malignant diagnosis
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2021 ◽  
Vol 28 (6) ◽  
pp. 4998-5008
Author(s):  
Madelon M. Voets ◽  
Catharina G. M. Groothuis-Oudshoorn ◽  
Liset H. J. Veneklaas ◽  
Srirang Manohar ◽  
Mariël Brinkhuis ◽  
...  

The goal of this study was to describe the variation in hospital-based diagnostic care activities for patients with symptomatology suspect for breast cancer in The Netherlands. Two cohorts were included: the ‘benign’ cohort (30,334 women suspected of, but without breast cancer) and the ‘malignant’ cohort (2236 breast cancer patients). Hospital-based financial data was combined with tumor data (malignant cohort) from The Netherlands Cancer Registry. Patterns within diagnostic pathways were analyzed. Factors influencing the number of visits and number of diagnostic care activities until diagnosis were identified in the malignant cohort with multivariable Cox and Poisson regression models. Compared to patients with benign diagnosis, patients with malignant disease received their diagnosis less frequently in one day, after an equal average number of hospital visits and higher average number of diagnostic activities. Factors increasing the number of diagnostic care activities were the following: lower age and higher cM-and cN-stages. Factors increasing the number of days until (malignant) diagnosis were as follows: higher BIRADS-score, screen-detected and higher cN-and cT-stages. Hospital of diagnosis influenced both number of activities and days to diagnosis. The diagnostic care pathway of patients with malignant disease required more time and diagnostic activities than benign disease and depends on hospital, tumor and patient characteristics.


2021 ◽  
Vol 71 (5) ◽  
pp. 1893-96
Author(s):  
Muhammad Awais Yasin ◽  
Muhammad Asif Farooq ◽  
Nasir Uddin ◽  
Bushra Parveen ◽  
Asma Asghar ◽  
...  

Objective: To evaluate different histopathological patterns and correlate them with indications, findings of Esophagogastroduodenoscopy Esophago-gastro-duodenal (EGD) and serological markers in patients presenting of unexplained anemia and chronic diarrhea. Study Design: Cross sectional study. Place and Duration of Study: Departments of Pathology and Gastroenterology, Combined Military Hospital Lahore Pakistan, from Jul to Dec 2020. Methodology: Histopathological patterns of endoscopic duodenal biopsies, submitted for evaluation of unexplained anemia and chronic diarrhea were studied. Hemoglobin and anti-tTG levels were recorded. Adults with history of unexplained diarrhea and anaemia were included. Biopsies with malignant diagnosis or unfit for evaluation were excluded. Histopathological patterns were correlated with indications and findings of Esophagogastroduodenoscopy and serological markers of celiac disease. Results: The most common indication for Esophagogastroduodenoscopy in 145 patients was chronic diarrhea. Upper gastrointestinal endoscopy in 2/3rd of patients revealed no pathology. Histopathological patterns of duodenal biopsies revealed only 15% cases suggestive of celiac disease. Only 12 patients were suggestive of celiac disease both on Esophagogastroduodenoscopy and histopathology combined. Half of patients with anti tTG level >100 u/ml, showed histopathological features of celiac disease on. There was no correlation between histopathological patterns, indications of Esophagogastroduodenoscopy, morphology of Esophagogastroduodenoscopy and serological markers of celiac disease. Conclusion: Indications for Esophagogastroduodenoscopy, Esophagogastroduodenoscopic findings and histopathological patterns cannot diagnose celiac disease alone.


