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1.
Elias Xirouchakis Fotini Laoudi Lemonia Tsartsali Charis Spiliadi Sotirios D. Georgopoulos 《Digestive diseases and sciences》2013,58(4):1084-1090
Background
Narrow band imaging (NBI) can accurately discriminate gastritis but premalignant lesions (PMLs) are difficult to detect.Aims
The purpose of this study was to compare white light endoscopy (WLE) and histopathologic findings using the updated Sydney protocol (USP) with NBI and targeted biopsies (TB).Methods
One hundred nineteen symptomatic patients referred for upper GI endoscopy were included in this prospective open study. All patients were assessed for gastritis and PMLs using WLE and NBI by two endoscopists selected in a random manner. Biopsies were taken according to USP and targeted from any area suspicious for PML. Imaging and histological findings between protocols were compared.Results
In total 45 patients (38 %) had atrophy of whom 39 (32.7 %) were detected with WLE-USP and 28 (23.5 %) with NBI-TB (p = 0.03), 25 (21 %) had intestinal metaplasia (IM) of whom 19 (16 %) were detected with WLE-USP and 18 (15.1 %) with NBI-TB (p = 0.7) and 14 (12 %) had dysplasia of whom 12 (10 %) were detected with WLE-USP and 7 (7 %) with NBI-TB (p = 0.5), and 1 (0.8 %) case of gastric cancer only detected with WLE-USP. Accuracies for atrophy and IM were 93 and 90 % for the WLE-USP and 80 and 82 % for NBI-TB. The NBI-TB detected six cases of atrophy (13 %), 5 (20 %) of IM, and 2 (14 %) of dysplasia missed by WLE-USP as agreement was moderate. Accuracies of the NBI patterns for body and antral gastritis were 80 and 84 %.Conclusions
In a non high-risk population NBI-TB has less accuracy in detecting premalignant lesions compared to WLE-USP. However, it may be used as an important and easy-to-use complementary method which increases overall detectability for gastric premalignant lesions. 相似文献2.
Amit Kumar Dutta Kattiparambil Gangadharan Sajith Anna Benjamin Pulimood Ashok Chacko 《Indian journal of gastroenterology》2013,32(1):37-42
Background and Aims
Narrow band imaging (NBI) detects mucosal surface details (pit pattern) as well as the microvasculature pattern of mucosa. In premalignant conditions the pattern and regularity of pits and microvasculature are altered. We aimed to assess whether NBI is superior to conventional white light gastroscopy (WLG) in detecting potentially premalignant gastric lesions.Patients and Methods
We conducted a randomized prospective crossover study from January 2009 to July 2009. Patients above 45 years of age with dyspepsia in absence of alarm symptoms underwent gastric mucosal examination using WLG and NBI in the same session by different endoscopists who were blinded to each other’s endoscopy findings. Biopsy was taken if required at the end of the second gastroscopy after a third observer reviewed reports of both scopists. The yield of gastric potentially premalignant lesions (atrophic gastritis, intestinal metaplasia, dysplasia, adenomatous polyp) was compared for both procedures.Results
Two hundred [mean age 52.3 (6.4) years, males-66 %] patients participated in the study. Thirty-two patients were diagnosed to have potentially premalignant lesions using both modalities. No patient had early gastric cancer. WLG detected lesions in 17 patients (atrophic gastritis in 12, atrophic gastritis with intestinal metaplasia in 5) and NBI in 31 patients (atrophic gastritis in 22, atrophic gastritis with intestinal metaplasia in 9). The sensitivity of lesion detection by NBI was significantly higher than WLG (p?=?0.001).Conclusions
NBI was superior to WLG for detection of atrophic gastritis and intestinal metaplasia. 相似文献3.
