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Abuserewa ST, Duff R. Incidental Diagnosis of Pulmonary Embolism in Asymptomatic Patient Using Endobronchial Ultrasound (EBUS) During Mediastinal Lymphadenopathy Assessment. Cureus 2021; 13:e13404. [PMID: 33758701 PMCID: PMC7979423 DOI: 10.7759/cureus.13404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The diagnosis of pulmonary embolism (PE) needs clinical manifestations and radiological findings. CT angiography (CTA) of pulmonary vessels is the gold standard of diagnosis of PE. However, endobronchial ultrasound (EBUS) can be a reliable and accurate alternative method of diagnosis in patients who are not candidates for CTA. Invasiveness and high cost are still the major limitations for EBUS, however, they should be considered in the appropriate population in future practice. We present a case of a 62-year-old asymptomatic male diagnosed with PE during EBUS for mediastinal lymph node assessment and biopsy.
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Affiliation(s)
- Sherif T Abuserewa
- Internal Medicine, Grand Strand Regional Medical Center, Myrtle Beach, USA
| | - Richard Duff
- Pulmonary and Critical Care Medicine, Grand Strand Medical Center, Myrtle Beach, USA
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Torous VF, Chen Y, VanderLaan PA. Comparison of plasma-thrombin, HistoGel, and CellGel cell block preparation methods with paired ThinPrep slides in the setting of mediastinal granulomatous disease. J Am Soc Cytopathol 2019; 8:52-60. [PMID: 31287420 DOI: 10.1016/j.jasc.2018.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 09/02/2018] [Accepted: 09/06/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Various cell block (CB) preparation methods are utilized by different laboratories, and not all laboratories perform CBs in tandem with ThinPreps (TPs). To compare the performance of different CB methods and their diagnostic value when used in conjunction with TP, we assessed the quantity and size of granulomas obtained from endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of lymph nodes in the evaluation of granulomatous mediastinal disease. MATERIALS AND METHODS A retrospective analysis of mediastinal lymph node EBUS-TBNA specimens that detected granulomas at our institution was performed. A total of 264 specimens from 124 patients had a TP followed by a CB (either plasma-thrombin, HistoGel, or CellGel) prepared from the residual material in the PreservCyt vial. The number and size of granulomas on each preparation was assessed using digital software. RESULTS Granulomas were detected only on the CB in 18.9% of cases and only on the TP in 5.3%. All 3 CB preparation methods showed significantly more and larger granulomas compared with the paired TP, with the plasma-thrombin and CellGel methods yielding more diagnostic material than the HistoGel method. In addition, the average number of granulomas (4.0 ± 0.4 versus 15.3 ± 1.1) and granuloma size (119.2 ± 3.2 μm versus 271.8 ± 7.3 μm) were significantly lower on TP compared with CB, respectively. CONCLUSIONS Plasma-thrombin and CellGel CB preparation methods had a higher granuloma yield compared with the HistoGel method. Additionally, significantly more numerous and larger granulomas were present on CBs compared with TP slides. Therefore, solely relying on TP slide evaluation may unintentionally overlook larger tissue fragments obtained during needle aspirations.
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Affiliation(s)
- Vanda F Torous
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Yigu Chen
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
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Jain D, Allen TC, Aisner DL, Beasley MB, Cagle PT, Capelozzi VL, Hariri LP, Lantuejoul S, Miller R, Mino-Kenudson M, Monaco SE, Moreira A, Raparia K, Rekhtman N, Roden AC, Roy-Chowdhuri S, da Cunha Santos G, Thunnissen E, Troncone G, Vivero M. Rapid On-Site Evaluation of Endobronchial Ultrasound–Guided Transbronchial Needle Aspirations for the Diagnosis of Lung Cancer: A Perspective From Members of the Pulmonary Pathology Society. Arch Pathol Lab Med 2017. [DOI: 10.5858/arpa.2017-0114-sa] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a very useful tool in the field of diagnostic respiratory cytology. Rapid on-site evaluation (ROSE) of EBUS-TBNA not only has the potential to improve diagnostic yield of the procedure but also to triage samples for predictive molecular testing to guide personalized treatments for lung cancer.
Objective.—
To provide an overview of the current status of the literature regarding ROSE of EBUS-TBNA in the diagnosis of lung cancer.
