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Golan S, Bar V, Salpeter SJ, Neev G, Creiderman G, Kedar D, Aharon S, Turovsky L, Zundelevich A, Shahar H, Shapira H, Mallel G, Stossel E, Gavert N, Straussman R, Dotan Z, Berger R, Stossel C, Golan T, Halperin S, Leibovici D, Breuer S, Rottenberg Y, Applebaum L, Hubert A, Nechushtan H, Peretz T, Zick A, Chertin B, Koulikov D, Sonnenblick A, Rosenbaum E. A clinical evaluation of an ex vivo organ culture system to predict patient response to cancer therapy. Front Med (Lausanne) 2023; 10:1221484. [PMID: 37840996 PMCID: PMC10569691 DOI: 10.3389/fmed.2023.1221484] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/07/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Ex vivo organ cultures (EVOC) were recently optimized to sustain cancer tissue for 5 days with its complete microenvironment. We examined the ability of an EVOC platform to predict patient response to cancer therapy. Methods A multicenter, prospective, single-arm observational trial. Samples were obtained from patients with newly diagnosed bladder cancer who underwent transurethral resection of bladder tumor and from core needle biopsies of patients with metastatic cancer. The tumors were cut into 250 μM slices and cultured within 24 h, then incubated for 96 h with vehicle or intended to treat drug. The cultures were then fixed and stained to analyze their morphology and cell viability. Each EVOC was given a score based on cell viability, level of damage, and Ki67 proliferation, and the scores were correlated with the patients' clinical response assessed by pathology or Response Evaluation Criteria in Solid Tumors (RECIST). Results The cancer tissue and microenvironment, including endothelial and immune cells, were preserved at high viability with continued cell division for 5 days, demonstrating active cell signaling dynamics. A total of 34 cancer samples were tested by the platform and were correlated with clinical results. A higher EVOC score was correlated with better clinical response. The EVOC system showed a predictive specificity of 77.7% (7/9, 95% CI 0.4-0.97) and a sensitivity of 96% (24/25, 95% CI 0.80-0.99). Conclusion EVOC cultured for 5 days showed high sensitivity and specificity for predicting clinical response to therapy among patients with muscle-invasive bladder cancer and other solid tumors.
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Affiliation(s)
- Shay Golan
- Department of Urology, Beilinson Hospital – Rabin Medical Center, Petah Tikva, Israel
| | | | | | | | - German Creiderman
- Department of Urology, Beilinson Hospital – Rabin Medical Center, Petah Tikva, Israel
| | - Daniel Kedar
- Department of Urology, Beilinson Hospital – Rabin Medical Center, Petah Tikva, Israel
| | | | | | | | | | | | | | | | - Nancy Gavert
- Department of Molecular Cell Biology, The Weizmann Institute of Science, Rehovot, Israel
| | - Ravid Straussman
- Department of Molecular Cell Biology, The Weizmann Institute of Science, Rehovot, Israel
| | - Zohar Dotan
- Department of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Raanan Berger
- Department of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Chani Stossel
- Department of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Talia Golan
- Department of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Sharon Halperin
- Department of Oncology, Sheba Medical Center, Ramat Gan, Israel
| | - Dan Leibovici
- Department of Urology, Kaplan Medical Center, Rehovot, Israel
| | - Shani Breuer
- Sharett Institute of Oncology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yakir Rottenberg
- Sharett Institute of Oncology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Liat Applebaum
- Sharett Institute of Oncology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ayala Hubert
- Sharett Institute of Oncology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hovav Nechushtan
- Sharett Institute of Oncology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tamar Peretz
- Sharett Institute of Oncology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aviad Zick
- Sharett Institute of Oncology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Boris Chertin
- Department of Urology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Dmitry Koulikov
- Department of Urology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Amir Sonnenblick
- Department of Oncology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Rosenbaum
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
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Koch N, Applebaum L, Mazeh H, Katz L, Pollack R. Interobserver Variability in Ultrasound Reporting - Tertiary Hospital Radiologists Do Better. J Endocr Soc 2021. [PMCID: PMC8090050 DOI: 10.1210/jendso/bvab048.1762] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Introduction: Thyroid Imaging Reporting and Data System (TI-RADS) was developed to provide a standardized risk-stratification system for patients with thyroid nodules. Single-center studies have demonstrated an acceptable level of interobserver agreement in applying TI-RADS in clinical practice, however data regarding consistency among different centers is limited. In Israel, thyroid nodules are initially evaluated by ultrasound performed by radiologists at the health maintenance organization (HMO) and then patients are referred to tertiary hospitals for ultrasound-guided fine needle aspiration (FNA) biopsy when indicated. Objective: To evaluate the interobserver concordance in TI-RADS classification system reporting between the HMO and a tertiary hospital. Methods: We performed a retrospective analysis of the sonographic features of 370 thyroid nodules TI-RADS category 2 or higher, from 350 patients evaluated by ultrasound at the HMO and at Hadassah Medical Center from January 1, 2018 to December 31, 2019. The primary outcome was concordance between the TI-RADS classification at the HMO compared to the hospital. Additional endpoints included correlation of TI-RADS to the Bethesda category following FNA, and correlation of TI-RADS with malignancy on final pathology. Results: Of 370 nodules, only 73 (19.8%) demonstrated concordance between the HMO and the hospital. The level of agreement was poor, with 277 (74.8%) nodules demonstrating higher TI-RADS at the HMO compared to the hospital, and 20 (5.4%) with lower TI-RADS at the HMO compared to the hospital (p<0.001, weighted Kappa = 0.120). Of the nodules referred to the hospital, 241 (65.1%) were selected for FNA. A strong correlation between the hospital TI-RADS and Bethesda category was demonstrated (p<0.001). Furthermore, 60 (16.2%) nodules were surgically removed. A strong correlation was identified between the hospital TI-RADS and malignancy on final pathology (p<0.001), yet there was no correlation with the TI-RADS of the HMO (p=0.346). Conclusions: There is poor concordance between TI-RADS classification on ultrasound performed in the HMO compared to a tertiary hospital. In patients who underwent FNA and eventually surgery, the hospital TI-RADS strongly correlated with Bethesda category and final risk of malignancy. Standardization of thyroid ultrasound terminology and dedicated training in thyroid imaging are needed to improve the interobserver concordance in clinical practice.
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Affiliation(s)
- Noam Koch
- Hebrew University, The Faculty of Medicine, Jerusalem, Israel
| | | | - Haggi Mazeh
- Hadassah University Hospital, Jerusalem, Israel
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Abstract
The delivery of public services in rural areas is a problem encountered not only by declining and peripheral areas but also by newly founded exurban communities. The problems of small size are exacerbated by the demand within these communities for high levels and a high quality of service provision. The existing local government network in these rural and rurban areas is unable to cope with the increased demand emanating from these new communities. This is particularly problematic in Israel, where the rural system of local government, the regional councils, have traditionally fulfilled the role of providing services to agricultural and cooperative communities. In this paper the nature of the service demands made by new exurban communities in Israel, the problems encountered by the regional councils in providing these same services, and the tensions which result from this lack of compatibility are discussed. Proposed functional solutions are presented and compared, ranging from minor modifications to the existing system of rural local government to those which require a change in the formal municipal status of the exurban communities.
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Affiliation(s)
- D Newman
- Department of Geography and Environmental Development, Ben Gurion University of the Negev, Beer Sheva 84105, Israel
| | - L Applebaum
- Development Study Center, PO Box 2375, Rehovot, Israel
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