Expert Reliability for the World Health Organization Standardized Ultrasound Classification of Cystic Echinococcosis

Solomon, Nadia; Fields, Paul J.; Tamarozzi, Francesca; Brunetti, Enrico; Macpherson, C. N. L.

doi:10.4269/ajtmh.16-0659

Cited by 22 publications

(14 citation statements)

References 15 publications

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“…The authors emphasized that an improvement can be achieved when non-static imaging (video recording etc.) is incorporated in future studies [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Patients with cystic echinococcosis in the three national referral centers of Mongolia: A model for CE management assessment

et al. 2018

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BackgroundMongolia is one of the endemic countries for cystic echinococcosis (CE), a zoonotic disease caused by the larval stage of Echinococcus granulosus. The goal of this study is to describe the current clinical management of CE in Mongolia, to capture the distribution of cyst stages of patients treated, and to contrast current practice with WHO-IWGE expert consensus.MethodsHospital records of CE patients treated between 2008 and 2015 at the three state hospitals and fulfilling the inclusion criterion ‘discharge diagnosis CE’ (ICD 10 code B.67.0–67.9) were reviewed. Demographical, geographical, clinical and ultrasonography (US) data were extracted and analyzed. The annual surgical incidence was estimated. The digital copies of US cyst images were independently staged by three international experts following the WHO CE cyst classification to determine the proportions of patients which ideally would have been assigned to the WHO recommended treatment modalities surgery, percutaneous, medical (benzimidazole) treatment and watch & wait.ResultsA total of 290 patient records fulfilled the inclusion criteria of the study. 45.7% of patients were below 15 years of age. 73.7% of CE cysts were located in abdominal organs, predominantly liver. US images of 84 patients were staged and assessed for interrater-agreement. The average raw agreement was 77.2%. Unweighted Kappa coefficient and weighted Kappa was 0.57 and 0.59, respectively. Mean proportions of images judged as stages CE1, CE2, CE3a, CE3b, CE4 and CL were 0.59, 0.01, 0.19, 0.08, 0.03 and 0.11, respectively. 40 cysts met the inclusion criteria of treatment modality analysis. The mean proportions of cases with a single cyst assigned to medical, percutaneous treatment, surgery and watch & wait were 52.5% (95% CI 42–65), 25.8% (95% CI 15–30), 5.1% (95% CI 0–10) and 3.3% (95% CI 0–10), respectively. 13.3% (95% CI 5–25) of cysts were staged as CL and therefore assigned to further diagnostic requirement.ConclusionWHO CE cyst classification and WHO-IWGE expert consensus on clinical CE management is not implemented in Mongolia. This results in exclusively surgical treatment, an unnecessary high risk approach for the majority of patients who could receive medical, percutaneous treatment or observation (watch & wait). Introduction of WHO-IWGE expert consensus and training in ultrasound CE cyst staging would be highly beneficial for patients and the health care services.

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“…The authors emphasized that an improvement can be achieved when non-static imaging (video recording etc.) is incorporated in future studies [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Patients with cystic echinococcosis in the three national referral centers of Mongolia: A model for CE management assessment

et al. 2018

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“…Although hydatid cysts can be described with precision by means of modern radiological diagnostics, abdominal ultrasound is still the cornerstone of diagnosis, staging, and follow-up (sensitivity of 90%-95%). Ultrasonographic classification of hydatid cysts and the estimation of their viability is based on Garbie's classification [10]. Despite the high specificity and sensitivity of diagnostic procedures, about 10% of cases remain unrecognized [11].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Management of Initially Unrecognized Splenic Hydatid Cysts: A Case Report and Review of the Literature

Milosavljević¹,

Veselinovic²,

Tadić³

et al. 2019

Medicina

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We present a case report that demonstrates diagnostic and intraoperative challenges in the laparoscopic management of initially unrecognized splenic hydatid disease. A male patient, aged 44, was admitted to our department with a big unilocular splenic cyst, radiologically (ultrasonography, computed tomography) characterized as a simple cyst. Serological tests for anti-Echonococcus antibody were negative, and chests X-ray findings were unremarkable, so laparoscopic cyst fenestration with omentoplasty was planned. The intraoperative finding did not correspond to a simple splenic cyst. Hydatid daughter cysts were recognized after the careful opening of the cyst wall. The operation was completed without shifting to open procedures. Laparoscopic partial pericystectomy with omentoplasty is a safe and effective surgical procedure for the management of splenic hydatid disease.

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“…13,20,21,30 As a painless, noninvasive technique which provides immediate visual results, FIGURE 1. World Health Organization standardized ultrasound classification of cystic echinococcosis (CE) 26,27 (adapted) 29 .…”

Section: Methodsmentioning

confidence: 99%

Cystic Echinococcosis in Turkana, Kenya: The Role of Cross-Sectional Screening Surveys in Assessing the Prevalence of Human Infection

Solomon

Zeyhle

Carter

et al. 2017

The American Society of Tropical Medicine and Hygiene

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Cystic echinococcosis (CE) is a neglected zoonotic disease caused by . Infection leads to formation of cysts within the viscera of the human host. In the 1980s, the transhumant population of northwest Turkana, Kenya, was found to have the highest prevalence of CE in the world. In 1983, AMREF Health Africa and the Kenya Medical and Research Institute launched a CE Control Program in northwest Turkana, screening and treating the local people. This epidemiological study of CE in Turkana analyses approximately 30 years of surveillance and surgical data. Cyst data were categorized using the World Health Organization CE ultrasound classification system before being analyzed for cyst, patient, and population characteristics, and surveillance data from 1985 are compared with more recent surveillance data to assess changes in prevalence in the control region since the commencement of control activities. In 1985, the prevalence of CE among the Turkana was 5.6%. In 2010-2011 and 2011-2012, calculated CE prevalence rates were 1.9% and 3.8%, respectively. Since the 1980s, the age distribution of people with CE in Turkana has shifted: initially, cases of CE appeared predominantly within younger age groups, but recent data reveal a higher prevalence within older age groups. The frequency of infection in females also significantly decreased. The reduction in CE prevalence from 5.6% in the 1980s to 1.9-3.8% in 2010-2012 and the shift in age distribution of CE-infected individuals over time indicate that the prevalence of CE in Turkana has decreased since the control program began.

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Expert Reliability for the World Health Organization Standardized Ultrasound Classification of Cystic Echinococcosis

Cited by 22 publications

References 15 publications

Patients with cystic echinococcosis in the three national referral centers of Mongolia: A model for CE management assessment

Patients with cystic echinococcosis in the three national referral centers of Mongolia: A model for CE management assessment

Laparoscopic Management of Initially Unrecognized Splenic Hydatid Cysts: A Case Report and Review of the Literature

Cystic Echinococcosis in Turkana, Kenya: The Role of Cross-Sectional Screening Surveys in Assessing the Prevalence of Human Infection

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