Comparison of the Microwave-Heated Ziehl-Neelsen Stain and Conventional Ziehl-Neelsen Method in the Detection of Acid-Fast Bacilli in Lymph Node Biopsies

BACKGROUND: Tuberculosis is a chronic inflammatory disease with lymphadenopathy being the most common extra-pulmonary manifestation. The conventional Ziehl–Neelsen method plays an essential role in the diagnosis of tuberculosis; however, it has a low sensitivity in detecting acid-fast bacilli. AIM: The present study emphasises the role of the microwave-heated method (modified Ziehl–Neelsen) over conventional Ziehl-Neelsen stain and to set at the best condition for irradiation. MATERIAL AND METHODS: The study included 90 patients with clinically suspected tuberculous lymphadenopathy who were referred to the Department of Pathology at Omdurman Military Hospital, Sudan. Demographic data such as age, sex, and site of swelling were documented for each patient. Specimens were stained with conventional Ziehl-Neelsen, fluoresce and the modified methods. RESULTS: Patient’s age ranged from 20 to 70 year. Of the total 90 cases with clinically suspected tuberculous lymphadenopathy, 18 cases were positive for AFB in conventional Ziehl-Neelsen method giving a sensitivity of 13.3%, while in microwave-heated method 82 cases of TB were detected positive for AFB yielded sensitivity and specificity of 97.6% and 85.7%, respectively, and positive and negative predictive values of 98.8% and 75.0% respectively compared to fluorescence methods. CONCLUSION: In the present study, the microwave-heated Ziehl-Neelsen method, was found to have sensitivity and specificity of 97.6% and 85.7%, respectively which matches the fluorescence technique. It has specificity in detecting lymph node tuberculosis that makes it superior over all other modified methods. However, the availability and cost-effectiveness might limit the use of fluorescence in routine practice. Furthermore, the study set the best staining temperature is provided at power 1 level (60 w) for 1.5 minutes.

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Maximizing FDG-PET/CT Utility in Staging of Follicular Lymphoma (FL): The Role of Spleen Involvement and Bone Standardized Uptake Values

Blood ◽

10.1182/blood-2019-131992 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 2811-2811 ◽

Cited By ~ 1

Author(s):

Frederique St-Pierre ◽

Stephen Broski ◽

Betsy Laplant ◽

Thomas M. Habermann ◽

Thomas E. Witzig

Keyword(s):

