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

Diagnostics ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. 474 ◽  
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.

scholarly journals 1494. Validation of Methicillin-Resistant Staphylococcus aureus (MRSA) Risk Factors in Predicting MRSA Community-Acquired Pneumonia at an Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S749-S749
Author(s):  
Joelle Arieno ◽  
Robert Seabury ◽  
Jeffrey Steele ◽  
William Darko ◽  
Christopher Miller ◽  
...  
Keyword(s):  
Risk Factors ◽  
Panel Member ◽  
Community Acquired Pneumonia ◽  
Review Panel ◽  
The Past ◽  
Post Test ◽  
History Of ◽  
Post Test Probability ◽  
Test Probability ◽  
Research Grant

Abstract Background The 2019 Infectious Diseases Society of America community-acquired pneumonia (CAP) guidelines recommend anti-methicillin-resistant Staphylococcus aureus (MRSA) therapy in patients with CAP based on previously identified risk factors for MRSA with an emphasis on local epidemiology and institutional validation of risk. Thus, we sought to assess the ability of guideline-recognized risk factors to predict MRSA CAP at our institution. Methods This was a single-center, retrospective cohort study from January 2016 to March 2020. Patients were included if they were >18 years old, diagnosed with CAP, and had a MRSA nasal screen and a respiratory culture obtained on admission. Patients were excluded if CAP diagnosis was not met, respiratory cultures were not obtained within 48 hours of antibiotic initiation, or they had cystic fibrosis. Sensitivity, specificity, negative predictive value, positive predictive value, and likelihood ratios (LR) were calculated using Vassar Stats 2019. Pre/post-test odds and pre/post-test probabilities were calculated using Microsoft Excel 2019. Results Of 705 screened patients, 221 were included. MRSA prevalence in CAP patients at our institution was 3.6%. History of MRSA isolated from a respiratory specimen had high specificity (98%), high positive LR of 20 (95% CI 5.3 – 74.8), and high post-test probability of 42.8%. Receipt of IV antibiotics during hospitalization within the past 90 days had a positive LR of 1.9 (95% CI 0.74 – 4.84). A positive MRSA nasal screen on admission had a positive LR of 6.9 (95% CI 4.0 – 12.1), negative LR 0.28 (95% CI 0.08 – 0.93), positive post-test probability of 20.7%, and negative post-test probability of 1.04%. Conclusion Our study utilized institutional data to validate guideline-recognized risk factors for MRSA CAP specifically at our institution. Risk factors including history of MRSA isolated from a respiratory specimen, and positive post-admission MRSA nasal screen were validated as significant risk factors; receipt of IV antibiotics during hospitalization within the past 90 days was not shown to be a risk factor for MRSA CAP based on our institutional data. Validated risk factors may help providers discern which patients with CAP at our institution would benefit most from empiric MRSA treatment. Disclosures Jeffrey Steele, PharMD, Paratek Pharmaceuticals (Advisor or Review Panel member) Wesley D. Kufel, PharmD, Melinta (Research Grant or Support)Merck (Research Grant or Support)Theratechnologies, Inc. (Advisor or Review Panel member)

scholarly journals Validation of Methicillin-Resistant Staphylococcus aureus (MRSA) Risk Factors in Predicting MRSA Community-Acquired Pneumonia at an Academic Medical Center

2021 ◽  
pp. 001857872110101
Author(s):  
Joelle Arieno ◽  
Robert Seabury ◽  
Wesley Kufel ◽  
William Darko ◽  
Christopher D. Miller ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Predictive Value ◽  
Community Acquired Pneumonia ◽  
Respiratory Specimen ◽  
The Past ◽  
Post Test ◽  
History Of ◽  
Post Test Probability ◽  
Test Probability

Background: The 2019 Infectious Diseases Society of America community-acquired pneumonia (CAP) guidelines recommend antimethicillin- resistant Staphylococcus aureus (MRSA) therapy in patients with CAP based on previously identified risk factors for MRSA with an emphasis on local epidemiology and institutional validation of risk. Thus, we sought to assess the ability of guideline-recognized risk factors to predict MRSA CAP at our institution. Methods: This was a single-center, retrospective cohort study from January 2016 to March 2020. Patients were included if they were >18 years old, diagnosed with CAP, and had a MRSA nasal screen and respiratory culture obtained on admission. Patients were excluded if CAP diagnosis was not met, respiratory cultures were not obtained within 48 hours of antibiotic initiation, or they had cystic fibrosis. Sensitivity, specificity, negative predictive value, positive predictive value, and likelihood ratios (LR) were calculated using Vasser Stats 2019. Pre/post-test odds and pre/post-test probabilities were calculated using Excel 2019. Results: Of 705 screened patients, 221 were included. MRSA prevalence in CAP patients at our institution was 3.6%. History of MRSA isolated from a respiratory specimen had high specificity (98%), high positive LR of 20 (95% CI 5.3–74.8), and high post-test probability of 42.8%. Receipt of IV antibiotics during hospitalization within the past 90 days had a positive LR of 1.9 (95% CI 0.74–4.84). A positive MRSA nasal screen on admission had a positive LR of 6.9 (95% CI 4.0–12.1), negative LR 0.28 (95% CI 0.08–0.93), positive post-test probability of 20.7%, and negative post-test probability of 1.04%. Conclusion: Our study utilized institutional data to validate guideline recognized risk factors for MRSA CAP specifically at our institution. Risk factors including history of MRSA isolated from a respiratory specimen, and positive post-admission MRSA nasal screen were validated as significant risk factors; receipt of IV antibiotics during hospitalization within the past 90 days was not shown to be a risk factor for MRSA CAP based on our institutional data. Validated risk factors may help providers discern which patients with CAP at our institution would benefit most from empiric MRSA treatment.

