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Ng W, Loh M, Yew YW. Investigating causal relationships between genetically determined increased risk of attention-deficit/hyperactivity disorder (ADHD) and atopic dermatitis (AD): A Mendelian randomization analysis. Exp Dermatol 2023; 32:1468-1475. [PMID: 37317926 DOI: 10.1111/exd.14851] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/08/2023] [Accepted: 05/30/2023] [Indexed: 06/16/2023]
Abstract
Atopic dermatitis (AD) is a chronic, inflammatory skin condition with a huge disease burden. Attention-deficit/hyperactivity disorder (ADHD) is often diagnosed in children, and is associated with symptoms of inattention, hyperactivity and impulsive behaviour. Observational studies have demonstrated associations between AD and ADHD. However, to date, there has been no formal assessment of causal relationship between the two. We aim to evaluate causal relationships between genetically increased risk of AD and ADHD using Mendelian randomization (MR) approach. Two-sample bi-directional MR was conducted to elucidate potential causal relationships between genetically increased risk of AD and ADHD, using the largest and most recent genome-wide association study datasets for AD and ADHD-EArly Genetics & Lifecourse Epidemiology AD consortium (21 399 cases and 95 464 controls) and Psychiatric Genomics Consortium (20 183 cases and 35 191 controls). Genetically determined increased risk of AD is not associated with ADHD based on genetic information: odds ratio (OR) of 1.02 (95% CI -0.93 to 1.11; p = 0.705). Similarly, genetic determined increased risk of ADHD is not associated with an increased risk of AD: OR of 0.90 (95% CI -0.76 to 1.07; p = 0.236). Horizontal pleiotropy was not observed from the MR-Egger intercept test (p = 0.328) Current MR analysis showed no causal relationship between genetically increased risk of AD and ADHD in either direction in individuals of European descent. Any observed associations between AD and ADHD in previous population studies could possibly be due to confounding lifestyle factors such as psychosocial stress and sleeping habits.
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Affiliation(s)
- W Ng
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - M Loh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- School of Public Health, Imperial College London, London, UK
- National Skin Centre, Singapore, Singapore
| | - Y W Yew
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- National Skin Centre, Singapore, Singapore
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Verghese G, Lennerz JK, Ruta D, Ng W, Thavaraj S, Siziopikou KP, Naidoo T, Rane S, Salgado R, Pinder SE, Grigoriadis A. Computational pathology in cancer diagnosis, prognosis, and prediction - present day and prospects. J Pathol 2023; 260:551-563. [PMID: 37580849 PMCID: PMC10785705 DOI: 10.1002/path.6163] [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: 05/05/2023] [Revised: 06/12/2023] [Accepted: 06/17/2023] [Indexed: 08/16/2023]
Abstract
Computational pathology refers to applying deep learning techniques and algorithms to analyse and interpret histopathology images. Advances in artificial intelligence (AI) have led to an explosion in innovation in computational pathology, ranging from the prospect of automation of routine diagnostic tasks to the discovery of new prognostic and predictive biomarkers from tissue morphology. Despite the promising potential of computational pathology, its integration in clinical settings has been limited by a range of obstacles including operational, technical, regulatory, ethical, financial, and cultural challenges. Here, we focus on the pathologists' perspective of computational pathology: we map its current translational research landscape, evaluate its clinical utility, and address the more common challenges slowing clinical adoption and implementation. We conclude by describing contemporary approaches to drive forward these techniques. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Gregory Verghese
- School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences and MedicineKing's College LondonLondonUK
- The Breast Cancer Now Research Unit, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and MedicineKing's College LondonLondonUK
| | - Jochen K Lennerz
- Center for Integrated Diagnostics, Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Danny Ruta
- Guy's CancerGuy's and St Thomas’ NHS Foundation TrustLondonUK
| | - Wen Ng
- Department of Cellular PathologyGuy's and St Thomas NHS Foundation TrustLondonUK
| | - Selvam Thavaraj
- Head & Neck PathologyGuy's and St Thomas NHS Foundation TrustLondonUK
- Centre for Clinical, Oral & Translational Science, Faculty of Dentistry, Oral & Craniofacial SciencesKing's College LondonLondonUK
| | - Kalliopi P Siziopikou
- Department of Pathology, Section of Breast PathologyNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Threnesan Naidoo
- Department of Laboratory Medicine and Pathology, Walter Sisulu University, Mthatha, Eastern CapeSouth Africa and Africa Health Research InstituteDurbanSouth Africa
| | - Swapnil Rane
- Department of PathologyTata Memorial Centre – ACTRECHBNINavi MumbaiIndia
- Computational Pathology, AI & Imaging LaboratoryTata Memorial Centre – ACTREC, HBNINavi MumbaiIndia
| | - Roberto Salgado
- Department of PathologyGZA–ZNA ZiekenhuizenAntwerpBelgium
- Division of ResearchPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Sarah E Pinder
- School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences and MedicineKing's College LondonLondonUK
- Department of Cellular PathologyGuy's and St Thomas NHS Foundation TrustLondonUK
| | - Anita Grigoriadis
- School of Cancer & Pharmaceutical Sciences, Faculty of Life Sciences and MedicineKing's College LondonLondonUK
- The Breast Cancer Now Research Unit, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and MedicineKing's College LondonLondonUK
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Ng W. Characterization of the optical-gain enhanced microwave-Q for a 20.97 GHz regeneratively mode-locked laser with a short ring-length. Appl Opt 2023; 62:1351-1356. [PMID: 36821238 DOI: 10.1364/ao.480100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/03/2023] [Indexed: 06/18/2023]
Abstract
By treating a regeneratively mode-locked laser with a short ring length of 5.85 m as a coupled optoelectronic (OE) RF oscillator, the microwave quality factor (Q R F ) of its ring-cavity was characterized with the phase-shift approach. Specifically, the phase shift in the OE feedback loop of the mode-locked laser was varied, and the corresponding frequency shift in the photodetected first harmonic of its emitted pulse train was measured. An optical-gain enhanced Q R F of ∼5.8×104 was measured, which is an order of magnitude larger than the Q R F estimated for the same cavity before regenerative mode-locking. The experimental results were then compared with theoretical models developed to estimate the optical-gain enhanced Q R F of coupled OE oscillators.
