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Damon J, Chase C, Higashimoto T. Primary amenorrhea in myotonic dystrophy type 1: Initial presentation versus incidental finding on whole genome sequencing. Am J Med Genet A 2024:e63650. [PMID: 38709060 DOI: 10.1002/ajmg.a.63650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/07/2024]
Abstract
Myotonic dystrophy type 1 is an autosomal dominant condition due to a CTG repeat expansion in the myotonic dystrophy protein kinase (DMPK) gene. This multisystem disorder affects multiple organ systems. Hypogonadism in males affected by myotonic dystrophy is commonly reported; however, the effect on female hypogonadism remains controversial. A 19-year-old female was referred to our genetics clinic due to primary amenorrhea without any family history of similar symptoms. Initial genetics evaluation identified a variant of uncertain significance in IGSF10, c.2210T>C (p.Phe737Ser). Follow-up genetic evaluation via whole genome sequencing identified at least 100 CTG repeats in the DMPK gene, thus resulting in the diagnosis of myotonic dystrophy type 1. The patient remains otherwise asymptomatic from myotonic dystrophy. This is the first report that demonstrates primary amenorrhea as a possible presenting feature of myotonic dystrophy type 1, thus providing evidence supporting female hypogonadism in myotonic dystrophy type 1.
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Affiliation(s)
- Jenna Damon
- Department of Internal Medicine, Division of Genetic Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Colby Chase
- Department of Internal Medicine, Division of Genetic Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Tomoyasu Higashimoto
- Department of Internal Medicine, Division of Genetic Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Pediatrics, Division of Genetics, Genomics, and Metabolism, University of Michigan, Ann Arbor, Michigan, USA
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Kim C, Moffat D, Brennan C. Comment on 'Is it necessary to block an entire appendix to exclude acute appendicitis?', a previously published article by Newton ACS Wong. Histopathology 2024. [PMID: 38651318 DOI: 10.1111/his.15201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Chankyung Kim
- Department of Anatomical Pathology, SA Pathology, Adelaide, South Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia
| | - David Moffat
- Department of Anatomical Pathology, SA Pathology, Adelaide, South Australia
- College of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | - Catriona Brennan
- Department of Anatomical Pathology, SA Pathology, Adelaide, South Australia
- College of Medicine, Flinders University, Bedford Park, South Australia, Australia
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Heremans R, Wynants L, Valentin L, Leone FPG, Pascual MA, Fruscio R, Testa AC, Buonomo F, Guerriero S, Epstein E, Bourne T, Timmerman D, Van den Bosch T. Estimating risk of endometrial malignancy and other intracavitary uterine pathology in women without abnormal uterine bleeding using IETA-1 multinomial regression model: validation study. Ultrasound Obstet Gynecol 2024; 63:556-563. [PMID: 37927006 DOI: 10.1002/uog.27530] [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] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/07/2023] [Accepted: 10/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To assess the ability of the International Endometrial Tumor Analysis (IETA)-1 polynomial regression model to estimate the risk of endometrial cancer (EC) and other intracavitary uterine pathology in women without abnormal uterine bleeding. METHODS This was a retrospective study, in which we validated the IETA-1 model on the IETA-3 study cohort (n = 1745). The IETA-3 study is a prospective observational multicenter study. It includes women without vaginal bleeding who underwent a standardized transvaginal ultrasound examination in one of seven ultrasound centers between January 2011 and December 2018. The ultrasonography was performed either as part of a routine gynecological examination, during follow-up of non-endometrial pathology, in the work-up before fertility treatment or before treatment for uterine prolapse or ovarian pathology. Ultrasonographic findings were described using IETA terminology and were compared with histology, or with results of clinical and ultrasound follow-up of at least 1 year if endometrial sampling was not performed. The IETA-1 model, which was created using data from patients with abnormal uterine bleeding, predicts four histological outcomes: (1) EC or endometrial intraepithelial neoplasia (EIN); (2) endometrial polyp or intracavitary myoma; (3) proliferative or secretory endometrium, endometritis, or endometrial hyperplasia without atypia; and (4) endometrial atrophy. The predictors in the model are age, body mass index and seven ultrasound variables (visibility of the endometrium, endometrial thickness, color score, cysts in the endometrium, non-uniform echogenicity of the endometrium, presence of a bright edge, presence of a single dominant vessel). We analyzed the discriminative ability of the model (area under the receiver-operating-characteristics curve (AUC); polytomous discrimination index (PDI)) and evaluated calibration of its risk estimates (observed/expected ratio). RESULTS The median age of the women in the IETA-3 cohort was 51 (range, 20-85) years and 51% (887/1745) of the women were postmenopausal. Histology showed EC or EIN in 29 (2%) women, endometrial polyps or intracavitary myomas in 1094 (63%), proliferative or secretory endometrium, endometritis, or hyperplasia without atypia in 144 (8%) and endometrial atrophy in 265 (15%) women. The endometrial sample had insufficient material in five (0.3%) cases. In 208 (12%) women who did not undergo endometrial sampling but were followed up for at least 1 year without clinical or ultrasound signs of endometrial malignancy, the outcome was classified as benign. The IETA-1 model had an AUC of 0.81 (95% CI, 0.73-0.89, n = 1745) for discrimination between malignant (EC or EIN) and benign endometrium, and the observed/expected ratio for EC or EIN was 0.51 (95% CI, 0.32-0.82). The model was able to categorize the four histological outcomes with considerable accuracy: the PDI of the model was 0.68 (95% CI, 0.62-0.73) (n = 1532). The IETA-1 model discriminated very well between endometrial atrophy and all other intracavitary uterine conditions, with an AUC of 0.96 (95% CI, 0.95-0.98). Including only patients in whom the endometrium was measurable (n = 1689), the model's AUC was 0.83 (95% CI, 0.75-0.91), compared with 0.62 (95% CI, 0.52-0.73) when using endometrial thickness alone to predict malignancy (difference in AUC, 0.21; 95% CI, 0.08-0.32). In postmenopausal women with measurable endometrial thickness (n = 848), the IETA-1 model gave an AUC of 0.81 (95% CI, 0.71-0.91), while endometrial thickness alone gave an AUC of 0.70 (95% CI, 0.60-0.81) (difference in AUC, 0.11; 95% CI, 0.01-0.20). CONCLUSION The IETA-1 model discriminates well between benign and malignant conditions in the uterine cavity in patients without abnormal bleeding, but it overestimates the risk of malignancy. It also discriminates well between the four histological outcome categories. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Heremans
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - L Wynants
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital Malmö and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - F P G Leone
- Department of Obstetrics and Gynecology, Clinical Sciences Institute Luigi Sacco, Milan, Italy
| | - M A Pascual
- Department of Obstetrics, Gynecology and Reproduction, Hospital Universitario Dexeus, Barcelona, Spain
| | - R Fruscio
- UOC Gynecology, Department of Medicine and Surgery, University of Milan-Bicocca, Fondazione IRCCS San Gerardo dei Tontori, Monza, Italy
| | - A C Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitatio A Gemelli, IRCCS, Rome, Italy
| | - F Buonomo
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - S Guerriero
- Department of Obstetrics and Gynecology, University of Cagliari, Policlinico Universitario Duilio Casula, Monserrato, Cagliari, Italy
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institutet, and Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - T Bourne
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynaecology, Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Kızılgöz V, Kantarcı M, Aydemir H. Incidental findings of cervical magnetic resonance imaging: A retrospective reinterpretation of a large adult population. Acta Radiol Open 2024; 13:20584601241244785. [PMID: 38585624 PMCID: PMC10993677 DOI: 10.1177/20584601241244785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 03/18/2024] [Indexed: 04/09/2024] Open
Abstract
Background Magnetic resonance imaging (MRI) of the cervical spine is one of the routine MRI scans of the cervical region in investigating spinal disc pathologies, spinal stenosis, and the detection of spinal lesions, which are the major parameters to be evaluated in this examination. Purpose The authors of this study are focused on a different aspect of cervical MRI, revealing the incidences and reporting rates of extraspinal incidental findings. Methods A total of 1000 patients (324 males, 676 females, mean age 47 ± 14) who had undergone an MRI of the cervical spine were enrolled in this study. The magnetic resonance (MR) images of these patients were re-interpreted with respect to the incidental extraspinal imaging findings. The incidence and reporting rate of each incidental finding encountered during the evaluation were presented in percentages. Results 726 patients in this study had at least one incidental lesion. The results of this study revealed that the most common incidental lesions encountered during the reinterpretation of cervical MRI were nasopharyngeal mucosal thickening (n = 442) and thyroid hypertrophy (n = 231). The total reporting rate of incidental findings was 5.29%. Conclusion There are many data to be reported and evaluated by MR imaging of the cervical spine, not only the main parameters of MRI scanning in the routine daily practice of radiologists. All our colleagues should be aware and careful of these incidental findings, which may be the initial medical data of the patients' diagnoses, or to avoid undesirable medicolegal problems.
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Affiliation(s)
- Volkan Kızılgöz
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Mecit Kantarcı
- Department of Radiology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Hüseyin Aydemir
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
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Mohan R, Puranik CP, Kaci P, Moore T, Katechia B, Schulman GS, Tadinada A. Prescription of panoramic radiographs in children using age-based prevalence of dental anomalies and pathologies. Int J Paediatr Dent 2024; 34:125-134. [PMID: 37330621 DOI: 10.1111/ipd.13095] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/02/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Panoramic radiographs (PRs) are used in the detection and diagnosis of developmental dental anomalies and pathologies (DDAPs) in children. AIM The primary objective of this observational cohort study was to evaluate the age-based prevalence of DDAP on PRs, whereas the secondary objective was to determine a threshold age for the detection of DDAP to provide supportive evidence for the prescription of PR in paediatric dental practice. DESIGN The study examined diagnostic PRs from 581 subjects aged 6 to 19 years. All PRs were reviewed by experienced, calibrated, masked examiners for the identification or presence of anomalies in size, shape, position, structure, and other developmental anomalies and pathologies (ODAP) of the face-neck region in a standardized condition. The data were statistically analyzed for interpretation. RESULTS Overall, 74% (n = 411) of the cohort had at least one anomaly (shape anomaly: 12%, number anomaly: 17%, positional anomaly: 28%, structural anomaly: 0%, and ODAP: 63%). The optimal Youden index cutoff for any anomaly was 9 years. Twelve and 15 years also showed predictive ability. CONCLUSION The results suggest that PRs should be prescribed at ages 9, 12, and 15 years for the diagnosis of DDAP.
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Affiliation(s)
- Ritu Mohan
- Division of Paediatric Dentistry, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Chaitanya P Puranik
- Children's Hospital Colorado and School of Dental Medicine, University of Colorado, Aurora, Colorado, USA
| | - Pickett Kaci
- Center for Research Outcomes in Children's Surgery (ROCS), Children's Hospital Colorado, Aurora, Colorado, USA
| | - Timothy Moore
- Statistical Consulting Services Center for Open Research Resources & Equipment, Nathan L. Whetten Graduate Center, University of Connecticut, Storrs, Connecticut, USA
| | - Bina Katechia
- Division of Paediatric Dentistry, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Gary S Schulman
- Division of Paediatric Dentistry, Department of Craniofacial Sciences, School of Dental Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Aditya Tadinada
- Department of Oral Maxillofacial Diagnostic Sciences, School of Dental Medicine, University of Connecticut, Farmington, Connecticut, USA
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Cunningham E, Hays S, Wainstein T, Zierhut H, Virani A, Tryon R. Exploring genetic counselors' experiences with non-paternity in clinical settings. J Genet Couns 2024. [PMID: 38323428 DOI: 10.1002/jgc4.1881] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/11/2024] [Accepted: 01/30/2024] [Indexed: 02/08/2024]
Abstract
Non-paternity (NP) is a challenging dilemma faced by genetics providers and there is little consensus on whether this finding should be disclosed. Discussions in the literature are highly theoretical, with limited research regarding how disclosure decisions are enacted in practice. We explored genetic counselors' (GCs) clinical experiences with NP to understand if, how, and why this finding is communicated. Our semi-structured interviews with genetic counselors in the United States and Canada were analyzed using reflexive thematic analysis to analyze data inductively, describe themes, and present a meaningful interpretation of the data. Eighteen participants who responded to list-serv messages were interviewed. Our framework describes five salient themes: (1) GC-lab relationship: the GCs awareness of laboratory processes such as quality control metrics that can uncover NP findings and the way in which a finding of NP was disclosed by the laboratory had an impact on disclosure decisions. This triggered a decision-making trajectory that involved (2) consultation, (3) ethical reasoning, and (4) practical constraints. GCs frequently consulted other professionals during decision-making. These conversations impacted disclosure decisions with some consultations carrying greater weight than others. GCs weighed moral concepts of patient autonomy, medical relevance, and preventing harm to rationalize decisions. Access to patients and documentation requirements often dictated how disclosure occurred. Finally, once a decision had been made and enacted, GCs used the experience to reconsider their approach to (5) consenting in future cases, with some GCs altering their pre-test counseling to always include a discussion of NP. Although NP scenarios are frequently unique in context, our findings demonstrate several common decision-making factors GCs harness to navigate the identification of NP through clinical genetic testing.
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Affiliation(s)
- Emma Cunningham
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Hays
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tasha Wainstein
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Heather Zierhut
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota, USA
| | - Alice Virani
- Department of Medical Genetics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Ethics Service, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Rebecca Tryon
- Department of Genetics, Cell Biology, and Development, University of Minnesota, Minneapolis, Minnesota, USA
- Blood & Marrow Transplant Program, M Health Fairview, Minneapolis, Minnesota, USA
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Machado PAB, Pereira CDO, de Bortolo JL, Martins ALCL, Campos HG, de Aguiar AJ, Postai RPTA, Wiederkehr JC, Wiederkehr HDA. Littoral cell angioma of the spleen: case report and literature review. Einstein (Sao Paulo) 2024; 22:eRC0267. [PMID: 38324846 PMCID: PMC10948099 DOI: 10.31744/einstein_journal/2024rc0267] [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: 09/27/2022] [Accepted: 09/19/2023] [Indexed: 02/09/2024] Open
Abstract
Littoral cell angioma is an extremely rare splenic vascular tumor originating from the cells lining the splenic red pulp sinuses. Approximately 150 cases of littoral cell angioma have been reported since 1991. Its clinical manifestation is usually asymptomatic and is mostly diagnosed as an incidental finding through abdominal imaging. Herein, we present a case of littoral cell angioma in a 41-year-old woman with no previous comorbidities, which initially presented as a nonspecific splenic lesion diagnosed on imaging in the emergency room. The patient was treated through laparoscopic intervention.
