scholarly journals Negative predictive value of preoperative computed tomography in determining pathologic local invasion, nodal disease, and abdominal metastases in gastric cancer

2016 ◽  
Vol 23 (4) ◽  
pp. 273 ◽  
Author(s):  
D.J. Kagedan ◽  
F. Frankul ◽  
A. El-Sedfy ◽  
C. McGregor ◽  
M. Elmi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Population Level ◽  
Distant Metastases ◽  
Ct Imaging ◽  
Abdominal Ct ◽  
Curative Intent ◽  
Local Invasion ◽  
Pathology Reports

BackgroundBefore undergoing curative-intent resection of gastric adenocarcinoma (ga), most patients undergo abdominal computed tomography (ct) imaging to determine contraindications to resection (local invasion, distant metastases). However, the ability to detect contraindications is variable, and the literature is limited to single-institution studies. We sought to assess, on a population level, the clinical relevance of preoperative ct in evaluating the resectability of ga tumours in patients undergoing surgery.Methods In a provincial cancer registry, 2414 patients with ga diagnosed during 2005–2008 at 116 institutions were identified, and a primary chart review of radiology, operative, and pathology reports was performed for all patients. Preoperative abdominal ct reports were compared with intraoperative findings and final pathology reports (reference standard) to determine the negative predictive value (npv) of ct in assessing local invasion, nodal involvement, and intra-abdominal metastases.Results Among patients undergoing gastrectomy, the npv of ct imaging in detecting local invasion was 86.9% (n = 536). For nodal metastasis, the npv of ct was 43.3% (n = 450). Among patients undergoing surgical exploration, the npv of ct for intra-abdominal metastases was 52.3% (n = 407).Conclusions Preoperative abdominal ct imaging reported as negative is most accurate in determining local invasion and least accurate in nodal assessment. The poor npv of ct should be taken into account when selecting patients for staging laparoscopy.

scholarly journals Whether to Fused PET/CT or CECT in Post-Therapeutic Colorectal Cancer Assessments: A Study of the Efficacy of the Modality of Choice among Egyptian Patients

2020 ◽  
Author(s):  
Ahmed Baz ◽  
Talaat Ahmed Hassan
Keyword(s):  
Colorectal Cancer ◽  
Computed Tomography ◽  
Predictive Value ◽  
Distant Metastases ◽  
Disease Recurrence ◽  
Whole Body ◽  
Colorectal Cancers ◽  
Recurrence Rates ◽  
Pet Ct ◽  
Egyptian Patients

Abstract One of the most common cancers, colorectal cancer accounts for several tumor-related mortalities; its high recurrence rates either as a local recurrence of the disease or as a distant metastatic disease (up to 35-40%) have been reported in the treated patients within the first two years following surgery. There has been heated debate over the modality of choice for imaging the primary colorectal cancer.This study investigates the diagnostic performance of fused Positron Emission Tomography/ Computed Tomography (PET/CT) in comparison to Contrast-enhanced Computed Tomography(CECT) as a follow-up and restaging imaging tool for post-therapeutic colorectal cancers. Data were collected from 84 Egyptian patients (26 females and 58 males, age ranges from 35 to 80) who were treated from colorectal cancers. They were referred to a private imaging center for evaluation of their disease recurrence by fused PET/CT.Disease recurrence was categorized as operative bed recurrence/residual (incomplete therapeutic response), nodal, and distal metastases.With reference to histopathology reports, the fused PET\CT had sensitivity, specificity, positive predictive value, negative predictive value, and an overall accuracy of 93.33%, 83.33%, 93.33%, 83.33% & 90.48% respectively as compared to CECT(73.33%, 58.33%, 81.48%, 46.67%, 69. 05% respectively).Our findings indicate that fused PET\CT may be more effective than the CECT regarding the detection of operative bed recurrent disease and incomplete therapeutic responses. PET\CT may also offer a cost-effective whole-body scan for restaging the recurrent diseases through an accurate detection of the nodal and distant metastases.

Torso Computed Tomography Can be Bypassed after Thorough Trauma Bay Examination of Patients who Fall from Standing

2015 ◽  
Vol 81 (8) ◽  
pp. 798-801 ◽  
Author(s):  
Kedar S. Lavingia ◽  
Jay N. Collins ◽  
Michael C. Soult ◽  
W. Helman Terzian ◽  
Leonard J. Weireter ◽  
...  
Keyword(s):  
Negative Predictive Value ◽  
Resource Utilization ◽  
Predictive Value ◽  
Ground Level ◽  
Aortic Injury ◽  
Ct Imaging ◽  
Abdominal Injury ◽  
Thoracic Injury ◽  
Trauma Service ◽  
Trauma Bay

