scholarly journals Prospective Consensus Reporting by Gynecologic Pathology and Dermatopathology Improves Diagnosis of Vulvar Biopsies

2020 ◽  
Vol 144 (12) ◽  
pp. 000-000
Author(s):  
Susanne K. Jeffus ◽  
Charles M. Quick ◽  
Chien Chen ◽  
Jerad M. Gardner ◽  
Jennifer R. Kaley ◽  
...  
Keyword(s):  
Diagnostic Category ◽  
Clinical History ◽  
Daily Practice ◽  
Diagnostic Agreement ◽  
Diagnostic Confidence ◽  
Multiple Data ◽  
Biopsy Interpretation ◽  
Diagnostic Concordance ◽  
Data Elements ◽  
Consensus Diagnosis

Context.— Vulvar biopsy interpretation and reporting, particularly of vulvar dermatoses, can be challenging in daily practice for both surgical pathologists (SPs) and dermatopathologists (DPs). Objective.— To investigate whether prospective consensus reporting of vulvar biopsies by SPs and DPs would provide value and improve overall diagnostic concordance. Design.— Consecutive vulvar biopsies during a 6-month period were reviewed prospectively by both gynecologic SPs and DPs. Preliminary, independently generated diagnoses were recorded and then shared in consensus review (SPs+DPs). A third pathologist adjudicated cases without consensus. Multiple data elements were collected for each case: division (SP/DP), age, site, clinical history, diagnostic category, preliminary and final (consensus) diagnosis, need for adjudication, ancillary tests, and diagnostic discrepancy. Results.— Eighty-four biopsies (48 SP, 36 DP) from 70 patients were reviewed. Forty-two of 84 cases (50%) were neoplastic, 38 of 84 (45%) were reactive/inflammatory, with the remaining (5%) showing both or other features. Independent diagnoses were discrepant in 22 of 84 cases (26%), but consensus review resulted in an agreed-upon diagnosis in all cases, with adjudication required in 6 cases. Independent diagnostic agreement increased over time with a reduction in major and minor discrepancies between the first and second half of the study period. Conclusions.— Prospective review of vulvar biopsies by both SPs and DPs can improve overall reporting. Consensus review allows pathologists to gain diagnostic confidence in interpretation of inflammatory (for SPs) and neoplastic (for DPs) vulvar biopsies; therefore, intradepartmental consultation is of value, particularly in select cases.

scholarly journals Interobserver Agreement in the Diagnosis of Inflammatory Bowel Disease-Associated Neoplasia in China in Comparison to Subspecialized American Gastrointestinal Pathologists

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Xian-rui Wu ◽  
Hua-shan Liu ◽  
Xue-ying Shi ◽  
Wei-xun Zhou ◽  
Zhi-nong Jiang ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Interobserver Agreement ◽  
Diagnostic Category ◽  
Clinical History ◽  
The United States ◽  
Low Grade ◽  
Kappa Value ◽  
Inflammatory Bowel ◽  
Consensus Diagnosis

Background. The aim of this study was to evaluate the interobserver variability in diagnosing inflammatory bowel disease (IBD)-associated neoplasia among practicing pathologists from China using telepathology, a practice of remote diagnostic consultation increasingly used nationally and internationally, and its comparison with the interpretation of subspecialized gastrointestinal (GI) pathologists from the United States (US).Methods. Eight GI pathologists from the US and 4 pathologists from China with an interest in GI pathology participated in this study. A total of 50 colonic biopsies from patients with a clinical history of IBD from 8 medical centers in China were included. All microscopic slides in each case were digitized using an Aperio system. One pathologist (XL) reviewed the digitized full-slide images, and selected areas of interest were captured at low, medium, and high magnifications at a resolution of 1712 × 1072 pixels and saved as tagged image file format (TIFF) files on read-only DVD. Each pathologist evaluated the images and selected the most appropriate diagnostic category for each case (negative, indefinite, low-grade dysplasia [LGD], high-grade dysplasia [HGD], and carcinoma). A Fleiss’ kappa coefficient (K) analysis was performed to determine interobserver agreement and the agreement of each pathologist from China with the consensus diagnosis (defined as diagnostic agreement by at least 4 participating US GI pathologists).Results. There was substantial interobserver agreement among 4 pathologists from China on the interpretation of IBD-associated neoplasia (kappa value 0.68, 95% confidence interval: 0.56–0.78). A consensus diagnosis included negative (n=22), LGD (n=22), HGD (n=3), carcinoma (n=2), and indefinite for dysplasia (n=1). Using consensus diagnoses as references, the agreement between each pathologist from China and the consensus diagnosis was substantial with kappa values ranging from 0.75 to 0.80.Conclusions. This study reveals substantial interobserver agreement for the interpretation of colonic neoplasia in IBD using digitized images among Chinese pathologists as well as between each Chinese pathologist and a consensus diagnosis generated by US GI pathologists.

