Clinical Pathology
Genetic analysis reveals Lipoprotein(a) is significantly more atherogenic than LDL on a per-particle basis
20 Mar, 2024 | 19:24h | UTCStudy Design and Population: This study utilized genome-wide association studies (GWAS) within the UK Biobank population to examine the atherogenicity of lipoprotein(a) (Lp(a)) compared to low-density lipoprotein (LDL), focusing on their apolipoprotein B (apoB) content. The researchers identified two clusters of single nucleotide polymorphisms (SNPs) associated with mass concentrations of Lp(a) and LDL, comprising 107 and 143 variants, respectively. The sample included subjects from the UK Biobank, allowing for a broad and genetically diverse analysis.
Main Findings: The study’s Mendelian randomization approach found that a 50 nmol/L increase in Lp(a)-apoB was associated with a 1.28 times higher odds ratio (OR) for coronary heart disease (CHD) compared to a 1.04 times increase for the same increment in LDL-apoB. Furthermore, a comparison using polygenic scores demonstrated that the hazard ratio (HR) for CHD per 50 nmol/L increase in apoB was significantly higher for the Lp(a) cluster (1.47) than for the LDL cluster (1.04), suggesting that Lp(a) is approximately 6.6 times more atherogenic than LDL on a per-particle basis.
Implications for Practice: These findings highlight the substantial atherogenic potential of Lp(a) compared to LDL, indicating that Lp(a) should be a key focus for drug intervention strategies in populations at risk for CHD. The marked difference in atherogenicity underscores the importance of targeted treatments and monitoring for individuals with elevated Lp(a) levels.
Reference: Björnson, E., Adiels, M., Taskinen, M.-R., Burgess, S., Chapman, M. J., Packard, C. J., & Borén, J. (2024). Lipoprotein(a) Is Markedly More Atherogenic Than LDL: An Apolipoprotein B-Based Genetic Analysis. Journal of the American College of Cardiology, 83(3), 385-395. DOI: https://doi.org/10.1016/j.jacc.2023.10.039. Access the study here: Link
Clinical validation of a cell-free DNA test for colorectal cancer screening: sensitivity and specificity analysis
20 Mar, 2024 | 19:16h | UTCStudy Design and Population: This study conducted a clinical validation of a cell-free DNA (cfDNA) blood-based test to screen for colorectal cancer in a cohort of 10,258 individuals, 7,861 of whom met the eligibility criteria and were evaluable. The research aimed to assess the test’s performance by comparing its sensitivity for detecting colorectal cancer and its specificity for identifying advanced neoplasia (including colorectal cancer or advanced precancerous lesions) against the outcomes of screening colonoscopy, a standard procedure.
Main Findings: The cfDNA test demonstrated a sensitivity of 83.1% for detecting colorectal cancer, with stage-specific sensitivities of 87.5% for stages I-III cancers. However, its sensitivity for identifying advanced precancerous lesions was notably lower at 13.2%. On the specificity front, the test showed an 89.6% ability to correctly identify individuals without any advanced colorectal neoplasia and had an overall specificity of 89.9% for those with a negative colonoscopy result, indicating no presence of colorectal cancer, advanced precancerous lesions, or non-advanced precancerous lesions.
Implications for Practice: The cfDNA blood-based test presents a promising tool for colorectal cancer screening, boasting substantial sensitivity for colorectal cancer detection and high specificity for advanced neoplasia. Its non-invasive nature could potentially enhance screening adherence, facilitating earlier cancer detection and possibly reducing colorectal cancer-related mortality. However, the test’s low sensitivity for advanced precancerous lesions suggests a need for further research and development to improve early detection capabilities.
Reference: Chung, D.C. et al. A Cell-free DNA Blood-Based Test for Colorectal Cancer Screening. Journal Name, Volume(Issue), Pages. Access the study here: [Link]
Prospective Study: Enhanced detection of colorectal cancer and precancerous lesions with next-generation stool DNA testing
20 Mar, 2024 | 17:41h | UTCStudy Design and Population:
This prospective study evaluated the efficacy of a next-generation multitarget stool DNA test for colorectal cancer screening in asymptomatic adults aged 40 and older. The study encompassed 20,176 participants undergoing screening colonoscopy to determine the test’s sensitivity and specificity in detecting colorectal cancer and advanced neoplasia, including advanced precancerous lesions.
