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Shen Y, Shamout FE, Oliver JR, Witowski J, Kannan K, Park J, Wu N, Huddleston C, Wolfson S, Millet A, Ehrenpreis R, Awal D, Tyma C, Samreen N, Gao Y, Chhor C, Gandhi S, Lee C, Kumari-Subaiya S, Leonard C, Mohammed R, Moczulski C, Altabet J, Babb J, Lewin A, Reig B, Moy L, Heacock L, Geras KJ. Artificial intelligence system reduces false-positive findings in the interpretation of breast ultrasound exams. Nat Commun 2021; 12:5645. [PMID: 34561440 PMCID: PMC8463596 DOI: 10.1038/s41467-021-26023-2] [Citation(s) in RCA: 69] [Impact Index Per Article: 23.0] [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: 07/22/2021] [Accepted: 09/14/2021] [Indexed: 02/08/2023] Open
Abstract
Though consistently shown to detect mammographically occult cancers, breast ultrasound has been noted to have high false-positive rates. In this work, we present an AI system that achieves radiologist-level accuracy in identifying breast cancer in ultrasound images. Developed on 288,767 exams, consisting of 5,442,907 B-mode and Color Doppler images, the AI achieves an area under the receiver operating characteristic curve (AUROC) of 0.976 on a test set consisting of 44,755 exams. In a retrospective reader study, the AI achieves a higher AUROC than the average of ten board-certified breast radiologists (AUROC: 0.962 AI, 0.924 ± 0.02 radiologists). With the help of the AI, radiologists decrease their false positive rates by 37.3% and reduce requested biopsies by 27.8%, while maintaining the same level of sensitivity. This highlights the potential of AI in improving the accuracy, consistency, and efficiency of breast ultrasound diagnosis.
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Affiliation(s)
- Yiqiu Shen
- grid.137628.90000 0004 1936 8753Center for Data Science, New York University, New York, NY USA
| | - Farah E. Shamout
- grid.440573.1Engineering Division, NYU Abu Dhabi, Abu Dhabi, UAE
| | - Jamie R. Oliver
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Jan Witowski
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Kawshik Kannan
- grid.482020.c0000 0001 1089 179XDepartment of Computer Science, Courant Institute, New York University, New York, NY USA
| | - Jungkyu Park
- grid.137628.90000 0004 1936 8753Vilcek Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, New York, NY USA
| | - Nan Wu
- grid.137628.90000 0004 1936 8753Center for Data Science, New York University, New York, NY USA
| | - Connor Huddleston
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Stacey Wolfson
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Alexandra Millet
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Robin Ehrenpreis
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Divya Awal
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Cathy Tyma
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Naziya Samreen
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Yiming Gao
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Chloe Chhor
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Stacey Gandhi
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Cindy Lee
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Sheila Kumari-Subaiya
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Cindy Leonard
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Reyhan Mohammed
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Christopher Moczulski
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Jaime Altabet
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - James Babb
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Alana Lewin
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Beatriu Reig
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Linda Moy
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA ,grid.137628.90000 0004 1936 8753Vilcek Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, New York, NY USA
| | - Laura Heacock
- grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA
| | - Krzysztof J. Geras
- grid.137628.90000 0004 1936 8753Center for Data Science, New York University, New York, NY USA ,grid.137628.90000 0004 1936 8753Department of Radiology, NYU Grossman School of Medicine, New York, NY USA ,grid.137628.90000 0004 1936 8753Vilcek Institute of Graduate Biomedical Sciences, NYU Grossman School of Medicine, New York, NY USA
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Huddleston C, Hon E, Farooqui N, Vitalpur G. M315 EOSINOPHILIC ESOPHAGITIS UNMASKED DURING PEANUT ORAL IMMUNOTHERAPY. Ann Allergy Asthma Immunol 2020. [DOI: 10.1016/j.anai.2020.08.338] [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: 10/23/2022]
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Wei ZA, Huddleston C, Trusty PM, Singh-Gryzbon S, Fogel MA, Veneziani A, Yoganathan AP. Analysis of Inlet Velocity Profiles in Numerical Assessment of Fontan Hemodynamics. Ann Biomed Eng 2019; 47:2258-2270. [PMID: 31236791 DOI: 10.1007/s10439-019-02307-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 12/11/2018] [Accepted: 06/08/2019] [Indexed: 12/16/2022]
Abstract
Computational fluid dynamic (CFD) simulations are widely utilized to assess Fontan hemodynamics that are related to long-term complications. No previous studies have systemically investigated the effects of using different inlet velocity profiles in Fontan simulations. This study implements real, patient-specific velocity profiles for numerical assessment of Fontan hemodynamics using CFD simulations. Four additional, artificial velocity profiles were used for comparison: (1) flat, (2) parabolic, (3) Womersley, and (4) parabolic with inlet extensions [to develop flow before entering the total cavopulmonary connection (TCPC)]. The differences arising from the five velocity profiles, as well as discrepancies between the real and each of the artificial velocity profiles, were quantified by examining clinically important metrics in TCPC hemodynamics: power loss (PL), viscous dissipation rate (VDR), hepatic flow distribution, and regions of low wall shear stress. Statistically significant differences were observed in PL and VDR between simulations using real and flat velocity profiles, but differences between those using real velocity profiles and the other three artificial profiles did not reach statistical significance. These conclusions suggest that the artificial velocity profiles (2)-(4) are acceptable surrogates for real velocity profiles in Fontan simulations, but parabolic profiles are recommended because of their low computational demands and prevalent applicability.
