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Gokozan HN, Mostyka M, Scognamiglio T, Solomon JP, Beg S, Stern E, Goyal A, Siddiqui MT, Heymann JJ. Diagnostic interobserver agreement for thyroid fine-needle aspirates: Effects of reviewer experience and molecular diagnostics. Am J Clin Pathol 2024:aqae043. [PMID: 38656386 DOI: 10.1093/ajcp/aqae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES Few cytologically indeterminate thyroid fine-needle aspirations (FNAs) harbor BRAF V600E. Here, we assess interobserver agreement for The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) category III (atypia of undetermined significance [AUS]) FNAs harboring BRAF V600E and contrast their features with those harboring non-BRAF V600E alterations, with attention to cytopathology experience. METHODS Seven reviewers evaluated 5 AUS thyroid FNAs harboring BRAF V600E. To blind reviewers, cases were intermixed with 19 FNAs falling within other TBSRTC categories and in which genetic alterations other than BRAF V600E had been identified (24 FNAs total). Interobserver agreement against both "index" and most popular ("mode") diagnoses was calculated. Four additional BRAF V600E cases were independently reviewed. RESULTS Reviewers included 3 trainees and 3 American Board of Pathology (board)-certified cytopathologists. Board-certified cytopathologists, whose experience ranged from 2 to more than 15 subspecialty practice years, had known AUS rates. BRAF V600E was identified in 5 of 260 (2%) AUS FNAs. Interobserver agreement was higher among cytopathologists with more experience. Mode diagnosis differed from index diagnosis in 6 of 11 cases harboring RAS-like alterations; mode diagnosis was AUS in 4 of 5 BRAF V600E FNAs. CONCLUSIONS Atypia of undetermined significance of thyroid FNAs harboring BRAF V600E is uncommon yet relatively reproducible, particularly among pathologists with experience. It is advisable to sequence BRAF across V600 in such cases.
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Affiliation(s)
- Hamza N Gokozan
- Department of Pathology and Laboratory Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, US
| | - Maria Mostyka
- Department of Pathology and Laboratory Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, US
| | - Theresa Scognamiglio
- Department of Pathology and Laboratory Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, US
| | - James P Solomon
- Department of Pathology and Laboratory Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, US
| | - Shaham Beg
- Department of Pathology and Laboratory Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, US
| | - Evan Stern
- Department of Pathology and Laboratory Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, US
| | - Abha Goyal
- Department of Pathology and Laboratory Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, US
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, US
| | - Jonas J Heymann
- Department of Pathology and Laboratory Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, NY, US
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Goyal A, Booth CN, Souers RJ, Tabbara SO, Roberson J, Henry MR, Sundling KE, Goodrich K, Nguyen L. Navigating Practice Issues Related to the Unsatisfactory Cervicovaginal Papanicolaou Test: Survey Results of Laboratories Participating in the 2020 College of American Pathologists PAP Education Program. Arch Pathol Lab Med 2024; 148:48-54. [PMID: 37074866 DOI: 10.5858/arpa.2022-0330-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 04/20/2023]
Abstract
CONTEXT.— Unsatisfactory Papanicolaou (Pap) tests pose a unique set of challenges to the laboratory with regard to their processing, review, reporting, and performance of human papillomavirus (HPV) testing. There are no standardized guidelines for the review process and handling of unsatisfactory Pap tests. OBJECTIVE.— To assess the current practice patterns regarding various aspects of the unsatisfactory Pap test, from processing to reporting, across laboratories worldwide. DESIGN.— A supplemental questionnaire was mailed to laboratories participating in the 2020 College of American Pathologists (CAP) Gynecologic Cytopathology (PAP Education) Program, requesting data regarding the unsatisfactory Pap test. RESULTS.— Of 1520 participating laboratories, 619 (40.7%) responded, and the responses of 577 laboratories were included for further analysis. Only 64.6% (373 of 577) laboratories used the unsatisfactory Pap test criteria as specified by the 2014 Bethesda System. About three-quarters of the respondents (433 of 576; 75.2%) routinely rescreened unsatisfactory Pap tests. Routine repreparation of such Pap tests was performed by 54.9% (316 of 576) of laboratories, and 52.0% (293 of 563) used glacial acetic acid for repreparing excessively bloody specimens. HPV test results were reported for unsatisfactory Pap tests, always or sometimes, by 62.4% (353 of 566) of respondents. CONCLUSIONS.— This CAP survey reveals important information regarding the practice patterns pertaining to several aspects of the unsatisfactory Pap test. It also provides valuable insight into the quality assurance measures that can be implemented for such tests. Future studies can further aid in the standardization of all components of the handling of unsatisfactory Pap tests for overall quality improvement.
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Affiliation(s)
- Abha Goyal
- From the Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York (Goyal)
| | - Christine N Booth
- the Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Booth)
| | - Rhona J Souers
- the Departments of Biostatistics (Souers) and Proficiency Testing (Goodrich), College of American Pathologists, Northfield, Illinois
| | - Sana O Tabbara
- the Department of Pathology, H. Lee Moffitt Cancer Center, Tampa, Florida (Tabbara)
| | - Janie Roberson
- the Department of Pathology, University of Alabama Birmingham Hospital, Birmingham (Roberson)
| | - Michael R Henry
- the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Henry)
| | - Kaitlin E Sundling
- the Department of Pathology and Laboratory Medicine, Wisconsin State Laboratory of Hygiene and University of Wisconsin, Madison (Sundling)
| | - Kelly Goodrich
- the Departments of Biostatistics (Souers) and Proficiency Testing (Goodrich), College of American Pathologists, Northfield, Illinois
| | - Lananh Nguyen
- the Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, Ontario, Canada (Nguyen)
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Kim D, Margolskee E, Goyal A, Siddiqui MT, Heymann JJ, Rao R, Hayden J. Optimal carcinoembryonic antigen (CEA) cutoff values in the diagnosis of neoplastic mucinous pancreatic cysts differ among assays. J Clin Pathol 2023:jcp-2023-209136. [PMID: 37940376 DOI: 10.1136/jcp-2023-209136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023]
Abstract
AIM Pancreatic cyst fluid carcinoembryonic antigen (CEA) is a pivotal test in the diagnosis and management of neoplastic mucinous cysts (NMC) of the pancreas. Cyst fluid CEA levels of 192 ng/mL have been widely used to identify NMC. However, CEA values are unique to and significantly differ between individual assays with various optimal cutoffs reported in the literature for NMC. Here, we investigate the optimal CEA cut-off value of pancreatic cysts from two different assays to identify differences in thresholds. METHODS Pancreatic cyst fluid CEA levels, CEA assay platform (Beckman Dxl (BD) or Siemens Centaur XP (SC)), and clinical/pathological information were retrospectively collected. Cases were categorised into either NMC or non-NMC. Optimal CEA cut-off values were calculated via a receiver operator characteristic curve. Cut-off values were then identified separately by assay platform. RESULTS In total, 149 pancreatic cystic lesions with concurrent CEA values (SC: n=47; BD: n=102) were included. Histological correlation was available for 26 (17%) samples. The optimal CEA cut-off value for all samples at the study institution was 45.9 ng/mL (area under the curve (AUC)=86, Sn=85.7%, Sp=73.8%). When analysed separately by CEA assay, the cut-off values were 45.9 ng/mL (AUC=84.27, Sn=89.7%, Sp=71.4%) for BD and 24.4 ng/mL (AUC=77, Sn=81.8%, Sp=75%) for SC (p=0.48). CONCLUSIONS This study showed an optimal pancreas cyst CEA cut-off threshold of 45.9 ng/mL, which is lower than commonly cited literature with different cutoffs on the two separate platforms (BD: 45.9 ng/mL, SC: 24.4 ng/mL).
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Affiliation(s)
- David Kim
- Department of Pathology & Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth Margolskee
- Department of Pathology & Laboratory Medicine, Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Abha Goyal
- Department of Pathology & Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Momin T Siddiqui
- Department of Pathology & Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Jonas J Heymann
- Department of Pathology & Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Rema Rao
- Department of Pathology & Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joshua Hayden
- Department of Chemistry, Norton Healthcare, Louisville, Kentucky, USA
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Agrawal A, Romics L, Thekkinkattil D, Soliman M, Kaushik M, Barmpounakis P, Mortimer C, Courtney CA, Goyal A, Garreffa E, Carmichael A, Lane RA, Rutherford C, Kim B, Achuthan R, Pitsinis V, Goh S, Ray B, Grover K, Vidya R, Murphy J. 'PartBreCon' study. A UK multicentre retrospective cohort study to assess outcomes following PARTial BREast reCONstruction with chest wall perforator flaps. Breast 2023; 71:82-88. [PMID: 37544090 PMCID: PMC10430575 DOI: 10.1016/j.breast.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/27/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Partial breast reconstruction with a pedicled chest wall perforator flap (CWPF) enables breast conservation in a higher tumour: breast volume ratio scenario. Since there is limited evidence, this retrospective cohort study aimed to ascertain immediate (30-days) and medium-term (follow-up duration) surgical outcomes. METHODS STROBE-compliant protocol ascertained CWPF outcomes between March 2011-March 2021. UK centres known to perform CWPF were invited to participate if they performed at least 10 cases. Data were retrospectively collected, including patient demographics, tumour and treatment characteristics, and surgical and oncological outcomes. Statistical analysis (R™) included multivariable logistic regression and sensitivity analysis. RESULTS Across 15 centres, 507 patients with median age (54 years, IQR; 48-62), body mass index (25.4 kg/m2, IQR; 22.5-29), tumour size (26 mm, IQR; 18-35), and specimen weight (62 g, IQR; 40-92) had following flap types: LiCAP (54.1%, n = 273), MiCAP/AiCAP (19.6%, n = 99), LiCAP + LTAP (19.8%, n = 100) and TDAP (2.2%, n = 11). 30-days complication rates were in 12%: haematoma (4.3%, n = 22), wound infection (4.3%, n = 22), delayed wound healing (2.8%, n = 14) and flap loss (0.6%, n = 3; 1 full) leading to readmissions (2.6%, n = 13) and re-operations (2.6%, n = 13). Positive margins (n = 88, 17.7%) led to 15.9% (n = 79) re-excisions, including 7.5% (n = 37) at the planned 2nd of 2-stage surgery and 1.8% (n = 9) mastectomy. At median 23 months (IQR; 11-39) follow-up, there were 1.2% (n = 6) symmetrisations; recurrences: local (1%), regional/nodal (0.6%) and distant (3.2%). CONCLUSIONS This large multicentre cohort study demonstrates acceptable complication and margin re-excision rates. CWPF extends the range of breast conservation techniques. Further studies are required for long-term oncological outcomes.