Reliance on CT imaging in the evaluation of low-impact blunt trauma is a major source of radiation exposure, cost, and resource utilization. This study sought to determine if torso (chest and abdomen) CT could be avoided in patients with ground level falls. This was a retrospective chart review of patients admitted to the trauma service between January 2013 and April 2014. The mechanism of injury was ground level fall or fall from sitting. Patient demographics, physical examination (PE) findings, imaging results, length of stay, and complications were reviewed. History and physical data were based on chief resident or attending documentation. A significant thoracic injury was defined as a hemothorax, a pneumothorax, greater than three rib fractures, or aortic injury. A significant abdominal injury was defined as a solid organ injury, an intra-abdominal hematoma, a hollow viscus injury, aortic injury, or a urologic injury. The trauma service evaluated 156 patients. Nine patients were excluded for intubation or Glasgow Coma Scale (GCS) < 13. Of the 147 remaining, mean age was 69 years, mean GCS was 14.8. A chest CT was obtained in 111 (76%). Eight (7%) had a significant thoracic injury. All patients with significant thoracic injury had positive examination findings. No patient with a normal PE was found to have a significant thoracic injury (negative predictive value of 100%). An abdominal CT was obtained in 86 (59%). Five (6%) were found to have a significant abdominal injury. All patients who had a significant radiographic injury had an abnormal PE (negative predictive value of 100%). In conclusion, thorough history and physical in the trauma bay allow the clinician to obtain selective torso CT imaging. Routine torso CT warrants re-evaluation in low-impact injury mechanisms as there appears to be little benefit compared with the resource utilization and expense.

scholarly journals RADIOLOGICAL AND PATHOLOGICAL CORRELATION OF LUNG NODULES IN A BACKGROUND OF METASTATIC DISEASE

2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Azra Akhtar ◽  
Noreen Akhtar ◽  
Sajid Mushtaq ◽  
Usman Hassan ◽  
Ali Raza Khan
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Lung Nodule ◽  
Age Groups ◽  
Lung Nodules ◽  
Diagnostic Challenge ◽  
Radiographic Appearance ◽  
Histopathological Findings

Background: Computed tomography (CT) imaging has improved the chances of detecting small indeterminate (<1 cm) lung nodules. The determination of the underlying malignant or benign nature of a lung nodule poses a great diagnostic challenge and depends on a number of factors, including the radiographic appearance of nodule, the presence of non-pulmonary metastases, characteristics of growth and histological criteria. Methods: The medical records of 89 patients admitted to our specialist cancer centre between 2008 and 2013 were reviewed. Patients of all age groups and tumour category were included in the study. Clinical data of these patients were collected and the following parameters were analysed: Radiographic diagnosis, location, size, laterality and number of nodules and histological impression. The radiological findings were then correlated with histopathological findings. The nodules were sub-classified into groups on the basis of size (A = 0–0.5 cm; B = 0.5–0.9 cm; C = 1.0–1.5 cm and D = >1.5 cm). Results: CT scan reports of 89 patients with lung nodules were reviewed. On radiology, 73/89 (82%) were reported to be malignant nodule. Histopathological review of the biopsies of these 89 nodules confirmed malignancy in 50/89 (56.2%) patients. CT scan was found to be highly sensitive (94%, 95% confidence interval [CI]: 83.43–98.68%) but with a very low specificity (33.3%, 95% CI: 19.10–50.22%). CT scan was found to have a higher negative predictive value (81.2%, 95% CI: 54.34–95.73%) and a lower positive predictive value 64.4% (95% CI: 52.31–75.25%) when correlated with histopathological findings. Pathology of these nodules included metastatic sarcoma (27/89; 30.3%) and carcinoma (18/89; 20.2%). The frequency of the biopsy-proven malignant nodules on the right side was 26/45 (57.8%) and on the left side was 24/44 (54.5%) (P = 0.832). Malignant nodules were more frequent in lower lobes (28/43, 65.1%) than in upper lobes (14/32, 43.8%). These two sites combined accounted for 84% of all malignant nodules. There was a significant correlation between nodule size and likelihood of underlying malignancy. The overall prevalence of malignancy in the larger nodules (C and D) was much higher (23/30 and 76.7%) compared to the smaller sized (A and B) nodules (27/58 and 46.8%), P < 0.05.Conclusion: CT scan is a useful tool in the initial clinical assessment of indeterminate lung nodules with high sensitivity (94%) and a high negative predictive value (81.2%).Key words: Computed tomography, fibrosis, indeterminate lung nodule, infection, lung nodule, malignancy, metastases

Detection of local failures after management of nasopharyngeal carcinoma: a prospective, controlled trial

