Assessing the Predictive Accuracy of the aMAP Risk Score for Hepatocellular Carcinoma (HCC): Diagnostic Test Accuracy and Meta-analysis.

Purpose: We aimed to perform a meta-analysis with the intention of evaluating the reliability and test accuracy of the aMAP risk score in the identification of HCC. Methods: A systematic search was performed in PubMed, Scopus, Cochrane, Embase, and Web of Science databases from inception to September 2023, to identify studies measuring the aMAP score in patients for the purpose of predicting the occurrence or recurrence of HCC. The meta-analysis was performed using the meta package in R version 4.1.0. The diagnostic accuracy meta-analysis was conducted using Meta-DiSc software. Results: Thirty-five studies 102,959 participants were included in the review. The aMAP score was significantly higher in the HCC group than in the non-HCC group, with a mean difference of 6.15. When the aMAP score is at 50, the pooled sensitivity, specificity, negative likelihood ratio, and positive likelihood ratio with 95% CI was 0.961 (95% CI 0.936, 0.976), 0.344 (95% CI 0.227, 0.483), 0.114 (95% CI 0.087, 0.15), and 1.464 (95% CI 1.22, 1.756), respectively. At a cutoff value of 60, the pooled sensitivity, specificity, negative likelihood ratio, and positive likelihood ratio with 95% CI was 0.594 (95% CI 0.492, 0.689), 0.816 (95% CI 0.714, 0.888), 0.497 (95% CI 0.418, 0.591), and 3.235 (95% CI 2.284, 4.582), respectively. Conclusion: The aMAP score is a reliable, accurate, and easy-to-use tool for predicting HCC patients of all stages, including early-stage HCC. Therefore, the aMAP score can be a valuable tool for surveillance of HCC patients and can help to improve early detection and reduce mortality.

Clinical evaluation of a multiplex PCR-based test for joint infection: a prospective diagnostic accuracy study of forty-nine patients.

PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy (sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)) of the PCR-based BioFire® Joint Infection Panel (BJI Panel) against microbiological culture growth for patients suspected of having a native or prosthetic joint infection. METHODS: Synovial fluid and tissue biopsies were prospectively collected from patients from June 2022 to June 2023. The results of the BJI Panel were compared with those of culture growth. RESULTS: 51 samples were included. Including all pathogens, the sensitivity was 69%, the specificity 89%, the PPV 73% and the NPV 86%. Including only pathogens in the BJI Panel, the sensitivity was 100%, the specificity 90%, the PPV 73% and the NPV 100%. CONCLUSION: The BJI Panel has a high accuracy for detecting the pathogens in its panel, but the absence of important common pathogens from the panel reduces its sensitivity and NPV. With a short turnaround time and precise pathogen detection, the BJI Panel has the potential to add value as a complementary diagnostic method.

Assessment of diagnostic value of unilateral systematic biopsy combined with targeted biopsy in detecting clinically significant prostate cancer.

Objectives: This retrospective study assessed the diagnostic accuracy of targeted biopsy (TB) and unilateral systematic biopsy in detecting clinically significant prostate cancer (csPCa) in 222 men with single magnetic resonance imaging (MRI) lesions (Prostate Imaging Reporting and Data System [PI-RADS] ≥ 3). Methods: Patients underwent multiparametric MRI and MRI/ultrasound fusion TB and 12-needle standard biopsy (SB) from September 2016 to June 2021. The study compared the diagnostic performance of TB + iSB (ipsilateral), TB + contralateral system biopsy (cSB) (contralateral), and TB alone for csPCa using the χ 2 test and analysis of variance. Results: Among 126 patients with csPCa (ISUP ≥ 2), detection rates for TB + iSB, TB + cSB, and TB were 100, 98.90, and 100% for lesions, respectively. TB + iSB showed the highest sensitivity and negative predictive value. No significant differences in accuracy were found between TB + iSB and the gold standard for type 3 lesions (P = 1). For types 4-5, detection accuracy was comparable across methods (P = 0.314, P = 0.314, P = 0.153). TB had the highest positive needle count rate, with TB + iSB being second for type 3 lesions (4.08% vs 6.57%, P = 0.127). Conclusion: TB + iSB improved csPCa detection rates and reduced biopsy numbers, making it a viable alternative to TB + SB for single MRI lesions.

