Background: Flow cytometry is an invaluable tool in the diagnostic evaluation of acute leukemia and post therapy monitoring; however, majority of Filipino population cannot afford the cost. The use of a minimal screening panel which is both cost-effective and provides an accurate diagnosis of acute lymphoblastic leukemia is seen as an alternative. Objectives: We aim to determine the cost-effectiveness and accuracy of using a minimal screening panel for the diagnosis of acute lymphoblastic leukemia (ALL). Methodology: We selected a limited panel of 9 antibodies comprising of CD45/CD19/CD20/CD10/HLA-DR/CD34/cCD3/cCD79a/cTdt and retrospectively reviewed newly diagnosed cases of B-cell and T-cell ALL from September 2016 to December 2019 using this panel. Results: Out of 719 bone marrow aspirates submitted for basic leukemia flow cytometric analysis we identified 268 ALL cases (239 B-ALL and 29 T-ALL). In all cases, a diagnosis was established using the limited panel. Compared to the current cost of our comprehensive panel (₱ 9,903.60). This limited panel cost ₱ 3,062.29, that offers a 69.08% savings per test, which translated to a ₱1.2 million savings a year (for an average of 180 annual cases). Conclusion: We underscore the utility of a limited panel for the diagnosis of ALL. Although this panel remains to be assessed with a larger validation cohort, its application in resource-limited developing countries is diagnostically useful and cost-effective. Recommendation: The use of a limited panel of 9 antibodies is recommended as a screening panel for patients who are highly suspected of having ALL both clinically and initial bone marrow smear assessment.
{"title":"Cost-Effectiveness of Limited Screening Panel for Acute Lymphoblastic Leukemia Diagnosis in a Resource-Limited Setting","authors":"Ivy Mae Medalla, M. B. Gepte, Qareem Pido, D. Ang","doi":"10.21141/pjp.2021.04","DOIUrl":"https://doi.org/10.21141/pjp.2021.04","url":null,"abstract":"Background: Flow cytometry is an invaluable tool in the diagnostic evaluation of acute leukemia and post therapy monitoring; however, majority of Filipino population cannot afford the cost. The use of a minimal screening panel which is both cost-effective and provides an accurate diagnosis of acute lymphoblastic leukemia is seen as an alternative. Objectives: We aim to determine the cost-effectiveness and accuracy of using a minimal screening panel for the diagnosis of acute lymphoblastic leukemia (ALL). Methodology: We selected a limited panel of 9 antibodies comprising of CD45/CD19/CD20/CD10/HLA-DR/CD34/cCD3/cCD79a/cTdt and retrospectively reviewed newly diagnosed cases of B-cell and T-cell ALL from September 2016 to December 2019 using this panel. Results: Out of 719 bone marrow aspirates submitted for basic leukemia flow cytometric analysis we identified 268 ALL cases (239 B-ALL and 29 T-ALL). In all cases, a diagnosis was established using the limited panel. Compared to the current cost of our comprehensive panel (₱ 9,903.60). This limited panel cost ₱ 3,062.29, that offers a 69.08% savings per test, which translated to a ₱1.2 million savings a year (for an average of 180 annual cases). Conclusion: We underscore the utility of a limited panel for the diagnosis of ALL. Although this panel remains to be assessed with a larger validation cohort, its application in resource-limited developing countries is diagnostically useful and cost-effective. Recommendation: The use of a limited panel of 9 antibodies is recommended as a screening panel for patients who are highly suspected of having ALL both clinically and initial bone marrow smear assessment.","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126670273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I am sharing with you the first issue of the Philippine Journal of Pathology for 2021, our tenth issue since we breathed life into our society publication in 2016. We have two case reports of gynecologic tumors, and an autopsy case of a disseminated hematolymphoid malignancy. Four original articles include a molecular pathology study for lung cancer, a real-world observational study on pooled testing among asymptomatic individuals, a cost effectiveness study on diagnostics for leukemia in the Philippines, and a 5-year soft tissue tumor review. On top of these, we are featuring a new section – Opinion, and we have on board, Dr. Raymundo Lo, to regularly provide his take on issues relevant to our profession and practice. This issue also comes alive with the inclusion of the entries and winners of the PSP 69th Annual Convention Photomicroscopy Contest sponsored by Omnibus Biomedical Systems.