2008 ◽  
Vol 122 (11) ◽  
pp. 1230-1234 ◽  
Author(s):  
S M Ragab ◽  
F A Erfan ◽  
M A Khalifa ◽  
E M Korayem ◽  
H A Tawfik
Keyword(s):  
Computed Tomography ◽  
Nasopharyngeal Carcinoma ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
External Beam Radiotherapy ◽  
Reliability Coefficient ◽  
Histological Findings ◽  
Significant Agreement ◽  
Sensitivity Specificity

AbstractObjectives:To conduct a prospective study (1) to evaluate and compare the efficacies of nasopharyngeal endoscopy and computed tomography in the diagnosis of local failure of external beam radiotherapy for nasopharyngeal carcinoma, and (2) to assess whether multiple endoscopic nasopharyngeal biopsies are superior to a single, targeted biopsy, for the same purpose.Methods:Forty-six patients who had been treated with external beam radiotherapy for primary nasopharyngeal carcinoma were enrolled in the study. For every patient recruited, computed tomography, rigid nasopharyngeal endoscopy and nasopharyngeal biopsies were performed 12 weeks after radiotherapy.Results:Twelve weeks after treatment, six patients (13 per cent) had evident disease on histological examination of biopsies. Nasopharyngeal endoscopy showed a sensitivity, specificity, positive predictive value and negative predictive value of 66.6, 95, 66.6 and 95 per cent, respectively. There was statistically significant agreement between the endoscopic findings and the histological findings (Kappa reliability coefficient = 0.617, p < 0.01). Computed tomography showed a sensitivity, specificity, positive predictive value and negative predictive value of 50, 45, 12 and 85.7 per cent, respectively. There was no statistically significant agreement between the computed tomography findings and the histological findings (Kappa reliability coefficient = 0.021, p > 0.05). A targeted, single biopsy performed under endoscopic control demonstrated excellent sensitivity, specificity, positive predictive value and negative predictive value, being 83.3, 100, 100 and 97.5 per cent, respectively. The Kappa test showed a very statistically significant agreement between the histological findings for the single and the multiple endoscopic biopsies (Kappa reliability coefficient = 0.897, p < 0.001).Conclusions:Rigid nasopharyngeal endoscopy should be considered the primary follow-up tool after radiotherapy treatment of nasopharyngeal carcinoma, with computed tomography being reserved for patients with histological or symptomatic indications. Routine postnasal biopsies are not necessary, given the excellent specificity and negative predictive value of rigid nasopharyngeal endoscopy. Single, targeted endoscopic biopsy provides an excellent alternative to the usual multiple biopsies. In addition, it reduces cost, time, morbidity and patient discomfort.

Value of SPECT/CT for Sentinel Lymph Node Localization in the Parotid and External Jugular Chain

2018 ◽  
Vol 159 (5) ◽  
pp. 866-870
Author(s):  
Rosh K.V. Sethi ◽  
Nicholas B. Abt ◽  
Aaron Remenschneider ◽  
Yingbing Wang ◽  
Kevin S. Emerick
Keyword(s):  
Computed Tomography ◽  
Lymph Nodes ◽  
Head And Neck ◽  
Predictive Value ◽  
Ct Imaging ◽  
Sternocleidomastoid Muscle ◽  
Head And Neck Malignancy ◽  
Level Ii ◽  
Neck Malignancy ◽  
Sensitivity Specificity

Objective Preoperative single-photon emission computed tomography/computed tomography (SPECT/CT) imaging may aid in the localization of sentinel lymph nodes (SLNs) in cutaneous head and neck malignancy and has been rigorously evaluated for deep cervical lymph nodes. The purpose of this study was to assess the sensitivity, specificity, and positive predictive value (PPV) of SPECT/CT for preoperative localization of nodal basins superficial to the sternocleidomastoid muscle, with comparison to deep nodal basins of the neck. Study Design Retrospective review. Setting Tertiary care center. Subjects and Methods SPECT/CT images obtained preoperatively for patients undergoing SLN biopsy for cutaneous head and neck malignancy between June 2015 and June 2016 were reviewed by a blinded nuclear medicine physician and head and neck surgeon. SPECT/CT imaging was compared to intraoperatively determined SLN location via gamma probe. Sensitivity, specificity, and positive and negative predictive values were determined and compared for superficial (external jugular [EJ] and parotid) nodes vs level II nodes. Results Fifty-three patients were included in the study. Most had cutaneous melanoma (69.8%). The PPV of EJ/parotid node identification by SPECT/CT imaging was 85.7%, specificity was 88.9%, and sensitivity was 69.2%. Comparatively, the PPV for level II nodes was 76.9%, specificity was 50%, and sensitivity was 85.7%. No significant difference in SPECT/CT predictive value was identified between EJ/parotid and level II node identification ( P > .05). Conclusion SPECT/CT imaging has strong specificity and positive predictability for preoperative localization of SLN superficial to the sternocleidomastoid muscle in cutaneous head and neck malignancy. SPECT/CT imaging may be a useful radiographic aid for preoperative SLN mapping in this patient population.

