VALIDATION OF THE FINNISH VERSION OF THE MONTREAL COGNITIVE ASSESSMENT TEST1

2018 ◽  
Vol 16 (4) ◽  
pp. 353-360 ◽  
Author(s):  
Taija Nortunen ◽  
Jukka Puustinen ◽  
Liisa Luostarinen ◽  
Heini Huhtala ◽  
Tuomo Hänninen
Keyword(s):  
Sensitivity And Specificity ◽  
High Sensitivity ◽  
High Specificity ◽  
Normal Volunteer ◽  
Study Groups ◽  
Control Group ◽  
Cutoff Score ◽  
Cognitively Normal ◽  
Diagnosis Of Dementia ◽  
Normal Controls

The aim of this study was to determine the clinical utility of the Finnish version of the MoCA test for screening Alzheimer’s disease and MCI. The purpose was to examine the ability (sensitivity and specificity) of the MoCA to distinguish patients with AD and MCI from cognitively normal controls. The study population consists of three participant groups: patients with AD (n=25), patients meeting the criteria for MCI (n=18), and cognitively normal controls (NC) (n=39). The AD group consists of subjects with very mild (CDR= 0.5, n=12), mild (CDR=1, n=12), and moderate (CDR=2, n=1) dementia, and they were given a diagnosis of dementia by using the revised NINCDS-ARDRA criteria. The normal control group (NC) consists of 39 cognitively normal volunteer participants. The three study groups differed from each other in terms of sex, age, and level of education. The NCs were younger than the subjects with AD (t [37,374] = 3.265, p = 0.002) and MCI (t [30,800] = 4.306, p = < 0.001). The NCs were also better-educated than the patients with AD (t [54,975] = -3.419, p = 0.001) and MCI (t [40,782] = -3.008, p = 0.004). The sensitivity and specificity of the MoCA in detecting AD and MCI was done according to various cutoff points. With a cutoff score of 26, the MoCA had a sensitivity of 100% to detect subjects with AD and a sensitivity of 100% to detect subjects with MCI. The specificity was 79.5%. With a cutoff score of 24, which was the best threshold in the present study, the MoCA not only had a high sensitivity to detect subjects with AD (96%) and MCI (89%) but also delivered a high specificity (97%). The MoCA has a high sensitivity and specificity to detect subjects with AD and MCI with a cutoff score of 24/30. The Finnish version of the MoCA is a feasible screening instrument for assessing cognitive decline. According to our study, the optimal cutoff score of the MoCA is 24/30.

Abstract 15928: Relative Sparing of Apical Longitudinal Strain for Detection of Cardiac Amyloidosis: Intervendor Variation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Julia M Simkowski ◽  
Michael Jiang ◽  
NADIA El HANGOUCHE ◽  
Jeesoo Lee ◽  
Milica Marion ◽  
...  
Keyword(s):  
Cardiac Amyloidosis ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
High Sensitivity ◽  
High Specificity ◽  
Left Ventricular ◽  
Control Group ◽  
Lower Sensitivity ◽  
Medical Systems ◽  
Roc Curve Analysis

Introduction: Relative apical longitudinal strain (RALS) is defined as (average apical LS/(average basal & mid-ventricular LS)). A threshold of 2 has been found to have high sensitivity and specificity for differentiating cardiac amyloidosis (CA) from other causes of left ventricular hypertrophy (LVH). This threshold was developed using General Electric (GE) software, and its reproducibility among different software vendors is unknown. Hypothesis: In patients with CA, regional segmental LS patterns and relative apical longitudinal strain will vary among software vendors. Methods: Speckle-tracking echocardiography was retroactively performed by an experienced technician on two patient cohorts, CA (n=52) and LVH (n=52), using software from two independent vendors: EchoPAC (GE Medical Systems) and TomTEC (TOMTEC Imaging Systems GMBH). For each vendor and patient, strain values for the basal, mid, and apical segments were averaged to obtain three regional LS values which were then used to calculate global longitudinal strain (GLS) and RALS. Results: EchoPAC demonstrated greater average apical LS (-16.5±5.7 vs -13.1±6.6, p<0.001) and RALS (2.1±0.9 vs 1.7±0.7, p<0.001) compared to TomTEC. Bland-Altman analysis yielded a mean bias of -0.4 with limit of agreement 2.2 (p<0.001) in RALS between the two vendors. ROC curve analysis using a RALS cutoff of 2 to differentiate CA from the overall control group showed similarly high specificity (EchoPAC 85%, TomTEC 83%) between vendors but lower sensitivity for TomTEC (23% vs 45%) (Figure 1). LVH subgroup analysis showed similar comparisons. Overall difference in area-under-curve (AUC) was significant (AUC = 0.78 EchoPAC vs AUC = 0.52 TomTEC, p < 0.001). Conclusions: Software measurements of regional LS and thus RALS vary between vendors. Further efforts are needed for intervendor regional strain fidelity. For now, different RALS thresholds to diagnose CA may be needed for various vendors.

