scholarly journals Role of endoscopy in suspicion of atrophic gastritis with and without intestinal metaplasia in comparison to histopathology

2021 ◽  
Vol 84 (1) ◽  
pp. 9-17
Author(s):  
H Ibrahim ◽  
A Shams El-Deen ◽  
ZA Kasemy ◽  
M Saad ◽  
AA Sakr
Keyword(s):  
Atrophic Gastritis ◽  
Intestinal Metaplasia ◽  
Sensitivity And Specificity ◽  
Chronic Gastritis ◽  
Gastrointestinal Symptoms ◽  
High Sensitivity ◽  
High Specificity ◽  
Poor Correlation ◽  
Gastric Lesions ◽  
Low Sensitivity

Background and study aims : Atrophic gastritis (AG) and intestinal metaplasia (IM) are established premalignant gastric lesions. Many studies documented a poor correlation between esophagogastroduodenoscopy (EGD) and histopathological (HP) findings of precancerous gastric lesions. The aim was to bridge the gap between endoscopy and HP in detection of chronic gastritis, AG and IM. Patients and methods : a prospective single-center study involved 150 patients with endoscopic criteria of gastric lesions with upper gastrointestinal symptoms referred for upper GI endoscopy met the endoscopic criteria and classified according to HP of biopsies from targeted gastric lesions into chronic gastritis (GI), AG(GII) or IM(GIII). We correlated the endoscopic criteria of the 3 groups with the HP results. Results : (73males & 75 females) with ages ranged17-75 years and mean± SD was 41.96 ± 15.95. GI, GII &GIII were [42 patients (28%),82 patients (54.7%) and 26 patients (17.3%)], respectively. Diffuse gastric mottling was more common in GI (74.3%, P<0.001), visible submucosal vessels, gastric atrophy predominated in GII (75.6, 82.3 & 73.1% (P 0.005,0.4 & <0.01)), respectively. Whitish raised lesions were more specific in GIII (85.7%) (P<0.001). The sensitivity and specificity of endoscopic suspicion of chronic gastritis were (86&88% in GI), (87&85% in GII) and (54% &100% in GIII) (p-0.001). The logistic regression model for risk factors was χ2= 25.74 and 49.32, p < 0.001. Conclusion : Conventional endoscopy has high sensitivity and specificity for suspicion of chronic gastritis and AG, but low sensitivity and very high specificity for IM. Targeted biopsies may be valuable with image enhanced techniques.

scholarly journals CD10 and Das1: A Biomarker Study Using Immunohistochemistry to Subtype Gastric Intestinal Metaplasia

2021 ◽  
Author(s):  
Athanasios Koulis ◽  
Natasha Costanzo ◽  
Catherine Mitchell ◽  
Stephen Lade ◽  
David Goode ◽  
...  
Keyword(s):  
Intestinal Metaplasia ◽  
High Sensitivity ◽  
High Specificity ◽  
Expression Data ◽  
Gastric Intestinal Metaplasia ◽  
Whitney Test ◽  
Mann Whitney Test ◽  
Risk Of Progression ◽  
Low Sensitivity ◽  
Digital Quantification

Abstract Background: Intestinal metaplasia (IM) is considered a key pivot point in the Correa model of gastric cancer (GC). It is histologically subtyped into the complete and incomplete subtypes, the latter being associated with a greater risk of progression. However, the clinical utility of IM subtyping remains unclear, partially due to the absence of reliable defining biomarkers.Methods: Based on gene expression data and existing literature, we selected CD10 and Das1 as candidate biomarkers to distinguish complete and incomplete IM glands in tissues from patients without GC (IM-GC) and patients with GC (IM+GC). Immunohistochemical staining of individually subtyped IM glands was scored after blinding by two researchers using tissue belonging to both IM-GC and IM+GC patients. Whole tissue Das1 staining was further assessed using digital image quantification (cellSens Dimension, Olympus).Results: Across both cohorts CD10 stained the IM brush border and was shown to have a high sensitivity (87.5% and 94.9% in IM-GC and IM+GC patients respectively) and specificity (100.0% and 96.7% respectively) with an overall AUROC of 0.944 for complete IM glands. By contrast Das1 stained mainly goblet cells and the apical membrane of epithelial cells, mostly of incomplete IM glands with a low sensitivity (28.6% and 29.3% in IM-GC and IM+GC patients respectively) but high specificity (98.3% and 85.1% respectively) and an overall AUROC of 0.603 for incomplete IM glands. A combined logistic regression model showed a significant increase in AUROC for detecting complete IM glands (0.955 vs 0.970). Whole tissue digital quantification of Das1 staining showed a significant association with incomplete IM compared to complete IM, both in IM-GC and in IM+GC patients (p=0.016 and p=0.009 respectively, Mann-Whitney test and unpaired t test used). Additionally, complete IM in IM+GC patients exhibited significantly more Das1 staining than in IM-GC patients (p=0.019, Mann-Whitney test). Conclusions: These findings suggest that CD10 is an outstanding biomarker for complete IM and Das1 may be useful as a secondary biomarker for IM glands at greater risk of progression irrespective of IM subtype. Overall, the clinical use of these biomarkers could lead to improved patient stratification and targeted surveillance.