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Stuart MJ, Antony J, Withers TK, Ng W. Systematic review and meta-analysis of external ventricular drain placement accuracy and narrative review of guidance devices. J Clin Neurosci 2021; 94:140-151. [PMID: 34863429 DOI: 10.1016/j.jocn.2021.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/23/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Insertion of external ventricular drain (EVD) is one of the most common neurosurgical procedures performed worldwide. This is generally performed freehand, on the basis of anatomical landmarks. There is significant variability in the reported accuracy of freehand placement, lacking Level I evidence. We present the first meta-analysis of freehand EVD placement accuracy and technologies or techniques to enhance accuracy. METHODS We report a systematic review of the Pubmed, Embase, and Cochrane Central databases according to MOOSE (Meta-analysis Of Observational Studies) guidelines. 37 studies were included for qualitative analysis and 19 studies (2983 cases) for quantitative analysis. RESULTS There is substantial heterogeneity in the outcome measures used to report EVD placement accuracy. Of those nineteen studies reporting accuracy using the Kakarla grading system the mean rate of ideal ipsilateral frontal horn placement was 73% (standard deviation ±7%). The use of formal stereotaxic guidance is consistently reported to improve accuracy to >90%, although with variable outcome measures. However, the reported efficacy of other guidance devices or techniques is highly variable. The quality of studies directly comparing all existing non-stereotaxic devices with freehand EVD placement is poor and precludes any assertion of superiority to freehand insertion. CONCLUSIONS We provide the first meta analysis of freehand placement accuracy. There is insufficient data to perform a meta-analysis of the relative efficacy of interventions to improve accuracy. Qualitative synthesis of reports of stereotaxic guidance is suggestive of higher accuracy than freehand placement.
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Affiliation(s)
- M J Stuart
- Department of Neurosurgery, Townsville University Hospital, QLD 4814, Australia; School of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia.
| | - J Antony
- Department of Neurosurgery, Gold Coast University Hospital, QLD 4215, Australia; School of Medicine, University of Queensland, St Lucia, QLD 4072, Australia
| | - T K Withers
- Department of Neurosurgery, Gold Coast University Hospital, QLD 4215, Australia; School of Medicine, Griffith University, QLD 4215, Australia
| | - W Ng
- Department of Neurosurgery, Gold Coast University Hospital, QLD 4215, Australia; School of Medicine, Griffith University, QLD 4215, Australia
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van Seijen M, Jóźwiak K, Pinder SE, Hall A, Krishnamurthy S, Thomas JSJ, Collins LC, Bijron J, Bart J, Cohen D, Ng W, Bouybayoune I, Stobart H, Hudecek J, Schaapveld M, Thompson A, Lips EH, Wesseling J. Variability in grading of ductal carcinoma in situ among an international group of pathologists. J Pathol Clin Res 2021; 7:233-242. [PMID: 33620141 PMCID: PMC8073001 DOI: 10.1002/cjp2.201] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/11/2020] [Accepted: 01/08/2021] [Indexed: 01/04/2023]
Abstract
The prognostic value of cytonuclear grade in ductal carcinoma in situ (DCIS) is debated, partly due to high interobserver variability and the use of multiple guidelines. The aim of this study was to evaluate interobserver agreement in grading DCIS between Dutch, British, and American pathologists. Haematoxylin and eosin-stained slides of 425 women with primary DCIS were independently reviewed by nine breast pathologists based in the Netherlands, the UK, and the USA. Chance-corrected kappa (κma ) for association between pathologists was calculated based on a generalised linear mixed model using the ordinal package in R. Overall κma for grade of DCIS (low, intermediate, or high) was estimated to be 0.50 (95% confidence interval [CI] 0.44-0.56), indicating a moderate association between pathologists. When the model was adjusted for national guidelines, the association for grade did not change (κma = 0.53; 95% CI 0.48-0.57); subgroup analysis for pathologists using the UK pathology guidelines only had significantly higher association (κma = 0.58; 95% CI 0.56-0.61). To assess if concordance of grading relates to the expression of the oestrogen receptor (ER) and HER2, archived immunohistochemistry was analysed on a subgroup (n = 106). This showed that non-high grade according to the majority opinion was associated with ER positivity and HER2 negativity (100 and 89% of non-high grade cases, respectively). In conclusion, DCIS grade showed only moderate association using whole slide images scored by nine breast pathologists. As therapeutic decisions and inclusion in ongoing clinical trials are guided by DCIS grade, there is a pressing need to reduce interobserver variability in grading. ER and HER2 might be supportive to prevent the accidental and unwanted inclusion of high-grade DCIS in such trials.
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Affiliation(s)
- Maartje van Seijen
- Division of Molecular PathologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Katarzyna Jóźwiak
- Division of Molecular PathologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Institute of Biostatistics and Registry ResearchBrandenburg Medical School Theodor FontaneNeuruppinGermany
| | - Sarah E Pinder
- Comprehensive Cancer Centre at Guy's Hospital, School of Cancer & Pharmaceutical SciencesKings College LondonLondonUK
- Department of Cellular PathologyGuy's and St Thomas' NHS Foundation Trust LondonLondonUK
| | - Allison Hall
- Department of PathologyDuke University Medical CenterDurhamNCUSA
| | - Savitri Krishnamurthy
- Department of PathologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | | | - Laura C Collins
- Department of PathologyBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA
| | - Jonathan Bijron
- Department of PathologyMartini HospitalGroningenThe Netherlands
| | - Joost Bart
- Department of PathologyIsala HospitalZwolleThe Netherlands
- Department of PathologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Danielle Cohen
- Department of PathologyLeiden University Medical CenterLeidenThe Netherlands
| | - Wen Ng
- Department of Cellular PathologyGuy's and St Thomas' NHS Foundation Trust LondonLondonUK
| | - Ihssane Bouybayoune
- Comprehensive Cancer Centre at Guy's Hospital, School of Cancer & Pharmaceutical SciencesKings College LondonLondonUK
| | | | - Jan Hudecek
- Department of Research ITThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Michael Schaapveld
- Department of Psychosocial Research and EpidemiologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Alastair Thompson
- Dan L Duncan Comprehensive Cancer CenterBaylor College of MedicineHoustonTXUSA
| | - Esther H Lips
- Division of Molecular PathologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
| | - Jelle Wesseling
- Division of Molecular PathologyThe Netherlands Cancer InstituteAmsterdamThe Netherlands
- Department of PathologyIsala HospitalZwolleThe Netherlands
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Jhala H, Harling L, Rodrigo A, Nonaka D, Mclean E, Ng W, Okiror L, Bille A. Clinicopathological predictors of survival in resected primary lung adenocarcinoma. J Clin Pathol 2021; 75:310-315. [PMID: 33827933 PMCID: PMC9046744 DOI: 10.1136/jclinpath-2021-207388] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/07/2022]
Abstract
Aims Primary lung adenocarcinoma consists of a spectrum of clinical and pathological subtypes that may impact on overall survival (OS). Our study aims to evaluate the impact of adenocarcinoma subtype and intra-alveolar spread on survival after anatomical lung resection and identify different prognostic factors based on stage and histological subtype. Methods Newly diagnosed patients undergoing anatomical lung resections without induction therapy, for pT1-3, N0-2 lung adenocarcinoma from April 2011 to March 2013, were included. The effect of clinical–pathological factors on survival was retrospectively assessed. Results Two hundred and sixty-two patients were enrolled. The 1-year, 3-year and 5-year OS were 88.8%, 64.3% and 51.1%, respectively. Univariate analysis showed lymphovascular, parietal pleural and chest wall invasion to confer a worse 1-year and 5-year prognosis (all p<0.0001). Solid predominant adenocarcinomas exhibited a significantly worse OS (p=0.014). Multivariate analysis did not identify solid subtype as an independent prognostic factor; however, identified stage >IIa, lymphovascular invasion (p=0.002) and intra-alveolar spread (p=0.009) as significant independent predictors of worse OS. Co-presence of intra-alveolar spread and solid predominance significantly reduced OS. Disease-free survival (DFS) was reduced with parietal pleural (p=0.0007) and chest wall invasion (p<0.0001), however, adenocarcinoma subtype had no significant impact on DFS. Conclusions Our study demonstrates that solid predominant adenocarcinoma, intra-alveolar spread and lymphovascular invasion confer a worse prognosis and should be used as a prognostic tool to determine appropriate adjuvant treatment.
