Predictors of re-attendance at biennial screening mammography following a false positive referral: A study among women in the south of the Netherlands.

AIM: A false positive (FP) referral after screening mammography may influence a woman's likelihood to re-attend the screening program. The impact of having a FP result in the first or subsequent screening round on re-attendance after a FP result was investigated. In addition, we aimed to study differences in re-attendance rates between women who underwent non-invasive and invasive additional examinations as part of the diagnostic work-up following a FP referral. METHODS: A consecutive series of 13,597 women with a FP referral following biennial screening mammography in the south of the Netherlands between 2009 and 2019 was included. RESULTS: The screening re-attendance rate was 81.2% after a FP referral, and 91.3% when also including women who had clinical mammographic follow-up. Women who received a FP referral in the first screening round were less likely to re-attend the screening programme in the following three years, compared to those with a FP test in any subsequent round (odds ratio (OR): 0.59, 95%-confidence interval (CI): 0.51-0.69). Women with a FP referral who underwent invasive examinations after referral were less likely to re-attend the screening programme than those who only received additional imaging (OR, 0.48; 95% CI 0.36-0.64). CONCLUSION: Women with a FP referral are less likely to re-attend the screening programme if this referral occurs at their first screening round or when they undergo invasive diagnostic workup. Hospitals and screening organizations should prioritize informing women about the importance of re-attending the programme following a FP referral.

Dextrose-containing fluids causing false-positive serum galactomannan: a case-control study and interrupted time series analysis.

OBJECTIVES: This study aimed to identify the cause of false-positive serum Aspergillus antigen galactomannan (GM) results in our centre. METHODS: We performed a case-control study aiming to elucidate the factors associated with false-positive GM results. Independent risk factors for false-positive GM were evaluated through a multivariable regression analysis. An interrupted time series analysis was used to evaluate the effectiveness of an intervention removing the identified factors. RESULTS: Among 568 patients tested, GM was positive in 130 patients of whom 97 had false-positive GM (cases). These were compared with 427 patients with true-negative GM (controls). Administration of dextrose-containing fluids within 6 days before GM testing was an independent predictor for false-positive GM results (adjusted odds ratio [aOR], 18.60; 95% CI, 8.95-38.66. An analysis of GM presence in different dextrose-containing fluids revealed positivity in 34.8% (8 of 23) (manufacturer A) and 33.3% (5 of 15) (manufacturer B) of the samples. Investigation of the manufacturing process revealed that the saccharification process employed enzymes derived from Aspergillus niger. After identifying the root cause of false positivity, GM-containing dextrose fluid use was restricted. Interrupted time series analysis showed an immediate reduction of GM false-positivity (-6.5% per week, p = 0.045) and a declining trend (-0.33% per week, p = 0.005) postintervention. CONCLUSIONS: Administering dextrose-containing fluids was the primary factor causing false-positive serum Aspergillus antigen GM assay results. Our investigation led to a modification of the manufacturing process of the dextrose-containing fluids.

An improved Simon reaction method to discriminate between methamphetamine and false-positive substances.

The conventional methamphetamine (MA) detection method using the Simon reaction can be affected by false positives owing to compounds similar to aliphatic secondary amines. In this study, we examined the new Simon reaction to improve the qualitative accuracy of MA detection to discriminate substances that give false positives in a conventional Simon reaction. After the conventional Simon reaction for MA and false positives (N-isopropylbenzylamine (NIP-BA), N-methylbenzylamine (NMe-BA), L-proline (Pro), and L-hydroxyproline (HYP)), which are colored blue, di-tert-butyl dicarbonate (t-Boc) reagent was added, and color tone changes were observed. When t-Boc was added to the false positives (NIP-BA, NMe-BA, Pro, and HYP), the colors of MA, Pro, and HYP changed to purple; NIP-BA changed to blue; and NMe-BA changed to light pink after 3 min. These results suggested that MA can be differentiated from NIP-BA and NMe-BA. Furthermore, the solid-phase chromogenic method was examined, and it was confirmed that MA could be differentiated from Pro and HYP. The method developed in this study should increase the accuracy of MA appraisal at crime scenes and contribute to the reduction of misclassifications arising from false-positive substances.

Sensitivity and specificity of SS-OCT for detecting macular pathologies vs SD-OCT.