scholarly journals Sensitivity and specificity of loss of heterozygosity analysis for the classification of rare germline variants in BRCA1/2: results of the observational AGO-TR1 study (NCT02222883)

2020 ◽  
pp. jmedgenet-2020-107353
Author(s):  
Jan Hauke ◽  
Philipp Harter ◽  
Corinna Ernst ◽  
Alexander Burges ◽  
Sandra Schmidt ◽  
...  
Keyword(s):  
Loss Of Heterozygosity ◽  
Sensitivity And Specificity ◽  
False Negative ◽  
High Sensitivity ◽  
High Specificity ◽  
Germline Variants ◽  
Variants Of Unknown Significance ◽  
Link Type ◽  
Registration Number ◽  
Low Sensitivity

Variant-specific loss of heterozygosity (LOH) analyses may be useful to classify BRCA1/2 germline variants of unknown significance (VUS). The sensitivity and specificity of this approach, however, remains unknown. We performed comparative next-generation sequencing analyses of the BRCA1/2 genes using blood-derived and tumour-derived DNA of 488 patients with ovarian cancer enrolled in the observational AGO-TR1 trial (NCT02222883). Overall, 94 pathogenic, 90 benign and 24 VUS were identified in the germline. A significantly increased variant fraction (VF) of a germline variant in the tumour indicates loss of the wild-type allele; a decreased VF indicates loss of the variant allele. We demonstrate that significantly increased VFs predict pathogenicity with high sensitivity (0.84, 95% CI 0.77 to 0.91), poor specificity (0.63, 95% CI 0.53 to 0.73) and poor positive predictive value (PPV; 0.71, 95% CI 0.62 to 0.79). Significantly decreased VFs predict benignity with low sensitivity (0.26, 95% CI 0.17 to 0.35), high specificity (1.0, 95% CI 0.96 to 1.00) and PPV (1.0, 95% CI 0.85 to 1.00). Variant classification based on significantly increased VFs results in an unacceptable proportion of false-positive results. A significantly decreased VF in the tumour may be exploited as a reliable predictor for benignity, with no false-negative result observed. When applying the latter approach, VUS identified in four patients can now be considered benign. Trial registration numberNCT02222883.

scholarly journals Association of Helicobacter pylori vacA polymorphisms with the risk of gastric precancerous lesions in a Moroccan population

2021 ◽  
Vol 15 (08) ◽  
pp. 1124-1132
Author(s):  
Mohamed Reda Jouimyi ◽  
Ghizlane Bounder ◽  
Imane Essaidi ◽  
Hasna Boura ◽  
Wafaa Badre ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
High Risk ◽  
Atrophic Gastritis ◽  
Intestinal Metaplasia ◽  
Chronic Gastritis ◽  
Precancerous Lesions ◽  
Gastric Lesions ◽  
D Region ◽  
Reliable Marker ◽  
H Pylori

