The Rule of Histology in the Diagnosis of Periprosthetic Infection: Specific Granulocyte Counting Methods and New Immunohistologic Staining Techniques may Increase the Diagnostic Value

Objective: The current study investigates the diagnostic accuracy of the criteria described for frozen sections and whether modern leukocyte specific staining techniques including leukocyte peroxidase and Naphtol-AS-D-chloroacetate-esterase will improve the accuracy of the intra-operative histology. Method: 77 patients undergoing revision total hip and knee arthroplasty were included in this retrospective study. Patients were grouped into septic and aseptic based on intraoperative cultures. Tissue samples were analyzed utilizing the Mirra, Feldman, Lonner, Banit and Athanasou criteria. Results: An experienced pathologist had a high specificity (96%), but rather low sensitivity (57%) diagnosing infection. By using the Banit-, Mirra-, or Athanasou-criteria the sensitivity is increased to 0.90. The Feldman- and Lonner-criteria have a lower sensitivity (0.48 and 0.38), however, an increased specificity of 0.96 and 0.98, respectively. The Banit cut off has the highest accuracy (86%). MPOX and NACE staining increased the sensitivity and accuracy up to 100% and 92% respectively. Conclusion: Banit’s cut off is the most accurate histologic criteria to diagnose infection. Modern leukocyte specific staining techniques slightly improve the accuracy. The synovial fluid white blood cell count appears to be the most accurate intraoperative test.

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Factors Impacting the Performance Characteristics of Bile Duct Brushings: A Clinico-Cytopathologic Analysis of 253 Patients

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2017-0150-oa ◽

2018 ◽

Vol 142 (7) ◽

pp. 863-870 ◽

Cited By ~ 4

Author(s):

Ezgi Hacihasanoglu ◽

Bahar Memis ◽

Burcin Pehlivanoglu ◽

Vaidehi Avadhani ◽

Alexa A. Freedman, ◽

...

Keyword(s):

Bile Duct ◽

Predictive Value ◽

High Specificity ◽

Daily Practice ◽

Performance Characteristics ◽

Lower Sensitivity ◽

Current State ◽

Risk Of Malignancy ◽

Low Sensitivity ◽

Sensitivity Specificity

Context.— Literature on factors impacting bile duct brushings (BDBs) performance characteristics remain limited. Objective.— To capture the current state of daily practice with BDB sign-out. Design.— Two hundred fifty-three of 444 BDBs signed out by more than 7 cytopathologists, with histopathologic and/or clinical follow-up of at least 18 months, were examined. Results.— One hundred thirty-five of 253 BDBs (53%) had histologically confirmed malignancies, 22 (9%) had cancer-related deaths, and 96 (38%) were benign. Cytologic diagnoses in the 444 BDBs were nondiagnostic (11 [2.5%]), negative (284 [64%]), atypical (62 [13.9%]), suspicious (34 [7.7%]), and malignant (53 [11.9%]). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of malignancy detection were 35%, 100%, 100%, 58%, and 66%, respectively. When atypical, suspicious, and malignant (ASM) categories were combined, sensitivity increased (58%), specificity and PPV dropped (97%), and accuracy increased (73%). Carcinoma type (bile-duct versus pancreatic-ductal) had no effect on accuracy (P = .60) or diagnostic class (P = .84), nor did time of performance (first 7.5 versus latter 7.5 years, P = .13). Interestingly, ThinPrep + cell block (n = 41) had higher sensitivity (61%) and lower specificity (80%) than ThinPrep only (versus 51% and 100%, respectively). Sensitivity and specificity were higher (47% and 100%) in nonstented than stented specimens (59% and 97%). Relative risk of malignancy for “suspicious” (2.30) and “atypical” (2.28) categories was lower but not very different from that of “malignant” category (2.41). Conclusions.— Bile duct brushings had fairly low sensitivity but high specificity and PPV with no false positives. Sensitivity almost doubled and specificity dipped minimally when ASM categories were combined, highlighting the need for better classification criteria for atypical/suspicious cases. Higher specificity, PPV, NPV, and accuracy but lower sensitivity in stented BDBs suggest that they be called malignant only when evidence is overwhelmingly convincing.

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Early chest computed tomography to diagnose COVID-19 from suspected patients: A multicenter retrospective study

10.1101/2020.03.24.20042432 ◽

2020 ◽

Cited By ~ 3

Author(s):

Congliang Miao ◽

Mengdi Jin ◽

Li Miao ◽

Xinying Yang ◽

Peng Huang ◽

...

