Diagnostic Yield of Diffusion-Weighted Brain Magnetic Resonance Imaging in Patients with Transient Global Amnesia: A Systematic Review and Meta-Analysis

Lim Su Jin,Kim Minjae,Suh Chong Hyun,Kim Sang Yeong,Shim Woo Hyun,Kim Sang Joon 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.10

Objective: To investigate the diagnostic yield of diffusion-weighted imaging (DWI) in patients with transient global amnesia (TGA) and identify significant parameters affecting diagnostic yield. Materials and Methods: A systematic literature search of the MEDLINE and EMBASE databases was conducted to identify studies that assessed the diagnostic yield of DWI in patients with TGA. The pooled diagnostic yield of DWI in patients with TGA was calculated using the DerSimonian-Laird random-effects model. Subgroup analyses were also performed of slice thickness, magnetic field strength, and interval between symptom onset and DWI. Results: Twenty-two original articles (1732 patients) were included. The pooled incidence of right, left, and bilateral hippocampal lesions was 37% (95% confidence interval [CI], 30–44%), 42% (95% CI, 39–46%), and 25% (95% CI, 20–30%) of all lesions, respectively. The pooled diagnostic yield of DWI in patients with TGA was 39% (95% CI, 27–52%). The Higgins I2 statistic showed significant heterogeneity (I2 = 95%). DWI with a slice thickness ≤ 3 mm showed a higher diagnostic yield than DWI with a slice thickness > 3 mm (pooled diagnostic yield: 63% [95% CI, 53–72%] vs. 26% [95% CI, 16–40%], p < 0.01). DWI performed at an interval between 24 and 96 hours after symptom onset showed a higher diagnostic yield (68% [95% CI, 57–78%], p < 0.01) than DWI performed within 24 hours (16% [95% CI, 7–34%]) or later than 96 hours (15% [95% CI, 8–26%]). There was no difference in the diagnostic yield between DWI performed using 3T vs. 1.5T (pooled diagnostic yield, 31% [95% CI, 25–38%] vs. 24% [95% CI, 14–37%], p = 0.31). Conclusion: The pooled diagnostic yield of DWI in TGA patients was 39%. DWI obtained with a slice thickness ≤ 3 mm or an interval between symptom onset and DWI of > 24 to 96 hours could increase the diagnostic yield.

Use of “Diagnostic Yield” in Imaging Research Reports: Results from Articles Published in Two General Radiology Journals

Park Ho Young,서정현,Seon-Ok Kim 대한영상의학회 2022 Korean Journal of Radiology Vol.23 No.12

Objective: “Diagnostic yield,” also referred to as the detection rate, is a parameter positioned between diagnostic accuracy and diagnosis-related patient outcomes in research studies that assess diagnostic tests. Unfamiliarity with the term may lead to incorrect usage and delivery of information. Herein, we evaluate the level of proper use of the term “diagnostic yield” and its related parameters in articles published in Radiology and Korean Journal of Radiology (KJR). Materials and Methods: Potentially relevant articles published since 2012 in these journals were identified using MEDLINE and PubMed Central databases. The initial search yielded 239 articles. We evaluated whether the correct definition and study setting of “diagnostic yield” or “detection rate” were used and whether the articles also reported companion parameters for false-positive results. We calculated the proportion of articles that correctly used these parameters and evaluated whether the proportion increased with time (2012–2016 vs. 2017–2022). Results: Among 39 eligible articles (19 from Radiology and 20 from KJR), 17 (43.6%; 11 from Radiology and 6 from KJR) correctly defined “diagnostic yield” or “detection rate.” The remaining 22 articles used “diagnostic yield” or “detection rate” with incorrect meanings such as “diagnostic performance” or “sensitivity.” The proportion of correctly used diagnostic terms was higher in the studies published in Radiology than in those published in KJR (57.9% vs. 30.0%). The proportion improved with time in Radiology (33.3% vs. 80.0%), whereas no improvement was observed in KJR over time (33.3% vs. 27.3%). The proportion of studies reporting companion parameters was similar between journals (72.7% vs. 66.7%), and no considerable improvement was observed over time. Conclusion: Overall, a minority of articles accurately used “diagnostic yield” or “detection rate.” Incorrect usage of the terms was more frequent without improvement over time in KJR than in Radiology. Therefore, improvements are required in the use and reporting of these parameters.