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Affiliation(s)
- Paulo André Bispo Machado
- General and Trauma Surgery ServiceHospital do TrabalhadorUniversidade Federal do ParanáCuritibaPRBrazil General and Trauma Surgery Service , Hospital do Trabalhador , Universidade Federal do Paraná , Curitiba , PR , Brazil .
- Escola de MedicinaPontifícia Universidade Católica do ParanáCuritibaPRBrazil Escola de Medicina , Pontifícia Universidade Católica do Paraná , Curitiba , PR , Brazil .
| | - Caroline de Oliveira Pereira
- General and Trauma Surgery ServiceHospital do TrabalhadorUniversidade Federal do ParanáCuritibaPRBrazil General and Trauma Surgery Service , Hospital do Trabalhador , Universidade Federal do Paraná , Curitiba , PR , Brazil .
| | - Julia Letícia de Bortolo
- Escola de MedicinaPontifícia Universidade Católica do ParanáCuritibaPRBrazil Escola de Medicina , Pontifícia Universidade Católica do Paraná , Curitiba , PR , Brazil .
| | - Ana Luísa Caetano Lopes Martins
- Escola de MedicinaPontifícia Universidade Católica do ParanáCuritibaPRBrazil Escola de Medicina , Pontifícia Universidade Católica do Paraná , Curitiba , PR , Brazil .
| | - Helder Groenwold Campos
- General and Trauma Surgery ServiceHospital do TrabalhadorUniversidade Federal do ParanáCuritibaPRBrazil General and Trauma Surgery Service , Hospital do Trabalhador , Universidade Federal do Paraná , Curitiba , PR , Brazil .
| | - Alan Junior de Aguiar
- Digestive System Surgery ServiceHospital Vita BatelCuritibaPRBrazil Digestive System Surgery Service , Hospital Vita Batel , Curitiba , PR , Brazil .
| | - Rayana Pecharki Teixeira Alves Postai
- Digestive System Surgery ServiceHospital Vita BatelCuritibaPRBrazil Digestive System Surgery Service , Hospital Vita Batel , Curitiba , PR , Brazil .
| | - Julio Cesar Wiederkehr
- Digestive System Surgery ServiceHospital Vita BatelCuritibaPRBrazil Digestive System Surgery Service , Hospital Vita Batel , Curitiba , PR , Brazil .
| | - Henrique de Aguiar Wiederkehr
- General and Trauma Surgery ServiceHospital do TrabalhadorUniversidade Federal do ParanáCuritibaPRBrazil General and Trauma Surgery Service , Hospital do Trabalhador , Universidade Federal do Paraná , Curitiba , PR , Brazil .
- Digestive System Surgery ServiceHospital Vita BatelCuritibaPRBrazil Digestive System Surgery Service , Hospital Vita Batel , Curitiba , PR , Brazil .
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Sacks M, Tjiattas‐Saleski L. A 70-year-old female with knee pain after a fall. J Am Coll Emerg Physicians Open 2024; 5:e13088. [PMID: 38186554 PMCID: PMC10766507 DOI: 10.1002/emp2.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Madison Sacks
- Department of Clinical AffairsEdward Via College of Osteopathic MedicineSpartanburgSouth CarolinaUSA
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Key S, Chia C, Magarey M, Dixon B. Risk of malignancy in incidental oropharyngeal lesions exhibiting fluorodeoxyglucose uptake which proceed to tissue biopsy. ANZ J Surg 2024; 94:122-127. [PMID: 38115646 DOI: 10.1111/ans.18839] [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: 08/07/2023] [Revised: 12/02/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Utilization of positron emission tomography/computed tomography (PET/CT) with fluorodeoxyglucose is increasing in use for a variety of indications, including surveillance of cancer patients. There is a paucity of evidence pertaining to the significance of incidental PET-avid oropharyngeal lesions. This study aims to examine the clinical and radiological features of these incidental oropharyngeal lesions in patients undergoing PET for indications other than head and neck cancer. METHODS Retrospective cohort study of three Australian tertiary hospitals, from 2015 to 2021, on adult patients undergoing biopsy of incidental PET-avid oropharyngeal lesions. Primary outcome of interest was the incidence of malignancy. Patients with a previous history of, or undergoing investigations for, head and neck cancer were excluded. RESULTS Thirty-one patients were included, wherein 21 patients had tonsillar uptake, and 13 patients had base of tongue uptake. Tonsillar disease was mostly asymmetrical (n = 15/21), bilateral (n = 11/21), and had median SUVmax 9.35 (n = 12, IQR 7.4-11.15). Base of tongue was mostly asymmetrical (n = 7/13, 54%), bilateral (n = 8/13, 62%), and had median SUVmax 8.2 (n = 10, IQR 6.9-12.65). Seven patients had malignancy confirmed on tissue biopsy: five biopsies confirmed the tissue diagnosis of suspected lymphoma, and two incidental findings of unexpected malignancies: one p16 positive tonsillar squamous cell carcinoma, and one metastatic breast cancer. CONCLUSION In 31 patients undergoing tissue biopsy for incidental PET-avid oropharyngeal lesions, there were two unexpected malignancies. Our study results indicate that although unexpected malignancies are uncommon, a malignant diagnosis cannot be excluded from clinical features alone.
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Affiliation(s)
- Seraphina Key
- Department of ENT, Head & Neck Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Clemente Chia
- Department of ENT, Head & Neck Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Matthew Magarey
- Division of Surgical Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Pinnacle Surgery, Epworth Hospital, Richmond, Victoria, Australia
- Department of Medical Education, University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Dixon
- Department of ENT, Head & Neck Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- Pinnacle Surgery, Epworth Hospital, Richmond, Victoria, Australia
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Kılınç Uğurlu A, Özdemir Gökce A, Çakır Gündoğan S, Ekşioğlu AS, Boyraz M. MRI evaluation of cranial pathologies in rapidly progressive early puberty cases aged 8-9. Front Endocrinol (Lausanne) 2024; 14:1316333. [PMID: 38229738 PMCID: PMC10789853 DOI: 10.3389/fendo.2023.1316333] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/05/2023] [Indexed: 01/18/2024] Open
Abstract
Purpose The aim of this study was to investigate the frequency and distribution of intracranial pathologies in female patients between 8 and 9 years of age who were diagnosed with early puberty (rapidly progressive) through the evaluation of MRI images. Materials and methods A total of 74 female patients diagnosed with central precocious puberty (CPP) (6-8 years) and rapidly progressive early puberty (RPEP) (8-9 years) were included in the study. The patients were categorized into two groups, normal and abnormal, based on the findings from their MRI scans. Recent literature has classified abnormal MRI findings into three groups: pathological findings, findings with a questionable relationship to CPP, and incidental findings. Furthermore, the patients were divided into four groups based on their MRI findings and whether they had CPP or RPEP : CPP (6-8 years) +Normal MRI, RPEP (8-9 years) + Normal MRI, CPP (6-8 years) +Abnormal MRI, RPEP (8-9 years) +Abnormal MRI. Results Out of the 74 girls included in the study, 54% (n=40) showed normal MRI results, while abnormal MRI findings were detected in 46% (n = 34) of the cases. No malignant lesions were identified among cases with abnormal MRI findings. The occurrence of abnormal MRI findings was observed in 46% of the PP group and 45% of the RPEP group. Incidental findings were the most common MRI findings in both groups. The proportion of cases with pathological findings and findings with a questionable relationship to CPP was similar in both groups (p = 0.06). Basal luteinizing hormone (LH) concentration was found to be higher in the RPEP (8-9 years) +Abnormal MRI group compared to the CPP (6-8 years) +Normal MRI group (p = 0.01). Conclusion Our study is the first to investigate MRI findings in cases of rapidly progressive early puberty in the age range of 8-9 years. Our study demonstrates that there is no difference in terms of intracranial findings between cases of precocious puberty at the age of 6-8 years and cases of rapidly progressive early puberty aged 8-9.
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Affiliation(s)
- Aylin Kılınç Uğurlu
- Ankara Bilkent City Hospital, Pediatric Endocrinology Clinic, Ankara, Türkiye
| | - Ayse Özdemir Gökce
- Ankara Bilkent City Hospital, Pediatric Radiology Clinic, Ankara, Türkiye
| | | | | | - Mehmet Boyraz
- Ankara Bilkent City Hospital, Pediatric Endocrinology Clinic, Ankara, Türkiye
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Jacome CS, Garcia A, Golembiewski E, Loor-Torres R, Duran M, Segura D, Toro-Tobon D, Fan JW, Singh Ospina N, Brito JP. Physical Examination of the Thyroid: Accuracy in Detecting Thyroid Nodules and Frequency of Additional Findings. Endocr Pract 2024; 30:31-35. [PMID: 37805101 PMCID: PMC10843284 DOI: 10.1016/j.eprac.2023.10.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/25/2023] [Accepted: 10/02/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE Thyroid palpation is a common clinical practice to detect thyroid abnormalities. However, its accuracy and potential for additional findings remain unclear. This study aimed to assess the diagnostic accuracy of physical exams in detecting thyroid nodules. METHODS A retrospective observational study was conducted on a random sample of adult patients who underwent their first-time thyroid ultrasound between January 2015 and September 2017, following a documented thyroid physical exam. The study assessed the performance of thyroid palpation in detecting 1 or multiple thyroid nodules, as well as the proportion of additional findings on ultrasounds due to false positive thyroid palpation. RESULTS We included 327 patients, mostly female (65.1%), white (84.1%), and treated in a primary care setting (54.4%) with a mean age of 50.8 years (SD 16.9). For solitary thyroid nodules, the physical exam had a sensitivity of 20.3%, specificity of 79.1%, an accuracy of 68.5%, negative predictive value of 81.8%, and positive predictive value of 17.6%. For detecting a multinodular goiter, physical exams demonstrated a sensitivity of 10.8%, specificity of 96.5%, accuracy of 55.4%, negative predictive value of 53.9, and positive predictive value of 73.9%. Among 154 cases with palpable nodules, 60% had additional nodules found in subsequent thyroid ultrasound. CONCLUSION Thyroid physical exam has limited diagnostic performance and leads to additional findings when followed by a thyroid ultrasound. Future efforts should be directed at improving the accuracy of thyroid physical exams or re-evaluating its routine use.
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Affiliation(s)
- Cristian Soto Jacome
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Andrea Garcia
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | | | | | - Mayra Duran
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Danny Segura
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - David Toro-Tobon
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jungwei W Fan
- Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Naykky Singh Ospina
- Department of Endocrinology, Department of Medicine, University of Florida, Gainesville, Florida
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
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12
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Melzer AC, Atoma B, Fabbrini AE, Campbell M, Clothier BA, Fu SS. Variation in Reporting of Incidental Findings on Initial Lung Cancer Screening and Associations With Clinician Assessment. J Am Coll Radiol 2024; 21:118-127. [PMID: 37516160 DOI: 10.1016/j.jacr.2023.03.023] [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: 11/15/2022] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE The aim of this study was to quantify the distribution, frequency, and clinical significance of incidental findings (IFs) on initial lung cancer screening (LCS) and the association of report characteristics with subsequent assessment. METHODS Health records of patients undergoing initial LCS from 2015 to 2018 in the Minneapolis VA Health Care System were retrospectively reviewed for demographics, Lung CT Screening Reporting & Data System coding, IFs, and subsequent clinical assessment. IFs were considered potentially significant if they were likely to require any follow-up. High-risk significant IFs (SIFs) were potentially malignant. The primary outcome was the SIF being addressed. Outcomes were analyzed using a mixed-effects model. RESULTS Patients (n = 901) were primarily male (94.1%) smokers (62.1%) with a mean age of 65.2 years. IFs were extremely common (93.9%), with an average of 2.6 IFs per scan (n = 2,296). Seven hundred eighty-six IFs (34.2%) were deemed likely SIFs, of which 58 (7.4%) were high risk. Two hundred twenty-two (28.2%) were addressed by clinicians, of which 104 (13.2%) underwent testing. Reporting of SIFs varied among radiologists, with at least one SIF in the impression in 24% to 78% of low-dose CT studies with the S modifier, used to indicate the presence of a SIF, applied to 0% to 51% of reports. In the mutually adjusted model, radiologist recommendation (adjusted odds ratio [OR], 4.67; 95% confidence interval [CI], 2.23-9.76), high-risk finding (adjusted OR, 4.35; 95% CI, 1.81-10.45), and reporting in the impression (adjusted OR, 2.58; 95% CI, 1.28-5.18) were associated with increased odds of the SIF's being addressed. CONCLUSIONS Radiologists vary in their reporting of IFs on LCS. Further standardization of reporting of SIFs may improve this process, with the simultaneous goals of generating appropriate testing when needed and minimizing low-value care.
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Affiliation(s)
- Anne C Melzer
- Medical Director of Lung Cancer Screening, Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota; Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota.
| | - Bethlehem Atoma
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Angela E Fabbrini
- Program Manager, National Center for Lung Cancer Screening, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Megan Campbell
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Barbara A Clothier
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Steven S Fu
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota; Director, Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, Minnesota
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Kota KJ, Dawson A, Papas J, Sotelo V, Su G, Li M, Lee W, Estervil J, Marquez M, Sarkar S, Lopez LL, Hu WT. Factors associated with attitudes toward research MRI in older Asian Americans. Alzheimers Dement (N Y) 2024; 10:e12449. [PMID: 38356478 PMCID: PMC10865479 DOI: 10.1002/trc2.12449] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/14/2023] [Accepted: 12/11/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION South Asian (SA) and East Asian (EA) older adults represent the fastest-growing racial/ethnic groups of Americans at risk for dementia. While recruiting older SA adults into a brain health study, we encountered unexpected hesitancy toward structural brain magnetic resonance imaging (MRI) analysis and stigmatizing attitudes related to internal locus of control (LoC) for future dementia risks. We hypothesized that support for MRI-related research was influenced by these attitudes as well as personal MRI experience, perceived MRI safety, and concerns for personal risk for future dementia/stroke. METHODS We developed a brief cross-sectional survey to assess older adults' MRI experiences and perceptions, desire to learn of six incidental findings of increasing impact on health, and attitudes related to dementia (including LoC) and research participation. We recruited a convenience sample of 256 respondents (74% reporting as 50+) from the New Jersey/New York City area to complete the survey (offered in English, Chinese, Korean, and Spanish) and modeled the proportional odds (PO) for favorable attitudes toward research activities. RESULTS Seventy-seven SA and 84 EA respondents were analyzed alongside 95 White, Black, or Hispanic adults. White (PO = 2.54, p = 0.013) and EA (PO = 2.14, p = 0.019) respondents were both more likely than SA respondents to endorse healthy volunteers' participation in research, and the difference between White and SA respondents was mediated by the latter's greater internal LoC for dementia risks. EA respondents had more worries for future dementia/stroke than SA respondents (p = 0.006) but still shared SA respondents' lower wish (measured by proportion of total) to learn of incidental MRI findings. DISCUSSION SA-and EA compared to SA-older adults had low desire to learn of incidental MRI findings but had different attitudes toward future dementia/stroke risks. A culturally appropriate protocol to disclose incidental MRI findings may improve SA and EA participation in brain health research. Highlights Older Asian Americans have limited interest in incidental findings on research MRISouth Asians are most likely to attribute dementia to people's own behaviorsSouth Asians' attitudes mediate lower support for healthy volunteers in researchSouth and East Asians differ in dementia worries and research-related attitudes.