Main Findings:
The next-generation stool DNA test demonstrated a sensitivity of 93.9% for detecting colorectal cancer and a specificity of 90.6% for advanced neoplasia, significantly outperforming the fecal immunochemical test (FIT) in sensitivity for both colorectal cancer and advanced precancerous lesions. However, the test showed slightly lower specificity for advanced neoplasia compared to FIT. No adverse events were reported, indicating the test’s safety for screening purposes.
Implications for Practice:
The findings suggest that the next-generation multitarget stool DNA test offers a superior option for colorectal cancer screening, with significantly higher sensitivity for detecting cancer and advanced precancerous lesions than the currently available FIT. This advance in non-invasive screening technology could lead to earlier detection and treatment of colorectal cancer, potentially improving patient outcomes. Further research may focus on optimizing the balance between sensitivity and specificity to enhance the clinical utility of stool DNA testing.
Reference:
Study | Uncovering the potential overuse of laboratory tests by combining cost, abnormal result proportion, and physician variation
11 Aug, 2023 | 15:34h | UTC
Cohort Study | High-sensitivity troponin’s role in assessing MI and CV death risk in stable CAD patients
7 Aug, 2023 | 15:01h | UTCHigh-Sensitivity Cardiac Troponin for Risk Assessment in Patients With Chronic Coronary Artery Disease – Journal of the American College of Cardiology (link to abstract – $ for full-text)
Commentaries:
High-Sensitivity Troponin Assays May Stratify Risk in Chronic CAD – TCTMD
Commentary on Twitter
In patients with chronic CAD, an elevated #troponin identifies those more likely to have MI or CV death. Routine troponin testing in this setting could inform patient selection for additional treatment. https://t.co/T4HfidPwOA#JACC #cvCAD #CardioTwitter #cvPrev #cvMI pic.twitter.com/2IOU8jsFPj
— JACC Journals (@JACCJournals) August 1, 2023
RCT | Limited antibiotic efficacy in children with sinusitis lacking nasopharyngeal pathogens
27 Jul, 2023 | 13:08h | UTCIdentifying Children Likely to Benefit From Antibiotics for Acute Sinusitis: A Randomized Clinical Trial – JAMA (free for a limited period)
Editorial: Acute Bacterial Sinusitis: Limitations of Test-Based Treatment – JAMA (free for a limited period)
News Release: Bacterial testing in kids with sinusitis could slash antibiotic use – University of Pittsburgh
Commentary: Trial suggests bacterial test could reduce antibiotics in kids with sinusitis – CIDRAP
Commentary on Twitter
In children with acute sinusitis, antibiotic treatment had minimal benefit for those without nasopharyngeal bacterial pathogens. The antibiotic effect did not depend on the color of nasal discharge. https://t.co/hgRx1Qou53 pic.twitter.com/zYs8Mfbjjp
— JAMA (@JAMA_current) July 26, 2023
New Cochrane handbook for systematic reviews of diagnostic test accuracy
25 Jul, 2023 | 14:02h | UTCCochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy – Cochrane Library
News Release: Introducing the new Cochrane Handbook for Diagnostic Test Accuracy – Cochrane Library
Guideline | Laboratory analysis in the diagnosis and management of diabetes mellitus
21 Jul, 2023 | 13:50h | UTCExecutive Summary: Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus – Diabetes Care
RCT | Molecular screening for bacterial vaginosis does not significantly reduce preterm birth rates
21 Jul, 2023 | 13:31h | UTCSee also: Visual Abstract
Cohort study | Poor sensitivity of procalcitonin-on-admission for ruling out bloodstream infections in patients with suspected sepsis
18 Jul, 2023 | 13:39h | UTCReliability of Admission Procalcitonin Testing for Capturing Bacteremia Across the Sepsis Spectrum: Real-World Utilization and Performance Characteristics, 65 U.S. Hospitals, 2008–2017 – Critical Care Medicine (link to abstract – $ for full-text)
