Radiomics and machine learning for the diagnosis of pediatric cervical non-tuberculous mycobacterial lymphadenitis.

Non-tuberculous mycobacterial (NTM) infection is an emerging infectious entity that often presents as lymphadenitis in the pediatric age group. Current practice involves invasive testing and excisional biopsy to diagnose NTM lymphadenitis. In this study, we performed a retrospective analysis of 249 lymph nodes selected from 143 CT scans of pediatric patients presenting with lymphadenopathy at the Montreal Children's Hospital between 2005 and 2018. A Random Forest classifier was trained on the ten most discriminative features from a set of 1231 radiomic features. The model classifying nodes as pyogenic, NTM, reactive, or proliferative lymphadenopathy achieved an accuracy of 72%, a precision of 68%, and a recall of 70%. Between NTM and all other causes of lymphadenopathy, the model achieved an area under the curve (AUC) of 89%. Between NTM and pyogenic lymphadenitis, the model achieved an AUC of 90%. Between NTM and the reactive and proliferative lymphadenopathy groups, the model achieved an AUC of 93%. These results indicate that radiomics can achieve a high accuracy for classification of NTM lymphadenitis. Such a non-invasive highly accurate diagnostic approach has the potential to reduce the need for invasive procedures in the pediatric population.

Standardized radiographic interpretation of thoracic tuberculosis in children.

There is a lack of standardized approach and terminology to classify the diverse spectrum of manifestations in tuberculosis. It is important to recognize the different clinical and radiographic patterns to guide treatment. As a result of changing epidemiology, there is considerable overlap in the radiologic presentations of primary tuberculosis and post-primary tuberculosis. In this article we promote a standardized approach in clinical and radiographic classification for children suspected of having or diagnosed with childhood tuberculosis. We propose standardized terms to diminish confusion and miscommunication, which can affect management. In addition, we present pitfalls and limitations of imaging.

[The surgical options of cervical tuberculous lymphadenitis].

OBJECTIVE: To analyze the clinical features & variation features of cervical tuberculous lymphadenitis and to discuss its effective surgical treatment. METHOD: Retrospective analysis of 27 cases of cervical tuberculous lymphadenitis patients admitted to the hospital from January 2008 to December 2013. The cervical tuberculous lymphadenitis is classified based on the enhanced CT scanning conducted before operation and the preoperative evaluation of clinical characters of patients. The lymphaden ncisional biopsy was conducted on the type I patients with cervical tuberculous lymphadenitis. The lesion resection was performed on the type II and mixed type I + II patients. The regional cervical lymph node dissection was carried on the type III, the type IV and other mixed type patients. The negative pressure drainage ball was placed after operation, and the cavity was flushed with 5% povidone iodine solution. The antituberculosis therapy was performed after wound healing. RESULT: The analysis of the clinical features for 27 patients: the incidence rate on the left side, right side, both sides and middle-line is 63.0%, 25.9%, 7.4% and 3.7% respectively. The majority of patients whose lesion involving more than one region account for 62.1%; the patients whose lesion involving one region account for 37.9%. The most common is level V involved lesion (69.0%), then level IV (62.1%), level III (51.7%), level II (34.5%), level I (10.3%) and level VI (3.4%) in order. The analysis of the CT imageology features for 27 patients: the simple type is the majority (65.5%), and the most common is type III (24.1%), then the type I (17.2%), type II (13.8%) and type IV (10.3%) in order. The mixed type is minority (34.5%), but the two mixed is often (31.0%). The three mixed is only located on one side (3.4%). The recurrence never happened on the patients with resection and standard antituberculosis therapy. CONCLUSION: For the cervical tuberculous lymphadenitis, the suitable surgical treatments shall be selected according to the lesion characteristics & location and CT imaging manifestations presurgical evaluation. The effective way to treat cervical tuberculous lymphadenitis is to conduct negative pressure drainage after operation, to flush the cavity with 5% povidone iodine solution and to perform antituberculosis therapy.

Nontuberculous mycobacterial cervicofacial lymphadenitis--a review and proposed classification system.

