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[PMID]:27773666
[Au] Autor:Korevaar DA; Crombag LM; Cohen JF; Spijker R; Bossuyt PM; Annema JT
[Ad] Endereço:Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. Electronic address: d.a.korevaar@amc.uva.nl.
[Ti] Título:Added value of combined endobronchial and oesophageal endosonography for mediastinal nodal staging in lung cancer: a systematic review and meta-analysis.
[So] Source:Lancet Respir Med;4(12):960-968, 2016 12.
[Is] ISSN:2213-2619
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Guidelines recommend endosonography with fine-needle aspiration for mediastinal nodal staging in non-small-cell lung cancer, but most do not specify whether this should be through endobronchial endoscopy (EBUS), oesophageal endoscopy (EUS), or both. We assessed the added value and diagnostic accuracy of the combined use of EBUS and EUS. METHODS: For this systematic review and random effects meta-analysis, we searched MEDLINE, Embase, BIOSIS Previews, and Web of Science, without language restrictions, for studies published between Jan 1, 2000, and Feb 25, 2016. We included studies that assessed the accuracy of the combined use of EBUS and EUS in detecting mediastinal nodal metastases (N2/N3 disease) in patients with lung cancer. For each included study, we extracted data on the age and sex of participants, inclusion criteria regarding tumour stage on imaging, details of the endoscopic testing protocol, duration of each endoscopic procedure, number of lymph nodes sampled, serious adverse events occurring during the endoscopic procedures, the reference standard, and 2 × 2 tables for EBUS, EUS, and the combined approach. We evaluated the added value (absolute increase in sensitivity and in detection rate) of the combined use of EBUS and EUS in detecting mediastinal nodal metastases over either test alone, and the diagnostic accuracy (sensitivity and negative predictive value) of the combined approach. This study is registered with PROSPERO, number CRD42015019249. FINDINGS: We identified 2567 unique manuscripts by database search, of which 13 studies (including 2395 patients) were included in the analysis. Median prevalence of N2/N3 disease was 34% (range 23-71). On average, addition of EUS to EBUS increased sensitivity by 0·12 (95% CI 0·08-0·18) and addition of EBUS to EUS increased sensitivity by 0·22 (0·16-0·29). Mean sensitivity of the combined approach was 0·86 (0·81-0·90), and the mean negative predictive value was 0·92 (0·89-0·93). The mean negative predictive value was significantly higher in studies with a prevalence of 34% or less (0·93 [95% CI 0·91-0·95]) compared with studies with a prevalence of more than 34% (0·89 [0·85-0·91]; p=0·013). We found no significant differences in mean sensitivity and negative predictive value between studies that did EBUS first or EUS first, or between studies that used an EBUS-scope or a regular echoendoscope to do EUS. INTERPRETATION: The combined use of EBUS and EUS significantly improves sensitivity in detecting mediastinal nodal metastases, reducing the need for surgical staging procedures. FUNDING: No external funding.
[Mh] Termos MeSH primário: Broncoscopia/métodos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem
Endossonografia/métodos
Neoplasias Pulmonares/diagnóstico por imagem
Linfonodos/diagnóstico por imagem
Mediastino/diagnóstico por imagem
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Carcinoma Pulmonar de Células não Pequenas/patologia
Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico/métodos
Esôfago/diagnóstico por imagem
Feminino
Seres Humanos
Neoplasias Pulmonares/patologia
Linfonodos/patologia
Masculino
Mediastino/patologia
Meia-Idade
Estadiamento de Neoplasias
Valor Preditivo dos Testes
Sensibilidade e Especificidade
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE


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[PMID]:29357388
[Au] Autor:Han Y; Kim HJ; Kong KA; Kim SJ; Lee SH; Ryu YJ; Lee JH; Kim Y; Shim SS; Chang JH
[Ad] Endereço:Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
[Ti] Título:Diagnosis of small pulmonary lesions by transbronchial lung biopsy with radial endobronchial ultrasound and virtual bronchoscopic navigation versus CT-guided transthoracic needle biopsy: A systematic review and meta-analysis.
