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Batheja V, Osman M, Wynne M, Nemirovsky D, Morcos G, Riess J, Shin B, Whalen M, Haji-Momenian S. Optimal size threshold for PIRADSv2 category 5 upgrade and its positive predictive value: is it predictive of "very high" likelihood of clinically-significant cancer? Clin Radiol 2024; 79:e94-e101. [PMID: 37945438 DOI: 10.1016/j.crad.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/21/2023] [Accepted: 10/05/2023] [Indexed: 11/12/2023]
Abstract
AIM To identify the optimal size metric and threshold for Prostate Imaging Reporting and Data System (PIRADS) 5 upgrade, calculate its positive predictive value (PPV) for clinically-significant prostate cancer (csPCA), and determine if it is indicative of a "very high" likelihood of csPCA. MATERIALS AND METHODS One hundred and forty-three PIRADS 4 or 5 lesions were evaluated. Lesion diameters were used to calculate lesion volume (LV). Pearson correlation between maximum lesion diameter (MLD) and LV was calculated. Area under the curve (AUC) for discriminating csPCA (Gleason grade ≥ 3 + 4) was calculated using MLD and LV. Optimal size thresholds (using Youden index) and highly predictive size thresholds were identified for the whole prostate (WP), peripheral zone (PZ), and transitional zone (TZ). RESULTS There was high correlation between MLD and LV (r=0.77-0.81), with comparable AUCs for MLD and LV in the identification of csPCA in the WP (0.73, 0.72), PZ (0.73, 0.73), and TZ (0.79, 0.75). Optimal MLD thresholds were 1.4, 1.4, and 1.6 cm in the WP, PZ, and TZ respectively, with PPVs of 76%, 81%, and 69%, respectively. An MLD threshold of 2.7 cm would be needed in the WP to achieve a PPV approaching 90%, with sensitivity decreasing to 10%. CONCLUSIONS There is high correlation between MLD and LV with comparable discrimination of csPCA using each. PIRADSv2's 1.5 cm MLD threshold is near the optimal threshold for PIRADS 5 upgrade but has moderate PPV. A much higher threshold would be needed to increase its PPV, with significant sacrifice in sensitivity.
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Affiliation(s)
- V Batheja
- George Washington University School of Medicine, Washington, DC, USA
| | - M Osman
- George Washington University School of Medicine, Washington, DC, USA
| | - M Wynne
- George Washington University School of Medicine, Washington, DC, USA
| | - D Nemirovsky
- George Washington University School of Medicine, Washington, DC, USA
| | - G Morcos
- George Washington University School of Medicine, Washington, DC, USA
| | - J Riess
- Department of Radiology, George Washington Medical Faculty Associates, Washington, DC, USA
| | - B Shin
- Department of Radiology, George Washington Medical Faculty Associates, Washington, DC, USA
| | - M Whalen
- Department of Urology, George Washington Medical Faculty Associates, Washington, DC, USA
| | - S Haji-Momenian
- Department of Radiology, George Washington Medical Faculty Associates, Washington, DC, USA.
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Roediger B, Lee Q, Tikoo S, Cobbin JCA, Henderson JM, Jormakka M, O'Rourke MB, Padula MP, Pinello N, Henry M, Wynne M, Santagostino SF, Brayton CF, Rasmussen L, Lisowski L, Tay SS, Harris DC, Bertram JF, Dowling JP, Bertolino P, Lai JH, Wu W, Bachovchin WW, Wong JJL, Gorrell MD, Shaban B, Holmes EC, Jolly CJ, Monette S, Weninger W. An Atypical Parvovirus Drives Chronic Tubulointerstitial Nephropathy and Kidney Fibrosis. Cell 2018; 175:530-543.e24. [PMID: 30220458 PMCID: PMC6800251 DOI: 10.1016/j.cell.2018.08.013] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [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: 10/20/2017] [Revised: 07/23/2018] [Accepted: 08/07/2018] [Indexed: 11/19/2022]
Abstract
The occurrence of a spontaneous nephropathy with intranuclear inclusions in laboratory mice has puzzled pathologists for over 4 decades, because its etiology remains elusive. The condition is more severe in immunodeficient animals, suggesting an infectious cause. Using metagenomics, we identify the causative agent as an atypical virus, termed "mouse kidney parvovirus" (MKPV), belonging to a divergent genus of Parvoviridae. MKPV was identified in animal facilities in Australia and North America, is transmitted via a fecal-oral or urinary-oral route, and is controlled by the adaptive immune system. Detailed analysis of the clinical course and histopathological features demonstrated a stepwise progression of pathology ranging from sporadic tubular inclusions to tubular degeneration and interstitial fibrosis and culminating in renal failure. In summary, we identify a widely distributed pathogen in laboratory mice and establish MKPV-induced nephropathy as a new tool for elucidating mechanisms of tubulointerstitial fibrosis that shares molecular features with chronic kidney disease in humans.