Keyword(s):

Ground Glass Opacity ◽

High Specificity ◽

Diagnostic Value ◽

Chest Ct ◽

Imaging Features ◽

Rt Pcr ◽

Polymerase Chain ◽

Low Sensitivity ◽

Chest Ct Scan ◽

Ct Features

AbstractObjectiveThe purpose of this study is to distinguish the imaging features of COVID-19 with other chest infectious diseases and evaluate diagnostic value of chest CT for suspected patients.MethodsAdult suspected patients aged>18 years within 14 days who underwent chest CT scan and reverse-transcription polymerase-chain-reaction (RT-PCR) tests were enrolled. The enrolled patients were confirmed and grouped according to results of RT-PCR tests. The data of basic demographics, single chest CT features, and combined chest CT features were analyzed for confirmed and non-confirmed groups.ResultsA total of 130 patients were enrolled with 54 cases positive and 76 cases negative. The typical CT imaging features of positive group were ground glass opacity (GGO), crazy-paving pattern and air bronchogram. The lesions were mostly distributed bilaterally, close to the lower lungs or the pleura. When features combined, GGO with bilateral pulmonary distribution and GGO with pleural distribution were more common, of which were 31 cases (57.4%) and 30 cases (55.6%) respectively. The combinations were almost presented statistically significant (P<0.05) except for the combination of GGO with consolidation. Most combinations presented relatively low sensitivity but extremely high specificity. The average specificity of these combinations is around 90%.ConclusionsThe combinations of GGO could be useful in the identification and differential diagnosis of COVID-19, which alerts clinicians to isolate patients for treatment promptly and repeat RT-PCR tests until incubation ends.

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Diagnostic value of three simple and rapid dry eye tests: Lid parallel conjunctival folds, tear meniscus height and tear ferning

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh190829024d ◽

2021 ◽

pp. 24-24

Author(s):

Bojana Dacic-Krnjaja ◽

Milan Hadzi-Milic ◽

Jelena Potic ◽

Danijela Raonic ◽

Milenko Stojkovic

Keyword(s):

Dry Eye ◽

High Specificity ◽

Diagnostic Value ◽

Control Group ◽

Ocular Surface Disease Index ◽

Mean Values ◽

Meniscus Height ◽

Tear Meniscus ◽

Tear Meniscus Height ◽

Low Sensitivity

Introduction/Objective. The objective of this paper was to assess the diagnostic value of three simple dry eye (DE) tests: lid parallel conjunctival folds (LIPCOF), tear meniscus height (TMH), and tear ferning (TF). Methods. Diagnostic DE tests LIPCOF, TMH and TF tests were performed in 100 patients. Eighty of them were referred to us by rheumatologists and general practitioners either during evaluation for Sj?gren?s syndrome, or because of DE symptoms. Control group was made of 20 patients, with no DE relating symptoms. Ocular Surface Disease Index (OSDI) questionnaire was used for DE symptoms? evaluation. Results of LIPCOF, TMH and TF tests were compared with results of Copenhagen criteria (CC) DE tests i.e., tear fluorescein break up time, Schirmer I and Rose Bengal tests. Ability of tests to recognize DE in various grades according to Dry Eye Work Shop (DEWS) report score system was assessed. Results. Compared to CC, sensitivity of LIPCOF and TMH was high: 92.8% and 83.5%, while specificity was low: 34.4% and 49.2%, respectively. TF had low sensitivity of 59.1% but high specificity of 82.7%. Mean values of both LIPCOF and TMH differed significantly (F = 7.222, p < 0.001 and F = 11.802, p < 0.001) between control group and all DEWS DE grades, but not among different grades of DE. Conclusions. Diagnostic tests TMH and LIPCOF showed high sensitivity which makes them excellent screening DE tests. Low sensitivity of TF suggests that it is not truly a good screening test on its own, but its high specificity is of definite value.

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Lorenz Plot Analysis in Dogs with Sinus Rhythm and Tachyarrhythmias

Animals ◽

10.3390/ani11061645 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1645

Author(s):

Giovanni Romito ◽

Carlo Guglielmini ◽

Helen Poser ◽

Marco Baron Toaldo

Keyword(s):