scholarly journals Clinical applicability of echocardiographic strict negative criteria for suspected infective endocarditis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
V Marcos Garces ◽  
A Gabaldon-Perez ◽  
H Merenciano-Gonzalez ◽  
M Soler ◽  
M Lorenzo-Hernandez ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Previous History ◽  
Real Life ◽  
Clinical History ◽  
Daily Practice ◽  
Definitive Diagnosis ◽  
Follow Up Study ◽  
Potential Applicability ◽  
Group 2

Abstract Introduction Infective endocarditis (IE) is an uncommon but potentially lethal disease that requires a timely diagnosis. Echocardiography has a pivotal role in EI diagnosis, but this may lead to an overuse of this technology in clinical daily practice, and it is unclear which patients can benefit from a follow-up study if the initial transthoracic echocardiogram (TTE) shows no signs of IE. The strict negative criteria (good ultrasound quality and no high-risk features such as significant valvular regurgitations or stenosis, pericardial effusion or intracardiac devices) have been recently proposed to avoid unnecessary follow-up echocardiograms. Purpose The objective of this study is to review the contemporary, real-world use of echocardiography in patients with suspected IE and analyze the potential applicability of the strict negative criteria. Methods We retrieved all the echocardiograms that were performed in our center for suspected or confirmed IE between January 2014 and December 2018. We defined different groups according to the strict negative criteria and reviewed the electronic clinical history to check if a definitive diagnosis of IE was established or not. Results We included a total of 905 TTEs. 451 (49.8%) of them fulfilled the strict negativity criteria (Group 1). In this group, IE was seldom diagnosed (n=4, 0.9%). In 338 (37.4%) patients no signs of IE were evident but they didn't fulfill the strict negative criteria (Group 2). A follow-up echocardiogram and definitive diagnosis of IE were more frequent (n=48, 14.2% and n=20, 5.9%). Finally, in 116 (12.8%) patients the initial TEE showed typical or suggestive signs of IE, in whom the diagnosis was confirmed in 48 (41.4%). The independent predictors of follow-up echocardiography were the previous history of valvular heart disease (HR 2.38 [1.39–3.89], p=0.001) or cancer (HR 0.47 [0.27–0.84], p=0.01), positive blood cultures for Enterococcus (HR 5.01 [2.34–10.73], p<0.001), methicillin-sensitive Staphylococcus aureus (HR 2.8 [1.27–6.17], p=0.011) or Streptococcus (HR 2.36 [1.12–5], p=0.024), and the presence of typical or suggestive signs of infective endocarditis on initial TTE (HR 13.77 [8.6–22.05], p<0.001). A definitive diagnosis of IE was confirmed in a minority of the study population (n=72, 8%). Only one readmission for underdiagnosis of IE during index hospitalization was noted on Group 2. Conclusions In a real-life, observational setting only a minority of patients in whom IE was suspected had a definite diagnosis. An initial TTE for suspected IE fulfilling the strict negative criteria predicts both a low probability of requesting a follow-up study and of a definitive diagnosis of IE. Further research should be performed to rationalize echocardiogram requests for suspected IE. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Adherence to Guideline Recommendations in Patients with Thyroid Nodules

2019 ◽  
Vol 10 (1) ◽  
pp. 1-2
Author(s):  
Rudruidee Karnchanasorn ◽  
Kristine Grdinovac ◽  
Nichole Smith ◽  
Bhairvi Jani ◽  
G. John Chen
Keyword(s):  
Thyroid Cancer ◽  
Thyroid Nodules ◽  
Retrospective Chart Review ◽  
Standard Of Care ◽  
Clinical History ◽  
Daily Practice ◽  
Needle Aspiration ◽  
History Of ◽  
Work Up ◽  
Current Guidelines

