Diagnostic accuracy of Multiparametric MRI in detection of prostate cancer compared with histopathology obtained by MRI directed TRUS guided cognitive fusion biopsy are T2WI, DWI and DCE enough for Indian scenario

2021 ◽  
Vol 20 (1) ◽  
pp. 10-12
Author(s):  
Mallinath Biradar ◽  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Prostatic Cancer ◽  
Tertiary Care ◽  
Multiparametric Mri ◽  
Care Hospital ◽  
Cognitive Fusion ◽  
Fusion Biopsy ◽  
Indian Scenario

Background: The incidence of prostatic carcinoma is increasing worldwide. With its high resolution, ability to provide excellent tissue characterization and multiplanar imaging capabilities, multi-parametric magnetic resonance imaging (mpMRI) plays a crucial role in detection, local staging and follow-up of carcinoma prostate. It also helps guide targeted biopsies in initial biopsy negative patient. Objectives: Study diagnostic accuracy of mp-MRI and primarily that of the three MR sequences T2, DWI and DCE in detection of prostatic cancer by correlating them with histopathology and thus whether it is feasible for a short MRI of 3 sequences to be used on a large scale in Indian scenario. Materials and Methods: A prospective study was done at a tertiary care hospital between April 2017 to November 2018 in which 50 patients who presented with suspicion of prostate cancer were referred to radiology department for evaluation using MRI. MRIexamination was done using 3T Siemens Magnetom Verio. Followed by this MRI directed TRUS guided cognitive fusion biopsy was done from the prostate. Samples were sent for histopathology. Results: Out of 50 cases studied, 24 cases (48%) were found to be malignant and 26 cases (52 %) were benign on histopathology. In our study, combined T2 + DWI + DCE gave sensitivity of 95.83 %, specificity of 57.69%, positive predictive value of 68.21 % and negative predictive value of 93.75%. Conclusion: Multiparametric MRI using T2, DWI and DCE has a high diagnostic accuracy for evaluation of prostatic cancer.

scholarly journals Diagnostic Accuracy of Sonographic Septations in Tuberculous and Malignant Pleural Effusions

2020 ◽  
Vol 9 (2) ◽  
pp. 95-102
Author(s):  
Abdul Rasheed Qureshi ◽  
Muhammad Irfan ◽  
Zeeshan Ashraf
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Tertiary Care ◽  
Positive Likelihood Ratio ◽  
Fisher Exact Test ◽  
Care Hospital ◽  
Pleural Effusions ◽  
Malignant Pleural Effusions ◽  
Malignant Group

Background: Discrimination between tuberculous (TB) and malignant pleural effusions is a real practical challenge because both exist as exudative lymphocytic type. Transthoracic ultrasonography not only identifies and quantifies pleural effusion but also displays sonographic septations, which are frequently seen in TB pleural effusions and can help in differentiation between tuberculosis and malignancy successfully, without any invasive procedure. We designed this study to determine the diagnostic usefulness of these septations for tuberculous and malignant pleural effusions. Material and Methods: This prospective study was conducted in the OPD of Gulab Devi Chest Hospital Lahore, Pakistan, a 1500 bedded tertiary care hospital, from November 2016 to February 2018. Total of 339 consecutive cases, aged 14-83 years with radiological evidence of pleural effusion were included in the study. After detailed history, thorough physical examination, radiological, haematological and biochemical findings were recorded. Pleural fluid macroscopic, cytological, microbiologic and biochemical analysis results were also recorded. Ultrasonography was done, septated and non-septated pleural effusions identified and findings were noted. SPSS-16 was used for statistical evaluation. Fisher Exact test was utilized for comparison between TB and malignant cases with P-value < 0.05 taken as significant. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and positive likelihood ratio were calculated. Results: Out of total 339 cases, 49 (14.45%) were malignant and 290 (85.55%) were non-malignant. In the malignant group, only 03 cases (6.12%) showed sonographic septations. In the non-malignant group, 259/290 (89.31%) cases showed tuberculous etiology and 187/259 (72.20%) of these cases displayed sonographic septations. By considering septations as predictor of TB, statistical analysis revealed a sensitivity of 79.23%, specificity of 92.85%, PPV of 98.42%, NPV of 44.31% and diagnostic accuracy of 81.29%, respectively. Conclusions: Sonographic septations can be a valuable predictor of tuberculosis, in a population with high prevalence of the disease. We found it to be a useful feature in differentiating between a malignant and tuberculous etiology, in exudative lymphocytic pleural effusions. It can be used with confidence in patients who are unfit for interventional procedures.