Heart failure diagnostic accuracy, intraoperative fluid management, and postoperative acute kidney injury: a single-centre prospective observational study.

BACKGROUND: The accurate diagnosis of heart failure (HF) before major noncardiac surgery is frequently challenging. The impact of diagnostic accuracy for HF on intraoperative practice patterns and clinical outcomes remains unknown. METHODS: We performed an observational study of adult patients undergoing major noncardiac surgery at an academic hospital from 2015 to 2019. A preoperative clinical diagnosis of HF was defined by keywords in the preoperative assessment or a diagnosis code. Medical records of patients with and without HF clinical diagnoses were reviewed by a multispecialty panel of physician experts to develop an adjudicated HF reference standard. The exposure of interest was an adjudicated diagnosis of heart failure. The primary outcome was volume of intraoperative fluid administered. The secondary outcome was postoperative acute kidney injury (AKI). RESULTS: From 40 659 surgeries, a stratified subsample of 1018 patients were reviewed by a physician panel. Among patients with adjudicated diagnoses of HF, those without a clinical diagnosis (false negatives) more commonly had preserved left ventricular ejection fractions and fewer comorbidities. Compared with false negatives, an accurate diagnosis of HF (true positives) was associated with 470 ml (95% confidence interval: 120-830; P=0.009) lower intraoperative fluid administration and lower risk of AKI (adjusted odds ratio:0.39, 95% confidence interval 0.18-0.89). For patients without adjudicated diagnoses of HF, non-HF was not associated with differences in either fluids administered or AKI. CONCLUSIONS: An accurate preoperative diagnosis of heart failure before noncardiac surgery is associated with reduced intraoperative fluid administration and less acute kidney injury. Targeted efforts to improve preoperative diagnostic accuracy for heart failure may improve perioperative outcomes.

Comparison of micro-flow imaging and contrast-enhanced ultrasonography in assessing segmental congestion after right living donor liver transplantation.

PURPOSE: This study aimed to determine whether micro-flow imaging (MFI) offers diagnostic performance comparable to that of contrast-enhanced ultrasonography (CEUS) in detecting segmental congestion among patients undergoing living donor liver transplantation (LDLT). METHODS: Data from 63 patients who underwent LDLT between May and December 2022 were retrospectively analyzed. MFI and CEUS data collected on the first postoperative day were quantified. Segmental congestion was assessed based on imaging findings and laboratory data, including liver enzymes and total bilirubin levels. The reference standard was a postoperative contrast-enhanced computed tomography scan performed within 2 weeks of surgery. Additionally, a subgroup analysis examined patients who underwent reconstruction of the middle hepatic vein territory. RESULTS: The sensitivity and specificity of MFI were 73.9% and 67.5%, respectively. In comparison, CEUS demonstrated a sensitivity of 78.3% and a specificity of 75.0%. These findings suggest comparable diagnostic performance, with no significant differences in sensitivity (P=0.655) or specificity (P=0.257) between the two modalities. Additionally, early postoperative laboratory values did not show significant differences between patients with and without congestion. The subgroup analysis also indicated similar diagnostic performance between MFI and CEUS. CONCLUSION: MFI without contrast enhancement yielded results comparable to those of CEUS in detecting segmental congestion after LDLT. Therefore, MFI may be considered a viable alternative to CEUS.

Diffusion-Weighted Magnetic Resonance Imaging for the Diagnosis of Lymph Node Metastasis in Patients with Biliary Tract Cancer.