{"title":"Life, Death, Transitions","authors":"A. Tandoc","doi":"10.21141/pjp.2021.01","DOIUrl":"https://doi.org/10.21141/pjp.2021.01","url":null,"abstract":"I am sharing with you the first issue of the Philippine Journal of Pathology for 2021, our tenth issue since we breathed life into our society publication in 2016. We have two case reports of gynecologic tumors, and an autopsy case of a disseminated hematolymphoid malignancy. Four original articles include a molecular pathology study for lung cancer, a real-world observational study on pooled testing among asymptomatic individuals, a cost effectiveness study on diagnostics for leukemia in the Philippines, and a 5-year soft tissue tumor review. On top of these, we are featuring a new section – Opinion, and we have on board, Dr. Raymundo Lo, to regularly provide his take on issues relevant to our profession and practice. This issue also comes alive with the inclusion of the entries and winners of the PSP 69th Annual Convention Photomicroscopy Contest sponsored by Omnibus Biomedical Systems.","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122789044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Danielle Anne Gonong, Grig Misiona, Melani Sionzon, Farrah Kristine Santiago, Aquiles Joseph Lira, Raymundo Lo
Background. The availability of reverse transcription-polymerase chain reaction (RT-PCR) in detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is limited by the scarcity of resources prompting the use of pooling strategies. Evaluated in this study is the Philippine Children’s Medical Center’s (PCMC) experience in pooled testing done in asymptomatic population. Objectives. Review the pooled SARS-CoV-2 RT-PCR results and case investigation forms (CIF) in asymptomatic population. Determine the incidence of SARS-CoV-2 in asymptomatic population and compare all the individual and pooled tests results. Determine the number of saved test kits and identify clustering in the community. Methodology. This is a retrospective study that reviewed the pooled and individual SARS-CoV-2 RT-PCR results using Allsheng Auto-Pure 32a extraction kit, Sansure Biotech PCR machine and Maccura Sars-CoV-2 test kits. The pooling protocol used by the institution followed the recommendation by Lo et al in the study entitled “An Evaluation of Pooling Strategies for RT-qPCR testing for SARS-CoV-2 infection.” Results. There are 1828 samples which resulted to 165 negative, 68 indeterminate, and 137 positive pools. There are 157, 135, and 68 pools containing 5 individual samples that were classified as negative, positive and indeterminate pools, respectively. Additionally, the negative pools contained 8 pools with 3 individual samples and the positive pools contained 2 pools with 2 individual samples. Deconvolution of the positive and indeterminate pools resulted to 227 and 74 positive individuals, respectively. In this review, the laboratory saved 24% of the test kits and shorten the overall turnaround time by 23 hours. Conclusions and Recommendations. The incidence of SARS-CoV-2 in the population is higher compared to the prevalence of infection in the country. Pooled testing conserved test kits and congruence of pooled and individual ORF Ct-values was observed. An in-depth study including other genes is recommended and assessment of pooling in other population may be pursued.