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Affiliation(s)
- Karthik J Kota
- Departments of NeurologyInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
- Departments of MedicineRutgers‐Robert Wood Johnson Medical SchoolInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Alice Dawson
- Departments of NeurologyInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Julia Papas
- Departments of NeurologyInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Victor Sotelo
- Departments of NeurologyInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Guibin Su
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Mei‐Ling Li
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Woowon Lee
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Jaunis Estervil
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Melissa Marquez
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Shromona Sarkar
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - Lisa Lanza Lopez
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
| | - William T. Hu
- Departments of NeurologyInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
- Center for Healthy AgingInstitute for Health, Health Care Policy, and Aging ResearchRutgers Biomedical and Health SciencesNew BrunswickNew JerseyUSA
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Borrell A, Ordoñez E, Pauta M, Otaño J, Paz-y-Miño F, de Almeida M, León M, Cirigliano V. Prenatal Exome Sequencing Analysis in Fetuses with Various Ultrasound Findings. J Clin Med 2023; 13:181. [PMID: 38202188 PMCID: PMC10780147 DOI: 10.3390/jcm13010181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/02/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES To evaluate the use of Exome Sequencing (ES) for the detection of genome-wide Copy Number Variants (CNVs) and the frequency of SNVs-InDels in selected genes related to developmental disorders in a cohort of consecutive pregnancies undergoing invasive diagnostic procedures for minor or simple ultrasound findings with no indication of ES. METHODS Women undergoing invasive diagnostic testing (chorionic villus sampling or amniocentesis) for QF-PCR and chromosomal microarray analysis (CMA) due to prenatal ultrasound findings without an indication for ES were selected over a five-month period (May-September 2021). ES was performed to compare the efficiency of genome-wide CNV detection against CMA analysis and to detect monogenic disorders. Virtual gene panels were selected to target genes related to ultrasound findings and bioinformatic analysis was performed, prioritizing variants based on the corresponding HPO terms. The broad Fetal Gene panel for developmental disorders developed by the PAGE group was also included in the analysis. RESULTS A total of 59 out of 61 women consented to participate in this study. There were 36 isolated major fetal anomalies, 11 aneuploidy markers, 6 minor fetal anomalies, 4 multiple anomalies, and 2 other ultrasound signs. Following QF-PCR analysis, two uncultured samples were excluded from this study, and six (10%) common chromosome aneuploidies were detected. In the remaining 51 cases, no pathogenic CNVs were detected at CMA, nor were any pathogenic variants observed in gene panels only targeting the ultrasound indications. Two (3.9%) monogenic diseases, apparently unrelated to the fetal phenotype, were detected: blepharo-cheilo-odontic syndrome (spina bifida) and Duchenne muscular dystrophy (pyelocaliceal dilation). CONCLUSIONS In our series of pregnancies with ultrasound findings, common aneuploidies were the only chromosomal abnormalities present, which were detected in 10% of cases. ES CNV analysis was concordant with CMA results in all cases. No additional findings were provided by only targeting selected genes based on ultrasound findings. Broadening the analysis to a larger number of genes involved in fetal developmental disorders revealed monogenic diseases in 3.9% of cases, which, although apparently not directly related to the indications, were clinically relevant.
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Affiliation(s)
- Antoni Borrell
- Barcelona Centre for Maternal-Fetal and Neonatal Medicine (BCNatal), Hospital Clínic Barcelona, Universitat de Barcelona, 08007 Barcelona, Spain; (J.O.); (F.P.-y.-M.)
| | - Elena Ordoñez
- Veritas Genetics, c/Zamora 46-48, 08005 Barcelona, Spain; (E.O.); (M.d.A.); (M.L.); (V.C.)
| | - Montse Pauta
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Juan Otaño
- Barcelona Centre for Maternal-Fetal and Neonatal Medicine (BCNatal), Hospital Clínic Barcelona, Universitat de Barcelona, 08007 Barcelona, Spain; (J.O.); (F.P.-y.-M.)
| | - Fernanda Paz-y-Miño
- Barcelona Centre for Maternal-Fetal and Neonatal Medicine (BCNatal), Hospital Clínic Barcelona, Universitat de Barcelona, 08007 Barcelona, Spain; (J.O.); (F.P.-y.-M.)
| | - Mafalda de Almeida
- Veritas Genetics, c/Zamora 46-48, 08005 Barcelona, Spain; (E.O.); (M.d.A.); (M.L.); (V.C.)
| | - Miriam León
- Veritas Genetics, c/Zamora 46-48, 08005 Barcelona, Spain; (E.O.); (M.d.A.); (M.L.); (V.C.)
| | - Vincenzo Cirigliano
- Veritas Genetics, c/Zamora 46-48, 08005 Barcelona, Spain; (E.O.); (M.d.A.); (M.L.); (V.C.)
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Blodgett M, Fradinho J, Gurley K, Burke R, Grossman S. The Value of Using a Quality Assurance Follow-Up Team to Address Incidental Findings After Emergency Department or Urgent Care Discharge: A Cost Analysis. J Emerg Med 2023; 65:e568-e579. [PMID: 37879972 DOI: 10.1016/j.jemermed.2023.08.001] [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: 01/18/2023] [Revised: 07/06/2023] [Accepted: 08/10/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Incidental finding (IF) follow-up is of critical importance for patient safety and is a source of malpractice risk. Laboratory, imaging, or other types of IFs are often uncovered incidentally and are missed, not addressed, or only result after hospital discharge. Despite a growing IF notification literature, a need remains to study cost-effective non-electronic health record (EHR)-specific solutions that can be used across different types of IFs and EHRs. OBJECTIVE The objective of this study was to evaluate the utility and cost-effectiveness of an EHR-independent emergency medicine-based quality assurance (QA) follow-up program in which an experienced nurse reviewed laboratory and imaging studies and ensured appropriate follow-up of results. METHODS A QA nurse reviewed preceding-day abnormal studies from a tertiary care hospital, a community hospital, and an urgent care center. Laboratory values outside preset parameters or radiology over-reads resulting in clinically actionable changes triggered contact with an on-call emergency physician to determine an appropriate intervention and its implementation. RESULTS Of 104,125 visits with 1,351,212 laboratory studies and 95,000 imaging studies, 6530 visits had IFs, including 2659 laboratory and 4004 imaging results. The most common intervention was contacting a primary care physician (5783 cases [88.6%]). Twenty-one cases resulted in a patient returning to the ED, at an average cost of $28,000 per potential life-/limb-saving intervention. CONCLUSIONS Although abnormalities in laboratory results and imaging are often incidental to patient care, a dedicated emergency department QA follow-up program resulted in the identification and communication of numerous laboratory and imaging abnormalities and may result in changes to patients' subsequent clinical course, potentially increasing patient safety.
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Affiliation(s)
- Maxwell Blodgett
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Jorge Fradinho
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Kiersten Gurley
- Department of Emergency Medicine, Anna Jaques Hospital, Newburyport, Massachusetts
| | - Ryan Burke
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Shamai Grossman
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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16
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Rudd I, Gill G, Buckley M, Downie L. An incidental finding in prenatal exome sequencing-A case study and review of the clinical and ethical considerations. Am J Med Genet A 2023; 191:2856-2859. [PMID: 37578328 DOI: 10.1002/ajmg.a.63372] [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: 03/29/2023] [Revised: 06/24/2023] [Accepted: 07/28/2023] [Indexed: 08/15/2023]
Abstract
The introduction of genomic testing into prenatal care has come at a rapid pace and has been met with significant clinical and ethical challenges, specifically when dealing with incidental findings. We present the case of a couple in their first pregnancy who were referred to our institution with isolated fetal cataracts on morphology scan. After an unremarkable infectious disease workup and microarray on an amniocentesis sample, the couple opted for fetal whole-exome sequencing to investigate the cataracts further. This investigation did not find any cause for the cataracts but yielded an incidental finding of a de novo pathogenic variant in the SCN1A gene unrelated to the cataracts. Pathogenic variants in the SCN1A gene are strongly associated with severe myoclonic epilepsy of infancy, or Dravet syndrome. After extensive genetic counseling, the couple decided to terminate the pregnancy at 28 weeks' gestation based on this finding. This case highlights some of the important clinical and ethical considerations in prenatal genetic diagnosis, particularly in the group of patients in which there is no phenotypic evidence in-utero of the incidental finding. The case demonstrates the value of frameworks and guidelines to guide management decisions for both clinicians and patients.
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Affiliation(s)
- Ignatius Rudd
- Department of Perinatal Medicine, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Gulvir Gill
- Genetics in the North East, Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Michael Buckley
- Randwick Genomics Laboratory, NSW Health Pathology, Newcastle, New South Wales, Australia
| | - Lilian Downie
- Genetics in the North East, Mercy Hospital for Women, Melbourne, Victoria, Australia
- Victorian Clinical Genetics Service, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Tejasvi T, Trupiano N, Scharnitz T, Novice T, Ellis CN. High rate of incidental detection of skin cancer following teledermatology consultation: Full body skin examination may detect more skin cancers than a referral-based approach. JAAD Int 2023; 13:115-116. [PMID: 37779556 PMCID: PMC10541486 DOI: 10.1016/j.jdin.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Affiliation(s)
- Trilokraj Tejasvi
- Dermatology Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Nicole Trupiano
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Thomas Scharnitz
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Taylor Novice
- Department of Dermatology, Henry Ford Health System, Detroit, Michigan
| | - Charles N. Ellis
- Dermatology Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
- Department of Dermatology, University of Michigan Medical School, Ann Arbor, Michigan
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Kantor J. This Month in JAAD International: November 2023: The total-body skin examination and skin cancer screening. J Am Acad Dermatol 2023; 89:908. [PMID: 37683934 DOI: 10.1016/j.jaad.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/10/2023]
Affiliation(s)
- Jonathan Kantor
- Department of Dermatology, Center for Global Health, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, and Florida Center for Dermatology, St Augustine, Florida.
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Vivanco RA, Aguirre AS, Montero M, Perez-Davila M, Baehring J. Atypical presentation of dysembryoplastic neuroepithelial tumor in an adult without epilepsy: a case report. Int J Neurosci 2023:1-4. [PMID: 37800586 DOI: 10.1080/00207454.2023.2268269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 10/03/2023] [Indexed: 10/07/2023]
Abstract
Aim of the study: Dysembryoplastic neuroepithelial tumor (DNET) is a rare glioneuronal tumor usually found in the temporal lobe of children and young adults. DNETs are commonly associated with drug-resistant partial seizures, with most cases diagnosed before age 20. Asymptomatic brain tumors are rare in the general healthy population, and the frequency of incidental DNETs in adults remains unknown.Materials and methods: We report the case of a 34-year-old healthy man who presented with a facial rash but was incidentally found to have a large T1 hypointense lesion in the left temporal cortex on neuroimaging. The patient opted for surgical removal of the mass, which was subsequently identified as a DNET, positive for a fibroblast growth factor receptor (FGFR) mutation.Results: This case report presents the first incidentally discovered DNET in an adult without epilepsy, highlighting its atypical presentation. In addition, the presence of an FGFR mutation emphasizes its role in DNET pathogenesis and potential therapeutic implications. DNETs exhibit varied behavior based on age, tumor location, and cortical dysplasia.Conclusions: In this case, the absence of seizure onset may be attributed to the lack of cortical dysplasia. Further research is needed to understand the incidence of DNETs and their association with seizure onset and cortical dysplasia.
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Affiliation(s)
- Ricardo A Vivanco
- School of Medicine, Universidad Catolica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Alex S Aguirre
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
| | - Marcelo Montero
- School of Medicine, Universidad de las Americas, Quito, Ecuador
| | | | - Joachim Baehring
- Department of Neurology, Yale School of Medicine, Yale University, New Haven, USA
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Chin HL, Lam JCM, Christopher D, Michelle PL, Junrong BY. Challenges associated with the identification of germline variants on myeloid malignancy genomic profiling-a Singaporean experience. Front Oncol 2023; 13:1182639. [PMID: 37860182 PMCID: PMC10582742 DOI: 10.3389/fonc.2023.1182639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 09/07/2023] [Indexed: 10/21/2023] Open
Abstract
Genomic profiling to identify myeloid-malignancy-related gene mutations is routinely performed for patients with suspected or definite myeloid malignancies. The most common specimen types in our experience are peripheral blood and bone marrow aspirates. Although primarily intended to identify somatic mutations, not infrequently, potentially clinically significant germline variants are also identified. Confirmation of the germline status of these variants is typically performed by hair follicle or skin fibroblast testing. If the germline variant is classified as a pathogenic or likely pathogenic variant and occurs in a gene known to be associated with a disease relevant to the patient's phenotype (for example, the identification of a DDX41 pathogenic variant in an individual with acute myeloid leukemia), the management algorithm is typically quite straightforward. Challenging situations may occur such as when the germline variant is classified as a pathogenic or likely pathogenic variant and occurs in a gene not known to be associated with the patient's phenotype/presenting complaint. We have encountered several such challenging cases in which potentially clinically significant germline variants were identified on the initial genomic profiling of peripheral blood or bone marrow aspirate. In this article, we present these cases and discuss the genetic counseling and management approaches.