Sinus Rhythm ◽

Graphical Representation ◽

High Specificity ◽

Side Lobe ◽

Diagnostic Value ◽

Plot Analysis ◽

Highly Sensitive ◽

Repeatability And Reproducibility ◽

Low Sensitivity ◽

Holter Recordings

The Lorenz plot (LP), a graphical representation of heart rate variability, has been poorly studied in dogs to date. The present study aimed to describe the graphic features of LP in dogs with sinus rhythm (SR) and tachyarrhythmias, and to analyze the usefulness of its pattern recognition. One hundred and nineteen canine Holter recordings were retrospectively evaluated. Cardiac rhythms were classified as: SR; SR with frequent (>100) premature ectopies (atrial, SR-APCs; ventricular, SR-VPCs; atrial and ventricular, SR-APCs-VPCs); atrial fibrillation (AF); and AF with frequent VPCs (AF-VPCs). Lorenz plots were studied qualitatively and quantitatively, and classified by distinct LP patterns (LPPs). Repeatability and reproducibility of LPP classification and diagnostic value were determined. Recordings included: 48 SR, 9 SR-APCs, 35 SR-VPCs, 5 SR-APCs-VPCs, 4 AF, and 18 AF-VPCs. Ten LPPs were identified: comet (n = 12), torpedo (n = 3), Y-shaped (n = 6), diamond (n = 10), diamond with a central silent zone (n = 17), double side-lobe (DSL) (n = 47), triple side-lobe (n = 1), quadruple side-lobe (n = 2), fan (n = 18), and fan with DSL (n = 3). Repeatability and reproducibility of LPP classification were excellent. The DSL pattern was both highly sensitive (91.3%) and specific (94.5%) for SR with frequent premature ectopies, either APCs, or VPCs, or both. The remaining LPPs had lower diagnostic value (high specificity but low sensitivity). Distinct rhythms imprint distinct and reproducible LPPs in dogs. The majority of canine LPPs are specific but insensitive indicators of SR and tachyarrhythmias.

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Validation of Claims Algorithms to Identify Alzheimer’s Disease and Related Dementias

The Journals of Gerontology Series A ◽

10.1093/gerona/glab373 ◽

2021 ◽

Author(s):

Ellen P McCarthy ◽

Chiang-Hua Chang ◽

Nicholas Tilton ◽

Mohammed U Kabeto ◽

Kenneth M Langa ◽

...

Keyword(s):

Test Performance ◽

Healthcare Delivery ◽

High Specificity ◽

Cognitive Status ◽

Lower Sensitivity ◽

Billing Data ◽

Trade Offs ◽

Low Sensitivity ◽

Study Participants ◽

Retirement Study

Abstract BACKGROUND Using billing data generated through healthcare delivery to identify individuals with dementia has become important in research. To inform tradeoffs between approaches, we tested the validity of different Medicare claims-based algorithms. METHODS We included 5,784 Medicare-enrolled, Health and Retirement Study participants aged >65 years in 2012 clinically assessed for cognitive status over multiple waves and determined performance characteristics of different claims-based algorithms. RESULTS Positive predictive value (PPV) of claims ranged from 53.8-70.3% and was highest using a revised algorithm and 1-year of observation. The trade-off of greater PPV was lower sensitivity; sensitivity could be maximized using 3-years of observation. All algorithms had low sensitivity (31.3-56.8%) and high specificity (92.3-98.0%). Algorithm test performance varied by participant characteristics, including age and race. CONCLUSIONS Revised algorithms for dementia diagnosis using Medicare administrative data have reasonable accuracy for research purposes, but investigators should be cognizant of the trade-offs in accuracy among the approaches they consider.

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Diagnostic value in colorectal tumorous lesions of SDC2/TFPI2 methylation based on bowel subsite difference

10.1101/2021.02.22.21252188 ◽

2021 ◽

Author(s):

Lianglu Zhang ◽

Lanlan Dong ◽

Changming Lu ◽

Wenxian Huang ◽

Cuiping Yang ◽

...

Keyword(s):

