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PubMedDate not supplied

Missed breast carcinoma: pitfalls and pearls.

Mammography is the standard of reference for the detection of breast carcinoma, yet 10%-30% of breast cancers may be missed at mammography. Possible causes for missed breast cancers include dense parenchyma obscuring a lesion, poor positioning or technique, perception error, incorrect interpretation of a suspect finding, subtle features of malignancy, and slow growth of a lesion. Recent studies have emphasized the use of alternative imaging modalities to detect and diagnose breast carcinoma, including ultrasonography (US), magnetic resonance imaging, and nuclear medicine studies. However, the radiologist can take a number of steps that will significantly enhance the accuracy of image interpretation at mammography and decrease the false-negative rate. These steps include performing diagnostic as well as screening mammography, reviewing clinical data and using US to help assess a palpable or mammographically detected mass, strictly adhering to positioning and technical requirements, being alert to subtle features of breast cancers, comparing recent images with earlier mammograms to look for subtle increases in lesion size, looking for additional lesions when one abnormality is seen, and judging a lesion by its most malignant features.

Adult↗
PubMed1989

Setting up an HIV screening program.

Human immunodeficiency virus-1 (HIV-1) screening programs currently are based primarily on the detection of specific HIV-1 antibodies by the commercially available enzyme immunoassay (EIA) combined with highly specific confirmation procedures. Factors to be considered in establishing a screening program include test performance characteristics, economy, confidentiality and notification procedures, legal and regulatory issues, proficiency and quality control measures, and laboratory safety. Commercial EIA screening in conjunction with a licensed Western blot assay permits the classification of all but a few serum samples into HIV-1-positive and HIV-1-negative categories. The occasional indeterminate results often can be resolved by following a defined retesting/resampling algorithm or by using research-level test procedures that may become available for diagnostic use in the future. Although screening of patient populations with an increased risk of HIV-1 exposure will improve the predictive accuracy of an initial screening assay, confirmation testing should nonetheless be performed for all EIA reactive sera regardless of the source. Local HIV-1 screening programs that meet minimum-volume requirements can result in considerable savings and flexibility for a moderate-size institution. However, before this type of program is undertaken, numerous technical and ethical considerations need to be addressed.

Algorithms↗
PubMed1994

Health-care screening among the elderly--a comparison between participants and non-participants.

Geriatric screening at health clinics has become a regular feature of the health-care services offered in some Norwegian municipalities. Normally there is good participation in such screening programmes, but there are always some non-attenders. There is little published material showing the intervention needs among non-respondents. In a municipality in the middle parts of Norway, screening was offered to the municipality's elderly inhabitants at the local health clinic. Those who did not attend were offered a domiciliary visit. The findings indicate that there is a category of people among those who do not attend for screening at the health clinic who have less need of a medical examination and socioeconomic support than those who do attend the screening. There is also a category in need of community nursing, technical aids and health care because of senile dementia, depression and unsought social isolation.

Aged↗
PubMed2004

Integrating mass spectrometry into membrane protein drug discovery.

Membrane proteins represent a valuable source of potential drug targets due to their intimate involvement in a wide variety of disease states, including diabetes, cancer and neurological disorders. Defining the proteome of these often rare amphipathic molecules can be accomplished by exploiting the highly accurate and sensitive nature of mass spectrometry (MS). Technical advances have enabled MS to become a valuable tool for detailed mechanistic investigations into membrane proteins of unknown and known structure. The transfer of MS-screening strategies that have already been successfully used to identify interactions between soluble proteins and potential ligands, should allow the identification of drug candidates for membrane proteins in the near future.

Animals↗
PubMed1998

A survey of current United Kingdom practice for antenatal screening for inherited disorders of globin chain synthesis. UK Forum for Haemoglobin Disorders.

AIMS: To document current United Kingdom practice for antenatal screening for inherited disorders of globin chain synthesis and to compare such practice with guidelines published by the British Committee for Standards in Haematology and the Standing Committee on Sickle Cell, Thalassaemia and other Haemoglobinopathies (SMAC). METHODS: The members of the UK Forum on Haemoglobin Disorders were surveyed about their current practice for antenatal haemoglobinopathy screening. The UK Forum is a national group of haematologists, paediatricians, laboratory scientists, and counsellors working in the field of diagnosis and management of disorders of haemoglobin synthesis; such disorders including the alpha and beta thalassaemias, sickle cell disease, and other haemoglobinopathies. RESULTS: Completed questionnaires from 38 hospitals (or cooperating groups of hospitals) were analysed. The great majority of hospitals were applying appropriate laboratory methods, but problems were commonly encountered in ensuring that appropriate testing of antenatal patients and, when necessary, of their partners, was carried out early in pregnancy. When screening was selective there was quite often a failure to identify all women in whom testing was indicated, and cut off points used as an indication for further testing were sometimes inappropriate. CONCLUSIONS: Many practical problems are still encountered in following guidelines for the antenatal diagnosis of haemoglobinopathies. A need for improved administrative procedures and increased funding was identified. In addition there is a need for agreed guidelines giving more specific advice on technical aspects of laboratory practice.