대장내시경 적응증의 적절성 및 진단율과의 연관성 조사

이춘영,이충현,김영호,이종우,박동일,성인경,김신연 대한소화기내시경학회 2009 Clinical Endoscopy Vol.38 No.6

Background/Aims: We wanted to evaluate if the guidelines for appropriately performing colonoscopy by the American Society for Gastrointestinal Endoscopy (ASGE) yield good diagnostic efficacy, and we wanted to assess the appropriateness of referrals. Methods: A total of 2,412 consecutive patients (1,605 men and 807 women) who were undergoing colonoscopy from September 2006 to February 2007 were prospectively enrolled in the study. The diagnostic yield was defined as the percentage of relevant colonic pathologies of the total number of performed colonoscopies. The 2000 ASGE guidelines were used to assess the appropriateness of the indications for the procedure. Results: The large majority (64.2%) of patients had colonoscopy for an indication that was considered ‘generally indicated’, while the procedure was considered ‘generally not indicated’ for 22.4% of the patients. The diagnostic yield of colonoscopy was significantly higher for the appropriate colonoscopies (59.1%) than for the inappropriate colonoscopies (23.2%). On the multivariable analysis, the diagnostic yield was independently associated with the appropriateness of the indication that was “generally indicated” (odds ratio=9.5) and with the referrals by a gastroenterologist (odds ratio=1.7). Conclusions: The ASGE guidelines have shown a good diagnostic yield. Further steps are required to update and standardize the guidelines to increase the diagnostic yield. 목적: 지난 수년간 대장암과 대장용종에 대한 관심이 높아지면서, 여러 가지 선별검사에서 이상소견을 보이는 경우에 시행되는 대장내시경의 건수도 증가하였지만, 증상이 없고 대장암의 위험요인이 없는 경우에도 대장내시경을 받길 원하는 사람이 지속적으로 증가하고 있다. 본 연구는 2000년 미국 소화기내시경 학회에서 제정한 대장내시경 적응증의 유용성을 전향적 연구를 통해 평가하고자 하였다. 대상 및 방법: 삼성서울병원, 건국대학교병원, 강북삼성병원에서 2006년 9월부터 2007년 2월까지 대장내시경 검사가 의뢰된 2,412명의 환자들을 사전 설문조사 후 대장내시경 검사를 시행하여 전향적으로 조사하였다. 대장내시경 적응증의 적절성을 평가하기 위해 2000년에 발표된 미국 소화기내시경학회의 진료지침이 사용되었고, 진단율은 각각의 적응증으로 시행된 전체 대장내시경 건수 분의 유의한 소견을 보인 건수로 정의 하였다. 결과: 64.2%의 환자군은 미국 소화기내시경 학회 진료지침의 ‘generally indicated’군에 해당하는 적응증으로 대장내시경을 시행하였고, 22.4%의 환자는 ‘generally not indicated’, 13.4%의 환자에서는 ‘not listed’군에 해당하는 적응증으로 대장내시경을 시행하였다. 진단율은 ‘generally indicated’군에서 59.1%, ‘generally not indicated’군에서 23.2%, ‘not listed’군에서 21.9%를 보였으며 다변량분석 시행결과, 진단율은 대장내시경 적응증의 적절성 여부와 유의한 상관관계를 보였고(Odds ratio=9.5, p<0.001), 소화기내과 의사에 의해 의뢰된 대장내시경 검사의 진단율이 타과의사에 의해 의뢰된 경우보다 유의하게 높은 진단율을 보였다(Odds ratio=1.7, p<0.01). 결론: 대장내시경 검사의 진단율은 의뢰된 적응증의 적절성과 유의한 연관성이 있었고 내시경 처방의의 전공과목과도 유의한 연관성이 있었다.