Takuya Inoue Noriya Uedo Ryu Ishihara Tsukasa Kawaguchi Natsuko Kawada Rika Chatani Takashi Kizu Chie Tamai Yoji Takeuchi Koji Higashino Hiroyasu Iishi Masaharu Tatsuta Yasuhiko Tomita Ervin Tóth 《Journal of gastroenterology》2010,45(1):45-51
Purpose
Diagnosis of chronic atrophic fundal gastritis (CAFG) is important to understand the pathogenesis of gastric diseases and assess the risk of gastric cancer. Autofluorescence imaging videoendoscopy (AFI) may enable the detection of mucosal features not apparent by conventional white-light endoscopy. The purpose of this study was to estimate the diagnostic ability of AFI in CAFG.Methods
A total of 77 patients were enrolled. Images of the gastric body in AFI and white-light mode were taken to assess the extent of gastritis, and biopsies were taken from green (n = 119) and purple (n = 146) mucosa in AFI images. The diagnostic accuracy of green mucosa for CAFG was investigated according to the Sydney system.Results
In per-patient analysis, the accuracy of green mucosa in patients with activity, inflammation, atrophy and intestinal metaplasia was 64, 93, 88 and 81%, respectively. In per-biopsy analysis, the accuracy for activity, inflammation, atrophy and intestinal metaplasia was 55, 62, 76 and 76%, respectively. Green areas in the gastric body exhibited more inflammation (p < 0.001), atrophy (p < 0.001) and intestinal metaplasia (p < 0.001), whereas purple areas rarely contained atrophy or intestinal metaplasia. The kappa statistics for inter- and intra-observer agreement of AFI on assessing the extent of CAFG were 0.66 and 0.47, while those for white-light endoscopy were 0.56 and 0.39.Conclusions
AFI could diagnose the extent of CAFG as a green area in the gastric body, with higher reproducibility compared with white-light endoscopy. Therefore, AFI may be a useful adjunct to endoscopy to identify patients at high risk of developing gastric cancer. 相似文献4.
Cheol Woong Choi Hyung Wook Kim Dong Hoon Shin Dae Hwan Kang Yong Mi Hong Jin Hyun Park Su Bum Park Mong Cho Jung Hee Lee 《Digestive diseases and sciences》2014,59(2):421-427
Background
Treatment with endoscopic submucosal dissection (ESD) for gastric category 3 lesion (low grade dysplasia, LGD) diagnosed by endoscopic forceps biopsy (EFB) is controversial.Aims
The purpose of the present study was to validate the use of ESD for gastric LGD diagnosed by EFB and to evaluate predictable factors for pathologic upgrade diagnosis to category 4 (high grade dysplasia, HGD) or 5 (early gastric cancer, EGC) lesions.Methods
Between November 2008 and October 2011, a retrospective analysis of a prospective database was conducted at a single tertiary referral center. A total of 218 ESD procedures were carried out for gastric LGD lesions identified by EFB. The under-diagnosis rate by EFB and the predictable factors for upgrade diagnosis to category 4 or 5 lesions were analyzed.Results
Pathologic discrepancy between EFB and surgical resection was 20.1 % (44/218). Thirty eight lesions (17.4 %) were diagnosed HGD or EGC by ESD. Gastric HGD lesions were 14 cases (6.4 %) and EGC lesions were 24 cases (23 mucosal and 1 submucosal cancer) (11.0 %). Multivariate analysis revealed that lesion diameter more than 1 cm (OR 3.496 [95 % CI 1.375–8.849]), surface redness (OR 6.493 [95 % CI 2.557–16.666]) and nodular surface (OR 2.762 [95 % CI 1.237–6.172]) were significant risk factors.Conclusions
Endoscopic resection can be recommended if a LGD lesion has risk factors such as a size of 1 cm or greater, surface redness or surface nodulariy. For lesions without the risk factors, follow-up endoscopy may be recommended. 相似文献5.
