Diagnostic Role of Pediatric Appendicitis Score (PAS) in Appendicitis of Children

Appendicitis is one of the most common causes of acute abdominal pain in pediatrics and is the most common indication for emergency abdominal surgery in childhood. The diagnosis of pediatric appendicitis remains challenging. To evaluate the role of pediatric appendicitis score (PAS) in the diagnosis of appendicitis of children.Methods: In this study, 200 suspected appendicitis patients attended in four private hospitals in old Dhaka city over a period of about 34 months from January 2011 to May 2014 were selected as study subjects. Patient age, sex and each of the eight PAS components were collected. Children who had PAS less than six were discharged and contacted by telephone upto 1 month to verify final outcome. Rest of the children with PAS equal or more than 6 were underwent appendectomy.Results: Two hundred patients were assessed in this study. Out of them 67 (33.5%) children had appendicitis and 76 (38.0%) children had PAS equal or more than 6. In appendicitis children, maximum (85.3%) children were in age group 10- 16 years and 10 (14.7%) patients were in age group 5-9 years.Male (73.5%) were predominant than female (26.5%) in appendicitis children. Migration of pain, nausea and anorexia were in 43 (63.2%), 45 (66.2%) and 48 (70.6%) appendicitis children respectively. Fever, cough/percussion tenderness and tenderness in RLQ were in 37 (54.4%), 52 (76.5%) and 59 (86.8%) appendicitis children respectively. Leukocytosis andneutophilia were present in 42 (61.8%) and 46 (67.6%) appendicitis children respectively. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy rate of PAS were 80.6%, 83.5%, 71.1%, 89.5% and 82.5% respectively.Conclusion: Paediatric Appendicitis Score is a good tool but not good enough for diagnosis of paediatirc appedicitis. It cannot be recommended for diagnosis of paediatric appendicitis because its negative appendicectomy rate as well as wrongly discharged rate is high.J. Paediatr. Surg. Bangladesh 6(1): 16-19, 2015 (Jan)

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Ultrasound for Appendicitis: Performance and Integration with Clinical Parameters

BioMed Research International ◽

10.1155/2016/5697692 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 10

Author(s):

Fanny Löfvenberg ◽

Martin Salö

Keyword(s):

Predictive Value ◽

Negative Likelihood Ratio ◽

C Reactive Protein ◽

Suspected Appendicitis ◽

Reactive Protein ◽

First Choice ◽

Sensitivity Specificity ◽

Surgery Center ◽

Appendicitis Score ◽

Higher Sensitivity

Objective. To evaluate the performance of ultrasound in pediatric appendicitis and the integration of US with the pediatric appendicitis score (PAS) and C-reactive protein (CRP).Method. An institution-based, retrospective study of children who underwent abdominal US for suspected appendicitis between 2012 and 2015 at a tertiary pediatric surgery center. US results were dichotomized, with a nonvisualized appendix considered as a negative examination.Results. In total, 438 children were included (mean 8.5 years, 54% boys), with an appendicitis rate of 29%. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for US were 82%, 97%, 92%, and 93%, respectively, without significant age or gender differences. Pediatric radiologists had significantly higher sensitivity compared to general radiologists, 88% and 71%, respectively (p<0.01), but no differences were seen for specificity, PPV, and NPV. The sensitivity, NPV, and negative likelihood ratio for the combination of negative US, PAS < 5, and CRP < 5 mg/L were 98%, 98%, and 0.05 (95% CI 0.03–0.15).Conclusion. US may be a useful tool for evaluating children with suspected appendicitis, regardless of age or gender, and should be the first choice of imaging modalities. Combining US with PAS and CRP may reduce several unnecessary admissions for in-hospital observation.

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Correlation of colposcopy with biopsy in cases of abnormal cervical cytology

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v14i1.26625 ◽

2019 ◽

Vol 14 (1) ◽

pp. 36-39

Author(s):

Kirtipal Subedi

Keyword(s):

