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1.
Ann Surg Oncol ; 29(3): 1774-1786, 2022 Mar.
Article in English | MEDLINE | ID: mdl-34839426

ABSTRACT

BACKGROUND: Nipple discharge is the third most frequent complaint of women attending rapid diagnostic breast clinics. Nipple smear cytology remains the single most used diagnostic method for investigating fluid content. This study aimed to conduct a systematic review and meta-analysis of the diagnostic accuracy of nipple discharge fluid assessment. METHODS: The study incorporated searches for studies interrogating the diagnostic data of nipple discharge fluid cytology compared with the histopathology gold standard. Data from studies published from 1956 to 2019 were analyzed. The analysis included 8648 cytology samples of women with a presenting complaint of nipple discharge. Both hierarchical and bivariate models for diagnostic meta-analysis were used to attain overall pooled sensitivity and specificity. RESULTS: Of 837 studies retrieved, 45 fulfilled the criteria for inclusion. The diagnostic accuracy of the meta-analysis examining nipple discharge fluid had a sensitivity of 75 % (95 % confidence interval [CI], 0.74-0.77) and a specificity of 87 % (95 % CI, 0.86-0.87) for benign breast disease. For breast cancer, it had a sensitivity of 62 % (95 % CI, 0.53-0.71) and a specificity 71 % (95 % CI, 0.57-0.81). Furthermore, patients presenting with blood-stained discharge yielded an overall malignancy rate of 58 % (95 % CI, 0.54-0.60) with a positive predictive value (PPV) of 27 % (95 % CI, 0.17-0.36). CONCLUSIONS: Pooled data from studies encompassing nipple discharge fluid assessment suggest that nipple smear cytology is of limited diagnostic accuracy. The authors recommend that a tailored approach to diagnosis be required given the variable sensitivities of currently available tests.


Subject(s)
Breast Neoplasms , Nipple Discharge , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , Cytodiagnosis , Female , Humans , Nipples/pathology , Sensitivity and Specificity
2.
Ann Surg Oncol ; 28(7): 3751-3760, 2021 Jul.
Article in English | MEDLINE | ID: mdl-33165721

ABSTRACT

PURPOSE: To calculate the diagnostic accuracy of nipple aspirate fluid (NAF) cytology. BACKGROUND: Evaluation of NAF cytology in asymptomatic patients conceptually offers a non-invasive method for either screening for breast cancer or else predicting or stratifying future cancer risk. METHODS: Studies were identified by performing electronic searches up to August 2019. A meta-analysis was conducted to attain an overall pooled sensitivity and specificity of NAF for breast cancer detection. RESULTS: A search through 938 studies yielded a total of 19 studies. Overall, 9308 patients were examined, with cytology results from 10,147 breasts [age (years), mean ± SD = 49.73 ± 4.09 years]. Diagnostic accuracy meta-analysis of NAF revealed a pooled specificity of 0.97 (95% CI 0.97-0.98), and sensitivity of 0.64 (95% CI 0.62-0.66). CONCLUSIONS: The diagnostic accuracy of nipple smear cytology is limited by poor sensitivity. If nipple fluid assessment is to be used for diagnosis, then emerging technologies for fluid biomarker analysis must supersede the current diagnostic accuracy of NAF cytology.


Subject(s)
Breast Neoplasms , Nipple Aspirate Fluid , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , Cytodiagnosis , Female , Humans , Nipples/pathology , Sensitivity and Specificity
3.
PLoS Pathog ; 13(9): e1006577, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28863187

ABSTRACT

Early events in the human airways determining whether exposure to Mycobacterium tuberculosis (Mtb) results in acquisition of infection are poorly understood. Epithelial cells are the dominant cell type in the lungs, but little is known about their role in tuberculosis. We hypothesised that human primary airway epithelial cells are part of the first line of defense against Mtb-infection and contribute to the protective host response in the human respiratory tract. We modelled these early airway-interactions with human primary bronchial epithelial cells (PBECs) and alveolar macrophages. By combining in vitro infection and transwell co-culture models with a global transcriptomic approach, we identified PBECs to be inert to direct Mtb-infection, yet to be potent responders within an Mtb-activated immune network, mediated by IL1ß and type I interferon (IFN). Activation of PBECs by Mtb-infected alveolar macrophages and monocytes increased expression of known and novel antimycobacterial peptides, defensins and S100-family members and epithelial-myeloid interactions further shaped the immunological environment during Mtb-infection by promoting neutrophil influx. This is the first in depth analysis of the primary epithelial response to infection and offers new insights into their emerging role in tuberculosis through complementing and amplifying responses to Mtb.