scholarly journals Local behavior and lymph node metastases of Wilms' tumor: accuracy of computed tomography

2014 ◽  
Vol 47 (1) ◽  
pp. 9-13 ◽  
Author(s):  
Eduardo Just da Costa e Silva ◽  
Giselia Alves Pontes da Silva
Keyword(s):  
Computed Tomography ◽  
Lymph Node ◽  
Positive Predictive Value ◽  
Lymph Nodes ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Wilms Tumor ◽  
Local Behavior ◽  
Adjacent Organ Invasion ◽  
Organ Invasion

Objective To evaluate the accuracy of computed tomography for local and lymph node staging of Wilms' tumor. Materials and Methods Each case of Wilms' tumor was evaluated for the presence of abdominal lymph nodes by a radiologist. Signs of capsule and adjacent organ invasion were analyzed. Surgical and histopathological results were taken as the gold standard. Results Sensitivity was 100% for both mesenteric and retroperitoneal lymph nodes detection, and specificity was, respectively, 12% and 33%, with positive predictive value of 8% and 11% and negative predictive value of 100%. Signs of capsular invasion presented sensitivity of 87%, specificity of 77%, positive predictive value of 63% and negative predictive value of 93%. Signs of adjacent organ invasion presented sensitivity of 100%, specificity of 78%, positive predictive value of 37% and negative predictive value of 100%. Conclusion Computed tomography tumor showed low specificity and low positive predictive value in the detection of lymph node dissemination. The absence of detectable lymph nodes makes their presence unlikely, and likewise regarding the evaluation of local behavior of tumors.

scholarly journals Computed tomography versus ureteroscopy in identification of renal tract stone with ureteral stent in situ

2011 ◽  
Vol 93 (8) ◽  
pp. 639-641 ◽  
Author(s):  
VCY Tang ◽  
A Attwell-Heap
Keyword(s):  
Computed Tomography ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Gold Standard ◽  
Ureteral Stent ◽  
The Difference ◽  
Contrast Ct ◽  
Sensitivity Specificity

INTRODUCTION The aim of this study was to validate the use of non-contrast computed tomography (CT) with a ureteral stent in situ instead of ureteroscopy for identification of renal tract stones. METHODS All patients who had stents inserted for renal tract stones and underwent non-contrast CT with the stent in situ followed by ureteroscopy between May 2008 and October 2009 at The Canberra Hospital, Australia, were analysed retrospectively. Statistical analysis was performed to compare any differences between CT and ureteroscopy in the identification of stones. RESULTS Overall, 57 patients were included in the study. The difference between CT and ureteroscopy findings was statistically significant. CT identification of stones with a stent in situ had a sensitivity of 86%, a specificity of 46%, a positive predictive value of 63%, a negative predictive value of 76% and an accuracy of 67%. CONCLUSIONS Our study suggests that non-contrast CT is inferior to the ‘gold standard’ of ureteroscopy. It lacks sensitivity, specificity, positive predictive value, negative predictive value and accuracy. Therefore, we cannot recommend using non-contrast CT to replace ureteroscopy.

Pre-operative prediction of cholesteatomas from radiology: retrospective cohort study of 106 cases

2019 ◽  
Vol 133 (06) ◽  
pp. 477-481 ◽  
Author(s):  
D Selwyn ◽  
J Howard ◽  
P Cuddihy
Keyword(s):  
Computed Tomography ◽  
Cohort Study ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Retrospective Cohort Study ◽  
Predictive Value ◽  
Retrospective Cohort ◽  
Anatomical Variation ◽  
Predictive Values ◽  
Mastoid Surgery

AbstractObjectivePre-operative imaging is often used to predict the extent of a cholesteatoma and anatomical variation to plan for surgery. This study aimed to measure the predictive accuracy of computed tomography findings.MethodsA retrospective cohort study was conducted of all patients in a district general hospital undergoing mastoid surgery within a consecutive 12-month period, in whom computed tomography had been performed prior to operative intervention. The study measured the key findings of pre-operative computed tomography imaging and compared them to the intra-operative findings.ResultsA total of 106 patients were included. The sensitivity and specificity for predicting cholesteatoma were 79 per cent and 81 per cent respectively. The positive predictive value was 90 per cent and the negative predictive value was 65 per cent. In predicting complications of cholesteatomas, the sensitivity was 70 per cent, whereas the specificity was 91 per cent. The positive predictive value was 88 per cent and the negative predictive value was 76 per cent.ConclusionPre-operative computed tomography conducted prior to mastoid surgery has high positive predictive values for both predicting cholesteatomas and complications (90 per cent and 88 per cent respectively).

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