Introduction. Thyroid nodules are common and fine-needleaspiration (FNA) biopsy is the standard of care for workupto exclude thyroid cancer. In this study, we examinedthe discrepancy between daily practice and recommendeddiagnostic approach for management of thyroid nodules,based on history taking, laboratory, and imaging studies. Methods. This was a retrospective chart review of 199 patientswho had ultrasound-guided fine needle aspiration(UGFNA) performed at a Midwest academic medicalcenter from January 2010 to December 2011. Thequality measures were selected based on recommended clinicalpractice guidelines, including family history, history of neckradiation, neck symptoms, TSH test, and thyroid ultrasound. Results. The majority of patients were Caucasian females. Familyhistory of thyroid cancer and childhood neck radiation exposurewere documented in 79 subjects (40%) and 76 subjects(38%), respectively. Neck symptoms were documented in mostsubjects, including dysphonia (56.8%), dysphagia (69.9%), anddyspnea (41.2%). Most subjects had a TSH measured and an ultrasoundperformed prior to biopsy (75% and 86%, respectively). Conclusions. It appears there is a gap between current patientcare and clinical practice guidelines for management of thyroidnodules. Clinical history and ultrasound features for risk stratificationof UGFNA were lacking, which could reflect physicians’unfamiliarity with the guidelines. As thyroid nodules are common,enhancing knowledge of the current guidelines could improveappropriate work-up. Further studies are needed to identifyfactors associated with the poor compliance with clinical guidelinesin management of thyroid nodules. KS J Med 2017;10(1):1-2.

scholarly journals Routine Use of Adjunctive p16 Immunohistochemistry Improves Diagnostic Agreement of Cervical Biopsy Interpretation

2018 ◽  
Vol 42 (8) ◽  
pp. 1001-1009 ◽  
Author(s):  
Mark H. Stoler ◽  
Thomas C. Wright ◽  
Alex Ferenczy ◽  
James Ranger-Moore ◽  
Qijun Fang ◽  
...  
Keyword(s):  
Diagnostic Agreement ◽  
Cervical Biopsy ◽  
P16 Immunohistochemistry ◽  
Biopsy Interpretation

Approach to Classifying Freight Data Elements across Multiple Data Sources

2015 ◽  
Vol 2529 (1) ◽  
pp. 56-65 ◽  
Author(s):  
Dan P. K. Seedah ◽  
Bharathwaj Sankaran ◽  
William J. O'Brien
Keyword(s):  
Data Sources ◽  
Multiple Data Sources ◽  
Multiple Data ◽  
Data Elements

scholarly journals Fibrosis retroperitoneal idiopática

2015 ◽  
Vol 40 (3) ◽  
pp. 260-262
Author(s):  
Andrés Garzón ◽  
María C Díaz ◽  
Daniel G Fernández-Ávila ◽  
Juan M Gutiérrez
Keyword(s):  
Left Kidney ◽  
Low Frequency ◽  
Clinical History ◽  
Daily Practice ◽  
Idiopathic Retroperitoneal Fibrosis ◽  
Ct Guided ◽  
Ct Guided Biopsy ◽  
Generalized Lymphadenopathy ◽  
Irritable Bowel ◽  
Marcadores Tumorales

Resumen Objetivo: Describir un caso clínico Metodología: reporte de caso Resultados: Mujer de 36 años de edad quien consulta por cuadro clínico de ocho meses de evolución consistente en dolor abdominal, asociado a diarrea y emesis, siendo manejada inicialmente como cuadro de colon irritable. Ante la persistencia del dolor solicitan estudios imagenológicos con hallazgos sugestivos de masa retroperitoneal por lo cual remiten para valoración por cirugía. Al examen físico se encuentra dolor a la palpación abdominal generalizada sin adenopatías o masas. Paraclínicos con resonancia abdominal evidenciando masa sólida retro peritoneal de localización para aórtica izquierda y espacio inter aorto-cavo, englobando de forma circunferencial la aorta abdominal a la emergencia de arterias renales comprometiendo tejidos adyacentes, con disminución del tamaño del riñón izquierdo, compensando con hipertrofia del riñón derecho. Marcadores tumorales negativos, colonoscopia sin evidencia de masas. Es llevada a biopsia guiada por TAC con patología conclusiva de fibrosis retroperitoneal idiopática. Conclusión: Se presenta un caso de fibrosis retrooperitoneal idiopática, enfermedad de muy baja frecuencia de presentación en la práctica clínica diaria Abstract Objective: To describe a clinical case Methodology: Case report Results: 36-year-old female who consulted for clinical history of eight-month of abdominal pain, diarrhea and emesis, was threated initially as irritable bowel disease. The continuing pain request imaging with findings suggestive of retroperitoneal mass, therefore referred for evaluation for surgery. On physical examination as positive findings abdominal tenderness without generalized lymphadenopathy or masses. MRI shows abdominal retroperitoneal solid mass localized to left aortic aorto-cava intercostal space, encompassing a circumferential abdominal aorta to the emergence of compromising renal arteries adjacent tissues, decreasing the size of the left kidney hypertrophy compensating right kidney. Negative tumor markers, colonoscopy without evidence of masses. It is carried by CT-guided biopsy pathology idiopathic retroperitoneal fibrosis conclusive. Conclusion: We present a case of idiophatic fibrosis retroperitoneal, disease of low frequency in daily practice