[So] Source:PLoS One;13(1):e0191590, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Advances in bronchoscopy and CT-guided lung biopsy have improved the evaluation of small pulmonary lesions (PLs), leading to an increase in preoperative histological diagnosis. We aimed to evaluate the efficacy and safety of transbronchial lung biopsy using radial endobronchial ultrasound and virtual bronchoscopic navigation (TBLB-rEBUS&VBN) and CT-guided transthoracic needle biopsy (CT-TNB) for tissue diagnosis of small PLs. METHODS: A systematic search was performed in five electronic databases, including MEDLINE, EMBASE, Cochrane Library Central Register of Controlled Trials, Web of Science, and Scopus, for relevant studies in May 2016; the selected articles were assessed using meta-analysis. The articles were limited to those published after 2000 that studied small PLs ≤ 3 cm in diameter. RESULTS: From 7345 records, 9 articles on the bronchoscopic (BR) approach and 15 articles on the percutaneous (PC) approach were selected. The pooled diagnostic yield was 75% (95% confidence interval [CI], 69-80) using the BR approach and 93% (95% CI, 90-96) using the PC approach. For PLs ≤ 2 cm, the PC approach (pooled diagnostic yield: 92%, 95% CI: 88-95) was superior to the BR approach (66%, 95% CI: 55-76). However, for PLs > 2 cm but ≤ 3 cm, the diagnostic yield using the BR approach was improved to 81% (95% CI, 75-85). Complications of pneumothorax and hemorrhage were rare with the BR approach but common with the PC approach. CONCLUSIONS: CT-TNB was superior to TBLB-rEBUS&VBN for the evaluation of small PLs. However, for lesions greater than 2 cm, the BR approach may be considered considering its diagnostic yield of over 80% and the low risk of procedure-related complications.
[Mh] Termos MeSH primário: Pneumopatias/diagnóstico
Neoplasias Pulmonares/diagnóstico
[Mh] Termos MeSH secundário: Biópsia por Agulha/efeitos adversos
Biópsia por Agulha/métodos
Broncoscopia/efeitos adversos
Broncoscopia/métodos
Endossonografia/efeitos adversos
Endossonografia/métodos
Hemoptise/etiologia
Hemorragia/etiologia
Seres Humanos
Biópsia Guiada por Imagem/efeitos adversos
Biópsia Guiada por Imagem/métodos
Pneumopatias/diagnóstico por imagem
Pneumopatias/patologia
Neoplasias Pulmonares/diagnóstico por imagem
Neoplasias Pulmonares/patologia
Pneumotórax/etiologia
Tomografia Computadorizada por Raios X/métodos
Interface Usuário-Computador
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180123
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191590


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[PMID]:29390314
[Au] Autor:Sagami R; Tsuji H; Nishikiori H; Murakami K
[Ad] Endereço:Department of Gastroenterology, Oita San-ai Medical Center, Oita city.
[Ti] Título:Endoscopic ultrasound-guided transduodenal drainage of idiopathic retroperitoneal abscess in an immunocompromised patient: A case report.
[So] Source:Medicine (Baltimore);96(50):e9132, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Idiopathic retroperitoneal abscesses are insidious, occult illnesses with high mortality if inadequately drained. Endoscopic ultrasound-guided drainage is an alternative to percutaneous or surgical drainage, it is not widely performed for retroperitoneal abscesses other than peripancreatic fluid collection. PATIENT CONCERNS: We present a 76-year-old Japanese woman with abdominal pain, high fever, and a history of rheumatism on treatment with immunosuppressants. DIAGNOSES: The patient was diagnosed with idiopathic retroperitoneal abscess based on results obtained from her clinical course and findings on computed tomography. INTERVENTIONS: We performed Endoscopic ultrasound-guided drainage. After we performed needle puncture via the descending portion of the duodenum, the fistula was expanded using a dilator, and a double-pigtail stent and endoscopic nasobiliary drainage tube were inserted. OUTCOMES: The patient was kept nil by mouth, together with intravenous antibiotic therapy, and repeated washing of the abscess cavity with saline was performed. After that, we confirmed disappearance of the cavity, and, after removing the tubes, commenced oral feeding. We were able to avoid surgery in this immunosuppressed patient. LESSONS: Endoscopic ultrasound (EUS)-guided abscess drainage can be overall considered a safe and useful procedure. We also propose the double-stent method, with both internal and external stents, for the treatment of idiopathic retroperitoneal abscesses.
[Mh] Termos MeSH primário: Abscesso Abdominal/diagnóstico por imagem
Abscesso Abdominal/cirurgia
Endossonografia
Hospedeiro Imunocomprometido
Doenças Peritoneais/diagnóstico por imagem
Doenças Peritoneais/cirurgia
[Mh] Termos MeSH secundário: Idoso
Drenagem
Feminino
Seres Humanos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009132


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[PMID]:28450252
[Au] Autor:Exacoustos C; Pizzo A; Lazzeri L; Pietropolli A; Piccione E; Zupi E
[Ad] Endereço:Department of Biomedicine and Prevention, Obstetrics and Gynecological Clinic, University of Rome "Tor Vergata", Rome, Italy.