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Affiliation(s)
- Hui-Lin Chin
- Khoo Teck Puat National University Children's Medical Institute, Department of Paediatrics, National University Hospital, Singapore, Singapore
- Department of Paediatrics, National University of Singapore, Singapore, Singapore
| | - Joyce Ching Mei Lam
- Children’s Blood and Cancer Centre, KK Women’s and Children’s Hospital, Singapore, Singapore
- Duke-National University of Singapore (NUS) Medical School, Singapore, Singapore
| | - Dheepa Christopher
- Department of Haematology, Tan Tock Seng Hospital, Singapore, Singapore
- Department of Laboratory Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Poon Limei Michelle
- Department of Haematology-Oncology, National University Cancer Institute, National University Hospital, Singapore, Singapore
| | - Benedict Yan Junrong
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
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Manero-Azua A, Pereda A, Llano-Rivas I, Garin I, Perez de Nanclares G. Incidental finding at methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA): how to proceed? Front Genet 2023; 14:1274056. [PMID: 37854056 PMCID: PMC10580081 DOI: 10.3389/fgene.2023.1274056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction: Since the advent of new generation sequencing, professionals are aware of the possibility of obtaining findings unrelated to the pathology under study. However, this possibility is usually forgotten in the case of studies aimed at a single gene or region. We report a case of a 16-month-old girl with clinical suspicion of Silver-Russell syndrome (SRS). Methods: Following the international SRS consensus, methylation alterations and copy number variations (CNVs) at 11p15 region and maternal uniparental disomy of chromosome 7 were analysed and discarded by MS-MLPA. Results: Unexpectedly, the 11p15 region MS-MLPA showed a decrease in the signal of a copy number reference probe. Deletions affecting a single probe are inconclusive. So, we faced the ethical dilemma of whether it was appropriate to confirm this alteration with independent techniques and to offer a diagnostic possibility that was in no way related to clinical suspicion. Fortunately, in this particular case, the informed consent had not been specific to a particular pathology but to any disorder associated with growth failure. Performed alternative studies allowed the final diagnosis of 22q deletion syndrome. Conclusion: We demonstrate the importance of informing patients about the possibility of obtaining incidental findings in genetic techniques (not only in next generation sequencing) during pre-test genetic counselling consultations. In addition, we highlight the relevance of including in the informed consent the option of knowing these unexpected incidental findings as in some cases, this will help to elucidate the definitive diagnosis and provide the correct follow-up and treatment.
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Affiliation(s)
- Africa Manero-Azua
- Rare Diseases Research Group, Molecular (Epi) Genetics Laboratory, Bioaraba Health Research Institute, Araba University Hospital-Txagorritxu, Vitoria-Gasteiz, Araba, Spain
| | - Arrate Pereda
- Rare Diseases Research Group, Molecular (Epi) Genetics Laboratory, Bioaraba Health Research Institute, Araba University Hospital-Txagorritxu, Vitoria-Gasteiz, Araba, Spain
| | - Isabel Llano-Rivas
- Service of Genetics, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Intza Garin
- Service of Genetics, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Guiomar Perez de Nanclares
- Rare Diseases Research Group, Molecular (Epi) Genetics Laboratory, Bioaraba Health Research Institute, Araba University Hospital-Txagorritxu, Vitoria-Gasteiz, Araba, Spain
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Etemad L, Mehta S, Lurie AG, Tadinada A. Prevalence and Clinical Significance of Incidental Findings in the Maxillofacial Complex of Adolescent Orthodontic Patients: A Retrospective Cone Beam Computed Tomography Analysis. Cureus 2023; 15:e47480. [PMID: 38022275 PMCID: PMC10663048 DOI: 10.7759/cureus.47480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES The aim of this study was to determine the prevalence and severity of incidental findings in the maxillofacial complex of orthodontic patients imaged with cone beam computed tomography (CBCT) and assign those findings an appropriate clinical significance. METHODOLOGY Incidental findings (IF) were identified in 250 CBCT scans of adolescent orthodontic patients (aged 13-18 years) with a large field-of-view and categorized based on their anatomic location and placed into one of six subgroups based on anatomic region: i) sino-nasal, ii) dentoalveolar, iii) nasooropharyngeal airway, iv) temporomandibular joint, v) neck, vi) calcifications, and vi) miscellaneous findings. Additionally, findings were assigned a clinical significance score based on severity on a scale of mild, moderate and severe. Mild IF was defined as an IF that does not require any further investigation or referral. Moderate IF was defined as an IF that has the tendency to become clinically significant and should be observed periodically. IFs that warrant further investigation and/or intervention were designated as severe. RESULTS The percentage of IFs in sino-nasal and dento-alveolar regions were 44.7% and 19.1% respectively. The percentage of IFs with mild, moderate, and severe clinical significance were 27%, 72%, and 1%, respectively. Out of the IFs involving calcifications, 80.8% were stylohyoid calcifications and <1% were cranial cavity IFs such as petroclinoid calcifications and falx cerebri calcifications. Among the sino-nasal findings, 1.2% were identified as severe. CONCLUSION The sino-nasal region had the highest frequency of IFs. Understanding the prevalence of incidental findings and its clinical relevance is important for clinicians to allow for appropriate monitoring and timely treatment of patients.
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Affiliation(s)
- Lily Etemad
- Orthodontics, Siddiqui Orthodontics, Ann Arbor, USA
| | - Shivam Mehta
- Orthodontics, Marquette University School of Dentistry, Milwaukee, USA
| | - Alan G Lurie
- Oral and Maxillofacial Radiology, University of Connecticut School of Dental Medicine, Farmington, USA
| | - Aditya Tadinada
- Oral and Maxillofacial Radiology, University of Connecticut School of Dental Medicine, Farmington, USA
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23
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Malik RF, Berry R, Lau BD, Busireddy KR, Patel P, Patel SH, Fishman EK, Bivalacqua TJ, Johnson PT, Sedaghat F. Systematic Evaluation of Imaging Features of Early Bladder Cancer Using Computed Tomography Performed before Pathologic Diagnosis. Tomography 2023; 9:1734-1744. [PMID: 37736991 PMCID: PMC10514844 DOI: 10.3390/tomography9050138] [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: 08/08/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Bladder cancer is the sixth most common malignancy in the United States (US). Despite its high prevalence and the significant potential benefits of early detection, no reliable, cost-effective screening algorithm exists for asymptomatic patients at risk. Nonetheless, reports of incidentally identified early bladder cancer on CT/MRI scans performed for other indications are emerging in the literature. This represents a new opportunity for early detection, with over 80 million CT scans performed in the US yearly, 40% of which are abdominopelvic CTs. This investigation aims to define the imaging features of early bladder cancer, with the mission of facilitating early diagnosis. METHODS Following IRB approval with a waiver of informed consent, a retrospective review was performed, identifying 624 patients with non-muscle-invasive bladder cancer diagnosed at Johns Hopkins Hospital between 2000 and 2019. Of these patients, 99 patients underwent pelvic CT within the 5 years preceding pathologic diagnosis. These imaging studies were reviewed retrospectively to evaluate for the presence and features of any focal bladder wall abnormality. RESULTS Median age at the time of pathologic diagnosis was 70 years (range: 51-88 years), and 82% (81/99) of patients were male. A total of 226 CT studies were reviewed. The number of studies per patient ranged from 1 to 33. Median time interval between all available imaging and pathologic diagnosis was 14 months. A total of 62% (141/226) of the scans reviewed were performed for indications other than suspected urinary tract cancer (UTC). A bladder wall mass was visualized in 67% (66/99) of patients and on 35% (78/226) of scans performed before diagnosis. The majority (84%, 67/80) of masses were intraluminal. Mean transverse long- and short-axis measurements were 24 mm and 17 mm, respectively, with long dimension measurements ranging between 5 and 59 mm. CONCLUSIONS Early bladder cancer was visualized on CT preceding pathologic diagnosis in more than 2/3 of patients, and the majority of scans were performed for indications other than suspected urinary tract cancer/UTC symptoms. These results suggest that cross-sectional imaging performed for other indications can serve as a resource for opportunistic bladder cancer screening, particularly in high-risk patients.
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Affiliation(s)
- Rubab F. Malik
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Renu Berry
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Brandyn D. Lau
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Kiran R. Busireddy
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Prasan Patel
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Sunil H. Patel
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (S.H.P.)
| | - Elliot K. Fishman
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Trinity J. Bivalacqua
- Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (S.H.P.)
| | - Pamela T. Johnson
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
| | - Farzad Sedaghat
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA (R.B.); (B.D.L.); (K.R.B.); (P.P.)
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24
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Sindzingre L, Witasse-Thézy AD, Chevallier A, Denis B, Lechowski L. [Frequency of incidentalomas on computed tomography scans in the hospitalised elderly]. Geriatr Psychol Neuropsychiatr Vieil 2023; 21:299-306. [PMID: 38093566 DOI: 10.1684/pnv.2023.1117] [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] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
INTRODUCTION Incidentaloma is the result of the medical problem created by the development of imaging. Without a universal definition, incidentaloma describes any incidental finding revealed by a medical examination performed for another indication, and which will be the origin of a questioning intended to give it a clinical meaning. The frequency of incidentalomas is very variable depending on the imaging technique, the organ affected and the definition used. The aim of this study was to investigate the frequency of incidentalomas on computed tomography (CT) scans in a geriatric hospitalised population. METHODS In an observational, retrospective, monocentric study, we analysed, for a full year, all the planned CT scans performed, during a hospitalisation in acute and subacute care service of a Parisian geriatric hospital in search of incidentalomas. RESULTS 113 patients were included in the study, with a mean age of 87,4 years. The frequency of incidentalomas on CT scans in this population was 53 %, with an average of two incidentalomas per patient. Eight percent of the incidentalomas required further examination, specialist advice or treatment. We found incidentalomas in half of the brain and abdomino-pelvic CT scans and in a quarter of the chest CT scans. Age was not associated with the presence of incidentalomas. DISCUSSION Incidentaloma has become an important part of current medical practice. The geriatrician must know how to anticipate it and propose to his patient an adapted management.
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Affiliation(s)
- Louise Sindzingre
- Service de médecine des aînés, Hôpital Sainte-Périne, Paris Groupe Hospitalo-Universitaire, Paris, APHP. Université Paris-Saclay, France
| | - Albane de Witasse-Thézy
- Service de médecine des aînés, Hôpital Sainte-Périne, Paris Groupe Hospitalo-Universitaire, Paris, APHP. Université Paris-Saclay, France
| | - Anita Chevallier
- Service de médecine des aînés, Hôpital Sainte-Périne, Paris Groupe Hospitalo-Universitaire, Paris, APHP. Université Paris-Saclay, France, Service de radiologie médicale et imagerie interventionnelle, Hôpital Ambroise-Paré, Paris Groupe Hospitalo-Universitaire APHP. Université Paris-Saclay, France
| | - Bertrand Denis
- Service de médecine des aînés, Hôpital Sainte-Périne, Paris Groupe Hospitalo-Universitaire, Paris, APHP. Université Paris-Saclay, France
| | - Laurent Lechowski
- Service de médecine des aînés, Hôpital Sainte-Périne, Paris Groupe Hospitalo-Universitaire, Paris, APHP. Université Paris-Saclay, France
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25
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Mazel B, Bertolone G, Baurand A, Cosset E, Sawka C, Robert M, Gautier E, Lançon A, Réda M, Favier L, Dérangère V, Richard C, Binquet C, Boidot R, Goussot V, Albuisson J, Ghiringhelli F, Faivre L, Nambot S. Advancing precision oncology through systematic germline and tumor genetic analysis: The oncogenetic point of view on findings from a prospective multicenter clinical trial of 666 patients. Cancer Med 2023; 12:18786-18796. [PMID: 37694493 PMCID: PMC10557826 DOI: 10.1002/cam4.6498] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/07/2023] [Accepted: 08/25/2023] [Indexed: 09/12/2023] Open
Abstract
INTRODUCTION With the emergence of targeted therapies, there is a need to accurately identify more tumor biomarkers. The EXOMA trial was designed to offer tumor and germline exome sequencing (ES) to patients with solid malignant tumors and facing therapeutic failure. As hereditary cancer predispositions could be identified, with genetic counseling and health management implications, a genetic consultation was systematically established. This design needs to be discussed as genetic human resources are limited and indication of theranostic tests will increase. METHODS Genetic counseling was conducted within 15 days following inclusion in the study for patients recruited between December 2015 and July 2019. In silico analyses from theranostic ES were limited to 317 genes involved in oncogenesis, from both tumor and blood DNA. RESULTS Six hundred and sixty six patients had a genetic consultation before ES. In 65/666 patients, 66 germline pathogenic or likely pathogenic (P/LP) variants were identified in 16 actionable genes and seven non-actionable genes according to French guidelines. 24/65 patients had previously received genetic analysis for diagnostic purposes, and for 17 of them, a P/LP variant had already been identified. Among the 48/65 remaining cases for which the EXOMA protocol revealed a previously unknown P/LP variant, only 19 met the criteria for genetic testing for inherited cancer risk after familial survey. These criteria had not been identified by the oncologist in 10 cases. In 21/65 cases, the variant was considered incidental. DISCUSSION In 7.4% of patients, an undiagnosed hereditary genetic predisposition was identified, whether or not related to the clinical presentation, and germline analysis impacted oncological management for only 6.3% of the cohort. This low percentage should be weighed against the burden of systematic genetic consultation and urgent circuits. Information or training tools to form oncologists to the prescription of germline genetic analyses should be explored, as well as information supports and patient preferences.
