F V Gleeson

Oxford University Hospitals NHS Trust, Oxford, England, United Kingdom

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Publications (69)424.43 Total impact

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    ABSTRACT: The definitive diagnosis of pleural malignancy depends upon histological confirmation by pleural biopsy. CT is reported to have a high sensitivity and specificity for the diagnosis of malignant pleural disease, and is part of the routine diagnostic workup of these patients. The aim of this study was to assess the sensitivity and specificity of CT in detecting pleural malignancy prior to definitive histology obtained via thoracoscopy in a large cohort of patients with suspected malignant pleural disease. Retrospective review of thoracoscopies between January 2008 and January 2013 at two UK tertiary referral centres: Oxford and Preston. The histological results were compared with the CT reported diagnosis before the procedure. CT scan reports were assessed by independent respiratory physicians as to whether the radiologist concluded evidence of malignant pleural disease or benign features only. 211 (57%) of 370 patients included in the analysis had malignant disease: CT scans were reported as 'malignant' in 144, giving a sensitivity of 68% (95% CI 62% to 75%). Of the 159 patients with benign disease, 124 had CT scans reported as benign: specificity 78% (72% to 84%). The positive predictive value of a malignant CT report was 80% (75% to 86%), with a negative predictive value of 65% (58% to 72%). A significant proportion of patients being investigated for malignant disease will have malignancy despite a negative CT report. The use of CT alone in determining which patients should have invasive pleural biopsies should be re-evaluated, and further studies to define the diagnostic pathway are now required.
    Thorax 07/2014; · 8.38 Impact Factor
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    ABSTRACT: Definitive diagnosis of pleural disease (particularly malignancy) depends upon histological proof obtained via pleural biopsy or positive pleural fluid cytology. Image-guided sampling is now standard practice. Local Anaesthetic Thoracoscopy (LAT) has a high diagnostic yield for malignant and non-malignant disease but is not always possible in frail patients, if pleural fluid is heavily loculated, or where the lung is adherent to the chest wall. Such cases can be converted during the same procedure as attempted thoracoscopy to cutting-needle biopsy. This study aimed to determine the diagnostic yield of a physician-led service in both planned biopsies and cases of failed thoracoscopy. Retrospective review of all ultrasound-guided cutting-needle biopsies performed in Oxford (January 2010 - July 2013). Histological results were assessed for the yield of pleural tissue, final diagnosis and clinical follow-up in non-malignant cases. 50 ultrasound-guided biopsies were undertaken. Overall, 47 (94.0%) successfully obtained sufficient tissue for histological diagnosis. 13 of 50 were biopsies conducted after failed thoracoscopy (5.2% of 252 attempted thoracoscopies over the same time period); of these, 11/13 (84.6%) obtained sufficient tissue. 13/50 (26.0%) demonstrated pleural malignancy on histology (despite previous negative pleural fluid cytology), while 34/50 (68.0%) were benign. Of the benign cases, ten were pleural tuberculosis, two were sarcoidosis and the 22 were benign pleural thickening. There was one "false negative" of mesothelioma (median follow-up of 16 months ). Within this population, physician-based ultrasound-guided cutting-needle pleural biopsy obtains pleural tissue successfully in a high proportion of cases, including those of failed thoracoscopy.
    Chest 05/2014; · 7.13 Impact Factor
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    ABSTRACT: PET-CT scans are routinely performed in patients with lung cancer after investigation by chest x-ray (CXR) and CT scan, when these have demonstrated potentially curable disease. If the majority of patients with lung cancer potentially suitable for curative treatment could be identified earlier in the diagnostic pathway on the basis of CXR findings they could be referred for PET-CT imaging without a prior CT scan. We investigated the clinical and financial implications of adopting such a strategy. The details of 1187 patients referred with suspected lung cancer between July 2006 and August 2009 were analysed. The initial CXR and subsequent imaging of patients fit for curative treatment (Performance Status 0/1, FEV1 > 1.0) were reviewed (n = 251). The clinical and financial implications of referring patients for first line PET-CT if deemed potentially curable based on CXR findings were assessed. 107 of 1187 patients had potentially curable lung cancer on PS, lung function, CT and PET-CT. 96 of these 107 patients (90%) were correctly identified on CXR. 149 patients overall were diagnosed as potentially curable on CXR. Referring suitable patients for an immediate PET-CT scan resulted in a reduction in the time to complete staging investigations. Early PET-CT scanning for patients with suspected lung cancer, potentially suitable for curative therapy could result in more efficient staging with little additional cost.