[Ti] Título:Three-Dimensional Hysterosalpingo Contrast Sonography with Gel Foam: Methodology and Feasibility to Obtain 3-Dimensional Volumes of Tubal Shape.
[So] Source:J Minim Invasive Gynecol;24(5):827-832, 2017 Jul - Aug.
[Is] ISSN:1553-4669
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To investigate the feasibility of hysterosalpingo foam sonography (HyFoSy) with automated 3-dimensional (3D) software in the evaluation of tubal patency and visualization of the tubal course by obtaining a 3D volume acquisition of tubes. DESIGN: Prospective observational study (Canadian Task Force classification III). SETTING: University hospital. PATIENTS: A total of 132 infertile females evaluated between October 2013 and February 2015. INTERVENTIONS: All patients underwent HyFoSy with the new automated 3D coded contrast imaging (CCI) followed by 2-dimensional (2D) real-time HyFoSy. To evaluate the feasibility of 3D visualization of the tubal course, consecutive volume acquisitions were performed during gel foam contrast agent injection. Conventional 2D real-time hysterosalpingo contrast sonography (HyCoSy) by detection of gel foam moving through the tubes and around the ovaries was finally performed and considered to indicate the final results of tubal status. MEASUREMENTS AND MAIN RESULTS: All the patients underwent 3D CCI HyFoSy, followed by 2D real-time HyFoSy. After both procedures, we observed 108 patients (81.8%) with bilateral tubal patency, 22 patients (16.6%) with unilateral tubal patency, and 2 patients (1.5%) with bilateral tubal occlusion. The concordance rate for tubal status between the first and second 3D volume acquisitions and the final 2D real-time evaluation was 84.8% and 97.0%, respectively. CONCLUSIONS: Transvaginal ultrasound HyFoSy with 3D volume reconstruction of the uterus and tubes is an accurate and safe technique that allows complete visualization of tubal shape and patency with high patient compliance.
[Mh] Termos MeSH primário: Endossonografia/métodos
Testes de Obstrução das Tubas Uterinas/métodos
Tubas Uterinas/diagnóstico por imagem
Histerossalpingografia/métodos
Imagem Tridimensional/métodos
[Mh] Termos MeSH secundário: Adulto
Meios de Contraste
Tubas Uterinas/patologia
Estudos de Viabilidade
Feminino
Seres Humanos
Infertilidade Feminina/diagnóstico
Infertilidade Feminina/diagnóstico por imagem
Tamanho do Órgão
Ovário/diagnóstico por imagem
Estudos Prospectivos
Software
Útero/diagnóstico por imagem
Cremes, Espumas e Géis Vaginais
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Contrast Media); 0 (Vaginal Creams, Foams, and Jellies)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE


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[PMID]:29419676
[Au] Autor:Zheng QF; Li JY; Qin L; Wei HM; Cai LY; Nong B
[Ad] Endereço:Department of Gastroenterology.
[Ti] Título:Gastrointestinal involvement by mantle cell lymphoma identified by biopsy performed during endoscopy: A case report.
[So] Source:Medicine (Baltimore);97(6):e9799, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Primary gastrointestinal mantle cell lymphoma is rare, and histopathological examination and specific immunohistochemical staining are still the gold standard for diagnosis. Therefore, it is necessary to find a new way to improve positive biopsy rates. PATIENT CONCERNS: A 58-year-old man was admitted to our hospital with epigastric pain, abdominal distension, nausea, and melena. Endoscopy identified submucosal neoplasms and diffuse gastrointestinal tract involvement including the esophagus. DIAGNOSES: A false-negative diagnosis was first determined by ordinary endoscopy. However, a large tissue biopsy was subsequently performed using endoscopic mucosal resection based on endoscopic ultrasonography (EUS). Pathological examination of the biopsy specimens taken from the lesions of the duodenum and rectum revealed diffuse lymphocytic proliferation and obscure nodular and small cleaved cells with irregularly shaped nuclei. Immunohistochemistry showed that the cells were positive for CyclinD1, BCL-2, CD20, CD21, and CD5; however, they were negative for CD3, CD6, CD10, and CD43. INTERVENTIONS: The patient refused to receive further treatment. OUTCOMES: Mantle cell lymphoma was conclusively diagnosed. CONCLUSIONS: EUS has an important role in the diagnosis and management of gastrointestinal submucosal tumors. Performing a pathological biopsy including EUS may be useful for identifying the unknown nature of tumors of the digestive tract.
