scholarly journals SUN-LB24 Clinical Performance of Multiplatform Mutation Panel MicroRNA Risk Classifier in Indeterminate Thyroid Nodules

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
J Woody Sistrunk ◽  
Alexander Shifrin ◽  
Marc Frager ◽  
Ricardo H Bardales ◽  
Johnson Thomas ◽  
...  
Keyword(s):  
High Risk ◽  
Patient Outcomes ◽  
Thyroid Nodules ◽  
Clinical Performance ◽  
Significant Risk ◽  
Fine Needle Aspirates ◽  
Clinical Risk ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Risk Of Malignancy

Abstract Introduction: We evaluated the clinical performance of an expanded mutation panel in combination with microRNA classification (MPTX) for the management of indeterminate thyroid nodules. Methods: MPTX included testing of fine needle aspirates with a combination of ThyGeNEXT® mutation panel for strong and weak driver oncogenic changes and ThyraMIR® microRNA risk classifier. MPTX test status (positive or negative) and MPTX clinical risk classifications (low, moderate, or high risk) were determined blind to patient outcomes. Surgical pathology and clinical follow-up records of patients from multiple centers were used to determine patient outcomes. MPTX performance was assessed by Kaplan Meier analysis for cancer-free survival of patients, with risk of malignancy determined by hazard ratios (HR). Results: Our study included 140 patients with AUS/FLUS or FN/SFN nodules, of which 13% had malignancy. MPTX negative test status and MPTX low risk results conferred a high probability (94%) that patients would remain cancer free. MPTX positive test status (HR 11.2, P<0.001) and MPTX moderate risk results (HR 8.5, P=0.001) were significant risk factors for malignancy, each conferring a 53% probability of malignancy. MPTX high risk results elevated risk of malignancy even more so, conferring a 70% probability of malignancy (HR 38.5, P<0.001). Conclusions: MPTX test status accurately stratifies patients for risk of malignancy. Further classification using MPTX clinical risk categories enhances utility by accurately identifying patients at low, moderate, or high risk of malignancy at the low rate of malignancy encountered when clinically managing patients with indeterminate thyroid nodules.

scholarly journals Influence of trends in hospital volume over time on patient outcomes for high-risk surgery

2019 ◽  
Author(s):  
Cécile Payet ◽  
Stéphanie Polazzi ◽  
Jean-Christophe Lifante ◽  
Eddy Cotte ◽  
Daniel Grinberg ◽  
...  
Keyword(s):  
High Risk ◽  
Patient Outcomes ◽  
Hospital Volume ◽  
Learning Effect ◽  
Hazard Ratios ◽  
Outcome Relationship ◽  
Volume Outcome ◽  
Procedure Volume ◽  
The Individual ◽  
Over Time

Abstract Background The more frequent a hospital performs a procedure, the better the outcome of the procedure; however, the mechanisms of this volume-outcome relationship have not been deeply elucidated to date. We aimed to determine whether patient outcomes improve in hospitals with a significantly increased volume of high-risk surgery over time and whether a learning effect existed at the individual hospital level. Methods We included all patients who underwent one of ten digestive, cardiovascular and orthopaedic procedures between 2010 and 2014 from the French nationwide hospitals database. For each procedure, we identified three groups of hospitals according to volume trend (increased, decreased, or no change). In-hospital mortality, reoperation, and unplanned hospital readmission within 30 days were compared between groups using Cox regressions, taking into account clustering of patients within hospitals and potential confounders. Learning effect was investigated by considering the interaction between hospital groups and procedure year. Results Over 5 years, 759,928 patients from 694 hospitals were analysed. Patients’ mortality in hospitals with procedure volume increase or decrease over time did not clearly differ from those in hospitals with unchanged volume across the studied procedures (e.g., Hazard Ratios [95%] of 1.04 [0.93-1.17] and 1.08 [0.97-1.21] respectively for colectomy). Furthermore, patient outcomes did not improve or deteriorate in hospitals with increased or decreased volume of procedures over time (e.g., 1.01 [0.95-1.08] and 0.99 [0.92-1.05] respectively for colectomy). Conclusions Trend in hospital volume over time does not appear to influence patient outcomes, which puts the relevance of the "practice-makes-perfect" dogma in question.