Sensitivity And Specificity ◽

Fdg Pet ◽

Iliac Crest ◽

Bone Involvement ◽

Routine Practice ◽

Newly Diagnosed ◽

Predictive Values ◽

Posterior Iliac Crest ◽

Pet Ct ◽

Fdg Pet Ct

Background: FDG PET/CT and bone marrow biopsy (BMB) are considered standard procedures for the staging of patients with new, untreated FL. A key issue in FL is the early identification of patients who will fail early. We recently reported (Am J Hematology 2019) that the presence of ≥2 EN sites, spleen, bone or soft tissue involvement as detected by PET all predicted failure to achieve EFS24. In Hodgkin lymphoma and diffuse large B-cell NHL, PET has replaced the routine need for a staging BMB. However, there is no such evidence in FL. The goal of this study was to determine the value of FDG PET/CT in determining bone involvement in FL using BMB as the gold standard. Methods: Patients were identified using the Mayo Clinic Lymphoma Database. 548 patients with newly diagnosed FL grades 1-3A between years 2003-2016, available BMB results, and PET/CT imaging at diagnosis, were included in the analysis. The presence of bone and spleen involvement on PET/CT, SUVmax and SUVmean of the axial skeleton at L3, and BMB results were recorded and compared. Results: In all, 36% (197/548) of patients had a positive BMB, and 34% (189/548) had bone involvement detected on PET/CT. Compared to BMB, the sensitivity and specificity of PET/CT in detecting bone involvement as determined by BMB were 60% and 80%, respectively. We noted that 59 patients had focal bone involvement on PET/CT rather than a diffuse component, and found that 47% (28/59) of these patients had a negative BMB obtained in the posterior iliac crest. Excluding these patients, the sensitivity and specificity of PET/CT in detecting bone involvement were 53% and 88%, respectively (Table 1). With respect to the spleen, 29% (157/548) of patients had evidence of splenic FL involvement on PET/CT, and of these, 69% (109/157) also had a positive BMB. The sensitivity and specificity of spleen involvement on PET/CT in predicting bone involvement on BMB were 55% and 86%, respectively (Table 2). We recorded SUV data at L3 in the 439 patients who had either a diffuse pattern of bone involvement on PET/CT, or a PET/CT read as negative. We analyzed the positive and negative predictive values (PPV and NPV) of SUVmax and SUVmean at several cut-off points to determine whether axial bone SUV is reliable at determining patients with a positive or negative BMB. The NPV for an SUVmax of less than 2.0 was 96% (n=25 patients classified as negative). For SUVmean, the best cut-off point was at less than 1.4, where NPV was 100% (n=15 patients classified as negative). There was no logical cut-off point for a significant PPV > 95%. Conclusion: In newly diagnosed FL, the sensitivity and specificity of bone involvement on PET/CT are insufficient for PET/CT to routinely replace BMB. However, in patients where the need for BMB at staging is being debated, certain factors on PET/CT can help facilitate this decision. The detection of focal bone lesions, especially those that may be missed on posterior iliac crest BMB, can make BMB unnecessary. If both the spleen and bone appear involved on PET/CT, this confers a relatively high chance that BMB will be positive. If SUVmax at L3 is less than 2.0, or if SUVmean is less than 1.4, the BMB will likely be negative, with a NPV > 95%. This decision-making algorithm is outlined in Figure 1 and may serve as a useful guideline for clinical trials and routine practice. Disclosures No relevant conflicts of interest to declare.

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Diagnosis of lymph node tuberculosis using the GeneXpert MTB/RIF in Bangladesh

Mediscope ◽

10.3329/mediscope.v6i1.38939 ◽

2018 ◽

Vol 6 (1) ◽

pp. 19-23

Author(s):

TE Nur ◽

AU Hosna ◽

N Rayhan ◽

N Nazneen

Keyword(s):

Lymph Node ◽

Sensitivity And Specificity ◽

Conventional Method ◽

Rapid Diagnosis ◽

Tuberculous Lymphadenitis ◽

Culture Test ◽

Lymph Node Tuberculosis ◽

Medical University

The purpose of this study was to evaluate the accuracy of the GeneXpert M. tuberculosis (MTB)/ rifampicin (RIF) test for the detection of MTB in lymph node aspirated samples. This study was conducted in the Department of Pathology, Bangabandhu Sheikh Mujib Medical University, Bangladesh. This study was done during the period from July 2013 to May 2015. A total of 317 clinically suspected tuberculous lymphadenitis patients without malignancy were included in the study. The culture test and GeneXpert test were used for detection of MTB in lymph node aspirated material. Among the 317 samples tested, the GeneXpert detected the DNA of MTB in 167 samples (52.7%), whereas culture test was positive in 74 (23.3%) specimens. GeneXpert also detected 8 RIF resistance cases. GeneXpert sensitivity and specificity results were assessed according to culture results. The sensitivity and specificity of the GeneXpert assay was 95.9% and 60.5%, respectively. The implementation of the GeneXpert MTB/RIF assay may dramatically improve the rapid diagnosis of lymph node TB. The GeneXpert MTB/RIF may replace usual conventional method like culture test for detection of MTB. Mediscope Vol. 6, No. 1: Jan 2019, Page 19-23

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Diagnostic Accuracy of the Xpert MTB/RIF Assay for Lymph Node Tuberculosis: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2019/4878240 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12 ◽

Cited By ~ 3

Author(s):

Guocan Yu ◽

Fangming Zhong ◽

Bo Ye ◽

Xudong Xu ◽

Da Chen ◽

...