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Affiliation(s)
- Hiral Jhala
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Leanne Harling
- Imperial College School of Medicine, Imperial College London, London, UK
| | - Alberto Rodrigo
- Medical Oncology, Arnau de Vilanova University Hospital, Lleida, Catalunya, Spain
| | | | | | - Wen Ng
- Pathology, Guy's Hospital, London, UK
| | | | - Andrea Bille
- Department of Thoracic Surgery, St Thomas' Hospital, London, UK.,Division of Cancer, King's College London, London, UK
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Ng W, Stasyuk V, Reddy KV. Pedestal analysis of jitter in a 20.97 GHz regeneratively mode-locked laser formed with a short polarization-maintaining fiber amplifier. Appl Opt 2021; 60:2870-2876. [PMID: 33798166 DOI: 10.1364/ao.417306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/15/2021] [Indexed: 06/12/2023]
Abstract
We demonstrated a 20.97 GHz regeneratively mode-locked Er fiber laser that has a short ring length of 5.84 m. The short active ring enabled large filter-rejection of adjacent supermodes during extraction of its clock signal for regenerative feedback. Very stable mode locking was observed with the generation of ∼5.5ps Gaussian pulses. A characterization of the noise pedestals in the photodetected first and second harmonics of the mode-locked pulses indicated there was cross-correlated coupling between the timing and amplitude jitter. From an analysis of the noise pedestals in these harmonics, as well as the noise spectrum at baseband, we estimated an amplitude jitter of ∼0.19%, and a timing jitter of ∼60fs. Using a generalized harmonic analysis approach, we estimated a cross correlation of 0.11% between the timing and amplitude jitter.
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Pemberton B, Ng W. Corporate governance paradigms of hazardous industries: Enduring challenges of Britain’s civil nuclear industry. Journal of General Management 2021. [DOI: 10.1177/0306307020915103] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article discusses risk management processes in Britain’s civil nuclear industry from a corporate governance perspective. As an example of a hazardous industry that can inflict catastrophic environmental damage and fatalities, effective governance of Britain’s nuclear industry is a critical issue. Yet the industry’s history of corporate governance suggests that processes of corporate governance have regularly failed to meet core requirements of its stakeholders. A core requirement is for governance designs that recognize the interests of public owner–stakeholders. In meeting this requirement, the article offers a framework for a relationship-driven form of corporate governance that enables meaningful stakeholder engagement in decision-making.
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Collier N, Oar A, Ng W, Johnston M, Ma Y, Becker T, Apte M, Pavey D, Arumugam S, Merrett N, Asghari R, Lee M. An Australian Three-Centre Feasibility Study of Neoadjuvant Modified FOLFIRINOX and Stereotactic Body Radiotherapy for Locally Advanced Pancreatic Cancer with Collection of Baseline Circulating Tumor Cells. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Torricelli F, Saxena A, Nuamah R, Neat M, Harling L, Ng W, Spicer J, Ciarrocchi A, Bille A. Genomic analysis in short- and long-term patients with malignant pleura mesothelioma treated with palliative chemotherapy. Eur J Cancer 2020; 132:104-111. [PMID: 32339978 DOI: 10.1016/j.ejca.2020.03.002] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/18/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is an aggressive tumour with poor prognosis. The aim of this study was to identify genetic mutations associated with poor or extended survival in patients who received palliative chemotherapy. METHODS A total of 720 patients diagnosed with MPM between 2005 and 2015 were identified. Overall survival (OS) was longer than 30 months from diagnosis for 27 patients. Twelve of 27 (44%) of the pleural biopsies from long-term survivors were retrieved and matched with 12 biopsies from patients who survived less than 12 months; one biopsy was then excluded for poor DNA quality. RESULTS A total of 11 patients had a mean OS of 5.5 months, whereas 12 patients lived more than 30 months (mean OS: 55.8 ± 25). Mutational analysis identified 428 alterations; of which, 148, classified as somatic and functional, were considered further. Among these, 85% were missense variants, 8% were variants causing a stop gain and 6% were splice variants. Loss-of-function mutations in UQCRC1 were significantly associated with reduced survival in patients with MPM (p = 0.027), while a higher frequency of mutations in MXRA5 and RAPGEF6 was registered in long-term survivors. CONCLUSION This is the first study evaluating the relationship between the mutational profile and outcome in patients with MPM after palliative chemotherapy. UQCRC1 codes for cytochrome b-c1 complex subunit 1 which plays a fundamental role in normal mitochondrial functions and in cell metabolism. Recent studies described UQCRC1 deregulation in other cancers. Our results suggest a possible role for mitochondrial metabolism in the biology of mesothelioma.
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Affiliation(s)
- Federica Torricelli
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Alka Saxena
- UK NIHR GSTFT/KCL Comprehensive Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Rosamond Nuamah
- UK NIHR GSTFT/KCL Comprehensive Biomedical Research Centre, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Michael Neat
- Cancer Genetics, Viapath, Guy's Hospital, London, UK
| | - Leanne Harling
- Department of Surgery and Cancer, Imperial College London, UK
| | - Wen Ng
- Department of Pathology, Guy's Hospital, London, UK
| | - James Spicer
- Division of Cancer Studies, King's College London, Guy's Hospital, London, UK
| | - Alessia Ciarrocchi
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Bille
- Division of Cancer Studies, King's College London, Guy's Hospital, London, UK; Department of Thoracic Surgery, Guy's Hospital, London, UK.
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To CY, Cheung P, Ng W, Mok WY. Comparison of facet joint violation in lumbar posterior spinal instrumentation using different techniques including cortical bone trajectory. Journal of Orthopaedics, Trauma and Rehabilitation 2020. [DOI: 10.1177/2210491720903471] [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: 11/17/2022] Open
Abstract
Study background: A retrospective study to compare the rate of facet joint violation (FJV) in lumbar posterior spinal instrumentation using open pedicle screw, percutaneous pedicle screw, and cortical bone trajectory (CBT) technique. CBT is a new posterior spinal instrumentation technique in which a more caudal entry point can minimize iatrogenic damage to the cranial facet joint. Only one recent study reports incidence of FJV of 11%; however, no previous reports comment on radiological outcomes comparing to traditional open and percutaneous screws. Methods: We reviewed 90 patients who underwent lumbar posterior spinal instrumentation from January 2016 to June 2017. Postoperative computer tomography scans were performed to evaluate FJV. Incidence of FJV was graded by three reviewers according to Seo classification. Results: Totally, 446 screws (open 43.4%, percutaneous 37.8%, CBT 18.9%) were inserted. Among these, 6.3% (28/446) had screw head or rod in contact with facet joint and 0.9% (4/446) had screws directly invaded the facet joint. Overall, FJV was 7.2% (CTB = 3.4%, open = 10.4%, and percutaneous = 4.5%, p = 0.075). Conclusion: CBT technique has potential advantage in reducing FJV. It has a unique entry site at lateral aspect of pars interarticular with a caudomedial to craniolateral pathway. It is a reasonable alternative to open or percutaneous techniques in lumbar posterior spinal instrumentation.