[Mh] Termos MeSH primário: Neoplasias Gastrointestinais
Linfoma de Célula do Manto
[Mh] Termos MeSH secundário: Biópsia/métodos
Ciclina D1/análise
Diagnóstico Diferencial
Duodeno/patologia
Ressecção Endoscópica de Mucosa/métodos
Endossonografia/métodos
Neoplasias Gastrointestinais/diagnóstico
Neoplasias Gastrointestinais/patologia
Neoplasias Gastrointestinais/fisiopatologia
Seres Humanos
Imuno-Histoquímica
Linfoma de Célula do Manto/diagnóstico
Linfoma de Célula do Manto/patologia
Linfoma de Célula do Manto/fisiopatologia
Masculino
Meia-Idade
Reto/patologia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
136601-57-5 (Cyclin D1)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180209
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009799


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[PMID]:29314798
[Au] Autor:Roganovic B; Perisic N; Roganovic A
[Ti] Título:The usefulness of endoscopic ultrasonography in differentiation between benign and malignant gastric ulcer.
[So] Source:Vojnosanit Pregl;73(7):657-62, 2016 Jul.
[Is] ISSN:0042-8450
[Cp] País de publicação:Serbia
[La] Idioma:eng
[Ab] Resumo:Background/Aim: Gastric ulcer may be benign or malignant. In terms of therapy and patient's prognosis early detection of malignancy is very important. The aim of this study was to assess the usefulness of endoscopic ultrasound (EUS) in differentiation between benign and malignant gastric ulcer. Methods: A prospective study included 20 consecutive adult patients with malignant gastric ulceration and 20 consecutive adult patients with benign gastric ulceration. All the patients underwent EUS. A total of 6 parameters were analyzed: ulcer width, ulcer depth, the thickness of the gastric wall along the edge of ulceration (T0), the thickness of the gastric wall 2 cm from the edge of ulceration (T2), loss of layering structure of the gastric wall, and the presence of regional lymph nodes. EUS criteria for malignancy and a point-score of malignancy were defined. The critical value of total point-score was also calculated showing the best reliability parameters. Results: There are 4 criteria for malignancy of gastric ulceration: T0 > 10 mm, T2 > 5 mm, EUS visualization of at least one lymph node, loss of layering structure of the gastric wall. Furthermore, T2 > 5 mm was the only EUS independent predictor of ulcer malignancy. The total point score of ≥ 4 was the cut-off pointscore value which gave the best reliability parameters in the assessment of malignant ulcers: sensitivity of 70%, specificity of 95%, positive predictive value of 93.3%, negative predictive value of 76% and accuracy of 82.5%. Conclusion: According to the results obtained in this study, we can conclude that EUS is usefull in differentiation between benign and malignant gastric ulcer.
[Mh] Termos MeSH primário: Endossonografia
Neoplasias Gástricas/diagnóstico por imagem
Úlcera Gástrica/diagnóstico por imagem
[Mh] Termos MeSH secundário: Idoso
Diagnóstico Diferencial
Feminino
Seres Humanos
Linfonodos/diagnóstico por imagem
Linfonodos/patologia
Metástase Linfática
Masculino
Meia-Idade
Estudos Prospectivos
Neoplasias Gástricas/patologia
Úlcera Gástrica/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.2298/VSP150518046R


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[PMID]:29241858
[Au] Autor:Chen M; Zhu H; Jin Z; Li Z; Du Y
[Ad] Endereço:Department of Gastroenterology, Changhai Hospital of Second Military Medical University, Shanghai, China; Company Eleven, Students Brigade, Second Military Medical University, Shanghai, China.
[Ti] Título:Safety of lumen-apposing metal stents for pancreatic fluid drainage: waiting for a clear answer.
[So] Source:Gastrointest Endosc;87(1):319-320, 2018 01.
[Is] ISSN:1097-6779
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Drenagem
Suco Pancreático
[Mh] Termos MeSH secundário: Endossonografia
Seres Humanos
Metais
Stents
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
0 (Metals)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171216
[St] Status:MEDLINE


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[PMID]:29173765
[Au] Autor:Kuijvenhoven JC; Crombag L; Breen DP; van den Berk I; Versteegh MIM; Braun J; Winkelman TA; van Boven W; Bonta PI; Rabe KF; Annema JT
[Ad] Endereço:Department of Respiratory Medicine, Academic Medical Center (AMC), Amsterdam, The Netherlands.