2021 ◽  
Vol 156 (Supplement_1) ◽  
pp. S62-S62
Author(s):  
M Esebua

Abstract Introduction/Objective Endoscopic ultrasound guided fine-needle aspiration is a safe and accurate diagnostic procedure for abdominal lymphadenopathy. Goal of this study is to evaluate the utility of EUS-FNA in two groups of patients with periportal lymphadenopathy: group 1 with diagnosis of malignancy and group 2 with no known malignant diagnosis. Methods/Case Report This is a retrospective study of 74 patients in our database with enlarged periportal lymph nodes detected on cross sectional imaging of the abdomen. All patients underwent EUS-FNA with 22-gauge needle. Three passes were performed for each lymph node detected. Median size of periportal lymph nodes was 19.8 mm (ranging from 5 to 59 mm). 2 groups were compared: group 1 with known malignancy and group 2 with no known malignancy. All patients were clinically followed 6-12month from the procedure. Results (if a Case Study enter NA) 25 of the 74 (34%) patients had malignant diagnosis. The types of neoplasia detected were lymphoma (3), metastatic adenocarcinoma (16), metastatic acinar cell carcinoma (1) and metastatic neuroendocrine tumor (5). 42 of 74 patients (57%) had negative fine-needle aspiration diagnosis: 40 patients had reactive lymph node diagnosis, 2 patients had granulomatous inflammation diagnosis. 2(1%) of 74 cases had atypical diagnosis, 5(7%) cases were unsatisfactory due to inadequate material obtained during procedure. Sensitivity of the procedure is 45.8% and, specificity is 100%. Positive predictive value (PPV) is 100% and negative predictive value (NPV) is 78.7%. EUS-FNA can detect positive lymph nodes as small as 1 cm, however, this method can also miss positive lymph nodes up to size of 3.5 cm which probably due to the uneven involving of the nodes by tumor cells. Lymph nodes 3.5cm and larger are more likely to be malignant, however in differential diagnosis of small lymph nodes (1 cm in length) they were noT statistically significant difference between the pathologic and benign lymph nodes. Conclusion EUS-FNA is effective method for investigating periportal lymphadenopathy with known or unknown malignancy.


2021 ◽  
Vol 10 (5) ◽  
pp. S18-S19
Author(s):  
Daniel Martinez Coconubo ◽  
Pooja Srivastava ◽  
Swikrity Upadhyay Baskota ◽  
Samer Khader

Respiration ◽  
2021 ◽  
pp. 1-4
Author(s):  
Nikhil Meena ◽  
Thaddeus Bartter ◽  
Roshen Mathew ◽  
Abhishek Kumar ◽  
Winnie Elma Roy ◽  
...  

<b><i>Background:</i></b> Rapid on-site cytologic evaluation (ROSE) is not always available for fine needle aspiration (FNA) specimens. We have examined the relationships between the presence of “GOOP” (defined as gooey white material) on FNA aspirates, on-site adequacy (OSA), and diagnosis. <b><i>Methods:</i></b> Consecutive FNA samples obtained over the study interval were included. Samples were assessed macroscopically for the presence or absence of GOOP (GOOP+ or GOOP−). GOOP+ samples were further characterized as shiny (G+<sub>S</sub>) or cheesy (G+<sub>C</sub>). Gross descriptors were correlated with OSA and final diagnoses. <b><i>Results:</i></b> Of the 204 sites biopsied, 102 were malignant, 94 benign, and 8 nondiagnostic. The presence of GOOP was highly predictive for adequacy (positive predictive value 98%). While these correlations for GOOP positivity were significant, the absence of GOOP did not rule out adequacy or malignancy. The presence of GOOP was also significantly correlated with a malignant diagnosis. <b><i>Conclusions:</i></b> We have prospectively demonstrated that the presence of GOOP correlates strongly with adequacy. This may be of value for those for whom ROSE is not available and, when available, may help prioritize specimens for on-site review.


2021 ◽  
pp. 000313482110249
Author(s):  
Trevor Silva ◽  
Nikita Kadakia ◽  
Chade Aribo ◽  
Andrea Gochi ◽  
Gi Yoon Kim ◽  
...  

Background Social determinants of health challenge in at-risk patients seen in safety net facilities. Study design We performed a retrospective review of surgical oncology specialty clinic referrals at a safety net institution evaluating referral compliance and times to first appointment and initiation of definitive treatment. Main outcomes measured included completion of initial visit, initiation of definitive treatment, time from referral to first appointment, and time from first appointment to initiation of definitive treatment. Results Of 189 new referrals, English was not spoken by 52.4% and 69.4% were Hispanic. Patients presented without insurance in 39.2% of cases. Electronic patient portal was accessed by 31.6% of patients. Of all new referrals, 55.0% arrived for initial consultation and 53.4% initiated definitive treatment. Malignant diagnosis ( P < .0001) and lack of insurance ( P = .01) were associated with completing initial consultation. Initiation of definitive treatment was associated with not speaking English ( P = .03), malignant diagnosis ( P < .0001), and lack of insurance ( P = .03). Times to first appointment and initiation of definitive treatment were not significantly affected by race/ethnicity, language, insurance, treatment recommended, or electronic patient portal access. Conclusion Access to surgical oncology care for at-risk patients at a safety net facility is not adversely affected by lack of insurance, primary spoken language, or race/ethnicity. However, a significant proportion of all patients fail to complete the initial consultation and definitive treatment. Lessons learned from safety net facilities may help to inform disparities in health care found elsewhere.


