• Clinical Endoscopy
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• v.56 no.2
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• pp.169-179
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• 2023

Background/Aims: This meta-analysis analyzed the effect of an indwelling biliary stent on endoscopic ultrasound (EUS)-guided tissue acquisition from pancreatic lesions. Methods: A literature search was performed to identify studies published between 2000 and July 2022 comparing the diagnostic outcomes of EUS-tissue acquisition (TA) in patients with or without biliary stents. For non-strict criteria, samples reported as malignant or suspicious for malignancy were included, whereas for strict criteria, only samples reported as malignant were included in the analysis. Results: Nine studies were included in this analysis. The odds of an accurate diagnosis were significantly lower in patients with indwelling stents using both non-strict (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.52-0.90) and strict criteria (OR, 0.58; 95% CI, 0.46-0.74). The pooled sensitivity with and without stents were similar (87% vs. 91%) using non-strict criteria. However, patients with stents had a lower pooled sensitivity (79% vs. 88%) when using strict criteria. The sample inadequacy rate was comparable between groups (OR, 1.12; 95% CI, 0.76-1.65). The diagnostic accuracy and sample inadequacy were comparable between plastic and metal biliary stents. Conclusions: The presence of a biliary stent may negatively affect the diagnostic outcome of EUS-TA for pancreatic lesions.

• Clinical Endoscopy
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• v.55 no.2
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• pp.279-286
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• 2022

Background/Aims: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a standard procedure for obtaining tissue from lesions near the gastrointestinal lumen. However, there is a scarcity of information on the diagnostic performance of EUS-FNA for abdominal lymphadenopathy of unknown causes. To assess the accuracy of EUS-FNA in diagnosing abdominal lymphadenopathy of unknown etiology. Methods: The EUS records of patients with undiagnosed abdominal lymphadenopathy between 2010 and 2015 were reviewed. Results: A total of 42 patients were included in this study. Adequate specimens were obtained from 40 patients (95%). The final diagnoses were metastatic cancer (n=16), lymphoma (n=9), tuberculosis (n=8), inflammatory changes (n=6), and amyloidosis (n=1). For diagnosing malignancy, EUS-FNA had a sensitivity of 84.6%, specificity of 95.7%, positive predictive value of 91.7%, negative predictive value of 91.7%, and area under the receiver operating characteristic curve (AUROC) of 0.901. For the diagnosis of lymphoma, EUS-FNA was 100% accurate when combined with cytologic evaluation and immunohistochemical staining. The diagnostic sensitivity decreased to 75%, whereas the specificity remained 100%, for tuberculosis. The overall AUROC was 0.850. No procedure-related complications occurred. Conclusions: EUS-FNA showed high diagnostic performance for abdominal lymphadenopathy of unknown causes, especially malignancy, lymphoma, and tuberculosis. Therefore, it is a crucial diagnostic tool for this patient population.

• Clinical Endoscopy
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• v.55 no.5
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• pp.615-625
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• 2022

Background/Aims: Mucosal incision-assisted biopsy (MIAB) for tissue acquisition (TA) from subepithelial lesions (SELs) is emerging as an alternative to endoscopic ultrasound (EUS)-guided TA. Only a limited number of studies compared the diagnostic utility of MIAB and EUS for upper gastrointestinal (GI) SELs; therefore, we conducted this systematic review and meta-analysis. Methods: A comprehensive literature search from January 2020 to January 2022 was performed to compare the diagnostic accuracy and safety of MIAB and EUS-guided TA for upper GI SELs. Results: Seven studies were included in this meta-analysis. The pooled technical success rate (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.89-1.04) and procedural time (mean difference=-4.53 seconds; 95% CI, -22.38 to 13.31] were comparable between both the groups. The overall chance of obtaining a positive diagnostic yield was lower with EUS than with MIAB for all lesions (RR, 0.83; 95% CI, 0.71-0.98) but comparable when using a fine-needle biopsy needle (RR, 0.93; 95% CI, 0.83-1.04). The positive diagnostic yield of MIAB was higher for lesions <20 mm (RR, 0.75; 95% CI, 0.63-0.89). Six studies reported no adverse events. Conclusions: MIAB can be considered an effective alternative to EUS-guided TA for upper GI SELs without an increased risk of adverse events.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.11
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• pp.5427-5432
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• 2012