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Affiliation(s)
- Benoit Mazel
- Centre de Génétique, FHU‐TRANSLAD, Centre Hospitalier Universitaire Dijon‐BourgogneDijonFrance
- INSERM UMR 1231 GAD, Génétique des Anomalies du Développement, Université Bourgogne Franche‐ComtéDijonFrance
| | - Geoffrey Bertolone
- Centre de Génétique, FHU‐TRANSLAD, Centre Hospitalier Universitaire Dijon‐BourgogneDijonFrance
- Unité d'Oncogénétique, Centre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Amandine Baurand
- Centre de Génétique, FHU‐TRANSLAD, Centre Hospitalier Universitaire Dijon‐BourgogneDijonFrance
- Unité d'Oncogénétique, Centre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Elodie Cosset
- Unité d'Oncogénétique, Centre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Caroline Sawka
- Centre de Génétique, FHU‐TRANSLAD, Centre Hospitalier Universitaire Dijon‐BourgogneDijonFrance
- Unité d'Oncogénétique, Centre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Marion Robert
- Centre de Génétique, FHU‐TRANSLAD, Centre Hospitalier Universitaire Dijon‐BourgogneDijonFrance
- Unité d'Oncogénétique, Centre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Elodie Gautier
- Centre de Génétique, FHU‐TRANSLAD, Centre Hospitalier Universitaire Dijon‐BourgogneDijonFrance
| | - Allan Lançon
- Unité d'Oncogénétique, Centre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Manon Réda
- Département d'Oncologie MédicaleCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
- Plateforme de Transfert en Biologie CancérologiqueCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Laure Favier
- Département d'Oncologie MédicaleCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
- Plateforme de Transfert en Biologie CancérologiqueCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Valentin Dérangère
- Plateforme de Transfert en Biologie CancérologiqueCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Corentin Richard
- INSERM UMR 1231 GIMI, Genomic and Immunotherapy Medical Institute, Université Bourgogne Franche‐ComtéDijonFrance
| | - Christine Binquet
- INSERM, CIC1432, Module Epidémiologie Clinique, Dijon, France; Centre Hospitalier Universitaire Dijon‐Bourgogne, Centre d'Investigation Clinique, module Epidémiologie clinique/essais cliniquesDijonFrance
| | - Romain Boidot
- Unité de Biologie MoléculaireCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
- Institut de Chimie Moléculaire de l'Université de Bourgogne, UMR CNRS 6302DijonFrance
| | - Vincent Goussot
- INSERM UMR 1231 GIMI, Genomic and Immunotherapy Medical Institute, Université Bourgogne Franche‐ComtéDijonFrance
- Unité de Biologie MoléculaireCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - Juliette Albuisson
- INSERM UMR 1231 GIMI, Genomic and Immunotherapy Medical Institute, Université Bourgogne Franche‐ComtéDijonFrance
- Unité de Biologie MoléculaireCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
| | - François Ghiringhelli
- Département d'Oncologie MédicaleCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
- Plateforme de Transfert en Biologie CancérologiqueCentre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
- INSERM UMR 1231 GIMI, Genomic and Immunotherapy Medical Institute, Université Bourgogne Franche‐ComtéDijonFrance
| | - Laurence Faivre
- Centre de Génétique, FHU‐TRANSLAD, Centre Hospitalier Universitaire Dijon‐BourgogneDijonFrance
- INSERM UMR 1231 GAD, Génétique des Anomalies du Développement, Université Bourgogne Franche‐ComtéDijonFrance
- INSERM UMR 1231 GIMI, Genomic and Immunotherapy Medical Institute, Université Bourgogne Franche‐ComtéDijonFrance
| | - Sophie Nambot
- Centre de Génétique, FHU‐TRANSLAD, Centre Hospitalier Universitaire Dijon‐BourgogneDijonFrance
- INSERM UMR 1231 GAD, Génétique des Anomalies du Développement, Université Bourgogne Franche‐ComtéDijonFrance
- Unité d'Oncogénétique, Centre de Lutte Contre le Cancer Georges François Leclerc—UNICANCERDijonFrance
- INSERM UMR 1231 GIMI, Genomic and Immunotherapy Medical Institute, Université Bourgogne Franche‐ComtéDijonFrance
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Abstract
Genome sequencing is increasingly used in research and integrated into clinical care. In the research domain, large-scale analyses, including whole genome sequencing with variant interpretation and curation, virtually guarantee identification of variants that are pathogenic or likely pathogenic and actionable. Multiple guidelines recommend that findings associated with actionable conditions be offered to research participants in order to demonstrate respect for autonomy, reciprocity, and participant interests in health and privacy. Some recommendations go further and support offering a wider range of findings, including those that are not immediately actionable. In addition, entities covered by the US Health Insurance Portability and Accountability Act (HIPAA) may be required to provide a participant's raw genomic data on request. Despite these widely endorsed guidelines and requirements, the implementation of return of genomic results and data by researchers remains uneven. This article analyzes the ethical and legal foundations for researcher duties to offer adult participants their interpreted results and raw data as the new normal in genomic research.
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Affiliation(s)
- Susan M Wolf
- Law School and Medical School, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Robert C Green
- Genomes2People Research Program, Harvard Medical School, Mass General Brigham, Broad Institute, and Ariadne Labs, Boston, Massachusetts, USA;
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Di Primio G, Boyd GJ, Fung CI, Hurrell C, Brahm GL, Bird JR, Co SJ, Kirkpatrick IDC. Recommendations for the Management of Incidental Musculoskeletal Findings on MRI and CT. Can Assoc Radiol J 2023; 74:514-525. [PMID: 36710521 DOI: 10.1177/08465371231152151] [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] [Indexed: 01/31/2023] Open
Abstract
The Canadian Association of Radiologists (CAR) Incidental Findings Working Group consists of both academic subspeciality and general radiologists tasked with either adapting American College of Radiology (ACR) guidelines to meet the needs of Canadian radiologists or authoring new guidelines where appropriate. In this case, entirely new guidelines to deal with incidental musculoskeletal findings that may be encountered on thoracoabdominal computed tomography or magnetic resonance imaging were drafted, focussing on which findings should prompt recommendations for further workup. These recommendations discuss how to deal with incidental marrow changes, focal bone lesions, abnormalities of the pubic symphysis and sacroiliac joints, fatty soft tissue masses, manifestations of renal osteodystrophy and finally discuss opportunistic osteoporosis evaluation.
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Affiliation(s)
- Gina Di Primio
- McMaster University, Hamilton, ON, Canada
- Department of Radiology, Oakville Trafalgar Memorial Hospital (Halton Health Care), Oakville, ON, Canada
| | - Gordon J Boyd
- Department of Radiology, Dalhousie University, Halifax, NS, Canada
| | - Christopher I Fung
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, ON, Canada
| | - Gary L Brahm
- Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jeffery R Bird
- Department of Medical Imaging, University of Saskatchewan, Saskatoon, SK, Canada
| | - Steven J Co
- University of British Columbia, Vancouver, BC, Canada
| | - Iain D C Kirkpatrick
- Department of Diagnostic Radiology, University of Manitoba, Winnipeg, MB, Canada
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28
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Corvino A, Granata V, Tafuri D, Cocco G, Catalano O. Incidental Focal Spleen Lesions: Integrated Imaging and Pattern Recognition Approach to the Differential Diagnosis. Diagnostics (Basel) 2023; 13:2536. [PMID: 37568899 PMCID: PMC10416953 DOI: 10.3390/diagnostics13152536] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 06/16/2023] [Revised: 07/16/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
Spleen lesions and pseudolesions, detected incidentally in imaging, are not uncommon and may require further work-up. The imaging appearance of focal splenic lesions (FSLs) may not be pathognomonic, because of considerably overlapping features. Consequently, all imaging techniques lack specificity to fully characterize FSLs. Clinical correlation is mandatory, so as, first of all, to categorize the patient as having or not having a history of solid or hematologic malignancy. Nowadays, many patients have old imaging studies available for comparison and, consequently, it is important to understand if the lesion was previously present or not, and if the size is the same or has changed. In the absence of comparison studies, and with a lack of imaging features of benignity, further investigation may be necessary, using PET, biopsy, or short-term follow-up. Some algorithms have been proposed to manage incidental FSLs; however, none of these strategies has been validated by prospective studies to date. In this review we illustrate the topic of incidental FSLs and we analyze a number of published algorithms.
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Affiliation(s)
- Antonio Corvino
- Movement Sciences and Wellbeing Department, University of Naples “Parthenope”, Via Medina 40, I-80133 Naples, Italy
| | - Vincenza Granata
- Division of Radiology, Istituto Nazionale Tumori IRCCS Fondazione Pascale, I-80131 Naples, Italy
| | - Domenico Tafuri
- Movement Sciences and Wellbeing Department, University of Naples “Parthenope”, Via Medina 40, I-80133 Naples, Italy
| | - Giulio Cocco
- Department of Neuroscience, Imaging and Clinical Sciences, University “G. d’Annunzio”, I-66100 Chieti, Italy
| | - Orlando Catalano
- Radiology Unit, Varelli Diagnostic Institute, I-80126 Naples, Italy
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29
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Crockett B, Broome A, Tawil P, Tyndall D. Comparison of incidental findings on cone beam computed tomographic and 2-dimensional images. Gen Dent 2023; 71:64-71. [PMID: 37358586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Cone beam computed tomography (CBCT) provides a 3-dimensional (3D) view of the patient and has a high frequency of incidental findings (IFs) that do not relate to the area of interest. Many of these IFs are not always visible on 2-dimensional (2D) intraoral or panoramic radiographs. Thus, the aim of the present study was to assess the IFs that did or did not appear on 3D vs 2D images. Significant IFs were recorded from a review of 510 CBCT reports by board-certified oral and maxillofacial radiologists. The IFs on CBCTs with 5-, 8-, and 11-cm fields of view (n = 170 per group) were recorded. A subset of these significant IFs was also viewed on intra-oral and panoramic radiographs to determine whether they were or were not visible in 2D imaging. A total of 677 significant IFs were discovered on 302 (59.2%) of the 510 reports. When a subset of 293 IFs was reviewed on intraoral and panoramic imaging, 112 (38.2%) were not visible on 2D radiographs, while 50 (17.1%) could not be confirmed with certainty. The frequency of significant IFs on CBCT imaging is high and increases with larger fields of view. A substantial number of these findings could not be seen on 2D radiographs, implying that many IFs are visible only on 3D images. Clinicians who order CBCT scans need to carefully review the volume in its entirety, regardless of previous imaging, so as not to miss any significant and relevant findings.
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30
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Virk SK, Lopez E, Pardo KM, Gonzalez AM. Incidental Finding of a Lipoleiomyoma During Robotic Inguinal Hernia Repair: A Case Report. Cureus 2023; 15:e40635. [PMID: 37476115 PMCID: PMC10355229 DOI: 10.7759/cureus.40635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Lipoleiomyomas are rare, fatty variants of leiomyomas (commonly referred to as fibroid), which are frequently found in the uterine corpus and cervix. Here, we present a case of a robotic inguinal hernia repair with resection of an incidental lipoleiomyoma. A 74-year-old woman presented to the office with complaints of pain and a palpable mass in the right inguinal region. Physical examination revealed tender, moderate-to-large bilateral inguinal hernias. Robotic bilateral inguinal hernia repair with mesh was performed. Intraoperatively, a mass measuring 4 × 3 cm was noted near the round ligament of the uterus. The mass was encapsulated without invading any surrounding structures. The mass was resected and sent to the histopathology department. The pathological evaluation identified a leiomyoma filled with mature adipocytes, compatible with the diagnosis of an extrauterine lipoleiomyoma. Lipoleiomyoma incidentally found in the inguinal canal is extremely rare. The medical literature regarding this incidental finding is limited. Resection of the mass was easily performed using the same robotic instruments as used for the inguinal hernia repair.
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Affiliation(s)
- Shohab K Virk
- Department of Surgery, Baptist Hospital of Miami, Miami, USA
| | - Edilin Lopez
- Department of Surgery, Baptist Health South Florida, Miami, USA
| | - Katrina M Pardo
- Department of Surgery, Baptist Health South Florida, Miami, USA
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Diderich KEM, Klapwijk JE, van der Schoot V, Brüggenwirth HT, Joosten M, Srebniak MI. Challenges and Pragmatic Solutions in Pre-Test and Post-Test Genetic Counseling for Prenatal Exome Sequencing. Appl Clin Genet 2023; 16:89-97. [PMID: 37216148 PMCID: PMC10198275 DOI: 10.2147/tacg.s411185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023] Open
Abstract
The yield of genetic prenatal diagnosis has been notably improved by introducing whole genome chromosomal microarray (CMA) and prenatal exome sequencing (pES). However, together with increased numbers of diagnoses made, the need to manage challenging findings such as variants of unknown significance (VUS) and incidental findings (IF) also increased. We have summarized the current guidelines and recommendations and we have shown current solutions used in our tertiary center in the Netherlands. We discuss four of the most common clinical situations: fetus with normal pES results, fetus with a pathogenic finding explaining the fetal phenotype, fetus with a variant of uncertain clinical significance fitting the phenotype and fetus with a variant leading to an incidental diagnosis. Additionally, we reflect on solutions in order to facilitate genetic counseling in an NGS-era.
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Affiliation(s)
| | | | | | | | - Marieke Joosten
- Department of Clinical Genetics, Erasmus MC, Rotterdam, the Netherlands
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Kwee TC, Roest C, Kasalak Ö, Pennings JP, de Jong IJ, Yakar D. A new medical imaging postprocessing and interpretation concept to investigate the clinical relevance of incidentalomas: can we keep Pandora's box closed? Acta Radiol 2023; 64:2170-2179. [PMID: 37116890 DOI: 10.1177/02841851231158769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Incidental imaging findings (incidentalomas) are common, but there is currently no effective means to investigate their clinical relevance. PURPOSE To introduce a new concept to postprocess a medical imaging examination in a way that incidentalomas are concealed while its diagnostic potential is maintained to answer the referring physician's clinical questions. MATERIAL AND METHODS A deep learning algorithm was developed to automatically eliminate liver, gallbladder, pancreas, spleen, adrenal glands, lungs, and bone from unenhanced computed tomography (CT). This deep learning algorithm was applied to a separately held set of unenhanced CT scans of 27 patients who underwent CT to evaluate for urolithiasis, and who had a total of 32 incidentalomas in one of the aforementioned organs. RESULTS Median visual scores for organ elimination on modified CT were 100% for the liver, gallbladder, spleen, and right adrenal gland, 90%-99% for the pancreas, lungs, and bones, and 80%-89% for the left adrenal gland. In 26 out of 27 cases (96.3%), the renal calyces and pelves, ureters, and urinary bladder were completely visible on modified CT. In one case, a short (<1 cm) trajectory of the left ureter was not clearly visible due to adjacent atherosclerosis that was mistaken for bone by the algorithm. Of 32 incidentalomas, 28 (87.5%) were completely concealed on modified CT. CONCLUSION This preliminary technical report demonstrated the feasibility of a new approach to postprocess and evaluate medical imaging examinations that can be used by future prospective research studies with long-term follow-up to investigate the clinical relevance of incidentalomas.