scholarly journals Post-Mortem diagnosis of dementia by informant interview

2010 ◽  
Vol 4 (2) ◽  
pp. 138-144 ◽  
Author(s):  
Renata Eloah de Lucena Ferretti ◽  
Antonio Eduardo Damin ◽  
Sonia Maria Dozzi Brucki ◽  
Lilian Schafirovits Morillo ◽  
Tibor Rilho Perroco ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Cognitive Disorders ◽  
High Specificity ◽  
Aging Brain ◽  
Cognitively Impaired ◽  
Memory Clinic ◽  
Postmortem Diagnosis ◽  
Specificity And Sensitivity ◽  
Diagnosis Of Dementia ◽  
Normal Cognition

Abstract The diagnosis of normal cognition or dementia in the Brazilian Brain Bank of the Aging Brain Study Group (BBBABSG) has relied on postmortem interview with an informant. Objectives: To ascertain the sensitivity and specificity of postmortem diagnosis based on informant interview compared against the diagnosis established at a memory clinic. Methods: A prospective study was conducted at the BBBABSG and at the Reference Center for Cognitive Disorders (RCCD), a specialized memory clinic of the Hospital das Clínicas, University of São Paulo Medical School. Control subjects and cognitively impaired subjects were referred from the Hospital das Clínicas to the RCCD where subjects and their informants were assessed. The same informant was then interviewed at the BBBABSG. Specialists' panel consensus, in each group, determined the final diagnosis of the case, blind to other center's diagnosis. Data was compared for frequency of diagnostic equivalence. For this study, the diagnosis established at the RCCD was accepted as the gold standard. Sensitivity and specificity were computed. Results: Ninety individuals were included, 45 with dementia and 45 without dementia (26 cognitively normal and 19 cognitively impaired but non-demented). The informant interview at the BBBABSG had a sensitivity of 86.6% and specificity of 84.4% for the diagnosis of dementia, and a sensitivity of 65.3% and specificity of 93.7% for the diagnosis of normal cognition. Conclusions: The informant interview used at the BBBABSG has a high specificity and sensitivity for the diagnosis of dementia as well as a high specificity for the diagnosis of normal cognition.

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 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 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

Is jaw fractal dimension a reliable biomarker for osteoporosis screening? A systematic review and meta-analysis of diagnostic test accuracy studies

2021 ◽  
Author(s):  
Davi de Sá Cavalcante ◽  
Paulo Goberlânio de Barros Silva ◽  
Francisco Samuel Rodrigues Carvalho ◽  
Ana Rosa Pinto Quidute ◽  
Lúcio Mitsuo Kurita ◽  
...  
Keyword(s):  
Systematic Review ◽  
Fractal Dimension ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
Grey Literature ◽  
High Sensitivity ◽  
Total Sample ◽  
Control Group ◽  
Test Accuracy ◽  
Osteoporosis Screening

Objective: To summarize the evidence on the feasibility of maxillomandibular imaging exams-related fractal dimension (FD) in screening patients with osteoporosis. Methods: This registered systematic review followed the PRISMA-DTA statement. High sensitivity search strategies were developed for six primary databases and grey literature. QUADAS-2 items evaluated the risk of bias, and the GRADE approach assessed the evidence certainty. Results: From 1,034 records initially identified through database searching, four studies were included (total sample of 747 patients [osteoporosis, 136; control group, 611]). The meta-analysis showed that the overall sensitivity and specificity of the FD were 86.17 and 72.68%, respectively. In general, all studies showed low RoB and applicability concern. The certainty of the evidence was very low to moderate. Conclusions: This systematic review showed that the jaw-related FD presented sensitivity and specificity values higher than 70%, and its sensitivity in osteoporosis screening was a better parameter than specificity.