OBJECTIVE: To describe a clinical staging system for nontuberculous mycobacterial (NTM) cervicofacial lymphadenitis that has both diagnostic and therapeutic implications. METHODS: A Medline database search was performed using key words "nontuberculous mycobacteria". All articles pertaining to nontuberculous mycobacterial cervicofacial lymphadenitis were reviewed for data evaluation regarding diagnosis and treatment methodologies. RESULTS: Nontuberculous cervicofacial lymphadenitis infections pass through distinctly segmented clinical phases. In Stage I, a painless mass presents with notable increase in vascularity. Stage II is characterized by liquefaction of the affected lymph node, causing the mass to appear fluctuant. Significant skin changes characterize Stage III, whereby overlying skin may develop violaceous discoloration and become notably thinner, or parchment-like, with a "shiny" appearance. During Stage IV, the lesion fistulizes to the skin surface causing a draining wound. CONCLUSIONS: While nontuberculous mycobacterial cervicofacial lymphadenitis has typically been thought of as a surgical disease, further characterization is warranted. We present a new classification system for appraising the clinical stages of nontuberculous mycobacterial cervicofacial lymphadenitis that may be used as part of a greater approach to disease management: (1) after other causes have been ruled out, the possibility of a tuberculous scrofula must be eliminated, and the degree of diagnostic suspicion must be categorized; (2) the clinical stage of the infection can be determined using the classification system described; and (3) a stage-specific treatment may be chosen based on the individual patient.

[Immunological changes in old-age group children with primary and secondary tuberculous infection].

In modern society, there is a rise in the incidence of tuberculosis in all age groups, including children and adolescents. In old age group, a specific inflammation is detectable from Mantoux test results only in every four children. Tuberculous infection is diagnosed in half of cases when they turn to physicians for complains. Disseminated and complicated forms of tuberculosis are more frequently identified in these situations. The immune system has a particular emphasis on the course and outcome of the disease. The authors have established that caseous masses actively form, followed by the stimulation of the adequate cell pathway promoting the limitation of specific inflammation in old-age group children with primary tuberculosis. In secondary forms of tuberculous infection, there is an increase in the level of monocytes where the persistence and multiplication of the causative microorganism, as well as the activation of the humoral pathway inadequate for tuberculous infection are likely to occur, i.e. the infectious agent may be inhibited until activation of the Th-2 pathway of an immune response takes place.

[Computed tomography in the diagnosis and classification of tuberculosis of intrathoracic lymph nodes].

Six hundred and seventy-six children suffering from tuberculosis and infected with Mycobacterium tuberculosis (MBT) were examined. The specific features of the involvement of intrathoracic lymph nodes (ITLN), their extent, site localization, size, structure, and secondary changes in the adjacent tissues were identified. A computed tomographic (CT) classification of ITLN was proposed. The types of ITLN were identified; these were severe adenopathy, mild adenopathy, and micropolyadenopathy. ITLN that were less than 5-mm, multiple, soft tissue, homogeneous in a child with Mycobacterium-infected tuberculosis were regarded an objective reflection of insidious tuberculosis infection. There is evidence for the necessity of making a CT study of children with tuberculosis and those infected with MBT as an absolutely indicated X-ray technique.

A proposed radiological classification of childhood intra-thoracic tuberculosis.

One of the obstacles in discussing childhood tuberculosis (TB) is the lack of standard descriptive terminology to classify the diverse spectrum of disease. Accurate disease classification is important, because the correct identification of the specific disease entity has definite prognostic significance. Accurate classification will also improve study outcome definitions and facilitate scientific communication. The aim of this paper is to provide practical guidelines for the accurate radiological classification of intra-thoracic TB in children less than 15 years of age. The proposed radiological classification is based on the underlying disease and the principles of pathological disease progression. The hope is that the proposed classification will clarify concepts and stimulate discussion that may lead to future consensus.

Polymerase chain reaction detection of Mycobacterium tuberculosis from fine-needle aspirate for the diagnosis of cervical tuberculous lymphadenitis.

