Methods to increase the diagnostic efficiency of endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesions:An updated review

Endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)is a means to procure adequate specimens for histological and cytologic analysis.The ideal EUS-FNA should be safe,accurate,and have a high sample adequacy rate and low adverse events rate.In recent years,many guidelines and trials on EUS-FNA have been published.The purpose of this article is to provide an update on the influence of some of the main factors on the diagnostic efficiency of EUS-FNA as well as a rare but serious complication known as needle tract seeding.

Diagnostic efficiency and complication rate of CT-guided lung biopsy： a single center experience of the procedures conducted over a 10-year period

Background Computed tomography （CT）-guided transthoracic lung biopsy is a well-established technique for the diagnosis of pulmonary lesions. The objective of this study was to evaluate the diagnostic efficiency and complication rate of CT-guided lung biopsy in a Chinese population. Methods CT-guided cutting needle lung biopsies were performed in our institution on 1014 patients between January 2000 and October 2010. A chest radiograph was taken after the biopsy. Data about basic patient information, final diagnosis, and complications secondary to biopsy procedure （pneumothorax and bleeding） were extracted. Results The diagnostic efficiency of CT-guided lung biopsy was 94.8%; only 53 patients did not get a final diagnosis from lung biopsy. Final diagnoses found 639 malignant lesions （63.0%） and 322 benign lesions （31.8%）. Pneumothorax occurred in 131 patients and 15 required insertion of an intercostal drain. Small hemoptysis occurred in 41 patients and mild parenchymal hemorrhage occurred in 16 patients. The overall complication rate was 18.5%. Conclusions CT-guided cutting needle biopsy of pulmonary lesions is a relatively safe technique with a high diagnostic accuracy. It can be safely performed in clinical trials.

Evaluation of the diagnostic efficacy of noninvasive diagnosis in patients with chronic viral hepatitis B complicated with nonalcoholic fatty liver disease and significant liver fibrosis

Objective:To evaluate the diagnostic efficacy of chronic viral hepatitis B(CHB)with significant liver fibrosis(S2)in patients with nonalcoholic fatty liver disease(NAFLD)by using noninvasive diagnosis and their combined models,and to explore their clinical features.Methods:A total of 104 inpatients with CHB diagnosed and complicated with NAFLD(hepatic steatosis suggested by liver biopsy)were retrospectively collected from January 2018 to January 2023 in the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University.Liver biopsy was performed in all patients.General data,laboratory test results,liver hardness(LSM),FIB-4,APRI,GGT/PLT,AST/PLT and other results of patients were collected and grouped according to different fibrosis stages(S)to explore the clinical and pathological characteristics of patients with<S2 and S2 stages.Receiver operating characteristic curve was used to evaluate the diagnostic value of LSM,FIB-4,APRI,GGT/PLT,AST/PLT and their combined models in patients with significant liver fibrosis in CHB patients with NAFLD.Results:Among the 104 patients,there were 55 patients had S1 fibrosis,32 patients had S2 fibrosis,11 patients had S3 fibrosis and 6 patients had S4 fibrosis.Patients had<S2 fibrosis,ALT 33.75±17.15 U/L,AST 24.00(19.77,29.00)U/L,inflammation above G2 stage accounted for 92.72%,GGT/PLT 0.07(0.10,0.15),AST/PLT 0.09(0.10,0.15),LSM 8.70(6.80,10.10)kPa,FIB-41.07±0.51,APRI 0.26(0.22,0.28).In patients S2 fibrosis,ALT 42.14±21.39 U/L,AST 29.04(24.00,40.32)U/L,inflammation above G2 stage accounted for 97.95%,GGT/PLT 0.15(0.10,0.28),AST/PLT 0.14(0.10,0.26),GGT/PLT 0.15(0.10,0.28),AST/PLT 0.14(0.10,0.26).LSM 11.80(8.50,16.65)kPa,FIB-41.39±0.72,APRI 0.35(0.26,0.66),the difference between the two groups was statistically significant(P<0.05).The area under the receiver operator characteristic curves of the subjects of LSM,FIB-4,APRI,GGT/PLT and AST/PLT were 0.716,0.623,0.669,0.644 and 0.669(P<0.05),respectively.In the combined model,the area under the receiver operator characteristic curves of LSM combined with FIB-4,LSM combined with APRI,LSM combined with GGT/PLT and LSM combined with AST/PLT were 0.712,0.719,0.715 and 0.719,respectively(P<0.05).Conclusion:Although the currently commonly used Noninvasive diagnosis of liver fibrosis has certain diagnostic efficacy for significant liver fibrosis in CHB complicated with NAFLD,it cannot replace liver biopsy.Noninvasive Diagnosis can be used as an auxiliary method for regular clinical evaluation of liver biopsy.