[Ti] Título:Esophageal ultrasound (EUS) assessment of T4 status in NSCLC patients.
[So] Source:Lung Cancer;114:50-55, 2017 Dec.
[Is] ISSN:1872-8332
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Mediastinal and central large vessels (T4) invasion by lung cancer is often difficult to assess preoperatively due to the limited accuracy of computed tomography (CT) scan of the chest. Esophageal ultrasound (EUS) can visualize the relationship of para-esophageally located lung tumors to surrounding mediastinal structures. AIM: To assess the value of EUS for detecting mediastinal invasion (T4) of centrally located lung tumors. METHODS: Patients who underwent EUS for the diagnosis and staging of lung cancer and in whom the primary tumor was detected by EUS and who subsequently underwent surgical- pathological staging (2000-2016) were retrospectively selected from two university hospitals in The Netherlands. T status of the lung tumor was reviewed based on EUS, CT and thoracotomy findings. Surgical- pathological staging was the reference standard. RESULTS: In 426 patients, a lung malignancy was detected by EUS of which 74 subjects subsequently underwent surgical- pathological staging. 19 patients (26%) were diagnosed with stage T4 based on vascular (n=8, 42%) or mediastinal (n=8, 42%) invasion or both (n=2, 11%), one patient (5%) had vertebral involvement. Sensitivity, specificity, PPV and NPV for assessing T4 status were: for EUS (n=74); 42%, 95%, 73%, 83%, for chest CT (n=66); 76%, 61%, 41%, 88% and the combination of EUS and chest CT (both positive or negative for T4, (n=34); 83%, 100%, 100% 97%. CONCLUSION: EUS has a high specificity and NPV for the T4 assessment of lung tumors located para-esophageally and offers further value to chest CT scan.
[Mh] Termos MeSH primário: Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem
Esôfago/diagnóstico por imagem
Neoplasias Pulmonares/diagnóstico por imagem
Invasividade Neoplásica/diagnóstico por imagem
Estadiamento de Neoplasias/métodos
Ultrassonografia/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Carcinoma Pulmonar de Células não Pequenas/patologia
Carcinoma Pulmonar de Células não Pequenas/cirurgia
Endossonografia/métodos
Feminino
Seres Humanos
Neoplasias Pulmonares/patologia
Neoplasias Pulmonares/cirurgia
Masculino
Neoplasias do Mediastino/diagnóstico por imagem
Neoplasias do Mediastino/patologia
Neoplasias do Mediastino/secundário
Mediastino/diagnóstico por imagem
Mediastino/patologia
Meia-Idade
Invasividade Neoplásica/patologia
Países Baixos/epidemiologia
Estudos Retrospectivos
Toracotomia/métodos
Toracotomia/estatística & dados numéricos
Tomografia Computadorizada por Raios X/métodos
Neoplasias Vasculares/diagnóstico por imagem
Neoplasias Vasculares/patologia
Neoplasias Vasculares/secundário
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180131
[Lr] Data última revisão:
180131
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE


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[PMID]:28742794
[Au] Autor:Menon U; McGuire AJ; Raikou M; Ryan A; Davies SK; Burnell M; Gentry-Maharaj A; Kalsi JK; Singh N; Amso NN; Cruickshank D; Dobbs S; Godfrey K; Herod J; Leeson S; Mould T; Murdoch J; Oram D; Scott I; Seif MW; Williamson K; Woolas R; Fallowfield L; Campbell S; Skates SJ; Parmar M; Jacobs IJ
[Ad] Endereço:Department of Women's Cancer, Institute for Women's Health, University College London, London W1T 7DN, UK.
[Ti] Título:The cost-effectiveness of screening for ovarian cancer: results from the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS).
[So] Source:Br J Cancer;117(5):619-627, 2017 Aug 22.
