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Rabinovici GD, Carrillo MC, Apgar C, Gareen IF, Gutman R, Hanna L, Hillner BE, March A, Romanoff J, Siegel BA, Smith K, Song Y, Weber C, Whitmer RA, Gatsonis C. Amyloid Positron Emission Tomography and Subsequent Health Care Use Among Medicare Beneficiaries With Mild Cognitive Impairment or Dementia. JAMA Neurol 2023; 80:1166-1173. [PMID: 37812437 PMCID: PMC10562987 DOI: 10.1001/jamaneurol.2023.3490] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/11/2023] [Indexed: 10/10/2023]
Abstract
Importance Results of amyloid positron emission tomography (PET) have been shown to change the management of patients with mild cognitive impairment (MCI) or dementia who meet Appropriate Use Criteria (AUC). Objective To determine if amyloid PET is associated with reduced hospitalizations and emergency department (ED) visits over 12 months in patients with MCI or dementia. Design, Setting, and Participants This nonrandomized controlled trial analyzed participants in the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) study, an open-label, multisite, longitudinal study that enrolled participants between February 2016 and December 2017 and followed up through December 2018. These participants were recruited at 595 clinical sites that provide specialty memory care across the US. Eligible participants were Medicare beneficiaries 65 years or older with a diagnosis of MCI or dementia within the past 24 months who met published AUC for amyloid PET. Each IDEAS study participant was matched to a control Medicare beneficiary who had not undergone amyloid PET. Data analysis was conducted on December 13, 2022. Exposure Participants underwent amyloid PET at imaging centers. Main Outcomes and Measures The primary end points were the proportions of patients with 12-month inpatient hospital admissions and ED visits. One of 4 secondary end points was the rate of hospitalizations and rate of ED visits in participants with positive vs negative amyloid PET results. Health care use was ascertained from Medicare claims data. Results The 2 cohorts (IDEAS study participants and controls) each comprised 12 684 adults, including 6467 females (51.0%) with a median (IQR) age of 77 (73-81) years. Over 12 months, 24.0% of the IDEAS study participants were hospitalized, compared with 25.1% of the matched control cohort, for a relative reduction of -4.49% (97.5% CI, -9.09% to 0.34%). The 12-month ED visit rates were nearly identical between the 2 cohorts (44.8% in both IDEAS study and control cohorts) for a relative reduction of -0.12% (97.5% CI, -3.19% to 3.05%). Both outcomes fell short of the prespecified effect size of 10% or greater relative reduction. Overall, 1467 of 6848 participants (21.4%) with positive amyloid PET scans were hospitalized within 12 months compared with 1081 of 4209 participants (25.7%) with negative amyloid PET scans (adjusted odds ratio, 0.83; 95% CI, 0.78-0.89). Conclusions and Relevance Results of this nonrandomized controlled trial showed that use of amyloid PET was not associated with a significant reduction in 12-month hospitalizations or ED visits. Rates of hospitalization were lower in patients with positive vs negative amyloid PET results.
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Affiliation(s)
- Gil D. Rabinovici
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco
- Associate Editor, JAMA Neurology
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco
| | | | - Charles Apgar
- Center for Research and Innovation, American College of Radiology, Reston, Virginia
| | - Ilana F. Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Roee Gutman
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - Lucy Hanna
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Bruce E. Hillner
- Department of Medicine, Virginia Commonwealth University, Richmond
| | - Andrew March
- Center for Research and Innovation, American College of Radiology, Reston, Virginia
| | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Barry A. Siegel
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Karen Smith
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco
| | - Yunjie Song
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | | | - Rachel A. Whitmer
- Department of Public Health Sciences and Neurology, University of California, Davis, Davis
| | - Constantine Gatsonis
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
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Stack BC, Duan F, Romanoff J, Sicks JD, Subramaniam RM, Lowe VJ. Impact of Neck PET/CT Positivity on Survival Outcomes-Visual and Quantitative Assessment: Results From ACRIN 6685. Clin Nucl Med 2023; 48:126-131. [PMID: 36562743 PMCID: PMC9987257 DOI: 10.1097/rlu.0000000000004483] [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] [Indexed: 12/24/2022]
Abstract
INTRODUCTION FDG PET/CT was prospectively studied in 287 cN0 head and neck cancer patients in ACRIN 6685, and additional analysis of neck FDG uptake upon recurrence-free survival (RFS) and overall survival (OS) was performed. PATIENTS AND METHODS Two hundred eight had analyzable data. Survival analysis was performed to compare RFS and OS based on neck FDG visual assessment (VA) and SUV max . For SUV max , the optimal thresholds were calculated using conditional inference trees on a randomly selected 70% training data set and validated using the remaining 30% of data. Kaplan-Meier curves with log-rank tests were generated for the patient groups based on VA and optimal SUV max thresholds, and the hazards ratios (HRs) and 95% confidence intervals (CIs) were also calculated. Hypothesis testing was set at a significance level of 0.05. RESULTS A total of 73.9% of bilateral cN0 and 50.0% of unilateral cN0 were alive at the end of the study with the remaining being dead or lost to follow-up. Overall survival median follow-up time was 24.0 months (interquartile range, 15.8-25.3; range, 0-37.0). A total of 63.3% of bilateral cN0 and 42.5% of unilateral cN0 patients remained disease free during the study. Recurrence-free survival median follow-up time was 23.9 months (interquartile range, 12.4-25.2; range, 0-35.6). Visual assessment of necks by our panel of radiologists was significantly associated with RFS (HR [95% CI], 2.30 [1.10-4.79]; P = 0.02), but not with OS (HR [95% CI], 1.64 [0.86-3.14]; P = 0.13). The optimal SUV max thresholds were 2.5 for RFS and 5.0 for OS. For SUV max assessment, applying the optimal thresholds to the 30% test data yielded HRs (95% CIs) of 2.09 (0.61-7.14; P = 0.23) for RFS and 3.42 (1.03-11.41; P = 0.03) for OS. The SUV max threshold of 5.0 was significantly associated with RFS (HR [95% CI], 5.92 [1.79-19.57]; P < 0.001). CONCLUSIONS Neck FDG uptake by VA is significant for RFS. An SUV max threshold of 5.0 is significantly associated with OS and RFS.
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Affiliation(s)
- Brendan C. Stack
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA 62702
| | - Fenghai Duan
- Department of Biostatistics, School of Public Health, Brown University, Providence, RI, USA 02912
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA 20912
| | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA 20912
| | - JoRean D. Sicks
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA 20912
| | - Rathan M. Subramaniam
- Department of Medicine, University of Otago Medical School, Dunedin 9016, New Zealand
- Department of Radiology, Duke University, Durham, NC
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA 55905
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Subramaniam RM, Duan FM, Romanoff J, Yu JQ, Bartel T, Dehdashti F, Intenzo CM, Solnes L, Sicks J, Stack BC, Lowe VJ. 18F-FDG PET/CT Staging of Head and Neck Cancer: Interobserver Agreement and Accuracy-Results from Multicenter ACRIN 6685 Clinical Trial. J Nucl Med 2022; 63:1887-1890. [PMID: 35552246 PMCID: PMC9730921 DOI: 10.2967/jnumed.122.263902] [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: 01/25/2022] [Revised: 04/27/2022] [Indexed: 01/11/2023] Open
Abstract
To our knowledge, no prior multicenter clinical trial has reported interobserver agreement of 18F-FDG PET/CT scans for staging of clinical N0 neck in head and neck cancer. Methods: A total of 287 participants were recruited. For visual analysis, positive nodal uptake of 18F-FDG was defined as uptake visually greater than activity seen in the blood pool. Results: The negative predictive value of the 18F-FDG PET/CT for N0 clinical neck was 86% or above for visual assessment (95% CI, 86%-88%) for the 2 central readers and above 90% (95% CI, 90%-95%) for SUVmax for central reads and site reads dichotomized at the optimal cutoff value of 1.8 and the prespecified cutoff value of 3.5, respectively. The κ coefficients between the 2 expert readers and between central reads and site reads varied between 0.53 and 0.78. Conclusion: The NPV of the 18F-FDG PET/CT for N0 clinical neck was 86% or above for visual assessment and above 90% for SUVmax cut points of 1.8 and 3.5 with moderate to substantial agreements.