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Affiliation(s)
- Zhenglun Alan Wei
- Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Suite 232, Atlanta, GA, 30313-2412, USA
| | - Connor Huddleston
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, GA, USA
| | - Phillip M Trusty
- Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Suite 232, Atlanta, GA, 30313-2412, USA
| | - Shelly Singh-Gryzbon
- Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Suite 232, Atlanta, GA, 30313-2412, USA
| | - Mark A Fogel
- Department of Cardiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alessandro Veneziani
- Department of Mathematics, Department of Computer Science, Emory University, Atlanta, GA, USA
| | - Ajit P Yoganathan
- Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Suite 232, Atlanta, GA, 30313-2412, USA.
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Huddleston C, Martin L, Woods K, Dindo L. One-Day Behavioral Intervention for Distressed Veterans with Migraine: Results of a Multimethod Pilot Study. Mil Med 2019; 183:e184-e192. [PMID: 29420786 DOI: 10.1093/milmed/usx090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/08/2017] [Indexed: 01/09/2023] Open
Abstract
Introduction Migraine, a chronic neurological disorder characterized by episodic severe headache pain and functional impairment, affects approximately 12% of the general US population. Veterans returning from Iraq or Afghanistan have two to four times the incidence of migraine of the general population. Veterans with migraines are more than twice as likely to have comorbid psychiatric conditions as veterans without migraines, with depression and post-traumatic stress disorder being most prevalent. This psychiatric-migraine comorbidity is of major public health significance, as it leads to decreased quality of life, poorer response to migraine and mental health treatment, and overall worse prognosis. Unfortunately, acceptable and effective treatments for these comorbid problems have rarely been investigated. The aims of this study are to examine the acceptability, feasibility, and preliminary efficacy of a 1-d acceptance and commitment therapy (ACT) plus Migraine Education workshop. Method Twenty-five veterans with migraines and co-occurring depression and/or anxiety completed the 1-d ACT plus Migraine Education workshop. Veterans completed assessments of depressive and anxiety symptoms, general functioning, headache-related disability, and ACT-specific skills at baseline and 3 mo after the workshop. Changes from baseline to 3-mo follow-up on the self-report and clinician-rated measures were assessed using the paired t-test and Wilcoxon signed-rank test. Veterans also completed semistructured qualitative interviews documenting their experiences with the workshop 2 wk and 3 mo following the intervention. Qualitative data were analyzed via directed content analysis. Individual codes were aggregated into larger themes agreed upon by consensus. Results At 3-mo follow-up, veterans significantly improved in depressive and anxiety symptoms, general functioning, and headache-related disability compared with baseline. Additionally, veterans significantly improved in pain acceptance and engagement in valued life areas. In interviews, veterans indicated that the migraine education helped them feel more knowledgeable about their condition, and this empowered them to better manage their headaches, including talking to their physician about medication adjustments. The ACT component led to greater awareness of the role stress plays in exacerbating pain and ways to manage this stress, including greater acceptance and greater engagement in valued life activities. For some, however, the role of stress in exacerbating migraines needed to be highlighted more. Veterans appreciated being in a group with other veterans with similar health difficulties and wanted this to be incorporated into ongoing care at the Veterans Affairs medical center. The patient education manuals were useful to the veterans, with some referring to them during the months following the workshop. Conclusion Findings of this small trial have important implications pending replication in a more rigorously designed large-scale study. A 1-d ACT plus Migraine Education workshop is an acceptable and feasible treatment approach for veterans with migraines and significant distress. Significantly reduced distress and disability, as well as improved coping skills, suggest that veterans were activated to engage more fully in their lives and clinical care. The availability of an effective transdiagnostic intervention that can be completed in 1 d is particularly valuable for veterans who have multiple comorbid conditions and who encounter practical barriers to engaging in the usual prescribed weekly therapy treatments.