Yukinaga Yoshida Koji Matsuda Kazuki Sumiyama Yosuke Kawahara Kai Yoshizawa Haruya Ishiguro Hisao Tajiri 《International journal of colorectal disease》2013,28(11):1511-1516
Purpose
Narrow band imaging (NBI) and flexible spectral imaging color enhancement (FICE) allow improved contrasted evaluation of the mucosal surface. However, no study has compared the utility of these two modalities. Therefore, the aim of this study was to compare the adenoma miss rate (AMR) between NBI and FICE.Methods
A total of 55 patients (38 men, 17 women) were enrolled in this study. Patients were randomly assigned to the NBI–FICE group (NBI followed by FICE) or the FICE–NBI group (FICE followed by NBI). NBI and FICE total colonic observations were tandemly performed for each patient during the scope withdrawal with white light following cecal intubation. All detected polyps with the NBI or FICE observation were categorized into three groups according to the size and number of polyps missed.Results
Twenty-nine patients were assigned to the NBI–FICE group, and 26 patients were assigned to the FICE–NBI group. There was no significant difference in the overall AMR when comparing the image-enhanced endoscopy technologies (17.9 % for NBI, 26 % for FICE, p?=?0.159). AMR was lower for NBI than for FICE for adenomas <5 mm in diameter (5.7 % for NBI, 12.6 % for FICE, p?=?0.036). AMR was not significantly different when comparing NBI and FICE for lesions 5 to 10 mm (p?=?0.967) or for lesions ≥10 mm (p?=?0.269).Conclusions
This study demonstrated that overall AMR was not different when comparing NBI and FICE. 相似文献6.
Amitava Goswami Sunil Dadhich Narendra Bhargava 《Indian journal of gastroenterology》2014,33(5):440-444
Background and Objective
Narrow band imaging endoscopy with magnification (NBI-ME) has already been established in Barrett’s esophagus, stomach, and colonic mucosa, but limited work has been done in the mucosal evaluation of duodenum. A study was done to determine the correlation between NBI and histology in grading villous architecture in varied etiology.Method
A prospective observational study comprising 105 subjects with suspected malabsorption. The presence of a diagnosed celiac disease, severe life threatening comorbidity, or pregnancy was considered as exclusion criteria. Standard endoscopy (SE), NBI-ME, multiple duodenal biopsies with histopathological examination were done in all.Results
Fifty-one patients had celiac disease while 54 patients comprised mainly functional dyspepsia, iron deficiency anemia, tropical malabsorption syndrome, and irritable bowel syndrome. Four NBI-ME image subtypes of villous morphology have been proposed (NBI type I/II/III/IV). NBI-ME had 95 % sensitivity, 90.2 % specificity, 91.2 % positive predictive value, and 94.2 % negative predictive value for diagnosing altered villous morphology. Intraobserver kappa agreement coefficient (κ) for NBI-ME was 0.83 while interobserver agreement was 0.89 (95 % CI 0.8–0.97).Conclusion
NBI-ME has good performance characteristics and very good kappa intra/interobserver agreement coefficient for varied subtypes of villous morphology. NBI-ME is most useful for obtaining a targeted biopsy which can be missed by conventional white light endoscopy. 相似文献7.
Lisette G. Capelle Jelle Haringsma Annemarie C. de Vries Ewout W. Steyerberg Katharina Biermann Herman van Dekken Ernst J. Kuipers 《Digestive diseases and sciences》2010,55(12):3442-3448
Background
Surveillance of premalignant gastric lesions relies mainly on random biopsy sampling. Narrow band imaging (NBI) may enhance the accuracy of endoscopic surveillance of intestinal metaplasia (IM) and dysplasia. We aimed to compare the yield of NBI to white light endoscopy (WLE) in the surveillance of patients with IM and dysplasia. 相似文献8.
