In our meta-analysis, lung ultrasound had significantly better sensitivity with similar specificity when compared to chest x-ray for the diagnosis of pediatric community acquired pneumonia.
Mammography has a crucial role in the detection of breast cancer (Bc), yet it is not limitation-free. We hypothesized that the combination of mammography and cell-free DnA (cfDnA) levels may better discriminate patients with cancer. This prospective study included 259 participants suspected with Bc before biopsy. Blood samples were taken before biopsy and from some patients during and at the end of treatment. cfDNA blood levels were measured using our simple fluorescent assay. The primary outcome was the pathologic diagnosis of Bc, and the secondary aims were to correlate cfDnA to severity, response to treatments, and outcome. Median cfDnA blood levels were similar in patients with positive and negative biopsy: 577 vs. 564 ng/ml (p = 0.98). A significant decrease in cfDnA blood level was noted after the following treatments: surgery, surgery and radiation, neoadjuvant chemotherapy and surgery, and at the end of all treatments. to conclude, the cfDnA level could not be used in suspected patients to discriminate Bc. Reduction of tumor burden by surgery and chemotherapy is associated with reduction of cfDnA levels. in a minority of patients, an increase in post-treatment cfDnA blood level may indicate the presence of a residual tumor and higher risk. further outcome assessment for a longer period is suggested. Breast cancer (BC) is the most common form of cancer diagnosed in women worldwide, and is a leading cause of death among women in the United States and Israel 1. Mortality rates in developed countries have been declining in the last decade due to mammographic screening and improved adjuvant/neo-adjuvant therapy. Conversely, the mortality rate in undeveloped countries has been increasing due to the lack of screening and the westernization of reproductive and nutritional patterns 2. Mammography is the only screening tool proven effective for detecting early breast cancer and reducing mortality. Yet mammography and ultrasound-assisted core needle biopsy (US-CNB) limitations have been raised. In a meta-analysis of eight eligible trials of 600,000 women, Gøtzsche and Nielsen found no effect of screening on BC mortality after 10 years. These authors concluded that screening led to 30% over-diagnosis and over-treatment, or an absolute increase of 0.5% in the risk of death. In fact, nearly 20% of women without BC underwent biopsy after ten mammograms 3. As for US-CNB, the overall false-negative rate may reach 6.1% and a diagnosis underestimation rate of 31.4%. While US-CNB is useful in confirming invasive carcinomas, it has much lower efficacy when only ductal carcinoma in-situ (DCIS) is detected. Among lesions yielding DCIS at US-CNB, surgery revealed an infiltrating carcinoma in 16-55.5% of patients 4 .
Focused assessment with sonography for trauma (FAST) has been incorporated into the initial evaluation of trauma for decades. It is an important screening tool in the detection of intra-abdominal fluid. The objective of this study was to perform a systematic review of the use and accuracy of FAST as an imaging tool for blunt abdominal trauma in disaster/mass casualty settings. A systematic review of literature was conducted using key words and search terms. Two independent reviewers screened abstracts to determine inclusion using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS). For studies passing QUADAS, a meta-analysis was performed calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). FAST results were compared with the gold standard, which was a combination of CT scan results, operative findings, and medical records of the clinical course. Initial database screening resulted in 133 articles, of which 21 were selected for QUADAS evaluation. Five studies passed QUADAS and were selected in the final meta-analysis, with a total of 4263 patients. The sensitivity of FAST was 92.1% (87.8–95.6), specificity 98.7% (96.0–99.9), PPV 90.7% (70.0–98.0), and NPV 98.8% (98.1–99.5) for the detection of intra-abdominal injury. In our meta-analysis, FAST was both sensitive and specific in the evaluation of trauma in the disaster setting.
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