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Kohli DR, Mettman D, Andraws N, Haer E, Porter J, Ulusurac O, Ullery S, Desai M, Siddiqui MS, Sharma P. Comparative accuracy of endosonographic shear wave elastography and transcutaneous liver stiffness measurement: a pilot study. Gastrointest Endosc 2023; 97:35-41.e1. [PMID: 36049537 DOI: 10.1016/j.gie.2022.08.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Vibration-controlled transient elastography (VCTE) is a validated test for assessing liver fibrosis but may be unreliable in select patients, including those with morbid obesity. The limitations of VCTE may be overcome by EUS-guided shear wave elastography (EUS-SWE). METHODS This single-center, prospective, nonrandomized tandem study compared the diagnostic accuracy of EUS-SWE and VCTE in consecutive patients undergoing liver biopsy sampling because of unreliable noninvasive testing. EUS-SWE of the left and right lobes were separately performed and then compared with VCTE. Liver elasticity cutoffs for different stages of fibrosis were estimated in 3 ways: optimized sensitivity and specificity using the Youden index; and with sensitivity and specificity fixed at 90% each, Diagnostic accuracy for fibrosis was compared with liver histology using the area under the receiver-operating characteristic curve (AUROC). The primary outcome was the diagnostic accuracy of EUS-SWE for advanced fibrosis. Secondary outcomes were diagnostic accuracy of VCTE, EUS-SWE for left and right hepatic lobes for significant/advanced fibrosis, and cirrhosis. RESULTS Forty-two patients (39 men, aged 54.5 ± 12.1 years) underwent EUS-SWE, VCTE, and liver biopsy sampling. The cross-validated AUROCs for advanced fibrosis were as follows: VCTE, .87 (95% confidence interval [CI], .76-.97); EUS-SWE left lobe, .8 (95% CI, .64-.96); and EUS-SWE right lobe, .78 (95% CI, .62-.95). The corresponding AUROCs for cirrhosis were as follows: VCTE, .9 (95% CI, .83-.97); EUS-SWE left lobe, .96 (95% CI, .9-1); and EUS-SWE right lobe, .9 (95% CI, .8-1). VCTE was unreliable in 8 patients who successfully underwent EUS-SWE. There was no statistically significant difference in the AUROCs for EUS-SWE and VCTE. CONCLUSIONS EUS-SWE correlates well with liver histology and is a safe and reliable diagnostic test for assessing liver fibrosis with accuracy comparable with VCTE. (Clinical trial registration number: NCT04533932.).
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Affiliation(s)
- Divyanshoo R Kohli
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA; Liver and Pancreas Clinic, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Daniel Mettman
- Department of Lab Medicine and Pathology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Nevene Andraws
- Department of Lab Medicine and Pathology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Erin Haer
- Department of Lab Medicine and Pathology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Jaime Porter
- Department of Lab Medicine and Pathology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Ozlem Ulusurac
- Department of Lab Medicine and Pathology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Steven Ullery
- North American Science Associates, Walnut Creek, California, USA
| | - Madhav Desai
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Mohammad S Siddiqui
- Division of Gastroenterology and Hepatology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Prateek Sharma
- Division of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, Missouri, USA
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Desai M, Srinivasan S, Sundaram S, Dasari C, Andraws N, Mathur S, Higbee A, Miller J, Beg S, Fateen W, Sami SS, Repici A, Ragunath K, Sharma P. Narrow-band imaging for the diagnosis of nonerosive reflux disease: an international, multicenter, randomized controlled trial. Gastrointest Endosc 2022; 96:457-466.e3. [PMID: 35487299 DOI: 10.1016/j.gie.2022.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/20/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS We examined the accuracy of narrow-band imaging (NBI) findings in nonerosive reflux disease (NERD) patients compared with control subjects and the impact of proton pump inhibitor (PPI) therapy on these mucosal changes in a multicenter, double-blind, randomized controlled trial. METHODS NERD patients (typical symptoms using a validated GERD questionnaire, absence of erosive esophagitis, and abnormal 48-hour pH study) and control subjects underwent high-definition white-light endoscopy followed by NBI and biopsy sampling of the distal esophagus. Then, NERD patients were randomized to esomeprazole 40 mg/day or placebo for 8 weeks, followed by repeat endoscopy. The presence of distal esophageal mucosal changes on NBI were recorded at baseline and after treatment: intrapapillary capillary loops (IPCLs; number, dilation, and tortuosity), microerosions, increased vascularity, columnar islands, and ridge/villous pattern (RVP) above the squamocolumnar junction. RESULTS Of 122 screened, 21 NERD and 21 control subjects were identified (mean age, 49.5 ± 14.6 years; 62% men; and 85% white). The combination of IPCL tortuosity, RVP, and microerosions (62% vs 19%, P < .05) had a high specificity (86%) and moderate sensitivity (60%) for NERD with an area under the curve of .74. In 10 NERD patients treated with PPIs, resolution of microerosions was most significant (P = .047) compared with placebo (n = 11). RVP resolved in all NERD patients after therapy (P = .02) and correlated with acid exposure time (P = .004). Papillary length (P = .02) and basal cell thickness (P = .02) significantly correlated with a combination of IPCL tortuosity, RVP, and microerosions. CONCLUSIONS In this randomized controlled trial, RVP on NBI demonstrated a high specificity, correlated with acid exposure time, and improved with PPI therapy, suggesting that it could be used as a surrogate marker for diagnosis of NERD. (Clinical trial registration number: NCT02081404.).