scholarly journals RAPID URINE TRYPSINOGEN-2 DIPSTICK ASSAY TO DIAGNOSE ACUTE PANCREATITIS IN EMERGENCY SETUP

2020 ◽  
pp. 1-4
Author(s):  
Shankar. S ◽  
Kolandasamy. C ◽  
Srinivasan.U. P ◽  
Naganath babu O. L.
Keyword(s):  
Acute Pancreatitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Tertiary Care ◽  
Care Hospital ◽  
Dipstick Test ◽  
Early Management ◽  
Laboratory Investigations ◽  
Set Up ◽  
Sensitivity Specificity

Background: Early diagnosis of acute pancreatitis remains a challenge in emergency set up. The early management results in better outcomes but none of the available investigations were rapid and accurate to guide the management in these patients. Hence in suspected cases of acute pancreatitis, the urinary trypsinogen 2 dipstick assay can be used to diagnose them at the earliest in the Emergency setup. The purpose of this study is to determine the accuracy of urine trypsinogen 2 assay in diagnosing acute pancreatitis. Methods: The patients presenting with symptoms consistent with acute pancreatitis to the emergency department, at a tertiary care hospital in Southern India between November 2018 to November 2019 were included in a prospective observational study after obtaining Institutional ethical committee clearance. In addition to the routine investigations done in cases of acute abdomen, patients underwent urine trypsinogen 2 dipstick test. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were calculated. Results were compared. Results: A total of 50 cases were included in the study. The urine trypsinogen 2 dipstick test was positive in 35 of 37 patients with acute pancreatitis (sensitivity, 94.59%) and in none of 13 patients with abdominal pain but without any evidence of acute pancreatitis (specificity, 100%). The diagnostic accuracy of the urine trypsinogen 2 dipstick test was 96% in this study higher than other conventional laboratory investigations. Conclusion: This study shows that the dipstick test has high diagnostic accuracy and can be considered for regular use for diagnosing pancreatitis along with the conventional methods.

scholarly journals DIAGNOSTIC ACCURACY OF 68Ga-PSMA PET/MRI AND MULTIPARAMETRIC MRI IN DETECTING INDEX TUMOR IN RADICAL PROSTATECTOMY SPECIMEN

2021 ◽  
Author(s):  
UGUR COSAR ◽  
Ilker Sen ◽  
Uguray Aydos ◽  
Murat Yavuz Koparal ◽  
Murat Ucar ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Predictive Value ◽  
Positive Likelihood Ratio ◽  
Multiparametric Mri ◽  
Psma Pet ◽  
Significant Difference ◽  
Index Tumour

ABSTRACT Objective To evaluate the diagnostic accuracy of the 68Gallium (68Ga) - prostate specific membrane antigen (PSMA) positron emission tomography/magnetic resonance imaging (PET/MRI) and multiparametric MRI (mpMRI) by region-based comparison of index tumour localisations using histopathological tumour maps of patients who underwent radical prostatectomy due to clinically significant prostate cancer. Patients and Methods The study included 64 patients who underwent radical prostatectomy after primary staging with mpMRI and 68Ga-PSMA PET/MRI. Diagnostic analysis was performed by dividing the prostate into four anatomic regions as left/right anterior and left/right posterior. The extension of the lesions in mpMRI and the pathological uptake in 68Ga-PSMA PET/MRI were matched separately for each region with the extension of the index tumour into each region. Results The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and the accuracy of mpMRI and 68Ga-PSMA PET/MRI are shown as 55.7%, 91.8%, 80.6%, 77.2%, 78.1% and 60.8%, 94.3%, 86.8% 79.8%, 83.5%, respectively. 68Ga-PSMA PET/MRI has higher sensitivity and specificity compared with mpMRI. However, no statistically significant difference was found (p = 0.464). Combined imaging had significantly higher diagnostic accuracy compared with mpMRI and 68Ga-PSMA PET/MRI (change in AUC: 0.084 and 0.046, p < 0.001 and p = 0.028, respectively), while no statistically significant difference was found between mpMRI and 68Ga-PSMA PET/MRI (change in AUC: 0.038, p = 0.246). Conclusion 68Ga-PSMA PET/MRI had higher clinical diagnostic accuracy in prostate cancer compared with mpMRI. Diagnostic accuracy was significantly increased in the combined use of both imaging modalities.

scholarly journals Comparison of biparametric and multiparametric MRI in the diagnosis of prostate cancer