Introduction: Helicobacter pylori infection is the major risk factor of atrophic gastritis and intestinal metaplasia. The vacA gene is one of the most virulence factors of H. pylori and genetic diversity in its s, m, i, and d regions is associated with gastric lesions severity. This study aimed to investigate the association of vacA s, m, i, and d regions with the risk of atrophic gastritis and intestinal metaplasia in a Casablanca population. Methodology: A total of 210 patients suffering from gastric lesions (chronic gastritis, atrophic gastritis, and intestinal metaplasia) were enrolled. The type of lesion was diagnosed by histological examination. Detection of H. pylori infection and genotyping of vacA regions were carried out by PCR. Results: The prevalence of H. pylori was 95%. The most common vacA genotypes were s2 (51.5%), m2 (77%), i2 (60.5%), and d2 (58.5%). VacA s1, m1, and i1 genotypes were associated with a high risk of intestinal metaplasia, while the vacA d1 genotype increases the risk of atrophic gastritis and intestinal metaplasia. The most common vacA combination was s2/m2/i2/d2 (52%), and it was more detected in chronic gastritis. The moderate virulent vacA combination (s1/m2/i1/d1) increases the risk of atrophic gastritis, while the most virulent vacA combination (s1/m1/i1/d1) increases the risk of intestinal metaplasia. Conclusions: Genotyping of vacA d region might be a reliable marker for the identification of vacA virulent strains that represent a high risk of developing precancerous lesions (atrophic gastritis and intestinal metaplasia).

Is Endoscopic Assessment of the Esophagus and Stomach Enough to Determine the Need for Biopsy at These Sites in Pediatric Patients Undergoing Endoscopy for Elevated TTG?

2021 ◽  
pp. 109352662199148
Author(s):  
M. Cristina Pacheco ◽  
Nicole Green ◽  
Jane Dickerson ◽  
Dale Lee
Keyword(s):  
Sensitivity And Specificity ◽  
Pediatric Patients ◽  
Tissue Transglutaminase ◽  
Immunoglobulin A ◽  
High Specificity ◽  
Visual Assessment ◽  
Pathology Report ◽  
Low Sensitivity ◽  
Endoscopic Assessment

Objectives The goal of our study was to determine whether visual assessment of the esophagus and stomach could predict abnormal histology and determine the frequency of interventions based on biopsies in patients undergoing endoscopy for elevated tissue transglutaminase immunoglobulin A antibody (TTG). Methods Pathology records were searched for patients with biopsy performed for elevated TTG. Pathology report, endoscopy report, and follow-up were obtained and slides from the duodenum reviewed. Pathology was considered gold standard for sensitivity and specificity calculations. Results 240 patients were included. 215 patients had esophageal biopsies performed. Esophageal endoscopic visual assessment had sensitivity of 47% and specificity of 93% for abnormal histology. 16(7%) patients had therapy or referral related to results and, of these, 6(38%) had visually normal endoscopy. 237 biopsies were performed of stomach. Gastric endoscopic visual assessment had a sensitivity and specificity of 20% and 87%. 24(10%) patients had therapy based on findings and, of these, 12 (50%) had visually normal endoscopy. Conclusions Endoscopic assessment of esophagus and stomach has low sensitivity and high specificity for pathologic abnormalities when indication for endoscopy is elevated TTG. When endoscopy is visually normal clinical interventions based on biopsy are rare, and foregoing biopsy may be considered.

Epstein-Barr Virus (EBV)-Encoded RNA: Automated In-Situ Hybridization (ISH) Compared with Manual ISH and Immunohistochemistry for Detection of EBV in Pediatric Lymphoproliferative Disorders

2009 ◽  
Vol 12 (3) ◽  
pp. 195-199 ◽  
Author(s):  
Naim K. Fanaian ◽  
Cynthia Cohen ◽  
Sandra Waldrop ◽  
Jennifer Wang ◽  
Bahig M. Shehata
Keyword(s):  
In Situ Hybridization ◽  
Predictive Value ◽  
Epstein Barr Virus ◽  
High Sensitivity ◽  
High Specificity ◽  
Lymphoproliferative Disorders ◽  
Barr Virus ◽  
Epstein Barr ◽  
Low Sensitivity

