Ultrasound diagnosis of molar pregnancy

Introduction The primary aims of this study were to establish what proportion of ultrasonically suspected molar pregnancies were proven on histological examination and what proportion of histologically diagnosed molar pregnancies were identified by ultrasound pre-operatively. The secondary aim was to review the features of these scans to help identify criteria that may improve ultrasound diagnosis. Methods This was a retrospective observational study conducted in the Early Pregnancy Unit at King’s College Hospital London over an 11-year period. Cases of ultrasonically suspected molar pregnancy or other gestational trophoblastic disease were identified and compared with the final histopathological diagnosis. In addition, cases which were diagnosed on histopathology that were not suspected on ultrasound were also examined. In discrepant cases, the images were reviewed unblinded by two senior sonographers. Statistical analysis for likelihood ratio and post-test probabilities was performed. Results One hundred eighty-two women had gestational trophoblastic disease suspected on ultrasound examination (1:360, 0.3%); 106/182 (58.2%, 95% CI 51.0 to 65.2%) had histologically confirmed gestational trophoblastic disease. The likelihood ratio for gestational trophoblastic disease after a positive ultrasound was 607.27, with a post-test probability of 0.628.The sensitivity of ultrasound for gestational trophoblastic disease was 70.7% (95% CI 62.9% to 77.4%) with an estimated specificity of 99.88% (95% CI 99.85% to 99.91%); 102/143 (71.3%, 95% CI 63.4 to 78.1%) molar pregnancies were suspected on pre-op ultrasound; 60/68 (88.2%, 95% CI 78.2 to 94.2%) of complete moles were suspected on pre-op ultrasound, compared with 42/75 (56.0%, 95% CI 44.7 to 66.7%) of partial moles. On retrospective review of the pre-op ultrasound images, there were cases that could have been suspected prior to surgery. Conclusion Detecting molar pregnancy by ultrasound remains a diagnostic challenge, particularly for partial moles. These data suggest that there has been an increase in both the predictive value and the sensitivity of ultrasound over time, with a high LR and post-test probability; however, the diagnostic criteria remain ill-defined and could be improved.

Download Full-text

Accuracy of closed pleural biopsy in the diagnosis of malignant pleural effusion

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562016000000323 ◽

2017 ◽

Vol 43 (6) ◽

pp. 424-430 ◽

Cited By ~ 1

Author(s):

Renata Báez-Saldaña ◽

Uriel Rumbo-Nava ◽

Araceli Escobar-Rojas ◽

Patricia Castillo-González ◽

Santiago León-Dueñas ◽

...

Keyword(s):

Pleural Effusion ◽

Diagnostic Test ◽

Likelihood Ratio ◽

Predictive Value ◽

Definitive Diagnosis ◽

Accuracy Analysis ◽

Pleural Biopsy ◽

Post Test ◽

Post Test Probability ◽

Test Probability

ABSTRACT Objective: Previous studies have demonstrated that closed pleural biopsy (CPB) has a sensitivity of less than 60% for diagnosing malignancy. Therefore, controversy has recently emerged regarding the value of CPB as a diagnostic test. Our objective was to assess the accuracy of CPB in diagnosing malignancy in patients with pleural effusion. Methods: This was a prospective 8-year study of individuals who underwent CPB to establish the etiology of pleural effusion. Information on each patient was obtained from anatomopathological reports and medical records. When CPB findings showed malignancy or tuberculosis, the biopsy was considered diagnostic, and that was the definitive diagnosis. In cases in which biopsy histopathological findings were nonspecific, a definitive diagnosis was established on the basis of other diagnostic procedures, such as thoracoscopy, thoracotomy, fiberoptic bronchoscopy, biochemical and cellular measurements in pleural fluid, and/or microbiological tests. The accuracy of CPB was determined with 2 × 2 contingency tables. Results: A total of 1034 biopsies from patients with pleural effusion were studied. Of those, 171 (16.54%) were excluded from the accuracy analysis either because of inadequate samples or insufficient information. The results of the accuracy analysis were as follows: sensitivity, 77%; specificity, 98%; positive predictive value, 99%; negative predictive value, 66%; positive likelihood ratio, 38.5; negative likelihood ratio, 0.23; pre-test probability, 2.13; and post-test probability, 82. Conclusions: CPB is useful in clinical practice as a diagnostic test, because there is an important change from pre-test to post-test probability.

