scholarly journals Can Dermoscopy Be Used to Predict if a Melanoma Is In Situ or Invasive?

2021 ◽  
pp. 2021079
Author(s):  
Sam Polesie ◽  
Edvin Jergéus ◽  
Martin Gillstedt ◽  
Hannah Ceder ◽  
Johan Dahlén Gyllencreutz ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Histopathological Diagnosis ◽  
Single Center ◽  
Accuracy Rate ◽  
Initial Management ◽  
Preoperative Prediction ◽  
Accuracy Rates

Background: The preoperative prediction of whether melanomas are invasive or in situ can influence initial management. Objectives: This study evaluated the accuracy rate, interobserver concordance, sensitivity and specificity in determining if a melanoma is invasive or in situ, as well as the ability to predict invasive melanoma thickness based on clinical and dermoscopic images. Methods: In this retrospective, single-center investigation, 7 dermatologists independently reviewed clinical and dermoscopic images of melanomas to predict if they were invasive or in situ and, if invasive, their Breslow thickness. Fleiss’ and Cohen’s kappa (κ) were used for interobserver concordance and agreement with histopathological diagnosis. Results: We included 184 melanomas (110 invasive and 74 in situ). Diagnostic accuracy ranged from 67.4% to 76.1%. Accuracy rates for in situ and invasive melanomas were 57.5% (95% confidence interval [CI], 53.1%-61.8%) and 81.7% (95% CI, 78.8%-84.4%), respectively. Interobserver concordance was moderate (κ = 0.47; 95% CI, 0.44-0.51). Sensitivity for predicting invasiveness ranged from 63.6% to 91.8% for 7 observers, while specificity was 32.4%-82.4%. For all correctly predicted invasive melanomas, agreement between predictions and correct thickness over or under 1.0 mm was moderate (κ = 0.52; 95% CI, 0.45-0.58). All invasive melanomas incorrectly predicted by any observer as in situ had a thickness <1.0 mm. All 32 melanomas >1.0 mm were correctly predicted to be invasive by all observers. Conclusions: Accuracy rates for predicting thick melanomas were excellent, melanomas inaccurately predicted as in situ were all thin, and interobserver concordance for predicting in situ or invasive melanomas was moderate. Preoperative dermoscopy of suspected melanomas is recommended for choosing appropriate surgical margins.    

scholarly journals Sensitivity and specificity of breast cancer ICD-9-CM codes in three Italian administrative healthcare databases: a diagnostic accuracy study

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e020627 ◽  
Author(s):  
Iosief Abraha ◽  
Diego Serraino ◽  
Alessandro Montedori ◽  
Mario Fusco ◽  
Gianni Giovannini ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Invasive Breast Cancer ◽  
Carcinoma In Situ ◽  
Case Definition ◽  
Administrative Databases ◽  
Diagnostic Accuracy Study ◽  
Accuracy Study

ObjectivesTo assess the accuracy of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in identifying patients diagnosed with incident carcinoma in situ and invasive breast cancer in three Italian administrative databases.DesignA diagnostic accuracy study comparing ICD-9-CM codes for carcinoma in situ (233.0) and for invasive breast cancer (174.x) with medical chart (as a reference standard). Case definition: (1) presence of a primary nodular lesion in the breast and (2) cytological or histological documentation of cancer from a primary or metastatic site.SettingAdministrative databases from Umbria Region, Azienda Sanitaria Locale (ASL) Napoli 3 Sud (NA) and Friuli VeneziaGiulia (FVG) Region.ParticipantsWomen with breast carcinoma in situ (n=246) or invasive breast cancer (n=384) diagnosed (in primary position) between 2012 and 2014.Outcome measuresSensitivity and specificity for codes 233.0 and 174.x.ResultsFor invasive breast cancer the sensitivities were 98% (95% CI 93% to 99%) for Umbria, 96% (95% CI 91% to 99%) for NA and 100% (95% CI 97% to 100%) for FVG. Specificities were 90% (95% CI 82% to 95%) for Umbria, 91% (95% CI 83% to 96%) for NA and 91% (95% CI 84% to 96%) for FVG.For carcinoma in situ the sensitivities were 100% (95% CI 93% to 100%) for Umbria, 100% (95% CI 95% to 100%) for NA and 100% (95% CI 96% to 100%) for FVG. Specificities were 98% (95% CI 93% to 100%) for Umbria, 86% (95% CI 78% to 92%) for NA and 90% (95% CI 82% to 95%) for FVG.ConclusionsAdministrative healthcare databases from Umbria, NA and FVG are accurate in identifying hospitalised news cases of carcinoma of the breast. The proposed case definition is a powerful tool to perform research on large populations of newly diagnosed patients with breast cancer.