TTMV-HPV DNA testing | Promising diagnostic and surveillance tool for HPV-linked oropharyngeal cancer
17 Jul, 2023 | 13:25h | UTCPerformance of Liquid Biopsy for Diagnosis and Surveillance of Human Papillomavirus–Associated Oropharyngeal Cancer – JAMA Otolaryngology–Head & Neck Surgery (free for a limited period)
Invited Commentary: Circulating Human Papillomavirus Tumor DNA—Ready for Prime Time? – – JAMA Otolaryngology–Head & Neck Surgery (free for a limited period)
Quality Improvement Study | Improved asymptomatic bacteriuria management by reduction of unnecessary urine culture requests
14 Jul, 2023 | 12:54h | UTCRelated:
Study: Hospital Intervention Resulted in a 45% Reduction in the Urine Cultures Ordered
USPSTF Recommendation Statement: Screening for Asymptomatic Bacteriuria in Adults
IDSA Guideline for the Management of Asymptomatic Bacteriuria
Commentary on Twitter
???Powerful message from our new study in @JAMAInternalMed: diagnostic stewardship (better use of diagnostic tests) was responsible for ALL the⬇️in unnecessary antibiotic use for ASB. ➕results??nudge to action. Time to??upstream to improve care! https://t.co/yO4UpA6ZKK pic.twitter.com/hXZGvNmVJP
— Valerie Vaughn (@ValerieVaughnMD) July 11, 2023
Podcast | Wisely ordering autoantibodies
28 Jun, 2023 | 13:09h | UTC#399 Wisely Ordering Autoantibodies – ACP IM2023 – The Curbsiders
Perspective | Early-stage lung cancer: using circulating tumor DNA to get personal
26 Jun, 2023 | 00:38h | UTCEarly-Stage Lung Cancer: Using Circulating Tumor DNA to Get Personal – Journal of Clinical Oncology
Review | Serial serum lipase testing after the initial diagnostic workup for inpatients with acute pancreatitis: what is the evidence?
21 Jun, 2023 | 13:27h | UTC
Review | Celiac disease: who should I test, and how?
19 Jun, 2023 | 13:54h | UTCCeliac disease: Who should I test, and how? – Cleveland Clinic Journal of Medicine
M-A | Comparing non-invasive tests, histology for predicting non-alcoholic fatty liver outcomes
15 Jun, 2023 | 14:50h | UTC
Review | Candidate biomarkers in psychiatric disorders
15 Jun, 2023 | 14:52h | UTCCandidate biomarkers in psychiatric disorders: state of the field – World Psychiatry
ESAIC focused guideline for the use of cardiac biomarkers in perioperative risk evaluation
5 Jun, 2023 | 13:37h | UTC
SR | Biomarkers for myalgic encephalomyelitis/chronic fatigue syndrome
1 Jun, 2023 | 12:06h | UTC
Cluster RCT | Point-of-care CRP testing cuts antibiotic prescriptions in respiratory illnesses in primary care
1 Jun, 2023 | 11:58h | UTCCommentary: Use of CRP testing reduced antibiotics for respiratory infections, trial finds – CIDRAP
Cohort Study | NT‐proBNP and all-cause and cardiovascular mortality
31 May, 2023 | 13:59h | UTC
Guideline | Use of non-invasive biomarkers for diagnosis of colorectal neoplasia
10 May, 2023 | 15:46h | UTC
AACC Guidance document on the clinical use of procalcitonin
8 May, 2023 | 13:12h | UTCAACC Guidance Document on the Clinical Use of Procalcitonin – The Journal of Applied Laboratory Medicine (free for a limited period)
Commentary on Twitter
Special Report: AACC Guidance Document on the Clinical Use of Procalcitonin https://t.co/RAjvJF6Q0e #LabMed #PathTwitter #Pathology #ClinChem pic.twitter.com/oKMnlhl8a0
— JournApplLabMed (@JALM_AACC) May 4, 2023
Review | Transforming tuberculosis diagnosis
5 May, 2023 | 15:18h | UTCTransforming tuberculosis diagnosis – Nature Microbiology (if the link is paywalled, try this one)
Commentary on Twitter
Diagnosis is the weakest aspect of tuberculosis care and control. A Comment article in @NatureMicrobiol describes seven critical transitions that can close the diagnostic gap and enable TB programmes worldwide to recover from the pandemic setbacks. ? https://t.co/hZyBmVJfRR pic.twitter.com/NDgXF8O9W5
— Nature Portfolio (@NaturePortfolio) May 2, 2023