Keyword(s):

Lymph Node ◽

Sensitivity And Specificity ◽

Meta Analysis ◽

Needle Aspiration ◽

Diagnostic Efficiency ◽

Tissue Samples ◽

Significant Difference ◽

Lymph Node Tuberculosis ◽

Meta Analyses ◽

Composite Reference Standard

Objectives. To evaluate the performance of Xpert MTB/RIF for lymph node tuberculosis (LNTB). Methods. We searched databases for published reports. We reviewed the studies and identified the performance of Xpert MTB/RIF with respect to a composite reference standard (CRS) and culture. We used a bivariate random-effects model to perform meta-analyses and used metaregression to analyze sources of heterogeneity. Results. 15 independent studies compared Xpert MTB/RIF with CRS while 21 comparing it with culture were included. The pooled sensitivity and specificity of Xpert MTB/RIF were 79% and 98% compared to that of CRS, respectively, and 84% and 91% compared to that of culture, respectively. The pooled sensitivity and specificity using fine needle aspiration (FNA) samples versus CRS were 80% and 96%, whereas those against culture were 90% and 89%, respectively. The percentages while working with tissue samples versus CRS were 76% and 100%, respectively, whereas those against culture were 76% and 92%, respectively. There was no significant difference in diagnostic efficiency among the types of specimen. Conclusions. Xpert MTB/RIF demonstrates good diagnostic efficiency for LNTB and is not related to the type of specimen, obtained via different routes.

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DOZ047.42: The value of rigid tracheobronchoscopy for the diagnosis of tracheomalacia in esophageal atresia patients

Diseases of the Esophagus ◽

10.1093/dote/doz047.42 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

I P Aanen ◽

B Pullens ◽

J van Rosmalen ◽

R M H Wijnen

Keyword(s):

Sensitivity And Specificity ◽

Esophageal Atresia ◽

Surgical Intervention ◽

Medical Center ◽

Primary Repair ◽

Demographic Data ◽

P Value ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Low Sensitivity

Abstract Aim of the Study The aim of this study is to evaluate routine airway endoscopy prior to the closure of the trachea-esophageal fistula (TOF) and esophageal atresia (EA) repair in a tertiary medical center concerning pre- and postoperative tracheomalacia. Methods We evaluated all patients with EA born between 2013 and 2016 who underwent routine rigid tracheobronchoscopy (TBS) before primary repair of the EA at our center. Inclusion criteria included peroperative rigid TBS performed by an otolaryngologist. Exclusion criteria included impossibility to determine pre- and or postoperative TM (because of logistic or medical reasons). Demographic data, comorbidities, surgical intervention, TBS findings, and subsequent surgical management were analyzed. Main Results Twenty-four patients with EA were included in this study. Eight of the 24 patients developed postoperative TM. Of these 8 patients with TM, 5 were diagnosed at the preoperative TBS (62.5%). Of the 16 patients without postoperative TM, there were 6 patients (37.5%) with peroperative diagnosed TM. So the sensitivity and specificity of routine airway endoscopy prior to EA-repair are, respectively, 62.5% (CI 30.4%–86.5%) and 62.5% (CI 38.5%–81.6%). Concerning postoperative TM, there is a significant higher appearance in females versus males (P-value 0.021). There was no significant causality between mean gestational age, birth weight, type of EA, type of surgery (open or thoracoscopic), presence of gastroesophageal reflux disease, and the appearance of postoperative TM. Conclusions Preoperative TBS can be useful for the evaluation of tracheoesophageal fistula but has a low sensitivity and specificity to detect postoperative TM.