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Affiliation(s)
- Rathan M Subramaniam
- Otago Medical School, University of Otago, Otago, Dunedin, New Zealand;
- Duke University, Durham, North Carolina
| | - Fenghai M Duan
- School of Public Health, Brown University, Providence, Rhode Island
| | - Justin Romanoff
- School of Public Health, Brown University, Providence, Rhode Island
| | - Jian Qin Yu
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | | | | | | | - Lilja Solnes
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - JoRean Sicks
- School of Public Health, Brown University, Providence, Rhode Island
| | - Brendan C Stack
- Southern Illinois School of Medicine, Springfield, Illinois; and
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Wilkins CH, Windon CC, Dilworth-Anderson P, Romanoff J, Gatsonis C, Hanna L, Apgar C, Gareen IF, Hill CV, Hillner BE, March A, Siegel BA, Whitmer RA, Carrillo MC, Rabinovici GD. Racial and Ethnic Differences in Amyloid PET Positivity in Individuals With Mild Cognitive Impairment or Dementia: A Secondary Analysis of the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) Cohort Study. JAMA Neurol 2022; 79:2796653. [PMID: 36190710 PMCID: PMC9531087 DOI: 10.1001/jamaneurol.2022.3157] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/29/2022] [Indexed: 02/06/2023]
Abstract
Importance Racial and ethnic groups with higher rates of clinical Alzheimer disease (AD) are underrepresented in studies of AD biomarkers, including amyloid positron emission tomography (PET). Objective To compare amyloid PET positivity among a diverse cohort of individuals with mild cognitive impairment (MCI) or dementia. Design, Setting, and Participants Secondary analysis of the Imaging Dementia-Evidence for Amyloid Scanning (IDEAS), a single-arm multisite cohort study of Medicare beneficiaries who met appropriate-use criteria for amyloid PET imaging between February 2016 and September 2017 with follow-up through January 2018. Data were analyzed between April 2020 and January 2022. This study used 2 approaches: the McNemar test to compare amyloid PET positivity proportions between matched racial and ethnic groups and multivariable logistic regression to assess the odds of having a positive amyloid PET scan. IDEAS enrolled participants at 595 US dementia specialist practices. A total of 21 949 were enrolled and 4842 (22%) were excluded from the present analysis due to protocol violations, not receiving an amyloid PET scan, not having a positive or negative scan, or because of small numbers in some subgroups. Exposures In the IDEAS study, participants underwent a single amyloid PET scan. Main Outcomes and Measures The main outcomes were amyloid PET positivity proportions and odds. Results Data from 17 107 individuals (321 Asian, 635 Black, 829 Hispanic, and 15 322 White) with MCI or dementia and amyloid PET were analyzed between April 2020 and January 2022. The median (range) age of participants was 75 (65-105) years; 8769 participants (51.3%) were female and 8338 (48.7%) were male. In the optimal 1:1 matching analysis (n = 3154), White participants had a greater proportion of positive amyloid PET scans compared with Asian participants (181 of 313; 57.8%; 95% CI, 52.3-63.2 vs 142 of 313; 45.4%; 95% CI, 39.9-50.9, respectively; P = .001) and Hispanic participants (482 of 780; 61.8%; 95% CI, 58.3-65.1 vs 425 of 780; 54.5%; 95% CI, 51.0-58.0, respectively; P = .003) but not Black participants (359 of 615; 58.4%; 95% CI, 54.4-62.2 vs 333 of 615; 54.1%; 95% CI, 50.2-58.0, respectively; P = .13). In the adjusted model, the odds of having a positive amyloid PET scan were lower for Asian participants (odds ratio [OR], 0.47; 95% CI, 0.37-0.59; P < .001), Black participants (OR, 0.71; 95% CI, 0.60-0.84; P < .001), and Hispanic participants (OR, 0.68; 95% CI, 0.59-0.79; P < .001) compared with White participants. Conclusions and Relevance Racial and ethnic differences found in amyloid PET positivity among individuals with MCI and dementia in this study may indicate differences in underlying etiology of cognitive impairment and guide future treatment and prevention approaches.
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Affiliation(s)
- Consuelo H. Wilkins
- Department of Medicine, Division of Geriatric Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Charles C. Windon
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
| | - Peggye Dilworth-Anderson
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill
| | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Constantine Gatsonis
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Lucy Hanna
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Charles Apgar
- Center for Research and Innovation, American College of Radiology, Reston, Virginia
| | - Ilana F. Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | | | - Bruce E. Hillner
- Department of Medicine, Virginia Commonwealth University, Richmond
| | - Andrew March
- Center for Research and Innovation, American College of Radiology, Philadelphia, Pennsylvania
| | - Barry A. Siegel
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Rachel A. Whitmer
- Division of Research, Kaiser Permanente, Oakland, California
- Department of Public Health Sciences, University of California, Davis
| | | | - Gil D. Rabinovici
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco
- Associate Editor, JAMA Neurology
- Department of Radiology & Biomedical Imaging, University of California, San Francisco
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Fazeli S, Snyder BS, Gareen IF, Lehman CD, Khan SA, Romanoff J, Gatsonis CA, Corsetti RL, Rahbar H, Spell DW, Blankstein KB, Han LK, Sabol JL, Bumberry JR, Miller KD, Sparano JA, Comstock CE, Wagner LI, Carlos RC. Association Between Surgery Preference and Receipt in Ductal Carcinoma In Situ After Breast Magnetic Resonance Imaging: An Ancillary Study of the ECOG-ACRIN Cancer Research Group (E4112). JAMA Netw Open 2022; 5:e2210331. [PMID: 35536580 PMCID: PMC9092204 DOI: 10.1001/jamanetworkopen.2022.10331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/16/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Guiding treatment decisions for women with ductal carcinoma in situ (DCIS) requires understanding patient preferences and the influence of preoperative magnetic resonance imaging (MRI) and surgeon recommendation. Objective To identify factors associated with surgery preference and surgery receipt among a prospective cohort of women with newly diagnosed DCIS. Design, Setting, and Participants A prospective cohort study was conducted at 75 participating institutions, including community practices and academic centers, across the US between March 25, 2015, and April 27, 2016. Data were analyzed from August 2 to September 24, 2021. This was an ancillary study of the ECOG-ACRIN Cancer Research Group (E4112). Women with recently diagnosed unilateral DCIS who were eligible for wide local excision and had a diagnostic mammogram within 3 months of study registration were included. Participants who had documented surgery and completed the baseline patient-reported outcome questionnaires were included in this substudy. Exposures Women received preoperative MRI and surgeon consultation and then underwent wide local excision or mastectomy. Participants will be followed up for recurrence and overall survival for 10 years from the date of surgery. Main Outcomes and Measures Patient-reported outcome questionnaires assessed treatment goals and concerns and surgery preference before MRI and after MRI and surgeon consultation. Results Of the 368 participants enrolled 316 (86%) were included in this substudy (median [range] age, 59.5 [34-87] years; 45 women [14%] were Black; 245 [78%] were White; and 26 [8%] were of other race). Pre-MRI, age (odds ratio [OR] per 5-year increment, 0.45; 95% CI, 0.26-0.80; P = .007) and the importance of keeping one's breast (OR, 0.48; 95% CI, 0.31-0.72; P < .001) vs removal of the breast for peace of mind (OR, 1.35; 95% CI, 1.04-1.76; P = .03) were associated with surgery preference for mastectomy. After MRI and surgeon consultation, MRI upstaging (48 of 316 [15%]) was associated with patient preference for mastectomy (OR, 8.09; 95% CI, 2.51-26.06; P < .001). The 2 variables with the highest ORs for initial receipt of mastectomy were MRI upstaging (OR, 12.08; 95% CI, 4.34-33.61; P < .001) and surgeon recommendation (OR, 4.85; 95% CI, 1.99-11.83; P < .001). Conclusions and Relevance In this cohort study, change in patient preference for DCIS surgery and surgery received were responsive to MRI results and surgeon recommendation. These data highlight the importance of ensuring adequate information and ongoing communication about the clinical significance of MRI findings and the benefits and risks of available treatment options.
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Affiliation(s)
- Soudabeh Fazeli
- Department of Radiology, University of California San Diego, San Diego
| | - Bradley S. Snyder
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Ilana F. Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Constance D. Lehman
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Seema A. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Constantine A. Gatsonis
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Ralph L. Corsetti
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Habib Rahbar
- Department of Radiology, University of Washington, Seattle
| | | | | | - Linda K. Han
- Department of Surgery, Indiana University, Indianapolis
| | - Jennifer L. Sabol
- Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania
| | - John R. Bumberry
- Department of Surgery, Mercy Hospital Springfield, Springfield, Missouri
| | - Kathy D. Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
| | - Joseph A. Sparano
- Department of Hematology-Oncology, Mount Sinai Health System, New York, New York
| | | | - Lynne I. Wagner
- Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, North Carolina
| | - Ruth C. Carlos
- Department of Radiology, University of Michigan, Ann Arbor
- Program for Women’s Health Effectiveness Research, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
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Windon C, Dilworth‐Anderson P, Carrillo MC, Apgar C, Gatsonis C, Gareen IF, Gutman R, Hanna L, Hill CV, Hillner BE, Hoover S, March A, O'Bryant S, Rissman RA, Rodriguez M, Romanoff J, Siegel BA, Smith K, Song Y, Weber CJ, Whitmer RA, Wilkins CH, Rabinovici GD. IDEAS and New IDEAS: Amyloid PET in diverse populations. Alzheimers Dement 2021. [DOI: 10.1002/alz.051946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Charles Windon
- Memory and Aging Center University of California San Francisco San Francisco CA USA
| | | | | | | | | | | | - Roee Gutman
- Dept. of Biostatistics Brown University Providence RI USA
| | - Lucy Hanna
- Dept. of Biostatistics Brown University Providence RI USA
| | | | | | | | | | - Sid O'Bryant
- University of North Texas Health Science Center Fort Worth TX USA
| | | | | | | | | | - Karen Smith
- University of California San Francisco, San Francisco CA USA
| | - Yunjie Song
- Center for Statistical Sciences Brown University School of Public Health Providence RI USA