Predictive Value ◽

Prospective Observational Study ◽

Accurate Diagnosis ◽

Cervical Cytology ◽

Histopathological Diagnosis ◽

Cervical Biopsy ◽

Abnormal Cervical Cytology ◽

Disease Threshold ◽

Sensitivity Specificity

Aims: This study aims to find out the role of colposcopy and its correlation with cervical biopsy in detection of pre malignant cervical lesion. Methodology: This is hospital based prospective observational study on 60 cases with abnormal cervical cytology reports conducted in the Department of Obstetrics and Gynecology, PMWH, Thapathali, Kathmandu. Colposcopy guided biopsies were done and findings noted. Results: Among 60 cases enrolled in the study the most common cervical cytology finding was ASCUS, LSIL, HSIL and ASC-H present in 46.6%, 31.6%, 15% and 6.6% respectively. The colposcopy finding among these cases was normal, CIN1, CIN 2 and CIN 3 in 45%, 23.3%, 16.7% and 9% respectively. Among these cases the most common biopsy finding was normal, CIN 1, CIN 2, CIN 3 and squamous cell carcinoma in 55%, 18.3%, 8.3%, 15% and 3.3% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of colposcopy with CIN 1 as disease threshold was calculated to be 80.6%, 93.1%, 81.8% and 92.6% respectively. While evaluating the validity of colposcopy with histopathology, colposcopy seems to make an accurate diagnosis in 75% of cases, overestimating in 15% and underestimating in 8% of cases. Conclusions: There is a good correlation of colposcopy with histopathological diagnosis of cervical cancer. Keywords: colposcopy, cytology, diagnosis, premalignant

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Can CT Virtual Cystoscopy Replace Conventional Cystoscopy in Early Detection of Bladder Cancer?

Advances in Urology ◽

10.1155/2015/926590 ◽

2015 ◽

Vol 2015 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Sachin Abrol ◽

Ankush Jairath ◽

Sanika Ganpule ◽

Arvind Ganpule ◽

Shashikant Mishra ◽

...

Keyword(s):

Bladder Cancer ◽

Early Detection ◽

Predictive Value ◽

Bladder Tumor ◽

Urothelial Cancer ◽

Routine Clinical Practice ◽

Bladder Tumors ◽

Virtual Cystoscopy ◽

Sensitivity Specificity

Aim. To correlate findings of conventional cystoscopy with CT virtual cystoscopy (CTVC) in detecting bladder tumors and to evaluate accuracy of virtual cystoscopy in early detection of bladder cancer.Material and Method. From June 2013 to June 2014, 50 patients (46 males, four females) with history and investigations suggestive of urothelial cancer, with mean age 62.76 ± 10.45 years, underwent CTVC by a radiologist as per protocol and subsequently underwent conventional cystoscopy (CPE) the same day or the next day. One urologist and one radiologist, blinded to the findings of conventional cystoscopy, independently interpreted the images, and any discrepant readings were resolved with consensus.Result. CTVC detected 23 out of 25 patients with bladder tumor(s) correctly. Two patients were falsely detected as negative while two were falsely labeled as positive in CTVC. Virtual and conventional cystoscopy were comparable in detection of tumor growth in urinary bladder. The sensitivity, specificity, positive predictive value, and negative predictive value of virtual cystoscopy were 92% each.Conclusion. CTVC correlates closely with the findings of conventional cystoscopy. Bladder should be adequately distended and devoid of urine at the time of procedure. However, more studies are required to define the role of virtual cystoscopy in routine clinical practice.

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The predictive value of videostroboscopy in the assessment of premalignant lesions and early glottis cancers

Otolaryngologia Polska ◽

10.5604/01.3001.0010.2243 ◽

2017 ◽

Vol 71 (4) ◽

pp. 14-18 ◽

Cited By ~ 1

Author(s):

Anna Rzepakowska ◽

Ewelina Sielska-Badurek ◽

Ewa Osuch-Wójcikiewicz ◽

Michał Sobol ◽

Kazimierz Niemczyk

Keyword(s):