{"title":"Analysis of SARS-CoV-2 RT-PCR Testing and Pooling Strategies for Screening of Asymptomatic Individuals - The Philippine Children's Medical Center Experience","authors":"Danielle Anne Gonong, Grig Misiona, Melani Sionzon, Farrah Kristine Santiago, Aquiles Joseph Lira, Raymundo Lo","doi":"10.21141/pjp.2021.03","DOIUrl":"https://doi.org/10.21141/pjp.2021.03","url":null,"abstract":"Background. The availability of reverse transcription-polymerase chain reaction (RT-PCR) in detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is limited by the scarcity of resources prompting the use of pooling strategies. Evaluated in this study is the Philippine Children’s Medical Center’s (PCMC) experience in pooled testing done in asymptomatic population. Objectives. Review the pooled SARS-CoV-2 RT-PCR results and case investigation forms (CIF) in asymptomatic population. Determine the incidence of SARS-CoV-2 in asymptomatic population and compare all the individual and pooled tests results. Determine the number of saved test kits and identify clustering in the community. Methodology. This is a retrospective study that reviewed the pooled and individual SARS-CoV-2 RT-PCR results using Allsheng Auto-Pure 32a extraction kit, Sansure Biotech PCR machine and Maccura Sars-CoV-2 test kits. The pooling protocol used by the institution followed the recommendation by Lo et al in the study entitled “An Evaluation of Pooling Strategies for RT-qPCR testing for SARS-CoV-2 infection.” Results. There are 1828 samples which resulted to 165 negative, 68 indeterminate, and 137 positive pools. There are 157, 135, and 68 pools containing 5 individual samples that were classified as negative, positive and indeterminate pools, respectively. Additionally, the negative pools contained 8 pools with 3 individual samples and the positive pools contained 2 pools with 2 individual samples. Deconvolution of the positive and indeterminate pools resulted to 227 and 74 positive individuals, respectively. In this review, the laboratory saved 24% of the test kits and shorten the overall turnaround time by 23 hours. Conclusions and Recommendations. The incidence of SARS-CoV-2 in the population is higher compared to the prevalence of infection in the country. Pooled testing conserved test kits and congruence of pooled and individual ORF Ct-values was observed. An in-depth study including other genes is recommended and assessment of pooling in other population may be pursued.","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"132 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120833082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joshua Uyboco, Mary Anne Cruz-Ignacio, Maria Concepcion Cenizal, J. So, Maximo Bello, J. Morán
Neuroendocrine carcinoma (NEC) of the endometrium is a rare, aggressive subtype of endometrial cancer. We report a 61-year-old female with a history of breast cancer, s/p modified radical mastectomy, chemotherapy, radiotherapy and hormonal (tamoxifen) therapy, who presented with post-menopausal bleeding. Patient underwent TAH-BSO with lymph node dissection, and was diagnosed with a mixed small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC), confirmed by positive immunohistochemical staining for neuroendocrine markers. No other lesions were identified on PET-CT, making a primary endometrial NEC the most likely diagnosis. We review the clinical and pathologic characteristics of endometrial neuroendocrine carcinomas.
{"title":"Mixed Small Cell and Large Cell Neuroendocrine Carcinoma of the Endometrium\" A Case Report and Literature Review","authors":"Joshua Uyboco, Mary Anne Cruz-Ignacio, Maria Concepcion Cenizal, J. So, Maximo Bello, J. Morán","doi":"10.21141/pjp.2021.05","DOIUrl":"https://doi.org/10.21141/pjp.2021.05","url":null,"abstract":"Neuroendocrine carcinoma (NEC) of the endometrium is a rare, aggressive subtype of endometrial cancer. We report a 61-year-old female with a history of breast cancer, s/p modified radical mastectomy, chemotherapy, radiotherapy and hormonal (tamoxifen) therapy, who presented with post-menopausal bleeding. Patient underwent TAH-BSO with lymph node dissection, and was diagnosed with a mixed small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC), confirmed by positive immunohistochemical staining for neuroendocrine markers. No other lesions were identified on PET-CT, making a primary endometrial NEC the most likely diagnosis. We review the clinical and pathologic characteristics of endometrial neuroendocrine carcinomas.","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"138 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124346956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Flora Mae Sta. Ines, J. Andal, R. M. Santiago, S. Sandoval, D. Ang
