Background: Endoscopic ultrasonography (EUS) is well-established, highly accurate clinical diagnostic test for detection and staging of gastrointestinal tract lesions and related organs. The addition of endoscopic gui...Background: Endoscopic ultrasonography (EUS) is well-established, highly accurate clinical diagnostic test for detection and staging of gastrointestinal tract lesions and related organs. The addition of endoscopic guided fine needle aspiration cytology (EUS-FNAC) has improved the performance characteristics of EUS. Aim: Evaluate the validity of EUS-FNAC in diagnosis of gastrointestinal tract lesions and related organs and assess predictive factors for an accurate EUS-FNAC diagnosis. Methods: Our study included cytological sampling from one hundred sixty-six lesions obtained from gastrointestinal tract and related organs. Factors affecting EUS-FNA accuracy were analyzed. The histopathological results or clinical follow-up were used as the gold standard method. Results: Samples were obtained from: pancreatic masses (n = 80), gastric masses (n = 34), lymph nodes (n = 22), hepatobiliary masses (n = 18) and rectal masses (n = 2). Statistical analysis of sensitivity, specificity, Positive Predictive Value, Negative Predictive Value, and diagnostic accuracy of EUS alone was 80.4%, 51.6%, 75.8%, 76.2% and 75.9% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of EUS-FNAC are 78.8%, 96.8%, 97.6% and 73.2% respectively. Addition of FNAC to EUS improved diagnostic accuracy to 85.5%. Positive statistical association was present between cytological adequacy and adequate cell block preparations, larger lesion size, presence of rapid on site evaluation (ROSE) and obtaining at least two passes from target lesion. Conclusions: EUS is valuable diagnostic and cost effective tool for gastrointestinal tract lesions and related organs when combined with FNAC.展开更多
目的探讨经支气管镜肺活检术及经皮穿刺肺活检术联合快速现场细胞学评价(C-ROSE)在肺部阴影诊断中的应用价值。方法回顾性分析2018年3月至2019年8月影像学提示疑难肺部阴影的患者61例,将其按照是否进行快速现场细胞学评价(C-ROSE)分为2...目的探讨经支气管镜肺活检术及经皮穿刺肺活检术联合快速现场细胞学评价(C-ROSE)在肺部阴影诊断中的应用价值。方法回顾性分析2018年3月至2019年8月影像学提示疑难肺部阴影的患者61例,将其按照是否进行快速现场细胞学评价(C-ROSE)分为2组,其中C-ROSE组32例,非C-ROSE组29例。以术后常规细胞及组织学病检结果为金标准。结果C-ROSE组确诊率为87.5%,其中CT引导下的C-ROSE确诊率达到100%(4例)。非C-ROSE组确诊率为79.3%。两组差异有统计学意义(χ^2=54.2,P<0.01)。C-ROSE组的穿刺次数少于非C-ROSE组(4.40±1.43 vs 6.03±1.54),两者差异有统计学意义(t=4.27,P<0.01)。结论在诊断肺部阴影性质时,肺活检技术联合快速现场细胞学评价(C-ROSE)的确诊率高,有效可靠;在预防并发症方面,术中C-ROSE技术可提示病变组织部位,减少了穿刺次数,值得临床推广应用。展开更多
ROSE is a method for fast sample evaluation that does not compromise sensitivity and specificity in the hospital environment when establishing the diagnosis and the therapeutic protocol. The technique is already well-...ROSE is a method for fast sample evaluation that does not compromise sensitivity and specificity in the hospital environment when establishing the diagnosis and the therapeutic protocol. The technique is already well-established in human medicine as it operates within the standard operational procedure, reducing the rates of inconclusive results and cancelled cytopathology assays in the hospital environment. However, its application is scarce in Veterinary Medicine, including in hospitals where intensive care is available. This study aims at conducting a case-by-case assessment of inconclusive and cancelled examinations in the Cytopathology Outpatient Clinic at UNESP (HV), Botucatu, Brazil, from 2012 to 2016 and ascertains the causes. For this purpose, a retrospective study was conducted for 9587 examinations in canines, of which 4.1% and 10.44% were inconclusive and cancelled, respectively. These results are not in line with ROSE, which foresees a total rate of 5% for these occurrences. The reasons for these high rates in the outpatient clinic were the lack of a Standard Operating Procedure (SOP) and the relative inexperience of the residents in a university hospital. Therefore, with the adoption of the ROSE protocol for veterinary cytopathological examinations, together with adequate training for the outpatient professionals responsible for the examinations, the goals set forth by the ROSE protocol would be met and the rates of inconclusive and cancelled examinations would decrease considerably. Lastly, this study hopes to contribute towards the diagnosis and therapeutic protocols of the main diseases affecting dogs.展开更多