Data Sources.—
An electronic literature search in PubMed and Google databases was performed using the following key words: cytology, lung cancer, on-site evaluation, rapid on-site evaluation, and ROSE EBUS-TBNA. Only articles published in English were included in this review.
Conclusions.—
Rapid on-site evaluation can ensure that the targeted lesion is being sampled and can enable appropriate specimen triage. If available, it should be used with EBUS-TBNA in the diagnosis of lung cancer because it can minimize repeat procedures for additional desired testing (ie, molecular studies). Some studies have shown that ROSE does not adversely affect the number of aspirations, total procedure time of EBUS-TBNA, or the rate of postprocedure complications; it is also helpful in providing a preliminary diagnosis that can reduce the number of additional invasive procedures, such as mediastinoscopy. As EBUS technology continues to evolve, our knowledge of the role of ROSE in EBUS-TBNA for the diagnosis of lung cancer will also continue to grow and evolve.
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Nosotti M, Palleschi A, Tosi D, Mendogni P, Righi I, Carrinola R, Rosso L. Color-Doppler sonography patterns in endobronchial ultrasound-guided transbronchial needle aspiration of mediastinal lymph-nodes. J Thorac Dis 2017; 9:S376-S380. [PMID: 28603648 DOI: 10.21037/jtd.2017.03.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is commonly used for the pathological diagnosis in patients with mediastinal lymphadenopathy. Even though the accuracy of EBUS-TBNA is considered high, several authors have tried to outline characteristic ultrasound criteria for malignant mediastinal lymph-node identification to maximize this accuracy. Recently, a color-Doppler patterns classification has been proposed by Nakajima to target suspected mediastinal lymph-nodes. The aim of this study was to assess such classification. METHODS Clinical, sonographic and pathological data of patients with suspected malignant mediastinal lymph-nodes on computed tomography (CT) and/or on positron emission tomography (PET) were prospectively recorded. On the basis of color-Doppler patterns, mediastinal lymph-nodes were classified in four grades and the bronchial-artery inflow sign was noted according to the Nakajima classification. The diagnostic sensitivity, specificity, positive predictive value (PPV), negative predicted value (NPV) and accuracy were calculated using standard definitions. RESULTS Seventy-five patients were enrolled in this prospective study, median age 66 years; 85% of patients had primary lung cancer and 15% had extra-thoracic malignancy. EBUS-TBNA was performed in 87 lymph-nodes (rate 1.16 per patient); 6 lymph-nodes had inadequate samples and were excluded from the analysis; 64 nodes were confirmed as malignant and 17 nodes as benign. Color-Doppler patterns classification was as follow: grade 0-I, 14 lymph-nodes; grade II-III, 67 lymph-nodes; bronchial-artery inflow sign, 8 lymph-nodes. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of the classification were 0.93, 0.64, 0.84, 0.6 and 0.81 respectively. CONCLUSIONS The color-Doppler sonography is a fast, reproducible and effective tool that could help in targeting suspected malignant lymph-nodes during EBUS-TBNA. The current study validates the efficacy of the color-Doppler patterns classification proposed by Nakajima.
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Affiliation(s)
- Mario Nosotti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alessandro Palleschi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Davide Tosi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Paolo Mendogni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Ilaria Righi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Rosaria Carrinola
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Lorenzo Rosso
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Aziz F. Endobronchial ultrasound-guided transbronchial needle aspiration for staging of lung cancer: a concise review. Transl Lung Cancer Res 2015; 1:208-13. [PMID: 25806182 DOI: 10.3978/j.issn.2218-6751.2012.09.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 09/17/2012] [Indexed: 11/14/2022]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) offers a minimally invasive alternative to mediastinoscopy with additional access to the hilar nodes, a better safety profile, and it removes the costs and hazards of theatre time and general anesthesia with comparable sensitivity, although the negative predictive value of mediastinoscopy (and sample size) is greater. EBUS- TBNA also obtains larger samples than conventional TBNA, has superior performance and theoretically is safer, allowing real-time sampling under direct vision. It can also have predictive value both in sonographic appearance of the nodes and histological characteristics. EBUS-TBNA is therefore indicated for NSCLC staging, diagnosis of lung cancer when there is no endobronchial lesion, and diagnosis of both benign (especially tuberculosis and sarcoidosis) and malignant mediastinal lesions. The procedure is different than for flexible bronchoscopy, takes longer, and requires more training. EBUS-TBNA is more expensive than conventional TBNA but can save costs by reducing the number of more costly mediastinoscopies. In the future, endobronchial ultrasound may have applications in airways disease and pulmonary vascular disease.