scholarly journals Diagnostic accuracy of ultrasonography with laparoscopy for assessment of benign adnexal masses

2019 ◽  
Vol 9 (1) ◽  
pp. 283
Author(s):  
Vinita Sarbhai ◽  
Medha Yadav
Keyword(s):  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Ovarian Cyst ◽  
Imaging Modality ◽  
Age Groups ◽  
Serous Cystadenoma ◽  
Histopathological Diagnosis ◽  
Adnexal Masses ◽  
Adnexal Pathology ◽  
Rule Out

Background: Adnexal masses are one of the most common pathologies among women of all age groups. Objective of this study was to assess efficacy of ultrasonography in diagnosing adnexal pathology, rule out malignancy and its comparison with laparoscopy and pathology results.Methods: A total 32 women with benign adnexal mass were evaluated by clinical examination, ultrasonography and laparoscopy. Findings of ultrasound were compared with laparoscopy and histopathology reports and diagnostic accuracy was calculated.Results: Sensitivity of USG in diagnosing simple ovarian cyst is 20% and specificity is 88.9% while laparoscopy has sensitivity of 100% and specificity of 94.4%. USG versus laparoscopy has sensitivity of 50% versus 100% and specificity of 94.1% versus 100% in diagnosing endometrioma. Sensitivity of USG in diagnosing dermoid cyst is 66.7% and specificity is 95% while laparoscopy has both sensitivity and specificity of 100%. USG and laparoscopy, both have 100% sensitivity and specificity in diagnosing ectopic pregnancy, para-ovarian cyst and TO abscess. Benign serous cystadenoma is a histopathological diagnosis and is missed by both laparoscopy and ultrasonography.Conclusions: Ultrasonography should be the primary imaging modality used to identify and characterize adnexal masses, as it is readily available, and noninvasive.

scholarly journals Diagnostic Accuracy of BD Phoenix CPO Detect for Carbapenemase Production in 190 Enterobacteriaceae Isolates

2018 ◽  
Vol 56 (12) ◽  
Author(s):  
Chiou Horng Ong ◽  
Lasantha Ratnayake ◽  
Michelle L. T. Ang ◽  
Raymond Tzer Pin Lin ◽  
Douglas Su Gin Chan
Keyword(s):  
Confidence Interval ◽  
Infection Control ◽  
Diagnostic Accuracy ◽  
Positive Result ◽  
Sensitivity And Specificity ◽  
Patient Management ◽  
Susceptibility Testing ◽  
Control Measures ◽  
Content Type ◽  
Infection Control Measures

ABSTRACT The rapid and accurate detection of carbapenemase-producing Enterobacteriaceae (CPE) is necessary for patient management and infection control measures. We compared the performance of the BD Phoenix CPO Detect with that of a homemade Carba NP assay and a modified carbapenem inactivation method (mCIM) by challenging all 3 assays with 190 isolates of Enterobacteriaceae with meropenem MICs of >0.125 mg/liter. A total of 160 isolates produced KPC-, IMI-1-, NDM-, IMP-, and OXA-type carbapenemases, while 30 isolates were negative for carbapenemase production. The sensitivity and specificity were 90.6% (95% confidence interval [CI], 85.0% to 94.7%) and 100.0% (95% CI, 88.4% to 100.0%), respectively, for the Carba NP; 100.0% (95% CI, 97.7% to 100.0%) and 96.7% (95% CI, 82.7% to 99.9%), respectively, for the mCIM; and 89.4% (95% CI, 83.5% to 93.7%) and 66.7% (95% CI, 47.2% to 82.7%), respectively, for the BD Phoenix CPO Detect. In particular, the BD CPO Detect failed to detect a significant number of CPE with IMI-1. While the BD Phoenix CPO Detect is able to classify carbapenemases and is built into routine susceptibility testing with the potential to reduce the time to CPE detection, its low specificity means that a positive result will need confirmatory testing by another method.