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lili Xu ◽  
Gumuyang Zhang ◽  
Bing Shi ◽  
Yanhan Liu ◽  
Tingting Zou ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Multiparametric Mri ◽  
Dce Mri ◽  
Prostate Imaging ◽  
The Difference ◽  
Sensitivity Specificity

Abstract Purpose To compare the diagnostic accuracy of biparametric MRI (bpMRI) and multiparametric MRI (mpMRI) for prostate cancer (PCa) and clinically significant prostate cancer (csPCa) and to explore the application value of dynamic contrast-enhanced (DCE) MRI in prostate imaging. Methods and materials This study retrospectively enrolled 235 patients with suspected PCa in our hospital from January 2016 to December 2017, and all lesions were histopathologically confirmed. The lesions were scored according to the Prostate Imaging Reporting and Data System version 2 (PI-RADS V2). The bpMRI (T2-weighted imaging [T2WI], diffusion-weighted imaging [DWI]/apparent diffusion coefficient [ADC]) and mpMRI (T2WI, DWI/ADC and DCE) scores were recorded to plot the receiver operating characteristic (ROC) curves. The area under the curve (AUC), accuracy, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for each method were calculated and compared. The patients were further stratified according to bpMRI scores (bpMRI ≥3, and bpMRI = 3, 4, 5) to analyse the difference in DCE MRI between PCa and non-PCa lesions (as well as between csPCa and non-csPCa). Results The AUC values for the bpMRI and mpMRI protocols for PCa were comparable (0.790 [0.732–0.840] and 0.791 [0.733–0.841], respectively). The accuracy, sensitivity, specificity, PPV and NPV of bpMRI for PCa were 76.2, 79.5, 72.6, 75.8, and 76.6%, respectively, and the values for mpMRI were 77.4, 84.4, 69.9, 75.2, and 80.6%, respectively. The AUC values for the bpMRI and mpMRI protocols for the diagnosis of csPCa were similar (0.781 [0.722–0.832] and 0.779 [0.721–0.831], respectively). The accuracy, sensitivity, specificity, PPV and NPV of bpMRI for csPCa were 74.0, 83.8, 66.9, 64.8, and 85.0%, respectively; and 73.6, 87.9, 63.2, 63.2, and 87.8%, respectively, for mpMRI. For patients with bpMRI scores ≥3, positive DCE results were more common in PCa and csPCa lesions (both P = 0.001). Further stratification analysis showed that for patients with a bpMRI score = 4, PCa and csPCa lesions were more likely to have positive DCE results (P = 0.003 and P < 0.001, respectively). Conclusion The diagnostic accuracy of bpMRI is comparable with that of mpMRI in the detection of PCa and the identification of csPCa. DCE MRI is helpful in further identifying PCa and csPCa lesions in patients with bpMRI ≥3, especially bpMRI = 4, which may be conducive to achieving a more accurate PCa risk stratification. Rather than omitting DCE, we think further comprehensive studies are required for prostate MRI.

scholarly journals Clinicopathological and Radiological Profile of Multinodular Goitre – A Prospective Study

2021 ◽  
Vol 29 (2) ◽  
pp. 164-168
Author(s):  
Koustav Mondal ◽  
Chiranjib Das
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Histopathological Examination ◽  
Tertiary Care ◽  
Final Diagnosis ◽  
Needle Aspiration ◽  
Histopathological Diagnosis ◽  
Care Hospital ◽  
Multinodular Goitre ◽  
Sensitivity Specificity

Introduction Multinodular goitre (MNG) is defined as multiple palpable distinct nodules in the enlarged thyroid gland. MNG can harbour malignancy in 1-10% cases. We undertook the present study to correlate the clinical, radiological and cytological features of MNG with that of final histopathological diagnosis. Materials and Methods A prospective cohort study was done in a tertiary care hospital in northern part of West Bengal from January 2018 to December 2019. Patients aged between 12 years and 75 years, presenting with MNG on clinical examination, were included in the study. We compared the pre-operative ultrasonography (USG) of neck and fine needle aspiration cytology (FNAC) reports with post-operative histopathological examination (HPE) report. Results Among 100 patients 80 were female and 20 were male. Most patients were in 41-50 years age group. For detection of malignancy in MNG, USG had 40% sensitivity, 97.78% specificity, 66.67% positive predictive value (PPV), 93.62% negative predictive value (NPV), and 92% diagnostic accuracy. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of FNAC for detection of malignancy in MNG were 20%, 93.33%, 25%, 91.3% and 86% respectively. When USG features were combined with FNAC features non-diagnostic result decreased from 6% to 2% and diagnostic accuracy for detecting malignancy in MNG increased from 86% to 90%. Conclusion USG and FNAC are complementary to each other in the diagnostic workup of MNG. USG guided FNAC is still better for reaching final diagnosis and exclusion of malignancy.