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Affiliation(s)
- Ben Roediger
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia.
| | - Quintin Lee
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Shweta Tikoo
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Joanna C A Cobbin
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life and Environmental Sciences and Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - James M Henderson
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Mika Jormakka
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Matthew B O'Rourke
- Mass Spectrometry Core Facility, University of Sydney, Sydney, NSW 2006, Australia; Proteomics Core Facility, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Matthew P Padula
- Proteomics Core Facility, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Natalia Pinello
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Marisa Henry
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia; Laboratory Animal Services, University of Sydney, Sydney, NSW 2006, Australia
| | - Maria Wynne
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia; Laboratory Animal Services, University of Sydney, Sydney, NSW 2006, Australia
| | - Sara F Santagostino
- Laboratory of Comparative Pathology, Center of Comparative Medicine and Pathology, Memorial Sloan Kettering Cancer Center, The Rockefeller University, Weill Cornell Medicine, New York, NY 10065, USA
| | - Cory F Brayton
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | | | - Leszek Lisowski
- Children's Medical Research Institute, University of Sydney, Sydney, NSW 2006, Australia; Military Institute of Hygiene and Epidemiology, Biological Threats Identification and Countermeasure Centre, Puławy 24-100, Poland
| | - Szun S Tay
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - David C Harris
- Centre for Transplantation and Renal Research, Westmead Institute for Medical Research, University of Sydney, NSW 2006, Australia
| | - John F Bertram
- Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, VIC 3800, Australia
| | - John P Dowling
- Department of Anatomical Pathology, Monash Medical Centre, Clayton, VIC 3168, Australia
| | - Patrick Bertolino
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Jack H Lai
- Sackler School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Wengen Wu
- Sackler School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA 02111, USA
| | - William W Bachovchin
- Sackler School of Biomedical Sciences, Tufts University School of Medicine, Boston, MA 02111, USA
| | - Justin J-L Wong
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Mark D Gorrell
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Babak Shaban
- Australian Genomics Research Facility, Parkville, VIC 3000, Australia; Melbourne Integrative Genomics, University of Melbourne, Parkville, VIC 3010, Australia
| | - Edward C Holmes
- Marie Bashir Institute for Infectious Diseases and Biosecurity, School of Life and Environmental Sciences and Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Christopher J Jolly
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Sébastien Monette
- Laboratory of Comparative Pathology, Center of Comparative Medicine and Pathology, Memorial Sloan Kettering Cancer Center, The Rockefeller University, Weill Cornell Medicine, New York, NY 10065, USA
| | - Wolfgang Weninger
- Centenary Institute, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2050, Australia; Discipline of Dermatology, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia; Department of Dermatology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia; Department of Dermatology, Medical University of Vienna, Vienna 1090, Austria.
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Walsh Ó, Wynne M, O’ Donnell M, O’Hara MC, Geoghegan R. The Perceptions of Patients, their Parents and Healthcare Providers on the Transition of Young Adults with Type 1 Diabetes to Adult Services in the West of Ireland. Ir Med J 2018; 111:787. [PMID: 30520613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Aim This study aims to describe the perceptions of young adults’, parents of young adults’ and health care professionals’ (HCPs) of the transition process for young adults with Type 1 Diabetes in the West of Ireland. Methods Thematic analysis of semi-structured interviews conducted with the three stakeholder groups was performed. Results Young adults hardly noticed the transition, with many of them seeing it as a physical move, whereas parents were more anxious and felt their involvement was still needed but not accommodated. Both groups perceived the young adults’ ability to manage their diabetes as a facilitator, as well as the continuity of care provided by the diabetes nurse. Resource limitations and an inability of a young adult to self-manage were identified as barriers to smooth transition by parents, whilst HCPs were experiencing problems with non-attendance and a lack of a psychology service. Conclusion This study highlights the importance of encouraging adolescents’ autonomy in the years leading to transition. A key healthcare professional link between both services appears to facilitate smooth transition. Being flexible and supportive of both parents and adolescents including the provision of mental health services are other important considerations.
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Affiliation(s)
- Ó Walsh
- Paediatric Department, University Hospital Galway, Newcastle Road, Galway, Ireland
| | - M Wynne
- School of Medicine, National University of Ireland Galway, University Road, Galway, Ireland
| | - M O’ Donnell
- Academic Department of Medicine, National University of Ireland Galway, University Road, Galway, Ireland
| | - M C O’Hara
- Research and Development, HSE Strategic Planning and Transformation
| | - R Geoghegan
- Academic Department of Medicine, National University of Ireland Galway, University Road, Galway, Ireland
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Abstract
PURPOSE Our study goal was to identify clinical factors associated with, and that might predict, treatment outcome for patients with an isolated cervical recurrence of squamous cell carcinoma in the previously treated neck (ICR-PTN). MATERIALS AND METHODS We reviewed all patients with noncutaneous head and neck squamous cell carcinoma treated at our tertiary care center between 1987 and 1997, and identified 17 patients (2%) who later developed an isolated recurrence in a previously treated neck. These patients made up our study group, and their charts were thoroughly reviewed. Outcome of salvage therapy (surgery, radiation, or combined therapy) for these patients was compared with pooled clinicopathologic data using the Fisher exact test (one tail). RESULTS Fifteen such ICR-PTN patients consented to salvage therapy. Six patients were without disease at last follow-up, and 3 were successfully palliated. A statistically significant association between the side of ICR-PTN relative to the primary tumor and outcome of salvage therapy (P =.026) was noted, with ipsilateral neck recurrence being a favorable prognostic factor. Trends that did not meet the standard for statistical significance were observed between a better outcome of salvage therapy and the following parameters: age of less than 60, nonsurgical initial treatment of the neck, and lack of a history of a recurrence before they developed the ICR-PTN. CONCLUSIONS The current study showed that only the side of the ICR-PTN relative to the primary site is associated with outcome of salvage therapy. Based on our findings and a review of the literature, we have developed a summary of factors that might predict which patients with an ICR-PTN are most likely to benefit from aggressive salvage therapy.
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Affiliation(s)
- B J Krol
- Department of Otolaryngology--Head and Neck Surgery, Indiana UniversityMedical Center, Indianapolis, IN, USA
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