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Affiliation(s)
- C Huddleston
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX
| | - L Martin
- Department of Medicine, Section of Health Services Research, Baylor College of Medicine, One Baylor Plaza, Suite 011D, Houston, TX.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, 2450 Holcombe Blvd, Houston, TX
| | - K Woods
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, 2450 Holcombe Blvd, Houston, TX
| | - L Dindo
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Houston, TX.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, 2450 Holcombe Blvd, Houston, TX
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Goel A, Iyengar A, Schowengerdt K, Fiore A, Huddleston C. Developmental Delay Is Not a Risk Factor for Poor Outcome in Pediatric Heart Transplantation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.1151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Towe C, Ogborn A, Ferkol T, Sweet S, Huddleston C, Faro A. 390 Bronchiolitis Obliterans Syndrome (BOS) Is Not Specific for Bronchiolitis Obliterans (BO) in Pediatric Lung Transplant (LTx). J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.398] [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: 11/17/2022] Open
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Simpson K, Canter C, Lee C, Huddleston C, Cibulka N. 493 Failed Fontan Heart Transplant Candidates with Preserved Versus Impaired Ventricular Ejection: 2 Distinct Patient Populations. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.503] [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] Open
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Reddy C, Riddle E, Checchia P, Huddleston C, Gandhi S, Phelan D, Canter C. 320: Donor-Specific Antibodies (DSA) Patterns after Pediatric Heart Transplantation with A + and – Crossmatch. J Heart Lung Transplant 2010. [DOI: 10.1016/j.healun.2009.11.333] [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: 11/24/2022] Open
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Faro A, Schuler P, Huddleston C, Gandhi S, Shepherd R, Lowell J, Nadler M, Sweet S. 405. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.420] [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: 10/25/2022] Open
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Abstract
No one set of characteristics has been consistently predictive of perioperative mortality and morbidity associated with the Norwood procedure. The purpose of the current study is to further validate a scoring system shown to be predictive of mortality following the Norwood procedure. We performed a retrospective review of all infants with the diagnosis of hypoplastic left heart syndrome (HLHS) who underwent the Norwood procedure at St. Louis Children's Hospital from July 1, 1994, to December 31, 2002. A weighted score for each of six factors comprised the scoring system. The factors included ventricular function, tricuspid regurgitation, ascending aortic diameter, atrial septal defect blood flow characteristics, blood type, and age. A score of > or = 7 points indicated lower reconstructive mortality risk, and a total score of < 7 points indicated a higher mortality risk. A total of 57 patients were analyzed. Twenty-five infants (44%) had a low risk score. These infants had a significantly greater survival at 48 hours compared to infants with a score of < 7 (92 vs 75%, p < 0.05). Infants with a high risk score had a significantly greater relative risk of mortality at 48 hours [OR = 2.04; confidence interval (CI) 1.04-4.00; p = 0.036]. The area under the receiver operating characteristic (ROC) curve is 0.8534 (95% CI, 0.78-0.922). This suggests that the scoring system has a very good degree of discriminatory power in selecting children who did not survive. Based on the results of the ROC, a cutoff score of >7 gives the best sensitivity and specificity for survival. When applied retrospectively, the survival outcomes predicted by our scoring system significantly correlated with actual outcomes. This supports the conclusion that a specific population of HLHS patients may have a higher mortality risk independent of surgical technique and postoperative care based on factors that can be assessed preoperatively.
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Affiliation(s)
- P A Checchia
- Division of Critical Care Medicine, Washington University School of Medicine, St. Louis Children's Hospital, Campus Box 8116, One Children's Place, Suite 5S20, St. Louis, MO, 63110, USA.
- Division of Cardiology, Washington University School of Medicine, St. Louis Children's Hospital, Campus Box 8116, One Children's Place, Suite 5S20, St. Louis, MO, 63110, USA.