Introduction. The current management of advanced non-small cell lung cancer (NSCLC) includes the characterization of Programmed Death Ligand-1 (PD-L1) expression for potential immune checkpoint inhibitor treatment. There is currently no available data regarding the patterns of PD-L1 expression in NSCLC, as well as their association with clinicopathologic profile in Filipino patients. Methodology. Clinicopathologic characteristics of 187 consecutive NSCLC clinical samples with PD-L1 testing using the clone 22C3 pharmaDx kit were collected. The presence of stromal tumor-infiltrating lymphocytes (TILs) were assessed in hematoxylin and eosin-stained slides. PD-L1 expression on tumor cells (TC) and stromal TILs were evaluated. Results. Of the 187 cases, there were 112 males and 75 females. The mean age at diagnosis was 66.4 years old (32-92 years old). It is composed of 131 cases of Adenocarcinoma, 15 Squamous cell carcinoma, 4 Adenosquamous carcinoma, 32 Non-small cell carcinoma, not otherwise specified, 3 poorly differentiated malignancy, 1 Large cell carcinoma, and 1 Mucinous carcinoma. Specimen types included 17 pleural fluid cell blocks, 60 tumor cell block samples, and 110 tissue biopsies. Tumor cell PD-L1 expression was identified in 59.1% of the 110 tissue biopsies. PD-L1 TPS for histologic specimens are as follows: TPS >50%, TPS 1-49%, and TPS <1% were observed in 23.6%, 35.5%, and 40.9% in our lung cancer cohort, respectively. Of the 77 cytology specimens, 50.6% presented with TC PD-L1 expression. TPS for this subgroup include: 49.4% with no PD-L1 expression, 35.1% with low PD-L1 expression, and 15.6% showing high PD-L1 expression. PD-L1 expression on TC did not correlate with age, sex, or histology for both specimen type subgroups. Stromal tumor-infiltrating lymphocytes were noted in 74.5% of tissue biopsies. Tumor cell block samples did not demonstrate stromal TILs. For tissue biopsies, female gender and TPS 1-49% were more likely to have <50% PD-L1 expression on TILs. Conclusion. Overall TC PD-L1 expression was observed in more than half (55.6%) of NSCLC patients in our cohort. The prognostic value of PD-L1 and clinical response to immune checkpoint inhibitors in the Filipino population needs to be further investigated.
{"title":"Programmed Death Ligand 1 (PD-L1) Expression and its Association with Clinicopathologic Profile in Patients with Non-Small Cell Lung Cancer in a Philippine Tertiary Medical Center","authors":"Flora Mae Sta. Ines, J. Andal, R. M. Santiago, S. Sandoval, D. Ang","doi":"10.21141/pjp.2021.08","DOIUrl":"https://doi.org/10.21141/pjp.2021.08","url":null,"abstract":"Introduction. The current management of advanced non-small cell lung cancer (NSCLC) includes the characterization of Programmed Death Ligand-1 (PD-L1) expression for potential immune checkpoint inhibitor treatment. There is currently no available data regarding the patterns of PD-L1 expression in NSCLC, as well as their association with clinicopathologic profile in Filipino patients. Methodology. Clinicopathologic characteristics of 187 consecutive NSCLC clinical samples with PD-L1 testing using the clone 22C3 pharmaDx kit were collected. The presence of stromal tumor-infiltrating lymphocytes (TILs) were assessed in hematoxylin and eosin-stained slides. PD-L1 expression on tumor cells (TC) and stromal TILs were evaluated. Results. Of the 187 cases, there were 112 males and 75 females. The mean age at diagnosis was 66.4 years old (32-92 years old). It is composed of 131 cases of Adenocarcinoma, 15 Squamous cell carcinoma, 4 Adenosquamous carcinoma, 32 Non-small cell carcinoma, not otherwise specified, 3 poorly differentiated malignancy, 1 Large cell carcinoma, and 1 Mucinous carcinoma. Specimen types included 17 pleural fluid cell blocks, 60 tumor cell block samples, and 110 tissue biopsies. Tumor cell PD-L1 expression was identified in 59.1% of the 110 tissue biopsies. PD-L1 TPS for histologic specimens are as follows: TPS >50%, TPS 1-49%, and TPS <1% were observed in 23.6%, 35.5%, and 40.9% in our lung cancer cohort, respectively. Of the 77 cytology specimens, 50.6% presented with TC PD-L1 expression. TPS for this subgroup include: 49.4% with no PD-L1 expression, 35.1% with low PD-L1 expression, and 15.6% showing high PD-L1 expression. PD-L1 expression on TC did not correlate with age, sex, or histology for both specimen type subgroups. Stromal tumor-infiltrating lymphocytes were noted in 74.5% of tissue biopsies. Tumor cell block samples did not demonstrate stromal TILs. For tissue biopsies, female gender and TPS 1-49% were more likely to have <50% PD-L1 expression