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Fazeli S, Snyder BS, Gareen IF, Lehman CD, Khan SA, Romanoff J, Gatsonis CA, Miller KD, Sparano JA, Comstock CE, Wagner LI, Carlos RC. Patient-Reported Testing Burden of Breast Magnetic Resonance Imaging Among Women With Ductal Carcinoma In Situ: An Ancillary Study of the ECOG-ACRIN Cancer Research Group (E4112). JAMA Netw Open 2021; 4:e2129697. [PMID: 34726748 PMCID: PMC8564581 DOI: 10.1001/jamanetworkopen.2021.29697] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE The use of magnetic resonance imaging (MRI) in pretreatment planning of ductal carcinoma in situ (DCIS) remains controversial. Understanding changes in short-term health-related quality of life associated with breast MRI would allow for a more complete comparative effectiveness assessment. OBJECTIVE To assess whether there are changes in patient-reported quality of life associated with breast MRI among women diagnosed with DCIS. DESIGN, SETTING, AND PARTICIPANTS This cohort study was a substudy of a nonrandomized clinical trial conducted at 75 participating US institutions from March 2015 to April 2016. Women recently diagnosed with unilateral DCIS who were eligible for wide local excision and had a diagnostic mammogram within 3 months of study registration were included. A total of 355 women met the eligibility criteria and underwent the study MRI. Data analysis was performed from June 3, 2020, to July 1, 2021. EXPOSURES Participants underwent bilateral breast MRI within 30 days of study registration and before surgery. Information on patient-reported testing burden for breast MRI was collected after MRI and before surgery. MAIN OUTCOMES AND MEASURES The primary outcome of this substudy was the patient-reported testing burden of breast MRI, measured by the Testing Morbidities Index (TMI) summated scale score. The TMI is a 7-item instrument that evaluates the temporary changes in quality of life associated with imaging before, during, and after the test (0 represents the worst possible, 100 the hypothetical ideal test experience). RESULTS Of the 355 women who met the eligibility criteria, 244 (69%) completed both questionnaires and were included in this analysis. The median age was 59 years (range, 34-85 years). The mean MRI TMI summated scale score was 85.9 (95% CI, 84.6-87.3). Of the 244 women, 142 (58%) experienced at least some fear and anxiety before the examination, and 120 women (49%) experienced fear and anxiety during the examination. A total of 156 women (64%) experienced pain or discomfort during the examination. In multivariable analyses, greater test-related burden was associated with higher levels of cancer worry (regression coefficient, -2.75; SE, 0.94; P = .004). CONCLUSIONS AND RELEVANCE In this cohort study, a clinically meaningful breast MRI testing burden among women with DCIS was revealed that was significantly associated with cancer worry. Understanding the potential quality-of-life reduction associated with MRI, especially when used in combination with mammography, may allow development of targeted interventions to improve the patient experience.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Anxiety/psychology
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/pathology
- Breast Neoplasms/psychology
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/psychology
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/psychology
- Clinical Trials as Topic
- Fear/psychology
- Female
- Humans
- Magnetic Resonance Imaging/methods
- Magnetic Resonance Imaging/psychology
- Middle Aged
- Quality of Life/psychology
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Affiliation(s)
- Soudabeh Fazeli
- Department of Radiology, University of California, San Diego
| | - Bradley S. Snyder
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Ilana F. Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Constance D. Lehman
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Seema A. Khan
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Constantine A. Gatsonis
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | | | - Joseph A. Sparano
- Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | | | - Lynne I. Wagner
- Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Ruth C. Carlos
- Department of Radiology, University of Michigan, Ann Arbor
- Program for Women’s Health Effectiveness Research, University of Michigan, Ann Arbor
- Institute for Health Policy and Innovation, University of Michigan, Ann Arbor
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Chou SHS, Romanoff J, Lehman CD, Khan SA, Carlos R, Badve SS, Xiao J, Corsetti RL, Javid SH, Spell DW, Han LK, Sabol JL, Bumberry JR, Gareen IF, Snyder BS, Gatsonis C, Wagner LI, Wolff AC, Miller KD, Sparano JA, Comstock CE, Rahbar H. Preoperative Breast MRI for Newly Diagnosed Ductal Carcinoma in Situ: Imaging Features and Performance in a Multicenter Setting (ECOG-ACRIN E4112 Trial). Radiology 2021; 301:E381. [PMID: 34543146 DOI: 10.1148/radiol.2021219016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chou SHS, Romanoff J, Lehman CD, Khan SA, Carlos R, Badve SS, Xiao J, Corsetti RL, Javid SH, Spell DW, Han LK, Sabol JL, Bumberry JR, Gareen IF, Snyder BS, Gatsonis C, Wagner LI, Wolff AC, Miller KD, Sparano JA, Comstock CE, Rahbar H. Preoperative Breast MRI for Newly Diagnosed Ductal Carcinoma in Situ: Imaging Features and Performance in a Multicenter Setting (ECOG-ACRIN E4112 Trial). Radiology 2021; 301:66-77. [PMID: 34342501 DOI: 10.1148/radiol.2021204743] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background There are limited data from clinical trials describing preoperative MRI features and performance in the evaluation of mammographically detected ductal carcinoma in situ (DCIS). Purpose To report qualitative MRI features of DCIS, MRI performance in the identification of additional disease, and associations of imaging features with pathologic, genomic, and surgical outcomes from the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) E4112 trial. Materials and Methods Secondary analyses of a multicenter prospective clinical trial from the ECOG-ACRIN Cancer Research Group included women with DCIS diagnosed with conventional imaging techniques (mammography and US), confirmed via core-needle biopsy (CNB), and enrolled between March 2015 and April 2016 who were candidates for wide local excision (WLE) based on conventional imaging and clinical examination results. DCIS MRI features and pathologic features from CNB and excision were recorded. Each woman without invasive upgrade of the index DCIS at WLE received a 12-gene DCIS score. MRI performance metrics were calculated. Associations of imaging features with invasive upgrade, dichotomized DCIS score (<39 vs ≥39), and single WLE success were estimated in uni- and multivariable analyses. Results Among 339 women (median age, 60 years; interquartile range, 51-66 years), most DCIS cases showed nonmass enhancement (NME) (195 of 339 [58%]) on MRI scans with larger median size than on mammograms (19 mm vs 12 mm; P < .001). Positive predictive value of MRI-prompted CNBs was 32% (21 of 66) (95% CI: 22, 44), yielding an additional cancer detection rate of 6.2% (21 of 339) (95% CI: 4.1, 9.3). MRI false-positive rate was 14.2% (45 of 318) (95% CI: 10.7, 18.4). No imaging features were associated with invasive upgrade or DCIS score (P = .05 to P = .95). Smaller size and focal NME distribution at MRI were linked to single WLE success (P < .001). Conclusion Preoperative MRI depicted ductal carcinoma in situ (DCIS) diagnosed with conventional imaging most commonly as nonmass enhancement, with larger median span than mammography, and additional cancer detection rate of 6.2%. MRI features of this subset of DCIS did not enable prediction of pathologic or genomic outcomes. Clinical trial registration no. NCT02352883 © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Kuhl in this issue.
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Affiliation(s)
- Shinn-Huey S Chou
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Justin Romanoff
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Constance D Lehman
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Seema A Khan
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Ruth Carlos
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Sunil S Badve
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Jennifer Xiao
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Ralph L Corsetti
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Sara H Javid
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Derrick W Spell
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Linda K Han
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Jennifer L Sabol
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - John R Bumberry
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Ilana F Gareen
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Bradley S Snyder
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Constantine Gatsonis
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Lynne I Wagner
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Antonio C Wolff
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Kathy D Miller
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Joseph A Sparano
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Christopher E Comstock
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
| | - Habib Rahbar
- From the Dept of Radiology, Massachusetts General Hosp, 55 Fruit Street, WAC-240, Boston, MA 02114 (S.H.S.C., C.D.L.); Ctr for Statistical Sciences, Brown Univ School of Public Health, Providence, RI (J.R., I.F.G., B.S.S., C.G.); Dept of Medicine, Northwestern Univ Feinberg School of Medicine, Chicago, Ill (S.A.K.); Dept of Radiology, Univ of Michigan Health System, Ann Arbor, Mich (R.C.); Depts of Pathology and Laboratory Medicine (S.S.B.) and Medicine (K.D.M.), Indiana Univ School of Medicine, Indianapolis, Ind; Dept of Radiology (J.X., H.R.) and Surgery (S.H.J.), Univ of Washington School of Medicine, Seattle, Wash; Dept of Surgery, Tulane Univ School of Medicine, New Orleans, La (R.L.C.); Community Oncology Research Program, Gulf-South National Cancer Inst, New Orleans, La (D.W.S.); Dept of Surgery, Parkview Cancer Inst, Fort Wayne, Ind (L.K.H.); Dept of Surgery, Lankenau Medical Ctr, Wynnewood, Pa (J.L.S.); Dept of Surgery, Mercy Hosp Springfield, Springfield, Mo (J.R.B.); Depts of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC (L.I.W.); Dept of Oncology, Johns Hopkins Univ School of Medicine, Baltimore, Md (A.C.W.); Dept of Medicine (Oncology), Montefiore Medical Center-Weiler Hosp, Bronx, NY (J.A.S.); and Dept of Radiology, Memorial Sloan-Kettering Cancer Ctr, New York, NY (C.E.C.)
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10
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Fazeli S, Snyder B, Gareen IF, Lehman CD, Khan SA, Romanoff J, Gatsonis C, Corsetti RL, Rahbar H, Spell DW, Blankstein KB, Han LK, Sabol JL, Bumberry JR, Miller K, Sparano JA, Comstock C, Wagner LI, Carlos R. Predictors of surgery preference and quality of life in DCIS after breast MRI: A trial of the ECOG-ACRIN Cancer Research Group (E4112). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.6564] [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: 11/20/2022] Open
Abstract
6564 Background: Management of ductal carcinoma in situ (DCIS) remains variable, requiring an understanding of patient preferences and concerns to enhance the treatment decision-making process. Pre-operative MRI and surgeon recommendation can further inform surgery choice. Quality of life (QoL) is also an important consideration in treatment decision-making. The aims of this study were to assess patients’ treatment preferences before and after MRI and surgeon consultation, concordance between treatment preference and surgery received, and trends in health-related QoL (HRQL) among a prospective cohort of women newly diagnosed with DCIS. Methods: A prospective nonrandomized clinical trial by the ECOG-ACRIN Cancer Research Group (E4112) enrolled women diagnosed with unilateral DCIS from 75 institutions between March 2015 and April 2016. Participants underwent either wide local excision (WLE) or mastectomy. Surveys queried patient-reported outcomes (PRO) including treatment preference and concerns, and HRQL before and after surgery. Logistic regression models were used to associate surgery preference and actual surgery received with demographic, clinical and PRO data. Change from baseline in HRQL was assessed using linear regression. Results: At study entry, age (OR 0.39, per 5-year increment, 95%CI, 0.21-0.75; p = 0.005) and treatment goals related to the importance of keeping one’s breast (OR 0.51, 95%CI 0.34-0.76; p = 0.001) and removal of the breast for peace of mind (OR 1.46, 95%CI 1.09-1.95; p = 0.01) drove surgery preference for mastectomy vs. WLE. After receipt of MRI and surgeon consultation, surgery preference was primarily mediated by MRI upstaging (OR 11.18, 95%CI 3.19-39.16; p < 0.001). Only 4% of women received a type of surgery that did not match their final treatment preference. The strongest predictors of actual surgery received were MRI upstaging (OR 15.80, 95%CI 4.85-51.46) and surgeon recommendation of mastectomy (OR 4.60, 95%CI 1.52-13.94). Receipt of a single surgery was associated with significantly improved mental health from baseline to one year after definitive surgery (p = 0.02 for mastectomy; p = 0.003 for single WLE). Self-reported Black race was an independent predictor of worsened mental (p = 0.001) and physical (p = 0.04) health at one year after definitive surgery, despite no significant racial differences in baseline HRQL. Conclusions: Our findings highlight the importance of communication between providers and patients regarding treatment preferences and goals, the clinical significance of MRI findings, and the benefits/risks of available treatment options. Future research to identify modifiable factors associated with declining mental and physical health is needed to inform targeted interventions to mitigate racial disparities and enhance HRQL in patients with DCIS.