Detection of Epstein-Barr virus (EBV) may be achieved by various methods, including EBV-encoded RNA (EBER) in-situ hybridization (ISH) and immunohistochemistry (IHC) for latent membrane protein (LMP-1). We compared novel automated ISH and IHC techniques in pediatric lymphoproliferative disorders with results obtained by manual ISH. Thirty-seven pediatric cases previously studied by manual EBER ISH (including 18 EBER-positive, 15 EBER-negative, and 4 EBER-equivocal cases) were used for the study. Automated EBER ISH and automated LMP-1 IHC were performed using the BondMax autostainer and prediluted EBER probe and EBV cell surface 1 to 4 at 1:50 dilution, respectively. Results of each of the automated techniques for EBV detection were compared with results by manual EBER ISH. Compared with manual EBER ISH as the gold standard, automated ISH had a sensitivity and specificity of 94% and 69%, respectively, accuracy of 83%, positive predictive value (PPV) of 79%, and negative predictive value (NPV) of 90%. Automated IHC had a sensitivity of 44%, specificity of 93%, accuracy of 67%, PPV of 88%, and NPV of 59%. Automated ISH and IHC correlated significantly ( P < 0.045). Automated ISH is useful for diagnosis of EBV-related pediatric neoplasms, being easy to perform and interpret and requiring only the technologist's time to set up and having a high sensitivity and NPV. The automated IHC protocol is of too low sensitivity for routine use, although results show high specificity and PPV.

scholarly journals Chronic atrophic gastritis: an update on diagnosis

2020 ◽  
Author(s):  
Adriana Botezatu ◽  
Nicolae Bodrug
Keyword(s):  
Atrophic Gastritis ◽  
Intestinal Metaplasia ◽  
Chronic Atrophic Gastritis ◽  
Diagnostic Methods ◽  
Digestive Endoscopy ◽  
Gastric Lesions ◽  
Inclusion Criteria ◽  
Non Invasive ◽  
Precancerous Gastric Lesions ◽  
Upper Digestive Endoscopy

Background and aim. Atrophic gastritis is a precancerous gastric lesion, therefore its early detection is a priority in preventing gastric cancer. The aim of the present paper is to develop a narrative synthesis of the present knowledge on diagnostic methods of chronic atrophic gastritis. Methods. A literature search was carried out on main databases: PubMed, Hinari, SpringerLink and Scopus (Elsevier) for the period 2000-2020. The searched keywords were: chronic atrophic gastritis, intestinal metaplasia and dysplasia + diagnosis. Inclusion criteria were focused on the articles about the invasive and non-invasive diagnosis of chronic atrophic gastritis and of precancerous gastric lesions, intestinal metaplasia and dysplasia; exclusion criteria were articles published before 2000 and those that did not include the proposed theme. Results. The search returned 575 papers addressing the topic of precancerous lesions. From these, 60 articles were qualified representative for the materials published on the topic of this synthesis article, being those that met the inclusion criteria. The data emphasize the need to use upper digestive endoscopy with biopsies for the diagnosis of chronic atrophic gastritis. However serological diagnosis is available as alternative mainly recommended in follow up. Conclusions. There are two main methodological approaches for the evaluation of chronic atrophic gastritis as a precancerous gastric lesions: invasive examination, which requires histological analysis of biopsy samples taken during upper digestive endoscopy, being the "gold standard" for diagnosis, and non-invasive serological examination using markers of gastric function.

scholarly journals Validation of the French version of the McLean Screening Instrument for Adolescent Borderline Personality Disorder (MSI-BPD)

2020 ◽  
Author(s):  
Bojan Mirkovic ◽  
Mario Speranza ◽  
Lionel Cailhol ◽  
Julien-Daniel Guelfi ◽  
Fernando Perez-Diaz ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychometric Properties ◽  
High Sensitivity ◽  
High Specificity ◽  
Structured Interview ◽  
Screening Instrument ◽  
Borderline Personality ◽  
French Version ◽  
Low Sensitivity