scholarly journals Concordance analysis between HER2 immunohistochemistry and in situ hybridization in non-small cell lung cancer

2017 ◽  
Vol 33 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Young San Ko ◽  
Nae Yu Kim ◽  
Jung-Soo Pyo
Keyword(s):  
Lung Cancer ◽  
In Situ Hybridization ◽  
Diagnostic Accuracy ◽  
Small Cell Lung Cancer ◽  
Diagnostic Test ◽  
Sensitivity And Specificity ◽  
Small Cell ◽  
Test Accuracy ◽  
Small Cell Lung

Purpose: This study aimed to elucidate the concordance between human epidermal growth factor receptor 2 (HER2) immunohistochemistry (IHC) and in situ hybridization (ISH) and the diagnostic accuracy of HER2 IHC in non-small cell lung cancer (NSCLC) through a meta-analysis and diagnostic test accuracy review. Methods: Seven eligible studies and 1,217 patients with NSCLC were included in the review. The concordance between HER2 IHC and ISH was analyzed. To confirm the diagnostic accuracy of HER2 IHC, the sensitivity and specificity were analyzed and the area under the curve (AUC) in the summary receiver operating characteristic (SROC) curve was calculated. Results: The concordance rate between HER2 IHC and ISH was 0.795 (95% confidence interval [CI] 0.534-0.929). In the HER2 IHC-negative (score 0/1+) subgroup, the concordance rate was 0.975 (95% CI 0.854-0.996). The concordance rates of the HER2 IHC score 2+ and 3+ subgroups were 0.091 (95% CI 0.039-0.197) and 0.665 (95% CI 0.446-0.830), respectively. In diagnostic test accuracy review, the pooled sensitivity and specificity were 0.67 (95% CI 0.54-0.78) and 0.89 (95% CI 0.87-0.91), respectively. The AUC in the SROC curve was 0.891 and the diagnostic odds ratio was 16.99 (95% CI 5.08-56.76). Conclusions: HER2 IHC was largely in agreement with ISH in cases of HER2 IHC score 0/1+. Because the concordance rates of HER2 IHC score 2/3+ cases were lower than that of HER2 IHC score 0/1+ cases, further studies for detailed analysis criteria for HER2 IHC score 2+ or 3+ are required.

scholarly journals Detection of Malignant Melanoma Using Artificial Intelligence: An Observational Study of Diagnostic Accuracy

2019 ◽  
pp. e2020011
Author(s):  
Michael Phillips ◽  
Jack Greenhalgh ◽  
Helen Marsden ◽  
Ioulios Palamaras
Keyword(s):  
Artificial Intelligence ◽  
Primary Care ◽  
Malignant Melanoma ◽  
Confidence Interval ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Primary Care Physicians ◽  
Meta Analysis ◽  
Screening Programs ◽  
Pigmented Lesions

Background: Malignant melanoma can most successfully be cured when diagnosed at an early stage in the natural history. However, there is controversy over screening programs and many advocate screening only for high-risk individuals. Objectives: This study aimed to evaluate the accuracy of an artificial intelligence neural network (Deep Ensemble for Recognition of Melanoma [DERM]) to identify malignant melanoma from dermoscopic images of pigmented skin lesions and to show how this compared to doctors’ performance assessed by meta-analysis. Methods: DERM was trained and tested using 7,102 dermoscopic images of both histologically confirmed melanoma (24%) and benign pigmented lesions (76%). A meta-analysis was conducted of studies examining the accuracy of naked-eye examination, with or without dermoscopy, by specialist and general physicians whose clinical diagnosis was compared to histopathology. The meta-analysis was based on evaluation of 32,226pigmented lesions including 3,277 histopathology-confirmed malignant melanoma cases. The receiver operating characteristic (ROC) curve was used to examine and compare the diagnostic accuracy. Results: DERM achieved a ROC area under the curve (AUC) of 0.93 (95% confidence interval: 0.92-0.94), and sensitivity and specificity of 85.0% and 85.3%, respectively. Avoidance of false-negative results is essential, so different decision thresholds were examined. At 95% sensitivity DERM achieved a specificity of 64.1% and at 95% specificity the sensitivity was 67%. The meta-analysis showed primary care physicians (10 studies) achieve an AUC of 0.83 (95% confidence interval: 0.79-0.86), with sensitivity and specificity of 79.9% and 70.9%; and dermatologists (92 studies) 0.91 (0.88-0.93), 87.5%, and 81.4%, respectively. Conclusions: DERM has the potential to be used as a decision support tool in primary care, by providing dermatologist-grade recommendation on the likelihood of malignant melanoma.