Download Full-text

Clinical predictors of hypoxemia in pneumonia

Paediatrica Indonesiana ◽

10.14238/pi43.5.2003.192-8 ◽

2016 ◽

Vol 43 (5) ◽

pp. 192

Author(s):

Eka Gunawijaya ◽

I M Widia

Keyword(s):

Developing Countries ◽

Oxygen Saturation ◽

Likelihood Ratio ◽

Causes Of Death ◽

Clinical Predictors ◽

Clinical Predictor ◽

Post Test ◽

Post Test Probability ◽

Test Probability ◽

Saturation Measurement

Background Pneumonia is one of the main causes of death ininfants in developing countries. The device of oxygen saturationmeasurement for detecting hypoxemia is limited in district hospi-tals.Objective The aim of our study was to find the best clinical pre-dictor for hypoxemia that could be used in Indonesia.Methods Between June 2001 until May 2002, the diagnostic testwas performed in 125 infants aged 2–12 month-old who sufferedfrom pneumonia. The oxygen saturation measured by pulse oxim-etry was used as the gold standard.Results The samples were divided into two groups, 52 infants withhypoxemia and 73 normal. The base characteristics of both groupswere not statistically different. The prevalence of hypoxemia was41.6%. The best single clinical predictor of hypoxemia was cyano-sis (the sensitivity 92%, specificity 86%, likelihood ratio 6.74, post-test probability 83%), as well as the combination of two clinicalpredictors i.e., cyanosis and nasal flaring. The best combination ofthree clinical predictors was cyanosis, nasal flaring, and refusal todrink (the sensitivity 92%, specificity 86%, likelihood ratio 6.74,post-test probability 81%).Conclusion The combination of cyanosis and nasal flaring isgood enough as a predictor to detect hypoxemia in area with nofacility of oxygen saturation measurement

Download Full-text

How Helpful Is aEEG? Context and User Experience Matter

American Journal of Perinatology ◽

10.1055/s-0040-1721711 ◽

2020 ◽

Author(s):

Amanda G. Sandoval Karamian ◽

Courtney J. Wusthoff

Keyword(s):

Likelihood Ratio ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Neonatal Seizure ◽

Neonatal Seizures ◽

Extreme Prematurity ◽

Clinical Scenarios ◽

Post Test ◽

Post Test Probability ◽

Test Probability

Objective The aim of the study is to model amplitude-integrated electroencephalography (aEEG) utility to diagnose seizures in common clinical scenarios. Study Design Using reported neonatal seizure prevalence and aEEG sensitivities and specificities, likelihood ratios (LRs) and post-test probabilities were calculated to quantify aEEG utility to diagnose seizures in three typical clinical scenarios. Results Prevalence data supported pretest probabilities for neonatal seizures of 0.4 in neonatal hypoxic ischemic encephalopathy (HIE), 0.27 in bacterial meningitis, and 0.05 in extreme prematurity. Reported sensitivity of 85% and specificity of 90% for seizures with expert aEEG interpretation yielded a positive likelihood ratio (LR+) of 8.7 and a negative likelihood ratio (LR−) of 0.17. Reported sensitivity of 65% and specificity of 70% with intermediate interpretation yielded LR+ 2.17 and LR− 0.5. Reported sensitivity of 40% and sensitivity of 50% with inexperienced interpretation gave LR+ 0.8 and LR− 1.2. These translate the ability to move pretest to post-test probability highly dependent on user expertise. For HIE, a pretest probability of seizure of 0.4 moves to a post-test probability of 0.85 when aEEG is positive for seizures by expert interpretation, and down to 0.1 when aEEG is negative. In contrast, no useful information was gained between pretest and post-test probability by aEEG interpreted as negative or positive for seizure at the inexperienced user level. Similarly, in the models of meningitis or extreme prematurity, incremental information gained from aEEG ranged widely based on interpreter experience. Conclusion aEEG is most useful to screen for neonatal seizures when used in conditions with high seizure prevalence, and when interpretation has a sensitivity and specificity as reported for expert users. In contrast, aEEG can become negligible in providing meaningful clinical information when applied in conditions having lower seizure prevalence or when interpretation has low accuracy. Appropriate patient selection and high quality interpretation are essential for aEEG utility in neonatal seizure detection. Key Points

Download Full-text

A Mobile Terminal-based Nomogram for Early Predicting Severity of Acute Pancreatitis

10.21203/rs.3.rs-764041/v1 ◽

2021 ◽

Author(s):

Na Shi ◽

Xiaoxin Zhang ◽

Wenhua He ◽

Lihui Deng ◽

Lan Li ◽

...