Hong Liu Jing Wu Xiang-Chun Lin Nan Wei Wu Lin Hong Chang Xue-Mei Du 《Digestive diseases and sciences》2014,59(7):1513-1519
Aim
To evaluate the accuracy of diagnosing gastric antral lesions in routine clinical practice using magnifying endoscopy with narrow-band imaging (M-NBI) as a real-time diagnosing technique.Methods
Consecutive patients undergoing upper endoscopy were selected for the study. In each patient, the mucosa of the gastric antrum was observed by M-NBI, and the gastric microstructure was categorized into five types (A–E). Based on these patterns, histological types were predicted in a real-time manner. The accuracy of these predictions was evaluated based on histological findings. Inter-observer agreement was also assessed.Results
A total of 207 sites in 90 patients were examined by M-NBI. Compared with type A gastric microstructure, types B and C gastric microstructure showed a significantly higher degree of inflammation (P < 0.001). The sensitivity, specificity and accuracy of types B + C microstructure as a predictor of gastric inflammation were 85.4, 81.7 and 83.1 %, respectively. Similarly, the sensitivity, specificity and accuracy of type D microstructure as a predictor of gastric intestinal metaplasia were 71.8, 95.2 and 90.8 %, respectively, and those of type E microstructure as a predictor of early gastric cancer were 80.0, 98.9 and 97.6 %, respectively. The sensitivity and specificity of type B alone, type C alone and types B + C combined for the detection of Helicobacter pylori infection were 52.2 and 87.0 %, 22.8 and 92.2 %, 75.0 and 79.1 %, respectively. The kappa value for the inter-observer agreement was 0.715 (95 % confidence interval 0.655–0.895).Conclusions
In conclusion, M-NBI can significantly improve the accuracy of the prediction of histopathology of gastric antral lesions in vivo, implying the possibility of using M-NBI as an effective diagnosis technique. 相似文献9.
Jeongmin Choi Sang Gyun Kim Jong Pil Im Joo Sung Kim Hyun Chae Jung 《Digestive diseases and sciences》2013,58(8):2329-2336
Background
Although the accurate estimation of tumor size is essential for proper patient selection for endoscopic resection in early gastric cancer (EGC), no study has been conducted to date on tumor size estimation. We aimed to evaluate the accuracy of endoscopic visual estimation of tumor size of EGC.Methods
In 508 EGC patients that underwent endoscopic resection, endoscopic visual estimations were performed retrospectively by independent two endoscopists using still images. Data were compared with pathologic measurements as gold standard. Inter-observer agreement was determined using the Bland–Altman method and intra-class correlation coefficients (ICC). Measurement discrepancies were presented as differences between measurements.Results
The ICC between the two endoscopists was 0.915 (95 % CI 0.900–0.928). Mean endoscopic estimates for both endoscopists were significantly lower than mean pathologic measurements (1.50 and 1.67 vs. 1.80 cm, P < 0.001). Absolute differences between average endoscopic estimates and pathologic measurements were found to be acceptable in most cases: an absolute difference of <0.4 cm was found for 80 % (404/508) of cases. Bland–Altman plot showed that 94 % of cases lay within the 95 % limits of agreement. Measurement discrepancy was proportional to tumor size and increased for an undifferentiated histology.Conclusions
Endoscopic visual estimations were found to show reliable agreement with pathologic measurement in EGC patients undergoing endoscopic resection, together with good inter-observer agreement. Further prospective study is needed to confirm the validity of this method. 相似文献10.