Predictive Value ◽

Vocal Fold ◽

Histopathological Examination ◽

High Sensitivity ◽

Vocal Folds ◽

Invasive Cancer ◽

Premalignant Lesions ◽

Good Tool ◽

Malignant Lesions ◽

Sensitivity Specificity

Objective: To assess the sensitivity and specificity of larngovideostroboscopy (LVS) in the diagnosis of precancerous and malignant lesions of the vocal folds. Material and methods: In 175 patients (128 men and 47 women), aged 19-88 years, mean age 61.5, who were admitted to the clinic with diagnosed premalignant conditions of vocal fold mucosa (leukoplakia, chronic hypertrophic inflammatory lesions) and thickening or tumor on the vocal fold, there was performed LVS before the laryngeal microsurgery. The LVS study included: localization of the leasion, movement of the vocal folds, mucosal wave, shape of glottis clousure, amplitude and symmetry of vocal fold vibration. In the evaluation, a point scale was applied for the individual functional parameters. The scale ranged from 0 to 14. Patients with impaired vocal fold motion or absent mucosal wave were positive on LVS for malignant lesions. Those with limitted mucosal wave were positive on LVS for dysplastic lesions. The results were compared with the final histopathological examination and the sensitivity, specificity, accuracy, positive (PPV) and negative (NPV) predictive value were calculated. Results: On the basis of histopathological examination, benign lesions (normal or inflammatory mucosa) accounted for 20% of diagnoses, hypertrophy and parakeratosis for 28%, low and middle grade dysplasia accounted for 10% and malignant lesions (high-grade dysplasia, pre-invasive cancer, Invasive cancer) was diagnosed in 42% of patients. The overall mean score for LVS was 4.5 and 8.0, respectively for benign and malignant lesions. Sensitivity, specificity, accuracy, PPV and NPV of LVS in detecting malignant lesions were respectively - 95.6%, 23.8%, 61.1%, 57.6% and 83.3% and in detecting both premalignant and malignant lesions were respectively – 90.7%, 31.4%, 78.9%, 84.1% and 45.8%. Conclusions: Because of the high sensitivity of LVS in detecting precancerous and malignant lesions, this method is a very good tool for screening of pathology within the larynx.

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Diagnostic evaluation of immune checkpoint inhibitor (CPI) colitis: The role of CT scan.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.821 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 821-821

Author(s):

Sienna Durbin ◽

Meghan Mooradian ◽

Leyre Zubiri ◽

Ian Matthew Allen ◽

Florian Fintelmann ◽

...

Keyword(s):

Ct Scan ◽

Predictive Value ◽

Gold Standard ◽

Invasive Procedure ◽

Primary Objective ◽

Lower Endoscopy ◽

Grade 3 ◽

Sensitivity Specificity ◽

Tumor Types

821 Background: CPI therapy has expanded rapidly in recent years and represents a major advancement in the treatment of many cancers, including hepatocellular carcinoma, gastric cancer, and colon cancer. However, these therapies are associated with significant toxicities. CPI colitis is one of the most common toxicities and can be fatal, especially when not diagnosed and treated promptly. The current gold standard for diagnosis is endoscopy with biopsy, an invasive procedure that is resource- and time-intensive. CT has emerged as a possible alternative. The primary objective of this study is to identify the diagnostic performance of CT in the evaluation of CPI colitis. Methods: With IRB approval, we conducted a retrospective cohort study of patients who received CPI therapy between 2009-2019 across a single healthcare system. Patients were included if they underwent both abdominal CT and upper/lower endoscopy with biopsy within 72 hours of each other. We reviewed the electronic medical record to identify possible cases of colitis based on either CT or pathology. All cases were labeled as either true positive or false positive based on pathology. We examined clinical characteristics, including CTCAE grade and treatment received. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CT for diagnosing CPI colitis when compared to the gold standard of tissue diagnosis. Results: Of the 4,474 patients screened, 141 met inclusion criteria. Average age was 63 years (23 – 91); 43% were male. Most common tumor types were melanoma (36%) and NSCLC (20%). Seventy-four percent of patients were treated with anti-PD-1/PD-L1 monotherapy. Forty percent had signs of colitis on CT scan and 59% had biopsy-proven CPI colitis. Sensitivity and specificity of CT were 51% and 74%, respectively. PPV of CT was 74% and NPV was 51%. Of those with confirmed CPI colitis, 78% had symptoms that were classified as grade 3 or above. Seventy-three percent received IV steroids and 38% received infliximab. Conclusions: CT demonstrates moderate specificity and PPV and remains an important diagnostic test but does not replace endoscopy/biopsy in the evaluation of CPI colitis.

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The Diagnostic Role of 18F-Choline, 18F-Fluciclovine and 18F-PSMA PET/CT in the Detection of Prostate Cancer With Biochemical Recurrence: A Meta-Analysis

Frontiers in Oncology ◽

10.3389/fonc.2021.684629 ◽

2021 ◽

Vol 11 ◽

Author(s):

Rang Wang ◽

Guohua Shen ◽

Mingxing Huang ◽

Rong Tian

Keyword(s):

