ABSTRACT
INTRODUCTION AND OBJECTIVE: Imaging diagnosis is essential for treatment planning in stroke patients. However, use of these techniques varies due to uncertainty about their effectiveness. Our purpose was to describe the use of CT and MRI in stroke and transient ischaemic attack (TIA) over 5years in hospitals belonging to the Canary Islands Health Service and analyse interhospital variability based on routinely collected administrative data. PATIENTS AND METHOD: We gathered the minimum basic dataset (MBDS) from patients diagnosed with stroke or TIA between 2005 and 2010 in 4hospitals. Patients' age, sex, procedures, secondary diagnoses, and duration of hospital stay were also recorded. We conducted a descriptive analysis of patient characteristics and a bivariate analysis using the t test and the chi square test to detect differences between patients assessed and not assessed with MRI. Logistic regression was used to analyse unequal access to MRI. RESULTS AND CONCLUSIONS: Our study included 10,487 patients (8,571 with stroke and 1,916 with TIA). The percentage of stroke patients undergoing a CT scan increased from 89.47% in 2005 to 91.50% in 2010. In these patients, use of MRI also increased from 25.41% in 2005 to 36.02% in 2010. Among patients with TIA, use of CT increased from 84.64% to 88.04% and MRI from 32.53% to 39.13%. According to our results, female sex, younger age, and presence of comorbidities increase the likelihood of undergoing MRI.
Subject(s)
Ischemic Attack, Transient/diagnostic imaging , Magnetic Resonance Imaging , Neuroimaging , Stroke/diagnostic imaging , Stroke/therapy , Tomography, X-Ray Computed , Age Factors , Aged , Female , Humans , Ischemic Attack, Transient/therapy , Length of Stay/statistics & numerical data , Male , Middle Aged , Sex Factors , SpainABSTRACT
Objetivo: Identificar los factores por los que un sumatorio de Gleason (SG) < 7 en la biopsia pase a ser ≥ 7 en la pieza quirúrgica. Material y métodos: Se estudiaron 185 pacientes operados por cáncer de próstata comparando el SG de las biopsias con el de las piezas quirúrgicas. Se calcularon la sensibilidad, especificidad y los valores predictivos del SG de la biopsia. La concordancia de la biopsia y la intervención quirúrgica para establecer SG < 7 y ≥ 7 fue estimada con el estadístico Kappa de Cohen. Se analizaron la edad, los antecedentes familiares de cáncer prostático, el antígeno prostático específico total (PSAt), el tacto transrectal, la estructura y el volumen prostáticos, y el número de cilindros de la biopsia (esquema de biopsia) utilizando una regresión logística multivariante. Resultados: La biopsia tuvo una alta sensibilidad (98%) y una baja especificidad (49%) para los SG ≤ 6; y una baja sensibilidad (35, 26%) y una alta especificidad (93, 99%) para los SG de 7 y ≥ 7, respectivamente. El índice Kappa de los SG fue de 0,43 (IC del 95%: 30-56%). El esquema de biopsia fue el único predictor del desacuerdo. Del resto de variables, solo el PSAt mostró una asociación significativa discreta. Tomando como referencia el esquema con < 7 cilindros, no hallamos diferencia con 8-9 cilindros, pero sí con 10-11, y ≥ 12 cilindros, con una razón de prevalencia de 0,138 (IC 95%: 0,030-0,513) y de 0,277 (IC 95%: 0,091-0,806), respectivamente. Conclusión: El SG de la biopsia depende del esquema. Este factor tiene que ser considerado a la hora de elegir una opción terapéutica en aquellos pacientes con un grado tumoral bajo en la biopsia (AU)
Objective: To identify factors that might explain why a prostate with a Gleason score (GS) <7 in the biopsy specimen can turn out to have a GS ≥7 in the surgical specimen.Material and methods: We compared the GS of biopsy specimens with the GS of surgical specimens in 185 patients who underwent surgery for prostate cancer. We calculated the sensitivity, specificity, and predictive values for the GS of the biopsy specimens. We used Cohens kappa to determine the degree of concordance between a GS of <7 and ≥7 for the biopsy specimen and the surgical specimen. Age, a family history of prostate cancer, total prostate-specific antigen (tPSA), digital rectal examination, prostate structure and volume, and the number of biopsy cores (biopsy scheme) were analyzed using multivariable logistic regression. Results: Histological study of biopsy specimens yielded high sensitivity (98%) but low specificity (49%) for GS ≤6 and low sensitivity (35, 26%) and high specificity (93, 99%) for GS=7 and GS ≥7, respectively. Cohens kappa for the GS from the biopsy and surgical specimens was 0.43 (95% CI=30-56%). The biopsy scheme was the only predictor of discordance in the GS between the two techniques. Among the other variables included in the model, only tPSA showed a slightly significant association. Taking a scheme with less than 7 cores as a reference, we found no difference with 8 to 9 cores but we did find a difference with 10 to 11 cores and with 12 or more cores, with a prevalence ratio of 0.138 (95% CI=0.030-0.513) and 0.277 (95% CI=0.091-0.806), respectively. Conclusion: The GS of the biopsy depends on the scheme. This factor must be taken into account when choosing a treatment option in patients with low tumor grade in biopsy specimens (AU)
Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Ultrasound, High-Intensity Focused, Transrectal/methods , Prostatic Neoplasms/diagnosis , Neoplasm Staging/methods , Image-Guided Biopsy/methods , Retrospective Studies , ProstatectomyABSTRACT
OBJECTIVE: To identify factors that might explain why a prostate with a Gleason score (GS) <7 in the biopsy specimen can turn out to have a GS ≥7 in the surgical specimen. MATERIAL AND METHODS: We compared the GS of biopsy specimens with the GS of surgical specimens in 185 patients who underwent surgery for prostate cancer. We calculated the sensitivity, specificity, and predictive values for the GS of the biopsy specimens. We used Cohen's kappa to determine the degree of concordance between a GS of <7 and ≥7 for the biopsy specimen and the surgical specimen. Age, a family history of prostate cancer, total prostate-specific antigen (tPSA), digital rectal examination, prostate structure and volume, and the number of biopsy cores (biopsy scheme) were analyzed using multivariable logistic regression. RESULTS: Histological study of biopsy specimens yielded high sensitivity (98%) but low specificity (49%) for GS ≤6 and low sensitivity (35, 26%) and high specificity (93, 99%) for GS=7 and GS ≥7, respectively. Cohen's kappa for the GS from the biopsy and surgical specimens was 0.43 (95% CI=30-56%). The biopsy scheme was the only predictor of discordance in the GS between the two techniques. Among the other variables included in the model, only tPSA showed a slightly significant association. Taking a scheme with less than 7 cores as a reference, we found no difference with 8 to 9 cores but we did find a difference with 10 to 11 cores and with 12 or more cores, with a prevalence ratio of 0.138 (95% CI=0.030-0.513) and 0.277 (95% CI=0.091-0.806), respectively. CONCLUSION: The GS of the biopsy depends on the scheme. This factor must be taken into account when choosing a treatment option in patients with low tumor grade in biopsy specimens.