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Affiliation(s)
- Soudabeh Fazeli
- University of California San Diego Medical Center, San Diego, CA
| | | | - Ilana F. Gareen
- Brown University–ECOG-ACRIN Biostatistics Center, Providence, RI
| | | | | | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI
| | | | | | - Habib Rahbar
- University of Washington Seattle Cancer Care Alliance, Seattle, WA
| | | | | | | | | | | | - Kathy Miller
- Indiana University Simon Cancer Center Indianapolis, Indianapolis, IN
| | - Joseph A. Sparano
- Montefiore Medical Center/Albert Einstein College of Medicine/Albert Einstein Cancer Center, Bronx, NY
| | | | | | - Ruth Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor, MI
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11
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Billatos E, Ash SY, Duan F, Xu K, Romanoff J, Marques H, Moses E, Han MK, Regan EA, Bowler RP, Mason SE, Doyle TJ, San José Estépar R, Rosas IO, Ross JC, Xiao X, Liu H, Liu G, Sukumar G, Wilkerson M, Dalgard C, Stevenson C, Whitney D, Aberle D, Spira A, San José Estépar R, Lenburg ME, Washko GR. Distinguishing Smoking-Related Lung Disease Phenotypes Via Imaging and Molecular Features. Chest 2021; 159:549-563. [PMID: 32946850 PMCID: PMC8039011 DOI: 10.1016/j.chest.2020.08.2115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/14/2019] [Revised: 08/11/2020] [Accepted: 08/15/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Chronic tobacco smoke exposure results in a broad range of lung pathologies including emphysema, airway disease and parenchymal fibrosis as well as a multitude of extra-pulmonary comorbidities. Prior work using CT imaging has identified several clinically relevant subgroups of smoking related lung disease, but these investigations have generally lacked organ specific molecular correlates. RESEARCH QUESTION Can CT imaging be used to identify clinical phenotypes of smoking related lung disease that have specific bronchial epithelial gene expression patterns to better understand disease pathogenesis? STUDY DESIGN AND METHODS Using K-means clustering, we clustered participants from the COPDGene study (n = 5,273) based on CT imaging characteristics and then evaluated their clinical phenotypes. These clusters were replicated in the Detection of Early Lung Cancer Among Military Personnel (DECAMP) cohort (n = 360), and were further characterized using bronchial epithelial gene expression. RESULTS Three clusters (preserved, interstitial predominant and emphysema predominant) were identified. Compared to the preserved cluster, the interstitial and emphysema clusters had worse lung function, exercise capacity and quality of life. In longitudinal follow-up, individuals from the emphysema group had greater declines in exercise capacity and lung function, more emphysema, more exacerbations, and higher mortality. Similarly, genes involved in inflammatory pathways (tumor necrosis factor-α, interferon-β) are more highly expressed in bronchial epithelial cells from individuals in the emphysema cluster, while genes associated with T-cell related biology are decreased in these samples. Samples from individuals in the interstitial cluster generally had intermediate levels of expression of these genes. INTERPRETATION Using quantitative CT imaging, we identified three groups of individuals in older ever-smokers that replicate in two cohorts. Airway gene expression differences between the three groups suggests increased levels of inflammation in the most severe clinical phenotype, possibly mediated by the tumor necrosis factor-α and interferon-β pathways. CLINICAL TRIAL REGISTRATION COPDGene (NCT00608764), DECAMP-1 (NCT01785342), DECAMP-2 (NCT02504697).
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Affiliation(s)
- Ehab Billatos
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Boston University, Boston, MA; Department of Medicine, Section of Computational Biomedicine, Boston University, Boston, MA.
| | - Samuel Y Ash
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Fenghai Duan
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI
| | - Ke Xu
- Department of Medicine, Section of Computational Biomedicine, Boston University, Boston, MA; Bioinformatics Program, Boston University College of Engineering, Boston, MA
| | - Justin Romanoff
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI
| | - Helga Marques
- Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI
| | - Elizabeth Moses
- Department of Medicine, Section of Computational Biomedicine, Boston University, Boston, MA
| | - MeiLan K Han
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI
| | - Elizabeth A Regan
- Department of Medicine, Division of Rheumatology, National Jewish Health, Denver, CO
| | - Russell P Bowler
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
| | - Stefanie E Mason
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Tracy J Doyle
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - Rubén San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Ivan O Rosas
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA
| | - James C Ross
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
| | - Xiaohui Xiao
- Department of Medicine, Section of Computational Biomedicine, Boston University, Boston, MA
| | - Hanqiao Liu
- Department of Medicine, Section of Computational Biomedicine, Boston University, Boston, MA
| | - Gang Liu
- Department of Medicine, Section of Computational Biomedicine, Boston University, Boston, MA
| | - Gauthaman Sukumar
- Department of Anatomy, Physiology & Genetics, The American Genome Center, Collaborative Health Initiative Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Matthew Wilkerson
- Department of Anatomy, Physiology & Genetics, The American Genome Center, Collaborative Health Initiative Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD
| | - Clifton Dalgard
- Department of Anatomy, Physiology & Genetics, The American Genome Center, Collaborative Health Initiative Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD
| | | | - Duncan Whitney
- Lung Cancer Initiative at Johnson & Johnson, New Brunswick, NJ
| | - Denise Aberle
- Department of Radiology, University of California at Los Angeles, Los Angeles, CA
| | - Avrum Spira
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, Boston University, Boston, MA; Department of Medicine, Section of Computational Biomedicine, Boston University, Boston, MA; Lung Cancer Initiative at Johnson & Johnson, New Brunswick, NJ
| | - Raúl San José Estépar
- Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Marc E Lenburg
- Department of Medicine, Section of Computational Biomedicine, Boston University, Boston, MA; Bioinformatics Program, Boston University College of Engineering, Boston, MA
| | - George R Washko
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA; Applied Chest Imaging Laboratory, Brigham and Women's Hospital, Boston, MA
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12
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Whisenant JG, Romanoff J, Rahbar H, Kitsch AE, Harvey SM, Moy L, DeMartini WB, Dogan BE, Yang WT, Wang LC, Joe BN, Wilmes LJ, Hylton NM, Oh KY, Tudorica LA, Neal CH, Malyarenko DI, McDonald ES, Comstock CE, Yankeelov TE, Chenevert TL, Partridge SC. Factors Affecting Image Quality and Lesion Evaluability in Breast Diffusion-weighted MRI: Observations from the ECOG-ACRIN Cancer Research Group Multisite Trial (A6702). J Breast Imaging 2021; 3:44-56. [PMID: 33543122 PMCID: PMC7835633 DOI: 10.1093/jbi/wbaa103] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The A6702 multisite trial confirmed that apparent diffusion coefficient (ADC) measures can improve breast MRI accuracy and reduce unnecessary biopsies, but also found that technical issues rendered many lesions non-evaluable on diffusion-weighted imaging (DWI). This secondary analysis investigated factors affecting lesion evaluability and impact on diagnostic performance. METHODS The A6702 protocol was IRB-approved at 10 institutions; participants provided informed consent. In total, 103 women with 142 MRI-detected breast lesions (BI-RADS assessment category 3, 4, or 5) completed the study. DWI was acquired at 1.5T and 3T using a four b-value, echo-planar imaging sequence. Scans were reviewed for multiple quality factors (artifacts, signal-to-noise, misregistration, and fat suppression); lesions were considered non-evaluable if there was low confidence in ADC measurement. Associations of lesion evaluability with imaging and lesion characteristics were determined. Areas under the receiver operating characteristic curves (AUCs) were compared using bootstrapping. RESULTS Thirty percent (42/142) of lesions were non-evaluable on DWI; 23% (32/142) with image quality issues, 7% (10/142) with conspicuity and/or localization issues. Misregistration was the only factor associated with non-evaluability (P = 0.001). Smaller (≤10 mm) lesions were more commonly non-evaluable than larger lesions (p <0.03), though not significant after multiplicity correction. The AUC for differentiating benign and malignant lesions increased after excluding non-evaluable lesions, from 0.61 (95% CI: 0.50-0.71) to 0.75 (95% CI: 0.65-0.84). CONCLUSION Image quality remains a technical challenge in breast DWI, particularly for smaller lesions. Protocol optimization and advanced acquisition and post-processing techniques would help to improve clinical utility.