Prostate Cancer ◽

Diagnostic Accuracy ◽

Biochemical Recurrence ◽

Meta Analysis ◽

Detection Rates ◽

Psma Pet ◽

Pet Ct ◽

Diagnostic Role ◽

Sensitivity Specificity

BackgroundDiagnosing the biochemical recurrence (BCR) of prostate cancer (PCa) is a clinical challenge, and early detection of BCR can help patients receive optimal treatment. We conducted a meta-analysis to define the diagnostic accuracy of PET/CT using 18F-labeled choline, fluciclovine, and prostate-specific membrane antigen (PSMA) in patients with BCR.MethodsMultiple databases were searched until March 30, 2021. We included studies investigating the diagnostic accuracy of 18F-choline, 18F-fluciclovine, and 18F-PSMA PET/CT in patients with BCR. The pooled sensitivity, specificity, and detection rate of 18F-labeled tracers were calculated with a random-effects model.ResultsA total of 46 studies met the included criteria; 17, 16, and 13 studies focused on 18F-choline, fluciclovine, and PSMA, respectively. The pooled sensitivities of 18F-choline and 18F-fluciclovine were 0.93 (95% CI, 0.85–0.98) and 0.80 (95% CI, 0.65–0.897), and the specificities were 0.91 (95% CI, 0.73–0.97) and 0.66 (95% CI, 0.50–0.79), respectively. The pooled detection rates of 18F-labeled choline, fluciclovine and PSMA were 66, 74, and 83%, respectively. Moreover, the detection rates of 18F-labeled choline, fluciclovine, and PSMA were 35, 23, and 58% for a PSA level less than 0.5 ng/ml; 41, 46, and 75% for a PSA level of 0.5–0.99 ng/ml; 62, 57, and 86% for a PSA level of 1.0–1.99 ng/ml; 80, 92, and 94% for a PSA level more than 2.0 ng/ml.ConclusionThese three 18F-labeled tracers are promising for detecting BCR in prostate cancer patients, with 18F-choline showing superior diagnostic accuracy. In addition, the much higher detection rates of 18F-PSMA showed its superiority over other tracers, particularly in low PSA levels.Systematic Review RegistrationPROSPERO, identifier CRD42020212531.

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Role of ultrasound guided fine needle aspiration cytology of right hypochondrial masses

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20175447 ◽

2017 ◽

Vol 5 (12) ◽

pp. 5312

Author(s):

Nidhi Verma ◽

. Neetu ◽

S. P. Sharma ◽

Preeti Singh ◽

Anuj Kumar

Keyword(s):

Fine Needle Aspiration ◽

Predictive Value ◽

Single Case ◽

Needle Aspiration ◽

Primary Hepatocellular Carcinoma ◽

Ultrasound Guided ◽

Fine Needle ◽

Abdominal Masses ◽

Sensitivity Specificity

Background: Patients having right hypochondrial intra-abdominal masses are commonly encountered in clinical practice. The study was done to know the role of ultrasound guided fine needle aspiration in diagnosing right hypochondrial masses and its most common cause.Methods: 112 cases were collected from department of surgery, SVBP hospital meerut. FNAC was done using 22-23 G disposable lumbar puncture needle with trochar fitted with 20 ml syringe, introduced under radiological guidance and aspiration is done under negative pressure. Smears were stained with Leishman’s stain, May Grunwald Geimsa (MGG) and Papnicolou stain.Results: Out of total 112 cases, 12 cases excluded from study as only blood was aspirated. Therefore, out of 100 cases, 83% (83/100) cases were malignant, 7% (7/100) benign and 10% (10/100) inconclusive/ due to low cellularity. Among the malignant masses, majority 52 (52.0%) cases were of liver secondaries followed by 24 (24.0%) cases of adenocarcinoma gall bladder, 5 (5.0%) cases of primary hepatocellular carcinoma (HCC) and single case (1%), each of cholangiocarcinoma GB and squamous cell carcinoma GB. Among the benign lesions, 3 (3.0%) cases of liver abscess, 2 (2.0%) cases of hydatid disease followed by single case (1.0%) of hepatic adenoma and cysticercosis liver. In this study, overall accuracy of USG guided FNAC was 96.66%. Sensitivity, specificity, positive predictive value, negative predictive value and efficacy of USG guided FNAC in right hypochondrial masses were 96.66%, 100%, 100%, 66.67% and 96.87% respectively.Conclusions: USG guided FNAC is simple, quick, safe, reliable and economical tool without any significant complication in diagnosing right hypochondrial masses.