Subject(s)
Epithelial Cells/microbiology , Immunity, Innate , Lung/microbiology , Macrophages/immunology , Mycobacterium tuberculosis/immunology , Tuberculosis/immunology , Cells, Cultured , Humans , Interferon-gamma/immunology , Monocytes/immunology
4.
BMJ Open Respir Res ; 4(1): e000174, 2017.
Article in English | MEDLINE | ID: mdl-28725444

ABSTRACT

Fibrosing mediastinitis (FM) is a rare disease where there is thickening of the fibrous tissue in the mediastinum. While histoplasmosis is the the most common recognised cause, the link with tuberculosis (TB) has been rarely documented. We review the link between TB and FM, and describe a case of probable TB-related FM.Our case is of a 74-year-old man who presented with breathlessness 3 years after fully treated TB. Scans revealed a calcified soft tissue mass within the mediastinum, and a diagnosis of fibrosing mediastinitis resulting in pulmonary hypertension was made. Tests for histoplasmosis and IgG4 staining were negative. Surgical intervention was not felt to be beneficial, and he was treated with prednisolone and mycophenolate mofetil.In the review, we highlight the two forms of mediastinitis-granulomatous versus fibrous, and how these two entities may be on a spectrum of disease progression. We also explore the prevalence, clinical presentation, pathogenesis, imaging techniques and treatment options of TB-related FM.

5.
Ann Am Thorac Soc ; 11(3): 392-6, 2014 Mar.
Article in English | MEDLINE | ID: mdl-24592937

ABSTRACT

RATIONALE: The Xpert (GeneXpert) MTB/RIF, an integrated polymerase chain reaction assay, has not been systematically studied in extrapulmonary and in particular mediastinal tuberculosis (TB). OBJECTIVES: To investigate the performance of Xpert MTB/RIF in the diagnosis of intrathoracic nodal TB in a large tertiary urban medical center in the UK. METHODS: We collected clinical, cytological, and microbiological data from two cohorts: 116 consecutive patients referred with mediastinal lymphadenopathy with detailed diagnostic information obtained, and an immediately subsequent second cohort of 52 consecutive patients with microbiologically confirmed mediastinal TB lymphadenopathy. All data were derived between January 2010 and October 2012. All patients underwent endobronchial ultrasound and transbronchial needle aspiration (TBNA). The performance of a single Xpert MTB/RIF assay alongside standard investigations, cytology, and microscopy/culture was evaluated against culture-confirmed TB. MEASUREMENTS AND MAIN RESULTS: Microbiologically confirmed TB mediastinal lymphadenopathy was diagnosed in a total of 88 patients from both cohorts. Three culture-negative cases with associated caseating granulomatous inflammation on TBNA were given a probable diagnosis. A single Xpert MTB/RIF assay demonstrated overall sensitivity for culture-positive TB of 72.6% (62.3-81.0%). Xpert specificity from cohort 1 was 96.3% (89.1-99.1%). The positive predictive value was 88.9% (69.7-97.1%), negative predictive value was 86.5% (76.9-92.1%), and odds ratio was 51.3 (24.0-98.0) for correctly identifying culture-positive disease. Xpert captured all microscopy-positive cases (14 of 14) and the majority of microscopy-negative cases (48 of 71, 67.6%). Among the cases that were culture positive by TBNA, Xpert identified two-thirds of the multiple drug-resistant TB cases, leading to immediate regimen change up to 5 weeks ahead of positive cultures. The use of Xpert combined with cytology increased the sensitivity to 96.6%. CONCLUSIONS: Xpert MTB/RIF provides a rapid, useful, and accurate test to diagnose mediastinal nodal TB in intermediate-incidence settings. The additional use of TBNA cytology further enhances the sensitivity of Xpert. This combination can facilitate rapid risk assessment and prompt TB treatment.


