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Assessing and responding to sudden deterioration in the adult
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
A sputum specimen may be sent for microbiological examination if infection, including tuberculosis (TB), is suspected. It may also be sent for cytology – examination for abnormal (e.g. cancerous) cells. Box 14.37 outlines the equipment needed, and the procedure and additional points are discussed below.
Postoperative margin assessment (re-excision or completion mastectomy)
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Intraoperative pathological assessment—Both frozen section and touch imprint cytology are time consuming and require input from a pathologist; in terms of diagnostic accuracy, frozen section was found on meta-analysis to have a pooled sensitivity of 0.86 (95% CI 0.78–0.91) and specificity of 0.96 (95% CI 0.92–0.98), but with significant heterogeneity between studies. By comparison, cytology had a pooled sensitivity of 0.91 (95% CI 0.71–0.97) and specificity of 0.95 (95% CI 0.90–0.98).18 In terms of comparative performance, these tissue-based techniques are most accurate for intraoperative margin assessment, but have very poor uptake in routine clinical practice. This most likely relates to the logistical issues of slow turnaround times, disruption of operating lists, and availability of pathology staff.18 Use of frozen section in American practice is reported to reduce rates of re-operation from 13.2% to 3.6%,19 although it remains unclear what proportion of practices in the United States employ methods for intraoperative assessment of margins.18
Healthcare Data Organization
Published in Arvind Kumar Bansal, Javed Iqbal Khan, S. Kaisar Alam, Introduction to Computational Health Informatics, 2019
Arvind Kumar Bansal, Javed Iqbal Khan, S. Kaisar Alam
LOINC is a standardized code for lab tests, clinical measurements and observations. LOINC database includes: 1) observations reported by clinical laboratories; 2) results of therapeutic drug monitoring; 3) toxicology study of toxic compounds' built-in responses to the administration of therapeutic drugs; 4) serology – study of blood serum; 5) hematology – study of blood-related diseases affecting production and regulation of various components of blood such as blood cells, hemoglobin, blood proteins, bone marrow, platelets and mechanism of coagulations; 6) blood bank study; 7) microbiology, including lab results involving pathogens – disease causing bacteria; 8) cytology – study of cell structure and function including cell culture studies helpful for screening tests related to cancer cell detection using various body-fluids and brush tissues such as a pap-smear; 9) surgical pathology – study of the tissues removed using surgery and 10) fertility studies such as sperm count, ovulation tests, checking of hormone levels. The results include nontest level measurements such as menstrual cycles, drug doses and units of concentrations.
PAX1 and SEPT9 methylation analyses in cervical exfoliated cells are highly efficient for detecting cervical (pre)cancer in hrHPV-positive women
Published in Journal of Obstetrics and Gynaecology, 2023
Lulu He, Xiping Luo, Qiaowen Bu, Jing Jin, Shuai Zhou, Shaoyi He, Liang Zhang, Yu Lin, Xiaoshan Hong
Around the world, cytology and/or HPV-based screening are currently the most commonly used methods for cervical cancer screening (Partanen et al.2021). There is strong evidence that hrHPV testing has superior sensitivity for detecting cervical (pre)cancer (Elfstrom et al.2014). However, 90% of HPV infections clear the virus spontaneously; thus, HPV testing cannot identify transient infections (Giorgi-Rossi et al.2012, Vink et al.2020). The combined use of cytology and HPV testing maximises sensitivity, while increasing specificity to detect certain cervical (pre)cancers (Sahasrabuddhe et al.2011). However, the obvious disadvantages of cytology testing include high false-negative rates and the fact that cytology testing is easily affected by sampling, i.e. laboratory and pathologist-subjective interpretations. To date, even high-quality Pap cytology may miss >30% of cervical (pre)cancer cases (Lorincz 2016). Thus, it is important to find an efficient triage strategy that is sensitive enough to detect cervical (pre)cancer but that has high enough specificity to rule out HPV-positive women without potential for progression.
Mastocytosis and related entities: a practical roadmap
Published in Acta Clinica Belgica, 2023
Michiel Beyens, Jessy Elst, Marie-Line van der Poorten, Athina Van Gasse, Alessandro Toscano, Anke Verlinden, Katrien Vermeulen, Marie-Berthe Maes, J. N. G. Hanneke Oude Elberink, Didier Ebo, Vito Sabato
If a child presents with typical cutaneous lesions of mastocytosis one should obtain a thorough history and perform a complete physical examination. Laboratory tests include a complete blood count, serum electrolytes, transaminases and measurement of bST. Furthermore, an abdominal ultrasound should be performed. A bone densitometry is only recommended in selected cases (e.g. a child with unexplained bone pain). If a child with suspicious skin lesions presents with – (a) clinically significant abnormalities in cytology or biochemistry, (b) a bST >100 ng/mL or a rapidly rising bST or (c) obvious organomegaly – a BM biopsy should be obtained. The prevalence of SM in children with MIS is unclear, mostly because children undergo a bone marrow only when signs and symptoms suggest the presence of an advanced/progressive neoplasm. Detection of KIT (D816V) in peripheral blood and the morphology (e.g. monomorphic lesions) of skin lesions might be suggestive of systemic disease and might represent an indication for BM examination [17]. On the other hand, if no abnormalities are found, we suggest a watchful waiting approach in these patients, because of the invasive nature of a BM examination.
Optimal diagnostic strategies for pleural diseases and identifying high-risk patients
Published in Expert Review of Respiratory Medicine, 2023
D N Addala, P Denniston, A Sundaralingam, N M Rahman
The use of PF cytology has long been the initial step in diagnosing malignant pleural effusion (MPE), although many recent studies have brought into question the diagnostic utility of PF cytology alone. The diagnostic sensitivity of PF cytology is relatively low at 37–47% in patients with proven MPE[64,65]. Additionally, there is huge variation by cancer type, with diagnostic rates in malignant pleural mesothelioma (MPM) only 6%, as many MPMs do not release tumor cells into adjacent pleural fluid. Table 3 lists the diagnostic sensitivity of pleural fluid according to malignancy type. Another key factor when appraising the utility of cytology is the frequency with which PF cytology can guide specific, personalized oncological treatment. This is particularly relevant in the current era of targeted immuno-modulating treatment and the requirement for molecular marker identification on tumor cells to guide this. This is exemplified in lung adenocarcinoma, wherein current international guidelines recommend the testing for multiple gene mutations such as epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) in advance of initiating systemic therapy[66]. A recent retrospective dataset has found the molecular marker yield of PF cytology to be only 20%, and as such direct to biopsy strategies have been advocated, particularly in cases when pleural fluid yield is likely to be poor (such as in patients with history and imaging suggestive of mesothelioma)[67–69].