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Affiliation(s)
- A Agrawal
- Cambridge University Hospitals, Cambridge, UK.
| | - L Romics
- New Victoria Hospital, Glasgow, UK.
| | | | - M Soliman
- Cambridge University Hospitals, Cambridge, UK; Mansoura University, Egypt.
| | - M Kaushik
- University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - P Barmpounakis
- Department of Statistics, Athens University of Economics and Business, Athens, Greece.
| | | | | | - A Goyal
- Royal Derby Hospital, Derby, UK.
| | | | - A Carmichael
- University Hospital of Derby and Burton, Belvedere Road, Burton on Trent, UK.
| | - R A Lane
- Cambridge University Hospitals, Cambridge, UK.
| | | | - B Kim
- St. James's University Hospital, Leeds, UK.
| | - R Achuthan
- St. James's University Hospital, Leeds, UK.
| | | | - S Goh
- Peterborough Hospital, Peterborough, UK.
| | - B Ray
- Harrogate NHS Trust, Harrogate, UK.
| | | | - R Vidya
- Royal Wolverhampton NHS Trust, Wolverhampton, UK.
| | - J Murphy
- Manchester University Hospital, Manchester, UK.
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Hennayake S, Goyal A, Cserni T, Bianchi A. Correspondence; 'Transformation of the female genitalia in congenital adrenal hyperplasia: MRI study'. J Pediatr Urol 2023; 19:596-597. [PMID: 37263835 DOI: 10.1016/j.jpurol.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 06/03/2023]
Affiliation(s)
- S Hennayake
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
| | - A Goyal
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - T Cserni
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - A Bianchi
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
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Li Z, Tabbara SO, Nwosu A, Souers RJ, Goyal A, Kurian EM, Lin X, VandenBussche C, Nguyen LN. Pancreaticobiliary Cytology Practice in 2021: Results of a College of American Pathologists Survey. Arch Pathol Lab Med 2023:495695. [PMID: 37702405 DOI: 10.5858/arpa.2023-0167-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 09/14/2023]
Abstract
CONTEXT.— The College of American Pathologists (CAP) surveys provide national benchmarks of pathology practice. OBJECTIVE.— To investigate pancreaticobiliary cytology practice in domestic and international laboratories in 2021. DESIGN.— We analyzed data from the CAP Pancreaticobiliary Cytology Practice Supplemental Questionnaire that was distributed to laboratories participating in the 2021 CAP Nongynecologic Cytopathology Education Program. RESULTS.— Ninety-three percent (567 of 612) of respondent laboratories routinely evaluated pancreaticobiliary cytology specimens. Biliary brushing (85%) was the most common pancreaticobiliary cytology specimen evaluated, followed by pancreatic fine-needle aspiration (79%). The most used sampling methods reported by 235 laboratories were 22-gauge needle for fine-needle aspiration (62%) and SharkCore needle for fine-needle biopsy (27%). Cell block was the most used slide preparation method (76%), followed by liquid-based cytology (59%) for pancreatic cystic lesions. Up to 95% (303 of 320) of laboratories performed rapid on-site evaluation (ROSE) on pancreatic solid lesions, while 56% (180 of 320) performed ROSE for cystic lesions. Thirty-six percent (193 of 530) of laboratories used the Papanicolaou Society of Cytopathology System for Reporting Pancreaticobiliary Cytology in 2021. Among all institution types, significant differences in specimen volume, specimen type, ROSE practice, and case sign-out were identified. Additionally, significant differences in specimen type, slide preparation, and ROSE practice were found. CONCLUSIONS.— This is the first survey from the CAP to investigate pancreaticobiliary cytology practice. The findings reveal significant differences among institution types and between domestic and international laboratories. These data provide a baseline for future studies in a variety of practice settings.
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Affiliation(s)
- Zaibo Li
- From the Department of Pathology, The Ohio State University, Columbus (Li)
| | - Sana O Tabbara
- The Department of Pathology, Moffitt Cancer Center, Tampa, Florida (Tabbara)
| | - Ann Nwosu
- Biostatistics, College of American Pathologists, Northfield, Illinois (Nwosu, Souers)
| | - Rhona J Souers
- Biostatistics, College of American Pathologists, Northfield, Illinois (Nwosu, Souers)
| | - Abha Goyal
- The Department of Pathology, Weill Cornell Medicine, New York, New York (Goyal)
| | - Elizabeth M Kurian
- The Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Kurian)
| | - Xiaoqi Lin
- The Department of Pathology, Northwestern University, Chicago, Illinois (Lin)
| | - Christopher VandenBussche
- The Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland (VandenBussche)
| | - Lananh N Nguyen
- The Department of Laboratory Medicine and Pathobiology, University of Toronto, Ontario, Canada (Nguyen)
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VandenBussche CJ, Nwosu A, Souers R, Sundling KE, Brainard J, Goyal A, Lin X, Masood S, Nguyen L, Roberson J, Tabbara SO, Booth C. The Implementation of Nongynecologic Reporting Systems in Cytopathology Laboratories Is Highly Variable: Analysis of Data From a 2020 Supplemental Survey of Participants in the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology. Arch Pathol Lab Med 2023:494901. [PMID: 37603681 DOI: 10.5858/arpa.2023-0010-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 08/23/2023]
Abstract
CONTEXT— In recent years, several reporting systems have been developed by national and international cytopathology organizations to standardize the evaluation of specific cytopathology specimen types. OBJECTIVE— To assess the current implementation rates, implementation methods, and barriers to implementation of commonly used nongynecologic reporting systems in cytopathology laboratories. DESIGN— Data were analyzed from a survey developed by the committee and distributed to participants in the College of American Pathologists Nongynecologic Cytopathology Education Program mailing. RESULTS— Nongynecologic reporting systems with the highest rate of adoption were the Bethesda System for Reporting Thyroid Cytopathology, 2nd edition (74.1%; 552 of 745); the Paris System for Reporting Urinary Cytology (53.9%; 397 of 736); and the Milan System for Reporting Salivary Gland Cytopathology (29.1%; 200 of 688). The most common reason given for not adopting a reporting system was satisfaction with a laboratory's current system. Implementation varied among laboratories with regard to which stakeholders were involved in deciding to implement a system and the amount of education provided during the implementation process. CONCLUSIONS— The implementation of nongynecologic reporting systems in cytopathology laboratories was highly variable.
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Affiliation(s)
- Christopher J VandenBussche
- From the Department of Pathology and Oncology, The Johns Hopkins University School of Medicine, Baltimore, Maryland (VandenBussche)
| | - Ann Nwosu
- The Biostatistics Division, College of American Pathologists, Northfield, Illinois (Nwosu, Souers)
| | - Rhona Souers
- The Biostatistics Division, College of American Pathologists, Northfield, Illinois (Nwosu, Souers)
| | - Kaitlin E Sundling
- The Wisconsin State Laboratory of Hygiene and Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison (Sundling)
| | - Jennifer Brainard
- The Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Brainard, Booth)
| | - Abha Goyal
- The Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York (Goyal)
| | - Xiaoqi Lin
- The Department of Pathology, Northwestern University, Chicago, Illinois (Lin)
| | - Shala Masood
- The Department of Pathology, University of Florida College of Medicine-Jacksonville, Jacksonville (Masood)
| | - Lananh Nguyen
- The Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada (Nguyen)
| | - Janie Roberson
- Hospital Laboratories, University of Alabama at Birmingham, Birmingham (Roberson)
| | | | - Christine Booth
- The Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Brainard, Booth)
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Sigel C, Xiao-Jun W, Agaram N, Sigel K, Raza R, Andrade R, Rao R, Shah P, Soares K, Goyal A. Diagnostic features of low- and high-grade mucinous neoplasms in pancreatic cyst FNA cytology. Cancer Cytopathol 2023; 131:325-336. [PMID: 36650420 PMCID: PMC10593125 DOI: 10.1002/cncy.22681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/18/2022] [Accepted: 12/05/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Pancreatic cyst cytology evaluates for neoplastic mucin and epithelial grade. This study describes cytological features of low- and high-grade mucinous neoplasms (MNs) using gastrointestinal contaminants for comparison. METHODS Histologically confirmed pancreatic cystic neoplasms were reviewed by a panel of cytopathologists to identify which, among 26 selected cytologic features, correlate significantly with low- and high-grade MN. A test for greater than or equal to four of eight high-grade features (three-dimensional architecture, high nuclear:cytoplasmic ratio, moderate nuclear membrane abnormalities, loss of nuclear polarity, hyperchromasia, >4:1 nuclear size variation in one cluster, karyorrhexis, and necrosis) was assessed for identifying a high-grade neoplasms. Additional characteristics of the cohort such as cyst fluid carcinoembryonic antigen results, molecular testing, Papanicolaou Society of Cytopathology classification, and select high-risk clinical features are described. RESULTS Endoscopic ultrasound fine-needle aspirations from 134 MN and 17 serous cystadenomas containing gastrointestinal contaminants were included. The MN consisted of 112 (84%) intraductal papillary MNs (low-grade = 69, 62%; high-grade = 24, 21%; and invasive = 19, 17%) and mucinous cystic neoplasms (low-grade = 20, 90%; high-grade = 2, 10%). Half had greater than five clusters of epithelium for analysis. Compared with gastrointestinal contaminants, mucin from MN was thick and colloid-like (40% vs. 6%, p < .01), covered >20% of the smear area (32% vs. none, p < .01), and contained histiocytes (46% vs. 18%, p = .04). Greater than or equal to four of eight select high-grade features was present in 36% of high-grade MN with sensitivity 37% and 98% specificity. CONCLUSION Colloid-like features, >20% of smear, and histiocytes correlated with MN. Testing for greater than or equal to four high-grade features had low sensitivity and high specificity for high-grade MN.