PURPOSE: To evaluate the sensitivity and specificity of swept-source optical coherence tomography (SS-OCT) biometer compared with the gold standard spectral-domain optical coherence tomography (SD-OCT) for detecting macular pathology in patients with cataract. SETTING: Eye Centers of Tennessee, Crossville, TN. DESIGN: Prospective, cross-sectional, observational, examiner-masked. METHODS: The study included 132 participants aged 50 years and older, who underwent precataract surgery work-up. All participants underwent fixation check retinal scans using SS-OCT biometer (IOLMaster 700) as well as full macular scans using Cirrus SD-OCT. 3 independent masked examiners evaluated the scans if they were normal or had a suspected pathology. Different measures of diagnostic accuracy were calculated for 3 examiners. RESULTS: True positive rate (sensitivity) ranged from 71.1% (32/45) to 79.2% (42/53), and false negative rate was between 20.8% (11/53) and 28.9% (13/45) for the 3 examiners. True negative rate (specificity) ranged from 86.8% (59/68) to 94.1% (64/68), and false positive rate was between 5.9 (4/68) and 13.2% (9/68). The fitted receiver operating characteristic area ranged from 0.83 to 0.95. CONCLUSIONS: Using retinal SS-OCT biometer scans as a replacement of the dedicated macular SD-OCT for screening or diagnosing macular health would not be appropriate because of its low sensitivity. SS-OCT biometer may potentially fail to identify approximately one-fourth of patients who actually have the disease. Therefore, the final decision on macular health should be based on the gold standard SD-OCT scans. When full macular SD-OCT scans are not accessible, the limited retinal scan information from SS-OCT biometer may still provide useful insights into the macular health.

Breast Cancer Incidence After a False-Positive Mammography Result.

Importance: False-positive mammography results are common. However, long-term outcomes after a false-positive result remain unclear. Objectives: To examine long-term outcomes after a false-positive mammography result and to investigate whether the association of a false-positive mammography result with cancer differs by baseline characteristics, tumor characteristics, and time since the false-positive result. Design, Setting, and Participants: This population-based, matched cohort study was conducted in Sweden from January 1, 1991, to March 31, 2020. It included 45 213 women who received a first false-positive mammography result between 1991 and 2017 and 452 130 controls matched on age, calendar year of mammography, and screening history (no previous false-positive result). The study also included 1113 women with a false-positive result and 11 130 matched controls with information on mammographic breast density from the Karolinska Mammography Project for Risk Prediction of Breast Cancer study. Statistical analysis was performed from April 2022 to February 2023. Exposure: A false-positive mammography result. Main Outcomes and Measures: Breast cancer incidence and mortality. Results: The study cohort included 497 343 women (median age, 52 years [IQR, 42-59 years]). The 20-year cumulative incidence of breast cancer was 11.3% (95% CI, 10.7%-11.9%) among women with a false-positive result vs 7.3% (95% CI, 7.2%-7.5%) among those without, with an adjusted hazard ratio (HR) of 1.61 (95% CI, 1.54-1.68). The corresponding HRs were higher among women aged 60 to 75 years at the examination (HR, 2.02; 95% CI, 1.80-2.26) and those with lower mammographic breast density (HR, 4.65; 95% CI, 2.61-8.29). In addition, breast cancer risk was higher for women who underwent a biopsy at the recall (HR, 1.77; 95% CI, 1.63-1.92) than for those without a biopsy (HR, 1.51; 95% CI, 1.43-1.60). Cancers after a false-positive result were more likely to be detected on the ipsilateral side of the false-positive result (HR, 1.92; 95% CI, 1.81-2.04) and were more common during the first 4 years of follow-up (HR, 2.57; 95% CI, 2.33-2.85 during the first 2 years; HR, 1.93; 95% CI, 1.76-2.12 at >2 to 4 years). No statistical difference was found for different tumor characteristics (except for larger tumor size). Furthermore, associated with the increased risk of breast cancer, women with a false-positive result had an 84% higher rate of breast cancer death than those without (HR, 1.84; 95% CI, 1.57-2.15). Conclusions and Relevance: This study suggests that the risk of developing breast cancer after a false-positive mammography result differs by individual characteristics and follow-up. These findings can be used to develop individualized risk-based breast cancer screening after a false-positive result.

Online false discovery rate control for LORD++ and SAFFRON under positive, local dependence.