on TILs. Conclusion. Overall TC PD-L1 expression was observed in more than half (55.6%) of NSCLC patients in our cohort. The prognostic value of PD-L1 and clinical response to immune checkpoint inhibitors in the Filipino population needs to be further investigated.","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130226225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"HPV-Independent Gastric Type Adenocarcinoma of the Uterine Cervix presenting as Ovarian Masses: A Case Report and Review of Literature","authors":"J. Chatto, Annette L. Salillas","doi":"10.21141/pjp.2021.06","DOIUrl":"https://doi.org/10.21141/pjp.2021.06","url":null,"abstract":"","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126238364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lara Mae Lorenzo, Sarah Jane Datay-Lim, J. Carnate
The relationship between the use of liquid silicone for breast augmentation and carcinogenesis remains undetermined due to limited data reported, especially regarding its risks for acquiring cancer. We documented a case of an 81-year-old woman who presented with bilateral enlarging breast masses with a known history of breast augmentation using liquid silicone. On microscopic examination, the malignancy showed both mesenchymal and epithelial components in a background of stromal changes related to liquid silicone. Based from morphology and immunohistochemistry studies (p63, CK, HMW-CK, and CK5/6, CD34, and BcL-2), this case was signed out as metaplastic carcinoma with mesenchymal differentiation. This rare case of metaplastic carcinoma with mesenchymal differentiation coexisting with liquid silicone, provides evidence supporting the link between cancer development and siliconomas.
{"title":"Metaplastic Carcinoma with Mesenchymal Differentiation in Augmented Breast using Liquid Silicone Injection: A Case Report","authors":"Lara Mae Lorenzo, Sarah Jane Datay-Lim, J. Carnate","doi":"10.21141/pjp.2020.10","DOIUrl":"https://doi.org/10.21141/pjp.2020.10","url":null,"abstract":"The relationship between the use of liquid silicone for breast augmentation and carcinogenesis remains undetermined due to limited data reported, especially regarding its risks for acquiring cancer. We documented a case of an 81-year-old woman who presented with bilateral enlarging breast masses with a known history of breast augmentation using liquid silicone. On microscopic examination, the malignancy showed both mesenchymal and epithelial components in a background of stromal changes related to liquid silicone. Based from morphology and immunohistochemistry studies (p63, CK, HMW-CK, and CK5/6, CD34, and BcL-2), this case was signed out as metaplastic carcinoma with mesenchymal differentiation. This rare case of metaplastic carcinoma with mesenchymal differentiation coexisting with liquid silicone, provides evidence supporting the link between cancer development and siliconomas.","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114890254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Raymundo Lo, Agnes V. Barrientos, Bernadette Espiritu, F. Santiago, A. Tandoc, J. Velasco, S. Yáñez
Background and Objectives. Sample pooling of COViD-19 PCR tests has been recently proposed as a low-cost alternative to individual tests. This multi-site, laboratory-based, proof-of-concept study explores the feasibility of pooled SARS-CoV-2 RT-qPCR testing, by demonstrating the effect of pooling on sensitivity, specificity, accuracy, number of tests saved, and turnaround time. Methodology. The research was conducted in two experiments. In Experiment 1, archival nasopharyngeal (NPS) and oropharyngeal (OPS) swab samples were diluted to simulate 5, 10, and 20 sized pools, and tested for SARS-CoV-2 RNA using RT-qPCR. In Experiment 2, actual nasopharyngeal and oropharyngeal swab samples were collected from asymptomatic low-risk volunteers. Aliquots of the samples were pooled following the 5, 10-5, and 20-10-5 multi-staged Dorfman pooling methods and tested. The sensitivity, specificity, accuracy, test savings, and turnaround time for each pooling method were documented. Results and Conclusions. The study provided evidence that pooling of NP and OP samples for SARS-CoV-2 RNA detection using RT-qPCR is feasible and can be implemented in the Philippines. A 2-stage Dorfman 5 pooling strategy appears to be the best method, because it has the highest over-all accuracy, while still achieving acceptable test savings, and turnaround time. Pooling of nasopharyngeal and oropharyngeal swab samples prior to RT-qPCR testing may be considered by select molecular diagnostic laboratories to further increase testing capacity and at the same time reduce the cost of testing.
