Adhesive Small-Bowel Obstruction: Value of CT in Identifying Findings Associated with the Effectiveness of Nonsurgical Treatment

This retrospective study of imaging findings in patients with SBO due to adhesions is mostly valuable because the author's have tried to actually correlate the findings to actual impact on management. It is a moderate sized review of 221 patients with SBO on CT, and review of findings on those studies. The specific features they identify as predictive of successful non-operative management is the presence of fewer than two beak signs and the presence of an anterior parietal adhesion are predictive of successful non-operative management. U shaped or C shaped loops were predictive of non-operative management failure.

PICO Analysis:
Population: patients with SBO on CT
Intervention: non-operative management
Comparison: none
Outcome: successful non-operative management

Reference: Pubmed Full Text

Accuracy of Multiparametric MRI for Prostate Cancer Detection: A Meta-Analysis

This meta-analysis of the current literature found 7 studies meeting their inclusion criteria for assessment of multiparametric MRI for prostate cancer (defined as using both T2-weighted imaging and functional MR techniques DWI and DCEMRI). All studies had to include comparison with either biopsy or surgical histopathology. Studies were assessed for quality using QUADAS-2.

Overall the meta-analysis of pooled data demonstrated a specificity of 0.88 and sensitivity of 0.74 for prostate cancer detection, with variable NPV ranging from 0.65 to 0.94.

The meta-analysis is methodologically sound, but does have a limited pool of only 7 studies to assess. This provides a good overview of the current literature and provides further evidence of the role of MRI in assessment of patients with suspected or diagnosed prostate cancer.

PICO Analysis:
Population: Patients with suspected prostate cancer.
Intervention: Multiparametric prostate MRI.
Comparison: Surgical or Biopsy histopathology.
Outcome: Sensitivity & Specificity.

Reference: Pubmed Full Text

Management of Nodules with Initially Nondiagnostic Results of Thyroid Fine-Needle Aspiration: Can We Avoid Repeat Biopsy?

This retrospective review of followup results from patients with non-diagnostic ultrasound guided thyroid biopsy. Of the 393 nodules with non-diagnostic initial result, only 9 were subsequently diagnosed with malignancy with either repeat FNA or surgical excision, and a very low percentage (2/336) had a malignancy diagnosed on repeat sampling. As such the authors propose ultrasound followup in lieu of repeat biopsy.

They further identify higher risk features including size, male gender and increased age.

While the study is limited as it is a retrospective sampling, it does provide some evidence to guide management of a frequent clinical conundrum in the setting of a non-diagnostic FNA.

PICO Analysis:
Population: Patients with initial negative US guided FNA
Intervention: Repeat FNA
Comparison: Followup US
Outcome: Prevalence of missed malignancy

 Reference: Pubmed Full Text