Objective: The diagnostic efficacy of the apparent diffusion coefficient (ADC) in diffusion-weighted magnetic resonance imaging (DW-MRI) for lymph node metastasis in biliary tract cancer was investigated in the present study. Methods: In total, 112 surgically resected lymph nodes from 35 biliary tract cancer patients were examined in this study. The mean and minimum ADC values of the lymph nodes as well as the long-axis and short-axis diameters of the lymph nodes were assessed by computed tomography (CT). The relationship between these parameters and the presence of histological lymph node metastasis was evaluated. Results: Histological lymph node metastasis was detected in 31 (27.7%) out of 112 lymph nodes. Metastatic lymph nodes had a significantly larger short-axis diameter compared with non-metastatic lymph nodes (p = 0.002), but the long-axis diameter was not significantly different between metastatic and non-metastatic lymph nodes. The mean and minimum ADC values for metastatic lymph nodes were significantly reduced compared with those for non-metastatic lymph nodes (p < 0.001 for both). However, the minimum ADC value showed the highest accuracy for the diagnosis of histological lymph node metastasis, with an area under the curve of 0.877, sensitivity of 87.1%, specificity of 82.7%, and accuracy of 83.9%. Conclusions: The minimum ADC value in DW-MRI is highly effective for the diagnosis of lymph node metastasis in biliary tract cancer. Accurate preoperative diagnosis of lymph node metastasis in biliary tract cancer should enable the establishment of more appropriate treatment strategies.

Artificial Intelligence Tools in Pediatric Urology: A Comprehensive Review of Recent Advances.

Artificial intelligence (AI) is providing novel answers to long-standing clinical problems, and it is quickly changing pediatric urology. This thorough analysis focuses on current developments in AI technologies that improve pediatric urology diagnosis, treatment planning, and surgery results. Deep learning algorithms help detect problems with previously unheard-of precision in disorders including hydronephrosis, pyeloplasty, and vesicoureteral reflux, where AI-powered prediction models have demonstrated promising outcomes in boosting diagnostic accuracy. AI-enhanced image processing methods have significantly improved the quality and interpretation of medical images. Examples of these methods are deep-learning-based segmentation and contrast limited adaptive histogram equalization (CLAHE). These methods guarantee higher precision in the identification and classification of pediatric urological disorders, and AI-driven ground truth construction approaches aid in the standardization of and improvement in training data, resulting in more resilient and consistent segmentation models. AI is being used for surgical support as well. AI-assisted navigation devices help with difficult operations like pyeloplasty by decreasing complications and increasing surgical accuracy. AI also helps with long-term patient monitoring, predictive analytics, and customized treatment strategies, all of which improve results for younger patients. However, there are practical, ethical, and legal issues with AI integration in pediatric urology that need to be carefully navigated. To close knowledge gaps, more investigation is required, especially in the areas of AI-driven surgical methods and standardized ground truth datasets for pediatric radiologic image segmentation. In the end, AI has the potential to completely transform pediatric urology by enhancing patient care, increasing the effectiveness of treatments, and spurring more advancements in this exciting area.

Longitudinal Analysis of Diagnostic Accuracy of Panoramic Radiography in Oral Pathology.

Objective: The purpose of this 5-year longitudinal study was to assess the diagnostic accuracy of panoramic radiography (PR) in identifying oral pathology at a tertiary care facility. Methods: A retrospective review of patient files was done, encompassing those of patients who had PR for suspected oral lesions, followed by a biopsy. At various times, several diagnostic accuracy metrics were computed, such as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratio (DOR). Results: The research had 250 patients in total. In terms of identifying oral pathology, PR showed a sensitivity of 85% and a specificity of 90%. There were 80% and 92% PPV and NPV, respectively. With a computed DOR of 25, PR's total discriminating power was found to be high. Conclusion: In summary, PR consistently demonstrates great diagnostic accuracy in identifying oral pathology at a tertiary care facility. These results confirm that PR is a useful screening technique for oral lesions in standard clinical practice. In order to overcome PR's shortcomings and investigate methods for enhancing its diagnostic effectiveness, more investigation is necessary.