BACKGROUND: Despite its well-established usefulness in the diagnosis of cervical tuberculous lymphadenitis, fine-needle aspiration cytology (FNAC) has several limitations in its clinical applications, especially when the presence of acid-fast bacilli is not proven. Furthermore, fine-needle aspirate is sometimes inadequate for diagnosis, and the sensitivity and specificity of this technique for cervical tuberculous lymphadenitis has not been firmly established. OBJECTIVE: The authors performed Mycobacterium tuberculosis polymerase chain reaction (PCR) for mycobacterial DNA sequences from the remainder of fine-needle aspirate after cytological examination and evaluated its diagnostic efficacy in clinical situations. METHODS: Conventional diagnostic procedures including FNAC and M tuberculosis PCR were performed simultaneously in 29 cases that had been suspected to be cervical tuberculous lymphadenitis on patients' first visit. The results of FNAC and M tuberculosis PCR were compared with the clinical outcomes after several months of follow-up and pathological results from open biopsy of some cases. RESULTS: Among the 17 cases of cervical tuberculous lymphadenitis diagnosed in clinical situations, M tuberculosis DNA was found by PCR in 13 cases (76.4%). Negative findings on PCR were achieved in 12 cases, which revealed non-granulomatous lymphadenopathy. CONCLUSION: From these results, we conclude that M tuberculosis PCR using the remainder of aspirate for cytological examination is a very useful tool for the diagnosis of cervical tuberculous lymphadenitis, and its clinical application with FNAC could reduce the necessity for open biopsy.

[The pathoanatomical,diagnosis of progressive forms of pulmonary tuberculosis in relation to the new clinical classification]. / Patologoanatomicheskaia diagnostika progressiruiushchikh form tuberkuleza legkikh v sviazi s novoi klinicheskoi klassifikatsiei.

This communication is a letter of information that gives for postmortem diagnosis a brief account of tuberculous inflammation and major types of pulmonary tuberculosis during their progression to death and an approximate outline of pathoanatomical diagnosis. Terminal tuberculosis is shown to be now complicated by miliary and caseous pneumonias. Caseous pneumonia may appear as an independent nosological entity and as a complication of acute progression, more frequently, of fibrocavernous tuberculosis. Caseous pneumonia as a tuberculosis type is an irreversible process that calls for emergency surgical treatment. It has been found that there are primarily impairments in lung connective tissue function, acute mesenchymopathy with high blood barrier permeability in caseous pneumonia. Terminal bronchiolar lesion is a later stage in the pathogenesis of caseous pneumonia.

[Clinical aspects of pulmonary tuberculosis]. / Klinische Aspekte der Lungentuberkulose.

The low incidence of pulmonary tuberculosis has led to a decrease of doctors expertise in this field. This review deals with clinical aspects of the disease. This article does not refer to the problem of simultaneous infection with tuberculosis and HIV. Pathogenesis, symptoms and diagnosis are discussed. A classification of intrathoracal manifestations of the disease with respect to clinical, radiologic and pathogenetic criteria is raised. To facilitate dealing with a certain case, a couple of questions are formulated and pragmatic answers are given. Risk-groups are specially emphasized to attract attention to the possibility of specific disease.

[Radiology in tuberculosis]. / Radiologie der Tuberkulose.

The radiological manifestations of pulmonary tuberculosis such as primary and secondary tuberculosis, micronodular tuberculosis and tuberculous pneumonia as well as postinfectious residual scarring, are described. Simultaneously the radiology of the extrapulmonary manifestations of tuberculosis such as tuberculous pleurisy, spondylitis, different forms of abdominal tuberculosis and renal tuberculosis is discussed. Pathophysiological mechanisms are used to classify the different manifestations of tuberculosis, to explain the localizations typical of pulmonary tuberculosis as well as of extrapulmonary tuberculosis and finally to specify the most important differential diagnoses.

[Results of ambulatory observation of patients registered as group O in an anti-tuberculosis dispensary]. / Rezul'taty dispansernogo nabliudeniia za kontingentami O gruppy ucheta protivotuberkuleznogo dispansera.

414 patients registered under O-group, 149-under VIIB and 129-under IA were observed by the antituberculosis dispensary of Alma-Ata. The minor differences detected in the clinical symptomatology of these patients did not allow one to decide how the process was proceeding in a specific case. The results showed that it was advisable to enroll++ subjects not with focal, but with cirrhotic and disseminated processes, tuberculomas and intrathoracic lymphatic tuberculosis into the O-group. The presence of X-ray archiv does not rule the necessity of following-up in this group in some cases. The process activity in the O-group can be defined by such methods, as bacillary excretion test and study of X-ray dynamics in the presence of challenge therapy, while in cirrhoses and intrathoracic lymphatic tuberculosis, only bacillary excretion test can be done. The outcomes of observation, in addition traditional ones (transfer to IA and VIIB groups), may lead to the transfer to VIIA group and striking off the register of the antituberculosis dispensary. Direct and indirect economic impact of the observation in the O-group of the dispensary registration was estimated.