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Diagnostic role of bronchoalveolar lavage: A cytohistopathological correlation

Journal of Pathology of Nepal ◽

10.3126/jpn.v9i1.23173 ◽

2019 ◽

Vol 9 (1) ◽

pp. 1441-144

Author(s):

Prabesh Kumar Choudhary ◽

Niraj Nepal ◽

Nirajan Mainali ◽

Ram Hari Ghimire

Keyword(s):

Lung Cancer ◽

Predictive Value ◽

Malignant Tumors ◽

False Negative ◽

Bronchial Biopsy ◽

Medical College ◽

Diagnostic Role ◽

Risk Of Malignancy ◽

Diagnosis Of Lung Cancer ◽

Sensitivity Specificity

Background: Tumors of lung are common in Nepal. The risk of malignancy has to be judged prior to surgery for which bronchoscopy is often done. Brocho-alveolar lavage and bronchial biopsy are routine procedure done for diagnosis of lung cancer during bronchoscopy. This study was done to correlate the cytology of broncho-alveolar lavage specimen with histopathology in malignant tumors of the lug in our setup. Materials and methods: This study was conducted at department of pathology, Nobel Medical College from August 2017 to December 2018. Histopathology reports with malignancy were compared to their cytological diagnosis. Results: A total of 141 cases were included in the study. Among the study population, Bronchogenic carcinoma was found more prevalent in female. The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of broncho-alveolar lavage in the diagnosis of lung cancer were 88.1%, 97.98%, 94.7%, 95.1% and 95.03% respectively. Conclusions: Brochoalveolar lavage cytology has a greater accuracy for the diagnosis of lung cancer; however, benign cases need regular follow up as there are false negative cases.

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An Investigation of the Aetiology of Chronic Headache. The Role of Headache Models

The British Journal of Psychiatry ◽

10.1192/bjp.145.6.665 ◽

1984 ◽

Vol 145 (6) ◽

pp. 665-666 ◽

Cited By ~ 32

Author(s):

Ira Daniel Turkat ◽

Andrzej R. Kuczmierczyk ◽

Henry E. Adams

Keyword(s):

Predictive Value ◽

Chronic Headache ◽

Family Members ◽

Sensitivity Specificity

SummaryHeadache sufferers (n = 30) reported significantly more immediate family members with headache, compared to controls (n = 22). Sensitivity, specificity, and efficiency analyses revealed that knowledge of family headache history has predictive value. The results are consistent with findings with other pain disorders.

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Predictive Value of Pleural Cytology in the Diagnosis of Complicated Parapneumonic Effusions and Empyema Thoracis

Pulmonary Medicine ◽

10.1155/2020/7175451 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

John Ferguson ◽

Michal Kazimir ◽

Michael Gailey ◽

Frank Moore ◽

Earl Schott

Keyword(s):

Logistic Regression ◽

Pleural Fluid ◽

Predictive Value ◽

Interobserver Agreement ◽

Empyema Thoracis ◽

Cytologic Diagnosis ◽

Wilcoxon Rank Sum Test ◽

Sensitivity Specificity ◽

Fluid Cytology

Introduction. Complicated parapneumonic effusions (CPE) are distinguished from uncomplicated parapneumonic effusions (UPE) by the ability to resolve without drainage. Determinants include pleural pH, pleural glucose, and pleural LDH, along with microbiologic cultures. Inflammation mediated by neutrophil chemotactic cytokines leads to fibrinous loculation of an effusion, and the degree of this inflammation may lead to a CPE. One role of the pathologist is to evaluate for the presence of malignancy in a pleural effusion; however, the ability of the pathologist to distinguish a CPE from UPE has not been evaluated. Materials and Methods. A single-center retrospective study was performed on pleural cytology specimens from 137 patients diagnosed with a parapneumonic effusion or empyema over a five-year interval. Pleural cytology was characterized as either uncomplicated or complicated by two pathologists based on cellular composition and the presence or absence of fibrinous exudate in the fluid. Cohen’s kappa was calculated for interobserver agreement. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of cytologic diagnoses were calculated. Determinants of cytologic accuracy were assessed using Wilcoxon rank sum test, unpaired t-test, and logistic regression. Results. Kappa interobserver agreement between pathologists was 0.753. Pleural fluid cytology sensitivity, specificity, PPV, and NPV for CPE/empyema were 76.0%, 95% CI [65.0, 84.9]; 50%, 95% CI [29.1, 70.9]; 83.3%, 95% CI [76.7, 88.4]; and 38.7%, 95% CI [26.5, 52.5], respectively. The presence of pleural bacteria, elevated pleural LDH, and reduced pleural pH were nonsignificant determinants of cytologic accuracy. Logistic regression was significant for the presence of pleural bacteria (p=0.03) in determining a successful cytologic diagnosis. Conclusion. Pleural cytology adds little value to traditional markers of distinguishing a UPE from CPE. Inflammation on pleural fluid cytology is suggestive of empyema or the presence of pleural fluid bacteria.

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