Transthoracic lung biopsy for pulmonary nodules ≤20mm in the routine clinical care

BACKGROUNDComputed tomography (CT) screening has improved lung cancer survival, yet increasingly detected small lung lesions. The number of transthoracic lung biopsies (TTLB) for small nodules is thus expected to rise significantly.RESEARCH QUESTIONTo evaluate the diagnostic accuracy and safety of CT-guided TTLB for nodules ≤20 mm versus nodules >20mm.STUDY DESIGN AND METHODSData for CT-guided TTLBs from 474 consecutive patients were prospectively collected over a 3-year period (198 lesions ≤20 mm and 276 lesions >20 mm) in a teaching hospital and analysed in terms of diagnostic performance and complications.RESULTSThere were more conclusive biopsies in the >20 mm lesion group (n=236; 85.5%) than in ≤20 mm lesion group (n=140; 70.7%; p<0.001). The overall accuracy, sensitivity, specificity, and negative predictive value for diagnosing malignant lesions after first TTLB were 88.4%, 84%, 100%, and 70.1% for ≤20 mm lesions and 94.2%, 93%, 100%, and 74.6% for >20 mm lesions, respectively. Pneumothorax requiring drainage was significantly more common for ≤20 mm lesions, compared to TTLB of larger lesions (9.6% versus 4.3%; p=0.02). Prolonged hospital stay due to pneumothorax occurred in 27 (17.4%) TTLBs of ≤20 mm lesions and 15 (7%) TTLBs of >20mm lesions (p=0.002). There were no deaths. The only variable significantly associated with diagnostic failure in the ≤20mm lesion group was the radiologist's experience.INTERPRETATIONTTLBs for lesions ≤20 mm were associated with slightly lower diagnostic performance, whereas the higher rate of major complications was still inferior to that extrapolated from United States insurance databases.

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Effect of lesion characteristics on diagnostic performance of CT-derived fractional flow reserve: exploring the indications for application based on CT-FFR CHINA trial (Preprint)

10.2196/preprints.35006 ◽

2021 ◽

Author(s):

Na Zhao ◽

Yang Gao ◽

Bo Xu ◽

Weixian Yang ◽

Lei Song ◽

...

Keyword(s):

Diagnostic Performance ◽

Coronary Calcification ◽

Lesion Group ◽

Lesion Length ◽

Fractional Flow ◽

Lesion Location ◽

Flow Reserve ◽

Bifurcation Lesions ◽

Coronary Lesions ◽

Sensitivity Specificity

BACKGROUND High diagnostic performance of coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFR; CT-FFR) in identifying flow-limiting stenosis has been confirmed. CT-FFR is recommended to assess the hemodynamic significance of coronary lesions. However, the optimal indications of CT-FFR relies on its ability to discriminating ischemia in situations of different types of lesions. And the effect of lesion-dependent factors on determining the diagnostic accuracy of CT-FFR have not been comprehensively evaluated yet. OBJECTIVE We aimed to investigate the effect of lesion-related factors on the diagnostic performance of CT-FFR with computational fluid dynamics algorithm, to promote the clinical application of it. METHODS This multicenter prospective clinical trial enrolled 317 patients with 30%–90% stenosis undergoing CCTA and invasive FFR from 5 centers across China. All target lesions were assigned into different lesion characteristics (target vessels, lesion location, lesion length, bifurcation lesions, and coronary calcification) subgroups. Diagnostic performance (accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under receiver operating characteristics curve (AUC)) of CT-FFR identifying ischemia were calculated and compared in all sub-groups. RESULTS Three hundred and sixty-six target vessels from 317 patients (mean age: 59.3 ± 9.6 years) were analyzed. The overall vessel-based diagnostic accuracy, sensitivity, specificity, PPV, NPV, and AUC of CT-FFR were 87.2%, 86.4%, 88.8%, 86.9%, 88.4%, and 0.90. Absence of bifurcation lesion group possessed the higher NPV of CT-FFR than presence of bifurcation lesion group (92.8% vs. 78.9%, p = 0.006). Whereas there was no statistically significant difference in diagnostic performance of CT-FFR among different target vessels, lesion location, lesion length, and coronary calcification sub-groups (all p > 0.05). CONCLUSIONS This study supported CT-FFR as a powerful noninvasive functional assessment tool for coronary lesions with different lesion characteristics, involving target vessel, lesion location, lesion length, and coronary calcification. While the diagnostic performance of CT-FFR was negatively affected by the presence of bifurcation lesions. CLINICALTRIAL https://clinicaltrials.gov; Unique identifier: NCT03692936.