Assessment of Diagnostic Accuracy and Clinical Utility of DNA Methylation (5-mC) in Detecting Severity of Occupational Lead Exposure.

This study investigated the diagnostic accuracy (DA) and clinical utility (CU) of DNA methylation (5 methylcytosine) in occupational Pb-exposure from Pb based industry. Blood Lead levels (BLLs) were measured using the ICP-OES method. The total DNA methylation (5-mC) was quantified using ELISA method. Based on their BLLs, the Pb-exposed workers were categorised into three groups: low (< 10 µg/dL), moderate (10-30 µg/dL), and high exposure (> 30 µg/dL). DNA methylation (5-mC) was significantly lower in moderate and high Pb-exposure groups when compared to the low Pb-exposure group. Workers exposed to high levels of Pb-exposure, the DA variables of 5-mC showed that the sensitivity was 74.7% [95% CI 65.4-84.0], specificity was 69.6% [95% CI 50.8-88.4], positive predictive value (PPV) was 89.9% [95% CI 82.7-97.0], Postive likelihood ratio (LR+) was 2.454 [95% CI 1.3-4.6], and diagnostic odds ratio (DOR) is 6.3 [95% CI 6.5-7.7]. In moderate Pb-exposure, the DA variables of 5-mC revealed that the sensitivity is 64.9% [95% CI 55.2-74.5], the specificity is 69.6% [95% CI 50.8-88.4], the PPV is 89.7% [95% CI 82.5-97.0], the LR+ is 2.132 [95% CI 1.13-4.03], and the DOR is 4.2 [95% CI 3.6-5.7]. The high Pb-exposure group had higher DA metrics when compared to moderate Pb exposure. The clinical utility (CU+) of 5-mC was found to have good utility of 0.671 [95% CI 0.566-0.776] in the high Pb exposure group and fair utility of 0.582 [95% CI 0.470-0.694] in moderate Pb exposure group. In conclusion, DNA methylation (5mC) could be used as a predictive biomarker for high Pb-exposure.

Circulating miRNA-373 and Vascular Endothelial Growth Factor as Potential Biomarkers for Early Detection of Breast Cancer.

Breast cancer is the leading cause of cancer-related mortality among women worldwide. MicroRNAs (miRNAs), short non-coding RNAs, have been implicated in cancer-related processes such as tumor development, metastasis, angiogenesis, and drug resistance. Circulating miRNA-373 demonstrates higher relative exosomal serum levels in breast cancer patients compared to healthy women, making it a potential non-invasive biomarker. Separately, vascular endothelial growth factor (VEGF) is crucial for angiogenesis, and is elevated in breast cancer. In this case-control study, we aimed to investigate the diagnostic accuracy of miRNA-373 and VEGF as biomarkers for early-stage breast cancer detection. Serum samples were collected from 120 participants, comprising 30 breast cancer patients, 30 benign breast tumor patients, and 60 healthy controls, over the period of April 2022 to January 2023. MiRNA-373 expression was analyzed by reverse transcription-quantitative PCR with GAPDH normalisation, while VEGF levels in serum samples were measured by ELISA. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of both biomarkers. MiRNA-373 expression (∆Ct) differed significantly between the three groups (breast cancer: - 12.20 ± 1.11; benign tumors: - 12.79 ± 1.09; controls: - 13.64 ± 0.93). ROC analysis revealed moderate discriminative power for miRNA-373 (specificity = 76.7%; sensitivity = 70.0%; AUC = 0.839) and excellent discriminative power for VEGF (specificity = 85.0%; sensitivity = 90.0%; AUC = 0.944) in distinguishing early-stage breast cancer patients from healthy controls. In summary, this study demonstrates the promising potential of miRNA-373 as an early diagnostic biomarker for breast cancer detection, requiring further validation in larger cohorts. Our findings also reinforce the diagnostic value of circulating VEGF levels for breast cancer screening. Supplementary Information: The online version contains supplementary material available at 10.1007/s12291-023-01174-9.

Role of CT imaging in addressing resectability issues in differentiated thyroid cancer: imaging-based Mahajan grading system for TI and ETE.