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Sensitivity and Specificity of Sheard and Percival’s Criteria for the Diagnosis of Young People with Near-heterophoria

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.6399 ◽

2021 ◽

Vol 9 (B) ◽

pp. 1128-1134

Author(s):

Saif Hassan Alrasheed ◽

Amel Mohamed Yousif ◽

Majid A. Moafa ◽

Abd Elaziz Mohamed Elmadina ◽

Mohammad Alobaid

Keyword(s):

Young People ◽

Negative Predictive Value ◽

Sensitivity And Specificity ◽

Binocular Vision ◽

Predictive Value ◽

High Sensitivity ◽

The Other ◽

Cross Sectional ◽

Predictive Values ◽

Low Sensitivity

BACKGROUND: Sheard and Percival assumed that symptoms from latent strabismus can be avoided if the relevant fusional vergence is adequate to support the heterophoria. AIM: The aim of the study was to determine the sensitivity and specificity of Sheard’s and Percival’s criterion for the diagnosis of heterophoria. METHODS: A cross-sectional hospital-based study was performed at Al-Neelain Eye Hospital Khartoum, Sudan from February to October 2019. Heterophoria was measured using Maddox Wing and fusional vergence using a prism bar. Thereafter, Sheard’s and Percival’s criteria were used for the diagnosis of heterophoria. RESULTS: A total of 230 participants (age = 15–30 years; mean age = 19.34 ± 3.325 years) were recruited for this study. The Sheard’s criteria showed a high sensitivity of 87.2% and a low specificity of 8.0% for the diagnosing of exophoria, with positive and negative predictive values of 65.5% and 26%, respectively. The criteria showed a relatively low sensitivity of 77.8% and a specificity of 9.0% in the diagnosis of esophoria, with a positive and negative predictive values of 56% and 20%, respectively. Percival criteria showed high sensitivity 84.2% and low specificity 9.1% in diagnosing esophoria, with a positive and negative predictive value of 61.5% and 25%, respectively. On the other hand, the criteria showed low sensitivity 67.4% and specificity 13.8% in diagnosing exophoria, with positive and negative predictive value 61.9% and 17%, respectively. CONCLUSION: Sheard’s and Percival’s criteria are useful in diagnosing binocular vision problems. Sheard’s criteria are accurate in diagnosing near exophoria and Percival’s criteria are more accurate in diagnosing near esophoria. Therefore, these criteria provide good clues and predictions for the diagnosis of binocular vision problems.

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Accuracy of Ultrasound for Determination of Fetal Gender

10.53350/pjmhs211561237 ◽

2021 ◽

Vol 15 (6) ◽

pp. 1237-1239

Author(s):

A. Ammar ◽

M. A. Z. Husnain ◽

M. Arshad ◽

T. M. Mirza ◽

Z. Arshad ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Ultrasound Examination ◽

Cross Sectional Study ◽

Military Hospital ◽

Inclusion Criteria ◽

Cross Sectional ◽

Predictive Values ◽

Fetal Gender ◽

Sensitivity Specificity

Aim: To evaluate the accuracy of ultrasound in determining the phenotypic foetal gender in all three trimesters. Study design: Cross sectional study. Place and duration of study: Department of Diagnostic Radiology Combined Military Hospital Lahore from 1st January 2020 to 30th April 2020. Methodology: Three hundred and seventy two patients in the inclusion criteria were selected. Ages of patients, gestational ages of foetuses and their genders were determined according to the ultrasonographic signs using ultrasound examination. Patients were contacted 3 weeks after the estimated date of delivery and phenotypic sex recorded. Results: Mean age was 34 years. Median gestational age was 21 weeks 3 days. Accuracy of gender determination by ultrasound in 1st, 2nd and 3rd trimesters was 62%, 97% and 95% respectively. Sensitivity and specificity of ultrasound in 1st trimester for males are 66% and 72%; and for females are 72% and 66% respectively. Positive and negative predictive values for male are 69% and 71%; and for female are 71% and 69% respectively. Sensitivity and specificity of ultrasound in 2nd trimester for males are 95% and 100%; and for females are 100% and 95% respectively. Positive and negative predictive values for male are 100% and 94%; and for female are 94% and 100% respectively. Sensitivity and specificity of ultrasound in 3rd trimester for males are 94% and 96%; and for females are 96% and 94% respectively. Positive and negative predictive values for male are 97% and 93%; and for female are 93% and 97% respectively. Conclusion: There is a high accuracy of ultrasound in determination of fetal gender in second and third trimesters. Keywords: Ultrasound, Gender, Trimester, Sensitivity, Specificity, Predictive Value