Subject(s)
Lymphatic Diseases/microbiology , Mediastinal Diseases/microbiology , Mycobacterium tuberculosis/isolation & purification , Polymerase Chain Reaction , Rifampin , Tuberculosis, Multidrug-Resistant/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Antibiotics, Antitubercular , Bronchoscopy , Cohort Studies , Drug Resistance, Bacterial , Endoscopic Ultrasound-Guided Fine Needle Aspiration , Female , Humans , Lymphatic Diseases/diagnosis , Male , Mediastinal Diseases/diagnosis , Middle Aged , Sensitivity and Specificity , Young Adult
7.
Eur J Cancer ; 49(9): 2179-86, 2013 Jun.
Article in English | MEDLINE | ID: mdl-23452990

ABSTRACT

AIM: To compare triage strategies using different human papillomavirus (HPV) consensus and genotyping tests and a p16(INK4a) test. METHODS: 1228 women referred with a borderline or single mildly dyskaryotic smear. Samples were taken at colposcopy using PreservCyt. Tests included Hybrid Capture 2, Abbott RealTime PCR, BD HPV, Cobas 4800, PreTect HPV-Proofer, APTIMA and p16(INK4a). Results were based on the worst histology within 9 months. RESULTS: 97/1228 (7.9%) women had CIN3+ (203/1228 (17%) CIN2+). HPV testing alone using Hybrid Capture 2, Abbott RealTime PCR, BD HPV, Cobas 4800 or APTIMA had a sensitivity for CIN3+ ranging from 99.0% to 100.0% and specificity for

Subject(s)
Papillomavirus Infections/diagnosis , Uterine Cervical Dysplasia/diagnosis , Uterine Cervical Neoplasms/diagnosis , Adolescent , Adult , Aged , DNA, Viral/analysis , Early Detection of Cancer , Female , Genotype , Human papillomavirus 16/genetics , Humans , Immunohistochemistry , Middle Aged , RNA, Viral/analysis , Sensitivity and Specificity , Uterine Cervical Neoplasms/virology , Young Adult , Uterine Cervical Dysplasia/virology
8.
Respir Med Case Rep ; 10: 48-52, 2013.
Article in English | MEDLINE | ID: mdl-26029513

ABSTRACT

Isolated mediastinal lymphadenopathy can result from a number of potentially serious aetiologies. Traditionally those presenting with mediastinal lymphadenopathy would undergo mediastinoscopy to elucidate a final diagnosis or receive empirical treatment. There is now increased utilization of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), in this setting. Five cases of mediastinal lymphadenopathy are presented here in which lymph node anthracosis was identified as the primary diagnosis using EBUS-TBNA. They were female, non-smokers presenting with non-specific symptoms, who retrospectively reported cooking over wood fires. Four were from South Asia. Three were investigated by F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scanning and increased signal was identified in the anthracotic nodes sampled. With expansion of PET/CT and EBUS-TBNA services it is likely that primary nodal anthracosis will be encountered more frequently and should be considered in the differential diagnosis of those with PET/CT positive lymphadenopathy. It may mimic pathologies including tuberculosis and malignancy, thus accurate sampling and follow-up are essential.

9.
J Clin Microbiol ; 50(6): 1867-73, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22422852

ABSTRACT

High-risk human papillomavirus (HPV) DNA/RNA testing provides higher sensitivity but lower specificity than cytology for the identification of high-grade cervical intraepithelial neoplasia (CIN). Several new HPV tests are now available for this purpose, and a direct comparison of their properties is needed. Seven tests were evaluated with samples in liquid PreservCyt transport medium from 1,099 women referred for colposcopy: the Hybrid Capture 2 (Qiagen), Cobas (Roche), PreTect HPV-Proofer (NorChip), Aptima HPV (Gen-Probe), and Abbott RealTime assays, the BD HPV test, and CINtec p16(INK4a) cytology (mtm laboratories) immunocytochemistry. Sensitivity, specificity, and positive predictive value (PPV) were based on the worst histology found on either the biopsy or the treatment specimen after central review. Three hundred fifty-nine women (32.7%) had CIN grade 2+ (CIN2+), with 224 (20.4%) having CIN3+. For detection of CIN2+, Hybrid Capture 2 had 96.3% sensitivity, 19.5% specificity, and 37.4% PPV. Cobas had 95.2% sensitivity, 24.0% specificity, and 37.6% PPV. The BD HPV test had 95.0% sensitivity, 24.2% specificity, and 37.8% PPV. Abbott RealTime had 93.3% sensitivity, 27.3% specificity, and 38.2% PPV. Aptima had 95.3% sensitivity, 28.8% specificity, and 39.3% PPV. PreTect HPV-Proofer had 74.1% sensitivity, 70.8% specificity, and 55.4% PPV. CINtec p16(INK4a) cytology had 85.7% sensitivity, 54.7% specificity, and 49.1% PPV. Cytology of a specimen taken at colposcopy (mild dyskaryosis or worse) had 88.9% sensitivity, 58.1% specificity, and 50.7% PPV. Our study confirms that, in a referral setting, HPV testing by a number of different tests provides high sensitivity for high-grade disease. Further work is needed to confirm these findings in a routine screening setting.