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Affiliation(s)
- Carlie Sigel
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center
| | - Wei Xiao-Jun
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center
| | - Narasimhan Agaram
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center
| | - Keith Sigel
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roshan Raza
- Department of Pathology, Baylor college of Medicine, Houston, Texas
| | - Rebecca Andrade
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center
| | - Rema Rao
- Department of Pathology and Laboratory Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Pari Shah
- Department of Medicine, Memorial Sloan Kettering Cancer Center
| | - Kevin Soares
- Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Abha Goyal
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
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Hennayake S, Cervellione R, Goyal A, Keene D, Cserni T, De Silva A, Rossi A, Bianchi A. Commentary: Symptomatic corpus spongiosum defect in adolescents and young adults who underwent distal hypospadias repair during childhood. J Pediatr Urol 2023:S1477-5131(23)00148-1. [PMID: 37147141 DOI: 10.1016/j.jpurol.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/03/2023] [Indexed: 05/07/2023]
Affiliation(s)
- S Hennayake
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK.
| | - R Cervellione
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - A Goyal
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - D Keene
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - T Cserni
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - A De Silva
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - A Rossi
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
| | - A Bianchi
- Paediatric Urology Department, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, UK
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Alahmad MM, Dalia T, Goyal A, Bhyan P, Shah Z. Endomyocardial Biopsy Utilization and Outcomes Among Patients with Myocarditis. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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11
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Goyal A. Role of Fine Needle Aspiration Cytology in the Diagnosis of Gynecologic Tumors. Acta Cytol 2023; 67:195-212. [PMID: 36917955 DOI: 10.1159/000529364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/17/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND The tumors involving the gynecologic tract encompass a wide range of lesions including those of epithelial, mesenchymal, sex cord-stromal, and germ cell origin. Amongst the carcinomas of tubo-ovarian origin, high-grade serous carcinoma is the most common malignancy. The primary role of fine needle aspiration (FNA) cytology in the management of gynecologic tract malignancies is in the diagnosis of their recurrences/metastases. In patients presenting with advanced disease, the cytology specimen may be the initial or the only sampling performed before the initiation of treatment. SUMMARY This review will discuss the cytologic findings of various gynecologic tract neoplasms with regard to their morphologic features, differential diagnoses, and the ancillary studies that can assist in their recognition. KEY MESSAGES FNA cytology serves as a valuable tool in the diagnosis and management of gynecologic tract malignancies. However, making an accurate diagnosis of these entities, especially on limited cytology specimens, can be challenging. Awareness regarding the morphologic spectrum of these tumors, their potential mimics, and the ancillary studies that can be employed to refine their characterization, can assist in arriving at the correct diagnosis.
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Affiliation(s)
- Abha Goyal
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York, USA
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12
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Suben J, Goyal A, Rao R, Sung S. Diagnostic implication of extracellular mucin in pancreatic/biliary brushing and stent cytology. Cancer Cytopathol 2023. [PMID: 36808869 DOI: 10.1002/cncy.22685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/30/2022] [Accepted: 01/18/2023] [Indexed: 02/20/2023]
Abstract
BACKGROUND Pancreatic and/or biliary (PB) brushing is commonly used to rule out malignant strictures. Many studies have attempted to characterize cytomorphologic characteristics of brushing and stent cytology. However, scant literature exists on the diagnostic implication (DI) of thick extracellular mucin (ECM) indicative of neoplasm in these samples. This study was aimed at reviewing the DI of thick ECM in PB brushing and stent cytology. METHODS A retrospective search of consecutive cytologic samples of PB brushings/stents with corresponding surgical pathology or relevant clinical information over a 1-year period was performed. Blinded review of the slides was performed by two cytopathologists. The slides were assessed for the presence, quantity, and quality of ECM. The results were analyzed for statistical significance with the Fisher exact and χ2 tests. RESULTS One hundred ten cases were identified from 63 patients. Twenty-two cases (20%) were PB brushings only without a prior stent. The remaining 88 cases (80%) had a preexisting stent for symptomatic obstruction. Fourteen of 22 cases (63%) without prior stents and 67 of 88 poststented cases (76%) were nonneoplastic (NN) upon follow-up. ECM was present more frequently in neoplastic cases than in NN cases (p = .03). Among NN cases (n = 87), poststented samples showed more evidence of ECM than prestented samples (15% vs. 45%, p = .045). Identical thick ECM was observed in NN poststent and main-duct intraductal papillary neoplasm samples. CONCLUSIONS Although ECM was frequently seen in neoplastic cases, NN cases showed increased evidence of thick ECM among poststented samples. Thick ECM may be common in stent cytology, regardless of the underlying biologic process.
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Affiliation(s)
- Jesse Suben
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Abha Goyal
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Rema Rao
- Department of Pathology, Montefiore Medical Center, Bronx, New York, USA
| | - Simon Sung
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
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Karaaslan S, Dilcher TL, Abdelsayed M, Goyal A. Significant outcomes associated with high-risk human papillomavirus negative Papanicolaou tests. J Am Soc Cytopathol 2023; 12:189-196. [PMID: 36739194 DOI: 10.1016/j.jasc.2023.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
INTRODUCTION The 2020 American Cancer Society guidelines preferred primary human papillomavirus (HPV) screening for cervical cancer prevention. Studies investigating the role of cytology in detection of cervical precancer/cancer have focused on high-grade squamous intraepithelial lesion (HSIL) or worse interpretations. Here, we have examined the significance of all those cytology results that require histologic follow-up as per the current management guidelines, regardless of the HPV test result. MATERIALS AND METHODS A database search (September 2010 to December 2019) retrieved cervical Papanicolaou tests with any of the following interpretations: ≥ atypical squamous cells - cannot exclude HSIL or low-grade squamous intraepithelial lesion, HSIL cannot be excluded, and ≥ atypical glandular cells, not otherwise specified and its subcategories. Of these, those with concurrent negative HPV test result were included for further analysis. For this cohort, relevant clinical history and histologic follow-up (within 1 year) were recorded. RESULTS The study cohort comprised 763 patients. Of them, 586 (76.8%) patients had histologic follow-up: 53 (9.0%) had ≥ HSIL/adenocarcinoma in situ; of which, 43 (81.1%) had prior abnormal cytology/histology/not otherwise specified history and/or HPV positivity, and 66 (11.3%) had HPV-unassociated neoplasia; of which, 60 (90.9%) had a known diagnosis or clinical signs/symptoms of the disease. CONCLUSION With widespread adoption of risk-based approach to management, the role of cytology, by itself, will likely diminish in the detection of HPV-associated lesions. Additional data regarding the role of cytology in the screening of patients with no/unknown/limited history and in the detection/management of HPV-independent lesions may be helpful for designing future screening guidelines.
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Affiliation(s)
- Selda Karaaslan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Thomas L Dilcher
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Mary Abdelsayed
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Abha Goyal
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York.
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Tansir G, Rastogi S, Dubasi S, Lavu R, Chitikela S, Barwad A, Goyal A. 414P Lessons learnt from clinico-genomic profiling of families with Li Fraumeni Syndrome: The largest case series from the Indian setting. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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15
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Mohamad Alahmad M, Goyal A, Mohammed M. Validity of CHA2DS2-VASc score in patients with malignancies. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Anticoagulation for patients with atrial fibrillation/flutter (AF) after risk stratification based on CHA2DS2-VASc score (congestive heart failure, hypertension, age group, Diabetes Mellitus, prior stroke, transient ischemic attack or thromboembolism, prior heart attack, peripheral artery disease or aortic plaque and patient's gender) has been the gold standard practice to prevent cerebrovascular accidents (CVA).
Purpose
Since patients with malignancies are at increased risk of thrombophilia, we tried to study if cancer patients with atrial fibrillation are at increased risk for CVA beyond what should be expected based on their comorbidities.
Methods
We used the Nationwide Readmissions Database (NRD) database for the years 2016–2019. First, we extracted all cases with a diagnosis of atrial fibrillation/flutter. Exclusion criteria included patients younger than 18-year-old. We studied the comorbidities and calculated CHA2DS2-VASc score. Then, we compared the risk for admission with an acute CVA in patients with and without any diagnosis of malignancies (solid cancer, leukemia, lymphoma or metastatic disease). Patients with carcinoma in situ were considered non-cancer patients. Corrected logistic regression and Chi-square tests using survey procedures in SAS 8.1 were applied to accommodate for complex sampling (Rao-Scott design).
Results
We identified 1,748,619 weighted admissions with AF equally distributed across the years. 5% were patients with malignancies. The mean age was 74-year-old for cancer patients and 71-year-old for non-cancer patients with quite equal gender distribution (43–49% were female). Patients with a diagnosis of cancer has high inpatient mortality (13%). Every additional point in CHA2DS2-VASc score was associated with increased odds of admission with CVA. Having a diagnosis of cancer was not associated with increased odds of admission with CVA (odd ratio for 95% confidence interval 1.0 [0.95–1.1]). Patients with history of VTE (assuming they are on anticoagulation) or who are on chronic anticoagulation have lower risk of admission with acute CVA if they have AF.