scholarly journals Beneficial Effects of Combining Computed Tomography Enteroclysis/Enterography with Capsule Endoscopy for Screening Tumor Lesions in the Small Intestine

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Hiroaki Shibata ◽  
Shinichi Hashimoto ◽  
Kensaku Shimizu ◽  
Ryo Kawasato ◽  
Tomohiro Shirasawa ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Small Intestine ◽  
Diagnostic Accuracy ◽  
Capsule Endoscopy ◽  
Accuracy Rate ◽  
Predictive Values ◽  
Beneficial Effects ◽  
The Difference ◽  
Accuracy Rates ◽  
Higher Sensitivity

Aim. To compare the efficacy of using computed tomography enteroclysis/enterography (CTE), capsule endoscopy (CE), and CTE with CE for diagnosing tumor lesions in the small intestine.Materials and Methods. We included 98 patients who underwent CE during the observation period and were subjected to CTE at our hospital from April 2008 to May 2014.Results. CTE had a significantly higher sensitivity than CE (84.6% versus 46.2%,P=0.039), but there were no significant differences in specificity, positive or negative predictive values, or diagnostic accuracy rates. The sensitivity of CTE/CE was 100%, again significantly higher than that of CEP=0.002. The difference in specificity between CTE/CE and CE was not significant, but there were significant differences in positive predictive values (100% for CTE/CE versus 66.7% for CE,P=0.012), negative predictive values (100% versus 92.1%,P=0.008), and diagnostic accuracy rate (100% versus 89.8%,P=0.001). The diagnostic accuracy rate was also significantly higher in CTE/CE versus CTE (100% versus 95.9%,P=0.043).Conclusion. Our findings suggested that a combination of CTE and CE was useful for screening tumor lesions in the small intestine. This trial is registered with numberUMIN000016154.

scholarly journals Optimal Range of Fecal Calprotectin for Predicting Mucosal Healing in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 1-11
Author(s):  
Bing-Jie Xiang ◽  
Min Jiang ◽  
Ming-Jun Sun ◽  
Cong Dai
Keyword(s):  
Inflammatory Bowel Disease ◽  
Diagnostic Accuracy ◽  
Likelihood Ratio ◽  
Sensitivity And Specificity ◽  
Bowel Disease ◽  
Meta Analysis ◽  
Positive Likelihood Ratio ◽  
Fecal Calprotectin ◽  
Mucosal Healing ◽  
Inflammatory Bowel

<b><i>Objective:</i></b> Fecal calprotectin (FC) is a promising marker for assessment of inflammatory bowel disease (IBD) activity. However, the utility of FC for predicting mucosal healing (MH) of IBD patients has yet to be clearly demonstrated. The objective of our study was to perform a meta-analysis evaluating the diagnostic accuracy of FC in predicting MH of IBD patients. <b><i>Methods:</i></b> We systematically searched the databases for studies from inception to April 2020 that evaluated MH in IBD. The methodological quality of each study was assessed according to the Quality Assessment of Diagnostic Accuracy Studies checklist. The extracted data were pooled using a summary receiver operating characteristic curve model. Random-effects model was used to summarize the diagnostic odds ratio, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio. <b><i>Results:</i></b> Sixteen studies comprising 1,682 ulcerative colitis (UC) patients and 4 studies comprising 221 Crohn’s disease (CD) patients were included. The best performance of FC for predicting MH in UC was at cut-off range of 60–75 μg/g with area under the curve (AUC) of 0.88 and pooled sensitivity and specificity of 0.87 and 0.79, respectively. The pooled sensitivity and specificity values of cutoff range 180–250 μg/g for predicting MH in CD were 0.67 and 0.76, respectively. The AUC of 0.79 also revealed improved discrimination for identifying MH in CD with FC concentration. <b><i>Conclusion:</i></b> Our meta-analysis has found that FC is a simple, reliable noninvasive marker for predicting MH in IBD patients. FC cutoff range 60–75 μg/g appears to have the best overall accuracy in UC patients.