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Affiliation(s)
- CY To
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - P Cheung
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - W Ng
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - WY Mok
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
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van Seijen M, Jóźwiak K, Pinder SE, Hall A, Krishnamurthy S, Thomas JSJ, Collins L, Bijron J, Bart J, Cohen D, Ng W, Stobart H, Hudecek J, Lips EH, Wesseling J. Abstract P5-02-05: Variability in ductal carcinoma in situ grading among an international group of pathologists. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p5-02-05] [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: 11/16/2022]
Abstract
Abstract
Introduction: Ductal Carcinoma In Situ (DCIS) is a proliferation of neoplastic cells confined to the ducto-lobular system. Due to uncertainty which DCIS lesions progress to invasive breast cancer women with DCIS receive surgery and radiotherapy. The PRECISION (PREvent ductal carcinoma In Situ Invasive Overtreatment Now) initiative intends to improve the management of DCIS including reduction of unnecessary treatment. Histological high grade is an unfavorable prognostic indicator used to guide treatment decisions, and used as an exclusion criterion for DCIS trials that randomize between active surveillance and standard treatment. Hence, accurate assessment of grade is important in current clinical practice. Pathologists within PRECISION setup this study to compare histological parameters of four retrospective DCIS cohorts from three different countries to investigate interobserver variability particularly in grading of DCIS.
Method: Tissue slides from two population-based cohorts (UK Sloane cohort n=110; Dutch DCIS cohort n= 110) and two hospital based cohorts (Duke n=110; MDACC n=95) were included, leading to a total of 425 slides. All slides were reviewed by 9 breast pathologists originating from the UK, US and the Netherlands (NL) using the digital software platform Slidescore. The slides included were a representative selection of histological grades from all cases in these respective studies (see table 1 for distribution). Kappa (κ) values were calculated based on a generalized linear mixed model using the ordinal package in R.
Results: The distribution of grade according to the majority opinion and originally assigned during diagnosis is shown in table 1. The cohort from NL demonstrated less grade 1 lesions according to the majority opinion compared to originally assigned grade. Table 2 shows the κ values of all evaluated histological variables. DCIS grade 1,2,3, grade 1/2 vs 3, necrosis and calcification show moderate agreement (κ between 0.4-0.6). Lymphocytic infiltrate, periductal fibrosis and mitoses demonstrate poor agreement (κ between 0.2-0.4).
Conclusion: Histological factors including DCIS grade 1/2/3 and DCIS grade 1/2 versus 3 show only moderate agreement in this study using whole slide images. Preliminary analyses show no differences in κ values with the inclusion of country of the pathologist. However, the distribution of grade differs between the grading originally assigned and determined by majority opinion. Since clinical decisions are based on histological variables, it is important to realize that interobserver variability play a part in the diagnostic process. We are currently reviewing con- versus discordant cases and discussing how pathology guidelines can be improved. In addition, we are exploring whether artificial intelligence-based methods could be used to standardize grading of DCIS.
Table 1. Distribution of grade of all slides and slides from participating centers. Slides were excluded if the majority opinion was equally divided between two grades or if originally grade 1-2/2-3 was assigned.Origin of tissue slidesGrade 1 (n)Grade 2 (n) Grade 3 (n)Excluded nAll tissue slides (n=425)Distribution according to majority opinion12% (49)40% (163)48% (197)16Distribution originally assigned12% (36)36% (111)53% (165)113Slides from Netherlands Cancer Institute (n=110)Distribution according to majority opinion6% (6)31% (33)64% (68)3Distribution originally assigned17% (19)33% (36)50% (55)0Slides from Sloane (n=110)Distribution according to majority opinion20% (20)51% (52)29% (30)8Distribution originally assigned11% (12)31% (34)58% (64)0Slides from Duke (n=110)Distribution according to majority opinion9% (10)44% (47)47% (50)3Distribution originally assigned5% (5)45% (41)50% (46)18Slides from MDAnderson (n=95)Distribution according to majority opinion14% (13)33% (31)53% (49)2Distribution originally assignedTo be collected
Table 2. Kappa values of evaluated histological parametersVariableModel based weighted kappa (κma)95% confidence intervalDCIS grade 1/2/30.500.440.57DCIS grade 1/2 vs 30.520.440.60DCIS grade 1 vs 2/30.450.400.50DCIS grade low vs high0.520.440.59Necrosis absent vs present (manually dichotomized)0.550.510.59Calcification absent vs present0.510.480.55Lymphocytic infiltrate0.470.390.55Periductal fibrosis0.350.300.40Mitoses0.340.250.42
Citation Format: Maartje van Seijen, Katarzyna Jóźwiak, Sarah E Pinder, Allison Hall, Savitri Krishnamurthy, Jeremy SJ Thomas, Laura Collins, Jonathan Bijron, Joost Bart, Danielle Cohen, Wen Ng, Hilary Stobart, Jan Hudecek, Esther H Lips, Jelle Wesseling. Variability in ductal carcinoma in situ grading among an international group of pathologists [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-02-05.
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Affiliation(s)
| | | | | | | | | | | | - Laura Collins
- 6Beth Israel Deaconess Medical Center Harvard Medical School, Boston, MA
| | | | | | | | - Wen Ng
- 10Guy's Hospital, London, Netherlands
| | | | - Jan Hudecek
- 1Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Esther H Lips
- 1Netherlands Cancer Institute, Amsterdam, Netherlands
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Das S, Tran Q, Moosavi V, Yang Q, Ariyarathna N, Wheelahan A, Ng W, Harvey T, Marley P, Farshid A. 536 Prognostic Implications of Post-Percutaneous Intervention Troponin Rise in Non-ST Elevation Myocardial and Unstable Angina Patients. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Das S, Ng W, Wheelahan A, Scott P. 537 Rapid Access Chest Pain Clinic Utilisation and Outcomes: Calvary Hospital Experience. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bennett L, Bernick C, Ng W. B-52 Improvements in Cognitive Functioning in Inactive Professional Fighters. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
Repetitive head injuries common in combat sports have been associated with increased risk for cognitive dysfunction. Interestingly, the Professional Fighter’s Brain Health Study (PFBHS) team has observed improvements in fighters’ cognitive performance following their transition to inactive fighting status. As this phenomenon was explored, it was hypothesized that fighters’ cognitive performance will initially improve following their discontinuation of fighting.