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

2014 ◽  
Vol 125 (1) ◽  
pp. 263-272 ◽  
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

scholarly journals Ultrasound diagnosis of molar pregnancy

Ultrasound ◽  
2018 ◽  
Vol 26 (3) ◽  
pp. 153-159 ◽  
Author(s):  
Jackie A. Ross ◽  
Alina Unipan ◽  
Jackie Clarke ◽  
Catherine Magee ◽  
Jemma Johns
Keyword(s):  
Likelihood Ratio ◽  
Gestational Trophoblastic Disease ◽  
Ultrasound Diagnosis ◽  
Histopathological Diagnosis ◽  
Molar Pregnancy ◽  
Diagnostic Challenge ◽  
Trophoblastic Disease ◽  
Post Test ◽  
Post Test Probability ◽  
Test Probability

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.

Liquid-Based Endometrial Cytology Using SurePath™ Is Not Inferior to Suction Endometrial Tissue Biopsy in Clinical Performance for Detecting Endometrial Cancer Including Atypical Endometrial Hyperplasia

2017 ◽  
Vol 61 (2) ◽  
pp. 133-139 ◽  
Author(s):  
Fumiko Yanaki ◽  
Yasuo Hirai ◽  
Azusa Hanada ◽  
Ken Ishitani ◽  
Hideo Matsui
Keyword(s):  
Endometrial Hyperplasia ◽  
Clinical Performance ◽  
Endometrial Tissue ◽  
Final Histology ◽  
Endometrial Cells ◽  
Atypical Endometrial Hyperplasia ◽  
Tissue Biopsy ◽  
Biopsy Specimens ◽  
Detection Tool ◽  
Endometrial Cytology

Objective: We evaluated the clinical performance of liquid-based endometrial cytology (SurePath™) for detecting endometrial malignancies by comparison with the performance of suction endometrial tissue biopsy. Study Design: From November 2011 to May 2013, we consecutively collected 1,118 liquid-based endometrial cytology specimens and 674 suction endometrial tissue biopsy specimens. Results: The rate of nonpositive final histology in nonpositive liquid-based endometrial cytology (98.2%) was higher than the rate of nonpositive final histology in nonpositive suction endometrial tissue biopsy (97.0%). None of the clinical performance values of liquid-based endometrial cytology for detecting the endometrial malignancies were statistically inferior to those of the suction endometrial tissue biopsy. When the positivity threshold was more than “atypical endometrial cells of undetermined significance,” the rate of positive liquid-based endometrial cytology from cases with a positive final histology (84.5%) was higher than the rate of positive suction endometrial tissue biopsy from cases with a positive final histology (69.8%). However, there were still no significant differences among all the performance values. Conclusions: Our liquid-based endometrial cytology would be more appropriate in various clinical situations as the initial detection tool for endometrial malignancies, rather than suction endometrial tissue biopsy. In addition, it could be used in screening for endometrial malignancies on a broader scale.

Volume, Conductivity and Scatter Properties of Leukocytes (VCS Technology) in Detecting Sepsis in Critically Ill Adult Patients

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4729-4729 ◽  
Author(s):  
Aikaterini Dilmoula ◽  
Zaina Kassengera ◽  
Hulyan Turkan ◽  
Dyanne Dalcomune ◽  
Dmitry Sukhachev ◽  
...  
Keyword(s):  
Critically Ill ◽  
Blood Count ◽  
Complete Blood Count ◽  
Adult Patients ◽  
Lower Quartile ◽  
Post Test ◽  
Reasonable Evidence ◽  
Light Loss ◽  
Post Test Probability ◽  
Test Probability