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Affiliation(s)
- Fahad Aziz
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1021, USA
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Bae W, Kim H, Kim YA, Lee J, Lee CH, Lee SM, Yim JJ, Yoo CG, Kim YW, Han SK, Park YS. Diagnostic concordance rate between histologic and cytologic specimens of endobronchial ultrasound-guided transbronchial needle aspiration in lung cancer: A single institution experience. Thorac Cancer 2014; 5:174-8. [PMID: 26766996 DOI: 10.1111/1759-7714.12072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Accepted: 08/04/2013] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The aspirates from endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) were examined using the tissue core and cytology. We assessed that the tissue core was a more reliable specimen and attempted to analyze how many discrepancies were found between the two specimens. We investigated diagnostic concordance rate between histology and cytology. METHODS From January 2011 to December 2011, a total of 267 consecutive patients with lung cancer, who underwent EBUS-TBNA, were included in this retrospective study. RESULTS Of the 267 lung cancer patients, 207 (77.5%) were men. The median age was 65 years old. The most common pathologic type was adenocarcinoma (120, 44.9%), followed by squamous cell carcinoma (79, 29.6%). Among the 267 patients, 579 mediastinal and hilar lymph nodes were punctured. The right lower paratracheal (204, 35.2%) and subcarinal (172, 29.7%) lymph nodes were the most common nodal stations. Among the 579 lymph nodes, malignant cells were observed in 267 (46.1%) nodes, in either the histologic, cytologic or both slides: 209 in both histology and cytology, 37 in histology only, and 21 in cytology only slides. The diagnostic concordance rate between the tissue core and cytology was 90.0% (95% confidence interval CI, 87.1-92.2) (κ = 0.79). CONCLUSIONS The diagnostic concordance rate between the histology and cytology of EBUS-TBNA in lung cancer was 90.0% (95% CI, 87.1-92.2) (κ = 0.79).
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Affiliation(s)
- Won Bae
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine Seoul, Korea
| | - Hyojin Kim
- Department of Pathology, Seoul National University College of Medicine Seoul, Korea
| | - Yong A Kim
- Department of Pathology, Seoul National University Boramae Medical Center Seoul, Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine Seoul, Korea
| | - Chang-Hoon Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine Seoul, Korea
| | - Sang-Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine Seoul, Korea
| | - Jae-Joon Yim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine Seoul, Korea
| | - Chul-Gyu Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine Seoul, Korea
| | - Young Whan Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine Seoul, Korea
| | - Sung Koo Han
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine Seoul, Korea
| | - Young Sik Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine Seoul, Korea
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True Negative Predictive Value of Endobronchial Ultrasound in Lung Cancer: Are We Being Conservative Enough? Ann Thorac Surg 2013; 95:1689-94. [DOI: 10.1016/j.athoracsur.2012.09.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 09/18/2012] [Accepted: 09/24/2012] [Indexed: 11/19/2022]
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Kirmani BH, Rintoul RC, Win T, Magee C, Magee L, Choong C, Wells FC, Coonar AS. Stage migration: results of lymph node dissection in the era of modern imaging and invasive staging for lung cancer†. Eur J Cardiothorac Surg 2012; 43:104-9; discussion 109-10. [DOI: 10.1093/ejcts/ezs184] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Khazai L, Kundu UR, Jacob B, Patel S, Sneige N, Eapen GA, Morice RC, Caraway NP. Endobronchial ultrasound-guided transbronchial needle aspiration biopsy is useful evaluating mediastinal lymphadenopathy in a cancer center. Cytojournal 2011; 8:10. [PMID: 21712956 PMCID: PMC3120041 DOI: 10.4103/1742-6413.82022] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 03/26/2011] [Indexed: 01/01/2023] Open
Abstract
Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) biopsy is used to stage mediastinal lymph nodes in cancer patients to optimize treatment strategies. In this retrospective study, the authors determined the utility of EBUS-TBNA biopsy in the evaluation of mediastinal lymphadenopathy at a high-volume cancer center. Materials and Methods: The pathology database was searched for all patients who had undergone EBUS-TBNA biopsy of mediastinal lymph nodes over a one-year period. Cytologic diagnoses were correlated with clinical histories, subsequent resection, and clinical follow-up data. Results: Of 928 lymph node samples, 226 (24%) were diagnosed as malignant, 4 (0.4%) were suspicious for malignancy, 9 (1%) were atypical, 640 (69%) were benign, and 47 (5%) were insufficient for evaluation. In 89 (9.6%) cases, the patients had surgical resection. There was one false positive, in which the primary tumor contained infiltrating lymphocytes, had been sampled. There were five false-negative cases, which resulted from sampling errors, including two with micrometastases. The sensitivity, specificity, and positive and negative predictive value rates for EBUS-TBNA biopsy in the evaluation of mediastinal lymph nodes were 68.7% and 98.6% and 91.6% and 93.5%, respectively on a per lymph node basis. The overall clinical sensitivity, specificity, and positive and negative predictive value rates after one year clinical/radiological and histologic follow-up were 97%, 99.3%, 96.7% and 99.4%, respectively. Conclusions: EBUS-TBNA biopsy is a sensitive and specific method for evaluating mediastinal lymphadenopathy in patients with lung and other primary tumors.