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Affiliation(s)
- Jennifer G Whisenant
- Vanderbilt University Medical Center, Department of Medicine, Nashville, TN
- Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Justin Romanoff
- Brown University, Center for Statistical Sciences, Providence, RI
| | - Habib Rahbar
- University of Washington, Department of Radiology, Seattle, WA
| | - Averi E Kitsch
- University of Washington, Department of Radiology, Seattle, WA
| | - Sara M Harvey
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN
| | - Linda Moy
- New York University School of Medicine, Department of Radiology, New York, NY
| | - Wendy B DeMartini
- Stanford University School of Medicine, Department of Radiology, Stanford, CA
| | - Basak E Dogan
- University of Texas Southwestern Medical Center, Department of Diagnostic Radiology, Dallas, TX
| | - Wei T Yang
- MD Anderson Cancer Center, Department of Breast Imaging, Houston, TX
| | - Lilian C Wang
- Northwestern University Feinberg School of Medicine, Department of Radiology, Chicago, IL
| | - Bonnie N Joe
- University of California San Francisco School of Medicine, Department of Radiology and Biomedical Engineering, San Francisco, CA
| | - Lisa J Wilmes
- University of California San Francisco School of Medicine, Department of Radiology and Biomedical Engineering, San Francisco, CA
| | - Nola M Hylton
- University of California San Francisco School of Medicine, Department of Radiology and Biomedical Engineering, San Francisco, CA
| | - Karen Y Oh
- Oregon Health and Science University, Department of Radiology, Portland, OR
| | | | - Colleen H Neal
- University of Michigan, Department of Radiology/MRI, Ann Arbor, MI
| | | | - Elizabeth S McDonald
- University of Pennsylvania Perelman School of Medicine, Department of Radiology, Philadelphia, PA
| | | | - Thomas E Yankeelov
- University of Texas Austin, Department of Biomedical Engineering, Austin, TX
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13
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Stack BC, Duan F, Subramaniam RM, Romanoff J, Sicks JD, Bartel T, Chen C, Lowe VJ. FDG-PET/CT and Pathology in Newly Diagnosed Head and Neck Cancer: ACRIN 6685 Trial, FDG-PET/CT cN0. Otolaryngol Head Neck Surg 2020; 164:1230-1239. [PMID: 33231504 DOI: 10.1177/0194599820969104] [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: 11/17/2022]
Abstract
OBJECTIVE FDG-PET/CT (fluorodeoxyglucose-positron emission tomography/computed tomography) is effective to assess for occult neck nodal disease. We report risks and patterns of nodal disease based on primary site and nodal level from data on the dissected cN0 per the results from ACRIN 6685. STUDY DESIGN Prospective nonrandomized enrollment included participants with first-time head and neck squamous cell carcinoma and at least 1 cN0 neck side to be dissected. SETTING Twenty-four ACRIN-certified centers internationally (American College of Radiology Imaging Network). METHODS A total of 287 participants were enrolled. Preoperative FDG-PET/CT findings were centrally reviewed and compared with pathology. Incidence, relative risk, pattern of lymph node involvement, and impact upon neck dissection were reported. RESULTS An overall 983 nodal levels were dissected (n = 261 necks, n = 203 participants). The highest percentages of ipsilateral positive nodes by primary location and nodal level were oral cavity (level I, 17/110, 15.5%), pharynx (level II, 6/30, 20.0%), and larynx (level VI, 1/3, 33.3%). CONCLUSION Levels at greatest risk for nodal disease in cN0 in terms of ipsilateral neck dissection are level I (oral cavity), II (pharynx), and VI (larynx). These data should be considered when treating patients presenting with cN0. This is the first study to comprehensively report the incidence, location, and risk of metastases in cN0 in the FDG-PET/CT era.
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Affiliation(s)
- Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Southern Illinois University, Springfield, Illinois, USA
| | - Fenghai Duan
- Department of Biostatistics and Center for Statistical Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Rathan M Subramaniam
- Division of Nuclear Medicine, Department of Radiology and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Justin Romanoff
- Center for Statistical Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - JoRean D Sicks
- Center for Statistical Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Twyla Bartel
- Global Advanced Imaging, PLLC, Tulsa, Oklahoma, USA
| | - Chien Chen
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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14
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McDonald ES, Romanoff J, Rahbar H, Kitsch AE, Harvey SM, Whisenant JG, Yankeelov TE, Moy L, DeMartini WB, Dogan BE, Yang WT, Wang LC, Joe BN, Wilmes LJ, Hylton NM, Oh KY, Tudorica LA, Neal CH, Malyarenko DI, Comstock CE, Schnall MD, Chenevert TL, Partridge SC. Mean Apparent Diffusion Coefficient Is a Sufficient Conventional Diffusion-weighted MRI Metric to Improve Breast MRI Diagnostic Performance: Results from the ECOG-ACRIN Cancer Research Group A6702 Diffusion Imaging Trial. Radiology 2020; 298:60-70. [PMID: 33201788 DOI: 10.1148/radiol.2020202465] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background The Eastern Cooperative Oncology Group and American College of Radiology Imaging Network Cancer Research Group A6702 multicenter trial helped confirm the potential of diffusion-weighted MRI for improving differential diagnosis of suspicious breast abnormalities and reducing unnecessary biopsies. A prespecified secondary objective was to explore the relative value of different approaches for quantitative assessment of lesions at diffusion-weighted MRI. Purpose To determine whether alternate calculations of apparent diffusion coefficient (ADC) can help further improve diagnostic performance versus mean ADC values alone for analysis of suspicious breast lesions at MRI. Materials and Methods This prospective trial (ClinicalTrials.gov identifier: NCT02022579) enrolled consecutive women (from March 2014 to April 2015) with a Breast Imaging Reporting and Data System category of 3, 4, or 5 at breast MRI. All study participants underwent standardized diffusion-weighted MRI (b = 0, 100, 600, and 800 sec/mm2). Centralized ADC measures were performed, including manually drawn whole-lesion and hotspot regions of interest, histogram metrics, normalized ADC, and variable b-value combinations. Diagnostic performance was estimated by using the area under the receiver operating characteristic curve (AUC). Reduction in biopsy rate (maintaining 100% sensitivity) was estimated according to thresholds for each ADC metric. Results Among 107 enrolled women, 81 lesions with outcomes (28 malignant and 53 benign) in 67 women (median age, 49 years; interquartile range, 41-60 years) were analyzed. Among ADC metrics tested, none improved diagnostic performance versus standard mean ADC (AUC, 0.59-0.79 vs AUC, 0.75; P = .02-.84), and maximum ADC had worse performance (AUC, 0.52; P < .001). The 25th-percentile ADC metric provided the best performance (AUC, 0.79; 95% CI: 0.70, 0.88), and a threshold using median ADC provided the greatest reduction in biopsy rate of 23.9% (95% CI: 14.8, 32.9; 16 of 67 BI-RADS category 4 and 5 lesions). Nonzero minimum b value (100, 600, and 800 sec/mm2) did not improve the AUC (0.74; P = .28), and several combinations of two b values (0 and 600, 100 and 600, 0 and 800, and 100 and 800 sec/mm2; AUC, 0.73-0.76) provided results similar to those seen with calculations of four b values (AUC, 0.75; P = .17-.87). Conclusion Mean apparent diffusion coefficient calculated with a two-b-value acquisition is a simple and sufficient diffusion-weighted MRI metric to augment diagnostic performance of breast MRI compared with more complex approaches to apparent diffusion coefficient measurement. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Elizabeth S McDonald
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Justin Romanoff
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Habib Rahbar
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Averi E Kitsch
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Sara M Harvey
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Jennifer G Whisenant
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Thomas E Yankeelov
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Linda Moy
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Wendy B DeMartini
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Basak E Dogan
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Wei T Yang
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Lilian C Wang
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Bonnie N Joe
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Lisa J Wilmes
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Nola M Hylton
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Karen Y Oh
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Luminita A Tudorica
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Colleen H Neal
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Dariya I Malyarenko
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Christopher E Comstock
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Mitchell D Schnall
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Thomas L Chenevert
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
| | - Savannah C Partridge
- From the Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa (E.S.M., M.D.S.); Center for Statistical Sciences, Brown University, Providence, RI (J.R.); Department of Radiology, University of Washington, 1144 Eastlake Ave E, LG2-200, Seattle, WA 98109 (H.R., A.E.K., S.C.P.); Departments of Radiology and Radiological Sciences (S.M.H.) and Medicine (J.G.W.), Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt-Ingram Cancer Center, Nashville, Tenn (J.G.W.); Department of Biomedical Engineering, University of Texas, Austin, Tex (T.E.Y.); Department of Radiology, New York University School of Medicine, New York, NY (L.M.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (W.B.D.); Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (B.E.D.); Department of Breast Imaging, MD Anderson Cancer Center, Houston, Tex (W.T.Y.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (L.C.W.); Department of Radiology and Biomedical Imaging, University of California, San Francisco School of Medicine, San Francisco, Calif (B.N.J., L.J.W., N.M.H.); Department of Radiology, Oregon Health and Science University, Portland, Ore (K.Y.O., L.A.T.); Department of Radiology/MRI, University of Michigan, Ann Arbor, Mich (C.H.N., D.I.M., T.L.C.); and Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY (C.E.C.)
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15
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Lehman CD, Gatsonis C, Romanoff J, Khan SA, Carlos R, Solin LJ, Badve S, McCaskill-Stevens W, Corsetti RL, Rahbar H, Spell DW, Blankstein KB, Han LK, Sabol JL, Bumberry JR, Gareen I, Snyder BS, Wagner LI, Miller KD, Sparano JA, Comstock C. Association of Magnetic Resonance Imaging and a 12-Gene Expression Assay With Breast Ductal Carcinoma In Situ Treatment. JAMA Oncol 2020; 5:1036-1042. [PMID: 30653209 DOI: 10.1001/jamaoncol.2018.6269] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Importance Advanced diagnostics, such as magnetic resonance imaging (MRI) and gene expression profiles, are potentially useful to guide targeted treatment in patients with ductal carcinoma in situ (DCIS). Objectives To examine the proportion of patients who converted to mastectomy after MRI and the reasons for those conversions and to measure patient adherence to radiotherapy guided by the 12-gene DCIS score. Design, Setting, and Participants Analysis of a prospective, cohort, nonrandomized clinical trial that enrolled women with DCIS on core biopsy who were candidates for wide local excision (WLE) from 75 institutions from March 25, 2015, to April 27, 2016, through the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network trial E4112. Interventions Participants underwent breast MRI before surgery, and subsequent management incorporated MRI findings for choice of surgery. The DCIS score was used to guide radiotherapy recommendations among women with DCIS who had WLE as the final procedure and had tumor-free excision margins of 2 mm or greater. Main Outcomes and Measures The primary end point was to estimate the conversion rate to mastectomy and the reason for conversion. Results Of 339 evaluable women (mean [SD] age, 59.1 [10.1] years; 262 [77.3%] of European descent) eligible for WLE before MRI, 65 (19.2%; 95% CI, 15.3%-23.7%) converted to mastectomy. Of these 65 patients, conversion was based on MRI findings in 25 (38.5%), patient preference in 25 (38.5%), positive margins after attempted WLE in 10 (15.4%), positive genetic test results in 3 (4.6%), and contraindication to radiotherapy in 2 (3.1%). Among the 285 who had WLE performed after MRI as the first surgical procedure, 274 (96.1%) achieved successful breast conservation. Of 171 women eligible for radiotherapy guided by DCIS score (clear margins, absence of invasive disease, and score obtained), the score was low (<39) in 82 (48.0%; 95% CI, 40.6%-55.4%) and intermediate-high (≥39) in 89 (52.0%; 95% CI, 44.6%-59.4%). Of these 171 patients, 159 (93.0%) were adherent with recommendations. Conclusions and Relevance Among women with DCIS who were WLE candidates based on conventional imaging, multiple factors were associated with conversion to mastectomy. This study may provide useful preliminary information required for designing a planned randomized clinical trial to determine the effect of MRI and DCIS score on surgical management, radiotherapy, overall resource use, and clinical outcomes, with the ultimate goal of achieving greater therapeutic precision. Trial Registration ClinicalTrials.gov identifier: NCT02352883.
