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Ulaner GA, Kuo PH, Allaf M, Schuster DM, Chapin B. Diagnostic Performance of 18F-rhPSMA-7.3 PET in Men with Newly Diagnosed High-Risk Prostate Cancer and Negative Conventional Imaging. Int J Radiat Oncol Biol Phys 2023; 117:e446. [PMID: 37785440 DOI: 10.1016/j.ijrobp.2023.06.1627] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The LIGHTHOUSE study (NCT04186819) evaluated high affinity radio hybrid (rh) prostate-specific membrane antigen (PSMA)-targeted PET radiopharmaceutical, 18F-rhPSMA-7.3, in patients across a range of prostate cancer (PCa) risk groups. Here, we report findings from a subgroup with high/very high-risk PCa who had no evidence of nodal or metastatic disease on conventional imaging. MATERIALS/METHODS Treatment-naïve patients scheduled for radical prostatectomy (RP) plus pelvic lymph node (PLN) dissection underwent PET 50-70 min after IV administration of 296 MBq 18F-rhPSMA-7.3. Local readers interpreted the scans prior to RP (performed ≤60 d post-PET) and ahead of a blinded read by 3 central readers. If the local read indicated M1 disease, verification (biopsy, surgery, or confirmatory follow-up imaging) of PET-positive M1 lesions was attempted before treatment. The present analysis evaluates the 18F-rhPSMA-7.3 sensitivity and specificity for detection of PLN metastases in all high/very high-risk patients with negative conventional imaging at baseline who underwent 18F-rhPSMA-7.3 PET and subsequent surgery. Histopathology was used as the standard of truth (SoT). Additionally, the M1 verified detection rate (VDR; % of patients with true positive (TP) M1 lesions using histopathology or follow-up imaging as SoT out of all patients scanned) was assessed in an extended population of all patients who had 18F-rhPSMA-7.3 PET regardless of surgery. RESULTS The sensitivity and specificity for PLN detection among 174 men with very/high-risk PCa and negative conventional imaging ranged from 24-33% and 92-96%, respectively, across readers (Table 1a). Across readers, M1 lesions were identified in 28-51 of the 197 patients in the extended population, giving an overall M1 detection rate of 14-26%. Of the identified lesions, 16-25 were successfully verified (predominantly using follow-up imaging as SoT) as TP, providing a M1 VDR of 8.1-13% (Table 1). CONCLUSION 18F-rhPSMA-7.3 PET provides clinically useful information on the presence of both N1 and M1 disease prior to surgery in high/very high-risk PCa patients who were staged N0 M0 on conventional imaging. Specifically, up to 13% of such patients had verified TP M1 lesions. 18F-rhPSMA-7.3 may guide treatment, potentially helping such patients avoid ultimately futile surgery.
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Affiliation(s)
- G A Ulaner
- Hoag Family Cancer Institute, Irvine, CA; University of Southern California, Los Angeles, CA
| | - P H Kuo
- Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, AZ
| | - M Allaf
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - D M Schuster
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | - B Chapin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
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2
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Wilkins LJ, Tosoian JJ, Reichard CA, Sundi D, Ranasinghe W, Alam R, Schwen Z, Reddy C, Allaf M, Davis JW, Chapin BF, Ross AE, Klein EA, Nyame YA. Oncologic outcomes among Black and White men with grade group 4 or 5 (Gleason score 8-10) prostate cancer treated primarily by radical prostatectomy. Cancer 2021; 127:1425-1431. [PMID: 33721334 DOI: 10.1002/cncr.33419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND The aim of this study was to describe pathologic and short-term oncologic outcomes among Black and White men with grade group 4 or 5 prostate cancer managed primarily by radical prostatectomy. METHODS This was a multi-institutional, observational study (2005-2015) evaluating radical prostatectomy outcomes by self-identified race. Descriptive analysis was performed via nonparametric statistical testing to compare baseline clinicopathologic data. Univariable and multivariable time-to-event analyses were performed to assess biochemical recurrence (BCR), metastasis, cancer-specific mortality (CSM), and overall survival between Black and White men. RESULTS In total, 1662 men were identified with grade group 4 or 5 prostate cancer initially managed by radical prostatectomy. Black men represented 11.3% of the cohort (n = 188). Black men were younger, demonstrated a longer time from diagnosis to surgery, and were at a lower clinical stage (all P < .05). Black men had lower rates of pT3/4 disease (49.5% vs 63.5%; P < .05) but higher rates of positive surgical margins (31.6% vs 26.5%; P = .14) on pathologic evaluation. There was no difference in BCR, CSM, or overall survival over a median follow-up of 40.7 months. Black men had a lower 5-year cumulative incidence of metastasis-free survival (93.6%; 95% confidence interval [CI], 86.5%-97.0%) in comparison with White men (85.8%; 95% CI, 83.1%-88.0%), which did not persist in an age-adjusted analysis. CONCLUSIONS Black and White men with high-grade prostate cancer at diagnosis demonstrated similar oncologic outcomes when they were managed by primary radical prostatectomy. Our findings suggest that racial disparities in prostate cancer mortality are not related to differences in the efficacy of extirpative therapy.