J. Mannath V. Subramanian E. Telakis K. Lau V. Ramappa M. Wireko P. V. Kaye K. Ragunath 《Digestive diseases and sciences》2013,58(2):465-470
Background
Autofluorescence imaging (AFI), which is a “red flag” technique during Barrett’s surveillance, is associated with significant false positive results. The aim of this study was to assess the inter-observer agreement (IOA) in identifying AFI-positive lesions and to assess the overall accuracy of AFI.Methods
Anonymized AFI and high resolution white light (HRE) images were prospectively collected. The AFI images were presented in random order, followed by corresponding AFI + HRE images. Three AFI experts and 3 AFI non-experts scored images after a training presentation. The IOA was calculated using kappa and accuracy was calculated with histology as gold standard.Results
Seventy-four sets of images were prospectively collected from 63 patients (48 males, mean age 69 years). The IOA for number of AF positive lesions was fair when AFI images were presented. This improved to moderate with corresponding AFI and HRE images [experts 0.57 (0.44–0.70), non-experts 0.47 (0.35–0.62)]. The IOA for the site of AF lesion was moderate for experts and fair for non-experts using AF images, which improved to substantial for experts [κ = 0.62 (0.50–0.72)] but remained at fair for non-experts [κ = 0.28 (0.18–0.37)] with AFI + HRE. Among experts, the accuracy of identifying dysplasia was 0.76 (0.7–0.81) using AFI images and 0.85 (0.79–0.89) using AFI + HRE images. The accuracy was 0.69 (0.62–0.74) with AFI images alone and 0.75 (0.70–0.80) using AFI + HRE among non-experts.Conclusion
The IOA for AF positive lesions is fair to moderate using AFI images which improved with addition of HRE. The overall accuracy of identifying dysplasia was modest, and was better when AFI and HRE images were combined. 相似文献11.
Chang Mo Moon Seok-Hyung Kim Sang Kil Lee Jiyeon Hyeon Ja Seung Koo Sangheun Lee Jean S. Wang Won Jae Huh Shradha S. Khurana Jason C. Mills 《Digestive diseases and sciences》2014,59(6):1244-1254
Background
Intestinal metaplasia (IM), a premalignant lesion, is associated with an increased risk of gastric cancer. Although estrogen exposure, including tamoxifen, has been studied in correlation with gastric cancer, little has been investigated about its effects on IM.Aims
Therefore, we investigated whether chronic tamoxifen use was associated with the risk of IM in human stomach.Methods
We evaluated 512 gastric biopsies from 433 female breast cancer patients that underwent endoscopic gastroduodenoscopy (EGD) ≥6 months after breast surgery. Histopathological findings were scored according to the updated Sydney classification. Demographic and clinical characteristics were also included to identify predictive factors for IM.Results
In a multivariate logistic regression analysis, age at EGD (odds ratio [OR], 1.04; P = 0.002), biopsies from antrum (OR 2.08; P < 0.001), and Helicobacter pylori positivity (OR 1.68; P = 0.016) were significantly associated with an increased risk of IM, whereas chronic tamoxifen use (≥3 months) was associated with a decreased risk of IM (OR 0.59; P = 0.025). After stratifying by biopsy site, association between tamoxifen use and IM persisted for corpus (OR 0.42; P = 0.026) but not for antrum (OR 0.74; P = 0.327). In analysis limited to patients with follow-up EGD, chronic tamoxifen use also correlated with improved IM score compared to no tamoxifen use (improved, 77.8 vs. 22.2 %; no change, 65.4 vs. 34.6 %; worsened, 30.0 vs. 70.0 %; P = 0.019).Conclusions
This study suggests that chronic tamoxifen use can decrease the risk of IM in human stomach. The effect of tamoxifen is predominantly observed in the corpus. 相似文献12.
Rita A. Perri Kristina Kairaitis Peter Cistulli John R. Wheatley Terence C. Amis 《Sleep & breathing》2014,18(1):39-52
Study objective
We used statistical modelling to probe the contributions of anthropometric and surface cephalometric variables to the OSA phenotype.Design
The design is prospective cohort study.Setting
The setting is community-based and sleep disorder laboratory.Patients or participants
Study #1—Model development study: 147 healthy asymptomatic volunteers (62.6 % Caucasian; age, 18–76 years; 81 females; median multivariable apnea prediction index?=?0.15) and 140 diagnosed OSA patients (84.3 % Caucasian; age, 18–83 years; 41 females; polysomnography [PSG] determined apnea–hypopnea index >10 events/h). Study #2—Model test study: 345 clinic patients (age, 18–86 years; 129 females) undergoing PSG for diagnosis of OSA.Intervention
We measured 10 anthropometric and 34 surface cephalometric dimensions (calipers) and calculated mandibular enclosure volumes for study #1 and recorded age and neck circumference for study #2. Statistical modelling included principal component (PC), logistic regression, and receiver–operator curve analyses.Measurements and results
Model development study: A regression model incorporating three identified PC predicted OSA with 88 % sensitivity and specificity. However, a simplified model based on age and NC alone was equally effective (87 % sensitivity and specificity). Model test study: The simplified model predicted OSA with high sensitivity (93 %) but poor specificity (21 %).Conclusion
We conclude that in our clinic-based cohort, craniofacial bony and soft tissue structures (excluding neck anatomy) do not play a substantial role in distinguishing patients with OSA from those without. This may be because craniofacial anatomy does not contribute greatly to the pathogenesis of OSA in this group or because referral bias has created a relatively homogeneous phenotypic population. 相似文献13.