| | - J K McGuire
- Division of Critical Care Medicine, Washington University School of Medicine, St. Louis Children's Hospital, Campus Box 8116, One Children's Place, Suite 5S20, St. Louis, MO, 63110, USA
| | - S Morrow
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, Campus Box 8116, One Children's Place, Suite 5S20, St. Louis, MO, 63110, USA
| | - N Daher
- School of Allied Health Professionals, Loma Linda University, Loma Linda, CA, 92350, USA
| | - C Huddleston
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, Campus Box 8116, One Children's Place, Suite 5S20, St. Louis, MO, 63110, USA
| | - F Levy
- Division of Critical Care Medicine, Washington University School of Medicine, St. Louis Children's Hospital, Campus Box 8116, One Children's Place, Suite 5S20, St. Louis, MO, 63110, USA
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Phelan D, Schechtman K, Sweet S, Huddleston C, Mendeloff E, De la Morena M, Mohanakumar T. HLA effect in children with a second lung transplant. Hum Immunol 2003. [DOI: 10.1016/j.humimm.2003.08.085] [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: 10/27/2022]
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Huddleston C, Mendeloff E, Mallory G. [Pediatric lung transplantation]. An Esp Pediatr 2001; 54:359-71. [PMID: 11273820] [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] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Approximately 700 transplants world-wide have been performed in patients aged less than 18 years; in contrast, over 11,000 lung transplants have been performed in adults. The major diagnostic group is cystic fibrosis. An emerging group of patients are infants born with congenitally based pulmonary diseases such as surfactant protein B deficiency. Survival in children is very similar to that in adults, although it is generally perceived that children are at higher risk. For instance, no children have been transplanted for chronic obstructive lung disease (a low-risk diagnostic group) while this disease comprises approximately 40% of all adult lung transplantations. Immunosuppression generally consists of cyclosporine, azathioprine and prednisone. Post-transplant complications in children are similar to those observed in adults. Around 40% of patients will develop bronchiolitis obliterans approximately 3 years after transplantation and this remains the major impediment to long term survival. Donor shortage is also a significant obstacle, especially in adolescents. As a partial solution to this problem, living donor lung transplantation has taken on a greater role in our program. Although this is a complex, expensive treatment strategy, lung transplantation remains the most effective therapy for end-stage pulmonary parenchymal and vascular diseases even in children.
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Affiliation(s)
- C Huddleston
- Division of Cardiothoracic Surgey, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA.
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De La Morena M, Sweet S, White F, Mendeloff E, McBride G, Huddleston C, Shapiro S, Schootman M. Pediatric lung transplantation and CMV pneumonitis: a ten year experience. J Heart Lung Transplant 2001; 20:221. [PMID: 11250411 DOI: 10.1016/s1053-2498(00)00484-8] [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: 11/26/2022] Open
Affiliation(s)
- M De La Morena
- 1Washington University, St. Louis, MO; 2St. Louis Children's Hospital, St. Louis, MO, USA
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Hayashi RJ, Kraus MD, Patel AL, Canter C, Cohen AH, Hmiel P, Howard T, Huddleston C, Lowell JA, Mallory G, Mendeloff E, Molleston J, Sweet S, DeBaun MR. Posttransplant lymphoproliferative disease in children: correlation of histology to clinical behavior. J Pediatr Hematol Oncol 2001; 23:14-8. [PMID: 11196263 DOI: 10.1097/00043426-200101000-00005] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine whether the morphologic features of posttransplant lymphoproliferative disease (PTLD) correlated to a response to therapy. PATIENTS AND METHODS We reviewed our experience with PTLD in the pediatric population. We identified 32 patients with a total of 36 episodes of PTLD. The diagnosis was confirmed by tissue examination and classified according to the degree of monomorphic features of the lesion. Thirty-four of 36 episodes were managed with immunosuppression reduction, and the patients were assessed for their response to this strategy. Chemotherapy was used to treat 10 of 15 patients who had progressive disease, and their subsequent course was also analyzed. RESULTS Sixteen of 17 (94%) patients with polymorphic morphology responded to immunosuppression reduction compared with only 5 of 17 (29%) patients with monomorphic features (P < 0.001). All of the patients with progressive disease who did not receive additional therapy died. Standard chemotherapy regimens for lymphoma were administered to 10 patients with progressive disease, with a high response rate (90%), durable remissions, and acceptable toxicity. CONCLUSIONS We conclude that the morphologic characteristics of PTLD provide information to potentially help guide treatment strategies in the management of this disease. Standard chemotherapy regimens for malignant lymphoma appear to be a viable treatment option for patients with progressive disease, although further investigation is needed.
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Affiliation(s)
- R J Hayashi
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Abstract
Three babies who developed infection in their median sternotomy wounds are reported. In one child, a retrosternal abscess was drained and in the other two cases, the wounds dehisced. The wound cavities were filled with a rectus abdominis myocutaneous island flap and in each case, the wounds healed primarily. Early flap repair resolved the infection, shortened the hospital stay and provided protection to the exposed mediastinum.
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Affiliation(s)
- D T Gault
- Department of Plastic Surgery, Hospital for Sick Children, London, UK
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