The value of fine needle aspiration cytology diagnosis in ovarian masses in children and adolescents.

STUDY QUESTION: Is ovarian cytology a reliable predictor for a malignant ovarian mass? SUMMARY ANSWER: Cytology of an ovarian mass in children and adolescents cannot be used to exclude malignancy. WHAT IS KNOWN ALREADY: It is hard to predict malignancy in case of an ovarian mass in a child or adolescent. The most common reason to perform fine needle aspiration cytology (FNAC) is to exclude malignancy. Ovarian cytology has shown varying results in adults, but test performance in a younger population is unknown. STUDY DESIGN, SIZE, DURATION: This was a retrospective diagnostic test accuracy study. We used a nationwide registry, the PALGA database, to select girls aged 18 or younger with matching ovarian cytology and histology reports available between 1990 and 2014. PARTICIPANTS/MATERIALS, SETTING, METHODS: Histology diagnoses were classified according to the WHO classification of ovarian pathology. Cytology diagnoses were classified as benign, borderline malignant or malignant. Cases with inconclusive cytology diagnoses were excluded from the analysis of diagnostic accuracy. Diagnostic accuracy was calculated using a 2 × 2 table. MAIN RESULTS AND THE ROLE OF CHANCE: Included were 552 girls under the age of 18 who had a cytology and a histology report of the same ovary available in the PALGA database. In 523 (94.7%) patients the mass was benign; 19 (3.4%) patients had a borderline malignancy and 9 (1.7%) patients had a malignant tumour. The histology diagnosis was unknown in one patient due to torsion of the ovary. Cytological diagnosis was inconclusive in 96 patients (17.4%). Cytology had a sensitivity of 32.0% and a specificity of 99.8%. Post-test probability of malignancy with positive cytology was 88.9%; the post-test probability of a malignancy with negative cytology was 3.8%, compared with a pre-test probability of 5.5%. LIMITATIONS, REASONS FOR CAUTION: This study was retrospective, using data gathered over 24 years. Cytology was retrieved during surgery or at the pathology department in 86.6% of the cases and pathologists were not blinded, which can be a cause for bias. WIDER IMPLICATIONS OF THE FINDINGS: Since the sensitivity is low, FNAC is not a recommended diagnostic tool in children. The post-test probability of a negative test compared with the incidence in our population resulted in a minimal difference not worth an invasive procedure. STUDY FUNDING/COMPETING INTERESTS: No study funding was received and no competing interests are present. TRIAL REGISTRATION NUMBER: NA.

External validation of the paediatric risk of malignancy index.

OBJECTIVE: This study aimed to validate the paediatric risk of malignancy index (PRMI), as previously published. DESIGN: External validation study. SETTING: Academic hospital: Radboud University Medical Center. POPULATION: Female paediatric patients under the age of 18 years diagnosed with, or treated for, an adnexal mass between January 1999 and October 2013. METHODS: Information was collected on diagnosis, presenting symptoms, and signs and imaging characteristics. The PRMI was calculated for each patient. Sensitivity, specificity, and positive and negative predictive values were calculated, and the results were visualised using a receiver operating characteristic curve (ROC curve). MAIN OUTCOME MEASURES: Histological diagnosis, discriminative performance using the area under the curve (AUC) of the ROC curve and sensitivity and specificity. RESULTS: Seventy-eight patients were included, with a median age of 12 years. A malignant mass was found in 17 patients (21.8%). The PRMI with a cut-off value of 7 resulted in a sensitivity of 70.1% (95% CI 44.1-89.6%) and a specificity of 85.3% (95% CI 73.8-93.0%). The area under the ROC curve was 0.868 (95% CI 0.756-0.980). CONCLUSIONS: The PRMI showed less discriminative capacity than originally published, but its performance was still good; however, further prospective validation studies are needed to define whether the model is useful in daily clinical practice.

Visual outcome of low-birth-weight infants (1500-2500 g) at one year of corrected age.

Visual functions (grating acuity, visual field size, optokinetic nystagmus and eye alignment) were tested as part of a longitudinal study in 96 low-birth-weight infants (birth weight 1500-2500 g) at one year of corrected age. Except for optokinetic nystagmus, deficit rates of all visual functions were low, and the obtained values comparable with normal age values in full-term infants. Effects of gestational duration, birth weight and intrauterine growth retardation on visual functions could not be demonstrated. Some perinatal risk factors (mechanical ventilation, oxygen treatment for more than one day, the presence of maternal hypertensive disorders) and a less-optimal neurodevelopmental status at one year had a negligible effect on visual field size. The observed deficits are not likely to cause disability. Low-birth-weight infants appeared not to be at risk for developing visual deficits at one year of corrected age.

Visual acuity in low birth weight (1500-2500 g) neonates.

Binocular grating acuity was tested in 138 low birth weight (LBW) neonates (birth weights ranging from 1500 to 2500 g) by means of the prototype version of the Acuity Card Procedure. No surrounding screen was used. Mean visual acuity of 107 neonates successfully assessed at mean corrected ages of -1.9 weeks (+/- 1.9 weeks) amounted to 0.58 cycles/degree (S.D. 0.71 octaves). Success rate was 77.5%. Mean postnatal age was 2.3 weeks (+/- 1.6 weeks). Acuity values of various subgroups ranged between 0.68 cycles/degree (S.D. 1.3 octaves) in low-risk, small for gestational age (SGA) preterms (n = 7), to 0.56 cycles/degree (S.D. 0.7 octaves) in SGA fullterms (n = 34), independent whether at low-or at high-risk. These differences were not significant, although with multiple regression analysis with adjustment for corrected age of testing, mean acuity of low-risk preterms was slightly better than of low-risk fullterms (P = 0.055). No significant change of acuity over corrected age could be demonstrated, except for a slight progress (r = 0.57; P less than 0.05) in the subgroup of 13 low-risk fullterms. The high variability of acuity values in neonates and the slow acuity development at term age hamper assessment of differences between various subgroups of neonates.

The influence of delta 9-tetrahydrocannabinol on intraocular pressure in the anaesthetized cat.

delta 9-Tetrahydrocannabinol (delta 9-THC) was injected both intravenously and into the brain stem via the left vertebral artery. Contrary to results obtained with clonidine, neither the fall in intraocular pressure (IOP), nor the arterial hypotension induced by delta 9-THC, were enhanced after the 'central' administration of the drug. For clonidine, a central mechanism underlying the ocular hypotensive effect has recently been proposed. This suggestion is based upon the enhanced fall in IOP after 'central' administration of clonidine. The pontomedullary area is considered to be the main initial target of this drug. Obviously, the IOP-lavering mechanism of delta 9-THC is different from that of clonidine.

The influence of clonidine on intraocular pressure after topical application to the eyes of anesthetized cats.

Clonidine was topically applied to the right eye of anesthetized cats. Unilateral administration induced a fall in intraocular pressure (IOP) in both eyes. This effect is not secondary to the slight fall in arterial blood pressure. Distribution experiments with 14C-clonidine revealed that only minor or negligible amounts of clonidine could be demonstrated in the contralateral eye. The concentrations of the labeled drug determined in the brain after topical application are sufficient to explain the bilateral decrease in IOP by a central mechanism. The IOP-lowering effect of clonidine upon its topical application to the eye is probably of central nervous origin and, therefore, similar to the centrally induced effect on IOP after systemic administration of the drug.