scholarly journals Diagnosis of Pulmonary Tuberculosis in Resource Limited Setting of Rawalpindi

2018 ◽  
Vol 12 (1) ◽  
pp. 376-380
Author(s):  
Fatima Zahra ◽  
Aamer Ikram ◽  
Gohar Zaman ◽  
Luqman Satti ◽  
Farida Lalani ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Tertiary Care ◽  
Fluorescent Microscopy ◽  
Simultaneous Detection ◽  
Smear Microscopy ◽  
Care Hospital ◽  
Indicator Tube ◽  
Resource Limited ◽  
Sensitivity Specificity

Introduction:Tuberculosis is an infectious disease with a high prevalence of about 9 million cases occurring annually. Ziehl Neelsen microscopy is the most widely used technique to detect Acid Fast Bacilli, but it is less sensitive. However, fluorescent microscopy is more helpful with simple diagnostic criteria. Gene Xpert®MTB/RIF assay is a rapid molecular assay that enables diagnosis of Tuberculosis with simultaneous detection of rifampicin resistance. Owing to this fact, we aimed at evaluating the diagnostic accuracy of Ziehl Neelsen microscopy, fluorescent microscopy and Xpert MTB/RIF keeping MTB culture (Mycobacterial Growth Indicator Tube) as a gold standard for the diagnosis of tuberculosis.Methodology:This study was carried out at a tertiary care hospital of Rawalpindi in the year 2016. Patients aged 18 to 70 years irrespective of gender with suspected TB based on history, clinical and radiological examination were included in the study. Respiratory clinical specimens including sputum, Broncho-Alveolar Lavage (BAL), and endobronchial washings were collected. Specimens were processed by MGIT (MTB culture), ZN microscopy, fluorescent microscopy and Gene Xpert MTB/RIF assay.Results:A total of 352 respiratory specimens were tested among which 160 (45%) samples were positive by culture. Out of culture positive samples, 158 samples (98.7%) were GeneXpert TB positive while 2 were negative. While only 49 (30.6%) were positive on ZN microscopy and 89 (55%) were positive on fluorescent microscopy. Out of the culture negative samples, 2 were positive with ZN microscopy, one was positive with fluorescent microscopy and 3 were positive on Gene Xpert. Sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and diagnostic accuracy of ZN Smear microscopy was 39%, 99.5%, 96%, 63% and 14.5% respectively. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of fluorescent smear microscopy was 55% and 99.5%, 98%, 72% and 79% respectively. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of Gene XPERT was 98% and 99%, 98%, 99% and 98% respectively.Conclusion:In countries like Pakistan where Tuberculosis is endemic, the diagnostic accuracy with highest sensitivity and specificity was Gene Xpert Polymerase Chain Reaction (PCR) MTB/RIF assay which can help in well-timed diagnosis of the disease.

scholarly journals Effectiveness Of Urine Dipstick In Diagnosis Of Pre-eclampsia

2019 ◽  
Vol 10 (1) ◽  
pp. 3-6
Author(s):  
Ferhat Uzair ◽  
Urooj Naz ◽  
Samia Shuja ◽  
Abdul Waheed ◽  
Tahira Assad
Keyword(s):  
Diagnostic Accuracy ◽  
Pregnant Women ◽  
Predictive Value ◽  
Tertiary Care ◽  
First Trimester ◽  
P Value ◽  
Care Hospital ◽  
Singleton Pregnancy ◽  
Cross Sectional ◽  
Urine Dipstick

Objective: To determine the efficacy of urine dipstick in Pre-eclamplasia. Study Design and Setting: This was a cross-sectional study conducted at the department of obstetrics & gynecology of a tertiary care hospital from May-2017 to September-2018. Methods: All the pregnant women of age 15-45 years, BP=140/90 mmHg on two occasions 4 hours apart or single diastolic value of 100 mmHg, gestational age >20 weeks, singleton pregnancy, booked in first trimester of pregnancy were included in the study. Statistical package SPSS 22 was used for the analysis of data chi-square tests were applied for the diagnostic accuracy of urine dipstick in detection of Pre-eclampsia in pregnant women. P-value was <0.05 was considered as significant. Results: Total 211 pregnant women were enrolled in the study. Mean (SD) age was 28.26(3.86) years. Overall sensitivity and specificity of urine dipstick was found to be 94% and 95.4% respectively, positive predictive value 95%, negative predictive value 94.5% and excellent diagnostic accuracy 94.7% of urine dipstick was observed for the diagnosis of spot urine protein creatinine ratio CONCLUSION: Urine dipstick found to be sensitive and reliable test to screen pre-eclampsia

scholarly journals A prospective study of accuracy of modified Alvarado score in patients with acute appendicitis in tertiary care hospital