    Clinical Radiology 01/2012; 67(6):564-73. · 1.66 Impact Factor
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    ABSTRACT: Can the detection rate of flexible bronchoscopy for lung cancer be increased by a series of simple quality improvement measures? Bronchoscopy-associated clinical parameters were prospectively recorded between 2001 and 2007 in patients with suspected lung malignancy. The detection rate of bronchoscopy, diagnostic yield of each biopsy modality and the possible impact of different service-improvement measures were assessed. 746 bronchoscopies were performed in 704 patients. The detection rate of bronchoscopy for malignancy was 83.6%, and increased over time (67.3% detection rate in 2001 (95% CI 52.9-79.7), 89.7% detection rate in 2007 (95% CI 81.3-95.2); p<0.001). Detection rate increased for bronchoscopically visible (75.0% in 2001 to 94.5% in 2007) and non-visible tumours (41.7% in 2001 to 81.2% in 2007; p<0.001 for both analyses). Prior computed tomography availability was associated with a higher diagnostic yield that did not reach statistical significance. Logistic regression analysis identified tumour visibility, year of study, use of transbronchial needle aspiration and pathologist identity as independent predictors of a positive diagnosis. A significant increase in bronchoscopic detection rate for malignancy occurred in association with a number of simple improvement measures.
    European Respiratory Journal 04/2011; 37(4):895-901. · 6.36 Impact Factor
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    H E Davies, C G Wathen, F V Gleeson
    BMJ (online) 02/2011; 342:d947. · 17.22 Impact Factor
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    ABSTRACT: The CXR is the most commonly performed radiographic examination worldwide. Its ease of performance, apparent ease of interpretation and low radiation dose, alongside its great spatial resolution would suggest that it should be the first investigation performed in all patients presenting with thoracic disease. But, the advent of ever-improving multislice CT and increasing scanner availability has resulted in some patients being referred directly for scanning, bypassing the CXR. This has resulted in an inexorable rise in the number of scans performed, with an increase in patient radiation exposure and concerns among legislators and physicians that the number of scans needs to be regulated. A key role in the reduction of unnecessary scanning in patients with thoracic disease is the understanding of the place of the CXR, its ability to help in disease detection and monitoring, and its limitations.
    Respirology 08/2010; 15(8):1152-6. · 2.78 Impact Factor
  • Chirag Patel, Andrew Scarsbrook, Fergus Gleeson
    The Lancet 05/2010; 375(9728):1778; author reply 1778-9. · 39.21 Impact Factor
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    ABSTRACT: Image analysis researchers would benefit considerably by sharing and reusing image processing algorithms. We consider some of the issues that researchers face in trying to provide algorithms in a shareable and reusable form illustrating our approach in the context of medical imaging needs and workflow for colorectal cancer. We consider the use of workflow as a model for developing and reusing components of medical imaging and specifically we consider a solution built using .Net and Windows Workflow Foundation.
    e-Science, 2009. e-Science '09. Fifth IEEE International Conference on; 01/2010
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    ABSTRACT: In multidisciplinary team (MDT) meetings for colorectal and liver cancer, each patient case is reviewed while evidence, including digital image scans such as MRI and PET/CT, is presented by clinicians. Currently these images are projected onto a wall, limiting clinician interaction. While multi-touch and interactive tabletops have been used to enhance collaboration in various scenarios, some aspects such as image quality and touch resolution need to be evaluated in this particular scenario. In this paper we present the results of work conducted to test the suitability of using a DiamondTouch tabletop, a multitouch and multi-user surface, in MDT meetings to enhance clinician interaction.