Keyword(s):

Acute Pancreatitis ◽

Prognostic Factors ◽

Likelihood Ratio ◽

Clinical Utility ◽

Negative Likelihood Ratio ◽

Mobile Terminal ◽

Prognostic Scores ◽

Post Test ◽

Post Test Probability ◽

Test Probability

Abstract Background: Early prediction of the severity of acute pancreatitis (AP) is important but there is no preferred method in China. We aimed to develop and validate a simple-to-use predictive nomogram for persistent organ failure (POF) on admission in patients with AP. Methods: Data from 816 consecutive patients was obtained from internal (Chengdu) retrospective datasets and formed the training cohort for nomogram development. Data from 398 and 880 consecutive patients from internal (Chengdu) and external (Nanchang) prospective datasets formed the validation cohorts (all admitted < 48 hours of symptom onset). Univariate and multivariate logistic regressions were used to identify independent prognostic factors to establish the nomogram for POF. The calibration curves, concordance index (C-index), decision curve analysis (DCA), and clinical impact curve (CIC) were used to evaluate the performance of the nomogram and its clinical utility. The area under the receiver-operating characteristic curve (AUC) with 95% CI and likelihood ratio as well as post-test probability were applied. Measurements and main results: Age, respiratory rate, albumin, lactate dehydrogenase, oxygen support, and pleural effusion were identified as independent prognostic factors for POF and were included in the nomogram model (web-based calculator: https://shina.shinyapps.io/DynNomapp/). This predictive nomogram had good predictive ability for POF (C-indexes of 0.88, 0.91 and 0.81 for the training and two validation cohorts) and promising clinical utility (DCA: better or equivalent than prognostic scores; CIC: high clinical net benefit). The AUC of (0.91 [0.88-0.94] and 0.81 [0.79-0.84]), negative likelihood ratio (NLR 0.11 and 0.29), post-test probability of negative (0.9% and 6.7%) of the nomogram were superior in predicting POF than all other routinely used clinical prognostic scoring systems in both validation cohorts. Similar findings were observed for predicting major infection (superior to other prognostic scores) and mortality (superior or equally to others). Conclusions: The validated nomogram comprises 6 independent prognostic factors to predict major clinical outcomes of patients with AP in two distinct Chinese centers. This mobile terminal-based nomogram should be validated in other settings and considered for clinical practice and trial allocation, until more accurate biomarkers are discovered.

Download Full-text

The Diagnostic Accuracy of Сoronary Сomputed Tomography Angiography in the Diagnosis of Stable Coronary Artery Disease in Patients Aged 70 Years and Older

Kardiologiia ◽

10.18087/cardio.2019.12.n565 ◽

2019 ◽

Vol 59 (12) ◽

pp. 28-34

Author(s):

S. G. Kozlov ◽

O. V. Chernova ◽

T. N. Veselova ◽

S. K. Ternovoy

Keyword(s):

Chest Pain ◽

Coronary Artery ◽

Diagnostic Accuracy ◽

Positive Result ◽

Likelihood Ratio ◽

Stable Coronary Artery Disease ◽

Post Test ◽

Artery Disease ◽

Post Test Probability ◽

Test Probability

Aim: The purpose of this study was to evaluate the diagnostic accuracy of сoronary сomputed tomography angiography (CCTA) in the diagnosis of stable coronary artery disease (CAD) in patients aged ≥70 years. Materials and methods: The study included 390 patients aged ≥70 years with symptoms suggested stable CAD which underwent elective coronary artery angiography (CAG). Initially the prevalence of angiographically significant CAD was estimated according to the gender and chest pain character, and identifications of patients in whom CCTA was appropriate. After that diagnostic accuracy and сost-efficiency of CCTA in the diagnosis of stable CAD in 82 patients with atypical angina and non-anginal chest pain were evaluated. Results: The prevalence of obstructive CAD in patients with typical angina was very high and they were excluded from the final analysis. Among 82 patients with atypical angina and non-anginal pain which underwent CCTA 48 (59%) patients had obstructive CAD. CСTA data matched with results of CAG in all cases. Among 34 patients that had non-obstructive CAD the results of CCTA and CAG matched in 88% cases. CCTA has sensitivity, specificity, positive predictive value, negative predictive value of 100%, 88%, 92% and 100% respectively. The likelihood ratio for positive result was 8.3, likelihood ratio for negative result was 0.3. Positive result increased post-test probability of obstructive CAD from 42% to 86%, negative result reduced post-test probability of obstructive CAD to 0%. Conclusion: negative CCTA result in patients aged 70 years and older with atypical angina and non-anginal pain allows to exclude the presence of obstructive CAD. The likelihood ratio for positive result indicates a moderately difference between the pre-test and post-test probability of the presence of obstructive CAD. In patients aged ≥70 years with atypical angina or non-anginal chest pain which have inconclusive results of functional testing or unable undergo functional testing CCTA allows to increase diagnostic yield of CAG and reduce the frequency of minor complications and diagnostic evaluation costs.