Conclusions
Although malignancies is associated with hypercoagulable status including higher risk for stroke, deep venous thrombosis and pulmonary embolism, our cross-sectional study indicates that CHA2DS2-VASc score is still a reliable tool for risk stratification in patients with atrial fibrillation. More longitudinal studies are needed.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Mohamad Alahmad
- University of Kansas Medical Center , Kansas City , United States of America
| | - A Goyal
- University of Kansas Medical Center , Kansas City , United States of America
| | - M Mohammed
- Rochester Regional Health, Cardiology , Rochester , United States of America
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Welliver M, Goyal A, Mo X, Dick S, Ma G, Bazan J, Brownstein J, Haglund K, Willimas T, DiCostanzo D, Grecula J, Addison D, Miller E. EP05.01-021 Radiation Dose to Cardiac Substructures and the Incidence of Cardiac Events in Patients with Stage III NSCLC Receiving CCRT. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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17
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Affiliation(s)
- A Goyal
- From the Department of Pulmonary and Critical Care Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Room No. 638, 6th floor, Superspeciality Block, Delhi 110029, India
| | - P Ish
- From the Department of Pulmonary and Critical Care Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Room No. 638, 6th floor, Superspeciality Block, Delhi 110029, India
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Kim D, Burkhardt R, Alperstein SA, Gokozan HN, Goyal A, Heymann JJ, Patel A, Siddiqui MT. Evaluating the role of Z-stack to improve the morphologic evaluation of urine cytology whole slide images for high-grade urothelial carcinoma: Results and review of a pilot study. Cancer Cytopathol 2022; 130:630-639. [PMID: 35584402 DOI: 10.1002/cncy.22595] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND Whole slide imaging (WSI) adoption has been slower in cytopathology due, in part, to challenges in multifocal plane scanning on 3-dimensional cell clusters. ThinPrep and other liquid-based preparations may alleviate the issue by reducing clusters in a concentrated area. This study investigates the use of Z-stacked images for diagnostic assessment and the experience of evaluating urine ThinPrep WSI. METHODS Thirty ThinPrep urine cases of high-grade urothelial carcinoma (n = 22) and cases of negative for high-grade urothelial carcinoma (n = 8) were included. Slides were scanned at 40× magnification without Z-stack and with Z-stack at 3 layers, 1 μm each. Six cytopathologists and 1 cytotechnologist evaluated the cases in 2 rounds with a 2-week wash-out period in a blinded manner. A Cohen's Kappa (CK) calculated concordance rates. A survey after each round evaluated participant experience. RESULTS CK with the original report ranged from 0.606 to 1.0 (P < .05) without Z-stack and 0.533 to 1.0 (P < .05) with Z-stack both indicating substantial-to-perfect concordance. For both rounds, interobserver CK was moderate-to-perfect (0.417-1.0, P < .05). Intraobserver CK was 0.697-1.0 (P < 0.05), indicating substantial to perfect concordance. The average scan time and file size for slides without Z-stack and with Z-stack are 6.27 minute/0.827 GB and 14.06 minute/2.650 GB, respectively. Surveys demonstrated a range in comfort and use with slightly more favorable opinions for Z-stacked cases. CONCLUSIONS Z-stack images provide minimal diagnostic benefit for urine ThinPrep WSI. In addition, Z-stacked urine WSI does not justify the prolonged scan times and larger storage needs compared to those without Z-stack.
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Affiliation(s)
- David Kim
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Robert Burkhardt
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Susan A Alperstein
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Hamza N Gokozan
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Abha Goyal
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Jonas J Heymann
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Ami Patel
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
| | - Momin T Siddiqui
- Division of Cytopathology, New York-Presbyterian Hospital-Weill Cornell Medical College, New York, New York, USA
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Nabi Z, Butt R, Mir R, Hills J, Tsang Y, Wheatley D, Bhattacharya I, Ranger A, Cramp S, Hammonds N, Goyal A. PO-1835 A glimpse at breast internal mammary chain radiotherapy practice in the United Kingdom. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03798-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Price H, Nabi Z, Butt R, Mir R, Diez P, Dodwell D, Sadiq S, Lewis M, Goyal A. PD-0335 Dosimetric differences between field and volume-based regional nodal RT in the POSNOC breast trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02828-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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Butt R, Nabi Z, Mir R, Hills J, Wheatley D, Bhattacharya I, Ranger A, Cramp S, Hammonds N, Goyal A, Tsang Y. MO-0644 Practice patterns for outlining the axilla and IMC, findings of the RTQA for the ATNEC trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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22
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Goyal A, Heymann JJ, Alperstein SA, Siddiqui MT. Underrecognized Patterns of High-Grade Squamous Intraepithelial Lesion on ThinPrep Preparations. Am J Clin Pathol 2022; 158:315. [PMID: 35474528 DOI: 10.1093/ajcp/aqac052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Abha Goyal
- Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Jonas J Heymann
- Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Susan A Alperstein
- Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Momin T Siddiqui
- Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
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Hockney S, Santoiemma P, Goyal A, Kumar R, Ghafourian K, Stosor V. Mucormycosis After Heart Transplantation: A Single Center Experience. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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24
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Goyal A, Hockney S, Kumar R, Harap R, Wilcox J, Pham D, Stosor V. Do VAD Infections Predict Post-Heart Transplant Infections or Mortality? J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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25
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Singh P, Arora S, Goyal A, Mittal N, Singh A, Sharma S, Shanthaiah D, Dardi I. INFLUENCE OF THE DURATION OF DIABETES AND VIBRATION PERCEPTION THRESHOLD ON THE SEVERITY OF ERECTILE DYSFUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS. Acta Endocrinol (Buchar) 2022; 18:174-180. [PMID: 36212268 PMCID: PMC9512378 DOI: 10.4183/aeb.2022.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Erectile dysfunction(ED) in men is a frequent under-reported complication of diabetes mellitus, which is becoming significant health problem worldwide. AIMS The study aims to determine the prevalence and risk factors for development of ED in North Indian patients with type 2 diabetes mellitus. METHODS We used international index of erectile function (IIEF-5) for the assessment of ED in 796 patients with type 2 diabetes mellitus. We recorded the age, duration of diabetes, glycemic status, body mass index, diabetes medications, microvascular and macrovascular complications. RESULTS The mean age of patients in the study was 49.38 ± 9.52 years. The prevalence of ED in patients with type 2 diabetes mellitus was 79.4%. Logistic regression analysis revealed that age, body mass index, glycemic control, insulin therapy, retinopathy and nephropathy was not significantly associated with erectile dysfunction in patients with type 2 diabetes mellitus. Duration of diabetes (OR = 1.054, 95% CI 1.007 to 1.102, P=0.023) and vibration perception threshold (OR = 1.071, 95% CI 1.042 to 1.102, P=0.000) were identified as key risk factors for development of ED. CONCLUSION Duration of diabetes and peripheral neuropathy emerged as significant risk factors for development of severe erectile dysfunction.
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Affiliation(s)
- P. Singh
- Dayanand Medical College and Hospital, Dept. of Endocrinology
| | - S. Arora
- Dayanand Medical College and Hospital, Dept. of Endocrinology
| | - A. Goyal
- Dayanand Medical College and Hospital, Dept. of Urology
| | - N. Mittal
- Dayanand Medical College and Hospital, Dept. of Endocrinology
| | - A. Singh
- Dayanand Medical College and Hospital, Dept. of Endocrinology
| | - S. Sharma
- Dayanand Medical College and Hospital, Dept. of social and preventive medicine, Ludhiana, Punjab
| | - D.M. Shanthaiah
- Institute of Medical Sciences, Dept. of Endocrinology and Metabolism, Banaras Hindu University, Varanasi, Uttar Pradesh
| | - I.K. Dardi
- Columbia Asia Hospital, Patiala, Punjab, India
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Kumar A, Goyal A, Gauba K, Kapur A, Singh SK, Mehta SK. An evaluation of remineralised MIH using CPP-ACP and fluoride varnish: An in-situ and in-vitro study. Eur Arch Paediatr Dent 2022; 23:79-87. [PMID: 34057698 DOI: 10.1007/s40368-021-00630-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 05/05/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Molar incisor hypomineralization (MIH) affected teeth have enamel with altered mineral content like decreased calcium and phosphorus and increased carbon content leading to porous enamel and subsequent post-eruptive breakdown. AIM An in situ study was conducted to evaluate and compare the effects of a Casein Phosphopeptide-Amorphous Calcium Phosphate (CPP-ACP)-based cream and fluoride varnish on the remineralization of MIH affected teeth. METHODS Enamel slabs were prepared from MIH affected teeth that had been extracted for various reasons and inserted in appliances of 30 participants who were undergoing interceptive orthodontic therapy. They were randomly divided into two groups using block randomization technique: Group A-daily single application of CPP-ACP cream (n = 15); Group B-professional application of fluoride varnishes every 3 months (n = 15). After 6 months of regular wear of the appliance, the enamel slabs were placed under Field Emission Scanning Microscope (FESEM) and Energy-Dispersive Spectroscopy (EDS) for evaluation of ultra structure and mineral content, respectively. RESULTS A significant increase in calcium and phosphorus content, and a decrease in carbon content was observed within the 6 months period, suggesting remineralization in both the groups. On comparing the Ca:P and Ca:C ratios, a significant increase in the Ca:C ratio was evident in the two groups. No significant difference was seen in the Ca:P ratio in the CPP-ACP group at six months. The inter-group comparison did not reveal any significant difference between the two groups either at baseline or at 6 months post-intervention. CONCLUSION Remineralization can be achieved in MIH affected teeth with the use of remineralizing agents.
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Affiliation(s)
- A Kumar
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Goyal
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gauba
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Kapur
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S K Singh
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - S K Mehta
- Punjab University, Chandigarh, India
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Singh SK, Goyal A, Gauba K, Bhandari S, Kaur S. Full coverage crowns for rehabilitation of MIH affected molars: 24 month randomized clinical trial. Eur Arch Paediatr Dent 2022; 23:147-158. [PMID: 34398412 DOI: 10.1007/s40368-021-00657-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/09/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Teeth affected with severe molar incisor hypomineralization (MIH) require extensive restorations, which do not last for a long time and often require treatment in the form of onlays or full coverage restorations. AIM To evaluate and compare the clinical performance of zirconia, lithium disilicate, and cast metal crowns as full-coverage restorations on MIH-affected first permanent molars (FPMs). METHODS 60 MIH affected FPMs requiring full-coverage crowns were identified in children aged 8-15 years and were randomly allocated to the three treatment groups according to the type of full coverage restoration received using block randomization technique. After an adequate removal of the MIH defect and restoration with composite resin, the tooth preparation was done followed by fabrication of crown and its cementation using resin cement. The intergroup comparison was done on the basis of USPHS criteria, gingival, plaque scores, patient and parents acceptance through a visual analog scale to decipher their clinical performance at 6, 12, 24 months. RESULTS After 24 months, the crowns showed similar clinical success in terms of the criterias used to compare their clinical performance. The retention, marginal adaptation, relief from hypersensitivity, proximal contact, gingival health with no statistically significant difference among the three groups. CONCLUSION Based on the observations, Lithium disilicate, Zirconia and full cast metal crowns showed similar clinical success in rehabilitation of First permanent molars with severe MIH over 24 months of evaluation. The clinical success is not influenced by the material of the restoration. However, prospective studies with a longer follow-up are required to reach a more definitive conclusion.