    IEEE 23rd International Symposium on Computer-Based Medical Systems (CBMS 2010), Perth, Australia, October 12-15, 2010; 01/2010
  • American Thoracic Society 2009 International Conference, May 15-20, 2009 • San Diego, California; 04/2009
  • Chirag Patel, Fergus Gleeson, Andrew Scarsbrook
    European Radiology 03/2009; 19(6):1335-6. · 4.34 Impact Factor
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    ABSTRACT: There are various issues that limit the development and deployment of new software solutions in cancer image analysis research. In this paper we discuss some of these and propose a framework design based on cloud computing concepts, Microsoft technologies, existing middleware and imaging toolkits. Furthermore, we address some of these issues by introducing collaborative visual tools for visual input data and multi-user interactions.
    eScience, 2008. eScience '08. IEEE Fourth International Conference on; 01/2009
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    N R Qureshi, N M Rahman, F V Gleeson
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    ABSTRACT: Malignant pleural effusion (MPE) is a common clinical problem with described investigation pathways. While thoracic ultrasound (TUS) has been shown to be accurate in pleural fluid detection, its use in the diagnosis of malignant pleural disease has not been assessed. A study was undertaken to assess the diagnostic accuracy of TUS in differentiating malignant and benign pleural disease. 52 consecutive patients with suspected MPE underwent TUS and contrast-enhanced CT (CECT). TUS was used to assess pleural surfaces using previously published CT imaging criteria for malignancy, diaphragmatic thickness/nodularity, effusion size/nature and presence of hepatic metastasis (in right-sided effusions). A TUS diagnosis of malignant or benign disease was made blind to clinical data/other investigations by a second blinded operator using anonymised TUS video clips. The TUS diagnosis was compared with the definitive clinical diagnosis and in addition to the diagnosis found at CECT. A definitive malignant diagnosis was based on histocytology (30/33; 91%) and clinical/CT follow-up (3/33; 9%). Benign diagnoses were based on negative histocytology and follow-up over 12 months in 19/19 patients. TUS correctly diagnosed malignancy in 26/33 patients (sensitivity 73%, specificity 100%, positive predictive value 100%, negative predictive value 79%) and benign disease in 19/19. Pleural thickening >1 cm, pleural nodularity and diaphragmatic thickening >7 mm were highly suggestive of malignant disease. TUS is useful in differentiating malignant from benign pleural disease in patients presenting with suspected MPE and may become an important adjunct in the diagnostic pathway.
    Thorax 10/2008; 64(2):139-43. · 8.38 Impact Factor
  • Radiology 09/2007; 244(2):623-4; author reply 625. · 6.34 Impact Factor
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    N M Rahman, R J O Davies, F V Gleeson
    BMJ (online) 02/2007; 334(7586):206-7. · 17.22 Impact Factor
  • F V Gleeson, S Turner, A F Scarsbrook
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    ABSTRACT: to determine the effectiveness of a new imaging algorithm in the investigation of suspected pulmonary embolism (PE). A new imaging algorithm for suspected PE was introduced following the installation of a multisection computed tomography (CT) machine at our institution. Before its installation, patients with suspected PE were evaluated with ventilation/perfusion (V/Q) scintigraphy. Subsequently, patients were triaged according to chest radiography (CR) and respiratory history to either lung scintigraphy or CT pulmonary angiography (CTPA). Patients with a normal CR and no history of lung disease were evaluated using perfusion (Q) scintigraphy [ventilation (V) scintigraphy was no longer performed]. Patients with an abnormal CR, asthma or chronic lung disease were evaluated using CTPA. All V/Q images in a continuous 3-year period before the introduction of the new imaging algorithm and all Q images performed in a 3-year period after its introduction were retrospectively reviewed. Imaging reports were categorized into normal, non-diagnostic (low or intermediate probability) or high probability for PE. Patients in the later group who subsequently underwent CTPA, were also reviewed. After the policy change the percentage of normal scintigrams significantly increased (39 to 60%; p<0.001). There was a non-significant increase in the percentage of high probability scintigrams (15 to 18%; p=0.716). Overall the diagnostic yield of lung scintigraphy improved significantly (54 to 78%; p<0.001). the diagnostic performance of lung scintigraphy can be improved by careful triage of patients to either Q scintigraphy or CTPA based on clinical history and CR findings. Q scintigraphy remains a valuable diagnostic test in the investigation of suspected PE in carefully selected patients.