Download Full-text

Choriocarcinoma with uterine rupture presenting as acute haemoperitoneum and shock

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170603 ◽

2017 ◽

Vol 6 (3) ◽

pp. 1141 ◽

Cited By ~ 2

Author(s):

Mamour Gueye ◽

Mame Diarra Ndiaye Gueye ◽

Ousmane Thiam ◽

Youssou Toure ◽

Mor Cisse ◽

...

Keyword(s):

Young Woman ◽

Uterine Rupture ◽

Gestational Trophoblastic Disease ◽

Uterine Perforation ◽

Molar Pregnancy ◽

Rare Neoplasm ◽

Trophoblastic Disease ◽

Intraperitoneal Bleeding ◽

Invasive Mole

Choriocarcinoma is a rare neoplasm and a malignant form of gestational trophoblastic disease. Invasive mole may perforate uterus through the myometrium resulting in uterine perforation and intraperitoneal bleeding. But uterine perforation due to choriocarcinoma is rare. We present a case of a young woman who presented 1 year after uterine evacuation of a molar pregnancy with invasive choriocarcinoma complicated by a uterine rupture and haemoperitoneum.

Download Full-text

Atypical Endometrial Hyperplasia and Unexpected Cancers at Final Histology: A Study on Endometrial Sampling Methods and Risk Factors

Diagnostics ◽

10.3390/diagnostics10070474 ◽

2020 ◽

Vol 10 (7) ◽

pp. 474 ◽

Cited By ~ 2

Author(s):

Luca Giannella ◽

Giovanni Delli Carpini ◽

Francesco Sopracordevole ◽

Maria Papiccio ◽

Matteo Serri ◽

...

Keyword(s):

Risk Factors ◽

Endometrial Hyperplasia ◽

Probability Analysis ◽

Secondary Outcome ◽

Endometrial Sampling ◽

Final Histology ◽

Atypical Endometrial Hyperplasia ◽

Post Test ◽

Post Test Probability ◽

Test Probability

Background: Up to 40% of women with atypical endometrial hyperplasia (AEH) can reveal endometrial cancer (EC) at hysterectomy. The pre-operative endometrial sampling method (ESM) and some independent cancer predictors may affect this outcome. The present study aimed to compare the rate of EC at hysterectomy in women with AEH undergoing dilation and curettage (D&C), hysteroscopically-guided biopsy (HSC-bio), or hysteroscopic endometrial resection (HSC-res). The secondary outcome was to compare the reliability of ESMs in women showing independent variables associated with EC. Methods: Two-hundred-and-eight consecutive women with AEH and undergoing hysterectomy between January 2000 and December 2017 were analyzed retrospectively. Based on pre- and post-test probability analysis for EC, three ESMs were compared: D&C, HSC-bio, and HSC-res. Univariate and multivariate analyses were performed to assess risk factors predicting cancer on final histology. Finally, the patient’s characteristics were compared between the three ESM groups. Results: D&C and HSC-bio included 75 women in each group, while HSC-res included 58 women. Forty-nine women (23.6%) revealed cancer at hysterectomy (pre-test probability). Post-test probability analysis showed that HSC-res had the lowest percentage of EC underestimation: HSC-res = 11.6%; HSC-bio = 19.5%; D&C = 35.3%. Patient characteristics showed no significant differences between the three ESMs. Multivariate analysis showed that body mass index ≥40 (Odds Ratio (OR) = 19.75; Confidence Intervals (CI) 2.193–177.829), and age (criterion > 60 years) (OR = 1.055, CI 1.002–1.111) associated significantly with EC. In women with one or both risk factors, post-test probability analysis showed that HSC-res was the only method with a lower EC rate at hysterectomy compared to a pre-test probability of 44.2%: HSC-res = 19.96%; HSC-bio = 53.81%; D&C = 63.12%. Conclusions: HSC-res provided the lowest rate of EC underestimation in AEH, also in women showing EC predictors. These data may be considered for better diagnostic and therapeutic planning of AEH.