Abstract Abstract 4729 Sepsis and its sequelae remain leading causes of death in critically ill patients. Early identification and subsequently prompt treatment of sepsis can have a major impact on the outcome of septic patients. White Blood Cell (WBC) count, neutrophils count or percentage and percentage of band and immature neutrophils have been included in the diagnostic criteria of sepsis d. Previous studies have shown that morphological changes of leukocytes during sepsis can be quantified using Volume, Conductivity and Scatter (VCS) technology by some hematology analyzers. DxH800 (Beckman Coulter, Fullerton, CA) has the potential to report, in addition to Volume and Conductivity, five extra-laser diffraction angles for each cellular event. The aim of the study was to evaluate the diagnostic accuracy of VCS parameters of leukocytes in detecting sepsis in critically ill adult patients. This prospective observational study involved all consecutive adult patients admitted to a 31-bed medico-surgical department of intensive care (ICU) for more than 4 hours in a 3.5-month period. Diagnosis of sepsis was based on standard definitions. Blood samples were run by DxH800. Complete blood count (CBC) and WBC differential, but not VCS parameters were reported to attending physicians. Of a total of 722 patients admitted during the observation period 422 had WBC differential (and thus VCS parameters) determined at admission, of whom 125 had sepsis Septic and non-septic patients had a median age (upper and lower quartile) of 60 (51-71) and 58 (45-72) years and APACHE II scores of 19 (14-25) and 11 (7-16). VCS parameters had higher Areas Under the Receiver Operating Characteristic Curve (AUC) than WBC or percentage of neutrophils for diagnosis of sepsis at admission (Table 1.).Table 1.DxH800 VCS parameters. Results as median values (upper and lower quartile)VCS parametersSepsis N=125No Sepsis N=317p valueAUC95%CI of AUCMean Volume of Neutrophils (MNVNE)153 (146–163)144 (140–148)<0.0010.780.72–0.83SD of Volume of Neutrophils (SDVNE)20 (18–23)17 (16–18)<0.0010.810.77–0.86Mean Axial Light loss of Neutrophils (MNAL2NE)155 (150–160)148 (144–151)<0.0010.780.73–0.84SD of Axial Light loss of Neutrophils (SDAL2NE)13 (12–16)11 (10–12)<0.0010.800.75–0.84Mean Volume of Monocytes (MNVMO)179 (169–189)163 (159–167)<0.0010.880.84–0.91SD of Volume of Monocytes (SDVMO)24 (21–28)18 (16–20)<0.0010.880.84–0.91SD of Axial Light loss of Monocytes (SDAL2MO)16 (15–20)13 (12–14)<0.0010.850.81–0.89WBC, 103/ml10.9 (7.3–15.3)10.5 (7.8–14.2)NS0.510.44–0.57Percent of Neutrophils, %85 (76–91)80 (68–88)<0.0010.610.55–0.67 On ICU admission, MNVMO had the highest discriminant values in detecting sepsis with sensitivity (Se) of 84%, specificity (Sp) 76%, positive predictive value (PPV)58%, negative predictive value (NPV) 92% and odds ratio (OR) 17 for a cutoff of 168. MNVMO<168 (59% of patients) gave reasonable evidence against sepsis (likelihood ratio (LR) of 0.21, pre- and post-test probability, 0.28 and 0.076,) and MNVMO≥175 (25% of patients) gave reasonable evidence for sepsis (LR of 6.85, pre- and post-test probability, 0.28 and 0.73, respectively). Only 16% of patients, in the intermediate range, had a rather uninformative test result (LR of 1.32). Combining monocyte or neutrophil VCS parameters with CRP slightly increases AUC to 0.91. During the ICU stay, VCS parameters were obtained in 316 initially non-septic patients, of whom 20 became septic. MNVMO < 174 excluded ICU-acquired infection with NPV of 99% and MNVMO > 174 predicted ICU-acquired infection 1.7 days earlier than clinical diagnosis (Se: 85%, Sp 68%, OR 12 and AUC=0.78, 95% CI: 66–90). CONCLUSIONS: This large prospective study in unselected critically ill adult patients demonstrates the diagnostic utility of VCS parameters, especially MNVMO, in detecting and, more importantly, excluding sepsis at admission and during ICU stay. VCS parameters are obtained automatically, routinely, within minutes, requiring neither additional sampling nor additional cost to that of complete blood count thus making their prospects very promising. Disclosures: Pradier: Beckman Coulter: Consultancy, Membership on an entity's Board of Directors or advisory committees.

Use of pre- and post-test probability of disease to interpret meningococcal PCR results

2004 ◽  
Vol 23 (8) ◽  
Author(s):  
H.C. Woerden ◽  
A. Howard ◽  
M. Lyons ◽  
D. Westmoreland ◽  
M. Thomas
Keyword(s):  
Post Test ◽  
Post Test Probability ◽  
Test Probability

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

2017 ◽  
Vol 43 (6) ◽  
pp. 424-430 ◽  
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.

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