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Affiliation(s)
- Constance D Lehman
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Constantine Gatsonis
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Seema A Khan
- Department of Surgery, Northwestern University, Chicago, Illinois
| | - Ruth Carlos
- Department of Radiology, University of Michigan, Ann Arbor
| | - Lawrence J Solin
- Department of Radiation Oncology, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - Sunil Badve
- Department of Pathology, Indiana University, Indianapolis
| | | | - Ralph L Corsetti
- Department of Surgical Oncology, Ochsner Medical Center, New Orleans, Louisiana
| | - Habib Rahbar
- Department of Radiology, University of Washington, Seattle
| | - Derrick W Spell
- Gulf South National Cancer Institute Community Oncology Research Program, New Orleans, Louisiana
| | - Kenneth B Blankstein
- Department of Medical Oncology, Hunterdon Medical Center, Flemington, New Jersey
| | - Linda K Han
- Department of Pathology, Indiana University, Indianapolis
| | - Jennifer L Sabol
- Department of Surgical Oncology, Lankenau Medical Center, Wynnewood, Pennsylvania
| | - John R Bumberry
- Department of Surgery, Mercy Hospital, Springfield, Missouri
| | - Ilana Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Bradley S Snyder
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Lynne I Wagner
- Department of Social Science and Health Policy, Wake Forest University Health Sciences, Winston Salem, North Carolina
| | - Kathy D Miller
- Department of Pathology, Indiana University, Indianapolis
| | - Joseph A Sparano
- Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Christopher Comstock
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
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16
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Rabinovici GD, Gatsonis C, Apgar C, Chaudhary K, Gareen I, Hanna L, Hendrix J, Hillner BE, Olson C, Lesman-Segev OH, Romanoff J, Siegel BA, Whitmer RA, Carrillo MC. Association of Amyloid Positron Emission Tomography With Subsequent Change in Clinical Management Among Medicare Beneficiaries With Mild Cognitive Impairment or Dementia. JAMA 2019; 321:1286-1294. [PMID: 30938796 PMCID: PMC6450276 DOI: 10.1001/jama.2019.2000] [Citation(s) in RCA: 312] [Impact Index Per Article: 62.4] [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] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Amyloid positron emission tomography (PET) detects amyloid plaques in the brain, a core neuropathological feature of Alzheimer disease. OBJECTIVE To determine if amyloid PET is associated with subsequent changes in the management of patients with mild cognitive impairment (MCI) or dementia of uncertain etiology. DESIGN, SETTING, AND PARTICIPANTS The Imaging Dementia-Evidence for Amyloid Scanning (IDEAS) study was a single-group, multisite longitudinal study that assessed the association between amyloid PET and subsequent changes in clinical management for Medicare beneficiaries with MCI or dementia. Participants were required to meet published appropriate use criteria stating that etiology of cognitive impairment was unknown, Alzheimer disease was a diagnostic consideration, and knowledge of PET results was expected to change diagnosis and management. A total of 946 dementia specialists at 595 US sites enrolled 16 008 patients between February 2016 and September 2017. Patients were followed up through January 2018. Dementia specialists documented their diagnosis and management plan before PET and again 90 (±30) days after PET. EXPOSURES Participants underwent amyloid PET at 343 imaging centers. MAIN OUTCOMES AND MEASURES The primary end point was change in management between the pre- and post-PET visits, as assessed by a composite outcome that included Alzheimer disease drug therapy, other drug therapy, and counseling about safety and future planning. The study was powered to detect a 30% or greater change in the MCI and dementia groups. One of 2 secondary end points is reported: the proportion of changes in diagnosis (from Alzheimer disease to non-Alzheimer disease and vice versa) between pre- and post-PET visits. RESULTS Among 16 008 registered participants, 11 409 (71.3%) completed study procedures and were included in the analysis (median age, 75 years [interquartile range, 71-80]; 50.9% women; 60.5% with MCI). Amyloid PET results were positive in 3817 patients with MCI (55.3%) and 3154 patients with dementia (70.1%). The composite end point changed in 4159 of 6905 patients with MCI (60.2% [95% CI, 59.1%-61.4%]) and 2859 of 4504 patients with dementia (63.5% [95% CI, 62.1%-64.9%]), significantly exceeding the 30% threshold in each group (P < .001, 1-sided). The etiologic diagnosis changed from Alzheimer disease to non-Alzheimer disease in 2860 of 11 409 patients (25.1% [95% CI, 24.3%-25.9%]) and from non-Alzheimer disease to Alzheimer disease in 1201 of 11 409 (10.5% [95% CI, 10.0%-11.1%]). CONCLUSIONS AND RELEVANCE Among Medicare beneficiaries with MCI or dementia of uncertain etiology evaluated by dementia specialists, the use of amyloid PET was associated with changes in clinical management within 90 days. Further research is needed to determine whether amyloid PET is associated with improved clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02420756.
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Affiliation(s)
- Gil D. Rabinovici
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
- Associate Editor, JAMA Neurology
| | - Constantine Gatsonis
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | | | - Kiran Chaudhary
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Ilana Gareen
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Lucy Hanna
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | | | - Bruce E. Hillner
- Department of Medicine, Virginia Commonwealth University, Richmond
| | | | - Orit H. Lesman-Segev
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Barry A. Siegel
- Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Rachel A. Whitmer
- Division of Research, Kaiser Permanente, Oakland, California
- Department of Public Health Sciences, University of California, Davis
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17
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Lowe VJ, Duan F, Subramaniam RM, Sicks JD, Romanoff J, Bartel T, Yu JQM, Nussenbaum B, Richmon J, Arnold CD, Cognetti D, Stack BC. Multicenter Trial of [ 18F]fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Staging of Head and Neck Cancer and Negative Predictive Value and Surgical Impact in the N0 Neck: Results From ACRIN 6685. J Clin Oncol 2019; 37:1704-1712. [PMID: 30768363 DOI: 10.1200/jco.18.01182] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The objective of this study was to determine the negative predictive value (NPV) of positron emission tomography (PET)/computed tomography (CT) for the clinically N0 neck on the basis of neck dissection. METHODS Participants with newly diagnosed, first-time, head and neck squamous cell carcinoma (HNSCC) and at least one clinically N0 neck side for which dissection was planned were included. A total of 287 participants were prospectively enrolled from 23 American College of Radiology Imaging Network-qualified institutions. PET/CT was compared with findings at neck dissection. RESULTS PET/CT scans and pathology findings were available for 270 N0 neck sides from 212 participants. For visual assessment, the NPV specific to the clinical-N0 sides was 0.868 (95% CI, 0.803 to 0.925). For dichotomized maximum standardized uptake value, the NPVs specific to the nodal basins were 0.940 (95% CI, 0.928 to 0.952) and 0.937 (95% CI, 0.925 to 0.949) at prespecified cutoffs of 2.5 and 3.5, respectively. The optimal cutoff maximum standardized uptake value was determined to be 1.8, with an NPV of 0.942 (95% CI, 0.930 to 0.953). The PET/CT-informed surgical treatment plan was changed in 51 of 237 participants (22%) compared with the PET/CT-blinded surgical plan. In 34 participants (14%), this led to planned dissection of additional nodal levels. In 12 participants (5%), this led to fewer planned dissected nodal levels. Negative PET/CT scans in N0 necks was true negative in 87% and false negative in 13%. CONCLUSION [18F]fluorodeoxyglucose-PET/CT has high NPV for the N0 neck in T2 to T4 HNSCC. The surgical treatment plans on the basis of PET/CT findings may be changed in approximately 22% of this group. These findings suggest that [18F]fluorodeoxyglucose-PET/CT may assist the clinician in deciding on the best therapy for the clinically N0 neck in HNSCC. Well-designed clinical trials should be performed to test the outcome of omitting neck dissection by using PET/CT.
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Affiliation(s)
| | - Fenghai Duan
- 2 Brown University School of Public Health, Providence, RI
| | | | - JoRean D Sicks
- 2 Brown University School of Public Health, Providence, RI
| | | | | | | | | | | | | | - David Cognetti
- 9 Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA
| | - Brendan C Stack
- 10 University of Arkansas for Medical Sciences, Little Rock, AR
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18
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Rahbar H, Zhang Z, Chenevert TL, Romanoff J, Kitsch AE, Hanna LG, Harvey SM, Moy L, DeMartini WB, Dogan B, Yang WT, Wang LC, Joe BN, Oh KY, Neal CH, McDonald ES, Schnall MD, Lehman CD, Comstock CE, Partridge SC. Utility of Diffusion-weighted Imaging to Decrease Unnecessary Biopsies Prompted by Breast MRI: A Trial of the ECOG-ACRIN Cancer Research Group (A6702). Clin Cancer Res 2019; 25:1756-1765. [PMID: 30647080 DOI: 10.1158/1078-0432.ccr-18-2967] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/05/2018] [Accepted: 11/30/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Conventional breast MRI is highly sensitive for cancer detection but prompts some false positives. We performed a prospective, multicenter study to determine whether apparent diffusion coefficients (ADCs) from diffusion-weighted imaging (DWI) can decrease MRI false positives.Experimental Design: A total of 107 women with MRI-detected BI-RADS 3, 4, or 5 lesions were enrolled from March 2014 to April 2015. ADCs were measured both centrally and at participating sites. ROC analysis was employed to assess diagnostic performance of centrally measured ADCs and identify optimal ADC thresholds to reduce unnecessary biopsies. Lesion reference standard was based on either definitive biopsy result or at least 337 days of follow-up after the initial MRI procedure. RESULTS Of 107 women enrolled, 67 patients (median age 49, range 24-75 years) with 81 lesions with confirmed reference standard (28 malignant, 53 benign) and evaluable DWI were analyzed. Sixty-seven of 81 lesions were BI-RADS 4 (n = 63) or 5 (n = 4) and recommended for biopsy. Malignancies exhibited lower mean in centrally measured ADCs (mm2/s) than benign lesions [1.21 × 10-3 vs.1.47 × 10-3; P < 0.0001; area under ROC curve = 0.75; 95% confidence interval (CI) 0.65-0.84]. In centralized analysis, application of an ADC threshold (1.53 × 10-3 mm2/s) lowered the biopsy rate by 20.9% (14/67; 95% CI, 11.2%-31.2%) without affecting sensitivity. Application of a more conservative threshold (1.68 × 10-3 mm2/s) to site-measured ADCs reduced the biopsy rate by 26.2% (16/61) but missed three cancers. CONCLUSIONS DWI can reclassify a substantial fraction of suspicious breast MRI findings as benign and thereby decrease unnecessary biopsies. ADC thresholds identified in this trial should be validated in future phase III studies.