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An automated EHR-based tool for identification of patients (pts) with metastatic disease to facilitate clinical trial pt ascertainment.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.2051 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 2051-2051

Author(s):

Jeffrey J. Kirshner ◽

Kelly Cohn ◽

Steven Dunder ◽

Karri Donahue ◽

Madeline Richey ◽

...

Keyword(s):

Machine Learning ◽

Clinical Trial ◽

Sensitivity And Specificity ◽

Real World ◽

Learning Model ◽

Routine Practice ◽

Model Accuracy ◽

Predictive Values ◽

Machine Learning Model ◽

User Review

2051 Background: Efforts to facilitate patient identification for clinical trials in routine practice, such as automating electronic health record (EHR) data reviews, are hindered by the lack of information on metastatic status in structured format. We developed a machine learning tool that infers metastatic status from unstructured EHR data, and we describe its real-world implementation. Methods: This machine learning model scans EHR documents, extracting features from text snippets surrounding key words (ie, ‘Metastatic’ ‘Progression’ ‘Local’). A regularized logistic regression model was trained, and used to classify patients across 5 metastatic status inference categories: highly-likely and likely positive, highly-likely and likely negative, and unknown. The model accuracy was characterized using the Flatiron Health EHR-derived de-identified database of patients with solid tumors, where manually abstracted information served as standard accurate reference. We assessed model accuracy using sensitivity and specificity (patients in the ‘unknown’ category omitted from numerator), negative and positive predictive values (NPV, PPV; patients ‘unknown’ included in denominator), and its performance in a real-world dataset. In a separate validation, we evaluated the accuracy gained upon additional user review of the model outputs after integration of this tool into workflows. Results: This metastatic status inference model was characterized using a sample of 66,532 patients. The model sensitivity and specificity (95%CI) were 82.% (82, 83) and 95% (95, 96), respectively; PPV was 89% (89, 90) and NPV was 94% (94, 94). In the validation sample (N = 200 originated from 5 distinct care sites), and after user review of model outputs, values increased to 97% (85, 100) for sensitivity, 98% (95, 100) for specificity, 92 (78, 98) for PPV and 99% (97, 100) for NPV. The model assigned 163/200 patients to the highly-likely categories, which were deemed not to require further EHR review by users. The prevalence of errors was 4% without user review, and 2% after user review. Conclusions: This machine learning model infers metastatic status from unstructured EHR data with high accuracy. The tool assigns metastatic status with high confidence in more than 75% of cases without requiring additional manual review, allowing more efficient identification of clinical trial candidates and clinical trial matching, thus mitigating a key barrier for clinical trial participation in community clinics.

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A Case of Erythema Nodosum with Lymph Node Tuberculosis and Colon Cancer

Nishi Nihon Hifuka ◽

10.2336/nishinihonhifu.77.10 ◽

2015 ◽

Vol 77 (1) ◽

pp. 10-13

Author(s):

Masayoshi NAKAO ◽

Satoshi TAKEUCHI ◽

Kazuhiro TAKAHASHI ◽

Hiromaro KIRYU ◽

Hiroshi TERAO ◽

...