Jian Song Hong Su Yang-yang Zhou Liang-liang Guo 《Digestive diseases and sciences》2014,59(2):436-445
Background
Cyclooxygenase-2 (COX-2) is believed to be involved in gastric carcinogenesis. However, it is still controversial whether COX-2 expression can be regarded as a prognostic factor for gastric cancer patients.Aim
To obtain a more accurate relationship between COX-2 overexpression and prognosis in gastric cancer by meta-analysis.Method
Relevant articles published up to May 2013 were searched by use of several keywords in electronic databases. Separate hazard ratio (HR) estimates and 95 % confidence intervals (95 % CI) for COX-2 overexpression and overall survival (OS) and disease-free survival (DFS) with gastric cancer were extracted. Combined HR with 95 % CI was calculated by use of Stata11.0 software to estimate the size of the effect. Publication bias testing and sensitivity analysis were also performed.Results
A total of 27 studies which included 3,891 gastric cancer patients were combined in the final analysis. Combined results suggested that COX-2 overexpression was associated with an unfavorable OS (HR 1.58, 95 % CI 1.36–1.84) but not DFS (HR 1.15, 95 % CI 0.93–1.43) among patients with gastric cancer. Publication bias was absent. Sensitivity analysis suggested that the results of this meta-analysis were robust.Conclusions
The results of this meta-analysis suggest that high COX-2 expression may be an independent risk factor for poor OS of patients with gastric cancer. More large prospective studies are now needed to further clarify the prognostic value of COX-2 expression for DFS in gastric cancer. 相似文献14.
Yu-Yu Lu Jin-Hua Chen Chun-Ru Chien William Tzu-Liang Chen Shih-Chuan Tsai Wan-Yu Lin Chia-Hung Kao 《International journal of colorectal disease》2013,28(8):1039-1047
Aim
The purpose of the present study was to conduct a systematic review and meta-analysis of the published literature to assess the diagnostic performance of FDG-PET or PET/CT in the detection of recurrent colorectal cancer (CRC) rising in patients with elevated CEA.Materials and methods
The authors conducted a systematic MEDLINE search of published articles. Two reviewers independently assessed the methodological quality of each study. We estimated pooled sensitivity and specificity and positive and negative likelihood ratios, and summary receiver-operating characteristic curves in the detection of recurrent CRC in patients with elevated CEA.Results
Eleven studies with a total of 510 patients met the inclusion criteria. One hundred and six patients (106/510?=?20.8 %) had true-negative FDG-PET (PET/CT) results in detection of recurrent CRC when rising CEA. The pooled estimates of sensitivity and specificity and positive and negative likelihood ratios of FDG-PET in the detection of tumor recurrence in CRC patients with elevated CEA were 90.3 % (95 % CI, 85.5–94.0 %), 80.0 % (95 % CI, 67.0–89.6 %), 2.88 (95 % CI, 1.37–6.07), and 0.12 (95 % CI, 0.07–0.20), respectively. The pooled estimates of sensitivity and specificity and positive and negative likelihood ratios of FDG-PET/CT in the detection of tumor recurrence in CRC patients with elevated CEA were 94.1 % (95 % CI, 89.4–97.1 %), 77.2 % (95 % CI, 66.4–85.9 %), 4.70 (95 % CI, 0.82–12.13), and 0.06 (95 % CI, 0.03–0.13), respectively.Conclusions
Whole-body FDG-PET and PET/CT are valuable imaging tools for the assessment of patients with suspected CRC tumor recurrence based on the increase of CEA. 相似文献15.