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Affiliation(s)
- Lamont J Wilkins
- Department of Urology, Johns Hopkins University, Baltimore, Maryland
| | | | - Chad A Reichard
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas.,Urology of Indiana, Indianapolis, Indiana
| | - Debasish Sundi
- Department of Urology, Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Weranja Ranasinghe
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ridwan Alam
- Department of Urology, Johns Hopkins University, Baltimore, Maryland
| | - Zeyad Schwen
- Department of Urology, Johns Hopkins University, Baltimore, Maryland
| | - Chandana Reddy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohammed Allaf
- Department of Urology, Johns Hopkins University, Baltimore, Maryland
| | - John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brian F Chapin
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ashley E Ross
- Department of Urology, Northwestern University, Chicago, Illinois
| | - Eric A Klein
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yaw A Nyame
- Department of Urology, University of Washington, Seattle, Washington.,Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death worldwide. Lifestyle changes are at the forefront of preventing the disease. This includes advice such as increasing physical activity and having a healthy balanced diet to reduce risk factors. Intermittent fasting (IF) is a popular dietary plan involving restricting caloric intake to certain days in the week such as alternate day fasting and periodic fasting, and restricting intake to a number of hours in a given day, otherwise known as time-restricted feeding. IF is being researched for its benefits and many randomised controlled trials have looked at its benefits in preventing CVD. OBJECTIVES To determine the role of IF in preventing and reducing the risk of CVD in people with or without prior documented CVD. SEARCH METHODS We conducted our search on 12 December 2019; we searched CENTRAL, MEDLINE and Embase. We also searched three trials registers and searched the reference lists of included papers. Systematic reviews were also viewed for additional studies. There was no language restriction applied. SELECTION CRITERIA We included randomised controlled trials comparing IF to ad libitum feeding (eating at any time with no specific caloric restriction) or continuous energy restriction (CER). Participants had to be over the age of 18 and included those with and without cardiometabolic risk factors. Intermittent fasting was categorised into alternate-day fasting, modified alternate-day fasting, periodic fasting and time-restricted feeding. DATA COLLECTION AND ANALYSIS Five review authors independently selected studies for inclusion and extraction. Primary outcomes included all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, and heart failure. Secondary outcomes include the absolute change in body weight, and glucose. Furthermore, side effects such as headaches and changes to the quality of life were also noted. For continuous data, pooled mean differences (MD) (with 95% confidence intervals (CIs)) were calculated. We contacted trial authors to obtain missing data. We used GRADE to assess the certainty of the evidence. MAIN RESULTS: Our search yielded 39,165 records after the removal of duplicates. From this, 26 studies met our criteria, and 18 were included in the pooled analysis. The 18 studies included 1125 participants and observed outcomes ranging from four weeks to six months. No studies included data on all-cause mortality, cardiovascular mortality, stroke, myocardial infarction, and heart failure at any point during follow-up. Of quantitatively analysed data, seven studies compared IF with ab libitum feeding, eight studies compared IF with CER, and three studies compared IF with both ad libitum feeding and CER. Outcomes were reported at short term (≤ 3 months) and medium term (> 3 months to 12 months) follow-up. Body weight was reduced with IF compared to ad libitum feeding in the short term (MD -2.88 kg, 95% CI -3.96 to -1.80; 224 participants; 7 studies; low-certainty