Background and Purpose: Ovarian cancer is the leading cause of death among gynecologic cancers because of the lack of effective early detection methods. Accuracies of the human epididymis protein 4 (HE4) and mesothelin in detecting ovarian cancer have never been systematically assessed. The current systematic review aimed to tackle this issue. Methods: MEDLINE, EMBASE, and Cochrane databases were searched (September 1995-November 2011) for studies on the diagnostic performances of HE4 and mesothelin in differentiating ovarian cancer from other benign gynecologic diseases. QUADAS items were used to evaluate the qualities of the studies. Meta-DiSc software was used to handle data from the included studies and to examine heterogeneity. All included studies for diagnostic performance were combined with sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratios (DORs) with 95% confidence intervals (CIs), summary receiver operating characteristic (SROC) curves, and areas under the SROC curves (AUC). Results: A total of 18 studies and 3,865 patients were eligible for the final analysis. The pooled sensitivity estimates for HE4 (74.4%) were significantly higher than those for mesothelin (49.3%). The pooled specificity estimates for mesothelin (94.5%) were higher than those for HE4 (85.8%). The pooled DOR estimates for HE4 (26.22) were higher than those for mesothelin (24.01). The SROC curve for HE4 showed better diagnostic accuracy than that for mesothelin. The PLR and NLR of HE4 were 6.33 (95% CI: 3.58 to 11.18) and 0.27 (95% CI: 0.21 to 0.34), respectively. The PLR and NLR for mesothelin were 11.0 (95% CI: 6.21 to 19.59) and 0.51 (95% CI: 0.42 to 0.62), respectively. The combination of the two tumor markers or their combination with CA-125 increased sensitivity and specificity to different extents. Conclusion: The diagnostic accuracy of HE4 in differentiating ovarian cancer from other benign gynecologic diseases is better than that of soluble mesothelin-related protein. Combinations of two or more tumor markers show more sensitivity and specificity.

• Journal of Periodontal and Implant Science
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• v.21 no.2
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• pp.188.1-188.1
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• 1991

• Journal of Chest Surgery
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• v.19 no.3
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• pp.429-432
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• 1986

Cardiac myxoma is most significant benign tumors constituting nearly 50% of all primary cardiac tumors. Its diagnosis is important because prognosis is excellent by surgical therapy and is usually fatal if unrecognized and untreated. Recently the development of diagnostic procedure and cardiac surgery increased the accuracy of diagnosis and the opportunity of successful treatment. Two cases of left atrial myxoma removed successfully were presented.

• Korean Journal of Head & Neck Oncology
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• v.27 no.2
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• pp.204-209
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• 2011

Background and Objectives : The usefulness of fine needle aspiration biopsy(FNAB) for diagnosis of parotid gland tumors is controversial, because of the generalized belief requiring surgery for most parotid tumors. The aim of this study was to evaluate the efficacy of FNAB for diagnosis in parotid gland tumors. Material and Methods : FNAB was performed in 91 patients who underwent parotid surgery at Kangbuk Samsung Hospital from January 2007 to December 2010. The result of FNAB, 11 malignancies and 75 benign tumors and 5 non-neoplasms were analyzed and compared with the final histopathologic diagnoses. Sensitivity, specificity, accuracy, positive predictive value(PPV), and negative predictive value(NPV) were calculated using final histopathologic diagnosis of the surgical specimen as the standard diagnostic reference for comparative analysis. Results : 86 specimens(94.5%) were suitable for evaluation. We compared the result of FNAB and the final histopathology in 79(89.4%) cases. The sensitivity, specificity, accuracy, PPV, and NPV of FNAB for detecting pleomorphic adenoma was 95.8%, 88.4%, 92.3%, 90.2%, and 95.0%. In Warthin's tumor, results were 86.4%, 94.2%, 92.3%, 82.6%, and 95.6%. Among 11 patients who were diagnosed with malignancy on final histopathologic report, only 3(30%) patients were diagnosed with the same as on FNAB, the other 8 patients were initially diagnosed incorrectly as benign tumors in FNAB. There were no complications related to FNAB. Conclusion : Diagnostic accuracy for FNAB in benign parotid tumors was high. However, in malignant tumors, FNAB shows low diagnostic usefulness compared with benign tumors. FNAB can be effective and safe diagnostic technique for evaluating the benign parotid glands tumors.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.2
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• pp.551-557
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• 2015