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Affiliation(s)
- Thomas C Kwee
- Medical Imaging Center, Departments of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Christian Roest
- Medical Imaging Center, Departments of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ömer Kasalak
- Medical Imaging Center, Departments of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Jan P Pennings
- Medical Imaging Center, Departments of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Igle Jan de Jong
- Department of Urology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Derya Yakar
- Medical Imaging Center, Departments of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Kota K, Dawson A, Papas J, Sotelo V, Su G, Li ML, Lee W, Estervil J, Marquez M, Sarkar S, Lopez LL, Hu WT. Too much information? Asian Americans' preferences for incidental brain MRI findings. medRxiv 2023:2023.04.17.23288629. [PMID: 37162874 PMCID: PMC10168418 DOI: 10.1101/2023.04.17.23288629] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION South Asian (SA) and East Asian (EA) older adults represent the fastest growing group of Americans at risk for dementia, but their participation in aging and dementia research has been limited. While recruiting healthy SA older adults into a brain health study, we encountered unexpected hesitancy towards structural brain MRI analysis along with some stigmatizing attitudes related to internal locus of control (LoC) for future dementia risks. We hypothesized that support for MRI-related research was influenced by these attitudes as well as one's own MRI experience, perceived MRI safety, and concerns for one's own risks for future dementia/stroke. METHODS We developed a brief cross-sectional survey to assess older adults' MRI experiences and perceptions, desire to learn of six incidental findings of increasing health implications, and attitudes related to dementia as well as research participation. We recruited a convenience sample of 256 respondents (74% reporting as 50+) from the New Jersey/New York City area to complete the survey, and modeled the proportional odds (P.O.) for pro-research attitudes. RESULTS 77 SA and 84 EA respondents were analyzed with 95 non-Asian adults. White (P.O.=2.54, p=0.013) and EA (P.O.=2.14, p=0.019) respondents were both more likely than SA respondents to endorse healthy volunteers' participation in research, and the difference between White and SA respondents was mediated by the latter's greater internal LoC for dementia risks. EA respondents had more worries for future dementia/stroke than SA respondents (p=0.006), but still shared SA respondents' low desire to learn of incidental MRI findings. DISCUSSION SA and EA older adults had different attitudes towards future dementia/stroke risks, but shared a low desire to learn of incidental MRI findings. A culturally-appropriate protocol to disclose incidental MRI findings may improve SA and EA participation in brain health research.
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Affiliation(s)
- Karthik Kota
- Department of Neurology Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Alice Dawson
- Department of Neurology Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Julia Papas
- Department of Neurology Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Victor Sotelo
- Department of Neurology Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Guibin Su
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Mei-Ling Li
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Woowon Lee
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Jaunis Estervil
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Melissa Marquez
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Shromona Sarkar
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - Lisa Lanza Lopez
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
| | - William T. Hu
- Department of Neurology Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
- Department of Center for Healthy Aging, Institute for Health, Health Care Policy, and Aging Research, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, 08901
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Pingili S, Yalamanchili S, Alaparthi R, Naik N PR, Juluri S. Osteomyelitis of the mandible in patients with a history of covid-19 infection: Clinical, histologic and radiographic presentations. Quintessence Int 2023; 0:0. [PMID: 37021605 DOI: 10.3290/j.qi.b4014521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Covid-19 is a serious global infectious disease impairing the quality of life of people across the world. SARS-CoV-2 may reside in nasopharyngeal and salivary secretions of Covid-infected patients and spreads mainly through respiratory droplets and fomites. It has presented a challenge to dentistry, as many dental procedures generate aerosols which could lead to cross-contamination. It also presents many post-infection complications which may continue to debilitate patients, even after successful management of the virus. One such complication may be osteomyelitis of the jaw. Here, we present two cases of post-Covid osteomyelitis of the jaw that were determined to be unrelated to Mucormycosis in otherwise healthy individuals with no prior dental complaints. In this report, we attempt to shed light on clinical signs in post-covid cases that may point to a diagnosis of the condition. We have also shared our thoughts on the pathophysiology which may help in formulating guidelines to prevent and manage post-covid osteomyelitis of the jaw.
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Qadiri QS, Ponzio DY, Thalody HS, Clark SC, Post ZD, Orozco FR, Ong AC. Incidental findings on CT scans for robot-assisted total joint arthroplasty. ANZ J Surg 2023; 93:1203-1206. [PMID: 36974354 DOI: 10.1111/ans.18393] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/01/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION This study documented the incidence of incidental findings from preoperative computerized-tomography (CT) scans obtained for robotic-arm-assisted total joint arthroplasty (TJA) and its effect on patient management. METHODS A retrospective review was conducted for patients who underwent robotic-arm assisted primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) from 2016 to 2020. All patients obtained preoperative CT scans which were formally read by fellowship-trained musculoskeletal radiologists. CT's were flagged with incidental findings and those requiring physician follow-up were identified as significant. RESULTS A total of 1519 patients (mean age, 66 years ±9; 849 females) were evaluated. Seventy-three (4.81%) patients had incidental CT scan findings, and 25 (1.65%) patients had significant incidental findings. Four patients required additional imaging and two patients required intervention. CONCLUSION This study found a 4.81% incidence of incidental findings from preoperative CT scans for robotic-arm-assisted THA and TKA. Of these findings, less than 2% required physician follow-up and less than 1% required intervention. With the increasing popularity of robotic-arm assisted total joint arthroplasty, it is important to consider the necessity of detection and management of associated incidental findings from preoperative CT scans.
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Affiliation(s)
- Qudratullah S Qadiri
- Rothman Orthopaedic Institute, 2500 English Creek Ave bldg. 1300, Egg Harbor Township, New Jersey, 08234, USA
| | - Danielle Y Ponzio
- Rothman Orthopaedic Institute, 2500 English Creek Ave bldg. 1300, Egg Harbor Township, New Jersey, 08234, USA
| | - Hope S Thalody
- Rothman Orthopaedic Institute, 2500 English Creek Ave bldg. 1300, Egg Harbor Township, New Jersey, 08234, USA
| | - Sean C Clark
- Rothman Orthopaedic Institute, 2500 English Creek Ave bldg. 1300, Egg Harbor Township, New Jersey, 08234, USA
| | - Zachary D Post
- Rothman Orthopaedic Institute, 2500 English Creek Ave bldg. 1300, Egg Harbor Township, New Jersey, 08234, USA
| | - Fabio R Orozco
- Orozco Orthopaedics, 1999 New Rd. Suite B, Linwood, New Jersey, 08221, USA
| | - Alvin C Ong
- Rothman Orthopaedic Institute, 2500 English Creek Ave bldg. 1300, Egg Harbor Township, New Jersey, 08234, USA
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Sharpe RE, Huffman RI, McLaughlin CG, Blubaugh P, Strobel MJ, Palen T. Applying Implementation Science Principles to Systematize High-Quality Care for Potentially Significant Imaging Findings. J Am Coll Radiol 2023; 20:324-334. [PMID: 36922106 DOI: 10.1016/j.jacr.2022.11.019] [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: 06/30/2022] [Revised: 10/29/2022] [Accepted: 11/16/2022] [Indexed: 03/14/2023]
Abstract
OBJECTIVE Use principles of implementation science to improve the diagnosis and management of potentially significant imaging findings. METHODS Multidisciplinary stakeholders codified the diagnosis and management of potentially significant imaging findings in eight organs and created a finding tracking management system that was embedded in radiologist workflows and IT systems. Radiologists were trained to use this system. An automated finding tracking management system was created to support consistent high-quality care through care pathway visualizations, increased awareness of specific findings in the electronic medical record, templated notifications, and creation of an electronic safety net. Primary outcome was the rate of quality reviews related to eight targeted imaging findings. Secondary outcome was radiologist use of the finding tracking management tool. RESULTS In the 4 years after implementation, the tool was used to track findings in 7,843 patients who received 10,015 ultrasound, CT, MRI, x-ray, and nuclear medicine examinations that were interpreted by all 34 radiologists. Use of the tool lead to a decrease in related quality reviews (from 8.0% to 0.0%, P < .007). Use of the system increased from 1.7% of examinations in the early implementation phase to 3.1% (+82%, P < .00001) in the postimplementation phase. Each radiologist used the tool on an average of 294.6 unique examinations (SD 404.8). Overall, radiologists currently use the tool approximately 4,000 times per year. DISCUSSION Radiologists frequently used a finding tracking management system to ensure effective communication and raise awareness of the importance of recommended future follow-up studies. Use of this system was associated with a decrease in the rate of quality review requests in this domain.
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Affiliation(s)
- Richard E Sharpe
- Division Chair of Breast Imaging and Radiologist, Mayo Clinic, Phoenix, Arizona; Member, ACR Peer Learning Committee; Member, ACR Appropriateness Panel for Breast Imaging; and Member, ACR Commission on Screening & Emerging Technology Committee.
| | - Ryan I Huffman
- Radiologist, Scripps Clinic Medical Group, La Jolla, California
| | - Christopher G McLaughlin
- Radiologist, Department Technical Lead, Radiology, Colorado Permanente Medical Group, Denver, Colorado
| | | | - Mary Jo Strobel
- Director, Clinical Quality Oversight, Quality, Risk, and Patient Safety, Kaiser Permanente Colorado, Denver, Colorado
| | - Ted Palen
- Internal Medicine Physician and Scientific Investigator, Colorado Permanente Medical Group, Denver, Colorado
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Farjah F, Monsell SE, Greenlee RT, Gould MK, Smith-Bindman R, Banegas MP, Schoen K, Ramaprasan A, Buist DSM. Patient and Nodule Characteristics Associated With a Lung Cancer Diagnosis Among Individuals With Incidentally Detected Lung Nodules. Chest 2023; 163:719-730. [PMID: 36191633 PMCID: PMC10154904 DOI: 10.1016/j.chest.2022.09.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Pulmonary nodules are a common incidental finding on CT imaging. Few studies have described patient and nodule characteristics associated with a lung cancer diagnosis using a population-based cohort. RESEARCH QUESTION Does a relationship exist between patient and nodule characteristics and lung cancer among individuals with incidentally detected pulmonary nodules, and can this information be used to create exploratory lung cancer prediction models with reasonable performance characteristics? STUDY DESIGN AND METHODS We conducted a retrospective cohort study of adults older than 18 years with lung nodules of any size incidentally detected by chest CT imaging between 2005 and 2015. All patients had at least 2 years of complete follow-up. To evaluate the relationship between patient and nodule characteristics and lung cancer, we used binomial regression. We used logistic regression to create prediction models, and we internally validated model performance using bootstrap optimism correction. RESULTS Among 7,240 patients with a median age of 67 years, 56% of whom were women, with a median BMI of 28 kg/m2, 56% of whom were ever smokers, 31% of whom had prior nonlung malignancy, with a median nodule size 5.6 mm, 57% of whom had multiple nodules, and 40% of whom had an upper lobe nodule, 265 patients (3.7%; 95% CI, 3.2%-4.1%) had a diagnosis of lung cancer. In a multivariate analysis, age, sex, BMI, smoking history, and nodule size and location were associated with a lung cancer diagnosis, whereas prior malignancy and nodule number and laterality were not. We were able to construct two prediction models with an area under the curve value of 0.75 (95% CI, 0.72-0.80) and reasonable calibration. INTERPRETATION Lung cancer is uncommon among individuals with incidentally detected lung nodules. Some, but not all, previously identified factors associated with lung cancer also were associated with this outcome in this sample. These findings may have implications for clinical practice, future practice guidelines, and the development of novel lung cancer prediction models for individuals with incidentally detected lung nodules.
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Affiliation(s)
- Farhood Farjah
- Department of Surgery, University of Washington, Seattle, WA.
| | - Sarah E Monsell
- Department of Biostatistics, University of Washington, Seattle, WA
| | | | - Michael K Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Rebecca Smith-Bindman
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA
| | - Matthew P Banegas
- Department of Radiation Medicine and Applied Sciences, University of San Diego, San Diego, CA
| | - Kurt Schoen
- Marshfield Clinic Research Institute, Marshfield, WI
| | | | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
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Kristensen SE, Gadsbøll K, Nicolaides KH, Vogel I, Pedersen LH, Wright A, Petersen OB, Wright D. Atypicality index: avoiding false reassurance in prenatal screening. Ultrasound Obstet Gynecol 2023; 61:333-338. [PMID: 36468756 DOI: 10.1002/uog.26135] [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] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/17/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To demonstrate the application of the atypicality index as an adjunct to first-trimester risk assessment for major trisomies by the combined test. METHODS This was a study of 123 998 Danish women with a singleton pregnancy who underwent routine first-trimester screening, including risk assessment for major trisomies. An atypicality index, which is a measure of the degree to which a profile is atypical, was produced for measurements of fetal nuchal translucency thickness and maternal serum free β-human chorionic gonadotropin and pregnancy-associated plasma protein-A. The incidence of adverse pregnancy outcome, including miscarriage, intrauterine death and termination of pregnancy, was tabulated according to the screening result and atypicality index. RESULTS In pregnancies with low risk and those with high risk for major trisomies according to the combined screening test, the incidence of adverse pregnancy outcome increased with increasing atypicality index. In pregnancies with a low risk for trisomies and atypicality index of ≥ 99%, the incidence of adverse outcome was 5.1 (95% CI, 3.4-7.6) times higher compared with that in low-risk pregnancies with a typical measurement profile, reflected by an atypicality index of < 80%. Similarly, in high-risk pregnancies, the incidence of adverse outcome was 7.9 (95% CI, 4.4-14.5) times higher in those with an atypicality index of ≥ 99% compared to those with an atypicality index of < 80%. Using individual profile plots, we were able to demonstrate a transparent and intuitive method for visualization of multiple variables, which can help interpret the individual combination of measurements and level of atypicality. CONCLUSIONS In pregnancies undergoing first-trimester combined screening and classified as being at low risk for major trisomies, profiles that are typical of pregnancies with normal outcome provide additional reassurance, whereas those with an atypical profile may warrant further investigation. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S E Kristensen
- Center for Fetal Medicine, Pregnancy and Ultrasound, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - K Gadsbøll
- Center for Fetal Medicine, Pregnancy and Ultrasound, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - K H Nicolaides
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
| | - I Vogel
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
- Center for Fetal Diagnostics, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - L H Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - A Wright
- Institute of Health Research, University of Exeter, Exeter, UK
| | - O B Petersen
- Center for Fetal Medicine, Pregnancy and Ultrasound, Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - D Wright
- Institute of Health Research, University of Exeter, Exeter, UK
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Martin S, LoPolito A, Whitney LD, Fenninger A, Bonneville K, Ward R, Graeff S, Saint Fort L, Brown CT, Miller V, Perea LL. Incidental Findings Protocol Implementation at a Level-I Trauma Center: A Review of Patient Follow-Up. Am Surg 2023:31348231157822. [PMID: 36792996 DOI: 10.1177/00031348231157822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
OBJECTIVES Pan scanning in trauma patients has become routine, resulting in increased identification of incidental findings (IF), findings unrelated to the reason for the scan. This has posed a conundrum of ensuring patients have appropriate follow-up for these findings. We sought to evaluate our compliance and follow-up for patients after implementation of an IF protocol at our level-I trauma center. METHODS We performed a retrospective review from 9/2020 to 4/2021, to encompass before and after protocol implementation. Patients were separated into PRE and POST groups. Charts were reviewed evaluating several factors including three- and six-month follow-ups on IF. Data were analyzed comparing PRE and POST groups. RESULTS A total of 1989 patients were identified, 31.22% (n = 621) with an IF. 612 patients were included in our study. Compared to PRE, POST showed a significant increase in PCP notification (35% vs 22%, P < .001) and patient notification (82% vs 65%, P < .001). As a result, patient follow-up regarding IF at six months was significantly higher in POST (44%) v. PRE (29%), (P < .001). There was no difference in follow-up based on insurance carrier. There was no difference in patient age for PRE (63 y) and POST (66 y) overall, (P = .089); nor in age of patients who followed up; 68.8 PRE vs 68.2 years POST (P = .819). CONCLUSION Implementation of an IF protocol with patient and PCP notification was significantly improved in overall patient follow-up for category one and two IF. Utilizing the results of this study, the protocol will be further revised to improve patient follow-up.