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 Performance and Implementation Evaluation of the Abbott BinaxNOW Rapid Antigen Test in a High-throughput Drive-through Community Testing Site in Massachusetts

2021 ◽  
Author(s):  
Nira R. Pollock ◽  
Jesica R. Jacobs ◽  
Kristine Tran ◽  
Amber Cranston ◽  
Sita Smith ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
High Throughput ◽  
Point Of Care ◽  
High Sensitivity ◽  
High Specificity ◽  
Molecular Testing ◽  
Rt Pcr ◽  
Asymptomatic Children ◽  
Testing Site ◽  
Very High

AbstractBackgroundRapid diagnostic tests (RDTs) for SARS-CoV-2 antigens (Ag) that can be performed at point-of-care (POC) can supplement molecular testing and help mitigate the COVID-19 pandemic. Deployment of an Ag RDT requires an understanding of its operational and performance characteristics under real-world conditions and in relevant subpopulations. We evaluated the Abbott BinaxNOW™ COVID-19 Ag Card in a high-throughput, drive-through, free community testing site in Massachusetts (MA) using anterior nasal (AN) swab RT-PCR for clinical testing.MethodsIndividuals presenting for molecular testing in two of seven lanes were offered the opportunity to also receive BinaxNOW testing. Dual AN swabs were collected from symptomatic and asymptomatic children (≤ 18 years) and adults. BinaxNOW testing was performed in a testing pod with temperature/humidity monitoring. One individual performed testing and official result reporting for each test, but most tests had a second independent reading to assess inter-operator agreement. Positive BinaxNOW results were scored as faint, medium, or strong. Positive BinaxNOW results were reported to patients by phone and they were instructed to isolate pending RT-PCR results. The paired RT-PCR result was the reference for sensitivity and specificity calculations.ResultsOf 2482 participants, 1380 adults and 928 children had paired RT-PCR/BinaxNOW results and complete symptom data. 974/1380 (71%) adults and 829/928 (89%) children were asymptomatic. BinaxNOW had 96.5% (95% confidence interval [CI] 90.0-99.3) sensitivity and 100% (98.6-100.0) specificity in adults within 7 days of symptoms, and 84.6% (65.1-95.6) sensitivity and 100% (94.5-100.0) specificity in children within 7 days of symptoms. Sensitivity and specificity in asymptomatic adults were 70.2% (56.6-81.6) and 99.6% (98.9-99.9), respectively, and in asymptomatic children were 65.4% (55.6-74.4) and 99.0% (98.0-99.6), respectively. By cycle threshold (Ct) value cutoff, sensitivity in all subgroups combined (n=292 RT-PCR-positive individuals) was 99.3% with Ct ≤25, 95.8% with ≤30, and 81.2% with ≤35. Twelve false positive BinaxNOW results (out of 2308 tests) were observed; in all twelve, the test bands were faint but otherwise normal, and were noted by both readers. One invalid BinaxNOW result was identified. Inter-operator agreement (positive versus negative BinaxNOW result) was 100% (n = 2230/2230 double reads). Each operator was able to process 20 RDTs per hour. In a separate set of 30 specimens (from individuals with symptoms ≤7 days) run at temperatures below the manufacturer’s recommended range (46-58.5°F), sensitivity was 66.7% and specificity 95.2%.ConclusionsBinaxNOW had very high specificity in both adults and children and very high sensitivity in newly symptomatic adults. Overall, 95.8% sensitivity was observed with Ct ≤ 30. These data support public health recommendations for use of the BinaxNOW test in adults with symptoms for ≤7 days without RT-PCR confirmation. Excellent inter-operator agreement indicates that an individual can perform and read the BinaxNOW test alone. A skilled laboratorian can perform and read 20 tests per hour. Careful attention to temperature is critical.

scholarly journals Evaluation of RNA extraction free method for detection of SARS-COV-2 in salivary samples for mass screening for COVID-19

2021 ◽  
Author(s):  
Sally A. Mahmoud ◽  
Esra Ibrahim ◽  
Subhashini Ganesan ◽  
Bhagyashree Thakre ◽  
Juliet G Teddy ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Gold Standard ◽  
Rna Extraction ◽  
High Sensitivity ◽  
High Specificity ◽  
Cost Effective ◽  
Kappa Coefficient ◽  
Nasopharyngeal Swab ◽  
Rt Pcr ◽  
Good Percentage

