lesions (66.7% vs. 55.6%). CT/MRI was less accurate than EUS-FNA in predicting benign (79.6% vs. 85.2%) and nonneoplastic lesions (79.6% vs. 81.5%) compared to malignant lesions wherein it was similar at 81.5%. The high NPV with a lower PPV for both EUS/FNA and CT/MRI suggests that follow-up definitive diagnosis was superior to both –. Conclusions: Endoscopic ultrasound-guided fine-needle aspiration had a higher specificity, but low sensitivity for the both neoplastic and nonneoplastic lesion of the pancreas compared to the world literature. The overall EUS-FNA yield was low when compared to the follow-up definitive diagnosis.

scholarly journals Rapid assessment of fine needle aspiration and the final diagnosis--how often and why the diagnoses are changed

CytoJournal ◽  
2006 ◽  
Vol 3 ◽  
pp. 25 ◽  
Author(s):  
Carolyn Woon ◽  
Ricardo H Bardales ◽  
Michael W Stanley ◽  
Edward B Stelow
Keyword(s):  
Fine Needle Aspiration ◽  
Diagnostic Yield ◽  
Rapid Assessment ◽  
Diagnostic Procedures ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Additional Material ◽  
Fine Needle ◽  
Inter Observer Variability ◽  
Ancillary Studies

Background: On-site rapid interpretation (RI) of fine needle aspiration (FNA) has been shown to increase the diagnostic yield of FNA and decrease the need for repeat diagnostic procedures. Because the pathologist interprets only a fraction of the sample and has limited resources available at such times, an occasional RI diagnosis will be changed at the time of the final diagnosis. We investigated how often these changes in diagnoses occur and the possible reasons for the changes. Methods: All cytology reports from 1/1/02 to 12/31/03 from a single institution were reviewed. Cases with RI with discrepant final diagnoses were noted. The discrepant diagnoses were categorized depending on how they were changed. Possible sources for changed diagnoses were noted. Results: Between 1/1/02 and 12/31/03 there were 1368 RIs of FNAs. Of these 80 (5.8%) had discrepancies between the RIs and final diagnoses. Seventy-eight cases had additional slides and/or cell block at time of final diagnosis. 16 cases had ancillary studies available at final diagnosis. Consultant pathologists were used in 7 cases. Different pathologists interpreted the RI and final diagnosis in 31 cases. Conclusion: Although uncommon, discrepancies between RIs and final diagnoses occur 5.8% of the time at our institution. Most commonly, this involves a change of diagnosis from either non-diagnostic or benign to malignancy. Although much of this is likely due to the presence of additional material and information at the time of final diagnosis, the number of cases that had different pathologists involved in the RI and final diagnosis suggests that inter-observer variability may also play some role.

F.N.A.C. AS DIAGNOSTIC TOOL OF PAROTID TUMORS AND ASSOCIATED PITFALLS IN CORRELATION WITH HISTOPATHOLOGY

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Bhawana Pant ◽  
Sanjay Gaur ◽  
Prabhat Pant
Keyword(s):  
Preoperative Diagnosis ◽  
Histopathological Examination ◽  
Clinical Information ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Histopathological Diagnosis ◽  
Cytological Diagnosis ◽  
Tertiary Referral Centre ◽  
Clear Cut ◽  
Parotid Tumors

F.NA.C has been used for ages as a safe and economical tool for fast preoperative diagnosis of parotid tumors. It has certain pitfall which sometimes leads to misdiagnosis and consequently it may have affect on treatment of the tumors. Keeping in view of the diverse classification of parotid tumors’ information from cytology should be combined with radiology as well as clinical diagnosis. Aim: To discuss some cases where there was discrepancy between cytological diagnosis and histopathological result and also suggest measures to improve the efficacy of F.N.A.C. Material and methods: The study includes 50 cases of parotid tumours who presented to the  department of ENT at Government medical college Haldwani which is a tertiary referral centre during 2009 to 2016. Only adult patients were included and inflammatory swelling were excluded from the study. All patients evaluated  Contrast enhanced computerized tomography(CECT) and  Magnetic resonance imaging (MRI) followed by Fine needle aspiration cytology .Preoperative diagnosis was made upon the findings of the above investigations and different types of  parotid surgeries  were done. . Final diagnosis was made on  histopathological  examination. Result :The most common tumour  came out to be pleomorphic adenoma (23 cases-46%) followed by mucoepidermoid carcinoma(12cases-24%). In ten  cases there was no clear cut  association between cytological diagnosis and final histopathological diagnosis. Conclusion: FNAC is highly sensitive and specific technique for diagnosis of many salivary gland swellings. FNAC can be used preoperatively to avoid unnecessary surgery and biopsy. Details of clinical information and radiologic features may help the pathologist to arrive at the appropriate diagnosis and reduce false interpretation. Pitfalls may also occur with improper technique of FNAC which can be overcome by proper caution.

The “gray zone” in fine-needle aspiration cytology of the organized mammography screening. Cytohistological correlation

2011 ◽  
Vol 152 (8) ◽  
pp. 292-295
Author(s):  
Mihály Bak ◽  
Éva Konyár ◽  
Ferenc Schneider ◽  
Mária Bidlek ◽  
Éva Szabó ◽  
...  
Keyword(s):  
Fine Needle Aspiration ◽  
Mammography Screening ◽  
Fine Needle Aspiration Cytology ◽  
Benign Lesion ◽  
Needle Aspiration ◽  
Gray Zone ◽  
Aspiration Cytology ◽  
Surgical Biopsy ◽  
Fine Needle ◽  
Needle Aspiration Cytology

The National Public Health Program has established the organized mammography screening in Hungary. The aim of this study was to conduct an audit of “gray zone” smears of the organized mammography screening in comparison with histopathological diagnoses. Methods: Cytology results were rated to C3 atypia probably benign and C4 suspicious of malignancy. Results: 1361 women had aspiration cytology performed from a total of 47,718 mammography non-negative lesions. 105 (7.8%) were diagnosed as C3, whereas 78 (5.7) as C4. Of the 105 patients with C3 diagnosis 61 (58%) patients underwent surgical biopsy. Histology proved malignancy in 20 (32.8%) cases, and benign lesion in 41 (67.2%) cases. All (100%) of the 78 patients with C4 diagnosis had open biopsies; 69 (88.4%) cases were histologically malignant and 9 (11.6%) cases were benign lesions. Conclusion: The auditing results of fine needle aspiration cytology of “gray zone” in organized mammography screening meet the proposed threshold values. Authors conclude that the “gray zone” category in breast cytology is useful and of value if used judiciously. Orv. Hetil., 2011, 152, 292–295.

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