2021 ◽  
Author(s):  
Dixit Nutan ◽  
Bansal Vikas Kumar ◽  
Bharti Rajni ◽  
Sharma Priyam

In 1996, to harmonize the reporting system of breast lesions on fine-needle aspiration cytology (FNAC), National Cancer Institute (NCI) proposed five categories from C1-C5. C3 and C4 categories are noted to be ambiguous during histopathological correlation, hence “grey-zoned.” There have been limited researches regarding its usefulness and its histopathological correlation. This study was undertaken to evaluate C3 and C4 categories and to correlate with histopathological examination. This perspective and retrospective study was undertaken for two years. Forty cases of C3 and 32 cases of C4 were retrieved from a total of 602 cases of breast FNAC. Histopathological follow-up and correlation were available in 30 cases of C3 and 15 cases of category C4 and were selected for further study. On the histopathological correlation of the C3 category, 22 (73.3%) cases turned out to be benign, and 8 (26.7%) cases revealed malignant diagnosis, and among the C4 category, 2 (13.3%) cases revealed benign findings, and 13(86.7%) of the cases showed malignancy. This difference was statistically significant (P<0.001). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the C4 category in the diagnosis of malignancy were 61.9%, 91.6%, 86.6%, and 73.3%, respectively. FNAC is a simple, rapid, cost-effective, and accurate method to diagnose easily accessible breast swellings. However, one should be aware of its limitations as well. Our study supports maintaining C3 and C4 categories, as there was a statistically significant difference in benign & malignant diagnosis for these categories.


2021 ◽  
Vol 11 (6) ◽  
pp. 2503
Author(s):  
Marco Alì ◽  
Natascha Claudia D’Amico ◽  
Matteo Interlenghi ◽  
Marina Maniglio ◽  
Deborah Fazzini ◽  
...  

Digital breast tomosynthesis (DBT) studies were introduced as a successful help for the detection of calcification, which can be a primary sign of cancer. Expert radiologists are able to detect suspicious calcifications in DBT, but a high number of calcifications with non-malignant diagnosis at biopsy have been reported (false positives, FP). In this study, a radiomic approach was developed and applied on DBT images with the aim to reduce the number of benign calcifications addressed to biopsy and to give the radiologists a helpful decision support system during their diagnostic activity. This allows personalizing patient management on the basis of personalized risk. For this purpose, 49 patients showing microcalcifications on DBT images were retrospectively included, classified by BI-RADS (Breast Imaging-Reporting and Data System) and analyzed. After segmentation of microcalcifications from DBT images, radiomic features were extracted. Features were then selected with respect to their stability within different segmentations and their repeatability in test–retest studies. Stable radiomic features were used to train, validate and test (nested 10-fold cross-validation) a preliminary machine learning radiomic classifier that, combined with BI-RADS classification, allowed a reduction in FP of a factor of 2 and an improvement in positive predictive value of 50%.


2021 ◽  
Author(s):  
Zilong He ◽  
Yue Li ◽  
Weimin Xu ◽  
Chanjuan Wen ◽  
Xiangyuan Ma ◽  
...  

Abstract Background: Computer-aided diagnosis (CAD) system can provide reference to radiologists in breast mass classification. This study was to verify if a CAD model, based on perceptive features learned from quantitative BI-RADS descriptions, can help radiologists improve diagnosis performance for breast masses in mammography.Methods: A retrospective multi-reader multi-case (MRMC) study was conducted to evaluate a CAD model established on perceptive features. Digital mammograms of 416 patients with breast masses were collected from 2014 to 2017, including 231 benign and 185 malignant masses. Altogether, 214 of them (109 benign, 105 malignant) were selected randomly to train the CAD model which consisted of perceptive feature extractor and classifier. The other 202 patients were used as the test set for evaluation from which 51 patients (29 benign and 22 malignant) were selected. Six radiologists were divided into three groups (junior, middle-senior, and senior).They evaluated 51 patients without and with support from the CAD model. BI-RADS category, benign or malignant diagnosis, probability of malignancy, and diagnosis time were recorded during two evaluation sessions. Results: In the MRMC evaluation, the average AUC of six radiologists with CAD support was significantly higher than that without support (0.896 vs. 0.850, p=0.02). Both of average sensitivity and average specificity increased (p = 0.0253). More cases were assessed as BI-RADS 4 than BI-RADS 2 or 3. Five radiologists showed comparable diagnosis time per case with and without CAD support, and one radiologist showed a significant decrease when the CAD model was involved. Conclusion: The CAD model could improve radiologists’ diagnostic performance for breast masses without improving the diagnosis time.


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