Takashi Hisabe Kenshi Yao Kentaro Imamura Hiroshi Ishihara Fumihito Hirai Toshiyuki Matsui Akinori Iwashita 《Digestive diseases and sciences》2014,59(10):2544-2549
Background
The presence of a white opaque substance (WOS) on magnifying endoscopy (ME) with narrow-band imaging (NBI) has been reported for gastric epithelial neoplasms, but the presence of WOS in colorectal epithelial neoplasms has not been investigated.Aims
The purpose of this study was to determine whether WOS is present in colorectal epithelial neoplasms and to clarify its clinical significance.Methods
A total of 590 colorectal epithelial neoplasms from 368 consecutive patients were retrospectively analyzed using prospectively collected data. Presence or absence of WOS in colorectal epithelial neoplasms was recorded based on the findings of ME with NBI.Results
White opaque substance was present in 236 of the 590 (40 %) colorectal epithelial neoplasms. Compared with WOS-negative patients, WOS-positive patients showed significantly larger tumors (p < 0.0001) and significantly more tumors in the proximal colon (p = 0.0003). WOS was more frequently present in carcinomas (66.0 %) than in adenomas (31.8 %; p < 0.0001). WOS was also more frequent in submucosal carcinomas (75.9 %) than in intramucosal carcinomas (59.0 %; p = 0.0380).Conclusions
This study confirmed the presence of WOS in colorectal epithelial neoplasms, and prevalence increased with the progression of cancer, from adenoma to carcinoma and from intramucosal carcinoma to submucosal carcinoma. 相似文献16.
Sze Lin Yoong B. NutrDiet Mariko Leanne Carey PhD Robert William Sanson-Fisher PhD Catherine Anne D’Este PhD Lisa Mackenzie B Psych Allison Boyes PhD 《Journal of general internal medicine》2014,29(2):328-334
BACKGROUND
Overweight and obese patients attempt weight loss when advised to do so by their physicians; however, only a small proportion of these patients report receiving such advice. One reason may be that physicians do not identify their overweight and obese patients.OBJECTIVES
We aimed to determine the extent that Australian general practitioners (GP) recognise overweight or obesity in their patients, and to explore patient and GP characteristics associated with non-detection of overweight and obesity.METHODS
Consenting adult patients (n?=?1,111) reported weight, height, demographics and health conditions using a touchscreen computer. GPs (n?=?51) completed hard-copy questionnaires indicating whether their patients were overweight or obese. We calculated the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for GP detection, using patient self-reported weight and height as the criterion measure for overweight and obesity. For a subsample of patients (n?=?107), we did a sensitivity analysis with patient-measured weight and height. We conducted an adjusted, multivariable logistic regression to explore characteristics associated with non-detection, using random effects to adjust for correlation within GPs.RESULTS
Sensitivity for GP assessment was 63 % [95 % CI 57–69 %], specificity 89 % [95 % CI 85–92 %], PPV 87 % [95 % CI 83–90 %] and NPV 69 % [95 % CI 65–72 %]. Sensitivity increased by 3 % and specificity was unchanged in the sensitivity analysis. Men (OR: 1.7 [95 % CI 1.1–2.7]), patients without high blood pressure (OR: 1.8 [95 % CI 1.2–2.8]) and without type 2 diabetes (OR: 2.4 [95 % CI 1.2–8.0]) had higher odds of non-detection. Individuals with obesity (OR: 0.1 [95 % CI 0.07–0.2]) or diploma-level education (OR: 0.3 [95%CI 0.1–0.6]) had lower odds of not being identified. No GP characteristics were associated with non-detection of overweight or obesity.CONCLUSIONS
GPs missed identifying a substantial proportion of overweight and obese patients. Strategies to support GPs in identifying their overweight or obese patients need to be implemented. 相似文献17.