Methods
Longitudinal demographic, fighting history, and cognitive functioning data from 31 fighters who discontinued fighting during their participation in the PFBHS. Cognitive functioning was assessed via CNS Vital Signs and C3/iComet computerized batteries. Number of professional fights, as well as inactive fighting status, was determined using published professional online records. Fighters were considered inactive if they had gone two or more years without a professional match.
Results
Paired-samples t test was conducted to evaluate cognitive functioning in fighters at time 1 (actively fighting) and time 2 (inactive fighting status). When comparing cognitive function at across time points, performance on CNS Vital Signs measures of verbal memory, processing speed, psychomotor speed, and reaction time, as well as C3/iComet measures of set-shifting and complex reaction time, significantly improved at time 2 (all p’s < 0.05). Interestingly, performance did not improve across time points on a C3/iComet measure of processing speed (Trailmaking Test Part A).
Conclusions
Cognitive performance improved on most measures when fighters transitioned to inactive fighting status. Given the limited sample size, future analysis is necessary to evaluate the relationship between fighting status and cognitive performance in a larger sample size.
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Hussey J, Kuwabara H, Ng W, Kinsora T, Ross S, Allen D. B-55 Performance of ImPACT Validity Indices for Athletes with Neurodevelopmental Disorders. Arch Clin Neuropsychol 2019. [DOI: 10.1093/arclin/acz034.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Objective
Research demonstrates neurodevelopmental diagnoses may increase likelihood of failing scores on ImPACT embedded validity indicators that flag questionable effort. New criteria have been proposed to enhance sensitivity of these indicators although their utility in athletes with neurodevelopmental diagnosis have not been thoroughly examined. This study investigates the effect of neurodevelopmental history on frequency of invalid performance on the standard and three proposed validity indicators.
Methods
Participants included 41,214 high school athletes (Mage = 15.1; 44.2% female; Meducation = 9.1) who completed baseline ImPACT testing. Athletes included these groups: ADHD (3.7%), Learning Disability (LD; 1.5%), Autism (0.2%), ADHD+LD (0.6%), Autism+ADHD/LD (0.1%), athletes with special education history but no diagnosis reported (SpEd; 2.8%), and healthy athletes (91.1%). Odds ratios were calculated to determine differences in invalid performance by both standard and proposed cutoffs.
Results
Neurodevelopmental disorder was associated with increased invalid performance using standard and proposed cutoffs with odds ratios ranging from 1.32 to 3.25. Invalid performance differed significantly across groups for both standard and two sets of proposed criteria (chi square p < .00001). For standard cutoffs, athletes with ADHD, LD, and ADHD/LD were significantly more likely than healthy athletes to have invalid performance. This pattern remained similar across the two sets of proposed criteria.
Conclusions
Results indicate increased incidence of invalid ImPACT performance based on standard and proposed validity indicators in athletes who self-report neurodevelopmental disorders. Findings indicate current and proposed cutoffs may not accurately capture low effort for neurodevelopmental populations. Future research should examine utility of separate cutoff criteria and expanded norms for athletes with neurodevelopmental history.
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Otton J, Li Z, Koh E, Adams D, Mok K, Harvey M, Ling S, Sungala N, Moylan E, Ng W, Xiong G, Juergens C, Delaney G. Establishment of a Cardio-Oncology Service for Assessment and Management of Acute and Late Cardiovascular Conditions. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.379] [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: 10/26/2022]
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18
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Graieg M, Luo K, Ng W, Playford D, Deague J. Does Severity of Coronary Artery Disease Predict an Abnormal Ankle Brachial Pressure Index (ABPI)? Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.373] [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: 10/26/2022]
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Harling L, Kolokotroni SM, Nair A, Smelt J, King J, Routledge T, Spicer J, Ng W, Bille A. Differential Survival Characteristics of Sarcomatoid Subtype in Biphasic Pleural Mesothelioma. Ann Thorac Surg 2018; 107:929-935. [PMID: 30389446 DOI: 10.1016/j.athoracsur.2018.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/23/2018] [Accepted: 09/10/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Biphasic pleural mesothelioma (BPM) accounts for approximately 10% of all pleural mesothelioma. Our aim was to assess the clinical, radiologic, and pathologic factors impacting survival in BPM and to better identify patients most likely to benefit from active treatment. METHODS A 10-year retrospective review was made of 214 biopsy-proven BPM cases with minimum 2-year follow-up. Patients with insufficient tissue for analysis were excluded (n = 96). Clinical and pathologic factors were evaluated along with radiologic assessment of pleural thickness. Survival was measured from time of diagnosis. Univariable and multivariable predictors of survival were evaluated. RESULTS In all, 118 patients were included; 28 underwent pleurectomy/decortication, with 27 receiving additional modalities. Ninety patients underwent chemotherapy (n = 18) or radiotherapy alone (n = 9), 63 received combination therapy, and 27 received best supportive care. Median overall survival was 11.2 months (range, 0.3 to 36.2). At univariable analysis, pleurectomy/decortication (p = 0.0061), radiotherapy (p < 0.0001), and chemotherapy (p < 0.0001) were associated with superior survival when compared with best supportive care alone. Pleurectomy/decortication demonstrated 40% survival improvement compared with no surgery (p = 0.122). In a multivariable model, necrosis was negatively prognostic (hazard ratio 2.1, SE 0.76). Furthermore, increased sarcomatoid component was associated with worse survival without radiotherapy. CONCLUSIONS BPM prognosis remains poor despite multimodality treatment. Anticancer treatment is associated with superior outcome in this nonrandomized retrospective series. Our findings suggest superior survival for patients with a lower proportion of sarcomatoid disease, with selective benefit of radiotherapy in higher proportions of sarcomatoid disease. When planning active treatment, the potential survival benefits require balancing against associated morbidity and recovery period.
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Affiliation(s)
- Leanne Harling
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | - Arjun Nair
- Department of Radiology, Guy's Hospital, London, United Kingdom
| | - Jeremy Smelt
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Juliet King
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - Tom Routledge
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom
| | - James Spicer
- School of Cancer Studies, King's College London, Guy's Hospital, London, United Kingdom
| | - Wen Ng
- Department of Pathology, Guy's Hospital, London, United Kingdom
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's Hospital, London, United Kingdom.