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Affiliation(s)
- Sarah Martin
- Department of Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Andrew LoPolito
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Larissa D Whitney
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Ashley Fenninger
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Kelly Bonneville
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Ryan Ward
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Shelby Graeff
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Launick Saint Fort
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Catherine T Brown
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Virginia Miller
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
| | - Lindsey L Perea
- Department of Surgery, Division of Trauma and Acute Care Surgery, 209639Penn Medicine Lancaster General Health, Lancaster, PA, USA
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Pinheiro RA, Leite AK, Cavalheiro BG, de Mello ES, Kowalski LP, Matos LL. Incidental Node Metastasis as an Independent Factor of Worse Disease-Free Survival in Patients with Papillary Thyroid Carcinoma. Cancers (Basel) 2023; 15:cancers15030943. [PMID: 36765899 PMCID: PMC9913150 DOI: 10.3390/cancers15030943] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Papillary thyroid carcinoma (PTC) have high node metastasis rates. Occasionally after thyroidectomy, the pathological report reveals node metastasis unintentionally resected. The present study aimed to evaluate the prognosis of these patients. METHODS A retrospective cohort of patients submitted to thyroidectomy with or without central compartment neck dissection (CCND) due to PTC with a minimum follow-up of five years. RESULTS A total of 698 patients were included: 320 Nx, 264 pN0-incidental, 37 pN1a-incidental, 32 pN0-CCND and 45 pN1a-CCND. Patients with node metastasis were younger, had larger tumors, higher rates of microscopic extra-thyroidal extension, and angiolymphatic invasion and most received radioiodine therapy. Treatment failure was higher in patients pN1a-incidental and pN1a-CCND (32% and 16%, respectively; p < 0.001-Chi-square test). Disease-free survival (DFS) was lower in patients pN1a-incidental compared to patients Nx and pN0-incidental (p < 0.001 vs. Nx and pN0-incidental and p = 0.005 vs. pN0-CCND) but similar when compared to patients pN1a-CCND (p = 0.091)-Log-Rank test. Multivariate analysis demonstrated as independent risk factors: pT4a (HR = 5.524; 95%CI: 1.380-22.113; p = 0.016), pN1a-incidental (HR = 3.691; 95%CI: 1.556-8.755; p = 0.003), microscopic extra-thyroidal extension (HR = 2.560; 95%CI: 1.303-5.030; p = 0.006) and angiolymphatic invasion (HR = 2.240; 95%CI: 1.077-4.510; p = 0.030). CONCLUSION Patients that were pN1a-incidental were independently associated with lower DFS.
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Affiliation(s)
- Renan Aguera Pinheiro
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
- Correspondence: ; Tel.: +55-11-3069-6425; Fax: +55-11-3069-7506
| | - Ana Kober Leite
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo 05653-120, Brazil
| | - Beatriz Godoi Cavalheiro
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Evandro Sobroza de Mello
- Pathology Department, Instituto do Câncer do Estado de São Paulo, São Paulo 01246-000, Brazil
- Laboratório de Investigação Médica 14 (LIM14), Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil
| | - Luiz Paulo Kowalski
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Leandro Luongo Matos
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
- Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo 05653-120, Brazil
- Laboratório de Investigação Médica 28 (LIM28), Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246-903, Brazil
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Dyer DS, White C, Conley Thomson C, Gieske MR, Kanne JP, Chiles C, Parker MS, Menchaca M, Wu CC, Kazerooni EA. A Quick Reference Guide for Incidental Findings on Lung Cancer Screening CT Examinations. J Am Coll Radiol 2023; 20:162-172. [PMID: 36509659 DOI: 10.1016/j.jacr.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The US Preventive Services Task Force has recommended lung cancer screening (LCS) with low-dose CT (LDCT) in high-risk individuals since 2013. Because LDCT encompasses the lower neck, chest, and upper abdomen, many incidental findings (IFs) are detected. The authors created a quick reference guide to describe common IFs in LCS to assist LCS program navigators and ordering providers in managing the care continuum in LCS. METHODS The ACR IF white papers were reviewed for findings on LDCT that were age appropriate for LCS. A draft guide was created on the basis of recommendations in the IF white papers, the medical literature, and input from subspecialty content experts. The draft was piloted with LCS program navigators recruited through contacts by the ACR LCS Steering Committee. The navigators completed a survey on overall usefulness, clarity, adequacy of content, and user experience with the guide. RESULTS Seven anatomic regions including 15 discrete organs with 45 management recommendations were identified as relevant to the age of individuals eligible for LCS. The draft was piloted by 49 LCS program navigators from 32 facilities. The guide was rated as useful and clear by 95% of users. No unexpected or adverse experiences were reported in using the guide. On the basis of feedback, relevant sections were reviewed and edited. CONCLUSIONS The ACR Lung Cancer Screening CT Incidental Findings Quick Reference Guide outlines the common IFs in LCS and can serve as an easy-to-use resource for ordering providers and LCS program navigators to help guide management.
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Affiliation(s)
- Debra S Dyer
- Chair, Department of Radiology, Director, Lung Cancer Screening Program, and Director, Incidental Lung Nodule Program & Lung Nodule Registry, National Jewish Health, Denver, Colorado.
| | - Charles White
- Vice Chair, Clinical Affairs, University of Maryland School of Medicine, Baltimore, Maryland. https://twitter.com/
| | - Carey Conley Thomson
- Chair, Department of Medicine and Director, Multidisciplinary Thoracic Oncology and Lung Cancer Screening Program, Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, Massachusetts; and Harvard Medical School, Boston, Massachusetts
| | - Michael R Gieske
- Director, Lung Cancer Screening Physician, Director, Virtual Health Director, Primary Care East Department, Lead Provider, Ft. Mitchell St. Elizabeth Primary Care, Physician Director, Policy and Government Relations, St Elizabeth Healthcare, Edgewood, Kentucky
| | - Jeffrey P Kanne
- Chief, Thoracic Imaging and Vice Chair, Quality and Safety, Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. https://twitter.com/
| | - Caroline Chiles
- Director, Lung Cancer Screening Program, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina. https://twitter.com/
| | - Mark S Parker
- Director, Thoracic Imaging Section and Director, Thoracic Imaging Fellowship Program, Early Detection Lung Screening Program, VCU Health Systems, Richmond, Virginia
| | - Martha Menchaca
- Department of Radiology, University of Illinois at Chicago, Chicago, Illinois
| | - Carol C Wu
- Deputy Chair Ad Interim, Department of Thoracic Imaging, MD Anderson Cancer Center, Houston, Texas. https://twitter.com/
| | - Ella A Kazerooni
- Associate Chief Clinical Officer for Diagnostics and Clinical Information Management, University of Michigan Medical School, Ann Arbor, Michigan. https://twitter.com/
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Annesi CA, Talutis SD, Goldman AL, Childs E, Knapp PE, McAneny D, Drake FT. Point-of-care access to clinical guidelines may improve management of incidental findings in the primary care setting. J Eval Clin Pract 2023; 29:632-638. [PMID: 36602429 DOI: 10.1111/jep.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023]
Abstract
RATIONALE Incidental radiographic findings are common, and primary care providers (PCPs) are often charged with the conducting or initiating an appropriate evaluation. Clinical guidelines are available for management of common 'incidentalomas' including lung and adrenal nodules, but guidelines-adherent evaluations are not always performed; for example, in the setting of incidental adrenal masses (IAMs), recent literature suggests that an evidence-based evaluation occurs in <25% of patients for whom it is warranted-a quality and safety concern. AIMS AND OBJECTIVES The objective of this study was to examine whether point-of-care access to concise clinical guidelines would promote appropriate evaluations of two common incidentalomas: IAMs and lung nodules. METHOD This study was a survey-based, single-blinded, randomized experiment of decision-making within clinical vignettes. Respondents were PCPs in a variety of clinical practice settings, and half were randomly assigned to surveys that included concise clinical guidelines while the other half served as controls without access to guidelines. Scenarios involved patients with IAMs and lung nodules, and the scenarios included both higher-risk and lower-risk lesions. Our primary analysis examined safe versus inappropriate clinical decisions, while a secondary analysis compared guidelines-concordant versus guidelines-discordant responses. RESULTS For both the higher-risk IAM and higher-risk lung nodule scenarios, safe answer choices were selected at a similar rate by respondents regardless of whether they had access to guidelines or not. However, for the lower risk scenarios, inappropriate answer choices were chosen substantially more frequently by respondents without access to guidelines compared to those with the guidelines (lung: 29.3% vs. 4.5%, p = 0.003, adrenal: 31.6% vs. 7.0%, p = 0.01). There was less variation in the secondary analysis. CONCLUSION Survey respondents were significantly more likely to make safe management decisions in lower-risk clinical scenarios when clinical guidelines were available. Point-of-care access to clinical guidelines for incidentalomas is an intervention that may reduce management errors and improve patient safety.
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Affiliation(s)
| | - Stephanie D Talutis
- Department of Surgery, Division of Vascular Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Anna L Goldman
- Department of Medicine, Section of Endocrinology, Boston Medical Center, Boston, Massachusetts, USA.,Department of Medicine, Section of Endocrinology, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Philip E Knapp
- Department of Medicine, Section of Endocrinology, Boston Medical Center, Boston, Massachusetts, USA.,Department of Medicine, Section of Endocrinology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David McAneny
- Department of Surgery, Section of Endocrine Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Surgery, Section of Endocrine Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Frederick Thurston Drake
- Department of Surgery, Section of Endocrine Surgery, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Surgery, Section of Endocrine Surgery, Boston Medical Center, Boston, Massachusetts, USA
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Satja M, Bunnag N, Vachatimanont S. Ossifying fibroma presented as an incidental [18F]FDG PET/CT uptake within the hard palate. Nucl Med Rev Cent East Eur 2023; 26:106-108. [PMID: 37525609 DOI: 10.5603/nmr.2023.0014] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 05/29/2023] [Accepted: 06/20/2023] [Indexed: 08/02/2023] Open
Abstract
Incidental uptake in [18F]FDG PET/CT is not uncommon, but uptake in the oral and sinonasal regions was less frequently reported. We present a case of incidental focal [18F]FDG PET/CT uptake within the hard palate, which was later revealed to be an ossifying fibroma. We also reviewed some relevant literature and suggested that further investigation may be necessary for some patients with incidental [18F]FDG PET/CT uptake in the oral and sinonasal regions.
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Affiliation(s)
- Minchanat Satja
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Radiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Napisa Bunnag
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Radiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Sira Vachatimanont
- Nuclear Medicine Unit, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
- International Doctor of Medicine program (CU-MEDi), Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Dubois ML, Winters PD, Rodrigue MA, Gekas J. Patient attitudes and preferences about expanded noninvasive prenatal testing. Front Genet 2023; 14:976051. [PMID: 37152999 PMCID: PMC10161390 DOI: 10.3389/fgene.2023.976051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction: Noninvasive prenatal testing (NIPT) using cell-free DNA (cfDNA) is typically carried out to screen for common fetal chromosomal anomalies, with the option to screen for a wider range of chromosomal changes (expanded NIPT) becoming increasingly available. However, little is known about pregnant patients' attitudes and preferences regarding expanded NIPT. Methods: To address this gap, we surveyed general-risk patients having first-tier cfDNA screening at a private prenatal clinic on their expectations for expanded NIPT. Patients were asked questions regarding their current pregnancy and previous pregnancy history, their opinions on fetal DNA screenings during pregnancy and incidental findings, information and opinions on financial resources for NIPT, as well as socio-cultural questions to determine patient demographics. Results: Of the 200 survey participants, the majority were educated, self-reported as white, had a higher than average income, and reported no aneuploidy risk factors. When asked what information they would like to receive from cfDNA screening, the vast majority of participants wanted all information available that could have an immediate impact on fetal health (88%) or an immediate impact on infant health from birth (82%). Many participants also wanted information that could have a future impact on the child's health or an immediate or future impact on the pregnant woman's own health. Most participants wanted information about the sex of fetus (86%) and common trisomies (71%), with almost half of participants desiring information about rare autosomal aneuploidies and/or all genetic information that may affect the baby. In addition, participants were found to be comfortable screening for conditions that are well-known, influence care during pregnancy, and are treatable. Finally, while most respondents either had insurance coverage for NIPT or were able to afford NIPT out of pocket, the majority of our participants felt that expanded NIPT should be either free for everyone or for those considered high risk. Discussion: Our findings suggest that with appropriate pre-test counseling, pregnant patients may choose NIPT for an expanding list of conditions.