Colorectal Cancer ◽

Methylation Level ◽

Precancerous Lesions ◽

High Specificity ◽

Diagnostic Value ◽

Detection Sensitivity ◽

Tissue Samples ◽

Potential Biomarker ◽

Healthy Control ◽

Auc Value

AbstractBackgroundSDC2 methylation is a potential biomarker for colorectal cancer detection with specificity over 90%, but its sensitivity is usually less than 90%. The study aims to improve the sensitivity and specificity by adding TFPI2 methylation as a complement.MethodsTFPI2 was identified using colorectal cancer samples from TCGA database with SDC2 methylation level lower than 0.2. SDC2/TFPI2 methylation specific PCR was performed using tissue samples (184 cancer and 54 healthy control) and stool samples (289 cancer, 190 adenoma and 217 healthy control). Detection sensitivity was calculated among tumors from different biopsy locations.Results88% of 50 TCGA specimens of colorectal cancer with SDC2 methylation level lower than 0.2 showed TFPI2 methylation level higher than 0.2. SDC2/TFPI2 combined detection in stool specimens showed AUC value of 0.98 with the specificity of 96.40% and sensitivity of 96.60% for cancer vs control, AUC value of 0.87 with the specificity of 95.70% and sensitivity of 80.00% for adenoma vs control. The sensitivities were much higher than those of SDC2, and the improvement was most significant in lesions from left colon and rectum.ConclusionsThis research indicated that the addition of TFPI2 can reduce the miss detection rate of colorectal cancer and adenomas while maintaining high specificity, probably by finding neoplasms in left colon.The method is non-invasive and has good compliance, also avoiding the pain of bowel preparation and risk of cross infection during endoscopy, so it will provide an easy and precise tool for colorectal cancer and its precancerous lesions screening.

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Diagnostic power of chest CT for COVID-19: to screen or not to screen

10.1101/2020.05.18.20097444 ◽

2020 ◽

Author(s):

K. De Smet ◽

D. De Smet ◽

I. Demedts ◽

B. Bouckaert ◽

T. Ryckaert ◽

...

Keyword(s):

High Sensitivity ◽

High Specificity ◽

Diagnostic Value ◽

Chest Ct ◽

Respiratory Pathogens ◽

Likelihood Ratios ◽

Asymptomatic Patients ◽

Diagnostic Power ◽

Low Sensitivity ◽

A Prospective Study

Structured abstractBackgroundchest CT is increasingly used for COVID-19 screening in healthcare systems with limited SARS-CoV-2 PCR capacity. Its diagnostic value was supported by studies with methodological concerns and its use is controversial. Here we investigated its potential to diagnose COVID-19 in symptomatic patients and to screen asymptomatic patients in a prospective study with minimal selection bias.MethodsFrom March 19, 2020 to April 20, 2020 we performed parallel SARS-CoV-2 PCR and CT with categorization of COVID-19 suspicion by CO-RADS, in 859 patients with COVID-19 symptoms and 1138 controls admitted to the hospital for COVID-19 unrelated medical urgencies. CT-CORADS was categorized on a 5-point scale from 1 (very low suspicion) to 5 (very high suspicion). AUC under ROC curve were calculated in symptomatic versus asymptomatic patients to predict positive SARS-CoV-2 positive PCR and likelihood ratios for each CO-RADS score were used for rational selection of diagnostic thresholds.FindingsCT-CORADS had significant (P<0.0001) diagnostic power in both symptomatic (AUC=0.891) and asymptomatic (AUC=0.700) patients hospitalized during SARS-CoV-2 peak prevalence. In symptomatic patients (41.7% PCR+), CO-RADS ≥ 3 detected positive PCR with high sensitivity (89.1%) and 72.5% specificity. In asymptomatic patients (5.3% PCR+), a CO-RADS score ≥ 3 detected SARS-CoV-2 infection with low sensitivity (45.0%) but high specificity (88.8%).InterpretationCT-CORADS has meaningful diagnostic power in symptomatic patients, supporting its application for time-sensitive triage. Sensitivity in asymptomatic patients is insufficient to justify its use as screening approach. Incidental detection of CO-RADS ≥ 3 in asymptomatic patients should trigger reflex testing for respiratory pathogens.

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Hit and False-Alarm Rates of Selected ABR Indices in Differentiating Cochlear Disorders From Acoustic Tumors

American Journal of Audiology ◽

10.1044/1059-0889.0501.90 ◽

1996 ◽

Vol 5 (1) ◽

pp. 90-96 ◽

Cited By ~ 4

Author(s):

Frank E. Musiek ◽

Cynthia A. McCormick ◽

Raymond M. Hurley

Keyword(s):

False Alarm ◽

Amplitude Ratio ◽

High Specificity ◽

Auditory Brainstem ◽

Latency Difference ◽

Cochlear Pathology ◽

Brainstem Response ◽

Absolute Latency ◽

Two Indices ◽

Low Sensitivity

We performed a retrospective study of 26 patients with acoustic tumors and 26 patients with otologically diagnosed cochlear pathology to determine the sensitivity (hit rate), specificity (false-alarm rate), and efficiency of six auditory brainstem response indices. In addition, a utility value was determined for each of these six indices. The I–V interwave interval, the interaural latency difference, and the absolute latency of wave V provided the highest hit rates, the best A’ values and good utility. The V/I amplitude ratio index provided high specificity but low sensitivity scores. In regard to sensitivity and specificity, using the combination of two indices provided little overall improvement over the best one-index measures.