Abstract Background: The study examines the psychometric properties of the French version of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) created by M. Zanarini to screen borderline personality disorder in clinical and non-clinical populations.Method: In this multicentric longitudinal study from the European Network on Borderline Personality Disorder, a sample of 84 adolescent patients from five psychiatric centres and 85 matched controls without psychiatric comorbidity completed the MSI-BPD, French version, and were interviewed with the Structured Interview for DSM-IV Personality (SIDP-IV), in order to assess the presence or absence of borderline personality disorder.Results: The MSI-BPD showed excellent internal consistency (α = 0.87 [0.84;0.90]). Compared to the semi-structured reference interview (SIDP-IV), the MSI-BPD showed substantial congruent validity (AUC = 0.93, CI 95%: 0.90 - 0.97). The optimal cut-off point in the present study was 5 or more, as it had relatively high sensitivity (0.87) and specificity (0.85). In our sample, the cut-off point (7 or more) proposed by the original developers of the MSI-BPD showed high specificity (0.95) but low sensitivity (0.63).Conclusions: The French version of the MSI-BPD is now available, and its psychometric properties are satisfactory. The French version of the MSI-PBD can be used as a screening tool for borderline personality disorder, for clinical purposes or in research studies.

scholarly journals A controlled study on the diagnostic accuracy of panoramic and peri-apical radiography for detecting furcation involvement

2020 ◽  
Author(s):  
Gijsbrecht Jan Berghuis ◽  
Jan Cosyn ◽  
Hugo De Bruyn ◽  
Geert Hommez ◽  
Melissa Dierens ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Clinical Experience ◽  
High Sensitivity ◽  
High Specificity ◽  
Weighted Kappa ◽  
Time Frame ◽  
Controlled Study ◽  
Significant Difference ◽  
Furcation Involvement

Abstract Background: The aim of this study was to determine diagnostic accuracy, sensitivity and specificity of panoramic and peri-apical radiography for detecting furcation involvement (1) and to evaluate the possible impact of clinical experience on these diagnostic parameters (2).Methods: Periodontitis patients in need of an implant were retrospectively selected. Inclusion criteria were the presence of a CBCT, panoramic and peri-apical radiograph of the site of interest within a one-year time frame. All furcation sites were classified on the basis of CBCT using Hamp’s index (1975). These data were considered gold standard. Ten experienced examiners and 10 trainees were asked to assess furcation involvement for the same defects on the basis of corresponding panoramic and peri-apical radiographs. Absolute agreement, Cohen’s weighted kappa, sensitivity and specificity were calculated. In addition, ROC-curves were constructed.Results: The study sample included 60 furcation sites in 29 multi-rooted teeth from 17 patients (10 females; mean age 62). On average 20/60 furcations were correctly classified on the basis of panoramic radiography, corresponding to weighted kappa of 0.209 indicative of slight agreement. Respective data for peri-apical radiography were 19/60 and 0.221. When recategorizing FI Grades into ‘no to limited FI’ (FI Grade 0 and I) and ‘advanced FI’ (FI Grade II and III), panoramic and peri-apical radiography showed low sensitivity (0.558 and 0.441, respectively), yet high specificity (0.791 and 0.790, respectively) for identifying advanced FI. Both showed diagnostic value given the area under the ROC-curve amounting to 0.79 and 0.69 for panoramic and peri-apical radiography, respectively. There was no significant difference between experienced periodontists and trainees (P = 0.257 versus P = 0.880).Conclusion: Panoramic and peri-apical radiography are relevant in the diagnosis of FI given high specificity. These are best combined with furcation probing showing high sensitivity. Clinical experience does not seem to improve the accuracy of a radiological diagnosis of furcation sites.Trial Registration: Patients were retrospectively registered.

scholarly journals Sensitivity and specificity of clinical features used in Alvarado scoring system

1970 ◽  
Vol 9 (1) ◽  
pp. 12-14 ◽  
Author(s):  
IP Mahato ◽  
R Bhandari ◽  
R Rajbhandari ◽  
S Kumari ◽  
AK Yadav
Keyword(s):  
Clinical Features ◽  
Sensitivity And Specificity ◽  
Iliac Fossa ◽  
High Sensitivity ◽  
High Specificity ◽  
Scoring Systems ◽  
Final Diagnosis ◽  
Alvarado Score ◽  
Rebound Tenderness ◽  
Right Iliac Fossa Pain