[Is] ISSN:1532-1827
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: To assess the within-trial cost-effectiveness of an NHS ovarian cancer screening (OCS) programme using data from UKCTOCS and extrapolate results based on average life expectancy. METHODS: Within-trial economic evaluation of no screening (C) vs either (1) an annual OCS programme using transvaginal ultrasound (USS) or (2) an annual ovarian cancer multimodal screening programme with serum CA125 interpreted using a risk algorithm (ROCA) and transvaginal ultrasound as a second-line test (MMS), plus comparison of lifetime extrapolation of the no screening arm and the MMS programme using both a predictive and a Markov model. RESULTS: Using a CA125-ROCA cost of £20, the within-trial results show USS to be strictly dominated by MMS, with the MMS vs C comparison returning an incremental cost-effectiveness ratio (ICER) of £91 452 per life year gained (LYG). If the CA125-ROCA unit cost is reduced to £15, the ICER becomes £77 818 per LYG. Predictive extrapolation over the expected lifetime of the UKCTOCS women returns an ICER of £30 033 per LYG, while Markov modelling produces an ICER of £46 922 per QALY. CONCLUSION: Analysis suggests that, after accounting for the lead time required to establish full mortality benefits, a national OCS programme based on the MMS strategy quickly approaches the current NICE thresholds for cost-effectiveness when extrapolated out to lifetime as compared with the within-trial ICER estimates. Whether MMS could be recommended on economic grounds would depend on the confirmation and size of the mortality benefit at the end of an ongoing follow-up of the UKCTOCS cohort.
[Mh] Termos MeSH primário: Algoritmos
Detecção Precoce de Câncer/economia
Detecção Precoce de Câncer/métodos
Neoplasias Ovarianas/sangue
Neoplasias Ovarianas/diagnóstico por imagem
[Mh] Termos MeSH secundário: Idoso
Antígeno Ca-125/sangue
Análise Custo-Benefício
Endossonografia
Feminino
Seres Humanos
Cadeias de Markov
Proteínas de Membrana/sangue
Meia-Idade
Neoplasias Ovarianas/economia
Neoplasias Ovarianas/mortalidade
Anos de Vida Ajustados por Qualidade de Vida
Medicina Estatal/economia
Reino Unido
Vagina
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (CA-125 Antigen); 0 (MUC16 protein, human); 0 (Membrane Proteins)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180131
[Lr] Data última revisão:
180131
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE
[do] DOI:10.1038/bjc.2017.222


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[PMID]:29310413
[Au] Autor:Yang MJ; Kim JH; Hwang JC; Yoo BM; Kim SS; Lim SG; Won JH
[Ad] Endereço:Department of Gastroenterology.
[Ti] Título:Usefulness of combined percutaneous-endoscopic rendezvous techniques after failed therapeutic endoscopic retrograde cholangiography in the era of endoscopic ultrasound guided rendezvous.
[So] Source:Medicine (Baltimore);96(48):e8991, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The rendezvous approach is a salvage technique after failure of endoscopic retrograde cholangiography (ERC). In certain circumstances, percutaneous-endoscopic rendezvous (PE-RV) is preferred, and endoscopic ultrasound-guided rendezvous (EUS-RV) is difficult to perform. We aimed to evaluate PE-RV outcomes, describe the PE-RV techniques, and identify potential indications for PE-RV over EUS-RV.Retrospective analysis was conducted of a prospectively designed ERC database between January 2005 and December 2016 at a tertiary referral center including cases where PE-RV was used as a salvage procedure after ERC failure.During the study period, PE-RV was performed in 42 cases after failed therapeutic ERC; 15 had a surgically altered enteric anatomy. The technical success rate of PE-RV was 92.9% (39/42), with a therapeutic success rate of 88.1% (37/42). Potential indications for PE-RV over EUS-RV were identified in 23 cases, and either PE-RV or EUS-RV could have effectively been used in 19 cases. Endoscopic bile duct access was successfully achieved with PE-RV in 39 cases with accessible biliary orifice using one of PE-RV cannulation techniques (classic, n = 11; parallel, n = 19; and adjunctive maneuvers, n = 9).PE-RV uses a unique technology and has clinical indications that distinguish it from EUS-RV. Therefore, PE-RV can still be considered a useful salvage technique for the treatment of biliary obstruction after ERC failure.
[Mh] Termos MeSH primário: Colangiopancreatografia Retrógrada Endoscópica
Colestase/diagnóstico por imagem
Colestase/cirurgia
Endossonografia
[Mh] Termos MeSH secundário: Ductos Biliares/diagnóstico por imagem
Ductos Biliares/cirurgia
Feminino
Seres Humanos
Masculino
Meia-Idade
Estudos Prospectivos
Melhoria de Qualidade
Estudos Retrospectivos
Terapia de Salvação
Resultado do Tratamento
Ultrassonografia de Intervenção
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180110
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008991



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