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The Diagnostic Performance of Chest Ultrasonography in the Up-to-date Workup in Patients with Chest Diseases

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i830879 ◽

2021 ◽

pp. 1-12

Author(s):

Esraa Mohammed El Zaablawy ◽

Mohamed Fouad Sherif ◽

Faten Mohammed Salem ◽

Rasha Mahmoud Dawoud

Keyword(s):

Diagnostic Accuracy ◽

Diagnostic Performance ◽

Pulmonary Nodules ◽

Disease Diagnosis ◽

Chest Ct ◽

Lung Collapse ◽

Chest Ultrasonography ◽

Respiratory Problems ◽

Female Patients ◽

Sensitivity Specificity

Background: Application of chest radiography for all patients with chest diseases is associated with a significant increase in total costs, exposure to radiation, and overcrowding of the emergency department in case of emergency. Ultrasound has been introduced as an alternative diagnostic tool in this regard. The aim of the work is to determine sensitivity, specificity and diagnostic accuracy of chest ultrasonography as an easy and fast form of imagery for different thoracic conditions. Results: This prospective study was carried out on sixty patients. The majority of patients presented with lung masses (20%) and pleural effusion (16.7%). Chest US findings showed great concordance or agreement with the chest CT findings. The only lower concordance is noted in the diagnosis of pulmonary nodules or mass, where chest US reported pulmonary nodules or mass in 33.3% of patients compared to 46.7%% by chest CT. US showed a highly comparable diagnostic performance in chest-related pathological entities, compared to chest CT. Chest US had 100% sensitivity in detecting all pathological chest entities except for lung collapse (83.3%) and pulmonary nodules (71.4%). However, chest US was more specific than sensitive. It had 100% specificity in all pathological entities except for lung collapse consolidation. Chest US had 100% diagnostic accuracy in all chest-related pathological entities except for lung collapse consolidation and pulmonary nodules or masses. However, when presenting these findings among male and female patients, Chest US had better overall diagnostic accuracy among female patients than male patients. Conclusion: US examination of the chest is a noninvasive and promising bedside tool for the examination of respiratory problems patients. Consequently, chest ultrasonography can be adjoined in the up-to-date work-up of the outpatients as an ancillary tool aiding in disease diagnosis.

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Predictive Evaluation on Cytological Sample of Metastatic Melanoma: The Role of BRAF Immunocytochemistry in the Molecular Era

Diagnostics ◽

10.3390/diagnostics11061110 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1110

Author(s):

Andrea Ronchi ◽

Marco Montella ◽

Federica Zito Marino ◽

Michele Caraglia ◽

Anna Grimaldi ◽

...

Keyword(s):

