PubMed · 12463303
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Douglas Trotter. Rapid strep testing.. https://pubmed.ncbi.nlm.nih.gov/12463303/
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The uptake of fluorine-18 fluorodeoxyglucose (FDG) is increased in processes with enhanced glycolysis, including malignancy. It is this property of FDG which is exploited in positron emission tomography (PET) imaging for lymphoma. FDG, whilst a good oncology tracer, is not perfect and there are limitations to its use. FDG may have low uptake in some types of lymphoma, predominantly low-grade lymphomas. High physiological uptake may occur within the bowel, urinary tract, muscle, salivary glands and lymphoid tissue. FDG is not specific for malignancy and increased uptake occurs in benign conditions with increased glycolysis such as infection, inflammation and granulomatous disease. Benign conditions usually have lower uptake than malignancy but there is overlap. These limitations of FDG mean that tumour may be 'missed', 'masked' or 'mimicked' by other pathology. These limitations are described in this article and methods to circumvent them where possible are discussed. These include performing baseline scans at presentation with lymphoma for comparison with post-treatment scans, simple manoeuvres to reduce physiological uptake such as administration of frusemide and diazepam and remaining alert to the possibility of alternative pathology in immunosuppressed patients. Patients with disease secondary to human immunodeficiency virus are a particular challenge in this regard as they often have dual or multiple pathology. One of the most important skills in PET reporting may be to recognise its limitations and be clear when a definitive answer cannot be given to the referring clinician's question. This may require using PET to direct the clinician to biopsy the site most likely to yield the correct diagnosis.
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BACKGROUND: Efficient quality assurance and improvement measures are essential ingredients in a well organized cytology-based program for cervical carcinoma screening. Various pap smear review procedures, aiming for optimization of accuracy, are described throughout the literature. Evaluation and synthesis of those methods are needed. In a previous study, we pooled data on the diagnostic quality of rapid reviewing (RR) of cervical smears initially reported as normal or unsatisfactory. We now focus on rapid prescreening (RPS) of unreported smears. METHODS: Six published studies on the accuracy of RPS relative to subsequent full screening were pooled using metaanalytic methods. Individual and pooled sensitivity, specificity, and predictive values were assessed using forest plots. Random effect pooling methods were used for interstudy heterogeneity. Variation in sensitivity according to influencing factors was explored by metaregression. RESULTS: The pooled average sensitivity of RPS was 64.9% (95% confidence interval [CI] 50.7-79.1%) for all abnormalities, 72.6% (95% CI 60.6-85.2%) for low-grade lesions or more severe, and 85.7% (95% CI 77.8-93.6%) for high-grade lesions or more severe. The pooled specificity was estimated at 96.8% (CI 95.8-97.8%). The sensitivity increased significantly with duration of screening and decreased with workload. Almost 3% of all abnormal slides were detected only by RPS (2.8%; CI 0.0-5.8%). This is comparable to the proportion of false-negative smears detectable by RR. CONCLUSIONS: Rapid prescreening has a high yield for severe dysplasia and shows diagnostic properties that support its use as a quality control procedure in cytologic laboratories. We showed previously that RR is superior to full reviewing of a 10% random sample of negative slides (10% FR). Because the yield of additional abnormalities found by RR and RPS is comparable, we expect RPS to be more efficient than 10% FR as well.