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Affiliation(s)
- S K Singh
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - A Goyal
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gauba
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Bhandari
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - S Kaur
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Mukhtar U, Goyal A, Luthra-Guptasarma M, Gauba K, Kapur A, Thakur AK. Label-free quantitative proteomics reveals molecular correlates of altered biomechanical properties in molar incisor hypomineralization (MIH): an in vitro study. Eur Arch Paediatr Dent 2022; 23:179-191. [PMID: 35013981 DOI: 10.1007/s40368-021-00687-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/13/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE Molar-incisor hypomineralization (MIH) is a qualitative developmental defect of enamel that affects first permanent molars with or without affecting permanent incisors. We aimed to carry out a quantitative proteomics-based study to compare and evaluate proteins in sound and MIH-affected enamel. MATERIALS AND METHODS Ten blocks each of the MIH-affected enamel and sound enamel were processed and prepared for LC-MS/MS analysis. Label-free quantitation was carried out to evaluate the differentially expressed proteins in the two groups of samples. RESULTS A significant increase in the number of proteins in MIH-affected enamel (50.3 ± 29.6) was observed compared to the sound enamel (21.4 ± 3.2). While proteins like collagens, α1-anti-trypsin, kallikrein-4 (KLK4), matrix metalloprotease-20 (MMP-20), alpha-2-macroglobulin, and alpha-2-HS-glycoprotein were upregulated in sound enamel, there was over-expression of albumin, calcium-binding proteins, anti-thrombin III, and dentin sialophosphoprotein (DSPP), along with proteins implicated in stress response and inflammatory processes in MIH. CONCLUSION We propose that altered biomechanical properties of the enamel in MIH samples arise due to (i) down-regulation of proteins contributing to collagen biosynthesis and fibril formation; (ii) an overall imbalance in required levels of proteases (KLK4 and MMP-20) and anti-proteases (anti-thrombin-III which inhibits KLK-4), essential for optimal mineralization; (iii) very low levels of alpha-2-macroglobulin with important consequences in enamel mineralization and amelogenesis; and (iv) increased albumin in MIH, preventing proper growth of hydroxyapatite crystals. Increased inflammatory component was also seen in MIH; however, whether inflammation is a cause or consequence of the poor mineralization process needs to be assessed.
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Affiliation(s)
- U Mukhtar
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Goyal
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - M Luthra-Guptasarma
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gauba
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Kapur
- Oral Health Sciences Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A K Thakur
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Gokozan HN, Dilcher TL, Alperstein SA, Qiu Y, Mostyka M, Scognamiglio T, Solomon JP, Song W, Rennert H, Beg S, Stern E, Goyal A, Siddiqui MT, Heymann JJ. Combining molecular testing and the Bethesda category III:VI ratio for thyroid fine‐needle aspirates: A quality‐assurance metric for evaluating diagnostic performance in a cytopathology laboratory. Cancer Cytopathol 2021; 130:259-274. [DOI: 10.1002/cncy.22542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/23/2021] [Accepted: 12/01/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Hamza N. Gokozan
- Division of Cytopathology New York‐Presbyterian Hospital–Weill Cornell Medical College New York New York
- Division of Head and Neck Pathology New York‐Presbyterian Hospital–Weill Cornell Medical College New York New York
| | - Thomas L. Dilcher
- Division of Cytopathology New York‐Presbyterian Hospital–Weill Cornell Medical College New York New York
| | - Susan A. Alperstein
- Division of Cytopathology New York‐Presbyterian Hospital–Weill Cornell Medical College New York New York
| | - Yuqing Qiu
- Department of Population Health Sciences New York‐Presbyterian Hospital–Weill Cornell Medical College New York New York
| | - Maria Mostyka
- Division of Head and Neck Pathology New York‐Presbyterian Hospital–Weill Cornell Medical College New York New York
| | - Theresa Scognamiglio
- Division of Head and Neck Pathology New York‐Presbyterian Hospital–Weill Cornell Medical College New York New York
| | - James P. Solomon
- Clinical Genomics Laboratory Department of Pathology and Laboratory Medicine New York‐Presbyterian Hospital–Weill Cornell Medical College New York New York
| | - Wei Song
- Clinical Genomics Laboratory Department of Pathology and Laboratory Medicine New York‐Presbyterian Hospital–Weill Cornell Medical College New York New York
| | - Hanna Rennert
- Division of Molecular and Genomic Pathology New York‐Presbyterian Hospital–Weill Cornell Medical College New York New York
| | - Shaham Beg
- Division of Cytopathology New York‐Presbyterian Hospital–Weill Cornell Medical College New York New York
| | - Evan Stern
- Division of Cytopathology New York‐Presbyterian Hospital–Weill Cornell Medical College New York New York
| | - Abha Goyal
- Division of Cytopathology New York‐Presbyterian Hospital–Weill Cornell Medical College New York New York
| | - Momin T. Siddiqui
- Division of Cytopathology New York‐Presbyterian Hospital–Weill Cornell Medical College New York New York
| | - Jonas J. Heymann
- Division of Cytopathology New York‐Presbyterian Hospital–Weill Cornell Medical College New York New York
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Mishra R, Kapur A, Goyal A, Gauba K, Trehan A. Salivary parameters and their correlation with neutrophil counts in children with acute lymphoblastic leukemia. Eur Arch Paediatr Dent 2021; 23:281-287. [PMID: 34843095 DOI: 10.1007/s40368-021-00679-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 10/23/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chemotherapy for Acute Lymphoblastic Leukemia (ALL) is known to render children immuno-deficient. A concomitant suppression of local defence mechanisms, such as saliva may further aggravate the adverse consequences of chemotherapy. The present study was conducted to evaluate alterations in salivary flow rate, pH and buffering capacity and to correlate these parameters with Absolute Neutrophil Counts (ANC). METHODS A cohort of 43 patients, aged 3-12 years were evaluated for the aforementioned parameters at baseline, post-induction and post-consolidation phases. Salivary collection was done and ANC was measured from routine haematological reports. RESULTS A decrease in the salivary parameters was observed at the end of Induction phase as compared to baseline, with a statistically significant decrease in unstimulated salivary flow rates (p < 0.01). Statistically significant positive correlations were found between ANC and salivary flow rate (p = 0.005), pH (p < 0.00) and buffering capacity (p < 0.00). On testing the significance of these correlations, all the values for these parameters were found to be statistically significant. CONCLUSION Salivary parameters showed derangements over the phases of chemotherapy, with maximum decrease at the end of induction phase. The positive correlations of salivary parameters with ANC of the subjects may be considered indicative of a concomitant immunological compromise in these children.
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Affiliation(s)
- R Mishra
- Pediatric Dentistry Unit, Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Kapur
- Pediatric Dentistry Unit, Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - A Goyal
- Pediatric Dentistry Unit, Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - K Gauba
- Pediatric Dentistry Unit, Department of Oral Health Sciences, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - A Trehan
- Unit of Hematology and Oncology, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Wong S, Sehgal R, Birks T, Allen D, Goyal A, Kucheria R, Ajayi L, Ellis G. 1191 The Use of CT Urography to Diagnose Upper Tract Urothelial Carcinomas (UTUC); Managing Surgical Resources During The COVID-19 Pandemic. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Upper tract urothelial carcinomas (UTUC) account for 5-10% of urothelial malignancies. Rapid diagnosis is essential as 60% are invasive at diagnosis and confer poor prognoses. European Association of Urology (EAU) guidelines recommend CT urography (CTU) for initial diagnosis and staging of UTUCs. Diagnostic ureteroscopy (URS) is used second line where diagnosis is unclear. The COVID-19 pandemic has limited theatre access and may delay diagnosis of suspected UTUC. Our aim was to evaluate specific CTU findings in predicting UTUC to aid prompt diagnosis and risk stratification in a tertiary centre.
Method
A retrospective analysis was performed on 122 patients who underwent CTU with diagnostic URS over two years from 2018-2019 for possible UTUC. Data including demographics, imaging and histology were collected from our electronic database.
Results
57 patients had confirmed UTUC, all had CT changes. CTU had an overall positive predictive value (PPV) of 45%. CT findings were divided into: hydronephrosis; filling defect/lesion; urothelial thickening; normal; or other. The PPV was highest for filling defects/lesions at 60%, hydronephrosis was 38%, urothelial thickening was 30%, and other was 33%. Of those with high-grade histology, 61% had evidence of filling defects/lesions and 24% had hydronephrosis.
Conclusions
A specific CTU finding of filling defect/lesion in combination with cytology can aid diagnosis and risk stratification of UTUC. This may enable us to reduce use of diagnostic URS, as well as associated risks of intravesical seeding, necessary in the COVID-19 pandemic. With other CTU findings of hydronephrosis or urothelial thickening, a diagnostic URS may be required.
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Affiliation(s)
- S Wong
- Royal Free Hospital, London, United Kingdom
| | - R Sehgal
- Royal Free Hospital, London, United Kingdom
| | - T Birks
- Royal Free Hospital, London, United Kingdom
| | - D Allen
- Royal Free Hospital, London, United Kingdom
| | - A Goyal
- Royal Free Hospital, London, United Kingdom
| | - R Kucheria
- Royal Free Hospital, London, United Kingdom
| | - L Ajayi
- Royal Free Hospital, London, United Kingdom
| | - G Ellis
- Royal Free Hospital, London, United Kingdom
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Wong S, Sehgal R, Goyal A, Allen D. 1054 A Simple Intervention to Minimise the Incidence of The Forgotten Ureteric Stent: Updating the Surgical Discharge Summary. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Ureteric stents are routinely used in ureteric obstruction, however, have considerable morbidity with major complications, such as encrustation, obstruction, urosepsis, and renal failure if left in situ for longer than six months. Despite an electronic stent register, there are still multiple emergency admissions of complications from forgotten stents, as well as those presenting with significant stent symptoms. Often stents are inserted as an emergency procedure with minimal information given on their discharge summary. A discharge template was therefore introduced that could also serve as a patient information leaflet to help minimise the incidence of forgotten stents.