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Positron emission mammography in the diagnosis of breast cancer

Nuklearmedizin ◽

10.3413/nukmed-0753-15-07 ◽

2016 ◽

Vol 55 (01) ◽

pp. 15-20 ◽

Cited By ~ 5

Author(s):

J. Farahati ◽

A. G. Müller ◽

E. Gillman ◽

M. Hentschel ◽

F. H. H. Müller

Keyword(s):

Breast Cancer ◽

High Specificity ◽

Diagnostic Value ◽

Glandular Tissue ◽

Breast Cancer Patients ◽

Malignant Tumours ◽

Benign Lesions ◽

Interventional Study ◽

Positron Emission Mammography ◽

Positron Emission

SummaryAim: To evaluate the diagnostic value (sensitivity, specificity) of positron emission mammography (PEM) in a single site non-interventional study using the maximum PEM uptake value (PUVmax). Patients, methods: In a singlesite, non-interventional study, 108 patients (107 women, 1 man) with a total of 151 suspected lesions were scanned with a PEM Flex Solo II (Naviscan) at 90 min p.i. with 3.5 MBq 18F-FDG per kg of body weight. In this ROI(region of interest)-based analysis, maximum PEM uptake value (PUV) was determined in lesions, tumours (PUVmaxtumour), benign lesions (PUVmaxnormal breast) and also in healthy tissues on the contralateral side (PUVmaxcontralateral breast). These values were compared and contrasted. In addition, the ratios of PUVmaxtumour / PUVmaxcontralateral breast and PUVmaxnormal breast / PUVmaxcontralateral breast were compared. The image data were interpreted independently by two experienced nuclear medicine physicians and compared with histology in cases of suspected carcinoma. Results: Based on a criteria of PUV>1.9, 31 out of 151 lesions in the patient cohort were found to be malignant (21%). A mean PUVmaxtumour of 3.78 ± 2.47 was identified in malignant tumours, while a mean PUVmaxnormal breast of 1.17 ± 0.37 was reported in the glandular tissue of the healthy breast, with the difference being statistically significant (p < 0.001). Similarly, the mean ratio between tumour and healthy glandular tissue in breast cancer patients (3.15 ± 1.58) was found to be significantly higher than the ratio for benign lesions (1.17 ± 0.41, p < 0.001). Conclusion: PEM is capable of differentiating breast tumours from benign lesions with 100% sensitivity along with a high specificity of 96%, when a threshold of PUVmax >1.9 is applied.

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Clinical application of the 2011 IFCPC colposcope terminology

BMC Women s Health ◽

10.1186/s12905-021-01395-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Bei Zhang ◽

Shuhui Hong ◽

Guihui Zhang ◽

Fengnian Rong

Keyword(s):

Diagnostic Accuracy ◽

Precancerous Lesions ◽

High Specificity ◽

Diagnostic Value ◽

Low Grade ◽

Squamous Intraepithelial Lesion ◽

Diagnostic Significance ◽

Cervical Precancerous Lesions ◽

Intraepithelial Lesion ◽

Common Sign

Abstract Background Colposcopy offers an accurate way to the diagnose of cervical precancerous lesions. However, the diagnostic accuracy of colposcopy is unsatisfied. This study was to evaluate colposcopic accuracy according to the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC) terminology. Methods A retrospective cohort study was performed in 1,838 patients who underwent colposcopy in Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University from October 2013 to April 2018. Using conization or cervical biopsy pathology as the gold standard, the agreement between colposcopic diagnosis and pathologic diagnosis was calculated, and correlations between variables were analyzed. Results As an authoritative and widely used terminology for colposcopy diagnosis, the 2011 IFCPC terminology has certain clinical practicality and diagnostic accuracy. However, some signs such as mosaic, punctation, sharp border, inner border sign and ridge sign had high specificity but unsatisfactory sensitivity, which limited the diagnostic value. Therefore, we discussed the Lugol’s staining, a very common sign in colposcopy, and analyzed the diagnostic significance of bright yellow staining in low-grade squamous intraepithelial lesion (LSIL) and mustard yellow staining in high-grade squamous intraepithelial lesion (HSIL). The results showed that mustard yellow may be a valuable indicator in the diagnosis of HSIL. Conclusion The 2011 IFCPC colposcope terminology has standardized interpretations of the colposcopic findings and improved the accuracy of colposcopy diagnosis. The aceto-white epithelium still has important diagnostic value; however, the value of a few signs is needed to be discussed and new signs are expected to be discovered. Although the significance of Lugol’s staining was diminishing, mustard yellow might be a valuable indicator for the diagnosis of HSIL.

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