Female↗
PubMed2001

Immunofluorescence--still the 'gold standard' in ANA testing?

A usefulness of enzyme immunoassay (EIA)-based antinuclear antibodies (ANA) tests was evaluated in comparison with the immunofluorescence ANA assay (IF-ANA). COBAS-ANA and MBL-ANA were used, in the former a mixture of antigens extracted from HEp-2 cells and multiple recombinant antigens was immobilized on beads as the antigen, and in the latter 9 kinds of purified or recombinant proteins are immobilized on 96-well plates. We first compared an ability to differentiate 258 connective tissue disease (CTD) patients (except rheumatoid arthritis) from 257 healthy subjects between COBAS-ANA and IF-ANA. The sensitivity and specificity of COBAS-ANA were 84% and 94%, respectively, while those of IF-ANA at a cutoff dilution of 1:160 were 81% and 87%. The receiver operating characteristic (ROC) analysis showed a significant superiority of COBAS-ANA to IF-ANA. Moreover, when the cutoff index was set at 0.6, the COBAS-ANA could detect the 8 disease-specific ANAs as well as IF-ANA at a cutoff dilution of 1:40. A possible availability of MBL-ANA in a periodic health examination in certain towns was also demonstrated. Among the 1123 subjects, a total of 145 disease-specific ANAs were detected in 126 subjects. MBL-ANA could catch disease-specific ANAs with almost same efficacy of IF-ANA. Annual survey of the residents by MBL-ANA may lead to a detection of CTD patients. EIA-based ANA tests are very useful for both detecting disease-specific ANAs and screening CTD patients. We believe that EIA-ANA should be the 'gold standard' especially for screening a large number of samples, although there is some room for technical improvement.

Antibodies, Antinuclear↗
PubMed1989

Why mandatory HIV antibody screening cannot work.

In 1985 this country introduced the first serologic screening test [enzyme immunoassays (EIAs)] designed to detect antibodies to the human immunodeficiency virus (HIV), the pathogen of acquired immunodeficiency syndrome (AIDS). Some people now suggest use of this test to identify people within the general population who are infected with the virus. This article will review technical and administrative problems pertaining to the use of EIAs to screen the general population for antibodies to HIV, and will explain why optometrists can provide safe and comprehensive care to all patients without knowledge of a patient's HIV antibody status. Prior knowledge by the optometrist of the patient's serological status is unnecessary if the practitioner 1) adheres to established guidelines pertaining to infection control, and 2) is aware of the various ocular manifestations of HIV disease. It concludes that mandatory HIV screening programs should not be adopted until the benefits to society have been more clearly elucidated and associated technical, administrative, and ethical problems have been resolved.

AIDS Serodiagnosis↗
PubMedDate not supplied

Measures of small airways disease as predictors of chronic obstructive pulmonary disease.

Deficits in FEV1 and FVC have been shown to correlate with the presence of occupationally related obstructive and restrictive lung disease, but significant changes do not occur in the two parameters until these diseases are already well established. The current understanding of the relationship between small airways testing and the subsequent development of COPD is reviewed. Various methods for evaluating peripheral airways are discussed, with emphasis on applicability in the field, reliability and reproducibility, and technical aspects of testing.

Humans↗
PubMed1995

[Epidemiological data. Neonatal and prenatal screening].

Unlike what is generally thought, cystic fibrosis is not the most frequent hereditary disease. Its frequency is approximately 1/3 200 and varies with the geographic area. The frequency of heterozygous subjects is about 1/28. No country has established a generalized neonatal screening programme, for technical reasons and because there has been no demonstration of a beneficial effect from early care. It would nevertheless be useful to develop experimental programmes defining which protocols might best be established. Antenatal screening can be based on detecting heterozygous subjects, a technically feasible operation, although answers to a large number of questions would be required.

Cystic Fibrosis↗
PubMed1981

Problems in screening for congenital hypothyroidism using thyroxine assays from small dried blood discs.