Background
Distinguishing malignant from benign pancreatic tumors is challenging with current imaging techniques. Endoscopic ultrasound (EUS) elastography has further improved the efficacy of EUS for characterizing pancreatic lesions.Aims
To assess, by combining data from existing trials, the accuracy of EUS elastography in diagnosing malignant tumors for patients with pancreatic masses.Methods
All relevant studies published were identified by systematic searching of databases. A meta-analysis was performed using a random-effects model to combine study results.Results
Seven studies involving 752 patients were included. The sensitivity of EUS elastography for differential diagnosis of solid pancreatic masses was 97 % (95 % CI, 0.95–0.98), and the specificity was 76 % (95 % CI, 0.69–0.82). The area under the curve under summary receiver operating characteristic (SROC) was 0.9529. The combined positive likelihood ratio was 3.71 (95 % CI, 2.72–5.07), and the negative likelihood ratio was 0.05 (95 % CI, 0.02–0.13).Conclusion
Our meta-analysis shows that EUS elastography is a useful tool for differential diagnosis of solid pancreatic neoplasms with very high sensitivity and relatively low specificity. The results indicate that EUS elastography not only provides information complementary to that from EUS but also potentially increases the yield of fine needle aspiration and reduces the number of unnecessary biopsies. 相似文献18.
Patricia Diana Sørensen Erik Hugger Jakobsen Jonna Skov Madsen Eva Brix Petersen Rikke Fredslund Andersen Birthe Østergaard Ivan Brandslund 《Journal of cancer research and clinical oncology》2013,139(6):1005-1013
Purpose
The aim of this study was to determine the sensitivity, specificity, and predictive values of serum HER-2 for detecting metastatic recurrence in breast cancer patients.Methods
In the period 2004–2009, serum HER-2 was measured in 1,348 patients with breast cancer: 837 during routine controls at the Oncology Department and 511 newly diagnosed. The patients with positive serum HER-2, all the newly diagnosed and 1/5 of the patients with negative serum HER-2 were followed with serum HER-2 measurements every 3–12 months using the ADVIA Centaur assay. Tissue HER-2 status was determined by IHC and FISH. Patients with a single serum HER-2 value above 15 μg/L were considered serum positive. Metastases were diagnosed according to the routine clinical methods using imaging/biopsy.Results
Of the 862 patients included, 21 had unavailable medical records and were excluded. Patients with unknown tissue status (218), missing blood sample before recurrence (74), or presenting with primary metastatic disease (9) were also excluded. Blood samples before the detection of metastatic recurrence were available in 154 tissue HER-2-positive and in 386 tissue HER-2-negative patients. The sensitivity, specificity, positive and negative predictive values in tissue HER-2-positive patients with values above 15 μg/L were 69 % (95 % CI 53–80 %), 71 % (62–78), 47 % (35–59), and 86 % (77–91), respectively. Combining the cutoff value of 15 μg/L with a delta value of >100 % increase from individual baseline after primary therapy, or increasing the cutoff to 32 μg/L raises the specificity to 96 %, but lowers the sensitivity to 50 and 47 %, respectively. Preoperative serum HER-2 values were accessible in 69 tissue-positive patients, but no significant association was found with later development of metastases. The sensitivity, specificity, positive and negative predictive values in tissue HER-2-negative patients with values above 15 μg/L were 33 % (21–47), 77 % (73–82), 18 % (12–27), and 88 % (84–91), respectively.Conclusions
Monitoring tissue HER-2-positive breast cancer patients with serum HER-2 has a sufficient sensitivity to detect metastatic recurrence, while its use in monitoring of tissue HER-2-negative patients is unsatisfactory. 相似文献19.