evidence). We are uncertain of the effect of IF when compared to CER in the short term (MD -0.88 kg, 95% CI -1.76 to 0.00; 719 participants; 10 studies; very low-certainty evidence) and there may be no effect in the medium term (MD -0.56 kg, 95% CI -1.68 to 0.56; 279 participants; 4 studies; low-certainty evidence). We are uncertain about the effect of IF on glucose when compared to ad libitum feeding in the short term (MD -0.03 mmol/L, 95% CI -0.26 to 0.19; 95 participants; 3 studies; very-low-certainty of evidence) and when compared to CER in the short term: MD -0.02 mmol/L, 95% CI -0.16 to 0.12; 582 participants; 9 studies; very low-certainty; medium term: MD 0.01, 95% CI -0.10 to 0.11; 279 participants; 4 studies; low-certainty evidence). The changes in body weight and glucose were not deemed to be clinically significant. Four studies reported data on side effects, with some participants complaining of mild headaches. One study reported on the quality of life using the RAND SF-36 score. There was a modest increase in the physical component summary score. AUTHORS' CONCLUSIONS Intermittent fasting was seen to be superior to ad libitum feeding in reducing weight. However, this was not clinically significant. There was no significant clinical difference between IF and CER in improving cardiometabolic risk factors to reduce the risk of CVD. Further research is needed to understand the safety and risk-benefit analysis of IF in specific patient groups (e.g. patients with diabetes or eating disorders) as well as the effect on longer-term outcomes such as all-cause mortality and myocardial infarction.
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Affiliation(s)
| | | | | | | | - Sadia Zaman
- School of Medicine, Imperial College London, London, UK
| | - Abdul-Majeed Salmasi
- Department of Cardiology, London North West University Healthcare NHS Trust, London, UK
| | - Kostas Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Abbas Dehghan
- School of Public Health, Imperial College London, London, UK
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4
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Khader AA, Allaf M, Lu OW, Lazopoulos G, Moscarelli M, Kendall S, Salmasi MY, Athanasiou T. Does the clinical effectiveness of Mitraclip compare with surgical repair for mitral regurgitation? J Card Surg 2021; 36:1103-1119. [PMID: 33428247 DOI: 10.1111/jocs.15298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/05/2020] [Accepted: 11/22/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Surgical repair of the mitral valve has long been the established therapy for degenerative mitral regurgitation (MR). Newer transcatheter methods over the last decade, such as the MitraClip, serve to restore mitral function with reduced procedural burden and enhanced recovery. This study aims to compare the shortterm and midterm outcomes of MitraClip insertion with surgical repair for MR. METHODS A systematic review of the literature was conducted for studies comparing outcomes between surgical repair and MitraClip. The initial search returned 1850 titles, from which 12 studies satisfied the inclusion criteria (one randomized controlled trial and 11 retrospective studies). RESULTS The final analysis comprised 4219 patients (MitraClip 1210; surgery 3009). Operative mortality was not different between the groups (odds ratio [OR] = 1.63, 95% confidence interval [CI]: [0.63-4.23]; p = .317). Length of hospital stay was significantly shorter in the MitraClip group (standardized mean difference [SMD] = 0.882, 95% CI: [0.77-0.99]; p < .001) with considerable heterogeneity (I2 > 90%; p < .001). The rate of reoperation on the mitral valve was lower in the surgical group (OR = 0.392; 95% CI: [0.188-0.817]; p = .012) as was the rate of MR recurrence grade moderate or above (OR = 0.29; 95% CI: [0.19-0.46]; p < .001) during midterm follow up. Long term survival (4-5 years) was also similar between both groups (hazard ratio = 0.70; 95% CI: [0.35-1.41]; p = .323). CONCLUSIONS This study highlights the superior midterm durability of surgical valve repair for MR compared with the MitraClip.