AbstractIn this current COVID - 19 pandemic, there is a dire need for cost effective and less time-consuming alternatives for SARS-COV-2 testing. The RNA extraction free method for detecting SARS-COV-2 in saliva is a promising option, this study found that it has high sensitivity (85.34%), specificity (95.04%) and was comparable to the gold standard nasopharyngeal swab. The method showed good percentage of agreement (kappa coefficient) 0.797 between salivary and NPS samples. However, there are variations in the sensitivity and specificity based on the RT-PCR kit used. The Thermo Fischer-Applied biosystems showed high sensitivity, PPV and NPV but also showed higher percentage of invalid reports. Whereas the BGI kit showed high specificity, better agreement (kappa coefficient) between the results of saliva and NPS samples and higher correlation between the Ct values of saliva and NPS samples. Thus, the RNA extraction free method for salivary sample serves as an effective alternative for SARS-CoV 2-testing.

Infectious Mononucleosis in an Outpatient Population

1999 ◽  
Vol 123 (10) ◽  
pp. 875-881 ◽  
Author(s):  
Malcolm L. Brigden ◽  
Sandra Au ◽  
Susan Thompson ◽  
Sean Brigden ◽  
Patrick Doyle ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Sensitivity And Specificity ◽  
Infectious Mononucleosis ◽  
High Specificity ◽  
Control Group ◽  
Heterophile Antibody ◽  
Number Of Patients ◽  
Wbc Count ◽  
Low Sensitivity ◽  
Hematology Analyzers

Abstract Objectives.—To determine the sensitivity and specificity of 2 modern hematology analyzers in flagging heterophile-positive patients; to determine if heterophile-positive, instrument-flagged specimens contain a larger number or a different spectrum of atypical lymphocytes; to document the overall sensitivity and specificity of Hoagland's morphologic criteria in identifying heterophile-positive patients in an outpatient population with a clinical diagnosis of mononucleosis; and to examine whether individual morphologic features might aid in the diagnosis of suspected infectious mononucleosis. Design.—A prospective study of patients referred with a clinical diagnosis of infectious mononucleosis who subsequently tested positive for the heterophile antibody. The control group consisted of a similar population of patients who tested negative for the heterophile antibody. Intervention.—Hematology profiles of peripheral blood samples were determined with Coulter STKS and Sysmex NE-8000 analyzers. A corresponding Wright-Giemsa–stained blood smear was subsequently examined by a single skilled technologist, who performed a 200-cell white blood cell differential and a 200-cell lymphocyte differential. A specific morphologic search was made for the presence of smudge cells or lymphocytes with cloverleaf nuclei. Results.—Using a combination of all flagging criteria, the 2 analyzers identified 156 (86.2%) of 181 heterophile-positive patients as meriting further review. The sensitivity and specificity values of the Coulter analyzer in predicting positive heterophile status for the blast flag were 41% and 97.1%, respectively; for the variant lymphocyte flags, 72.4% and 79.1%, respectively; and for both flags, 40% and 98.1%, respectively. For the Sysmex analyzer, the sensitivity and specificity values in predicting positive heterophile status for the blast flag were 43.4% and 88.6%, respectively; for the variant lymphocyte flag, 15.8% and 90.8%, respectively; and for both flags, 10.5% and 96%, respectively. Considering the classic criteria developed by Hoagland, a lymphocytosis of at least 50% was present in 120 (66.3%) heterophile-positive patients, while an atypical lymphocytosis of at least 10% of the total WBC count was noted in 135 patients (74.6%). The sensitivity and specificity values of a lymphocytosis ≥50% for diagnosing heterophile-positive status were 66.3% and 84.5%, respectively, while the sensitivity and specificity of an atypical lymphocytosis ≥10% were 74.6% and 92.3%, respectively. The presence of smudge cells or cloverleaf lymphocyte nuclei was verified as having high specificity but low sensitivity for suggesting a diagnosis of infectious mononucleosis. Conclusion.—Although a number of patients did not meet Hoagland's criteria for the diagnosis of infectious mononucleosis, the flagging systems of modern hematology analyzers successfully identified most cases as requiring further review.

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