Metastatic Melanoma ◽

Molecular Analysis ◽

Predictive Value ◽

Diagnostic Performance ◽

Cost Effective ◽

Needle Aspiration ◽

Braf V600e ◽

Mutational Status ◽

Needle Aspiration Cytology ◽

Sensitivity Specificity

Background: Cutaneous malignant melanoma is an aggressive neoplasm. In advanced cases, the therapeutic choice depends on the mutational status of BRAF. Fine needle aspiration cytology (FNA) is often applied to the management of patients affected by melanoma, mainly for the diagnosis of metastases. The evaluation of BRAF mutational status by sequencing technique on cytological samples may be inconvenient, as it is a time and biomaterial-consuming technique. Recently, BRAF immunocytochemistry (ICC) was applied for the evaluation of BRAF V600E mutational status. Although it may be useful mainly in cytological samples, data about BRAF ICC on cytological samples are missing. Methods: We performed BRAF ICC on a series of 50 FNA samples of metastatic melanoma. BRAF molecular analysis was performed on the same cytological samples or on the corresponding histological samples. Molecular analysis was considered the gold standard. Results: BRAF ICC results were adequate in 49 out of 50 (98%) cases, positive in 15 out of 50 (30%) cases and negative in 34 out of 50 (68%) of cases. Overall, BRAF ICC sensitivity, specificity, positive predictive value and negative predictive value results were 88.2%, 100%, 100% and 94.1%, respectively. The diagnostic performance of BRAF ICC results was perfect when molecular evaluation was performed on the same cytological samples. Hyperpigmentation represents the main limitation of the technique. Conclusions: BRAF ICC is a rapid, cost-effective method for detecting BRAF V600E mutation in melanoma metastases, applicable with high diagnostic performance to cytological samples. It could represent the first step to evaluate BRAF mutational status in cytological samples, mainly in poorly cellular cases.

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Diagnostic performance of chest CT in differentiating COVID-19 from other causes of ground-glass opacities

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00398-6 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Ali H. Elmokadem ◽

Dalia Bayoumi ◽

Sherif A. Abo-Hedibah ◽

Ahmed El-Morsy

Keyword(s):

Diagnostic Performance ◽

Pulmonary Nodules ◽

Ground Glass Opacity ◽

Chest Ct ◽

Ground Glass ◽

Rt Pcr ◽

Laboratory Findings ◽

Halo Sign ◽

Traction Bronchiectasis ◽

Chest Ct Scan

Abstract Background To evaluate the diagnostic performance of chest CT in differentiating coronavirus disease 2019 (COVID-19) and non-COVID-19 causes of ground-glass opacities (GGO). Results A total of 80 patients (49 males and 31 females, 46.48 ± 16.09 years) confirmed with COVID-19 by RT-PCR and who underwent chest CT scan within 2 weeks of symptoms, and 100 patients (55 males and 45 females, 48.94 ± 18.97 years) presented with GGO on chest CT were enrolled in the study. Three radiologists reviewed all CT chest exams after removal of all identifying data from the images. They expressed the result as positive or negative for COVID-19 and recorded the other pulmonary CT features with mention of laterality, lobar affection, and distribution pattern. The clinical data and laboratory findings were recorded. Chest CT offered diagnostic accuracy ranging from 59 to 77.2% in differentiating COVID-19- from non-COVID-19-associated GGO with sensitivity from 76.25 to 90% and specificity from 45 to 67%. The specificity was lower when differentiating COVID-19 from non-COVID-19 viral pneumonias (30.5–61.1%) and higher (53.1–70.3%) after exclusion of viral pneumonia from the non-COVID-19 group. Patients with COVID-19 were more likely to have lesions in lower lobes (p = 0.005), peripheral distribution (p < 0.001), isolated ground-glass opacity (p = 0.043), subpleural bands (p = 0.048), reverse halo sign (p = 0.005), and vascular thickening (p = 0.013) but less likely to have pulmonary nodules (p < 0.001), traction bronchiectasis (p = 0.005), pleural effusion (p < 0.001), and lymphadenopathy (p < 0.001). Conclusions Chest CT offered reasonable sensitivity when differentiating COVID-19- from non-COVID-19-associated GGO with low specificity when differentiating COVID-19 from other viral pneumonias and moderate specificity when differentiating COVID-19 from other causes of GGO.

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Gout of feet and ankles in different disease durations: diagnostic value of single-source DECT and evaluation of urate deposition with a novel semi-quantitative DECT scoring system

Advances in Rheumatology ◽

10.1186/s42358-021-00194-4 ◽

2021 ◽

Vol 61 (1) ◽

Author(s):

Jin Shang ◽

Xiao-Hu Li ◽

Shu-Qin Lu ◽

Yi Shang ◽

Lu-Lu Li ◽

...