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Affiliation(s)
- Ashiq A Khader
- Department of Medicine, Imperial College London, London, UK
| | - Mohammed Allaf
- Department of Medicine, Imperial College London, London, UK
| | - Oscar W Lu
- Division of Biosciences, University College London, London, UK.,Faculty of Medicine, Dentistry and Health Sciences, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - George Lazopoulos
- Department of Cardio-thoracic Surgery, University Hospital of Heraklion, Crete, Greece
| | - Marco Moscarelli
- Department of Cardiovascular Surgery, GVM Care and Research, Lugo, Ravenna, Italy
| | - Simon Kendall
- Deparment of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | | | - Thanos Athanasiou
- Department of Surgery and Cancer, Imperial College London, London, UK
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5
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Affiliation(s)
- Hanad Ahmed
- Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK.
| | - Mohammed Allaf
- Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
| | - Hussein Elghazaly
- Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK
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Allaf M, Mohamed O, Elghazaly H. Medical student mistreatment: an inconvenient truth? Med Educ Online 2019; 24:1633172. [PMID: 31219414 PMCID: PMC6586147 DOI: 10.1080/10872981.2019.1633172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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7
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Allaf M, Elghazaly H, Mohamed OG, Fareen MFK, Zaman S, Salmasi AM, Tsilidis K, Dehghan A. Intermittent fasting for the prevention of cardiovascular disease. Cochrane Database Syst Rev 2019. [DOI: 10.1002/14651858.cd013496] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | - Sadia Zaman
- Imperial College London; School of Medicine; London UK
| | - Abdul-Majeed Salmasi
- London North West University Healthcare NHS Trust; Department of Cardiology; London UK
| | - Kostas Tsilidis
- Imperial College London; Department of Epidemiology and Biostatistics, School of Public Health; London UK
- University of Ioannina School of Medicine; Department of Hygiene and Epidemiology; Ioannina Greece
| | - Abbas Dehghan
- Imperial College London; School of Public Health; London UK
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8
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Rashid A, Shah HA, Allaf M. Medical student learning styles: does it really matter? [Letter]. Adv Med Educ Pract 2019; 10:513-514. [PMID: 31406479 PMCID: PMC6642619 DOI: 10.2147/amep.s220147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 07/08/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Ahsan Rashid
- School of Medicine, Imperial College London, London, UK
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9
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Mohamed O, Elghazaly H, Allaf M. Medical education: an unforgettable experience? [Letter]. Adv Med Educ Pract 2019; 10:399-400. [PMID: 31239802 PMCID: PMC6556527 DOI: 10.2147/amep.s212196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 05/07/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Omer Mohamed
- Faculty of Medicine, Imperial College London, London, UK
| | | | - Mohammed Allaf
- Faculty of Medicine, Imperial College London, London, UK
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10
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Phillips R, Gorin M, Rowe S, Hayman J, Radwan N, Pomper M, Allaf M, Eisenberger M, Ross A, Pienta K, DeWeese T, Greco S, Song D, Deville C, Tran P. Changes in Radiotherapeutic Management of Prostate Cancer Following PSMA-based 18 F-DCFPyL PET Imaging: A Snapshot of Prospective Trials at a Single Institution. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Harshman L, Drake C, Haas N, Manola J, Puligandla M, Signoretti S, Cella D, Gupta R, Bhatt R, Van Allen E, Lara P, Choueiri T, Kapoor A, Heng D, Shuch B, Jewett M, George D, Michaelson D, Carducci M, McDermott D, Allaf M. Transforming the Perioperative Treatment Paradigm in Non-Metastatic RCC-A Possible Path Forward. Kidney Cancer 2017; 1:31-40. [PMID: 30334002 PMCID: PMC6179104 DOI: 10.3233/kca-170010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In 2017, there is no adjuvant systemic therapy proven to increase overall survival in non-metastatic renal cell carcinoma (RCC). The anti-PD-1 antibody nivolumab improves overall survival in metastatic treatment refractory RCC and is generally tolerable. Mouse