PubMed · 10201160
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T Kurashige, Y Morisawa, M Fujieda. 1999. [Smallpox].. https://pubmed.ncbi.nlm.nih.gov/10201160/
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BACKGROUND: Positron emission tomography (PET) with (18)F-fluorodeoxyglucose (FDG) is a rapidly developing new imaging technique in the diagnosis and staging of melanoma. The objective of the current study was to determine the diagnostic accuracy of FDG-PET in patients with melanoma. METHODS: A systematic review and meta-analysis of clinical studies regarding FDG-PET and cutaneous melanoma was conducted. Studies were identified by a comprehensive search of the MEDLINE, EMBASE, and Current Contents databases, without any language restrictions. Eleven studies were selected. The methodologic quality of these studies was assessed independently by two reviewers. Levels of evidence and grades of recommendation were determined for each study. Six studies could be included in the statistical pooling. Sources of heterogeneity were studied by meta-regression of the diagnostic odds ratio (DOR). A summary receiver operating characteristic curve was calculated. RESULTS: The pooled sensitivity and specificity of FDG-PET in the detection of melanoma metastases were 0.79 (95% confidence interval [95% CI], 0.66-0.93) and 0.86 (95% CI, 0.78-0.95), respectively. The pooled DOR of 33.1 (95% CI, 21.9-54.0) suggests a high diagnostic accuracy for PET. Subgroup analysis revealed that PET is more accurate for systemic staging (DOR of 36.4) than for regional staging (DOR of 19.5). When used for regional staging, PET performed better in patients with American Joint Committee on Cancer Stage III disease, compared with patients with Stage I and Stage II disease. However, the methodologic quality of the studies was limited. Major problems were verification, review, and selection bias. CONCLUSIONS: Due to the poor methodologic quality of the available studies, to the authors' knowledge it is yet not possible to develop guidelines for the effective use of PET in patients with melanoma. Future accuracy studies should meet the methodologic criteria outlined in the current review.
Dyspareunia is genital pain associated with sexual intercourse. Although this condition has historically been defined by psychologic theories, the current treatment approach favors an integrated pain model. Identification of the initiating and promulgating factors is essential to reaching a successful diagnosis. The differential diagnoses include vaginismus, inadequate lubrication, atrophy and vulvodynia (vulvar vestibulitis). Less common etiologies are endometriosis, pelvic congestion, adhesions or infections, and adnexal pathology. Urethral disorders, cystitis and interstitial cystitis may also cause painful intercourse. The location of the pain may be described as entry or deep. Vulvodynia, atrophy, inadequate lubrication and vaginismus are associated with painful entry. Deep pain occurs with the other conditions previously noted. The physical examination may reproduce the pain, such as localized pain with vulvar vestibulitis, when the vagina is touched with a cotton swab. The involuntary spasm of vaginismus may be noted with insertion of an examining finger or speculum. Palpation of the lateral vaginal walls, uterus, adnexa and urethral structures helps identify the cause. An understanding of the present organic etiology must be integrated with an appreciation of the ongoing psychologic factors and negative expectations and attitudes that perpetuate the pain cycle.
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