{"title":"An Evaluation of Pooling Strategies for RT-qPCR testing for SARS-CoV-2 Infection: A Pragmatic Multi-site Parallel Operational Study","authors":"Raymundo Lo, Agnes V. Barrientos, Bernadette Espiritu, F. Santiago, A. Tandoc, J. Velasco, S. Yáñez","doi":"10.21141/pjp.2020.12","DOIUrl":"https://doi.org/10.21141/pjp.2020.12","url":null,"abstract":"Background and Objectives. Sample pooling of COViD-19 PCR tests has been recently proposed as a low-cost alternative to individual tests. This multi-site, laboratory-based, proof-of-concept study explores the feasibility of pooled SARS-CoV-2 RT-qPCR testing, by demonstrating the effect of pooling on sensitivity, specificity, accuracy, number of tests saved, and turnaround time. Methodology. The research was conducted in two experiments. In Experiment 1, archival nasopharyngeal (NPS) and oropharyngeal (OPS) swab samples were diluted to simulate 5, 10, and 20 sized pools, and tested for SARS-CoV-2 RNA using RT-qPCR. In Experiment 2, actual nasopharyngeal and oropharyngeal swab samples were collected from asymptomatic low-risk volunteers. Aliquots of the samples were pooled following the 5, 10-5, and 20-10-5 multi-staged Dorfman pooling methods and tested. The sensitivity, specificity, accuracy, test savings, and turnaround time for each pooling method were documented. Results and Conclusions. The study provided evidence that pooling of NP and OP samples for SARS-CoV-2 RNA detection using RT-qPCR is feasible and can be implemented in the Philippines. A 2-stage Dorfman 5 pooling strategy appears to be the best method, because it has the highest over-all accuracy, while still achieving acceptable test savings, and turnaround time. Pooling of nasopharyngeal and oropharyngeal swab samples prior to RT-qPCR testing may be considered by select molecular diagnostic laboratories to further increase testing capacity and at the same time reduce the cost of testing.","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133774689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kathrina Acapulco, Shayne Julieane L. Morales, Tzar Francis Verame
Objective. The aim of this systematic review and meta-analysis is to determine summary estimates of the diagnostic accuracy of mean platelet volume for the diagnosis of myocardial infarction among adult patients with angina and/or its equivalents in terms of sensitivity, specificity, diagnostic odds ratio, and likelihood ratios. Methodology. The primary search was done through search in electronic databases. Cross-sectional, cohort, and case-control articles studying the diagnostic performance of mean platelet volume in the diagnosis of acute myocardial infarction in adult patients were included in the study. Eligible studies were appraised using well-defined criteria. Results. The overall mean MPV value of those with MI (9.702 fl; 95% CI 9.07 – 10.33) was higher than in those of the non-MI control group (8.85 fl; 95% CI 8.23 – 9.46). Interpretation of the calculated t-value of 2.0827 showed that there was a significant difference in the mean MPV values of those with MI and those of the non-MI controls. The summary sensitivity (Se) and specificity (Sp) for MPV were 0.66 (95% CI; 0.59 - 0.73) and 0.60 (95% CI; 0.43 – 0.75), respectively. The pooled diagnostic odds ratio (DOR) was 2.92 (95% CI; 1.90 – 4.50). The positive likelihood ratio of MPV in the diagnosis of myocardial infarction was 1.65 (95% CI; 1.20 – 22.27), and the negative likelihood ratio was 0.56 (95% CI; 0.50 – 0.64). Conclusion. The intended role for MPV in the diagnostic pathway of myocardial infarction would perhaps be best as a triage tool. MPV values can discriminate between those who have MI and those without. For a patient with angina presenting with elevated MPV values, it is 1.65 times more likely that he has MI. It is implied that the decision to treat a patient with angina or its equivalents as a case of MI could be supported by an elevated MPV value.