Fluorescent in situ hybridization (FISH): A useful diagnostic tool for childhood conjunctival melanoma

2021 ◽  
pp. 112067212110307
Author(s):  
Raquel María Moral ◽  
Carlos Monteagudo ◽  
Javier Muriel ◽  
Lucía Moreno ◽  
Ana María Peiró
Keyword(s):  
In Situ Hybridization ◽  
Fluorescent In Situ Hybridization ◽  
Pediatric Population ◽  
Diagnostic Technique ◽  
Histopathological Diagnosis ◽  
Fish Analysis ◽  
Conjunctival Melanoma ◽  
Adequate Treatment ◽  
First Case

Introduction: Conjunctival melanoma is extremely rare in children and has low rates of resolution. Definitive histopathological diagnosis based exclusively on microscopic findings is sometimes difficult. Thus, early diagnosis and adequate treatment are essential to improve clinical outcomes. Clinical case: We present the first case in which the fluorescent in situ hybridization (FISH) diagnostic technique was applied to a 10-year-old boy initially suspected of having amelanotic nevi in his right eye. Based on the 65% of tumor cells with 11q13 (CCND1) copy number gain and 33% with 6p25 (RREB1) gain as measured by the FISH analysis, and on supporting histopathological findings, the diagnosis of conjunctival melanoma could be made. Following a larger re-excision, adjuvant therapy with Mitomycin C (MMC), cryotherapy and an amniotic membrane graft, the patient has remained disease-free during 9 years of long-term follow-up. Case discussion: Every ophthalmologist should remember to consider and not forget the possibility of using FISH analyses during the differential diagnosis of any suspicious conjunctival lesions. Genetic techniques, such as FISH, have led to great advances in the classification of ambiguous lesions. Evidence-based guidelines for diagnosing conjunctival melanoma in the pediatric population are needed to determine the most appropriate strategy for this age group.

scholarly journals Extranodal NK/T-cell lymphoma in Tunisia: clinicopathological features, immunophenotype and EBV infection

2019 ◽  
Vol 31 (1) ◽  
Author(s):  
Nabiha Missaoui ◽  
Sarra Mestiri ◽  
Aida Bouriga ◽  
Nihed Abdessayed ◽  
Mouna Belakhdher ◽  
...  
Keyword(s):  
In Situ Hybridization ◽  
T Cell ◽  
Granzyme B ◽  
Clinicopathological Features ◽  
Histopathological Diagnosis ◽  
Ebv Infection ◽  
Nk T Cell ◽  
Epstein Barr ◽  
Hodgkin's Lymphomas

Abstract Background Extranodal NK/T-cell lymphomas (ENKTL) are rare non-Hodgkin’s lymphomas with aggressive clinical behavior. ENKTL are frequently associated with the Epstein-Barr virus (EBV). Data on ENKTL in Africa and Arab world are extremely limited. The study investigated the clinicopathological characteristics, EBV infection, and immunophenotype of ENKTL in Tunisia. We conducted a retrospective study of ENKTL. Main clinicopathological features were reported. The expression of CD3, CD4, CD5, CD8, CD20, CD56, CD57, and Granzyme B were analyzed by immunohistochemistry. EBV infection was detected by IHC (LMP-1) and Epstein-Barr encoding region (EBER1/2) in situ hybridization. Results A total of nine ENKTL were identified (mean age of 48 years and male-to-female ratio of 8:1). There were five nasal ENKTL, and the remaining four cases had extranasal involvement (palate, sub-mandibular gland, skin, and soft tissues of the ankle). The histopathology showed a lymphoid and pleomorphic proliferation characterized by images of angiocentrism. Strong and diffuse CD3 expression was observed in all cases. Tumor cells exhibited an expression of CD5 (two cases), CD8 (three cases), CD56 (six cases), CD57 (three cases), and Granzyme B (eight cases). All ENKTL cases were EBV-associated. Overall 5-year survival rate was 57%. Although six ENKTL were diagnosed at early clinical stages, the prognosis was unfavorable and associated with patient death in three cases. Conclusions ENKTL are exceptional in Tunisia with unfavorable outcome. Histopathological diagnosis remains challenging in clinical practice. However, a careful histopathological examination combined with a correct interpretation of immunohistochemistry and in situ hybridization results refines the ENKTL diagnosis.

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