Background and objective: Extrathyroidal extension (ETE) is the term used to describe the growth of the primary thyroid tumor beyond the thyroid capsule. ETE is a critical prognostic marker for thyroid tumors, necessitating accurate preoperative assessment. This study aims to evaluate the diagnostic performance of computed tomography (CT)-based grading for ETE and tracheal invasion (TI) for preoperative prediction in patients with differentiated papillary thyroid carcinoma (PTC) and compare the diagnostic accuracy with ultrasound (US). Materials and methods: This retrospective study was approved by our institutional review board. Preoperative US and CT were performed for 83 patients who underwent surgery for PTC between 1 January 2010 and 31 December 2020. The US and CT features of ETE and TI of each case were retrospectively and independently investigated by two radiologists. The diagnostic performances of US and CT, including their specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV) for ETE, and their accuracy in predicting ETE and TI were analyzed. As per the grading for ETE on USG and CT, lesions were graded into three grades and Mahajan grading was also devised on CT to predict the TI and graded into four grades. Results: The accuracy and specificity of CT are relatively good for identifying tumor infiltration into the adjacent structures and range from 82% to 87% and 95% to 98%, respectively. It, however, has a low sensitivity, between 14.3% and 77.78%, when compared to US, which suggests that in case of any doubt regarding CT evidence of tumor infiltration into surrounding structures, additional clinical examination must be performed. CT showed better sensitivity (78%) and specificity (75%) in detecting TI compared to previous studies. The diagnostic accuracy of CT Mahajan grading was 91.5% with p <0.005 in the prediction of TI. Conclusion: Preoperative US should be regarded as a first-line imaging modality for predicting minimal ETE, and CT should be additionally performed for the evaluation of maximal ETE. The specificity and PPV of CT are higher than those of US in detecting overall ETE and TI of PTC. The US- and CT-based grading systems have the potential to optimize preoperative surgical planning.

1H magnetic resonance spectroscopy in the differentiation between low- and high-grade cervical carcinoma: is it efficient?

Purpose: To evaluate the extent to which magnetic resonance spectroscopy (MRS) lipid metabolites are accurate in predicting high-grade cervical cancer. Material and methods: This prospective single-centre pilot study included 20 cases with pathologically proven cervical cancer. They underwent pelvic magnetic resonance imaging (MRI) with MRS. Two radiologists, blinded to the histopathological results, with 10 years of experience in gynaecological imaging, independently analysed the MRI images and MRS curves, and a third one resolved any disagreement. Using the histopathological results as a standard test, the receiver operating characteristics (ROC) curve was utilised to calculate the optimal lipid peak (1.3 ppm) cutoff for predicting high-grade cervical cancer. The difference in MRS metabolites between low- and high-grade cervical cancer groups was estimated using the Mann-Whitney test. Results: The study included 11 high-grade and nine low-grade cervical cancer cases based on the histopathological evaluation. A lipid (1.3 ppm) peak of 29.9 was the optimal cutoff for predicting high-grade cervical cancer with 100% sensitivity, 77.8%, specificity, and 90% accuracy. Moreover, there was a significant difference between low- and high-grade cervical cancer cases concerning lipid peak at 0.9 ppm, lipid peak at 1.3 ppm, and the peak of choline with (p-value 0.025, 0.001, and 0.023), respectively. Conclusions: MRS might be considered a useful imaging technique for assessing the grade of cervical cancer and improving the planning of treatment. It shows a good diagnostic accuracy. Therefore, it can be adopted in clinical practice for better patient outcome.

The diagnostic accuracy of single-item scales in detecting fatigue in patients with cancer: A systematic review and meta-analysis.