Introduction: Alvarado score is one of the scoring systems for diagnosis of appendicitis. Objective: To assess the sensitivity and specificity of clinical features used in Alvarado score. Subjects and methods: A prospective study of 171 patients with pain in the right iliac fossa presenting to emergency at BPKIHS, Dharan, Nepal was conducted. The sensitivity and specificity of clinical features and lab parameters used in Alvarado score were evaluated comparing with final diagnosis based on operative and histopathological findings. Results: The sensitivity of clinical parameter were: migrating right iliac fossa pain- 99.1%, anorexia- 45.7%, nausea/vomiting- 73.7%, right iliac fossa tenderness- 100%, fever- 24.5%, rebound tenderness in right iliac fossa- 89.8%, leucocytosis (>10,000)- 84.7% and a neutrophilic shift to the left (>75%)- 68.6%. The specificity of clinical parameters were: migrating right iliac fossa pain- 45.3%, anorexia- 86.7%, nausea/vomiting- 54.7%, right iliac fossa tenderness- 1.8%, fever- 81.1%, rebound tenderness in right iliac fossa- 64.1%, leucocytosis (>10,000)- 83.1% and a neutrophilic shift to the left (>75%)- 71.6%.Conclusion: Migrating right iliac fossa pain, right iliac fossa tenderness and rebound tenderness in right iliac fossa had a high sensitivity, leucocytosis (>10,000) had both high sensitivity and high specificity. Thus, in our set up, use of Alvarado score appears helpful for diagnosis of appendicitis Keywords: Alvarado score; sensitivity; specificityDOI: 10.3126/hren.v9i1.4355Health Renaissance, 2011: Vol.9 No.1:12-14

EFFICACY OF HYBRID THERAPY (RA-RACM) IN PATIENTS WITH HELICOBACTER PYLORI POSITIVE-CHRONIC GASTRITIS

2015 ◽  
pp. 17-23
Author(s):  
Thanh Van Nguyen ◽  
Van Huy Tran
Keyword(s):  
Adverse Effects ◽  
Atrophic Gastritis ◽  
Intestinal Metaplasia ◽  
Chronic Gastritis ◽  
Eradication Rate ◽  
Clinical Symptoms ◽  
Epigastric Pain ◽  
Upper Gastrointestinal Endoscopy ◽  
Hybrid Therapy ◽  
Hybrid Regime

Objectives: To evaluate the efficacy and adverse effects of hybrid regime in patients with chronic gastritis patients H.pylori positive. Subjects and methods: A prospective cross-sectional study was conducted on 189 chronic gastritis patients at Cho Ray Hospital, from 25/09/2013 to 29/07/2014. All patients underwent upper gastrointestinal endoscopy and biopsy to perform CLO Test and analyse histo-pathological. 92 patients H.pylori with CLO test positive were enrolled in the therapy with hybrid therapy RA-RACM. Results: 92 patients with positive H.pylori (36 males and 56 females), the mean age of population study was 41.65 ± 11.69. The percentage of H.pylori infection was 48.7. The eradication rate of H.pylori was 88.0%. In general, comparison of before and after eradication, the prevalence of epigastric pain was 89.1% vs. 69.1%, delayed gastric empty and sour reflux and the other clinical symptoms were 61.9% vs. 30.8%, 46.7% vs. 30.8% and 31.5% vs. 4.9%, respectively (p < 0.05). Endoscopically, after H.pylori eradication: congestive antritis (from 53.2% to 63.1%), raised erosion (from 15.2% to 14.1%), flat erosion (from 31.5% to 22.8%) (p > 0.05). Histopathology, before H.pylori eradication: Antral active gastritis (61.9%), atrophic gastritis (13.0%), intestinal metaplasia (6.5%), dysplasia (5.4%). Corpus active gastritis (59.8%), atrophic gastritis (5.4%), intestinal metaplasia (2.2%), dysplasia (4.3%); (p> 0.05). Most of lesions were mild. The rate of H.pylori infection in antrum (33.9%), and in corpus (28.0%). The most common adverse effects were 70.6%, mainly bitter taste, none of patients was excluded. Conclusions: The eradication rate of hybrid regime (RA-RACM) is high; the side effects were rare and relatively mild. Hybrid therapy may be considered as a first line of H.pylori treatment in current clinical practice. Key words: Chronic gastritis, hybrid regime (RA-RACM), H.pylori

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