Keyword(s):

Scoring System ◽

Diagnostic Performance ◽

Disease Duration ◽

Bone Erosion ◽

Early Stage ◽

Gouty Arthritis ◽

Single Source ◽

Crystal Deposition ◽

Urate Crystal ◽

Sensitivity Specificity

Abstract Objectives To investigate the diagnostic performance of single-source dual-energy computed tomography (DECT) based on gemstone spectral imaging technology (including Discovery CT750HD and Revolution CT) in patients with suspected feet/ankles gouty arthritis, and evaluate the urate deposition with a novel semi-quantitative DECT scoring system. Methods A total of 196 patients were consecutively included. Feet and ankles were evaluated in all patients by single-source DECT scan. The 2015 EULAR/ACR criteria were used as the reference for the diagnosis of gout. The sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of DECT for the diagnosis of gout in the early (≤1 year), middle (1–3 years), and late (> 3 years) disease durations were calculated. Besides, a novel semi-quantitative DECT scoring system was assessed for the measurement of urate deposition, and the correlation between the scores and the clinical and serological data were also evaluated. Moreover, the influences of artifacts on the diagnostic performance of DECT were also determined. Results The sensitivity, specificity, and AUC of DECT in 196 patients were 38.10, 96.43%, and 0.673 in the early-stage group; 62.96, 100.00%, and 0.815 in the middle-stage group; and 77.55, 87.50%, and 0.825 in the late-stage group, respectively. The overall diagnostic accuracies in the AUC of DECT (Discovery CT750HD and Revolution CT) in the middle and late stages of gout were higher than that in the early stage of gout. Besides, the monosodium urate crystals were deposited on the first metatarsophalangeal joints and ankles/midfeet. Age, the presence of tophus, bone erosion, and disease duration considerably affected the total urate score. No statistical difference in the positive detection of nail artifact, skin artifact, vascular calcification, and noise artifact was found between the case and control groups. Conclusion DECT (Discovery CT750HD and Revolution CT) showed promising diagnostic accuracy for the detection of urate crystal deposition in gout but had limited diagnostic sensitivity for short-stage gout. Longer disease duration, the presence of tophus, and bone erosion were associated with the urate crystal score system. The artifacts do not remarkably affect the diagnostic performance of DECT in gout.

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Comparison of 2D Fat Suppressed Proton Density (FS-PD) and 3D (WATS-c) MRI pulse sequences in evaluation of chondromalacia patellae

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0102-z ◽

2019 ◽

Vol 50 (1) ◽

Author(s):

Ahmed Ibrahim Tawfik ◽

Wael Hamza Kamr ◽

Saher Ebrahim Taman

Keyword(s):

Diagnostic Performance ◽

False Negative ◽

Pulse Sequences ◽

Proton Density ◽

Grading System ◽

Reference Standard ◽

Mr Images ◽

Arthroscopic Findings ◽

Chondromalacia Patella ◽

Sensitivity Specificity

Abstract Background Comparing the diagnostic performance of widely used 2D FSE technique (fat-suppressed proton density; FS-PD) and the 3D technique (water-selective cartilage scan; WATS-c) in evaluation of the chondromalacia patella by using arthroscopy as reference standard Results Seventy-five adult patients were enrolled in this study. They underwent MRI examinations then arthroscopy done in 2–4 days after it. MRI was done using 2D (FS-PD) and 3D (WATS-c) sequences and MR images were compared by two radiologists separately, then grading of the cartilage lesions was performed according to modified Noyes grading system and comparison between grade 0–1, 2, and 3 lesions was done using arthroscopic findings as a reference. A false-negative result is considered if there was undergrading of chondromalacia and false-positive result if chondromalacia was overgraded. Each sequence sensitivity, specificity, and accuracy was calculated by both readers. For reader 1, the sensitivity is 69% for WATS-c and 80% for FS-PD and the accuracy is 90% for WATS-c and 92% for FS-PD and for reader 2, the sensitivity is 56% for WATS-c and 84% for FS-PD and the accuracy is 88% for WATS-c and 94% for FS-PD. Conclusion 2D FS-PD images showed better diagnostic performance than 3D WATS-c images for evaluating chondromalacia patella.

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