BACKGROUND: Early detection of fatigue is crucial for cancer patients. Although single-item scales are convenient, their diagnostic accuracy remain unclear, and the variability across studies may affect generalizability. This systematic review and meta-analysis evaluates the diagnostic value of single-item fatigue detection scales. METHODS: We systematically searched CINAHL, Cochrane Library, Embase, and PubMed. Meta-analyses were conducted to calculate pooled sensitivity, specificity, likelihood ratios, predictive values, and diagnostic odds ratios (DOR). We also calculated the area under a hierarchical summary receiver operating characteristic curve. Subgroup analyses were performed to address heterogeneity. All analyses were done R (version 4.3.1). The study registered in PROSPERO (CRD42023457658). RESULTS: Eleven studies involving 3509 participants were included. Pooled results revealed a sensitivity of 0.89 (95 % CI: 0.82-0.93), specificity of 0.72 (95 % CI: 0.63-0.80), DOR of 19.95 (95 % CI: 10.47-38.04), and an AUC of 0.90 (95 % CI: 0.89-0.91). Moderate to high heterogeneity was observed, influenced by variations in cancer types, study designs, and gold standard references. CONCLUSION: Single-item fatigue scales demonstrate commendable diagnostic accuracy, comparable to multidimensional scales. Despite study variability, they are effective for routine clinical use to detect and manage fatigue in cancer patients. Future research should focus on standardizing assessment criteria and optimizing the balance between simplicity and diagnostic precision.

Diagnostic Accuracy of Hip Joint Ultrasound for Detection of Calcium Pyrophosphate Deposition.

OBJECTIVE: Calcium Pyrophosphate Crystal Deposition (CPPD) disease is a chronic and disabling arthropathy. Ultrasound (US) has been shown to be a tool with high sensitivity and specificity for the diagnosis of CPPD disease, but its value at the hip joint has not yet been determined. Therefore, our objective was to evaluate the diagnostic accuracy of US for the identification of calcium pyrophosphate (CPP) crystals in the hip joint as compared with histopathology. METHODS: Diagnostic test study involving patients over 50 years of age with osteoarthritis, scheduled for hip replacement surgery. US was performed on the affected hip. Acetabular fibrocartilage (FC) and hyaline cartilage (HC) of the femoral head were assessed, and a dichotomous score was used for the presence/absence of CPP crystals. Synovial fluid (SF) was obtained from the affected hip and examined using polarized light microscopy. Histopathological examination was performed by an experienced pathologist in search for CPP crystals in FC and HC samples. RESULTS: One hundred patients were enrolled, of whom 62% were found to have hyperechoic areas suggestive of CPP deposition on US examination. Pathological evaluation revealed a prevalence of 61% of CPP crystals. The sensitivity, specificity and the positive predictive and the negative predictive values were 90%, 82%, 89%, and 84%, respectively. The area under the curve for US compared with histopathology for the diagnosis of hip CPPD was 0.86 (CI 95% 0.78-0.94). CONCLUSION: US is a valid imaging modality with good diagnostic accuracy for the detection of hip CPPD.

Ancillary immunohistochemistry testing for loss of p16 in melanoma: A systematic review and meta-analysis of diagnostic accuracy studies.

BACKGROUND: Ancillary immunohistochemistry testing for p16 loss has been proposed as a diagnostic tool for melanoma, but its accuracy remains uncertain. METHODS: A systematic review and meta-analysis were conducted on 26 studies involving 979 melanomas and 974 nevi. RESULTS: Through bivariate analysis of data across all cut-off values, the sensitivity and specificity were calculated to be 0.55 (95% confidence interval [CI]: 0.38, 0.70) and 0.85 (95% CI: 0.70, 0.94), respectively. Summary estimates of diagnostic accuracy fell below recommended thresholds for effective tests, but subgroup analysis suggested that p16 loss could aid in diagnosing ambiguous lesions as melanoma in certain scenarios. However, the presence of p16 expression in these contexts does not definitively rule out melanoma. The findings were limited by underpowered exploratory study designs at risk for bias in patient selection and test interpretation. CONCLUSIONS: While the use of p16 immunohistochemistry for detecting melanoma is not universally reliable, it may serve as a confirmatory test in differential diagnoses involving common, congenital, acral, Spitz, and deep penetrating nevi. Nevertheless, further studies are needed to validate its utility. Until then, the application of p16 immunohistochemistry in melanoma diagnosis should be regarded as experimental.