Method
A discharge template was designed based off the trust-endorsed and British Association of Urological Surgeons (BAUS) patient leaflet and distributed amongst the juniors. A total of 28 patients were interviewed via telephone questionnaires – 21 randomly selected pre-intervention and 7 post-intervention from a one-month scale either side of the intervention. The template included: information on stents, common stent symptoms, indications to seek healthcare advice, and contact details to use in the event they are lost to follow-up.
Results
Patients aware that stents should be changed within six months went from 52% to 100%. Awareness of stent symptoms and red-flag symptoms went from 52% to 91%, and 57% to 100% respectively. Those who felt they had sufficient information on the discharge letter to understand their stent increased from 52 to 89%.
Conclusions
Significant improvement in patient understanding of stents and therefore hopefully in appropriate health-seeking behaviour, patient rapport, safety, and improvement in stents removed within target.
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Affiliation(s)
- S Wong
- Royal Free Hospital, London, United Kingdom
| | - R Sehgal
- Royal Free Hospital, London, United Kingdom
| | - A Goyal
- Royal Free Hospital, London, United Kingdom
| | - D Allen
- Royal Free Hospital, London, United Kingdom
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Kaushal D, Rajan N, Soni K, Sharma A, Choudhury B, Yadav T, Khera P, Gupta P, Kaur N, Goyal A. Reducing mortality in mucormycosis of the head and neck in diabetic patients: A CARE case series. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 139:146-152. [PMID: 34489194 DOI: 10.1016/j.anorl.2021.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 05/19/2021] [Accepted: 06/22/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Rhinocerebral mucormycosis is extremely fatal, with mortality rates ranging from 85-93% despite the best treatment in immunocompromised patients. We emphasize the importance of early diagnosis, repeated debridement, and aggressive antifungal treatment to reduce mortality. CASE SUMMARY We report six cases (five male and one female), with a mean age of 51 years who were diagnosed to have mucormycosis from 2017 to 2019. All patients were diabetic. Intracranial involvement and orbital involvement were found in four cases. Facial nerve palsy was seen in two cases, one without any apparent otological involvement. Aggressive serial debridement and amphotericin B was started. Posaconazole was added subsequently to the treatment in two cases. One patient succumbed to the disease five months after discharge. The other five patients are on regular follow-up for a mean duration of 14 months at the end of which two had residual disease which was under control. DISCUSSION Repeated surgical debridement with an early aggressive and combination antifungal therapy can result in good outcomes even in advanced mucormycosis. Concurrent management of the underlying pathology, monitoring of liver and kidney functions, and therapeutic drug monitoring are useful to ensure smooth and effective treatment.
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Affiliation(s)
- D Kaushal
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, 174001 Bilaspur, India.
| | - N Rajan
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - K Soni
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - A Sharma
- Department of Microbiology, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - B Choudhury
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - T Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - P Khera
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - P Gupta
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - N Kaur
- Department of Microbiology, All India Institute of Medical Sciences, 342005 Jodhpur, India
| | - A Goyal
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, 342005 Jodhpur, India
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Malhotra R, Goyal A, Shamim SA. Multiple endocrine neoplasia type 2B syndrome. QJM 2021; 114:272-273. [PMID: 32483633 DOI: 10.1093/qjmed/hcaa184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- R Malhotra
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110029, India
| | - A Goyal
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi 110029, India
| | - S A Shamim
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi 110029, India
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Bhalla AS, Das A, Naranje P, Goyal A, Guleria R, Khilnani GC. Dilemma of diagnosing thoracic sarcoidosis in tuberculosis endemic regions: An imaging-based approach. Part 1. Indian J Radiol Imaging 2021; 27:369-379. [PMID: 29379230 PMCID: PMC5761162 DOI: 10.4103/ijri.ijri_200_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Sarcoidosis is a multi-systemic disorder of unknown etiology, although commonly believed to be immune-mediated. Histologically, it is characterized by noncaseating granuloma which contrasts against the caseating granuloma seen in tuberculosis (TB), an infectious disease that closely mimics sarcoidosis, both clinically as well as radiologically. In TB-endemic regions, the overlapping clinico-radiological manifestations create significant diagnostic dilemma, especially since the management options are markedly different in the two entities. Part 1 of this review aims to summarize the clinical, laboratory, and imaging features of sarcoidosis, encompassing both typical and atypical manifestations, in an attempt to distinguish between the two disease entities.
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Affiliation(s)
- Ashu S Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - A Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - P Naranje
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - A Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - R Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Gopi C Khilnani
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
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36
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Bhalla AS, Das A, Naranje P, Goyal A, Guleria R, Khilnani GC. Dilemma of diagnosing thoracic sarcoidosis in tuberculosis-endemic regions: An imaging-based approach. Part 2. Indian J Radiol Imaging 2021; 27:380-388. [PMID: 29379231 PMCID: PMC5761163 DOI: 10.4103/ijri.ijri_201_17] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The second part of the review discusses the role of different existing imaging modalities in the evaluation of thoracic sarcoidosis, including chest radiograph, computed tomography, magnetic resonance imaging, endobronchial ultrasound, and positron emission tomography. While summarizing the advantages and pitfalls of each imaging modality, the authors propose imaging recommendations and an algorithm to be followed in the evaluation of clinically suspected case of sarcoidosis in tuberculosis-endemic regions.
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Affiliation(s)
- Ashu S Bhalla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - A Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - P Naranje
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - A Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - R Guleria
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Gopi C Khilnani
- Department of Pulmonary Medicine and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Lower rectal and anal cancers are distinct from neoplasms involving rest of the rectum. These are relatively difficult to manage owing to important relationships with the sphincter muscles. Involvement of the latter portends a poorer prognosis and increased chance of recurrence. Lymphatic drainage of these tumours is into the systemic circulation and the exact set of lymph nodes involved depends on the precise location of the tumour. The role of imaging includes assessment of local invasion, infiltration of adjacent pelvic organs, assessment of locoregional lymphatic spread and metastasis, post-chemoradiation restaging as well as post-treatment surveillance.
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Affiliation(s)
- N Hemachandran
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - A Goyal
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - H K Bhattacharjee
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - R Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
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38
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Goyal A, Heymann JJ, Alperstein SA, Siddiqui MT. Underrecognized Patterns of High-Grade Squamous Intraepithelial Lesion on ThinPrep Preparations. Am J Clin Pathol 2021; 156:300-312. [PMID: 33630033 DOI: 10.1093/ajcp/aqaa237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To identify less readily identifiable patterns of high-grade squamous intraepithelial lesions (HSIL) in negative human papillomavirus (HPV)-positive Papanicolaou (Pap) tests on ThinPrep preparations. METHODS Of all HPV-positive Pap tests that were negative for intraepithelial lesion or malignancy (NILM) from July 2013 to June 2018, those with HSIL on subsequent histology within 6 months were identified. ThinPrep slides from the latter group (group 1) and from NILM HPV-negative Pap tests with negative follow-up (group 2) were reviewed independently by 4 participants. Group 1 cases were then reviewed together for consensus and with the ThinPrep Imaging System (TIS). Any discrepancies from the original interpretation were recorded. RESULTS The study cohort included 57 cases each in groups 1 and 2. On final review of group 1 cases, 17 (29.8%) were classified as NILM or unsatisfactory. Of the remaining, 4 cases revealed rare abnormal cells not flagged by the TIS in the fields of view. In the 36 cases (63.1%) with screening or interpretative errors, the key cytologic findings accounting for major discrepancies included atypical metaplastic cells, atypical repair, rare syncytial groups, and atypical immature metaplastic cells. CONCLUSIONS There are 3 main underrecognized patterns of HSIL in cervical cytology: atypical metaplastic cells, atypical repair, and rare syncytial groups.
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Affiliation(s)
- Abha Goyal
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Jonas J Heymann
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Susan A Alperstein
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Momin T Siddiqui
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
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Sehgal R, Wong S, Abu-Ghanem Y, Birks T, Kucheria R, Allen D, Goyal A, Singh P, Ajayi L, Ellis G. What part does ureteroscopy play in the diagnostic pathway of upper tract urothelial carcinoma? A two-year review in a high volume institution. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01175-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Goyal A, O'Leary D, Goyal K, Rubin N, Janakiram M. Screening for second malignancies in mycosis fungoides: non-Hodgkin lymphoma, Hodgkin lymphoma, lung cancer, bladder cancer and melanoma. J Eur Acad Dermatol Venereol 2021; 35:1821-1829. [PMID: 34013554 DOI: 10.1111/jdv.17384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with mycosis fungoides (MF) are at increased risk of developing non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), lung cancer, bladder cancer and melanoma. The characteristics of patients developing these malignancies have not been specifically delineated. In addition, there are no established guidelines for screening MF patients for second malignancies. MATERIALS/METHODS We identified 742 patients with MF who developed second malignancies in the Surveillance Epidemiology and End Result-18 database. RESULTS The majority of second malignancy patients were white and male, mean age 55-67 years at diagnosis of MF, and mean age 61-72 years at diagnosis of second malignancy. The majority of patients diagnosed with second malignancies had early stage MF. MF patients with NHL, lung cancer, and bladder cancer tended to be diagnosed at earlier stages of the second malignancy than patients without MF and demonstrated better 5-year overall survival. There was no improvement in stage at diagnosis or survival for MF patients who were diagnosed with melanoma compared to patients without MF. CONCLUSIONS Improvements in survival in MF/NHL, MF/lung cancer and MF/bladder cancer patients may reflect differences in disease biology secondary to having MF or the importance of increased contact with the healthcare system. MF/melanoma data suggest that patients require regular pigmented-lesion-focused skin examinations. Tools for screening include regular lymph node examinations, pigmented-lesion-focused examinations and detailed review of systems questions. Smoking cessation counseling is key intervention in this population, as is ensuring that all age- and sex-specific cancer screenings are up-to-date (e.g. lung cancer screening, mammography, and colonoscopy). The utility of regular imaging for second malignancy screening and lab testing such as routine urinalysis requires additional study and expert consensus.