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Shippee T, Ng W, Restorick Roberts A, Bowblis J. FAMILY SATISFACTION WITH NURSING HOME CARE: FINDINGS AND IMPLICATIONS FROM TWO STATE COMPARISON. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.1479] [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: 11/13/2022] Open
Affiliation(s)
- T Shippee
- University of Minnesota School of Public Health
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Do V, Ng W, Jacob S, Delaney G, Barton M. An estimation of the population-based survival benefit of first-course chemotherapy for advanced incurable cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy440.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Shippee T, Ng W, Bowblis J, Cooke V. RACIAL DISPARITIES IN QUALITY OF LIFE FOR NURSING HOME RESIDENTS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2267] [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: 11/12/2022] Open
Affiliation(s)
- T Shippee
- Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, United States
| | - W Ng
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN
| | - J Bowblis
- Associate Professor, Economics, U of Miami OH
| | - V Cooke
- MN Department of Human Services
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Hussey J, Ng W, Flood S, Kinsora T, Ross S, Allen D. A - 56Rates of Sport Concussion in Contact and Non-Contact Sports. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy061.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kuwabara H, Sheikh R, Ng W, Kinsora T, Ross S, Allen D. C - 57Demographic Factors of Invalid Baselines on ImPACT. Arch Clin Neuropsychol 2018. [DOI: 10.1093/arclin/acy061.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Au K, Ngan R, Ng A, Poon D, Ng W, Lee V, Lee A, Cheng A, Tam H. Treatment outcomes of nasopharyngeal carcinoma in modern era after intensity modulated radiotherapy (IMRT) in Hong Kong: A report of 3328 patients. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx665.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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26
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Do V, Ng W, Jacob S, Delaney G, Barton M. An estimation of the population survival benefit of first-course chemotherapy for head and neck cancers. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx374.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Chua H, Peh K, Hon F, Koh E, Cheong P, Ng W. CARE MANAGEMENT IN COMSA: SHIFTING FROM A HOSPITAL-CENTRED TO A PROACTIVE, COMMUNITY-BASED APPROACH. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.450] [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: 11/12/2022] Open
Affiliation(s)
- H. Chua
- Tsao Foundation, Singapore, Singapore
| | - K. Peh
- Tsao Foundation, Singapore, Singapore
| | - F. Hon
- Tsao Foundation, Singapore, Singapore
| | - E. Koh
- Tsao Foundation, Singapore, Singapore
| | - P. Cheong
- Tsao Foundation, Singapore, Singapore
| | - W. Ng
- Tsao Foundation, Singapore, Singapore
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Hildon Z, Tan C, Shiraz F, Ng W, Deng X, Koh G, Tan K, Vrijhoef H. “HOW CAN WE HELP?”: A BIO-PSYCHO-SOCIAL RISK SCREENER FOR COMMUNITY DETECTION OF VULNERABLE ELDERS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1889] [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: 11/14/2022] Open
Affiliation(s)
- Z.J. Hildon
- Saw Swee Hock School of Public Health, Singapore, Singapore,
| | - C. Tan
- Saw Swee Hock School of Public Health, Singapore, Singapore,
| | - F. Shiraz
- Saw Swee Hock School of Public Health, Singapore, Singapore,
| | - W. Ng
- Tsao Foundation, Singapore, Singapore,
| | - X. Deng
- Saw Swee Hock School of Public Health, Singapore, Singapore,
| | - G.C. Koh
- Saw Swee Hock School of Public Health, Singapore, Singapore,
| | - K. Tan
- Ministry of Health, Singapore, Singapore
| | - H.J. Vrijhoef
- Saw Swee Hock School of Public Health, Singapore, Singapore,
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Tsao M, Ng W, Peh K, Harding S, Hildon Z, Lim Z, Vrijhoef H. AN OVERVIEW OF COMSA—ITS THEORETICAL FRAMEWORK AND ESSENTIAL COMPONENTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.447] [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: 11/14/2022] Open
Affiliation(s)
- M. Tsao
- Tsao Foundation, Singapore, Singapore,
| | - W. Ng
- Tsao Foundation, Singapore, Singapore,
| | - K. Peh
- Tsao Foundation, Singapore, Singapore,
| | | | - Z.J. Hildon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore,
- London School of Hygiene and Tropical Medicine, London, United Kingdom,
| | - Z.Z. Lim
- Tsao Foundation, Singapore, Singapore,
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore,
| | - H.J. Vrijhoef
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore,
- National University Health System, Singapore, Singapore,
- Department of Patient & Care, Maastricht University Medical Center, Maastricht, Netherlands
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Ng W, Lim C, Wong Y. HUA MEI DEMENTIA CARE SYSTEM: A HOME-BASED, PHYSICIAN-ENHANCED DEMENTIA CARE MANAGEMENT SERVICE. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4101] [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: 11/13/2022] Open
Affiliation(s)
- W. Ng
- Tsao Foundation, Singapore, Singapore
| | - C. Lim
- Tsao Foundation, Singapore, Singapore
| | - Y. Wong
- Tsao Foundation, Singapore, Singapore
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Ng W, Peh K, Chua H, Hon F, Koh E, Cheong P. THE DEVELOPMENT OF A SYSTEM OF CARE FOR THE AT-RISK ELDERS IN COMSA. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.448] [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: 11/13/2022] Open
Affiliation(s)
- W. Ng
- Tsao Foundation, Singapore, Singapore
| | - K. Peh
- Tsao Foundation, Singapore, Singapore
| | - H. Chua
- Tsao Foundation, Singapore, Singapore
| | - F. Hon
- Tsao Foundation, Singapore, Singapore
| | - E. Koh
- Tsao Foundation, Singapore, Singapore
| | - P. Cheong
- Tsao Foundation, Singapore, Singapore
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Lim Z, Shiraz F, Ng W, Vrijhoef H, Hildon Z. RECOMMENDATIONS FOR IMPLEMENTING
A BIO-PSYCHO-SOCIAL RISK SCREENER FOR STRATIFIED CARE AT OLDER AGES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.1892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Z.Z. Lim
- Tsao Foundation, Singapore, Singapore,
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore,
| | - F. Shiraz
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore,
| | - W. Ng
- Tsao Foundation, Singapore, Singapore,
| | - H.J. Vrijhoef
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore,
- National University Health System, Singapore, Singapore,
- Department of Patient & Care, Maastricht University Medical Center, Maastricht, Netherlands,
| | - Z.J. Hildon
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore,
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Ng W, Yea K, Mok F, Lim Z. TEAM-MANAGED HOME-BASED PRIMARY CARE IN SINGAPORE: A CASE SERIES THAT DEMONSTRATES COST SAVING. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.094] [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: 11/14/2022] Open
Affiliation(s)
- W. Ng
- Tsao Foundation, Singapore, Singapore
| | - K. Yea
- Tsao Foundation, Singapore, Singapore
| | - F. Mok
- Tsao Foundation, Singapore, Singapore
| | - Z.Z. Lim
- Tsao Foundation, Singapore, Singapore
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Byrd A, Deming C, Cassidy S, Harrison O, Ng W, Conlan S, Belkaid Y, Segre J, Kong H. 625 Differential diversity of staphylococcal strains shapes cutaneous response in atopic dermatitis. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Spiteri M, Ng W, Matthews J, Power D. Functional Outcome of Fixation of Complex Intra-articular Distal Radius Fractures with a Variable-Angle Distal Radius Volar Rim Plate. J Hand Microsurg 2017; 9:11-16. [PMID: 28442856 DOI: 10.1055/s-0037-1601325] [Citation(s) in RCA: 5] [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: 12/03/2016] [Accepted: 02/17/2017] [Indexed: 12/30/2022] Open
Abstract
Aim To evaluate the outcome of these complex fractures using a volar approach and the DePuy Synthes variable-angle 2.4-mm distal radius rim plate. This plate is precontoured to the volar rim for placement distal to the watershed line allowing purchase of the rim fragment of the lunate facet. Its low profile and smooth edges are designed to minimize flexor tendon irritation. Method We report on a consecutive series of far distal AO-23B3 and AO-23C3 fractures treated using this plate in a tertiary hand center between November 2011 and May 2014. Range of motion, grip strength, and complications were assessed at the final clinical review. Disabilities of the arm, shoulder, and hand (DASH) and patient evaluation measure (PEM) scores were assessed at 12 months after surgery. Results Twenty-six patients were included in this review. Six patients were lost to follow-up at 3 months. This plate was used in isolation in 17 cases, and in combination with a dorsal plate, in cases of dorsal instability after volar plating, in 10 patients. DASH and PEM scores 1 year after surgery were 17.6 and 27%, respectively. Visual analog scores for patient treatment satisfaction and severity of pain showed good satisfaction with treatment and mild intermittent pain on activity. Postoperative range of motion was variable and grip strength was of 71% of the uninjured contralateral side. There were no cases of flexor or extensor tendon rupture. Tendon irritation was noted in two patients. Removal of metal was performed in four patients. Loss of reduction occurred in one case and neurologic complications in two cases. Conclusion This implant is specifically designed for the management of far distal complex intra-articular fractures of the distal radius. Despite the complexity of these fracture patterns and the challenge they pose to accurate reduction and stable fixation, outcomes were satisfactory in this small series. There were no cases of tendon rupture. Removal of metal is not necessary in all cases, but prompt removal should be performed in cases of tendon irritation in view of the risk of tendon rupture.