scholarly journals Application of the Bethesda System for Reporting Thyroid Cytopathology in the Pediatric Population

2020 ◽  
Author(s):  
Huy Gia Vuong ◽  
Ayana Suzuki ◽  
Hee Young Na ◽  
Pham Van Tuyen ◽  
Doan Minh Khuy ◽  
...  
Keyword(s):  
Thyroid Nodules ◽  
Pediatric Population ◽  
Asian Countries ◽  
Resection Rate ◽  
Fine Needle Aspirates ◽  
Risk Of Malignancy ◽  
Bethesda System ◽  
Thyroid Cytopathology ◽  
The Bethesda System

Abstract Objectives We aimed to provide the Asian experience with the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) in pediatric thyroid nodules. Methods Consecutive thyroid fine-needle aspirates (patient age, ≤18 years) were retrospectively collected from 7 tertiary centers in 5 Asian countries. Results Of 194,364 thyroid aspirates, 0.6% were pediatric cases (mean age, 15.0 years). Among 827 nodules with accessible follow-up, the resection rate and risk of malignancy (ROM) were 36.3% and 59.0%, respectively. Malignant nodules (n = 179) accounted for 59.7% of resected nodules and 21.6% of all thyroid nodules with available follow-up. Compared with the published adult series, pediatric nodules had a higher resection rate and ROM, particularly in the indeterminate categories. Conclusions Our study demonstrates that Asian pediatric thyroid nodules had higher ROM than those from adults. The prototypic outputs of TBSRTC may need to be adjusted in the pediatric population.

Relation Between Cereblon Expression and Survival in Patients with Newly Diagnosed Multiple Myeloma Treated with Thalidomide

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3973-3973
Author(s):  
Annemiek Broyl ◽  
Rowan Kuiper ◽  
Mark van Duin ◽  
Bronno van der Holt ◽  
Laila el Jarari ◽  
...  
Keyword(s):  
High Risk ◽  
Research Funding ◽  
Cox Regression ◽  
Progression Free Survival ◽  
Hazard Ratio ◽  
Phase Iii ◽  
Newly Diagnosed ◽  
Cox Regression Analysis ◽  
Kaplan Meier ◽  
Hazard Ratios

Abstract Abstract 3973 Introduction: Cereblon (CRBN) expression has been described to be essential for the activity of Thalidomide and Lenalidomide. This suggests that presence and possibly increased level of CRBN expression would be associated with better outcome in Thalidomide/Lenalidomide treated patients. The aim of this study was to evaluate CRBN expression in relation to outcome in patients receiving Thalidomide maintenance. Patients and methods: The HOVON-65/GMMG-HD4 trial is a multi-center, phase III trial, comparing Bortezomib in induction and post-intensification vs. conventional chemotherapy and daily Thalidomide 50 mg for 2 years post-intensification in newly diagnosed MM patients. This trial demonstrated that Bortezomib during induction and maintenance improved CR and achieved superior PFS and OS (Sonneveld et al., JCO, July 16, 2012). Gene expression profiling was performed at the start of the trial by Affymetrix U133 Plus 2.0 GeneChip, and was available for 96 patients which started Thalidomide maintenance. CRBN expression levels were based on a combined value of probe sets 218142_s_at and 222533_at. CRBN expression was validated using real-time PCR. All survival analyses were performed in SPSS, with survival time taken from the start of maintenance. Results: In patients receiving Thalidomide maintenance, increased CRBN expression was significantly associated with longer progression free survival (p=0.005, hazard ratio = 0.7) and longer overall survival (p=0.04, hazard ratio= 0.7). Using Kaplan-Meier analysis for visualization and using the median expression to define high and low expression, a significant separation was found for PFS (Log rank p=0.009) but not for OS (Log rank p=0.13). No association was observed between CRBN expression and PFS/OS after Bortezomib maintenance (PFS, p=0.4, hazard ratio=1.1; OS, p=0.7, hazard ratio=1.1). Multivariate Cox regression analysis was performed using the covariates ISS, CRBN and high-risk cytogenetics, defined as having del(17p) and/or 1q gain and/or t(4;14). Higher CRBN levels remained significantly related to longer PFS (hazard ratio 0.7, p=0.03), but not OS (hazard ratio of 0.8, p=0.3). High-risk cytogenetics and ISS were both significant in both PFS and OS multivariate models, with hazard ratios of 2.8 and 3.6, for high-risk cytogenetics and 2.5 and 5.5, for ISS stage 3, respectively (p=0.0004, p=0.003, high-risk cytogenetics and p=0.01 and p=0.005, ISS stage 3, respectively). Conclusion: These data suggest use of CRBN as a biomarker for thalidomide outcome, but further analysis in other Thalidomide trials is required to validate this finding. Disclosures: Lokhorst: Genmab: Consultancy. Sonneveld:Onyx: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; celgene: Honoraria, Research Funding.