solid tumor models have revealed a benefit with a short course of neoadjuvant PD-1 blockade compared to adjuvant therapy. Two ongoing phase 2 studies of perioperative nivolumab in RCC patients have shown preliminary feasibility and safety with no surgical delays or complications. The recently opened PROSPER RCC trial (A Phase 3 RandOmized Study Comparing PERioperative Nivolumab vs. Observation in Patients with Localized Renal Cell Carcinoma Undergoing Nephrectomy; EA8143) will examine if the addition of perioperative nivolumab to radical or partial nephrectomy can improve clinical outcomes in patients with high risk localized and locally advanced RCC. With the goal of increasing cure and recurrence-free survival (RFS) rates in non-metastatic RCC, we are executing a three-pronged, multidisciplinary approach of presurgical priming with nivolumab followed by resection and adjuvant PD-1 blockade. We plan to enroll 766 patients with clinical stage ≥T2 or node positive M0 RCC of any histology in this global, randomized, unblinded, phase 3 National Clinical Trials Network study. The investigational arm will receive two doses of nivolumab 240 mg IV prior to surgery followed by adjuvant nivolumab for 9 months. The control arm will undergo the current standard of care: surgical resection followed by observation. Patients are stratified by clinical T stage, node positivity, and histology. The trial is powered to detect a 14.4% absolute benefit in the primary endpoint of RFS from the ASSURE historical control of 55.8% to 70.2% at 5 years (HR = 0.70). The study is also powered to detect a significant overall survival benefit (HR 0.67). Key safety, feasibility, and quality of life endpoints are incorporated. PROSPER RCC exemplifies team science with a host of planned correlative work to investigate the impact of the baseline immune milieu and changes after neoadjuvant priming on clinical outcomes.
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Affiliation(s)
- L.C. Harshman
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - C.G. Drake
- Division of Hematology/Oncology, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - N.B. Haas
- Division of Hematology/Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
| | - J. Manola
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - M. Puligandla
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - S. Signoretti
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA, USA
| | - D. Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - R.T. Gupta
- Departments of Radiology and Surgery and The Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - R. Bhatt
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - E. Van Allen
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - P. Lara
- University of California Davis School of Medicine, Sacramento, CA, USA
| | - T.K. Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - A. Kapoor
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - D.Y.C. Heng
- Tom Baker Cancer Center, Calgary, AB, Canada
| | - B. Shuch
- Division of Urology, Yale Cancer Institute, New Haven, CT, USA
| | - M. Jewett
- Departments of Surgery(Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and the University of Toronto, Toronto, ON, Canada
| | - D. George
- Duke University Departments of Medicine, Surgery, and Pharmacology and Cancer Biology, Division of Medical Oncology, The Duke Cancer Institute, Durham, NC, USA
| | - D. Michaelson
- Genitourinary Cancer Center, Massachusetts General Hospital, Boston, MA, USA
| | - M.A. Carducci
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
| | - D. McDermott
- Division of Hematology-Oncology and Cancer Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - M. Allaf
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
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13
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Kaouk JH, Autorino R, Kim FJ, Han DH, Lee SW, Yinghao S, Cadeddu JA, Derweesh IH, Richstone L, Cindolo L, Branco A, Greco F, Allaf M, Sotelo R, Liatsikos E, Stolzenburg JU, Rane A, White WM, Han WK, Haber GP, White MA, Molina WR, Jeong BC, Lee JY, Linhui W, Best S, Stroup SP, Rais-Bahrami S, Schips L, Fornara P, Pierorazio P, Giedelman C, Lee JW, Stein RJ, Rha KH. Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases. Int Braz J Urol 2011. [DOI: 10.1590/s1677-55382011000500017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- JH Kaouk
- Glickman Urological & Kidney Institute, USA
| | - R Autorino
- Glickman Urological & Kidney Institute, USA
| | - FJ Kim
