ABSTRACT
OBJECTIVES: We evaluated the validity and reliability of ultrasonography measurement of rectus femoris cross-sectional area compared to computed tomography in patients in pre-dialysis chronic kidney disease and analyzed the association between these measurements and the diagnosis of sarcopenia. METHODS: One hundred patients with nondialysis chronic kidney disease were evaluated. Sarcopenia was defined using the criteria of the Foundation for the National Institutes of Health Sarcopenia Project (FNIH). The rectus femoris cross-sectional area was evaluated using ultrasonography and computed tomography. RESULTS: The prevalence of sarcopenia was 29% according to the FNIH criteria. The difference in mean rectus femoris cross-sectional area by ultrasonography and computed tomography was 3.97 mm, with a strong correlation between the two methods (p<0.001). Bland-Altman plot analysis showed good agreement between computed tomography and ultrasonography. Rectus femoris cross-sectional area was significantly correlated with muscle strength (r=0.300, p=0.002), lean body mass in the upper limbs (r=0.286, p=0.004), and lean body mass in the lower limbs (r=0.271, p=0.006). The prevalence of sarcopenia was 12% (n=12) based on the definition of low muscle mass according to ultrasonography of the rectus femoris cross-sectional area. CONCLUSION: Ultrasonography was demonstrated to be a valid and reliable method for evaluating the rectus femoris cross-sectional area in patients in pre-dialysis chronic kidney disease.
Subject(s)
Humans , Male , Female , Aged , Quadriceps Muscle/diagnostic imaging , Renal Insufficiency, Chronic/complications , Sarcopenia/diagnostic imaging , Tomography, X-Ray Computed , Cross-Sectional Studies , Reproducibility of Results , Ultrasonography , Sarcopenia/complicationsABSTRACT
A graduação de Gleason é amplamente utilizada na avaliação histopatológica dos carcinomas prostáticos por ter boa reprodução intra e interobservadores. O grau de concordância interobservadores na utilização desta graduação entre uropatologistas, patologistas gerais e médicos residentes em patologia foi avaliado neste estudo em âmbito nacional. Foram selecionadas randomicamente lâminas de biópsia de próstata guiada por agulha de 30 pacientes com diagnóstico de adenocarcinoma confirmado por análise da peça cirúrgica e pesquisa imunoistoquímica de citoqueratina de alto peso molecular, no Cito Laboratório de Citopatologia Ltda, no período de junho de 1998 a julho de 1999. Cada lâmina foi fotografada em três aumentos: 40, 100 e 200x. As fotos dos 3 casos foram disponibilizadas na página do Departamento de Patologia da Faculdade de Medicina da Universidade Federal de Juiz de Fora (www.patologia.ufjf.br), junto de carta convite e questionário demográfico, endereçados aos patologistas que acessam o PATOCTO (patocito@yahoogroups.com.br), para graduação on-line das biópsias. Os resultados das graduações foram alocados em gráficos de acordo com a distribuição dos percentuais de acerto e cruzamento com os dados demográficos. Foi considerado "verdadeiro" diagnóstico aquele em que a graduação de Gleason obteve maior percentual de consenso. O grau de concordância média global de acerto entre os participantes foi de 65,20% e 79,68% o grau máximo de concordância no escore considerado verdadeiro diagnóstico. Este índice de reprodutibilidade com escore idêntico, tendo em vista a variação de + ou - 1 no escore considerado o "verdadeiro" diagnóstico, passou a 85%, o que vai ao encontro de trabalhos realizados pelo próprio Gleason, idealizador da graduação, e de outros citados na literatura. A presente experiência revela-se importante ferramenta instrucional on-line, podendo ser utilizada em programas de educação continuada.
Because it has good intra and interobserver reproducibility, Gleason`s score is widely used for the histopathological assessment of prostate carcinomas. This was a nationwide study assessing the interobserver agreement of uropathologists, general pathologists and pathology residents, concerning the use of Gleason's score. Slides from 30 patients, with a diagnosis of adenocarcinoma confirmed by analysis of the prostatectomy specimen and immunohistochemical analysis of high-molecular weight cytokeratin, were randomly selected from the needle-guided prostate biopsy specimens of the Cito Laboratory of Cytopathology, Juiz de Fora, MG, Brazil, during the period June 1998 through July 1999. Each slide was photographed at three magnification powers: 40, 100 and 200x. The photos from the 30 cases were made available on-line, for grading of the biopsy materials, in the website of the Pathology Department of the School of Medicine of the Juiz de Fora Federal University (www.patologia.ufjf.br), along with an invitation letter and demographic questionnaire, addressed to pathologists accessing the PATOCITO website (patocito@yahoogroups.com.br). Grading results were graphically plotted according to the percentages of correct diagnoses and against the demographic data. "True" diagnosis was considered that for which Gleason's score reached higher consensus. Mean total agreement was 65.20%, with maximum agreement of 79.68% for the score considered to be the "true" diagnosis. This reproducibility index with identical score, with + or - 1 variation in the score considered to be the "true" diagnosis, reached 85%, consistent with data by Gleason himself and the literature. This experience presents an important on-line tool which may be used for continuing medical education.