Utility and Safety of Sole Electromagnetic Navigation Bronchoscopy Under Moderate Sedation for Lung Cancer Diagnosis

( Yeon Wook Kim ),( Hyung-jun Kim ),( Myung Jin Song ),( Byoung Soo Kwon ),( Sung Yoon Lim ),( Yeon Joo Lee ),( Jong Sun Park ),( Young-jae Cho ),( Ho Il Yoon ),( Jae Ho Lee ),( Choon-taek Lee ) 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Purpose Electromagnetic navigation bronchoscopy is an emerging technique for diagnosing pulmonary lesions. However, limited data is available on its utility under a least-invasive without general anesthesia. This study aimed to evaluate the diagnostic performance and safety of sole ENB procedure under moderate sedation for the diagnosis of pulmonary lesions suspicious for lung cancer, and determine clinical factors associated with better diagnostic yield. Method We performed a retrospective analysis of consecutive patients who underwent sole ENB under moderate sedation for lung lesion biopsy between August 2016 and June 2021 at Seoul National University Bundang Hospital, a tertiary center in South Korea. Diagnostic yield of the ENB-guided biopsy, safety endpoints defined by incidence and severity of associated complications, and factors associated with higher diagnostic yield were evaluated. Result A total of 94 patients were evaluated. The final diagnostic yield of ENB was 81.5% excluding the 2 indeterminate cases. The diagnostic yield ranged from 79.8% to 81.9% assuming all indeterminate cases were false-negatives and true-negatives, respectively. Sensitivity and specificity for malignancy were 77.6% (ranged 75.6% to 77.6%) and 100%, respectively. Any-grade pneumothorax occurred in 4 of 94 (4.3%), and 2.1 (2/94%) developed pneumothorax requiring additional intervention. No respiratory failure events or deaths related to ENB were reported. By multivariable analyses, the presence of a class 2 bronchus sign was the only significant predictor for a higher diagnostic yield (OR = 4.83, 95% CI = 1.16 - 20.12). The diagnostic yield of ENB among those with class 2 bronchus sign was 89.8% (53/59). Conclusion Sole ENB under moderate sedation for the diagnosis of pulmonary lesions showed good diagnostic yield and safety profile, supporting the utility of ENB procedure in the least-invasive setting. For diagnosis of lesions with class 2 bronchus sign, sole ENB can possibly be superior to transthoracic needle aspiration.

MiroCam® 캡슐내시경 검사의 완전 소장 검사 및 양성 진단에 영향을 미치는 요인

정원호 ( Wonho Jung ),고진성 ( Jin Sung Koh ),김성호 ( Sung Ho Kim ),임상아 ( Sang Ah Lim ),임은혜 ( Eun Hye Lim ),이준영 ( Joon Young Lee ),주문경 ( Moon Kyung Joo ),이범재 ( Beom Jae Lee ),김지훈 ( Ji Hoon Kim ),연종은 ( Jong Eu 대한장연구학회 2011 Intestinal Research Vol.9 No.1