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Affiliation(s)
- Laila Khazai
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Andrade RS. Relevance of endobronchial ultrasonography to thoracic surgeons. Semin Thorac Cardiovasc Surg 2010; 22:150-4. [PMID: 21092893 DOI: 10.1053/j.semtcvs.2010.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2010] [Indexed: 11/11/2022]
Abstract
The relevance of endobronchial ultrasonography (EBUS) to thoracic surgeons is 2-fold: first, EBUS is an accurate and versatile diagnostic tool; second, EBUS is of importance to our specialty. The diagnostic performance of endobronchial ultrasonography (EBUS) is similar to that of mediastinoscopy, except for a lower negative predictive value for EBUS. Consequently, EBUS does not replace mediastinoscopy, but instead EBUS and mediastinoscopy are complementary. A thoracic surgeon proficient in EBUS has the ability to decide which tool or combination of tools to use to optimize patient care. The relevance of EBUS can be described in evolutionary terms: proficiency in EBUS exemplifies a new trait that can enhance our adaptability to the current environment. An indirect measure of the acquisition of this new skill by our specialty can be gleaned from an overview of original EBUS publications: nearly one-half are authored or coauthored by thoracic surgeons. EBUS is an excellent diagnostic tool available to thoracic surgeons to optimize patient care and an example of a skill that may enhance our survival as a surgical specialty.
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Affiliation(s)
- Rafael S Andrade
- Division of General Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
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Andrade RS, Groth SS, Rueth NM, D'Cunha J, Pambuccian SE, Maddaus MA. Evaluation of mediastinal lymph nodes with endobronchial ultrasound: The thoracic surgeon's perspective. J Thorac Cardiovasc Surg 2010; 139:578-82; discussion 582-3. [DOI: 10.1016/j.jtcvs.2009.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Revised: 10/29/2009] [Accepted: 11/13/2009] [Indexed: 10/19/2022]
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Cameron SEH, Andrade RS, Pambuccian SE. Endobronchial ultrasound-guided transbronchial needle aspiration cytology: a state of the art review. Cytopathology 2009; 21:6-26. [PMID: 20015257 DOI: 10.1111/j.1365-2303.2009.00722.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a recently developed, accurate, safe and cost-effective technique that allows sampling of mediastinal lymph nodes and peribronchial lesions including pulmonary and mediastinal lesions. Its major indications are the nodal staging of non-small cell carcinomas of the lung, their restaging after chemotherapy and/or radiation, the diagnosis of sarcoidosis and of metastases from extrathoracic malignancies, and the diagnosis of mediastinal lymphadenopathy and masses of unknown aetiology. From our experience at the University of Minnesota and a comprehensive review of the literature, we discuss technical aspects of the procedure, its advantages and limitations in comparison with other methods of sampling mediastinal lymph nodes, focusing on the role of the cytopathologist in ensuring the effectiveness of the procedure. An algorithmic approach to the cytological diagnosis, starting with the determination of the adequacy of the sample, is also presented.
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Affiliation(s)
- S E H Cameron
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
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