Keyword(s):

Colon Cancer ◽

Lymph Node ◽

Erythema Nodosum ◽

Lymph Node Tuberculosis

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Extracellular Vesicles in Tumor Diagnosis: A Mini-Review

Current Molecular Medicine ◽

10.2174/1573405616666201209103154 ◽

2020 ◽

Vol 20 ◽

Author(s):

Si Yu ◽

Menglin Huang ◽

Jingyu Wang ◽

Yongchang Zheng ◽

Haifeng Xu

Keyword(s):

Clinical Diagnosis ◽

Sensitivity And Specificity ◽

Cancer Diagnosis ◽

Cancer Biomarkers ◽

Related Substances ◽

Physiological Processes ◽

Cancer Pathogenesis ◽

Limited Application ◽

Low Sensitivity ◽

Shed Light

: Widely exploration of noninvasive tumor/cancer biomarkers has shed light on clinical diagnosis. However, many under-investigated biomarkers showed limited application potency due to low sensitivity and specificity, while extracellular vehicles (EVs) were gradually recognized as promising candidates. EVs are small vesicles transporting bioactive cargos between cells in multiple physiological processes and also in tumor/cancer pathogenesis. This review aimed to offer recent studies of EVs on structure, classification, physiological functions, as well as changes in tumor initiation and progression. Furthermore, we focused on advances of EVs and/or EV-related substances in cancer diagnosis, and summarized ongoing studies of promising candidates for future investigations.

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The value of serum progesterone level on day of human chorionic gonadotrophin administration / metaphase II oocyte ratio in predicting IVF/ICSI outcome in patients with normal ovarian reserve

Journal of Ovarian Research ◽

10.1186/s13048-021-00800-5 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Ahmad Mahran ◽

Mohammed Khairy ◽

Reham Elkhateeb ◽

Abdel Rahman Hegazy ◽

Ayman Abdelmeged ◽

...

Keyword(s):

Sensitivity And Specificity ◽

Ovarian Response ◽

Pregnancy Rates ◽

Clinical Pregnancy ◽

Progesterone Level ◽

Receiver Operating Curve ◽

Serum Progesterone ◽

Predictive Values ◽

Significant Difference ◽

Assisted Reproduction Treatment

Abstract Background The clinical implication of the increased serum progesterone level on the day of HCG administration in assisted reproduction treatment (ART) is still controversial. The current study aimed to compare the predictive value of serum progesterone on day of HCG administration / metaphase II oocyte (P/MII) ratio on IVF/ ICSI outcome to serum progesterone (P) level alone and the ratio of serum progesterone/estradiol level (P/E2) ratio in prediction of pregnancy rates after ART. Material & methods Two hundred patients admitted to the IVF/ICSI program at Minia IVF center in Egypt in the period from October 2016 to May 2018 were included in this study. Serum Progesterone (P) and Estradiol (E2) levels were estimated on the day of HCG administration. The ratio between serum P and the number of MII oocytes (P/MII ratio) was calculated and the predictive values of the three parameters (P, P/E2 ratio and P/MII ratio) in prediction of cycle outcomes were measured. Results P/ MII oocyte ratio was significantly lower in patients who attained clinical pregnancy (n = 97) as compared with those who couldn’t whilst there was no significant difference in P and P/E2 ratio between the two groups. Using a cut off value of 0.125, the sensitivity and specificity of progesterone/ MII ratio in prediction of no pregnancy in IVF/ICSI were 75.7 and 77.1% respectively with the area under The Receiver operating curve (ROC-AUC) = 0.808. The respective values of the ROC-AUC for the P and P/E2 ratio were 0.651 and 0.712 with sensitivity and specificity of 71.2 and 73.5%for P level and of 72.5 and 75.3% for P/E2 ratio. Implantation or clinical pregnancy rates were significantly different between patients with high and low P/MII ratio irrespective of day of embryo transfer (day 3 or 5). Conclusions In patients with normal ovarian response, serum progesterone on day of HCG / MII oocyte ratio can be a useful predictor of pregnancy outcomes and in deciding on freezing of all embryos for later transfer instead of high progesterone level alone.

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