The Value of Ultrasound in the Application of Water Enema in Intussusception

Objective:To introduce high-frequency ultrasound diagnostic technology to cooperate with diagnosis and treatment for patients with intussusception,and to observe its clinical application effect.Methods:The study took patients with intussusception as the object of observation,with a total of 52 cases participating,all of which were clinically admitted from December 2022 to December 2023.After enrollment,the patients underwent high-frequency ultrasound detection in sequence,recording the ultrasound imaging characteristics,and referring to the results of surgical or leaky saline enema reset to confirm the diagnosis(the gold standard)to assess the diagnostic efficacy of high-frequency ultrasound technology.Results:Comparing the confirmed diagnostic results of surgery or leaking saline enema restoration,the detection rate of high-frequency ultrasound technology was 98.07%(P>0.05).Among the 52 patients treated with hydropneumatic enema restoration with the cooperation of high-frequency ultrasound monitoring,39 patients were successfully reset in the first treatment(75.00%),while 9 patients were successfully reset(17.30%)after multiple treatments(≥2 times);the remaining 4 patients were unsuccessful and then converted to surgical treatment,and all of them were successfully treated and cured.Conclusion:For the diagnosis of intussusception,high-frequency color Doppler ultrasound has the advantages of high accuracy and simple operation,which provides a scientific and accurate reference basis for the clinical diagnosis and treatment of patients.

Correlation of basic indicators with stages of keratoconus assessed by Pentacam tomography

AIM: To evaluate the diagnostic efficiency of basic indicators and find characteristic indicators for keratoconus (KC) at adjacent stages, and to assess the progression pattern of KC. METHODS: One hundred and eight (41 subclinical, 40 moderate, and 27 severe) keratoconic patients (108 eyes) and 105 myopic patients (105 eyes) as controls were recruited in this prospective, comparative case series study. Pentacam topography was performed. Receiver operating -characteristic curves were used to get the characteristic indicators. RESULTS: The most efficient distinguishing index between the subclinical KC and the controls was posterior elevation value (PEV, AUC =0.882), with the highest specificity being 93.8%. Corneal thickness (AUC=0.852) and posterior inferior-superior value (I-S) ranked second and third (AUC=0.776). When KC became moderate, PEV remained to be of the highest diagnostic efficiency (AUC=0.988), followed by the anterior elevation value (AUC=0.986) and other parameters of anterior surface. The diagnostic value increased significantly in the anterior curvature indices (all AUC >0.900) and appeared in the anterior best fitting sphere radius (AUC= 0.919) when KC developed into the severe stage. CONCLUSION: In the subclinical stage of KC, PEV, thickness, and posterior I-S had important diagnostic values, and elevation values remained most efficient when KC developed to the moderate stage. The anterior curvature indices were most characteristic when KC became severe. KC first appeared in the inferior cornea of posterior surface, but the feature of protrusion formed at the moderate stage.

Prediction of hepatic inflammation in chronic hepatitis B patients with a random forest-backward feature elimination algorithm

