Monitoring diagnostic accuracy and complications. A report from the Children's Oncology Group Hodgkin lymphoma study

Ehrlich, Peter F.; Friedman, Debra L.; Schwartz, Cynthia L.

doi:10.1016/j.jpedsurg.2006.12.030

Cited by 15 publications

(7 citation statements)

References 13 publications

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“…In our study, two of the three repeat biopsies (lymphoma) were more likely associated with difficulties in obtaining histologic confirmation rather than with failures of the surgical technique. This is in keeping with previous reports, which noted the difficulties in making the diagnosis of round cell tumors [7,8,21]. Without ongoing close scrutiny, the performance of a process may deviate unbeknownst to the care providers participating in that same process.…”

Section: Discussionsupporting

confidence: 90%

Using the CUSUM Test to Control the Proportion of Inadequate Open Biopsies of Musculoskeletal Tumors

Biau

Weiß

Bhumbra

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Biopsies of musculoskeletal tumors lead to alterations in treatment in almost 20% of cases. Control charts are useful to ensure that a process is operating at a predetermined level of performance, although their use has not been demonstrated in assessing the adequacy of musculoskeletal biopsies. Questions/purposes We therefore (1) assessed the incidence of and the reasons for inadequate musculoskeletal biopsies when following guidelines for performing the procedure; and (2) implemented a process control chart, the CUSUM test, to monitor the proportion of inadequate biopsies. Methods We prospectively studied 116 incisional biopsies. The biopsy was performed according to 10 rules to (1) minimize contamination in the tissues surrounding the tumor; and (2) improve accuracy. A frozen section was systematically performed to confirm that a representative specimen was obtained. Procedures were considered inadequate if: (1) another biopsy was necessary; (2) the biopsy tract was not appropriately placed; and (3) the treatment provided based on the diagnosis from the biopsy was not appropriate. Results Five (4.3%) of the 116 incisional biopsy procedures were considered failures. Three patients required a second repeat open biopsy and two were considered to receive inappropriate treatment. No alarm was raised by the control chart and the performance was deemed adequate over the monitoring period. Conclusions The proportion of inadequate musculoskeletal open biopsies performed at a referral center was low. Using a statistical process control method to monitor the failures provided a continuous measure of the performance.

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Section: Discussionsupporting

confidence: 90%

Using the CUSUM Test to Control the Proportion of Inadequate Open Biopsies of Musculoskeletal Tumors

Biau

Weiß

Bhumbra

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Of these, five underwent core biopsy. In four of five of these, Hodgkin’s disease was identified 17. Additional insight into the utility of core biopsies may be derived from previous studies of mixed adult and paediatric populations 18 19.…”

Section: Indications and Limitationsmentioning

confidence: 98%

“…They did not report whether any of the patients with negative core biopsy were later diagnosed with cancer 16. Ehrlich et al 17 studied the diagnostic precision and adverse events of core needle biopsy, FNA and excision biopsy in 185 children with Hodgkin’s lymphoma. Of these, five underwent core biopsy.…”

Section: Indications and Limitationsmentioning

confidence: 99%

How to use… lymph node biopsy in paediatrics

Farndon

Behjati²,

Jonas

et al. 2017

Arch Dis Child Educ Pract Ed

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“…In patients with no other disease sites more accessible to histological sampling, EBUS-TBNA is likely to compare favorably to previously used methods of mediastinal sampling. Thoracoscopy is associated with significant morbidity, 17 has low diagnostic accuracy in the setting of lymphoma, 47 and conversion to open thoracotomy in the investigation of mediastinal or hilar lesions is high due to frequent inability to localize the lesion. 48 The rise in prevalence of drug-resistant tuberculosis disease makes it even more important to obtain definitive tissue samples.…”

Section: Linear Probe Endobronchial Ultrasound (Ebus-tbna)mentioning

confidence: 99%

Endobronchial ultrasound in pediatric pulmonology

Steinfort

Wurzel

Irving

et al. 2009

Pediatric Pulmonology

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Endobronchial ultrasound (EBUS) is a recently introduced technique that has significantly advanced bronchoscopic techniques in adult medicine. Use of ultrasound allows far more accurate localization and sampling of both peripheral pulmonary, as well as mediastinal and hilar lesions. This has led to greater diagnostic success, with a reduced rate of complications. Its performance characteristics in adult populations are equivalent to surgical procedures previously considered gold standard, but it has dramatically reduced morbidity and mortality among patients requiring invasive diagnostic procedures, when compared to surgical approaches. We describe the types of EBUS in clinical use, the method of use, the clinical indications for each procedure, and the potential role for EBUS in pediatric pulmonology. Radial probe EBUS is used in the investigation of peripheral lung lesions and could be adopted in children to achieve accurate biopsy of such lesions. Linear probe EBUS allows minimally invasive biopsy of mediastinal and hilar lesions. It has potentially greater performance characteristics than current biopsy techniques, with no significant complications reported to date. It may be useful in the diagnosis of lymphoma, or neurogenic tumors, as well as many other diseases resulting in mediastinal or hilar lymphadenopathy. EBUS is a minimally invasive technique that allows tissue sampling of peripheral lung lesions, or mediastinal/hilar masses, with a high diagnostic accuracy, and a significantly lower morbidity and mortality than alternative approaches. The indications for and the use of EBUS in pediatric patients is certain to increase in the future.

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Monitoring diagnostic accuracy and complications. A report from the Children's Oncology Group Hodgkin lymphoma study

Cited by 15 publications

References 13 publications

Using the CUSUM Test to Control the Proportion of Inadequate Open Biopsies of Musculoskeletal Tumors

Using the CUSUM Test to Control the Proportion of Inadequate Open Biopsies of Musculoskeletal Tumors

How to use… lymph node biopsy in paediatrics

Endobronchial ultrasound in pediatric pulmonology

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