Outcomes of Intraoperative Frozen Section Examination of Surgical Resection Margins of the Penis in Penile Cancer.

INTRODUCTION: Frozen section examination (FSE) of the tumor resection margins is important during penile-preserving surgery (PPS) in penile cancer. The margin status will impact on how much penile or urethral tissue is excised. We aim to evaluate the outcomes of intraoperative FSE of resection margins in PPS. PATIENTS AND METHODS: A retrospective analysis of patients with penile squamous cell carcinoma (SCC) who underwent a FSE of resection margins between 2010 and 2022 was conducted. FSEs were compared with the final histopathological analysis and the Diagnostic Testing Accuracy (DTA): sensitivity, specificity, positive (PPV) and negative predictive values (NPV) were calculated. RESULTS: Overall, 137 FSE were performed. The median (IQR) age was 65 (53-75) years. 118 (86.1%) patients had negative FSE margins, 16 (11.7%) had positive FSE margins and 3 (2.2%) had equivocal (atypical cells) results. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of penile FSE were 66.7%, 100%, 100%, 93.2% and 94% respectively. 18 patients underwent further resection in the same episode due to a positive or equivocal FSE and 12 (66.7%) achieved negative margins. Limitations include the retrospective nature of the study and lack of control arm to compare with. CONCLUSIONS: Intraoperative FSE performed at our center for the assessment of penile SCC margins is 66.7% sensitive and 100% specific. FSE should be considered in PPS, as it's an essential and a reliable diagnostic tool in minimizing over-treatment.

Targeted Prostate Biopsy: How, When, and Why? A Systematic Review.

OBJECTIVE: Prostate cancer, the second most diagnosed cancer among men, requires precise diagnostic techniques to ensure effective treatment. This review explores the technological advancements, optimal application conditions, and benefits of targeted prostate biopsies facilitated by multiparametric magnetic resonance imaging (mpMRI). METHODS: A systematic literature review was conducted to compare traditional 12-core systematic biopsies guided by transrectal ultrasound with targeted biopsy techniques using mpMRI. We searched electronic databases including PubMed, Scopus, and Web of Science from January 2015 to December 2024 using keywords such as "targeted prostate biopsy", "fusion prostate biopsy", "cognitive prostate biopsy", "MRI-guided biopsy", and "transrectal ultrasound prostate biopsy". Studies comparing various biopsy methods were included, and data extraction focused on study characteristics, patient demographics, biopsy techniques, diagnostic outcomes, and complications. CONCLUSION: mpMRI-guided targeted biopsies enhance the detection of clinically significant prostate cancer while reducing unnecessary biopsies and the detection of insignificant cancers. These targeted approaches preserve or improve diagnostic accuracy and patient outcomes, minimizing the risks associated with overdiagnosis and overtreatment. By utilizing mpMRI, targeted biopsies allow for precise targeting of suspicious regions within the prostate, providing a cost-effective method that reduces the number of biopsies performed. This review highlights the importance of integrating advanced imaging techniques into prostate cancer diagnosis to improve patient outcomes and quality of life.

Assessment of the Diagnostic Accuracy of CT as Compared to MRI in Detecting Metastases in Patients With Colorectal Cancer.