    Clinical Radiology 01/2007; 61(12):1010-5. · 1.66 Impact Factor
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    ABSTRACT: Objective:  Accurate tumour re-assessment after down-sizing preoperative chemoradiotherapy (CRT) for locally advanced middle and lower rectal cancer provides valuable prognostic information prior to surgical resection. (1) We assessed the accuracy of post-CRT magnetic resonance imaging (MRI) in predicting circumferential resection margin status. (2) The accuracy of MRI in staging chemoradiation down-sized rectal tumours was also assessed.Method:  Patients from a single tertiary referral centre who received preoperative CRT for biopsy-proven rectal cancer between January 2003 and February 2005 were identified from a database. All patients received long-course CRT (50 Gy over 5 weeks and 5-fluorouracil/leucovorin) prior to surgery. A comprehensive MRI reporting proforma was completed for each patient and results were compared directly with histological specimens.Results:  Fifty patients were eligible for the study. The overall accuracy for predicting circumferential resection margin status was 76% (38/50, P = 0.006, sensitivity = 96.9%, specificity = 73.8%, negative predictive value = 96.9%). For T staging, MRI was accurate in 52% (26/50) and for nodal staging MRI was correct in 60% (30/50). Venous invasion was predicted in 66% (33/50, P = 0.04). A radiological rectal cancer regression grade was derived and this correlated with histological rectal cancer regression grade in 65% (32/49).Conclusion:  This study demonstrates that post-CRT MRI is accurate in predicting the circumferential resection margin status, which provides useful prognostic information prior to surgery.
    Colorectal Disease 10/2006; 8(9):816 - 816. · 2.08 Impact Factor
  • N M Rahman, F V Gleeson
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    ABSTRACT: The optimum management of patients with parapneumonic effusion and empyema remains uncertain. This article will review the evidence and current opinion on the pathophysiology of this disease, the role of fibrinolytic therapy, and the use of modern surgical techniques.
    Clinical Radiology 10/2006; 61(9):719-22. · 1.66 Impact Factor
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    F V Gleeson
    Thorax 02/2006; 61(1):5-7. · 8.38 Impact Factor
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    ABSTRACT: Venous thromboembolic disease is a leading cause of maternal mortality during pregnancy. Early and accurate radiological diagnosis is essential as anticoagulation is not without risk and clinical diagnosis is unreliable. Although the disorder is potentially treatable, unnecessary treatment should be avoided. Most of the diagnostic imaging techniques involve ionizing radiation which exposes both the mother and fetus to finite radiation risks. There is a relative lack of evidence in the literature to guide clinicians and radiologists on the most appropriate method of assessing this group of patients. This article will review the role of imaging of suspected venous thromboembolic disease in pregnant patients, highlight contentious issues such as radiation risk, intravenous contrast use in pregnancy and discuss the published guidelines, as well as suggesting an appropriate imaging algorithm based on the available evidence.
    Clinical Radiology 02/2006; 61(1):1-12. · 1.66 Impact Factor

Publication Stats

1k Citations
424.43 Total Impact Points

Institutions

  • 2004–2014
    • Oxford University Hospitals NHS Trust
      • Department of Radiology
      Oxford, England, United Kingdom
    • Chelsea and Westminster Hospital NHS Foundation Trust
      Londinium, England, United Kingdom
  • 2011
    • University of Wales
      Cardiff, Wales, United Kingdom
  • 2008–2011
    • Papworth Hospital NHS Foundation Trust
      Papworth, England, United Kingdom
  • 2003
    • University of Oxford
      Oxford, England, United Kingdom