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Affiliation(s)
- M Spiteri
- Hand Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - W Ng
- Hand Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - J Matthews
- Hand Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - D Power
- Hand Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom
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Delaney GP, Do V, Ng W, Barton MB. Abstract P5-14-11: An estimation of the population survival benefit of first-line chemotherapy and immunotherapy for breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-14-11] [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: 11/16/2022]
Abstract
Abstract
Purpose:Randomized clinical trials describe the benefit of chemo-and immunotherapy for specific breast cancer patients with selected patient and disease characteristics. However, variability in practice occurs despite evidence-based guidelines [1]. The overall survival benefit for the whole population of breast cancer patients in Australia, if evidence-based guidelines for chemo-and immunotherapy were implemented, is unknown. Our study's purpose was to estimate the overall population survival benefit of routinely using evidence-based practice.
Methods and Materials:Decision trees with evidence-based indications for chemotherapy have been previously defined [2]. Each branch corresponds to a specific cohort who have, or do not have, defined indications for chemotherapy and/or immunotherapy. Chemo -and immunotherapy benefit was defined as the absolute incremental benefit of either chemotherapy and/or immunotherapy over no chemo- and/or immunotherapy for radical and palliative indications. Multiple electronic citation databases were systematically queried, including Medline and the Cochrane Library. In cases where there were multiple sources of the same level of evidence, hierarchical meta-analysis was performed. The benefits of chemo- and immunotherapy were estimated for 1, 5, 10-year survival. To assess the robustness of our estimates, sensitivity analyses were performed.
Results: The estimated 1-year, 5-year and 10-year absolute population-based overall survival benefits of optimally utilized chemo- and immunotherapy for breast cancer in Australia are 1.0% (95% CI, 0.9%-1.2%), 4.4% (95% CI, 4.3%-4.6%) and 5.2% (%-%), respectively. They are summarized in the Table 1.
Estimation of Population Survival Benefit for First Line Chemo- and Immuno TherapyBreast CancerProportion of all cancer in Australia1 year survival benefit (Sensitivity range)5 year survival benefit (Sensitivity range)10 year survival benefit (Sensitivity range)Stage I-II10.0%0.6% (0.6%-0.7%)4.8% (4.6%-5.0%)6.9% (6.7%- 7.2%)Stage III1.6%3.0% (3.0%-3.1%)6.1% (5.8%-6.3%)0%Stage IV0.5%5.3% (5.1%-5.5%)4.9% (4.7%-5.1%)0%Whole Breast Cancer population12.1%1.0% (0.9%-1.2)4.4% (4.3%-4.6%)5.2% (5.0%-5.4%)
Conclusion: Chemo- and immunotherapy agents improves overall survival in breast cancer at 1-, 5- and 10-years. Chemo-and immunotherapy provides a modest survival benefit to this patient population in Australia when it is used in accordance with guideline recommendations. These outcomes may allow comparison of treatment outcomes in a jurisdiction against what would be considered optimal based on evidence.
1. Fong, A., et al., A comparison of systemic breast cancer therapy utilization in Canada (British Columbia), Scotland (Dundee), and Australia (Western Australia) with models of "optimal" therapy. Breast, 2012. 21(4): p. 562-9.
2. Ng, W., Estimating the optimal chemotherapy utilisation rate as an evidence-based benchmark in cancers of the breast, upper gastrointestinal tract, gynaecological tract, head and neck, kidney, bladder, thyroid and unknown primary., in University of NSW, Faculty of Medicine. 2010, UNSW: Sydney.
Citation Format: Delaney GP, Do V, Ng W, Barton MB. An estimation of the population survival benefit of first-line chemotherapy and immunotherapy for breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-14-11.