2018 ◽  
Vol 5 (3) ◽  
pp. 937
Author(s):  
Suman Parihar ◽  
M. S. Parihar ◽  
J. L. Kumawat ◽  
C. P. Joshi
Keyword(s):  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Predictive Value ◽  
Scoring System ◽  
Tertiary Care ◽  
Care Hospital ◽  
Alvarado Score ◽  
Medical College ◽  
Modified Alvarado Score ◽  
A Prospective Study

Background: Acute appendicitis is the most common acute emergency of the abdomen. Clinical diagnosis of acute appendicitis is challenging in most of situation. The present study was designed to evaluate the role of modified Alvarado scoring system in diagnosis of acute appendicitis.Methods: One hundred consecutive patients presenting in the department of surgery Geetanjali Medical College and Hospital from January 2014 to 2016 were included. Demographic characteristics, symptoms and signs, laboratory results were recorded. Data was collected using a pre-tested questionnaire and analyzed using statistical calculation.Results: In the present study 100 patients were studied in a period of two years. Maximum percentage of patients were in age group 20-30 years and males dominated the series. The sensitivity and specificity of modified Alvarado score was 91.57% and 76.47% respectively with positive predictive value 95% and negative predictive value 65% and diagnostic accuracy of 89%.Conclusions: This study shows that use of modified Alvarado scoring system in patients with acute appendicitis provides a high degree of diagnostic accuracy.

scholarly journals Study protocol for a single-centre non-inferior randomised controlled trial on a novel three-dimensional matrix positioning-based cognitive fusion-targeted biopsy and software-based fusion-targeted biopsy for the detection rate of clinically significant prostate cancer in men without a prior biopsy

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041427
Author(s):  
Biming He ◽  
Rongbing Li ◽  
Dongyang Li ◽  
Liqun Huang ◽  
Xiaofei Wen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Detection Rate ◽  
Three Dimensional ◽  
Multiparametric Mri ◽  
Fusion Method ◽  
Targeted Biopsy ◽  
Cognitive Fusion ◽  
Single Centre ◽  
Clinically Significant ◽  
Randomised Controlled

IntroductionThe classical pathway for diagnosing prostate cancer is systematic 12-core biopsy under the guidance of transrectal ultrasound, which tends to underdiagnose the clinically significant tumour and overdiagnose the insignificant disease. Another pathway named targeted biopsy is using multiparametric MRI to localise the tumour precisely and then obtain the samples from the suspicious lesions. Targeted biopsy, which is mainly divided into cognitive fusion method and software-based fusion method, is getting prevalent for its good performance in detecting significant cancer. However, the preferred targeted biopsy technique in detecting clinically significant prostate cancer between cognitive fusion and software-based fusion is still beyond consensus.Methods and analysisThis trial is a prospective, single-centre, randomised controlled and non-inferiority study in which all men suspicious to have clinically significant prostate cancer are included. This study aims to determine whether a novel three-dimensional matrix positioning cognitive fusion-targeted biopsy is non-inferior to software-based fusion-targeted biopsy in the detection rate of clinically significant cancer in men without a prior biopsy. The main inclusion criteria are men with elevated serum prostate-specific antigen above 4–20 ng/mL or with an abnormal digital rectal examination and have never had a biopsy before. A sample size of 602 participants allowing for a 10% loss will be recruited. All patients will undergo a multiparametric MRI examination, and those who fail to be found with a suspicious lesion, with the anticipation of half of the total number, will be dropped. The remaining participants will be randomly allocated to cognitive fusion-targeted biopsy (n=137) and software-based fusion-targeted biopsy (n=137). The primary outcome is the detection rate of clinically significant prostate cancer for cognitive fusion-targeted biopsy and software-based fusion-targeted biopsy in men without a prior biopsy. The clinically significant prostate cancer will be defined as the International Society of Urological Pathology grade group 2 or higher.Ethics and disseminationEthical approval was obtained from the ethics committee of Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China. The results of the study will be disseminated and published in international peer-reviewed journals.Trial registration numberClinicalTrials.gov Registry (NCT04271527).

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