Download Full-text

A Study of Molar Pregnancy at Low Resource Settings of Tertiary Care Hospital Sindh

10.53350/pjmhs211571547 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1547-1549

Author(s):

Sabahat Fatima ◽

A. G.ul Shaikh ◽

Tahmina Mahar ◽

Hameed-Ur-Rehman Bozdar ◽

Sameena Memon ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Economic Status ◽

Gestational Trophoblastic Disease ◽

Common Symptom ◽

Care Hospital ◽

Molar Pregnancy ◽

Socio Economic Status ◽

Trophoblastic Disease

Aim: To determine the epidemiological factors/characteristics and clinical presentation of molar pregnancy Study design: Qualitative observational / retrospective study Place and duration: Department of Obstetrics and Gynaecology Unit-II, Ghulam Muhammad Mahar Medical College Sukkur from 1st January 2016 to 31st December 2020. Methodology: Forty five diagnosed cases with molar pregnancy and aged between 18-40 years were enrolled. Patient’s details demographics age, body mass index, parity and socio economic status were recorded. The total birth records and gynecological admission for the study period were also collected from the gynaecology and labour room record books case and operational registration data were obtained, descriptive statistics examined . Results: Mean age of the patients was 31.15±7.41 years with mean body mass index 26.16±7.22 kg/m2. Mean gestational age of the patients were 25.62±9.19 weeks. Twenty seven (60%) patients were multiparous and 18 (40%) were primiparous. 30 (66.7%) were illiterate and 15(33.3%) cases were literate. There were 14(31.11%) patients belonged lower class, 18 (40%) patients belonged middle and 13(28.9%) had high socioeconomic status. Twenty nine (64.4%) were from rural area and 16 (35.6%) were from urban area. Five (11.1%) patients had previous history of gestational trophoblastic disease. Abnormal vaginal bleeding was the most common symptom found in 34(75.5%) cases followed by lower abdominal pain found in 30 (66.7%) patients, hyperemesis found in 14(31.1%) and dyspnea in 9 (20%). Thirty six (80%) patients received suction evacuation and 9 (20%) cases referred. Forty one (91.1%) patients were recovered but the rest 4 (8.9%) were lost during follow up. Conclusion: Low/middle socio-economic status, illiteracy and cases from rural areas had multiparous parity was highly effected by molar pregnancy disease and it can be controlled by early diagnose to take regular follow-up by using suction evacuation. Key words: Gestational trophoblastic disease (GTD), Molar pregnancy, Primiparous, Multiparous

Download Full-text

Impact of thyroid nodule size on prevalence and post-test probability of malignancy: A systematic review

The Laryngoscope ◽

10.1002/lary.24784 ◽

2014 ◽

Vol 125 (1) ◽

pp. 263-272 ◽

Cited By ~ 46

Author(s):

Jennifer J. Shin ◽

Diana Caragacianu ◽

Gregory W. Randolph

Keyword(s):

Systematic Review ◽

Thyroid Nodule ◽

Nodule Size ◽

Post Test ◽

Post Test Probability ◽

Test Probability

Download Full-text

Gestational Trophoblastic Disease Presents as an Ectopic Tubal Pregnancy, a Rare Entity

Case Reports in Obstetrics and Gynecology ◽

10.1155/2019/7153170 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Haneen Al-Maghrabi ◽

Daniyah Saleh ◽

Abdelrazak Meliti

Keyword(s):

Gold Standard ◽

Histopathological Examination ◽

Lower Abdominal Pain ◽

Gestational Trophoblastic Disease ◽

Low Grade ◽

Molar Pregnancy ◽

Fallopian Tubes ◽

Rare Entity ◽

Trophoblastic Disease ◽

Laboratory Investigations

Ectopic molar pregnancy is an uncommon event in clinical practice. In this paper, we report a case of ectopic complete molar pregnancy in a 39-year-old lady who presented to the emergency department with lower abdominal pain, abdominal distention, and low-grade fever. Based on radiological and laboratory investigations, the differential diagnosis included ruptured ectopic pregnancy versus metastatic diseases. Ectopic hydatidiform molar pregnancies can occur at any extrauterine pelvic sites, yet more frequently affecting fallopian tubes. The histopathological examination remains the gold standard for the diagnosis.

Download Full-text