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Affiliation(s)
- GP Delaney
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; Crown Princess Mary Cancer Centre Westmead, Sydney University, Sydney, NSW, Australia; University of NSW, Sydney, NSW, Australia
| | - V Do
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; Crown Princess Mary Cancer Centre Westmead, Sydney University, Sydney, NSW, Australia; University of NSW, Sydney, NSW, Australia
| | - W Ng
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; Crown Princess Mary Cancer Centre Westmead, Sydney University, Sydney, NSW, Australia; University of NSW, Sydney, NSW, Australia
| | - MB Barton
- Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; Crown Princess Mary Cancer Centre Westmead, Sydney University, Sydney, NSW, Australia; University of NSW, Sydney, NSW, Australia
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Ng W, Shin J, Yang T, Roberts T, Wang B, Begg J, Lee C. Inhibition of polo-like kinase 1 (PLK1) additively improves outcome of ionising irradiation (IR) in colorectal cancer (CRC). Pathology 2017. [DOI: 10.1016/j.pathol.2016.09.047] [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: 10/20/2022]
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Bille A, Kolokotroni SM, King J, Smelt J, Ashrafian L, Spicer J, Routledge T, Ng W. P3.03-037 Impact of Sarcomatoid Component in Patients with Biphasic Mesothelioma: Review of 118 Patients. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Do V, Jacob S, Ng W, Delaney G, Barton M. 346P An estimation of the population survival benefit of first-course chemotherapy and immunotherapy for leukemia. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw586.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Do V, Jacob S, Ng W, Delaney G, Barton M. 346P An estimation of the population survival benefit of first-course chemotherapy and immunotherapy for leukemia. Ann Oncol 2016. [DOI: 10.1016/s0923-7534(21)00504-4] [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: 10/22/2022] Open
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Brungs D, Healey E, Rose J, Tubaro T, Ng W, Chua W, Carolan M, de Souza P, Aghmesheh M, Ranson M. Adjuvant chemotherapy for stage III colorectal cancer in the elderly. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Affiliation(s)
- Wen Ng
- Royal Marsden Hospital, London, UK
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Abstract
Solitary fibrous tumor (SFT) is a fibroblastic mesenchymal tumor originally described in the pleura but now shown at almost every anatomic site. Histopathologically, SFT is characteristically a circumscribed neoplasm composed of variably cellular and patternless distributions of bland spindle and ovoid cells within prominent collagenous stroma and shows diffuse expression of CD34, but it has a broad spectrum of both morphology and of biologic behavior. Many different names (particularly hemangiopericytoma) were previously used in the course of our understanding of this neoplasm but are now subsumed under the term "SFT," and the putative cell of origin was debated. However, it is now recognized that SFT is a translocation-associated neoplasm, consistently associated with NAB2-STAT6 gene fusions arising from recurrent intrachromosomal rearrangements on chromosome 12q, and this translocation is a likely major contributor to its pathogenesis. While most SFT with classical morphologic features behave in an indolent manner and those with overtly malignant histologic features tend to be aggressive neoplasms that behave as high-grade sarcomas, the behavior of SFT is unpredictable, and it is important to be aware of the propensity for aggressive behavior in a minority of histologically classical SFT and to ensure adequate clinical follow-up. Surgical excision remains the treatment gold standard; while radiotherapy and conventional chemotherapeutic agents have only shown limited efficacy, further understanding of the molecular events underlying tumorigenesis may allow the development of novel targeted treatments. We review SFT, discussing the morphologic spectrum and variants, including malignant and dedifferentiated subtypes, clinicopathological aspects, recent molecular genetic findings, and the differential diagnosis.
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Affiliation(s)
| | - Wen Ng
- Royal Marsden Hospital, London, UK
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Do V, Jacob S, Ng W, Delaney G, Barton M. 120PD An estimation of the population-based survival benefit of first-line chemotherapy for adult primary malignant brain tumour. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv520.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lim S, Spring K, Chua W, Ng W, Descallar J, Ma Y, Becker T, De Souza P. Circulating Tumor Cells in Locally Advanced Rectal Cancer Treated With Neoadjuvant Chemoradiation. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Distinguishing well-differentiated liposarcoma (WDL) from lipoma is of clinical and prognostic importance, but can be difficult on imaging and histology alone. WDL characteristically harbor amplifications of the MDM2 and CDK4 cell cycle oncogenes and overexpress the cell cycle regulator p16. Fluorescence in situ hybridization (FISH) to assess for MDM2 and CDK4 gene amplification is the diagnostic gold standard, and immunohistochemistry for the overexpressed MDM2 and CDK4 proteins is also useful but may not be routinely offered by pathology laboratories. p16 immunohistochemistry is a sensitive marker for WDL and is in the repertoire of most laboratories, and it has been suggested as a useful method of distinguishing WDL from lipomas when other ancillary modalities are not readily available. We describe a case of a large retroperitoneal adipocytic mass occurring in a 27-year-old male, which was clinically and radiologically in keeping with WDL. Histologically this was a differentiated adipocytic neoplasm with prominent fibrous septa and fat necrosis, more suggestive of retroperitoneal lipoma. Immunohistochemistry showed diffuse, strong nuclear expression of p16 in the areas of fat necrosis. However, CDK4 was negative and the lesion lacked evidence of MDM2 amplification with FISH. Diffuse expression of p16 in areas of fat necrosis in large or deep lipomas highlights the potential for diagnostic misinterpretation as well differentiated liposarcoma, and we therefore emphasize that p16 immunohistochemistry should always be interpreted as part of a panel with CDK4 +/− MDM2 in the differential diagnosis of WDL and lipoma.
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Affiliation(s)
- Wen Ng
- Royal Marsden Hospital, London, UK
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Lim S, Chua W, Ng W, Descallar J, Bokey L, Spring K, De Souza P. 2172 Presence of circulating tumour cells and correlation with inflammatory markers in non-metastatic rectal cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31092-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
DOG1 is a highly sensitive marker for gastrointestinal stromal tumor (GIST) and is in the routine diagnostic antibody repertoire of many surgical pathology laboratories. Moreover, GIST is well recognized by both pathologists and clinicians in the differential diagnosis of intra-abdominal and pelvic neoplasms. Low-grade fibromyxoid sarcoma (LGFMS) is, however, much less frequently anticipated, particularly when occurring at unusual sites, because of its rarity and bland histology, particularly on core biopsy. We describe a case of a 53-year-old male with a large pelvic and pararectal mass, which on biopsy showed a moderately cellular spindle cell neoplasm within fibrous stroma. Immunohistochemistry at the referring center showed diffuse and strong expression of DOG1 with negativity for other markers. After referral to a tertiary center, repeat DOG1 immunohistochemistry again showed diffuse expression, but MUC4 was also positive, and this was confirmed to be LGFMS, harboring FUS-CREB3L2 fusion transcripts by reverse transcription-polymerase chain reaction and FUS rearrangement with fluorescence in situ hybridization. In view of this we assessed DOG1 expression in 10 other LGFMS (all MUC4 positive, and 9 molecularly confirmed to harbor FUS-CREB3L2 fusion transcripts and/or FUS or EWSR1 gene rearrangement), of which 5 showed DOG1 expression in up to 75% of tumor cells, varying in intensity from weak to strong. While LGFMS and GIST are generally morphologically dissimilar, less typical variants of each exist, and both can contain bland spindled cells within fibrous stroma. As the morphologic spectrum of LGFMS is wide, and as it can occur in unusual sites and may not be well recognized by general pathologists and non–soft tissue pathologists, we highlight the potential for diagnostic confusion with GIST owing to aberrant DOG1 expression. This is clinically pertinent, as the management and prognosis of these 2 neoplasms differs significantly.
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Affiliation(s)
| | - Wen Ng
- Royal Marsden Hospital, London, UK
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Lim S, Ng W, Chua W, Descallar J, Spring K, De Souza P. 1558 Quality of life and circulating tumour cells in patients treated with neoadjuvant chemoradiation for rectal cancer - is there a link? Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30648-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Intraneural extension of soft tissue sarcomas is uncommon; it is most frequently seen in malignant peripheral nerve sheath tumor, but its occurrence is exceptional in synovial sarcoma. We describe a case arising extraneurally within the deep soft tissues of the forearm, which recurred and resulted in above-elbow amputation, revealing an unexpected finding of diffuse intraneural extension of tumor within a macroscopically normal major nerve. Despite macroscopic and microscopically clear soft tissue margins, the neoplasm had "traveled" a significant distance intraneurally to involve the neural resection margin. This feature does not appear to have been described before; it highlights the issue of whether intraneural spread of synovial sarcoma might have been previously underrecognized, and we discuss briefly some practical implications.
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Affiliation(s)
- Wen Ng
- Royal Marsden Hospital, London, UK
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