Background/Aims: Mirocam® capsule endoscopy has been widely used in Korea; however, data with respect to Mirocam® capsule endoscopy is lacking. We have assessed the factors affecting complete small bowel studies and diagnostic yield in Mirocam® capsule endoscopic studies. Methods: We retrospectively analyzed 103 cases that were assessed with Mirocam® capsule endoscopy between June 2007 and February 2010 at Guro Korea University Hospital. Results: The mean age of the 103 cases was 55.47 years (range, 16-99 years) and 67 cases (65%) were male. The indications for capsule endoscopy were hematochezia/melena (77 cases, 74.8%), anemia (8 cases, 7.8%), abdominal pain (12 cases, 11.7%), and miscellaneous (weight loss and chronic diarrhea; 6 cases, 5.8%). The mean stomach transit time was 59.9±88.3 minutes (range, 1-630 minutes) and the mean small bowel transit time was 396.0±131.7 minutes (range, 117-708 minutes). The rate of successfully performing a complete small bowel study was 82.5% (85 cases), and the stomach transit time was a significant factor for a complete small bowel study (OR=0.991, 95% CI= 0.984-0.998, P=0.012). The diagnostic yield was 51.5% (53 cases); visual quality was a significant factor in determining the diagnostic yield (OR=6.776, 95% CI=1.32-34.70, P=0.022). Conclusions: In a Mirocam® capsule endoscopic study, short stomach transit time was a significant factor affecting completion of the small bowel study. Achieving excellent visual quality by good bowel preparation was a significant factor for improving the diagnostic yield. (Intest Res 2011;9:0-34)

Extended use of P504S Positive Primary Circulating Prostate Cell Detection to Determine the Need for Initial Prostate Biopsy in a Prostate Cancer Screening Program in Chile

Murray, Nigel P.,Reyes, Eduardo,Fuentealba, Cynthia,Jacob, Omar,Orellana, Nelson Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.21

Background: To determine the frequency of primary circulating prostate cells (CPC) detection according to age and serum PSA levels in a cohort of men undergoing screening for prostate cancer and to determine the diagnostic yield in those men complying with the criteria for prostate biopsy. Materials and Methods: A prospective study was carried out to analyze all men evaluated in a hospital prostate cancer screening program. Primary CPCs were obtained by differential gel centrifugation and detected using standard immunocytochemistry using anti-PSA, positive samples undergoing a second process with anti-P504S. A malignant primary CPC was defined as PSA+ P504S+, and a test positive if 1 cell/4ml was detected. The frequency of primary CPC detection was compared with age and serum PSA levels. Men with a PSA >4.0ng/ml and/or abnormal rectal examination underwent 12 core prostate biopsy, and the results were registered as cancer/no-cancer and compared with the presence/absence of primary CPCs to calculate the diagnostic yield. Results: A total of 1,117 men participated; there was an association of primary CPC detection with increasing age and increasing serum PSA. Some 559 men underwent initial prostate biopsy of whom 207/559 (37.0%) were positive for primary CPCs and 183/559 (32.0%) had prostate cancer detected. The diagnostic yield of primary CPCs had a sensitivity of 88.5%, a specificity of 88.0%, and positive and negative predictive values of 78.3% and 94.9%, respectively. Conclusions: The use of primary CPCs for testing is recommended, since its high negative predictive value could be used to avoid prostate biopsy in men with an elevated PSA and/or abnormal DRE. Men positive for primary CPCs should undergo prostate biopsy. It is a test that could be implemented in the routine immunocytochemical laboratory.

Factors Related to Diagnostic Yield of Lung Biopsy Using both Radial EBUS and Fluoroscopy

( Seung Hyun Yong ),( Soojoung Yu ),( Young Mok Park ),( A La Woo ),( Ah Young Leem ),( Su Hwan Lee ),( Sang Hoon Lee ),( Kyung Soo Chung ),( Song Yee Kim ),( Eun Young Kim ),( Ji Ye Jung ),( Young Ae 대한결핵 및 호흡기학회 2021 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.129 No.-

