A case-control study to assess the role of polyomavirus in transplant complications: Where do we stand?

PURPOSE: The study's aim was to assess whether polyomavirus DNAemia screening was associated with different outcomes in patients with positive viremia compared with negative viremia. METHODS: Case-control retrospective study of patients with polyomavirus DNAemia (viremia > 1000 copies/mL) matched 1:1 with controls. Control group consists of the patient who received a transplant immediately before or after each identified case and did have nil viremia. FINDING: Ultimately, 120 cases of BK polyomavirus (BKPyV) were detected and matched with 130 controls. Of these, 54 were adult kidney transplant recipients (KTRs), 43 were pediatric KTRs, and 23 were undergoing hemato-oncologic therapy, of which 20 were undergoing hematopoietic stem cell transplantation. The odds ratio (OR) for overall risk of poorer outcomes in cases versus controls was 16.07 (95% CI: 5.55-46.54). The unfavorable outcome of switching the immunosuppressive drug (ISD) (14/40,35%) was no different from that of those treated with reduced ISD doses (31/71, 43.6%, P = .250). Acute rejection or graft-versus-host disease, previous transplant, and intensity of immunosuppression (4 ISDs plus induction or conditioning) were risk factors for BKPyV-DNAemia (OR: 13.96, 95% CI: 11.25-15.18, P < .001; OR: 6.14, 95% CI: 3.91-8.80, P < .001; OR: 5.53, 95% CI: 3.37-7.30, P < .001, respectively). CONCLUSIONS: Despite viremia screening, dose reduction, and change in therapeutic protocol, patients with positive BKPyV-DNAemia present poorer outcomes and unfavorable results.

[Usefulness CT-guided F.N.A.C. in the diagnosis of mediastinal lesions]. / Utilidad de la PAAF guiada por TC en el diagnóstico de lesiones mediastínicas.

OBJECTIVE: To evaluate the diagnostic accuracy of the percutaneous fine needle aspiration cytology (FNAC) for mediastinal lesions by using histology or follow-up clinical diagnosis as gold standard. PATIENTS AND METHODS: CT-guided percutaneous FNAC was performed on 131 patients with mediastinal lesions. Helical CT was used with 3-10 mm image thickness range and low radiation dose (40 mAs, 120 kV). Samples were immediately examined by a cytologist to determine if they were representative. Histological samples were obtained by means of biopsy or resection specimens in 73 patients and clinical follow-up in 50. RESULTS: The material was satisfactory for diagnosis in 126 patients (95.2 %), in whom 103 lesions (78.6%) were considered malignant (62 primary tumours and 41 metastases) and 23 (17.6%) benign. In the 123 patients with clinical monitoring or pathological diagnosis, using FNAC led to the identification of malignancy with a sensitivity of 95.2 % (95%CI: 89.2-97.9%), specificity 84.2% (95%CI: 62.4-94.5%), positive predictive value 97.1% (95%-CI: 91.7-99.0%), negative predictive value 76.2% (95%CI: 54.9-89.4%), likelihood-ratio positive 6.03 (95%CI: 2.13-17.05) and accuracy 93.5% (95%CI: 87.7-96.7%). Pneumothorax was the most frequent complication (3 cases). There was good agreement between the cytological findings and the histological findings, not only for malignant lesions (kappa coefficient: 0.641) but also for benign (kappa 0.607). CONCLUSIONS: CT-guided percutaneous FNAC is a safe and effective technique for the diagnosis of the mediastinal masses, with a high diagnostic yield for malignancy depicting.

Utilidad de la PAAF guiada por TC en el diagnóstico de lesiones mediastínicas / Usefulness CT-guided F.N.A.C. in the Diagnosis of Mediastinal Lesions

ObjetivosEvaluar la validez diagnóstica de la punciónaspiración con aguja fina (PAAF) percutánea en lesiones mediastínicas considerando la biopsia o el seguimiento clínico como patrón de referencia.Pacientes y métodosSe realizó PAAF percutánea guiada por TC a 131 pacientes con lesiones mediastínicas. Se usó un TC helicoidal con cortes de 3–10mm y baja dosis de radiación (40mAs, 120kV). Las muestras fueron examinadas in situ por un citólogo para determinar su validez. Se obtuvo comprobación histológica mediante biopsia o estudio de pieza quirúrgica en 73 pacientes y seguimiento clínico en 50, comparándose los resultados globales y en subgrupos.ResultadosEn 126 pacientes (96,2%) el material fue válido para diagnóstico. Ciento tres lesiones (78,6%) fueron consideradas malignas (62 tumores primarios y 41 metástasis) y 23 (17,6%) benignas. En los 123 pacientes de los que se dispuso de seguimiento clínico o patológico, la PAAF permitió identificar malignidad con una sensibilidad del 95,2% (IC95%: 89,2–97,9%), especificidad 84,2% (IC95%: 62,4–94,5%), valor predictivo positivo 97,1% (IC95%: 91,7–99,0%), valor predictivo negativo 76,2% (IC95%: 54,9–89,4%), razón de verosimilitud positiva 6,03 (IC95%: 2,13–17,05) y exactitud 93,5% (IC95%: 87,7–96,7%). La complicación más frecuente fue el neumotórax (3 casos). La correlación citohistológica fue elevada tanto en las lesiones malignas (kappa 0,641) como en las benignas (kappa 0,607).ConclusionesLa PAAF percutánea guiada por TC es una técnica segura y eficaz para el diagnóstico de masas mediastínicas con alta rentabilidad para la detección de malignidad(AU)

ObjectiveTo evaluate the diagnostic accuracy of the percutaneous fine needle aspiration cytology (FNAC) for mediastinal lesions by using histology or follow-up clinical diagnosis as gold standard.Patients and MethodsCT-guided percutaneous FNAC was performed on 131 patients with mediastinal lesions. Helical CT was used with 3–10mm image thickness range and low radiation dose (40mAs, 120kV). Samples were immediately examined by a cytologist to determine if they were representative. Histological samples were obtained by means of biopsy or resection specimens in 73 patients and clinical follow-up in 50.ResultsThe material was satisfactory for diagnosis in 126 patients (95.2 %), in whom 103 lesions (78.6%) were considered malignant (62 primary tumours and 41 metastases) and 23 (17.6%) benign. In the 123 patients with clinical monitoring or pathological diagnosis, using FNAC led to the identification of malignancy with a sensitivity of 95.2 % (95%CI: 89.2–97.9%), specificity 84.2% (95%CI: 62.4–94.5%), positive predictive value 97.1% (95%-CI: 91.7–99.0%), negative predictive value 76.2% (95%CI: 54.9–89.4%), likelihood-ratio positive 6.03 (95%CI: 2.13–17.05) and accuracy 93.5% (95%CI: 87.7–96.7%). Pneumothorax was the most frequent complication (3 cases). There was good agreement between the cytological findings and the histological findings, not only for malignant lesions (kappa coefficient: 0.641) but also for benign (kappa 0.607).ConclusionsCT-guided percutaneous FNAC is a safe and effective technique for the diagnosis of the mediastinal masses, with a high diagnostic yield for malignancy depicting(AU)