Subject(s)
Immunohistochemistry/methods , Molecular Diagnostic Techniques/methods , Papillomaviridae/isolation & purification , Parvoviridae Infections/diagnosis , Reagent Kits, Diagnostic , Uterine Cervical Dysplasia/diagnosis , Adult , Female , Humans , Parvoviridae Infections/complications , Sensitivity and Specificity , Uterine Cervical Dysplasia/pathology , Uterine Cervical Dysplasia/virology
10.
Fertil Steril ; 91(2): 489-99, 2009 Feb.
Article in English | MEDLINE | ID: mdl-18353318

ABSTRACT

OBJECTIVE: To characterize possible endometrial defects in infertile women with isolated PCO morphology. DESIGN: Prospective study. SETTING: An academic hospital with an IVF unit. PATIENT(S): Women with primary unexplained infertility and isolated PCO, fertile women, and women with infertility secondary to male factor. INTERVENTION(S): Thirty-one women (fertile and with male factor infertility) had endometrial sampling across the menstrual cycle. Nine fertile women and 10 infertile women with isolated PCO had sampling on day LH +7, adjusted for histologic dating. MAIN OUTCOME MEASURE(S): Expression of alphavbeta3 and its ligand, osteopontin, were determined using real-time quantitative polymerase chain reaction and immunohistochemistry. In vitro regulation of osteopontin was assessed using the Ishikawa cell line. RESULT(S): Cyclic variations revealed a fall in integrin alphavbeta3 mRNA during the secretory phase with concomitant up-regulation of osteopontin mRNA. Immunohistochemistry on day LH +7 demonstrated a significant reduction in expression of osteopontin in the isolated PCO group with no difference in expression of alphavbeta3. In vitro studies confirmed up-regulation of osteopontin by estrogen with no apparent effect of androgen. CONCLUSION(S): These results demonstrate an apparent reduction of osteopontin expression, important in cell-cell adhesion, during the window of implantation in infertile women with isolated PCO morphology.


Subject(s)
Embryo Implantation , Endometrium/metabolism , Infertility, Female/metabolism , Integrin alphaVbeta3/metabolism , Osteopontin/metabolism , Polycystic Ovary Syndrome/metabolism , Adult , Cell Line , Down-Regulation , Estradiol/metabolism , Female , Humans , Immunohistochemistry , Infertility, Female/etiology , Infertility, Female/physiopathology , Integrin alphaVbeta3/genetics , Male , Metribolone/pharmacology , Osteopontin/genetics , Polycystic Ovary Syndrome/complications , Polycystic Ovary Syndrome/physiopathology , Progesterone/metabolism , Prospective Studies , RNA, Messenger/metabolism , Reverse Transcriptase Polymerase Chain Reaction , Testosterone Congeners/pharmacology , Time Factors
11.
Pediatr Dev Pathol ; 7(4): 385-90, 2004.
Article in English | MEDLINE | ID: mdl-15455480

ABSTRACT

Infantile myofibromatosis (IM) is a condition characterized by the formation of spindle cell tumors of skin, soft tissue, and viscera. Although small vessel involvement by the process is a frequently identified and indeed diagnostically useful histological finding, involvement of large vessels is not widely reported. Fibromuscular dysplasia (FMD) is a noninflammatory arteriopathy characterized by intimal, medial, and/or adventitial fibroplasias leading to luminal compromise and aneurysm formation. Although venous disease has been reported, involvement of arterioles and viscera has not been identified. We report a patient in whom IM was diagnosed, on the basis of multiple soft tissue tumors present from birth, who subsequently developed generalized and ultimately fatal FMD. These two conditions exhibit overlapping pathologic features, including pronounced intimal fibroplasia. Their occurrence in a single individual may provide insights into the pathogenesis of both conditions, suggesting that they represent part of the same spectrum of vascular myofibroblastic proliferations.


Subject(s)
Fibromuscular Dysplasia/complications , Fibromuscular Dysplasia/pathology , Myofibromatosis/complications , Myofibromatosis/pathology , Child, Preschool , Fatal Outcome , Humans , Immunohistochemistry , Infant , Infant, Newborn , Male , Myofibromatosis/congenital
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