Background Transbronchial lung biopsy (TBLB) is a key modality in the diagnosis of peripheral lung lesions. Radial EBUS is new diagnostic technology which can apply to enhance the accuracy of peripheral lung biopsy during bronchoscopy. The purpose of this study was to investigate factors related to diagnostic yield of TBLB with radial EBUS Method A retrospective analysis on the diagnostic yield of TBLB under fluoroscopy consist with radial EBUS, with or without guide sheath (GS) was conducted. Data included TBB that was performed from 2020 to 2021 at a single center by a single operator Results 294 patients with confirmed final diagnoses were included in this study. Definitive diagnosis was established by TBLB in 117/155 (75.48%) patients using radial EBUS without GS, 55/69 (79.71%) patients using EBUS with GS, and 54/70 (77.14%) patients whose tissues were obtained partly without GS and partly with GS. We compared diagnostic yield by type pulmonary lesion which was inconsistent between the diagnostic modalities, but overall, solid lesions had highest diagnostic yield (77.05%) compared to pure ground glass opacities (75%) and part-solid lesions (76.09%). Lung cancer patients that underwent rebiopsy were analyzed in this study which showed diagnostic yield of 68.29%. Diagnostic yield showed improvement over time in radial EBUS assisted TBLB cases that did not use GS with yield of 59.62% in 2020 and 83.5% in 2021. Conclusion For many decades there has not been another diagnostic method to enhance the TBLB in diagnosis of peripheral pulmonary lesions until radial EBUS is introduced. This investigation reviewed current diagnostic usage of TBLB accompanied by radial EBUS and compared diagnostic yields not only by size and targeting, but solid components and exam period as well. Further studies on re-biopsy by TBLB will be needed to learn more about its significance in clinical application.

Diagnostic Yield and Safety of Biopsy Guided by Electromagnetic Navigation Bronchoscopy for High-risk Pulmonary Nodules

( Ju Hyun Oh ),( Chang-min Choi ),( Woo Sung Kim ),( Hee Sang Hwang ),( Se Jin Jang ),( Sang Young Oh ),( Mi Young Kim ),( Jae Cheol Lee ),( Wonjun Ji ) 대한결핵 및 호흡기학회 2020 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.128 No.-

Introduction Electromagnetic navigation bronchoscopy (ENB) is a useful tool that allows to access peripheral lung nodules. But little is known about its diagnostic yield and safety in evaluating pulmonary nodules that cannot be accessed by percutaneous transthoracic needle biopsy (PCNB). Methods In this single center retrospective study, we reviewed the patients performed ENB for peripheral pulmonary nodules which were difficult to get tissues by PCNB Method. Patients who had endobronchial lesions observed by conventional bronchoscopy before ENB and inaccessible ENB cases were excluded from analysis. All procedure was performed under light sedation using intravenous midazolam and fentanyl. Results Total 100 pulmonary nodules in 91 patients underwent ENB between November 2018 and April 2020 were analyzed. The median age of study population was 66[59-73] years, the male was 61.1% (55/90). The mean diameter of lung nodules was 27.9±13.7 mm. About half of the nodules were found in upper lobe(49.0%) and 55% of nodules were solid. The diagnostic yield of ENB guided biopsy was 53.0% (53/100). Although nodule size (Odd ratio (OR) 1.055, 95% confidential interval (CI) 1.015- 1.097, p=0.007) and positive airbroncho-sign (OR 2.229, 95%CI 0.974-5.102, p=0.058) were associated with diagnostic yields in univariate analysis, nodule size was independent variable affecting diagnostic yield in multivariable analysis. Interestingly, the diagnosis yield showed increased pattern after 60 cases from 45% to 65%.(Figure 1) 16 patients (17.6%) were experienced the procedure-related complication events. The pneumothorax occurred in 3 patients (3.3%). Although the bleeding complication occurred in 13 patients (14.3%), only 4 patients (4.4%) showed moderate bleeding. There was no major bleeding or death related to the procedure. Conclusions In this study, ENB guided biopsy showed an increased pattern of the diagnostic yield according to experience accumulation, and acceptable good safety profile to evaluate peripheral pulmonary nodules even if percutaneous approach was difficult and dangerous.