This study aimed to compare the diagnostic accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) in detecting metastases of colorectal cancer (CRC) in a hospital in Najran, Saudi Arabia. A total of 51 patients with CRC were included in the study. The radiological findings of metastatic lesions and the diagnostic accuracy measures of CT compared to MRI were analyzed. The results showed that CT had a false negative rate of 7.8%, a false positive rate of 7.8%, a true negative rate of 27.5%, and a true positive rate of 56.9% in detecting metastases. Diagnostic accuracy measures varied based on the number of metastatic lesions, with higher sensitivity observed for cases with fewer lesions. Gender, timing of imaging in relation to surgical intervention, and administration of nonsurgical therapy showed significant associations with diagnosis mismatch between CT and MRI. The site of metastases and the site of the primary tumor in the colon also demonstrated significant associations with diagnosis mismatch. The size of the largest metastasis detected by MRI was significantly associated with diagnosis mismatch. The overall diagnostic accuracy of CT in detecting any metastases, compared to MRI as the reference standard, was estimated to have a sensitivity of 87.8%, a specificity of 77.8%, a positive predictive value of 87.8%, and a negative predictive value of 77.8%. This study provides valuable insights into the comparative diagnostic performance of CT and MRI in detecting metastases of CRC, highlighting the importance of considering patient characteristics, disease outcome, and tumor characteristics in the interpretation of imaging results.

A review of methods for the analysis of diagnostic tests performed in sequence.

BACKGROUND: Many clinical pathways for the diagnosis of disease are based on diagnostic tests that are performed in sequence. The performance of the full diagnostic sequence is dictated by the diagnostic performance of each test in the sequence as well as the conditional dependence between them, given true disease status. Resulting estimates of performance, such as the sensitivity and specificity of the test sequence, are key parameters in health-economic evaluations. We conducted a methodological review of statistical methods for assessing the performance of diagnostic tests performed in sequence, with the aim of guiding data analysts towards classes of methods that may be suitable given the design and objectives of the testing sequence. METHODS: We searched PubMed, Scopus and Web of Science for relevant papers describing methodology for analysing sequences of diagnostic tests. Papers were classified by the characteristics of the method used, and these were used to group methods into themes. We illustrate some of the methods using data from a cohort study of repeat faecal immunochemical testing for colorectal cancer in symptomatic patients, to highlight the importance of allowing for conditional dependence in test sequences and adjustment for an imperfect reference standard. RESULTS: Five overall themes were identified, detailing methods for combining multiple tests in sequence, estimating conditional dependence, analysing sequences of diagnostic tests used for risk assessment, analysing test sequences in conjunction with an imperfect or incomplete reference standard, and meta-analysis of test sequences. CONCLUSIONS: This methodological review can be used to help researchers identify suitable analytic methods for studies that use diagnostic tests performed in sequence.

Exploring Total Immunoglobulin A's Impact on Non-Biopsy Diagnosis of Celiac Disease: Implications for Diagnostic Accuracy.

OBJECTIVE: In the current debate surrounding the biopsy-free diagnosis of CeD, it is crucial to identify factors influencing the accuracy of results. This study investigated the impact of total IgA on the non-invasive diagnosis of celiac disease (CeD). METHODS: We retrospectively assessed total IgA titers' influence on the diagnostic accuracy of different tTG-IgA thresholds compared to the upper reference value (UNL). RESULTS: Of 165 included patients, tTG-IgA values at 10× UNL and 6× UNL showed specificity of 82.6% and 73.9% and sensitivity of 49.3% and 69.0%, respectively, in predicting intestinal villous atrophy (Marsh 3). In 130 patients, total IgA levels were known at baseline. These patients were divided into three tertiles according to total IgA, i.e., patients with lower, intermediate, or higher total IgA within the population. For patients with total IgA ≥ 245 mg/dL, using a tTG-IgA cutoff of 6× UNL instead of 10× UNL resulted in decreased specificity from 71.4% to 42.8% and increased sensitivity from 67.6% to 81.1%. For patients with total IgA < 174 mg/dL and between 174 mg/dL and 245 mg/dL, using a tTG-IgA cutoff of 6× UNL instead of 10× UNL maintained specificity (75.0% and 85.7%, respectively) with increased sensitivity (from 46.2% to 64.1% and from 36.1% to 52.8%, respectively). CONCLUSIONS: In conclusion, total IgA influences the diagnostic accuracy of a predetermined tTG-IgA cutoff. Greater consideration should be given to total IgA, beyond its deficiency, in evaluating the applicability and accuracy of non-invasive CeD diagnosis.