Online testing procedures assume that hypotheses are observed in sequence, and allow the significance thresholds for upcoming tests to depend on the test statistics observed so far. Some of the most popular online methods include alpha investing, LORD++, and SAFFRON. These three methods have been shown to provide online control of the "modified" false discovery rate (mFDR) under a condition known as CS. However, to our knowledge, LORD++ and SAFFRON have only been shown to control the traditional false discovery rate (FDR) under an independence condition on the test statistics. Our work bolsters these results by showing that SAFFRON and LORD++ additionally ensure online control of the FDR under a "local" form of nonnegative dependence. Further, FDR control is maintained under certain types of adaptive stopping rules, such as stopping after a certain number of rejections have been observed. Because alpha investing can be recovered as a special case of the SAFFRON framework, our results immediately apply to alpha investing as well. In the process of deriving these results, we also formally characterize how the conditional super-uniformity assumption implicitly limits the allowed p-value dependencies. This implicit limitation is important not only to our proposed FDR result, but also to many existing mFDR results.

False-positive HIV screening tests during the COVID-19 pandemic, a passing trend?

False-positive fourth-generation HIV screening tests are rare and are usually associated with various infections and autoimmune diseases. SARS-CoV-2 infection and vaccination were recently linked with false-positive HIV screening test results. However, little is known about false-positives in people who performed HIV screening tests after outbreaks of different SARS-CoV-2 strains and vaccination campaigns. Here, we examined the false-positive rates in samples collected by the Israeli AIDS Task Force in 2018--2022, with respect to such factors.

False-positive Aspergillus galactomannan immunoassay in the glucose component of total parenteral nutrition products.

IMPORTANCE: This manuscript describes an occurrence of false-positive GM tests in patients receiving TPN products from a manufacturer who had recently changed the supplier of the glucose component. We describe the clinical presentation of nine false-positive cases and the results of serologic and microbiological investigations of the TPN products suspected of contamination with GM. Attempts to detect GM in parenteral nutrition products were made since the detection of GM in sodium gluconate-containing solutions in 2007, but none of them identified the source of elevated GM indexes in TPN products. However, the present study demonstrated that the glucose component of the TPN products contained a high level of GM antigen, which caused false-positive GM assay results. The source of GM was glucoamylase, which was derived from A. niger in the manufacturing process. Physicians and clinical microbiology laboratories should be aware of this issue to improve interpretation and patient care.

[False positives in infectious serology : a rare issue that should not be ignored]. / Faux positifs en sérologie infectieuse : un problème rare à ne pas ignorer.

Although rare, false-positive results from infectious serology tests can mislead the practitioner and have harmful consequences for the patient. The causes are not always clear, but there are certain principles that are important to be aware of, and that help to interpret these diagnostic puzzles correctly. Similarities between different families of pathogens, the technical characteristics of the tests used, the use of therapeutic human immunoglobulins, the detection of vaccine-induced antibodies or even the detection of vaccine antigens themselves can cause non-specific reactions. This article uses examples from routine laboratory practice to illustrate the problem and draw the attention of the treating physician to this issue.

Bien que rares, les résultats faussement positifs des tests de sérologies infectieuses peuvent induire en erreur le praticien et entraîner des conséquences délétères pour le patient. Leurs causes ne sont pas toujours claires, mais certains principes sont importants à connaître et permettent d'interpréter correctement ces casse-têtes diagnostiques. Des similarités entre différentes familles de pathogènes, les caractéristiques techniques des tests utilisés, l'utilisation d'immunoglobulines humaines thérapeutiques, la détection d'anticorps induits par des vaccins ou même la détection des antigènes vaccinaux eux-mêmes peuvent causer des réactions non spécifiques. Cet article illustre ce problème par des exemples tirés de la routine du laboratoire afin d'attirer l'attention du médecin traitant sur ce problème.

Reconstrucción mamaria diferida con colgajo de dorsal ancho: aportación de la ecografía Doppler-Dúplex / Delayed breast reconstruction with latissimus dorsi fiap: contribution of Doppler-Duplex ultrasound