소아청소년에서 주증상에 기초한 대장 내시경 검사의 진단적 성과분석

조윤정,조일현,유효주,최황,이보인,김상용,정대철,정승연,강진한 대한소아소화기영양학회 2011 Pediatric gastroenterology, hepatology & nutrition Vol.14 No.4

Purpose: We performed this study retrospectively to review the diagnostic yield of colonoscopies in children and adolescents with various gastrointestinal symptoms and to investigate the relationship between presenting symptoms and the colonoscopic findings in a secondary hospital. Methods: We reviewed the medical records of patients under the age of 19-years who underwent ileocolonoscopy between January 2001 and December 2010. The total number of patients (n=238) were divided into three age groups and six symptom groups. We analyzed clinical characteristics and the colonoscopic findings, and compared the colonoscopic yield between each groups. Results: The median age of the patients was 16.1 (3.1∼18.9) years. The most common presenting symptoms were lower gastrointestinal (GI) bleeding (48.1%) in the ≤12 years group (n=27), chronic abdominal pain (31.8%) in the 13∼15 years group (n=85), and chronic diarrhea (34.9%) in the ≥16 years group (n=126). Positive colonoscopic findings were found in 21.4% of the bowel habit change group (n=28), 51.9% of the low GI bleeding group (n=54), 37.7% of the chronic diarrhea group (n=69), and 94.4% of the group with suspected inflammatory bowel disease (IBD) (n=18), 38.9% of the chronic abdominal pain group (n=54) and 13.3% of the anemia group (n=15). The diagnostic yield of the total examination was 42.0%. The suspected IBD group had a higher yield than the presenting symptom groups (p<0.001). Conclusion: Colonoscopy is a safe and useful investigation in children and adolescents with suspected colonic disease. The diagnostic yield of colonoscopy is higher in patients presenting with suspected IBD. Pediatricians practicing in primary or secondary care settings should recommend colonoscopy for patients with suspected IBD. (Korean J Pediatr Gastroenterol Nutr 2011; 14: 368∼375)

Diagnostic Value of Computed Tomography in Crohn’s Disease Patients Presenting with Acute Severe Lower Gastrointestinal Bleeding

이선영,예병덕,Seong Ho Park,Kyung Jin Lee,Ah Young Kim,이종석,김현진,Suk-Kyun Yang 대한영상의학회 2018 Korean Journal of Radiology Vol.19 No.6

Objective: To investigate the diagnostic yield of contrast-enhanced computed tomography (CT) in Crohn’s disease (CD) patients presenting with acute severe lower gastrointestinal bleeding (LGIB), and the role of CT in predicting the risk of rebleeding. Materials and Methods: A consecutive series of 110 CD patients presenting with acute severe LGIB between 2005 and 2016 were analyzed. Among them, 86 patients who had undergone contrast-enhanced CT constituted the study cohort. The diagnostic yield of CT for detecting contrast extravasation was obtained for the entire cohort and compared between different CT techniques. In a subgroup of 62 patients who had undergone CT enterography (CTE) and showed a negative result for extravasation on CTE, the association between various clinical and CTE parameters and the risk of rebleeding during subsequent follow-up was investigated using Cox regression analysis. Results: The diagnostic yield of CT was 10.5% (9 of 86 patients). The yield did not significantly differ between singlephase and multiphase examinations (p > 0.999), or between non-enterographic CT and CTE (p = 0.388). Extensive CD (adjusted hazard ratio [HR], 3.27; 95% confidence interval [CI], 1.09–9.80; p = 0.034) and bowel wall-to-artery enhancement ratio (adjusted HR, 2.81; 95% CI, 1.21–6.54; p = 0.016) were significantly independently associated with increased rebleeding risks, whereas anti-tumor necrosis factor-α therapy after the bleeding independently decreased the risk of rebleeding (adjusted HR, 0.26; 95% CI, 0.07–0.95; p = 0.041). Conclusion: The diagnostic yield of contrast-enhanced CT was not high in CD patients presenting with acute severe LGIB. Nevertheless, even a negative CTE may be beneficial as it can help predict the risk of later rebleeding.