{"title":"Diagnostic Performance of Mean Platelet Volume in the Diagnosis of Acute Myocardial Infarction: A Meta-Analysis","authors":"Kathrina Acapulco, Shayne Julieane L. Morales, Tzar Francis Verame","doi":"10.21141/pjp.2020.11","DOIUrl":"https://doi.org/10.21141/pjp.2020.11","url":null,"abstract":"Objective. The aim of this systematic review and meta-analysis is to determine summary estimates of the diagnostic accuracy of mean platelet volume for the diagnosis of myocardial infarction among adult patients with angina and/or its equivalents in terms of sensitivity, specificity, diagnostic odds ratio, and likelihood ratios. Methodology. The primary search was done through search in electronic databases. Cross-sectional, cohort, and case-control articles studying the diagnostic performance of mean platelet volume in the diagnosis of acute myocardial infarction in adult patients were included in the study. Eligible studies were appraised using well-defined criteria. Results. The overall mean MPV value of those with MI (9.702 fl; 95% CI 9.07 – 10.33) was higher than in those of the non-MI control group (8.85 fl; 95% CI 8.23 – 9.46). Interpretation of the calculated t-value of 2.0827 showed that there was a significant difference in the mean MPV values of those with MI and those of the non-MI controls. The summary sensitivity (Se) and specificity (Sp) for MPV were 0.66 (95% CI; 0.59 - 0.73) and 0.60 (95% CI; 0.43 – 0.75), respectively. The pooled diagnostic odds ratio (DOR) was 2.92 (95% CI; 1.90 – 4.50). The positive likelihood ratio of MPV in the diagnosis of myocardial infarction was 1.65 (95% CI; 1.20 – 22.27), and the negative likelihood ratio was 0.56 (95% CI; 0.50 – 0.64). Conclusion. The intended role for MPV in the diagnostic pathway of myocardial infarction would perhaps be best as a triage tool. MPV values can discriminate between those who have MI and those without. For a patient with angina presenting with elevated MPV values, it is 1.65 times more likely that he has MI. It is implied that the decision to treat a patient with angina or its equivalents as a case of MI could be supported by an elevated MPV value.","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129424022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Raymundo Lo, Philippines St. Luke's Medical Center-Quezon City
http://philippinejournalofpathology.org | Vol. 5 No. 2 December 2020 Scarcely a year ago, we heard the rumblings of a looming pandemic. What followed was a journey of selfdiscovery for the Philippine Society of Pathologists and its members. Early on, we watched helplessly while the pandemic raged on in our country, handicapped by the lack of laboratory resources to test the increasing number of cases. Only the Research Institute for Tropical Medicine (RITM) was equipped and enabled to test for SARS-CoV-2 at that point in time. Most molecular testing was done in private hospitals where the emphasis was on oncology.
{"title":"A New Era in Infectious Disease Testing","authors":"Raymundo Lo, Philippines St. Luke's Medical Center-Quezon City","doi":"10.21141/pjp.2020.15","DOIUrl":"https://doi.org/10.21141/pjp.2020.15","url":null,"abstract":"http://philippinejournalofpathology.org | Vol. 5 No. 2 December 2020 Scarcely a year ago, we heard the rumblings of a looming pandemic. What followed was a journey of selfdiscovery for the Philippine Society of Pathologists and its members. Early on, we watched helplessly while the pandemic raged on in our country, handicapped by the lack of laboratory resources to test the increasing number of cases. Only the Research Institute for Tropical Medicine (RITM) was equipped and enabled to test for SARS-CoV-2 at that point in time. Most molecular testing was done in private hospitals where the emphasis was on oncology.","PeriodicalId":166708,"journal":{"name":"Philippine Journal of Pathology","volume":"114 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124118597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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