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Affiliation(s)
- A Goyal
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - D O'Leary
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - K Goyal
- Department of Dermatology, University of Minnesota, Minneapolis, MN, USA
| | - N Rubin
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - M Janakiram
- Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, MN, USA
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Goyal A, Davey DD, Souers RJ, Tabbara SO, Goodrich K, Booth CN. Rescreening Practices of Negative Papanicolaou Tests With Positive Human Papillomavirus Test Result: Survey Results of Laboratories Participating in the College of American Pathologists Gynecologic Cytology (PAP Education) Program. Arch Pathol Lab Med 2021; 146:78-83. [PMID: 33929528 DOI: 10.5858/arpa.2020-0618-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The yield of the prospective rescreening process for "negative for intraepithelial lesion or malignancy" (NILM) Papanicolaou (Pap) tests is higher with the inclusion of a greater proportion of high-risk cases. One of the suggested criteria for classifying a Pap test finding as high-risk is recent or concurrent high-risk human papillomavirus (HPV) positivity. OBJECTIVE.— To evaluate how the results of HPV testing have been incorporated in the prospective rescreening of NILM Pap tests across a wide range of laboratories. DESIGN.— A questionnaire survey was sent to laboratories participating in the 2019 College of American Pathologists (CAP) Gynecologic Cytology (PAP Education) Program. RESULTS.— Of the 1507 participating laboratories, 667 (44%) responded to the survey. Most laboratories (59.4%; 396 of 667) had not incorporated HPV test/genotyping results to select NILM Pap tests for rescreening. Amongst the remaining laboratories, for NILM HPV-positive Pap test results, 112 (16.8%) had a policy to rescreen by a cytotechnologist only, 51 (7.6%) by a pathologist only, and 86 (12.9%) by both. Of 264 laboratories, 181 (68.6%) reported the cytology upon availability of the HPV test result and completion of the secondary review. Of 661 laboratories, 145 (21.9%) included consensus-type recommendations in the cytology report for such Pap tests. CONCLUSIONS.— This CAP survey provides significant information regarding the current trends in the use of HPV test results in prospective rescreening of NILM Pap tests. Future studies on quality improvement can further assist in the standardization of this process across different laboratories.
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Affiliation(s)
- Abha Goyal
- From the Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York (Goyal)
| | - Diane D Davey
- The Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando (Davey)
| | - Rhona J Souers
- Statistics/Biostatistics (Souers), College of American Pathologists, Northfield, Illinois
| | - Sana O Tabbara
- The Department of Pathology, The George Washington University, Washington, District of Columbia (Tabbara)
| | - Kelly Goodrich
- Surveys Department (Goodrich), College of American Pathologists, Northfield, Illinois
| | - Christine N Booth
- The Department of Pathology, Cleveland Clinic, Cleveland, Ohio (Booth)
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Harkenrider M, Darwish N, Adams W, Gliniewicz A, Alite F, Albain K, Borowicz S, Czerlanis C, Goyal A, Lubawski J, Wagner C, Rosi D, Thomas T, Vigneswaran W, Welsh J, Small W. Phase II Study of Stereotactic Body Radiation Therapy for Clinically Diagnosed Early-Stage Lung Cancer: Early Analysis of Toxicity. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patodia J, Mittal J, Sharma V, Verma M, Rathi M, Kumar N, Jain R, Goyal A. Reducing admission hypothermia in newborns at a tertiary care NICU of northern India: A quality improvement study. J Neonatal Perinatal Med 2020; 14:277-286. [PMID: 33044201 DOI: 10.3233/npm-190385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hypothermia at admission to neonatal intensive care units (NICU) is associated with increased morbidity and mortality in newborns. A baseline study at a tertiary care hospital with all out-born babies showed admission hypothermia of 82%. OBJECTIVE To reduce admission hypothermia (moderate) in newborns at least by 50% in next 6 months. METHODS A quality improvement (QI) study was planned using WHO Point of Care Quality Improvement Model (POCQI), [17] using PDSA (Plan-Do-Study-Act) cycle approach from April 2018 to March 2019, and including 427 term and preterm babies. We educated the staff, reinforced the use of caps, cling wraps, warm linen, introduced Ziploc bags and ensured adequate use of transport incubator. RESULTS After 6 months, overall admission hypothermia decreased from 82% to 45%, moderate hypothermia reduced from 46% to <10% (P < 0.001) and severe hypothermia (3%) was completely eliminated. There was also significant reduction in incidence of Intraventricular hemorrhage (13% Vs 4.7%), Late onset neonatal sepsis (38% Vs 19%) and metabolic acidosis (43% Vs 28%). We were able to sustain this improvement for the next 6 months and is ongoing. The strongest predictor of hypothermia was newborns being in the phase before QI initiative was started (OR 2.36, 95% CI 1.47, 3.23). CONCLUSION This study is a cost effective approach in reducing admission hypothermia in NICU in a resource limited setting with all outborn babies, and further decreasing the morbidity associated with it. Hence, emphasizing the importance of maintaining euthermia, not only in delivery rooms, but also during transportation.
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Affiliation(s)
- J Patodia
- Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India
| | - J Mittal
- Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India
| | - V Sharma
- Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India
| | - M Verma
- Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India
| | - M Rathi
- Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India
| | - N Kumar
- Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India
| | - R Jain
- Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India
| | - A Goyal
- Department of Neonatology, Neoclinic Children Hospital, Jaipur, Rajasthan, India
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Kahn R, Badiner N, Nicholson N, Siddiqui M, Goyal A, Gordhandas S, Caputo T, Holcomb K, Frey M, Chapman-Davis E. E-cadherin expression as a prognostic biomarker for cervical adenocarcinoma in situ (ACIS) and cervical adenocarcinoma (AC). Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kahn R, Zhou Z, Goyal A, Nicholson N, Caputo T, Holcomb K, Frey M, Chapman-Davis E. Is hysterectomy necessary for the treatment of stratified mucin-producing intraepithelial lesions (SMILE) of the cervix? Gynecol Oncol 2020. [DOI: 10.1016/j.ygyno.2020.05.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Goyal A, Patel AP, Dilcher TL, Alperstein SA. Effects of Implementing the Dual Papanicolaou Test Interpretation of ASC-H and LSIL Following Bethesda 2014. Am J Clin Pathol 2020; 154:553-558. [PMID: 32556080 DOI: 10.1093/ajcp/aqaa069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To evaluate the impact of implementing the dual interpretation of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) and low-grade squamous intraepithelial lesion (LSIL) after the Bethesda System 2014 and to compare it with other indeterminate interpretations. METHODS Rates of high-risk human papillomavirus (HPV) positivity and histologic follow-up and the proportion of women with high-grade squamous intraepithelial lesion on histologic follow-up were compared for the combined interpretation of ASC-H and LSIL (ASCHL) and the categories of LSIL, cannot exclude high-grade squamous intraepithelial lesion (LSIL-H) and ASC-H. RESULTS The percentage of ASCHL HPV-positive cases (86.0%) was similar to that of LSIL-H but significantly higher in comparison to that of ASC-H. The rates of cervical intraepithelial neoplasia grade 2 or higher (CIN 2+) and CIN 3+ for ASCHL (29.6% and 3.6%, respectively) were similar to those of LSIL-H and ASC-H. When stratified by HPV test results, the proportions of patients with CIN 2+ and CIN 3+ remained statistically similar to those with ASCHL and with LSIL-H and ASC-H. CONCLUSIONS Considering the similar risks of CIN 2+ and CIN 3+ for ASCHL and ASC-H, having a separate category of ASCHL for reporting cervical cytology appears to be redundant.
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Affiliation(s)
- Abha Goyal
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine–New York Presbyterian Hospital, New York, NY
| | - Ami P Patel
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine–New York Presbyterian Hospital, New York, NY
| | - Thomas L Dilcher
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine–New York Presbyterian Hospital, New York, NY
| | - Susan A Alperstein
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine–New York Presbyterian Hospital, New York, NY
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Patel AP, Schatz-Siemers NF, Dilcher TL, Goyal A. The interpretation of high-grade squamous intraepithelial lesion on anal cytology: a comparative analysis with the cervical Papanicolaou test. J Am Soc Cytopathol 2020; 9:540-549. [PMID: 32800528 DOI: 10.1016/j.jasc.2020.07.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Prior studies have shown that high-grade squamous intraepithelial lesion (HSIL) tends to be underdiagnosed on anal cytology. Our study aims to decipher the interpretative challenges of HSIL that are more specific to anal cytology specimens by comparing them to cervical Papanicolaou tests. MATERIALS AND METHODS One hundred cases each of anal and cervical cytology specimens with HSIL interpretation and concordant histologic follow-up were retrieved and diagnostically confirmed. Patient demographic data were obtained from the electronic medical record. The cytologic specimens were reviewed and statistically compared in terms of proportion of HSIL cells, HSIL patterns and types, and cytoplasmic area of HSIL cells (with digital image analysis). A P value of <0.05 was considered statistically significant. RESULTS Of the patients with anal HSIL, 97% were human immunodeficiency virus-positive and 60% were men who have sex with men. The anal cytology specimens significantly differed from the cervical ones in several respects: proportion of HSIL cells, cytoplasmic area of HSIL cells, cases with HSIL cells in syncytial groups (10 versus 57) and cases with keratinizing HSIL (45 versus 10). The P value was <0.0001 for all comparisons except for the proportion of HSIL cells (P = 0.001). CONCLUSIONS Anal cytologic HSIL, in contrast to its cervical counterpart, exhibits fewer abnormal cells and smaller size of the diagnostic cells with a higher percentage of keratinizing lesions. A careful scrutiny of the sample with an enhanced understanding of the morphology and better sampling may help improve the detection of anal HSIL on cytology.
