CEUS LI-RADS for diagnosing liver cancer

In a validation study by Canadian researchers, the contrast agent-enhanced CE US Liver Imaging Reporting and Data System (CEUS LI-RADS) provided high specificity for noninvasive imaging-based diagnosis of hepatocellular carcinoma (HCC), avoiding the need for tissue biopsy and enabling accurate categorization of nodules in patients at risk of HCC, the most common type of primary liver cancer. The research involved a single center, retrospective review of 196 nodules in 184 patients at risk for HCC, with three-reader blinded read format. Radiologist categorization of nodules using the CEUS LI-RADS algorithm demonstrated 86% sensitivity, 96% specificity, 98% positive predictive value and 73% negative predictive value for diagnosis of LR-5 (definite) category HCC. A multivariable logistic regression analysis found washout of more than 60 seconds to be the contrast-enhanced US feature most predictive of HCC diagnosis, while washout below 60 seconds was most predictive of nonhepatocellular cancer. “This study showed excellent specificity for the CEUS LI-RADS LR-5 category, allowing for confident imaging diagnosis of HCC, without necessity for pathologic confirmation,” the team wrote. “In addition, there was accurate differentiation of HCC from non-HCC malignancies and benign nodules. Only a single cholangiocarcinoma was misdiagnosed as category LR-5, with the remainder of the cholangiocarcinomas in the sample appropriately characterized as category LR-M.” The study was published online March 27, 2020, in Radiology: Imaging Cancer

Variations in echocardiography recommendations for patients with S. aureus

Researchers in Australia have found that while echocardiography to detect infective endocarditis is deemed a key quality measure in caring for patients with Staphylococcus aureus infections, clinicians disagree widely on the preferred echocardiography strategy and the need for a highly exclusionary strategy among patients with lower risk. The study involved an anonymous, web-based survey describing 50 text-based scenarios for patients with S. aureus bacteremia and various combinations of risk factors for endocarditis. A total of 656 expert clinicians from 24 countries provided 4,837 echocardiography recommendations across the hypothetical situations. “Poor interrespondent agreement was seen across all scenarios … but was most notable for scenarios with a lower risk of endocarditis,” the researchers wrote, noting an extracardiac focus of infection also affected choice of echocardiography strategy. In particular, “[t]he lack of association between echocardiography recommendations and the estimated consequence of relapse on overt questioning stands at odds with the strong association seen with the presence of an extracardiac focus requiring prolonged treatment in scenario descriptions,” they wrote. “Prolonged treatment with regimens used for the specific extracardiac foci described in these scenarios would be expected to be generally effective for the treatment of uncomplicated native valve endocarditis.” Their work appeared online April 9, 2020, in JAMA Network Open.

Reusable bronchoscopes and COVID-19 patients

Bronchoscopes can be used to look into people’s lungs, examine the airways and extract samples, including in some cases of COVID-19. Now, Cori Ofstead, president and CEO of Ofstead & Associates Inc., and researchers at the Mayo Clinic warn that contaminated bronchoscopes could spread other microbes to COVID-19 patients, causing secondary infections and increasing mortality rates. Currently, most bronchoscopes are reusable, requiring cleaning and disinfections between procedures. In an earlier review of bronchoscopes at three U.S. hospitals, the team found microbial and fungal growth on 58% of the scopes. While it is unclear how many COVID-19 patients are undergoing bronchoscopies, they point out that many COVID-19 tests provide false negatives and bronchoscopy is the most accurate way to confirm the new coronavirus. Use of sterile, disposable bronchoscopes could “substantially reduce the risks” to patients and hospital staff, the researchers wrote, noting the American Association of Bronchology and Interventional Pulmonology recommends disposable devices. Their paper was published in the April 2020 issue of Infection Control & Hospital Epidemiology.

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