Background: Differentiating morphologic features based on hematoxylin-eosin (HE) staining is the most common method to classify pathological subtypes of non-small-cell lung cancer (NSCLC). However, its accuracy and inter-observer reproducibility in pathological diagnosis of poorly differentiated NSCLC remained to be improved. Materials and Methods: We attempted to explore the role of immunohistochemistry (IHC) staining in diagnosing pulmonary squamous cell carcinoma (SQCC) with poorly differentiated features by HE staining or with elevated serum adenocarcinoma-specific tumor markers (AD-TMs). We also compared the difference of epidermal growth factor receptor (EGFR) mutation rate between patients with confirmed SQCC and those with revised pathological subtype. Logistic regression analyses were used to test the association between different factors and diagnostic accuracy. Results: A total of 132 patients who met the eligible criteria and had adequate specimens for IHC confirmation were included. Pathological revised cases in poor differentiated subgroup, biopsy samples and high-level AD-TMs cases were more than those with high/moderate differentiation, surgical specimens and normal-level AD-TMs. Moreover, biopsy sample was a significant factor decreasing diagnostic accuracy of pathological subtype (OR, 4.037; 95% CI 1.446-11.267, p=0.008). Additionally, EGFR mutation rate was higher in patients with pathological diagnostic changes than those with confirmed SQCC (16.7% vs 4.4%, p=0.157). Conclusions: Diagnosis based on HE staining only might cause pathological misinterpretation in NSCLC patients with poor differentiation or high-level AD-TMs, especially those with biopsy samples. HE staining and IHC should be combined as pathological diagnostic standard. The occurrence of EGFR mutations in pulmonary SQCC might be overestimated.

• Imaging Science in Dentistry
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• v.30 no.3
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• pp.155-158
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• 2000

The purpose of this paper is to explain the making procedure and the usage of receiver operating characteristic (ROC) curve for interpretation of radiographic images. The conventional radiograms obtained after the creation of the lesions in the acrylic plates and were enhanced in color. The observer were informed of which tooth to examine, the 'a priori' probability of a lesion present and the approximate diameter of the lesions. The two groups of films were interpreted separately by the same observer using the same rating scale. The following rating scale was used: A; definitely no lesion, B; probably no lesion, C; not sure, D; probably a lesion, and E; definitely a lesion. In analysis, for each observer the diagnostic results in terms of true positive (TP) and false positive (FP) decisions were plotted on a graph. The lowest point on the graph represents the TP and FP when only decisions designated as E according to the rating scale are included. The next point shows the TP and FP values when diagnoses designated as D are added and so forth. By connecting such plot points, a receiver operating characteristic (ROC) curves is obtained. The area under the curve represents the diagnostic accuracy resulting from a diagnostic performance at pure chance level and a value of 1.0 at perfect performance. This method has been known as an useful method to detect the minute difference for each radiographic technic, each observer and for the different lesion depths.

• Journal of Trauma and Injury
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• v.30 no.4
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• pp.158-165
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• 2017

Purpose: The purpose of this study was to evaluate the diagnostic accuracy of X-rays in patients with acute traumatic vertebral fractures visiting the emergency department and to analyze the diagnostic value of X-rays for each spine level. Methods: We retrospectively analyzed basal characteristics by reviewing medical records of 363 patients with adult traumatic vertebral fractures, admitted to the emergency center from March 1, 2014 to February 28, 2017. We analyzed spine X-rays and magnetic resonance imaging (MRI) scans to determine distribution according to the vertebral level, and we evaluated the efficacy of X-rays by comparing discrepancies between X-rays and MRI scans. Results: For a total of 363 patients, the mean age was 56.65 (20-93) and 214 (59%) were males. On the basis of X-rays, 67 cases (15.1%) were of the cervical spine, 133 cases (30.0%) were of the thoracic spine, and 243 cases (54.9%) were of the lumbar spine. In particular, the thoracolumbar region (T11-L2) was the most common, with 260 cases (58.7%). In X-rays, fractures were the least in the upper thoracic region (T1-T3), whereas MRI scans revealed fairly uniform distribution across the thoracic spine. Sensitivity of X-rays was lowest in the upper thoracic spine and specificity was almost always greater than 98%, except for 94.7% in L1. Positive predictive value was lower in the mid-thoracic region (T4-T9) and negative predictive value was slightly lower in C6, T2, and T3 than at other sites. Diagnostic accuracy of X-rays by vertebral body, transverse process, and spinous process according to fractured vertebral structures was significantly different according to vertebral level. Conclusions: Diagnostic accuracy of X-rays was lower in the upper thoracic region than in other parts. Further studies are needed to identify better methods for diagnosis considering cost and neurological prognosis.