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Affiliation(s)
- Habib Rahbar
- University of Washington School of Medicine, Seattle, Washington.
| | - Zheng Zhang
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | | | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Averi E Kitsch
- University of Washington School of Medicine, Seattle, Washington
| | - Lucy G Hanna
- Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Sara M Harvey
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Linda Moy
- New York University School of Medicine, New York, New York
| | - Wendy B DeMartini
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Wei T Yang
- MD Anderson Cancer Center, Houston, Texas
| | - Lilian C Wang
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bonnie N Joe
- University of California, San Francisco School of Medicine, San Francisco, California
| | - Karen Y Oh
- Oregon Health Sciences University, Portland, Oregon
| | - Colleen H Neal
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Elizabeth S McDonald
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Mitchell D Schnall
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Constance D Lehman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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19
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Partridge SC, Zhang Z, Newitt DC, Gibbs JE, Chenevert TL, Rosen MA, Bolan PJ, Marques HS, Romanoff J, Cimino L, Joe BN, Umphrey HR, Ojeda-Fournier H, Dogan B, Oh K, Abe H, Drukteinis JS, Esserman LJ, Hylton NM. Diffusion-weighted MRI Findings Predict Pathologic Response in Neoadjuvant Treatment of Breast Cancer: The ACRIN 6698 Multicenter Trial. Radiology 2018; 289:618-627. [PMID: 30179110 PMCID: PMC6283325 DOI: 10.1148/radiol.2018180273] [Citation(s) in RCA: 154] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/12/2018] [Accepted: 07/18/2018] [Indexed: 01/06/2023]
Abstract
Purpose To determine if the change in tumor apparent diffusion coefficient (ADC) at diffusion-weighted (DW) MRI is predictive of pathologic complete response (pCR) to neoadjuvant chemotherapy for breast cancer. Materials and Methods In this prospective multicenter study, 272 consecutive women with breast cancer were enrolled at 10 institutions (from August 2012 to January 2015) and were randomized to treatment with 12 weekly doses of paclitaxel (with or without an experimental agent), followed by 12 weeks of treatment with four cycles of anthracycline. Each woman underwent breast DW MRI before treatment, at early treatment (3 weeks), at midtreatment (12 weeks), and after treatment. Percentage change in tumor ADC from that before treatment (ΔADC) was measured at each time point. Performance for predicting pCR was assessed by using the area under the receiver operating characteristic curve (AUC) for the overall cohort and according to tumor hormone receptor (HR)/human epidermal growth factor receptor 2 (HER2) disease subtype. Results The final analysis included 242 patients with evaluable serial imaging data, with a mean age of 48 years ± 10 (standard deviation); 99 patients had HR-positive (hereafter, HR+)/HER2-negative (hereafter, HER2-) disease, 77 patients had HR-/HER2- disease, 42 patients had HR+/HER2+ disease, and 24 patients had HR-/HER2+ disease. Eighty (33%) of 242 patients experienced pCR. Overall, ΔADC was moderately predictive of pCR at midtreatment/12 weeks (AUC = 0.60; 95% confidence interval [CI]: 0.52, 0.68; P = .017) and after treatment (AUC = 0.61; 95% CI: 0.52, 0.69; P = .013). Across the four disease subtypes, midtreatment ΔADC was predictive only for HR+/HER2- tumors (AUC = 0.76; 95% CI: 0.62, 0.89; P < .001). In a test subset, a model combining tumor subtype and midtreatment ΔADC improved predictive performance (AUC = 0.72; 95% CI: 0.61, 0.83) over ΔADC alone (AUC = 0.57; 95% CI: 0.44, 0.70; P = .032.). Conclusion After 12 weeks of therapy, change in breast tumor apparent diffusion coefficient at MRI predicts complete pathologic response to neoadjuvant chemotherapy. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Savannah C. Partridge
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Zheng Zhang
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - David C. Newitt
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Jessica E. Gibbs
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Thomas L. Chenevert
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Mark A. Rosen
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Patrick J. Bolan
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Helga S. Marques
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Justin Romanoff
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Lisa Cimino
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Bonnie N. Joe
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Heidi R. Umphrey
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Haydee Ojeda-Fournier
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Basak Dogan
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Karen Oh
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Hiroyuki Abe
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Jennifer S. Drukteinis
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Laura J. Esserman
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - Nola M. Hylton
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
| | - For the ACRIN 6698 Trial Team and I-SPY 2 Trial Investigators
- From the Department of Radiology, University of Washington, 825
Eastlake Ave E, G2-600, Seattle, WA 98109 (S.C.P.); Department of Biostatistics
(Z.Z.) and Center for Statistical Sciences (Z.Z., H.S.M., J.R.), Brown
University, Providence, RI; American College of Radiology Imaging Network
(ACRIN), Reston, Va (Z.Z., H.S.M., J.R.); Department of Radiology and Biomedical
Imaging, University of California, San Francisco, San Francisco, Calif (D.C.N.,
J.E.G., B.N.J., L.J.E., N.M.H.); Department of Radiology/MRI, University of
Michigan, Ann Arbor, Mich (T.L.C.); Department of Radiology, University of
Pennsylvania, Philadelphia, Pa (M.A.R.); Department of Radiology, Center for
Magnetic Resonance Research, University of Minnesota, Minneapolis, Minn
(P.J.B.); American College of Radiology and ECOG-ACRIN Cancer Research Group,
Reston, Va (L.C.); Department of Radiology, University of Alabama, Birmingham,
Birmingham, Ala (H.R.U.); Department of Radiology, University of California, San
Diego, San Diego, Calif (H.O.); Department of Radiology, University of Texas MD
Anderson Cancer Center, Houston, Tex and the University of Texas Southwestern
Medical Center, Dallas, Tex (B.D.); Department of Radiology, Oregon Health and
Science University, Portland, Ore (K.O.); Department of Radiology, University of
Chicago, Chicago, Ill (H.A.); and Department of Diagnostic Radiology, H. Lee
Moffitt Cancer Center and Research Institute, Tampa, Fla and Department of
Women’s Imaging, St Joseph’s Women’s Hospital, Tampa, Fla (J.S.D.)
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20
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Merchant RC, Clark MA, Liu T, Romanoff J, Rosenberger JG, Bauermeister J, Mayer KH. Comparison of Home-Based Oral Fluid Rapid HIV Self-Testing Versus Mail-in Blood Sample Collection or Medical/Community HIV Testing By Young Adult Black, Hispanic, and White MSM: Results from a Randomized Trial. AIDS Behav 2018; 22:337-346. [PMID: 28540562 DOI: 10.1007/s10461-017-1802-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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] [Indexed: 11/26/2022]
Abstract
We aimed to determine in a randomized trial if young adult black, Hispanic, and white men-who-have-sex-with-men (YMSM) are more likely to complete home-based oral fluid rapid HIV self-testing than either mail-in blood sample collection or medical facility/community organization-based HIV testing. Stratified by race/ethnicity, participants were randomly assigned to use a free oral fluid rapid HIV self-test (n = 142), a free mail-in blood sample collection HIV test (n = 142), or be tested at a medical facility/community organization of their choice (n = 141). Of the 425 participants, completion of assigned test (66% oral fluid vs. 40% mail-in blood sample vs. 56% medical facility/community), willingness to refer (36% oral fluid vs. 20% mail-in blood sample vs. 26% medical facility/community), and legitimate referrals (58% oral fluid vs. 43% mail-in blood sample vs. 43% medical facility/community) were greater in the oral fluid rapid HIV self-test than the mail-in blood sample collection HIV test arm, but not the medical facility/community testing arm. There were no differences in assigned test completion by race/ethnicity. Although free home-based oral fluid rapid HIV self-testing showed moderate promise in facilitating HIV testing among black, Hispanic, and white YMSM, it did not lead to greater testing than directing these YMSM to medical facility/community HIV testing venues. ClinicalTrials.gov Identifier: NCT02369627.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, USA.
- Department of Epidemiology, School of Public Health, Brown University, Providence, USA.