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Affiliation(s)
- Madhav Desai
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Sachin Srinivasan
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Suneha Sundaram
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Chadra Dasari
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Nevene Andraws
- Department of Pathology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Sharad Mathur
- Department of Pathology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - April Higbee
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Jennifer Miller
- Pharmacy Services, Kansas City VA Medical Center, Kansas City, Missouri, USA
| | - Sabina Beg
- NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Waleed Fateen
- NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sarmed S Sami
- NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Alessandro Repici
- Department of Endoscopy, Humanitas Research Hospital, IRCCS, 20089 Rozzano, Italy
| | - Krish Ragunath
- NIHR Nottingham Biomedical Research Centre, University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Prateek Sharma
- Department of Gastroenterology, Kansas City VA Medical Center, Kansas City, Missouri, USA; Department of Gastroenterology and Hepatology, University of Kansas School of Medicine, Kansas City, Kansas, USA
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Vennelaganti S, Cuatrecasas M, Vennalaganti P, Kennedy KF, Srinivasan S, Patil DT, Plesec T, Lanas A, Hörndler C, Andraws N, Cherian R, Mathur S, Hassan C, Repici A, Klotz D, Musulen E, Risio M, Castells A, Gupta N, Sharma P. Interobserver Agreement Among Pathologists in the Differentiation of Sessile Serrated From Hyperplastic Polyps. Gastroenterology 2021; 160:452-454.e1. [PMID: 32950521 DOI: 10.1053/j.gastro.2020.09.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 09/08/2020] [Accepted: 09/12/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Sreekar Vennelaganti
- Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri
| | - Miriam Cuatrecasas
- Department of Pathology, Hospital Clinic and Biobank Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Prashanth Vennalaganti
- Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri; Gastroenterology, University of Kansas School of Medicine, Kansas City, Kansas
| | - Kevin F Kennedy
- Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri
| | - Sachin Srinivasan
- Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri
| | | | | | - Angel Lanas
- Gastroenterology, Aragón Health Research Institute, University of Zaragoza, CIBERehd, Zaragoza Spain
| | - Carlos Hörndler
- Gastroenterology, Aragón Health Research Institute, University of Zaragoza, CIBERehd, Zaragoza Spain
| | - Nevene Andraws
- Pathology, Veterans Affairs Medical Center, Kansas City, Missouri
| | - Rachel Cherian
- Pathology, Veterans Affairs Medical Center, Kansas City, Missouri
| | - Sharad Mathur
- Pathology, Veterans Affairs Medical Center, Kansas City, Missouri
| | - Cesare Hassan
- Gastroenterology and Hepatology, Istituto Clinico Humanitas, Milan, Italy
| | - Alessandro Repici
- Gastroenterology and Hepatology, Istituto Clinico Humanitas, Milan, Italy
| | - Dagmar Klotz
- Pathology, Oslo University Hospital, Oslo, Norway
| | - Eva Musulen
- Pathology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Mauro Risio
- Pathology, Institute of Cancer Research and Treatment, Candiolo-Torino, Italy
| | - Antoni Castells
- Department of Gastroenterology, Hospital Clinic of Barcelona, University of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Catalonia, Spain
| | - Neil Gupta
- Gastroenterology, Loyola University, Maywood, Illinois
| | - Prateek Sharma
- Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri; Gastroenterology, University of Kansas School of Medicine, Kansas City, Kansas.
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Ku T, Andraws N, Plautz M. AN UNUSUAL GROUND GLASS OPACITY. Chest 2019. [DOI: 10.1016/j.chest.2019.08.1115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ahmed AA, Andraws N, Almutairi AM, Saied HM, Elbagir-Mohamed AM. Cytologic and Immunophenotypic Features of Malignant Cells in Pediatric Body Fluids. Acta Cytol 2015; 59:332-8. [PMID: 26422236 DOI: 10.1159/000440795] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 08/31/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cytospin preparations and immunocytochemistry are common methods in hospitals to evaluate malignancies in body fluids. Characteristics of malignant cells in pediatric body fluids have not been adequately evaluated. STUDY DESIGN 183 pleural, peritoneal and pericardial pediatric fluid specimens were examined by cytospin preparations and immunocytochemistry from two hospitals using similar procedural techniques. Cytologic diagnoses were correlated with the results of clinical history, histology and ancillary studies. RESULTS Forty cases with malignancy were identified (21.9%); the most common diagnoses were rhabdomyosarcoma and acute lymphoblastic lymphoma (9 and 8 cases, respectively). Small round cell tumors revealed similar morphology as clusters of small round cells with central nuclei and scant cytoplasm with frequent small vacuoles. Twenty-one cases were evaluated by immunocytochemistry, 12 by flow cytometry and 5 by cytogenetic analysis. CD3, CD20, TdT, CD10, desmin and myogenin were the most common markers. Staining artifacts causing interpretation difficulties were noted in 5 cases that were resolved by molecular studies and deferral for surgical specimens. CONCLUSIONS Small round cell tumors are the most common malignancies encountered in pediatric body fluids and share a nonspecific morphology. Although immunocytochemistry is helpful to arrive at the correct diagnosis, other ancillary studies may be necessary, particularly in hematologic malignancies and other difficult cases.