文摘Background: Endoscopic ultrasonography (EUS) is well-established, highly accurate clinical diagnostic test for detection and staging of gastrointestinal tract lesions and related organs. The addition of endoscopic guided fine needle aspiration cytology (EUS-FNAC) has improved the performance characteristics of EUS. Aim: Evaluate the validity of EUS-FNAC in diagnosis of gastrointestinal tract lesions and related organs and assess predictive factors for an accurate EUS-FNAC diagnosis. Methods: Our study included cytological sampling from one hundred sixty-six lesions obtained from gastrointestinal tract and related organs. Factors affecting EUS-FNA accuracy were analyzed. The histopathological results or clinical follow-up were used as the gold standard method. Results: Samples were obtained from: pancreatic masses (n = 80), gastric masses (n = 34), lymph nodes (n = 22), hepatobiliary masses (n = 18) and rectal masses (n = 2). Statistical analysis of sensitivity, specificity, Positive Predictive Value, Negative Predictive Value, and diagnostic accuracy of EUS alone was 80.4%, 51.6%, 75.8%, 76.2% and 75.9% respectively. The sensitivity, specificity, positive predictive value and negative predictive value of EUS-FNAC are 78.8%, 96.8%, 97.6% and 73.2% respectively. Addition of FNAC to EUS improved diagnostic accuracy to 85.5%. Positive statistical association was present between cytological adequacy and adequate cell block preparations, larger lesion size, presence of rapid on site evaluation (ROSE) and obtaining at least two passes from target lesion. Conclusions: EUS is valuable diagnostic and cost effective tool for gastrointestinal tract lesions and related organs when combined with FNAC.
文摘目的探讨经支气管镜肺活检术及经皮穿刺肺活检术联合快速现场细胞学评价(C-ROSE)在肺部阴影诊断中的应用价值。方法回顾性分析2018年3月至2019年8月影像学提示疑难肺部阴影的患者61例,将其按照是否进行快速现场细胞学评价(C-ROSE)分为2组,其中C-ROSE组32例,非C-ROSE组29例。以术后常规细胞及组织学病检结果为金标准。结果C-ROSE组确诊率为87.5%,其中CT引导下的C-ROSE确诊率达到100%(4例)。非C-ROSE组确诊率为79.3%。两组差异有统计学意义(χ^2=54.2,P<0.01)。C-ROSE组的穿刺次数少于非C-ROSE组(4.40±1.43 vs 6.03±1.54),两者差异有统计学意义(t=4.27,P<0.01)。结论在诊断肺部阴影性质时,肺活检技术联合快速现场细胞学评价(C-ROSE)的确诊率高,有效可靠;在预防并发症方面,术中C-ROSE技术可提示病变组织部位,减少了穿刺次数,值得临床推广应用。
文摘ROSE is a method for fast sample evaluation that does not compromise sensitivity and specificity in the hospital environment when establishing the diagnosis and the therapeutic protocol. The technique is already well-established in human medicine as it operates within the standard operational procedure, reducing the rates of inconclusive results and cancelled cytopathology assays in the hospital environment. However, its application is scarce in Veterinary Medicine, including in hospitals where intensive care is available. This study aims at conducting a case-by-case assessment of inconclusive and cancelled examinations in the Cytopathology Outpatient Clinic at UNESP (HV), Botucatu, Brazil, from 2012 to 2016 and ascertains the causes. For this purpose, a retrospective study was conducted for 9587 examinations in canines, of which 4.1% and 10.44% were inconclusive and cancelled, respectively. These results are not in line with ROSE, which foresees a total rate of 5% for these occurrences. The reasons for these high rates in the outpatient clinic were the lack of a Standard Operating Procedure (SOP) and the relative inexperience of the residents in a university hospital. Therefore, with the adoption of the ROSE protocol for veterinary cytopathological examinations, together with adequate training for the outpatient professionals responsible for the examinations, the goals set forth by the ROSE protocol would be met and the rates of inconclusive and cancelled examinations would decrease considerably. Lastly, this study hopes to contribute towards the diagnosis and therapeutic protocols of the main diseases affecting dogs.
