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Biomedical subjects

R W Giard

Publications and source records attributed to R W Giard.

13 recordsLinked to original sources
PubMed1992

The value of aspiration cytologic examination of the breast. A statistical review of the medical literature.

The decision to perform surgery in patients with a breast mass usually is made on the basis of combined diagnostic information, with fine-needle aspiration cytologic examination (FNAC) playing a central role. To determine and compare the quality of FNAC of the breast, a search was performed of the English literature for articles with quantitative information about their results. Twenty-nine such articles, containing 31,340 aspirations, were identified and summarized. Required data were extracted from these articles. These numbers were analyzed with the use of a two-by-four contingency table to relate the FNAC result (definitely malignant, suspect, benign, or unsatisfactory cytologic material) with the final diagnosis (malignant or benign breast disease). Test characteristics such as sensitivity, specificity, and the likelihood ratios for the four different FNAC results were derived for each study and compared. There was a striking difference between studies with regard to the probability of a particular FNAC upshot (e.g., in patients with breast cancer, the chance of obtaining definitely malignant cytologic material ranged from 0.35 to 0.92), the sensitivity (range, 0.65 to 0.98), the specificity (range, 0.34 to 1.0), and likelihood ratios. In the opinion of the authors, it is virtually impossible to infer general test characteristics of FNAC of the breast from the medical literature because of differences in methods and different biases. At best, the maximum attainable performance of this test can be described. For the development of a policy for breast mass management, the local test characteristics of this highly operator-dependent test should be established.

Biopsy, Needle↗
PubMed1990

[Aspiration cytology of palpable breast lesions: testing of the results using the PALGA data (Pathological Anatomical National Automated Archives)].

For the testing of the results of 1233 breast punctures performed on 1132 women in the period 1985-1988, the question was studied whether a less time-consuming procedure than status examination might be used. The national computerized record office where all data on cytological and histological diagnostics per patient are centralized (PALGA) offered the possibility of determining whether and, if so, with what results histological examination of the breast had been carried out. Histological follow-up examination proved to be available of 476 punctates. In case of abnormal cytological findings without subsequent histological examination, the final diagnosis was made on the basis of the clinical findings (53 punctates; 4.6% of the women examined). In case of non-abnormal cytological findings without subsequent cytological or histological follow-up examination, the lesion was regarded as benign. It proved technically feasible with use of these final diagnoses to arrive at a numerical evaluation of aspiration cytology for the laboratory. These characteristics are valuable in making the decision whether, given a particular result of puncture biopsy, women with a palpable breast tumour should or should not be operated, provided the characteristics are always used only in combination with clinical and mammographic diagnostics. The method is also appropriate for evaluation of other forms of cytodiagnostic examination.

Adolescent↗
PubMed1990

Malignant leiomyomatosis peritonealis disseminata.

Leiomyomatosis peritonealis disseminata is a rare condition characterized by the presence of multiple intraabdominal nodules that consist of benign smooth muscle. We found 42 documented cases in the literature. Malignant degeneration appears to be extremely rare. We describe the second case with proved malignancy.

Abdominal Neoplasms↗
PubMed1990

Interpretation of diagnostic cytology with likelihood ratios.

Sensitivity, specificity, and predictive values are commonly used to report the performance characteristics of a diagnostic test. With tests that by their nature have more than two classes of results, calculation of sensitivity and specificity demands the combination of categories into two classes, leading to a loss of diagnostic information. Fine-needle aspiration cytology of the breast is usually reported using four categories: definitely malignant, suspicious, benign, and unsatisfactory. We used likelihood ratios to show that fine-needle aspiration cytology of the breast appreciates each of these four categories fully. This approach is preferred above the usual one, which combines "definitely malignant" and "suspicious" categories as abnormal and often discards unsatisfactory aspirations from calculation. Knowledge of the prior probability of breast cancer and the likelihood ratio for a particular class of results of fine-needle aspiration cytology of the breast allows for easy calculation of the posttest probability of the disease. Application of this method should lead to more rational support from fine-needle aspiration cytology for clinical decision making.

Adolescent↗
PubMed1989

Malignant fibrous histiocytoma of the spermatic cord.

We report a case of malignant fibrous histiocytoma of the spermatic cord and review 11 previously reported cases. Radical orchiectomy along with wide local excision is the treatment of choice. The rate of local recurrences and distant metastases is 33 per cent (4 of 12 cases) and the 5-year survival rate is 57 per cent (4 of 7 cases).

Genital Neoplasms, Male↗
PubMed1985

Variations in histopathological evaluation of non-neoplastic colonic mucosal abnormalities; assessment and clinical significance.

The variation between three pathologists examining histological features seen in non-neoplastic colonic mucosa from 40 biopsies was analysed. Several procedures to express observer variation were used and compared, with emphasis on kappa statistics. Only five features, the presence of ulceration, villous surface, epithelioid granulomas, severe mucus depletion and crypt abscesses were sufficiently reproducible by the three pairs of pathologists. These findings suggest that other criteria used for the classification of inflammatory bowel disease are potentially unsatisfactory. When results from different studies on biopsies are being compared, influence of observer variation should be identified. Comparison of statistical techniques showed overall variation to be less useful than other statistical procedures. There was little difference between results from kappa statistics and other measures of agreement (overall agreement excluded).

Biopsy↗