The Prevalence of Incidentally Detected Idiopathic Misty Mesentery on Multidetector Computed Tomography: Can Obesity be the Triggering Cause?

2016 ◽  
Vol 67 (3) ◽  
pp. 212-217
Author(s):  
Ebru Unlu ◽  
Nazan Okur ◽  
Mehtap Beker Acay ◽  
Emre Kacar ◽  
Serife Ozdinc ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Body Mass Index ◽  
Clinical History ◽  
Daily Practice ◽  
Wall Thickening ◽  
Female Predominance ◽  
Abdominopelvic Ct ◽  
Bowel Wall Thickening ◽  
Inflammatory Changes

Purpose Misty mesentery appearance is commonly reported in daily practice, usually as a secondary finding of various pathological entities, but sometimes it is encountered as an isolated finding that cannot be attributed to any other disease entity. We aimed to assess the prevalence of cases with incidentally detected idiopathic misty mesentery on computed tomography (CT) and to summarize the pathologies leading to this appearance. Methods Medical records and initial and follow-up CT features of patients with misty mesentery appearance between January 2011 and January 2013 were analysed. The study included cases with no known cause of misty mesentery according to associated CT findings, clinical history, or biochemical manifestations, and excluded patients with diseases known to cause misty mesentery, lymph nodes greater than a short-axis diameter of 5 mm, discrete mesenteric masses, or bowel wall thickening. Results There were a total of 561 patients in whom misty mesentery appearance was depicted on abdominopelvic CT scans. A total of 80 cases were found to have isolated incidental idiopathic misty mesentery, giving a prevalence of 7%. The common indication for CT examination was abdominal pain. There was a slight female predominance (51.3%). 67.5% of all patients were classified as obese and 17.5% as overweight. Conclusions The results of the present study show that idiopathic incidental misty mesentery appearance has a significant prevalence. Also, the high body mass index of these patients and the growing evidence of obesity-induced inflammatory changes in adipose tissue are suggestive of an association between obesity and misty mesentery appearance on CT.

scholarly journals Diagnostic Concordance of Pathological Methods and Reports of Hematopathologists Compared to Local Nonspecialized Pathologists in the Diagnosis of Lymphoma in Mexico

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4727-4727
Author(s):  
Manuel Solano ◽  
Luis Arteaga ◽  
Ramon Martinez Hernandez ◽  
Alvaro Cabrero Garcia ◽  
David Gomez-Almaguer ◽  
...  
Keyword(s):  
Research Funding ◽  
Hodgkin’S Lymphoma ◽  
Benign Lesion ◽  
Treatment Decision ◽  
B Cell Lymphoma ◽  
Treatment Decisions ◽  
Hodgkin's Lymphoma ◽  
Diagnostic Agreement ◽  
Diagnostic Concordance ◽  
Study Sites