BACKGROUND Persistent liver inflammatory damage is the main risk factor for developing liver fibrosis,cirrhosis,and even hepatocellular carcinoma in chronic hepatitis B(CHB)patients.Thus,accurate prediction of the degree of liver inflammation is a high priority and a growing medical need.AIM To build an effective and robust non-invasive model for predicting hepatitis Brelated hepatic inflammation.METHODS A total of 650 treatment-naïve CHB(402 HBeAg-positive and 248 HBeAgnegative)patients who underwent liver biopsy were enrolled in this study.Histological inflammation grading was assessed by the Ishak scoring system.Serum quantitative hepatitis B core antibody(qAnti-HBc)levels and 21 immunerelated inflammatory factors were measured quantitatively using a chemiluminescent microparticle immunoassay.A backward feature elimination(BFE)algorithm utilizing random forest(RF)was used to select optional features and construct a combined model.The diagnostic abilities of the model or variables were evaluated based on the estimated area under the receiver operating characteristics curve(AUROC)and compared using the DeLong test.RESULTS Four features were selected to predict moderate-to-severe inflammation in CHB patients using the RF-BFE method.These predictive features included qAnti-HBc,ALT,AST,and CXCL11.Spearman’s correlation analysis indicated that serum qAnti-HBc,ALT,AST,and CXCL11 levels were positively correlated with the histology activity index(HAI)score.These selected features were incorporated into the model to establish a novel model named I-3A index.The AUROC[0.822;95%confidence interval(CI):0.790-0.851]of the I-3A index was significantly increased compared with qAnti-HBc alone(0.760,95%CI:0.724-0.792,P<0.0001)in all CHB patients.The use of an I-3A index cutoff value of 0.41 produced a sensitivity of 69.17%,specificity of 81.44%,and accuracy of 73.8%.Additionally,the I-3A index showed significantly improved diagnostic performance for predicting moderate-to-severe inflammation in HBeAg-positive and HBeAgnegative CHB patients(0.829,95%CI:0.789-0.865 and 0.810,95%CI:0.755-0.857,respectively).CONCLUSION The selected features of the I-3A index constructed using the RF-BFE algorithm can effectively predict moderate-to-severe liver inflammation in CHB patients.

Shear wave elastography may be sensitive and more precise than transient elastography in predicting significant fibrosis

BACKGROUND Noninvasive measurements including transient elastography(TE)and twodimensional shear wave elastography(SWE)have been used clinically instead of liver biopsy for regular assessment of liver fibrosis in chronic hepatitis B(CHB)patients.AIM To investigate the diagnostic efficiency of SWE compared to TE by assessing independent influencing factors and performance for diagnosing significant fibrosis based on our cohort of treatment-naive CHB patients.METHODS Fifty-four treatment-naive CHB patients who underwent liver biopsy to determine whether to initiate antiviral therapy were enrolled.SWE,TE,serum tests and liver biopsy were performed for all participants.The fibrosis-4 and aspartate aminotransferase to platelet ratio index scores were also calculated.Potential independent influencing factors on SWE and TE values were analyzed.Based on liver pathology results,the agreement and correlation were determined,and a comparison of the two methods was performed.RESULTS There were 27 cases(50%)of mild fibrosis(F0-F2)and 27(50%)cases of significant fibrosis(F3-F6);fibrosis was assessed with the Ishak scoring system.Multivariate linear regression analyses revealed that the fibrosis stage was the only factor that affected the SWE values(P<0.001),whereas the total bilirubin level(P=0.013)and fibrosis stage(P=0.037)were independent factors that affected TE values.Orthogonal partial least squares discriminant analysis showed that the number of independent factors(VIP>1)was higher for TE than SWE.Bland-Altman analysis showed satisfactory agreement between liver stiffness measurements(LSMs)of SWE and TE.Both SWE and TE could significantly discriminate significant fibrosis from mild fibrosis(P<0.001).SWE exhibited a higher correlation with LSMs of liver fibrosis than TE(r=0.65 and 0.50,P<0.001).The diagnostic performance of SWE was better than that of TE for significant fibrosis(F>2).The areas under the receiver operating characteristic curves of SWE and TE were 0.786 and 0.714,respectively.The optimal LSM cutoff values of SWE and TE were 9.05 kPa and 8.15 kPa,respectively.CONCLUSION Compared to the TE value,the SWE value was less affected by other factors.SWE may be more sensitive and precise than TE in predicting significant fibrosis(>F2)in CHB patients.

Diagnostic Value of tb-RNA in Pleural Effusion in Tuberculous Pleurisy

Objective:To explore the diagnostic value of tb-RNA in pleural effusion in tuberculous pleurisy.Methods:60 patients with tuberculous pleurisy treated from March 2018 to September 2019 were selected as the research object,and 60patients with non-tuberculous pleurisy treated at the same time were selected as the control group to analyze the diagnostic consistency of tuberculous pleurisy.Results:Through the consistency analysis of the gold standard and tb-RNA diagnosis,the diagnosis consistency of the two methods was strong.By comparing the tb-RNA level of the two groups,the tb-RNA level of the observation group was significantly higher than that of the control group(P<0.05);Through the analysis of diagnostic efficacy of tb-RNA,the diagnostic sensitivity and specificity of tb-RNA were 58.33%and 97.50%,respectively.Conclusion:tb-RNA detection of pleural effusion has a high positive diagnostic value and short detection cycle,which is of positive significance for the diagnosis of tuberculous pleural effusion.