- Department of Emergency Medicine, Rhode Island Hospital, 593 Eddy Street, Claverick Bldg., Providence, RI, 02903, USA.
| | - Melissa A Clark
- Department of Quantitative Health Sciences and Center for Health Policy and Research, University of Massachusetts Medical School, Worcester, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, USA
| | - Justin Romanoff
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, State College, USA
| | - Jose Bauermeister
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Kenneth H Mayer
- Fenway Health, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, USA
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21
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Merchant RC, Romanoff J, Zhang Z, Liu T, Baird JR. Impact of a brief intervention on reducing alcohol use and increasing alcohol treatment services utilization among alcohol- and drug-using adult emergency department patients. Alcohol 2017; 65:71-80. [PMID: 29084632 PMCID: PMC5681406 DOI: 10.1016/j.alcohol.2017.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/24/2016] [Revised: 05/30/2017] [Accepted: 07/13/2017] [Indexed: 11/22/2022]
Abstract
Most previous brief intervention (BI) studies have focused on alcohol or drug use, instead of both substances. Our primary aim was to determine if an alcohol- and drug-use BI reduced alcohol use and increased alcohol treatment services utilization among adult emergency department (ED) patients who drink alcohol and require an intervention for their drug use. Our secondary aims were to assess when the greatest relative reductions in alcohol use occurred, and which patients (stratified by need for an alcohol use intervention) reduced their alcohol use the most. In this secondary analysis, we studied a sub-sample of participants from the Brief Intervention for Drug Misuse in the Emergency Department (BIDMED) randomized, controlled trial of a BI vs. no BI, whose responses to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) indicated a need for a BI for any drug use, and who also reported alcohol use. Participants were stratified by their ASSIST alcohol subscore: 1) no BI needed, 2) a BI needed, or 3) an intensive intervention needed for alcohol use. Alcohol use and alcohol treatment services utilization were measured every 3 months for 12 months post-enrollment. Of these 833 participants, median age was 29 years-old, 46% were female; 55% were white/non-Hispanic, 27% black/non-Hispanic, and 15% Hispanic. Although any alcohol use, alcohol use frequency, days of alcohol use, typical drinks consumed/day, and most drinks consumed/day decreased in both the BI and no BI arms, there were no differences between study arms. Few patients sought alcohol use treatment services in follow-up, and utilization also did not differ by study arm. Compared to baseline, alcohol use reduced the most during the first 3 months after enrollment, yet reduced little afterward. Participants whose ASSIST alcohol subscores indicated a need for an intensive intervention generally had the greatest relative decreases in alcohol use. These results indicate that the BI was not efficacious in reducing alcohol use among alcohol- and drug-using adult ED patients than the self-assessments alone, but suggest that self-assessments with or without a BI may confer reductions in alcohol use.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA; Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
| | - Justin Romanoff
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Zihao Zhang
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Janette R Baird
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI, USA
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22
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Merchant RC, Romanoff J, Clark MA, Liu T, Rosenberger JG, Bauermeister J, Mayer KH. Variations in Recruitment Yield and Characteristics of Participants Recruited Across Diverse Internet Platforms in an HIV Testing Study of Young Adult Men-Who-Have-Sex-With-Men (YMSM). Am J Mens Health 2017; 11:1342-1357. [PMID: 28691552 PMCID: PMC5675213 DOI: 10.1177/1557988317717383] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 11/16/2022] Open
Abstract
The Internet is a commonly used medium for recruiting geographically dispersed, smaller populations quickly, such as young adult men-who-have-sex-with-men (YMSM). One approach to improve reach and representativeness is to employ multiple Internet platforms to recruit this hard-to-reach population. The utility of this approach has not been studied adequately, and its impact on the study sample recruited is not yet known. Using data from a study of 18- to 24-year-old HIV-uninfected, Black, Hispanic, and White United States (US) YMSM, this investigation compared advertising and enrollment metrics and participant characteristics of those recruited across Internet platforms. Of the 2,444 participants, their median age was 22 years old; 21% were Black, 37% Hispanic, and 42% White; 90% had been tested for HIV at least once in their life; and 87% reported prior condomless anal intercourse (CAI) with another man. There were noticeable differences across platforms in the number of people accessing the study website, meeting study eligibility requirements, consenting to participate, consenting to participate per day of advertising and per click, as well as costs of advertising per consented participant. Participants recruited also varied across platform by race/ethnicity, geographic area of residence in the US, health-care insurance status, years of formal education, history of HIV testing, and CAI by partner type and sexual positioning. The investigation results indicate that the Internet platforms used for recruitment significantly impact not only enrollment but also diversity and characteristics of the sample obtained and consequently, the observations and conclusions rendered.
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Affiliation(s)
- Roland C Merchant
- 1 Department of Emergency Medicine and Department of Epidemiology, Alpert Medical School and the School of Public Health, Brown University, Providence, RI, USA
| | - Justin Romanoff
- 2 Department of Biostatistics, Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Melissa A Clark
- 3 Department of Quantitative Health Sciences and Center for Health Policy and Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - Tao Liu
- 2 Department of Biostatistics, Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Joshua G Rosenberger
- 4 Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Jose Bauermeister
- 5 Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Kenneth H Mayer
- 6 Fenway Health, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
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23
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Rabinovici GD, Gatsonis C, Apgar C, Gareen IF, Hanna L, Hendrix J, Hillner BE, Olson C, Romanoff J, Siegel BA, Whitmer RA, Carrillo MC. [DT‐01–01]: IMPACT OF AMYLOID PET ON PATIENT MANAGEMENT: EARLY RESULTS FROM THE IDEAS STUDY. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Gil D. Rabinovici
- Memory and Aging CenterUniversity of California, San FranciscoSan FranciscoCAUSA
| | | | - Charles Apgar
- Memory and Aging CenterUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Ilana F. Gareen
- American College of Radiology Imaging NetworkPhiladelphiaPAUSA
| | | | - James Hendrix
- Department of MedicineVirginia Commonwealth UniversityRichmondVAUSA
| | | | | | - Justin Romanoff
- Memory and Aging CenterUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Barry A. Siegel
- Memory and Aging CenterUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Rachel A. Whitmer
- Memory and Aging CenterUniversity of California, San FranciscoSan FranciscoCAUSA
| | - Maria C. Carrillo
- Memory and Aging CenterUniversity of California, San FranciscoSan FranciscoCAUSA
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24
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Stack BC, Duan F, Sicks J, Romanoff J, Opanowski A, Horng D, Mahon I, Hollenbeak CS. The negative predictive value (NPV) of FDG-PET/CT in the Head and Neck Squamous Cell Carcinoma (HNSCC) N0 patient, the first report of the ACRIN 6685 trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.6041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6041 Background: This study evaluated the negative predictive value for node negativity in HNSCC. Methods: Patients were enrolled from 8/10 until 12/16 from 38 centers in the US and 1 center in China. This was a prospective, non-randomized trial. The study was designed to recruit 292 patients; however, 287 were enrolled by study closure. Inclusion criteria were newly diagnosed cT2-T4 SCC patients from the head and neck with one side cN0 who were willing to undergo an elective neck dissection. CN0 was determined by a negative neck CT or MR scan. Exclusions included non-SCC, non-surgical candidates, skin, nasopharynx or sinus primaries. PET/CT imaging reading performed centrally and pathology were analyzed at the neck level (left or right). To estimate confidence intervals, we used a nonparametric bootstrap to account for the correlation of data between sides of neck of the same patient. Correlative data and other image analyses will be reported separately. Results: PET/CT scans and pathology were available for 211 (table) N0 sides of neck for review at last interim analysis. NPV estimate with 95% CI for bilateral necks: 0.896 (0.831, 0.950) and specific to the N0 sides: 0.922 (0.862, 0.973). Conclusions: FDG PET/CT has high NPV for node negativity in HNSCC. This may obviate the need for elective neck dissection in N0 HNSCC patients. This trial was open about three times longer than planned, and a major obstacle to accrual was the generalized assumption among the oncology community that PET/CT had a high NPV. Therefore, patients sent to study centers for further diagnosis and treatment often had their PET/CT scans performed on non-ACRIN certified equipment. This required investigators to forgo offering the trial or the PET/CT was repeated. Our results may suggest application for pre-operative PET/CT nodal imaging of other primaries/lymphatic basins staged cN0. Funding from the National Cancer Institute through the grants U01 CA079778, U01 CA080098, CA180820, CA180794. Clinical trial information: NCT00983697. [Table: see text]
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Affiliation(s)
| | | | | | - Justin Romanoff
- Center for Statistical Sciences, Brown University School of Public Health, Providence, RI
| | | | | | - Irene Mahon
- American College of Radiology, Philadelphia, PA
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25
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Corl KA, George NR, Romanoff J, Levinson AT, Chheng DB, Merchant RC, Levy MM, Napoli AM. Inferior vena cava collapsibility detects fluid responsiveness among spontaneously breathing critically-ill patients. J Crit Care 2017; 41:130-137. [PMID: 28525778 DOI: 10.1016/j.jcrc.2017.05.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [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: 02/26/2017] [Revised: 04/25/2017] [Accepted: 05/07/2017] [Indexed: 11/19/2022]
Abstract
PURPOSE Measurement of inferior vena cava collapsibility (cIVC) by point-of-care ultrasound (POCUS) has been proposed as a viable, non-invasive means of assessing fluid responsiveness. We aimed to determine the ability of cIVC to identify patients who will respond to additional intravenous fluid (IVF) administration among spontaneously breathing critically-ill patients. METHODS Prospective observational trial of spontaneously breathing critically-ill patients. cIVC was obtained 3cm caudal from the right atrium and IVC junction using POCUS. Fluid responsiveness was defined as a≥10% increase in cardiac index following a 500ml IVF bolus; measured using bioreactance (NICOM™, Cheetah Medical). cIVC was compared with fluid responsiveness and a cIVC optimal value was identified. RESULTS Of the 124 participants, 49% were fluid responders. cIVC was able to detect fluid responsiveness: AUC=0.84 [0.76, 0.91]. The optimum cutoff point for cIVC was identified as 25% (LR+ 4.56 [2.72, 7.66], LR- 0.16 [0.08, 0.31]). A cIVC of 25% produced a lower misclassification rate (16.1%) for determining fluid responsiveness than the previous suggested cutoff values of 40% (34.7%). CONCLUSION IVC collapsibility, as measured by POCUS, performs well in distinguishing fluid responders from non-responders, and may be used to guide IVF resuscitation among spontaneously breathing critically-ill patients.
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Affiliation(s)
- Keith A Corl
- Department of Medicine, Division of Pulmonary Critical Care & Sleep, Alpert Medical School of Brown University, USA; Department of Emergency Medicine, Alpert Medical School of Brown University; School of Public Health of Brown University, Providence, RI, USA.
| | - Naomi R George
- Department of Emergency Medicine, Alpert Medical School of Brown University
| | - Justin Romanoff
- School of Public Health of Brown University, Providence, RI, USA.
| | - Andrew T Levinson
- Department of Medicine, Division of Pulmonary Critical Care & Sleep, Alpert Medical School of Brown University, USA.
| | - Darin B Chheng
- Department of Emergency Medicine, Alpert Medical School of Brown University
| | - Roland C Merchant
- Department of Emergency Medicine, Alpert Medical School of Brown University; School of Public Health of Brown University, Providence, RI, USA.
| | - Mitchell M Levy
- Department of Medicine, Division of Pulmonary Critical Care & Sleep, Alpert Medical School of Brown University, USA.
| | - Anthony M Napoli
- Department of Emergency Medicine, Alpert Medical School of Brown University.
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