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Affiliation(s)
- Atif A Ahmed
- Department of Pathology and Laboratory Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
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Saunders CJ, Miller NA, Soden SE, Dinwiddie DL, Noll A, Alnadi NA, Andraws N, Patterson ML, Krivohlavek LA, Fellis J, Humphray S, Saffrey P, Kingsbury Z, Weir JC, Betley J, Grocock RJ, Margulies EH, Farrow EG, Artman M, Safina NP, Petrikin JE, Hall KP, Kingsmore SF. Rapid whole-genome sequencing for genetic disease diagnosis in neonatal intensive care units. Sci Transl Med 2012; 4:154ra135. [PMID: 23035047 PMCID: PMC4283791 DOI: 10.1126/scitranslmed.3004041] [Citation(s) in RCA: 441] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Monogenic diseases are frequent causes of neonatal morbidity and mortality, and disease presentations are often undifferentiated at birth. More than 3500 monogenic diseases have been characterized, but clinical testing is available for only some of them and many feature clinical and genetic heterogeneity. Hence, an immense unmet need exists for improved molecular diagnosis in infants. Because disease progression is extremely rapid, albeit heterogeneous, in newborns, molecular diagnoses must occur quickly to be relevant for clinical decision-making. We describe 50-hour differential diagnosis of genetic disorders by whole-genome sequencing (WGS) that features automated bioinformatic analysis and is intended to be a prototype for use in neonatal intensive care units. Retrospective 50-hour WGS identified known molecular diagnoses in two children. Prospective WGS disclosed potential molecular diagnosis of a severe GJB2-related skin disease in one neonate; BRAT1-related lethal neonatal rigidity and multifocal seizure syndrome in another infant; identified BCL9L as a novel, recessive visceral heterotaxy gene (HTX6) in a pedigree; and ruled out known candidate genes in one infant. Sequencing of parents or affected siblings expedited the identification of disease genes in prospective cases. Thus, rapid WGS can potentially broaden and foreshorten differential diagnosis, resulting in fewer empirical treatments and faster progression to genetic and prognostic counseling.
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Affiliation(s)
- Carol Jean Saunders
- Center for Pediatric Genomic Medicine, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Pathology, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
- University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Neil Andrew Miller
- Center for Pediatric Genomic Medicine, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Sarah Elizabeth Soden
- Center for Pediatric Genomic Medicine, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Darrell Lee Dinwiddie
- Center for Pediatric Genomic Medicine, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Pathology, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
- University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Aaron Noll
- Center for Pediatric Genomic Medicine, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - Noor Abu Alnadi
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Nevene Andraws
- Department of Pathology, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - Melanie LeAnn Patterson
- Center for Pediatric Genomic Medicine, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Pathology, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - Lisa Ann Krivohlavek
- Center for Pediatric Genomic Medicine, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Pathology, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - Joel Fellis
- Illumina Inc., Chesterford Research Park, Little Chesterford, CB10 1XL Essex, UK
| | - Sean Humphray
- Illumina Inc., Chesterford Research Park, Little Chesterford, CB10 1XL Essex, UK
| | - Peter Saffrey
- Illumina Inc., Chesterford Research Park, Little Chesterford, CB10 1XL Essex, UK
| | - Zoya Kingsbury
- Illumina Inc., Chesterford Research Park, Little Chesterford, CB10 1XL Essex, UK
| | | | - Jason Betley
- Illumina Inc., Chesterford Research Park, Little Chesterford, CB10 1XL Essex, UK
| | | | | | - Emily Gwendolyn Farrow
- Center for Pediatric Genomic Medicine, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - Michael Artman
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Nicole Pauline Safina
- Center for Pediatric Genomic Medicine, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Joshua Erin Petrikin
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Pathology, Children’s Mercy Hospital, Kansas City, MO 64108, USA
| | - Kevin Peter Hall
- Illumina Inc., Chesterford Research Park, Little Chesterford, CB10 1XL Essex, UK
| | - Stephen Francis Kingsmore
- Center for Pediatric Genomic Medicine, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Pediatrics, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- Department of Pathology, Children’s Mercy Hospital, Kansas City, MO 64108, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA
- University of Kansas Medical Center, Kansas City, KS 66160, USA
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