Introducción y objetivo: Para obtener buenos resultados en reconstrucción mamaria autóloga con colgajo de dorsal ancho se requiere verificar la presencia de una vascularización tóracodorsal adecuada. En el presente trabajo evaluamos la aportación de la ecografía Doppler-Dúplex para la localización de la arteria torácodorsal, previa a la reconstrucción mamaria diferida con colgajo de dorsal ancho. Material y método: Revisión de 51 pacientes con antecedentes de cirugía axilar por cáncer de mama candidatas a reconstrucción diferida con colgajo homolateral del músculo dorsal ancho. La exploración ecográfica la realizó un solo radiólogo utilizando la modalidad ecográfica Doppler-Dúplex. Resultados: Entre las 51 pacientes, se localizó la arteria tóracodorsal mediante ecografía en 39 casos (76.47%). En 12 casos no se pudo localizar o bien su identificación resultó dudosa. Entre estos 12 casos, en 8 se realizó angio-tomografía computarizada o bien angio-resonancia magnética que identificaron la arteria en 5 casos. En los otros 3, las pacientes rechazaron las exploraciones y no se sometieron a reconstrucción mediante la técnica estudiada o bien no se reconstruyeron. Se dispone de datos confirmados en 47 casos, entre los cuales no se ha visualizado vascularización tóracodorsal en 3 casos, lo que supone un 6.38%. Los parámetros diagnósticos resultantes fueron: sensibilidad 88.63%; especificidad 100%; valor predictivo positivo 100%;y valor predictivo negativo 37.50%, con una exactitud del 89.36%. Conclusiones: En base a nuestra experiencia podemos concluir que, siempre que se disponga de la experiencia y los medios técnicos adecuados, la ecografía Doppler-Dúplex debería ser el primer procedimiento a utilizar para la evaluación de la vascularización tóracodorsal. y en el caso de no reunir tales requisitos o bien si la ecografía fuera dudosa/negativa, realizar otros métodos como la angio-tomografía computarizada o la angio-resonancia magnética(AU).

Background and objective: To obtain good results with autologous latissimus dorsi flap in breast reconstruction it's necessary to verify the presence of adequate thoracodorsal vascularity. In this paper we evaluate the contribution of Doppler-Duplex ultrasound for the localization of the thoracodorsal vessels prior to delayed breast reconstruction with a dorsal fap. Methods: Review of 51 patients with a history of axillary surgery for breast cancer, candidates for delayed breast reconstruction with an ipsilateral flap of the latissimus dorsi muscle. The ultrasound examination was performed by a single radiologist using the Doppler-Duplex ultrasound modality. Results: Among the 51 patients, the thoracodorsal artery was located by ultrasound in 39 cases (76.47%). In 12 cases it could not be located or its identification was doubtful. Among these 12 cases, 8 underwent computed tomography angiography or magnetic resonance angiography, which identified the artery in 5 cases. In the remaining 3 cases the patients refused such examinations and did not undergo reconstruction. Confirmed data are available in 47 cases, among which thoracodorsal vasculature was not visualized in 3 cases, which represents 6.38%,The resulting diagnostic parameters were: sensitivity 88.63%; specificity 100%; positive predictive value 100%; and negative predictive value 37.50%, with an accuracy of 89.36%. Conclusions: From our experience we can conclude that,when the appropriate experience and equipment are available, Doppler-Duplex ultrasound should be the first procedure to be used for the evaluation of the thoracodorsal vasculature. And in the case of not meeting these requirements or the ultrasound was doubtful/negative, perform other methods such as computed tomography angiography or magnetic resonance angiography. Level of evidence 5c Diagnostic.(AU)

Long-term psychosocial consequences of false-positive screening mammography: a cohort study with follow-up of 12-14 years in Denmark.

OBJECTIVE: To compare the long-term psychosocial consequences of mammography screening among women with breast cancer, normal results and false-positive results. DESIGN: A matched cohort study with follow-up of 12-14 years. SETTING: Denmark from 2004 to 2019. PARTICIPANTS: 1170 women who participated in the Danish mammography screening programme in 2004-2005. INTERVENTION: Mammography screening for women aged 50-69 years. OUTCOME MEASURES: We assessed the psychosocial consequences with the Consequences Of Screening-Breast Cancer, a condition-specific questionnaire that is psychometrically validated and encompasses 14 psychosocial dimensions. RESULTS: Across all 14 psychosocial outcomes, women with false-positive results averagely reported higher psychosocial consequences compared with women with normal findings. Mean differences were statistically insignificant except for the existential values scale: 0.61 (95% CI (0.15 to 1.06), p=0.009). Additionally, women with false-positive results and women diagnosed with breast cancer were affected in a dose-response manner, where women diagnosed with breast cancer were more affected than women with false-positive results. CONCLUSION: Our study suggests that a false-positive mammogram is associated with increased psychosocial consequences 12-14 years after the screening. This study adds to the harms of mammography screening. The findings should be used to inform decision-making among the invited women and political and governmental decisions about mammography screening programmes.