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Affiliation(s)
| | | | - Marc-André Rodrigue
- CHU de Quebec Research and Mother and Child Center, Department of Medical Genetics, University Hospital of Quebec, Laval University, Quebec City, QC, Canada
| | - Jean Gekas
- Faculty of Medicine, Laval University, Quebec City, QC, Canada
- CHU de Quebec Research and Mother and Child Center, Department of Medical Genetics, University Hospital of Quebec, Laval University, Quebec City, QC, Canada
- *Correspondence: Jean Gekas,
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Woods AP, Godley F, Feeney T, Vigna C, Crable EL, O'Brien M, Gupta A, Walkey AJ, Drainoni ML, McAneny D, Drake FT. A Standardized Radiology Template Improves Incidental Adrenal Mass Follow-Up: A Prospective Effectiveness and Implementation Study. J Am Coll Radiol 2023; 20:87-97. [PMID: 36521629 PMCID: PMC9898147 DOI: 10.1016/j.jacr.2022.11.011] [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: 08/18/2022] [Revised: 10/25/2022] [Accepted: 11/03/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Incidental adrenal masses (IAMs) are common but rarely evaluated. To improve this, we developed a standardized radiology report recommendation template and investigated its implementation and effectiveness. METHODS We prospectively studied implementation of a standardized IAM reporting template as part of an ongoing quality improvement initiative, which also included primary care provider (PCP) notifications and a straightforward clinical algorithm. Data were obtained via medical record review and a survey of radiologists. Outcomes included template adoption rates and acceptability (implementation measures), as well as the proportion of patients evaluated and time to follow-up (effectiveness outcomes). RESULTS Of 4,995 imaging studies, 200 (4.0%) detected a new IAM. The standardized template was used in 54 reports (27.0%). All radiologists surveyed were aware of the template, and 91% affirmed that standardized recommendations are useful. Patients whose reports included the template were more likely to have PCP follow-up after IAM discovery compared with those with no template (53.7% versus 36.3%, P = .03). After adjusting for sex, current or prior malignancy, and provider ordering the initial imaging (PCP, other outpatient provider, or emergency department or inpatient provider), odds of PCP follow-up remained 2.0 times higher (95% confidence interval 1.02-3.9). Patients whose reports included the template had a shorter time to PCP follow-up (log-rank P = .018). PCPs ultimately placed orders for biochemical testing (35.2% versus 18.5%, P = .01), follow-up imaging (40.7% versus 23.3%, P = .02), and specialist referral (22.2% versus 4.8%, P < .01) for a higher proportion of patients who received the template compared with those who did not. CONCLUSIONS Use of a standardized template to communicate IAM recommendations was associated with improved IAM evaluation. Our template demonstrated high acceptability, but additional strategies are necessary to optimize adoption.
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Affiliation(s)
- Alison P Woods
- Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; and Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Frederick Godley
- Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois. https://twitter.com/GusGodley
| | - Timothy Feeney
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina. https://twitter.com/TFeend
| | - Chelsea Vigna
- Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Erika L Crable
- Department of Psychiatry, University of California San Diego, La Jolla, California. https://twitter.com/ErikaCrable
| | - Mollie O'Brien
- Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Avneesh Gupta
- Department of Radiology, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; Abdominal Imaging Fellowship Director, Department of Radiology, Information Technology Officer, Boston Medical Center, Boston, Massachusetts
| | - Allan J Walkey
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts; The Pulmonary Center, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; and Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University, Boston, Massachusetts; Codirector of the Evans Center for Implementation and Improvement Sciences, Boston University. https://twitter.com/WalkeyAllan
| | - Mari-Lynn Drainoni
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA; Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University, Boston, Massachusetts; and Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Codirector of the Evans Center for Implementation and Improvement Sciences, Boston University
| | - David McAneny
- Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; Chief Medical Officer, Senior Vice President of Medical Affairs, Associate Dean for Clinical Affairs, Boston Medical Center
| | - Frederick Thurston Drake
- Department of Surgery, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts; Chief of Endocrine Surgery, Boston Medical Center. https://twitter.com/F_ThurstonDrake
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Zhu X, Gao Z, Wang Y, Huang W, Li Q, Jiao Z, Liu N, Kong X. Utility of trio-based prenatal exome sequencing incorporating splice-site and mitochondrial genome assessment in pregnancies with fetal ultrasound anomalies: prospective cohort study. Ultrasound Obstet Gynecol 2022; 60:780-792. [PMID: 35726512 DOI: 10.1002/uog.24974] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the utility of trio-based prenatal exome sequencing (pES), incorporating splice-site and mitochondrial genome assessment, in the prenatal diagnosis of fetuses with ultrasound anomalies and normal copy-number variant sequencing (CNV-seq) results. METHODS This was a prospective study of 90 ongoing pregnancies with ultrasound anomalies that underwent trio-based pES after receiving normal CNV-seq results, from September 2020 to November 2021, in a single center in China. By using pES with a panel encompassing exome coding and splicing regions as well as mitochondrial genome for fetuses and parents, we identified the underlying genetic causes of fetal anomalies, incidental fetal findings and parental carrier status. Information on pregnancy outcome and the impact of pES findings on parental decision-making was collected. RESULTS Of the 90 pregnancies included, 28 (31.1%) received a diagnostic result that could explain the fetal ultrasound anomalies. The highest diagnostic yield was noted for brain abnormalities (3/6 (50.0%)), followed by hydrops (4/9 (44.4%)) and skeletal abnormalities (13/34 (38.2%)). Collectively, 34 variants of 20 genes were detected in the 28 diagnosed cases, with 55.9% (19/34) occurring de novo. Variants of uncertain significance (VUS) associated with fetal phenotypes were detected in six (6.7%) fetuses. Interestingly, fetal (n = 4) and parental (n = 3) incidental findings (IFs) were detected in seven (7.8%) cases. These included two fetuses carrying a de-novo likely pathogenic (LP) variant of the CIC and FBXO11 genes, respectively, associated with neurodevelopmental disorders, and one fetus with a LP variant in a mitochondrial gene. The remaining fetus presented with unilateral renal dysplasia and was incidentally found to carry a pathogenic PKD1 gene variant resulting in adult-onset polycystic kidney, which was later confirmed to be inherited from the mother. In addition, parental heterozygous variants associated with autosomal recessive diseases were detected in three families, including one with additional fetal diagnostic findings. Diagnostic results or fetal IFs contributed to parental decision-making about termination of the pregnancy in 26 families (26/72 (36.1%)), while negative pES results or identification of VUS encouraged 40 families (40/72 (55.6%)) to continue their pregnancy, which ended in a live birth in all cases. CONCLUSION Trio-based pES can provide additional genetic information for pregnancies with fetal ultrasound anomalies without a CNV-seq diagnosis. The incidental findings and parental carrier status reported by trio-based pES with splice-site and mitochondrial genome analysis extend its clinical application, but careful genetic counseling is warranted. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- X Zhu
- Genetics and Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Z Gao
- Genetics and Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Y Wang
- Genetics and Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - W Huang
- Genetics and Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Q Li
- Genetics and Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Z Jiao
- Genetics and Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - N Liu
- Genetics and Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - X Kong
- Genetics and Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Borg M, Hilberg O, Andersen MB, Weinreich UM, Rasmussen TR. Increased use of computed tomography in Denmark: stage shift toward early stage lung cancer through incidental findings. Acta Oncol 2022; 61:1256-1262. [PMID: 36264585 DOI: 10.1080/0284186x.2022.2135134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Computed tomography (CT) examinations are increasingly used worldwide and incidental findings are growing likewise. Lung cancer stage at diagnosis is pivotal to survival. The earliest stage of lung cancer, stage IA is in most cases asymptomatic. Potentially, increased use of clinical CTs could induce a stage shift toward earlier lung cancer diagnosis. MATERIALS AND METHODS Data on the number of CT thorax in Denmark and the stage distribution of Danish lung cancer patients 2013-2020 were acquired from, respectively, the Danish Health Data Authority and the Danish Lung Cancer Registry. Clinical auditing of stage IA lung cancer patients was performed in the period 2019-2021 in a Danish region to assess the reasons for referral. Auditing of stage IV lung cancer patients was done to see whether a CT thorax was performed in a two-year period before diagnosis. RESULTS All regions showed an increase in CTs per 1000 inhabitants. However, the number of CTs performed in 2013 differed by more than 50% among regions, and the increase per year also differed, from an increase of 1.9 to 3.4 more examinations per year. A significant correlation between CTs and fraction of stage IA lung cancers was seen in four out of the five regions. The audit of stage IA lung cancer cases revealed that 86.8% were incidental findings. Audit of stage IV lung cancer found that 4.3% had a nodule/infiltrate on a previous CT within a 2-year period prior to the diagnosis of lung cancer that was the probable origin of stage IV lung cancer. CONCLUSION The study found that the vast majority of early-stage lung cancers were incidental findings. It highlights that follow-up algorithms of incidental findings should be used in accordance with guidelines and it should be unequivocally how the CT follow-up of pulmonary infiltrates is managed.
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Affiliation(s)
- M Borg
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Medicine, Lillebaelt Hospital Vejle, University Hospital of Southern Denmark, Vejle, Denmark
| | - O Hilberg
- Department of Medicine, Lillebaelt Hospital Vejle, University Hospital of Southern Denmark, Vejle, Denmark
| | - M B Andersen
- Department of Radiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - U M Weinreich
- Department of Respiratory Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - T R Rasmussen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Henriques D, Mota Pinto A, Donato H, Leão R. Prevalence and Management of Incidental Testicular Masses-A Systematic Review. J Clin Med 2022; 11. [PMID: 36233639 DOI: 10.3390/jcm11195770] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/07/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Management of incidentally diagnosed small testicular masses (STM) is controversial. Although there is the risk of malignancy, it might be realistic to safely seek preservation of testicles bearing benign masses. This study aims to systematically evaluate the evidence regarding prevalence of STMs, their benign or malignant histology and their management. We conducted a systematic literature search for studies reporting small or incidental testicular masses and their management by radical orchiectomy, testis sparing surgery (TSS) or ultrasound (US) surveillance. We initially screened 2126 abstracts and from these, 57 studies met the inclusion criteria. Testicular masses were detected in 1.74% of patients undergoing US examination. Regarding STMs removed by surgery, 41.12% were benign. Intraoperative frozen section examination (FSE) is a reliable tool to discriminate between benign and malignant testicular masses (average 93.05% accuracy), supporting TSS. Benign lesions were associated with smaller diameter (<1 cm 68.78% benign), were often hypoechoic and exhibited regular margins on US. Conclusions: Small testicular masses are often benign. Clinical and US patterns are not accurate enough for including patients in surveillance protocols and TSS paired with FSE is pivotal for precluding the removal of testicles bearing benign lesions. Future research might unveil new imaging tools or biomarkers to support clinical management.
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Korbmacher-Böttcher D, Bamberg F, Peters A, Linkohr B, Ladwig KH, Schwettmann L, Weckbach S, Schlett CL, Rospleszcz S. Long-Term Psychosocial Consequences of Whole-Body Magnetic Resonance Imaging and Reporting of Incidental Findings in a Population-Based Cohort Study. Diagnostics (Basel) 2022; 12. [PMID: 36292045 DOI: 10.3390/diagnostics12102356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Management of radiological incidental findings (IF) is of rising importance; however, psychosocial implications of IF reporting remain unclear. We compared long-term psychosocial effects between individuals who underwent whole-body magnetic resonance imaging (MRI) with and without reported IF, and individuals who did not undergo imaging. We used a longitudinal population-based cohort from Western Europe. Longitudinal analysis included three examinations (exam 1, 6 years prior to MRI; exam 2, MRI; exam 3, 4 years after MRI). Psychosocial outcomes included PHQ-9 (Patient Health Questionnaire), DEEX (Depression and Exhaustion Scale), PSS-10 (Perceived Stress Scale) and a Somatization Scale. Univariate analyses and adjusted linear mixed models were calculated. Among 855 included individuals, 25% (n = 212) underwent MRI and 6% (n = 50) had at least one reported IF. Compared to MRI participants, non-participants had a higher psychosocial burden indicated by PHQ-9 in exam 1 (3.3 ± 3.3 vs. 2.5 ± 2.3) and DEEX (8.6 ± 4.7 vs. 7.7 ± 4.4), Somatization Scale (5.9 ± 4.3 vs. 4.8 ± 3.8) and PSS-10 (14.7 ± 5.7 vs. 13.7 ± 5.3, all p < 0.05) in exam 3. MRI participation without IF reporting was significantly associated with lower values of DEEX, PHQ-9 and Somatization Scale. There were no significant differences at the three timepoints between MRI participants with and without IF. In conclusion, individuals who voluntarily participated in whole-body MRI had less psychosocial burden and imaging and IF reporting were not associated with adverse long-term psychosocial consequences. However, due to the study design we cannot conclude that the MRI exam itself represented a beneficial intervention causing improvement in mental health scores.
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Farrell MH, Mooney KE, Laxova A, Farrell PM. Parental Preferences about Policy Options Regarding Disclosure of Incidental Genetic Findings in Newborn Screening: Using Videos and the Internet to Educate and Obtain Input. Int J Neonatal Screen 2022; 8:ijns8040054. [PMID: 36278624 PMCID: PMC9590039 DOI: 10.3390/ijns8040054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 11/16/2022] Open
Abstract
Our objective was to develop and test a new approach to obtaining parental policy guidance about disclosure of incidental findings of newborn screening for cystic fibrosis (CF), including heterozygote carrier status and the conditions known as CFTR-related metabolic syndrome (CRMS) and/or cystic fibrosis screen positive inconclusive diagnosis, CFSPID. The participants were parents of infants up to 6 months old recruited from maternity hospitals/clinics, parent education classes and stores selling baby products. Data were collected using an anonymous, one-time Internet-based survey. The survey introduced two scenarios using novel, animated videos. Parents were asked to rank three potential disclosure policies-Fully Informed, Parents Decide, and Withholding Information. Regarding disclosure of information about Mild X (analogous to CRMS/CFSPID), 57% of respondents ranked Parents Decide as their top choice, while another 41% ranked the Fully Informed policy first. Similarly, when considering disclosure of information about Disease X (CF) carrier status, 50% and 43% gave top rankings to the Fully Informed and Parents Decide policies, respectively. Less than 8% ranked the Withholding Information policy first in either scenario. Data from value comparisons suggested that parents believed knowing everything was very important even if they became distressed. Likewise, parents preferred autonomy even if they became distressed. However, when there might not be enough time to learn everything, parents showed a slight preference for deferring decision-making. Because most parents strongly preferred the policies of full disclosure or making the decision, rather than the withholding option for NBS results, these results can inform disclosure policies in NBS programs, especially as next-generation sequencing increases incidental findings.
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Affiliation(s)
- Michael H. Farrell
- Departments of Internal Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455, USA
| | - Katherine E. Mooney
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Anita Laxova
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA
| | - Philip M. Farrell
- Departments of Pediatrics and Population Health Sciences, University of Wisconsin School of Medicine and Public Health, CSC Room K4/948, 600 Highland Avenue, Madison, WI 53792, USA
- Correspondence: ; Tel.: +1-608-345-2308; Fax: +1-608-263-2820
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