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Affiliation(s)
- Ami P Patel
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Nina F Schatz-Siemers
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Thomas L Dilcher
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York
| | - Abha Goyal
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, New York.
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Viswanathan K, Patel A, Abdelsayed M, Rosado L, Soong L, Margolskee E, Heymann JJ, Goyal A, Rao RA. Interobserver variability between cytopathologists and cytotechnologists upon application and characterization of the indeterminate category in the Milan System for Reporting Salivary Gland Cytopathology. Cancer Cytopathol 2020; 128:828-839. [PMID: 32573971 DOI: 10.1002/cncy.22312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/26/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The indeterminate categories in the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) are diagnostically challenging because of inherent heterogeneity and complexity, with wide interobserver variability (IOV). Herein, the authors explore the concordance rate (CR) between cytopathologists (CPs) and cytotechnologists (CTs) in interpreting indeterminate salivary gland lesions using the MSRSGC. METHODS Between 2011 and 2016, 86 indeterminate fine-needle aspirations had slides available for review, of which 48 had follow-up. Four CPs and 2 CTs performed an independent, blinded review of these slides and categorized them according to the MSRSGC. The CRs between CTs and CPs with the final sign-out cytopathologist (FCP) were assessed, and interobserver agreement was categorized into uniform, majority, divided, minimal, or no agreement. RESULTS The overall CR with the FCP ranged from 48.8% to 60.5% for CPs and from 22.1% to 36% for CTs. IOV κ scores for the entire group were 0.314 and, with the FCP as the reference, ranged from 0.403 to 0.539 for CPs and from 0.091 to 0.254 for CTs. Uniform, majority, divided, minimal, and no agreement was noted in 12.8%, 31.4%, 38.4%, 10.5%, and 6.9%, respectively, of all cases and in 16.7%, 35.4%, 31.3%, 8.3%, and 6.3%, respectively, of the cases with follow-up. Diagnostic challenges included distinguishing lymphoma from a reactive process and distinguishing mucin from mucin-like material. CONCLUSIONS CPs had modestly higher CRs compared with CTs; and, although the variable CRs highlight indeterminate IOV, the MSRSGC enables reproducibility. Characterizing larger cohorts in the indeterminate categories will further improve MSRSGC criteria. Moreover, education on the MSRSGC should include CTs and CPs to improve overall diagnostic accuracy.
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Affiliation(s)
- Kartik Viswanathan
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Ami Patel
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Mary Abdelsayed
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Lucelina Rosado
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Lauren Soong
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Elizabeth Margolskee
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonas J Heymann
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Abha Goyal
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Rema A Rao
- Department of Pathology and Laboratory Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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Gupta Y, Goyal A, Kalaivani M, Singhal S, Bhatla N, Gupta N, Tandon N. High burden of cardiometabolic risk factors in spouses of Indian women with hyperglycaemia in pregnancy. Diabet Med 2020; 37:1058-1065. [PMID: 32112453 DOI: 10.1111/dme.14283] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2020] [Indexed: 12/13/2022]
Abstract
AIM To evaluate the burden and association of cardiometabolic risk factors in the spouses of women with and without hyperglycaemia in pregnancy. METHODS Women with (n = 204) and without (n = 197) hyperglycaemia in pregnancy, along with their spouses, participated in this cross-sectional study. The hyperglycaemia in pregnancy group included women with gestational diabetes and diabetes in pregnancy. A detailed questionnaire was completed for all participants (men and women), documenting relevant personal and medical history, along with biochemical investigations (men). RESULTS A total of 401 couples were evaluated at the time point during the pregnancy of 24.7 ± 5.2 gestational weeks (mean ± sd). Dysglycaemia (prediabetes or diabetes), overweight/obesity (BMI ≥25 kg/m2 ) and metabolic syndrome were detected in 120 (58.9%), 123 (60.3%) and 98 spouses (48.3%) of women with hyperglycaemia in pregnancy, respectively. In the fully adjusted model, an increased risk of dysglycaemia [odds ratio 1.43 (95% CI 0.95-2.17); P = 0.088], overweight/obesity [odds ratio 1.49 (95% CI 0.98-2.27); P = 0.064] and metabolic syndrome [odds ratio 2.00 (95% CI 1.30-3.07); P = 0.001] was seen in the spouses of women with hyperglycaemia in pregnancy. The prevalence of these metabolic conditions was higher in spouses of women with diabetes in pregnancy compared to spouses of women with gestational diabetes mellitus. CONCLUSIONS A high burden of cardiometabolic risk factors was observed in the spouses of women with hyperglycaemia in pregnancy. The opportunity provided by pregnancy could be used by the healthcare system not only to improve the health of the woman and her offspring, but also her spouse.
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Affiliation(s)
- Y Gupta
- Departments of, Department of, Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - A Goyal
- Departments of, Department of, Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - M Kalaivani
- Department of, Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - S Singhal
- Department of, Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - N Bhatla
- Department of, Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - N Gupta
- Departments of, Department of, Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - N Tandon
- Departments of, Department of, Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Gupta R, Das MK, Mohanan PP, Deb PK, Parashar SK, Chopra HK, Shrivastava S, Guha S, Goswami KC, Yadav R, Alagesan R, Amuthan V, Bansal M, Chakraborty RN, Chakraborti N, Chandra S, Chatterjee A, Chatterjee D, Chatterjee SS, Dutta AL, De A, Garg A, Garg VK, Goyal A, Goyal NK, Govind SC, Gupta VK, Hasija PK, Jabir A, Jain P, Jain V, Jayagopal PB, Kasliwal RR, Katyal VK, Kerkar PG, Khan AK, Khanna NN, Mandal M, Majumder B, Mishra SS, Meena CB, Naik N, Narain VS, Pancholia AK, Pathak LA, Ponde CK, Raghu K, Ray S, Roy D, Sarma D, Shanmugasundarum S, Singh BP, Tyagi S, Vijayaraghavan G, Wander GS, Wardhan H, Nanda NC. Cardiological society of India document on safety measure during echo evaluation of cardiovascular disease in the time of COVID-19. Indian Heart J 2020; 72:145-150. [PMID: 32768012 PMCID: PMC7250084 DOI: 10.1016/j.ihj.2020.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 01/08/2023] Open
Abstract
An echocardiographic investigation is one of the key modalities of diagnosis in cardiology. There has been a rising presence of cardiological comorbidities in patients positive for COVID-19. Hence, it is becoming extremely essential to look into the correct safety precautions, healthcare professionals must take while conducting an echo investigation. The decision matrix formulated for conducting an echocardiographic evaluation is based on presence or absence of cardiological comorbidity vis-à-vis positive, suspected or negative for COVID-19. The safety measures have been constructed keeping in mind the current safety precautions by WHO, CDC and MoHFW, India.
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Affiliation(s)
- Rakesh Gupta
- JROP Institute of Echocardiography, Ultrasound & Vascular Doppler, JROP Healthcare Pvt. Ltd., C-1/16, Ashok Vihar-II, Delhi, 110052, India; JROP Charak Heart City, MD City Hospital, Model Town Northex, Delhi, 110009, India.
| | - Mrinal Kanti Das
- C K Birla Group of Hospitals (BMB and CMRI), Kolkata, West Bengal, India
| | - P P Mohanan
- Westfort Hi-Tech Hospital, Thrissur, Kerala, India
| | | | - S K Parashar
- Metro Heart Hospital, Lajpat Nagar, New Delhi, India
| | | | | | - Santanu Guha
- Calcutta Medical College Hospital, Kolkata, West Bengal, India
| | | | - Rakesh Yadav
- All India Institute of Medical Sciences, New Delhi, India
| | | | - V Amuthan
- Jeyalakshmi Heart Center, Madurai, Tamilnadu, India
| | - M Bansal
- Medanta, The Medicity, New Delhi, India
| | - R N Chakraborty
- Medica Group of Superspeciality Hospitals, Kolkata, West Bengal, India
| | - N Chakraborti
- Medica Group of Superspeciality Hospitals, Kolkata, West Bengal, India
| | - S Chandra
- King George's Medical University, Lucknow, India
| | | | - D Chatterjee
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | | | | | - A De
- Apollo Gleneagles Hospital, Kolkata, India
| | - A Garg
- Jaipur Heart Institute, Jaipur, India
| | - V K Garg
- R D Gardi Medical College, Ujjain, India
| | - A Goyal
- Bani Park Hospital, Jaipur, India
| | - N K Goyal
- BLK Superspeciality Hospital, New Delhi, India
| | | | - V K Gupta
- Kishori Ram Hospital & Diabetes Care Centre, Bhatinda, India
| | | | - A Jabir
- Lisie Hospital Kochi, Kerala, India
| | - P Jain
- Lifeline Superspeciality Hospital, Jhansi, India
| | - V Jain
- Choithram Hospital &R.C., Indore, India
| | | | | | | | | | | | | | - M Mandal
- NRS Medical College, Kolkata, India
| | - B Majumder
- R.G. Kar Medical College & Hospital, Kolkata, India
| | - S S Mishra
- Hi-Tech Medical College and Hospital, Bhubaneshwar, India
| | - C B Meena
- SMS Medical College, Jaipur, Rajasthan
| | | | - V S Narain
- King George's Medical University, Lucknow, India
| | | | - L A Pathak
- Nanavati Heart Institute, Nanavati Superspeciality Hospital, Mumbai, India
| | - C K Ponde
- PD Hinduja National Hospital & RC, Mumbai, India
| | - K Raghu
- Care Hospital, Hyderabad, India
| | - S Ray
- Vivekananda Institute of Medical Sciences, Kolkata, India
| | - D Roy
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
| | - D Sarma
- Jorhat Christian Medical Centre Hospital, Jorhat, Assam, India
| | | | | | - S Tyagi
- GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | | | - G S Wander
- Hero DMC Heart Institute, Ludhiana, India
| | - Harsh Wardhan
- Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - N C Nanda
- University of Alabama at Birmingham, Birmingham, AL, USA
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