Abstract Background: Distinct diagnostic assays and algorithms are employed by contemporary pathologists when seeking to identify lymphoma. There is a paucity of data on the degree of concordance between pathologists diagnosing lymphoma and its subtypes in different institutional settings in Latin America. The objective of this study was to assess the concordance between lymphoma diagnoses made via tissue biopsy by local pathologists and after review of these specimens by more specialized hematopathologists. Methods: This prospective, noninterventional and multicenter study was conducted at seven sites in Mexico from January 2017 to October 2017. Eligible biopsy samples were from patients with a previous diagnosis of lymphoma on lymph node biopsy or a diagnosis of extranodal lymphoma, with adequate tissue preservation and adequate amount of tissue for the review analysis. Patients receiving either chemotherapy or corticosteroids before sampling of tissue biopsies were excluded. Seven sites representing local pathologists and three hematopathologists participated in the study. The same biopsy tissues reviewed by the local pathologists were also sent to the hematopathologists participating in this study. Physicians in charge of patients' treatment decided whether to make any changes to a patient's treatment decision when comparing diagnosis results from the local pathologists and hematopathologists. The concordance in diagnosis results were classified into 3 categories: diagnostic agreement (i.e. the local pathologist and hematopathologist diagnoses concurred), minor discrepancy (i.e. there was a difference in diagnosis but it didn't change the treatment decision) and major discrepancy (i.e. there was a difference in diagnosis and it changed the treatment decision based on guidelines from the National Comprehensive Cancer Network). Results: Of 111 samples received, 105 met eligibility criteria for full review by hematopathologists and were included for full analysis. The median (range) patient age was 53 (16-94) years. More specimens were obtained from women (n = 57; 54.3%). A total of 53 (50.5%) patients were recruited from private institutions and the remaining (52; 49.5%) from public institutions. Within the 105 biopsies, a total of 89 cases were diagnosed as lymphoma by hematopathologists, including non-hodgkin's lymphoma (NHL; n = 72; 68.6%) and hodgkin's lymphoma (HL; n = 17; 16.2%). The most common subtype of NHL diagnosed was diffuse large B cell lymphoma (DLBCL), with a total of 32 cases. Diagnostic agreement was observed in 23 (21.9%) biopsies, minor discrepancies in 32 (30.5%) biopsies and major discrepancies in 50 (47.6%) biopsies, indicating treatment decisions changed in 47.6% of the total cases. Subtypes of lymphoma that local pathologists and hematopathologists most commonly found in diagnostic agreements were DLBCL (8/23; 34.8%) and HL (6/23; 26.1%), potentially due to their higher prevalence in the overall studied samples. Three types of error from the local pathologists were observed in major discrepancies, including ambiguity or lack of full diagnosis (27/50; 54%), a change from malignant to benign lesion (11/50; 22%) and a change of the type of neoplasm (12/50; 24%). Hematopathologists reported more immunohistochemical disease markers per tissue specimen: a median of 8.7 and a mode of 8 compared to a median of 5 and a mode of 0 for local pathologists. The diagnostic concordance varied across the seven study sites; the rate of major discrepancies ranged from 0% to 100% and the rate of diagnostic agreement ranged from 0% to 81.8%. The local pathologist from only one site received formal training in hematopathology and reported no major discrepancies. When excluding results from this site, the diagnostic agreement was observed in 14 (14.9%) biopsies, minor discrepancies in 30 (31.9%) biopsies and major discrepancies in 50 (53.2%) biopsies. Conclusions: This study showed that physicians from the seven study sites in Mexico changed their original treatment decisions that were initially based on local pathologist's diagnosis in nearly one-half (47.6%) cases after they reviewed the hematopathologist's diagnosis. In addition, there was a wide variation in the percentage of diagnostic agreements and discrepancies among different study sites, where sites with more experienced pathologists demonstrated a lower rate of diagnosis discrepancies in the diagnosis of lymphoma. Disclosures Solano: Janssen: Honoraria, Research Funding. Arteaga:Janssen: Honoraria, Research Funding. Martinez Hernandez:Janssen: Honoraria, Research Funding. Cabrero Garcia:Janssen: Honoraria, Research Funding. Gomez-Almaguer:AbbVie: Consultancy; Novartis: Consultancy. Lopez:Janssen: Honoraria, Research Funding. Perez:Janssen: Honoraria, Research Funding. Maldonado:Janssen: Honoraria, Research Funding. Bernal:Janssen: Honoraria, Research Funding. Osorno:Janssen: Honoraria, Research Funding. Fernandez:Janssen: Employment. Barreyro:Janssen: Employment. Regalado:Janssen: Employment. Herrera-Rojas:Janssen: Employment.

Sign in / Sign up

Export Citation Format

Share Document