- Glickman Urological & Kidney Institute, USA
| | - DH Han
- Glickman Urological & Kidney Institute, USA
| | - SW Lee
- Glickman Urological & Kidney Institute, USA
| | - S Yinghao
- Glickman Urological & Kidney Institute, USA
| | - JA Cadeddu
- Glickman Urological & Kidney Institute, USA
| | | | | | - L Cindolo
- Glickman Urological & Kidney Institute, USA
| | - A Branco
- Glickman Urological & Kidney Institute, USA
| | - F Greco
- Glickman Urological & Kidney Institute, USA
| | - M Allaf
- Glickman Urological & Kidney Institute, USA
| | - R Sotelo
- Glickman Urological & Kidney Institute, USA
| | | | | | - A Rane
- Glickman Urological & Kidney Institute, USA
| | - WM White
- Glickman Urological & Kidney Institute, USA
| | - WK Han
- Glickman Urological & Kidney Institute, USA
| | - GP Haber
- Glickman Urological & Kidney Institute, USA
| | - MA White
- Glickman Urological & Kidney Institute, USA
| | - WR Molina
- Glickman Urological & Kidney Institute, USA
| | - BC Jeong
- Glickman Urological & Kidney Institute, USA
| | - JY Lee
- Glickman Urological & Kidney Institute, USA
| | - W Linhui
- Glickman Urological & Kidney Institute, USA
| | - S Best
- Glickman Urological & Kidney Institute, USA
| | - SP Stroup
- Glickman Urological & Kidney Institute, USA
| | | | - L Schips
- Glickman Urological & Kidney Institute, USA
| | - P Fornara
- Glickman Urological & Kidney Institute, USA
| | | | | | - JW Lee
- Glickman Urological & Kidney Institute, USA
| | - RJ Stein
- Glickman Urological & Kidney Institute, USA
| | - KH Rha
- Glickman Urological & Kidney Institute, USA
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14
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Lee BR, Allaf M, Moore R, Bohlman M, Wang GM, Bishoff JT, Jackman SV, Cadeddu JA, Jarrett TW, Khazan R, Kavoussi LR. Clinical decision making using teleradiology in urology. AJR Am J Roentgenol 1999; 172:19-22. [PMID: 9888731 DOI: 10.2214/ajr.172.1.9888731] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Using a personal computer-based teleradiology system, we compared accuracy, confidence, and diagnostic ability in the interpretation of digitized radiographs to determine if teleradiology-imported studies convey sufficient information to make relevant clinical decisions involving urology. Variables of diagnostic accuracy, confidence, image quality, interpretation, and the impact of clinical decisions made after viewing digitized radiographs were compared with those of original radiographs. MATERIALS AND METHODS We evaluated 956 radiographs that included 94 IV pyelograms, four voiding cystourethrograms, and two nephrostograms. The radiographs were digitized and transferred over an Ethernet network to a remote personal computer-based viewing station. The digitized images were viewed by urologists and graded according to confidence in making a diagnosis, image quality, diagnostic difficulty, clinical management based on the image itself, and brief patient history. The hard-copy radiographs were then interpreted immediately afterward, and diagnostic decisions were reassessed. All analog radiographs were reviewed by an attending radiologist. RESULTS Ninety-seven percent of the decisions made from the digitized radiographs did not change after reviewing conventional radiographs of the same case. When comparing the variables of clinical confidence, quality of the film on the teleradiology system versus analog films, and diagnostic difficulty, we found no statistical difference (p > .05) between the two techniques. Overall accuracy in interpreting the digitized images on the teleradiology system was 88% by urologists compared with that of the attending radiologist's interpretation of the analog radiographs. However, urologists detected findings on five (5%) analog radiographs that had been previously unreported by the radiologist. CONCLUSION Viewing radiographs transmitted to a personal computer-based viewing station is an appropriate means of reviewing films with sufficient quality on which to base clinical decisions. Our focus was whether decisions made after viewing the transmitted radiographs would change after viewing the hard-copy images of the same case. In 97% of the cases, the decision did not change. In those cases in which management was altered, recommendation of further imaging studies was the most common factor.
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Affiliation(s)
- B R Lee
- Department of Urology, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA
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