The feasibility of screening for neonatal hypothyroidism by initial thyroxine (T4) measurements from small (3.2 mm diam.) discs of dried heel or cord blood was assessed using double-antibody radioimmunoassay and solid-phase radioassay kits. Adult heparinized venous blood or finger-prick capillary blood served as references. Reproducibility of results was satisfactory in adult but not infant samples, probably because of problems in collecting and handling the latter. In comparative studies, most of the 16 infants with congenital primary hypothyroidism had within-run T4 values above the 2.5 percentile; some were as high as the 7th and the 5th percentile for heel and cord blood, respectively. Simultaneously determined heel and cord dried-blood thyrotropin (TSH) values were clearly increased to greater than 40 microU/ml in 15 of these infants. Thus, when small discs are used for initial blood T4 screening to detect primary hypothyroidism, a higher cut-off points is recommended to safeguard against the observed technical problems.

Blood Specimen Collection↗
PubMed2002

Eye healthcare services in eastern Europe: Part 2. Vitreoretinal surgical services.

AIM: To describe vitreoretinal surgical services in 1998 in 12 eastern European countries and to identify ways for their further improvement. METHODS: All inpatient eye departments in the 12 countries received a standardised questionnaire; the data obtained were processed at the international study coordinating centre in Prague. RESULTS: All 458 eye departments in the region were involved. The number of retinal detachments treated by extraocular surgery, or pars plana vitrectomy, per one million inhabitants respectively, were as follows: Belarus (52; 6), Federation of Bosnia and Herzegovina (21; 2), Bulgaria (39; 19), the Czech Republic (78; 40), Estonia (60; 17), Hungary (81; 88), Latvia (82; 36), Lithuania (68; 6), Trans-Dniester Region of Moldova (6; -), Poland (70; data not available), Romania (24; 25), and Slovakia (67; 55). The number of people per one retinal laser was assessed (in millions): Belarus (1.26), Federation of Bosnia and Herzegovina (2.23), Bulgaria (0.59), the Czech Republic (0.22), Estonia (0.24), Hungary (0.23), Latvia (0.41), Lithuania (0.62), Poland (0.36), Romania (2.25), and Slovakia (0.14). CONCLUSIONS: Conditions for posterior eye segment surgery in the central and eastern European region vary substantially. Underserved regions require (1) more eye doctors trained in surgical and laser retinal treatment; (2) improvement in screening for diabetic eye complications and retinopathy of prematurity; (3) technical equipment for places in need.

Aged↗
PubMed2006

Cervical cancer screening: state of the art.

PURPOSE OF REVIEW: The objective of cervical cancer screening is to prevent the occurrence of and death from cervical cancer by detecting and treating high-grade squamous intraepithelial lesions. A significant decline in occurrence and mortality from cervical cancer in developed countries has been associated with the application of organized cervical screening programs. The use of the available local health methods in cervical cancer screening can be adjusted in different countries. This review discusses the recent results in traditional and alternative cervical cancer screening. RECENT FINDINGS: The current recommendations of both the American Cancer Society and the American College of Obstetricians and Gynecologists concerning clinical practice guidelines for cervical cancer screening are commented upon. New methods and new technology for cervical cancer screening are described. Attributable failure factors in the screening process, particularly in the coverage, are analyzed. A critical assessment of the suitability of local cervical cancer screening resources is discussed. SUMMARY: Screening is clearly a complex multifactorial process, not a test. Nowadays, with the human papillomavirus vaccine on the horizon, screening is the best strategy for cervical cancer control. Good screening programs, with high coverage, quality control and follow-up included, are the basis of obtaining better results. The Papanicolaou test and its variants are the best methods of cervical cancer screening in high-resource settings. Alternative visual inspection using cervical dyes could be the most useful method in low-resource settings. The challenge for the future may be less of a technical nature and more dependent on local finances and screening policies.

Female↗
PubMed1990

Mass screening for neuroblastoma in Japan. Committee of the Neuroblastoma Mass Screening Study of the Japanese Society of Pediatric Oncology.

The present status of NB mass screening in Japan, which is the first national trial in the world, is presented. This program was conducted in cooperation with infants' mothers, local health centers, screening centers and hospitals. Three hundred and thirty-seven cases detected by the program, from the start in Kyoto in 1974 to the end of 1989, are analyzed. As many cases were detected at early stages, 97% of them were expected to be cured. Several clinical, technical and programmatic problems are also discussed.

Child↗