scholarly journals MULTINODULAR GOITER;

2013 ◽  
Vol 20 (06) ◽  
pp. 1035-1041
Author(s):  
ZULFIQAR ALI BHATTI, ◽  
JAVED AHMED PHULPOTO, ◽  
NOOR AHMED SHAIKH,
Keyword(s):  
Multinodular Goiter ◽  
Prospective Observational Study ◽  
Thyroid Nodules ◽  
Significant Risk ◽  
Nodular Goiter ◽  
University Hospital ◽  
Risk Of Malignancy ◽  
The Common ◽  
Thyroid Profile ◽  
Surgical Unit

Objective: The object of this study was to determine the frequency and type of thyroid carcinoma in Multi nodular goiter(MNG) after surgical resection on histopathological basis. Introduction: Multi nodular goiter (MNG) is one of the common presentationsof various thyroid diseases. Thyroid nodules have been reported to be found in 4% to 7% of the population on neck palpation. Although incomparison to solitary nodule, the risk of malignancy in MNG is low but certain studies are showing significant risk. Material andmethods: This prospective, observational study was carried out in the surgical unit I of Ghulam Mohammad Mahar Medical collegehospital sukkur from 2007 to 2012. 94 cases with clinical diagnosis of MNG were analyzed during this period. All the patients wereadmitted through opd with routine investigations plus investigations specific to thyroid including thyroid profile, thyroid scan, FNAC ofdominant nodule before being subjected to surgery. All FNACs were carried out at agha khan university hospital Karachi. Histopathologyof operated specimen was the main criteria for malignancy. Results: Among the 94 cases which were included in this study, 9 (9.5%)cases containing foci of malignancy. Incidence of malignancy commonly occurs in females, papillary carcinoma is being the commonestentity. Conclusions: The incidence of malignancy in MNG in this study is 9.5% that is quite high. So people should be educated andencouraged to attend the thyroid clinics for proper evaluation and early diagnosis of Malignancy.

scholarly journals Influence of trends in hospital volume over time on patient outcomes for high-risk surgery

2020 ◽  
Author(s):  
Cécile Payet ◽  
Stéphanie Polazzi ◽  
Jean-Christophe Lifante ◽  
Eddy Cotte ◽  
Daniel Grinberg ◽  
...  
Keyword(s):  
High Risk ◽  
Patient Outcomes ◽  
Hospital Volume ◽  
Learning Effect ◽  
Real World Data ◽  
Hazard Ratios ◽  
Procedure Volume ◽  
The Individual ◽  
Individual Hospital ◽  
Over Time

Abstract Background The “practice makes perfect” concept considers the more frequent a hospital performs a procedure, the better the outcome of the procedure. We aimed to study this concept by investigating whether patient outcomes improve in hospitals with a significantly increased volume of high-risk surgery over time and whether a learning effect existed at the individual hospital level. Methods We included all patients who underwent one of ten digestive, cardiovascular and orthopaedic procedures between 2010 and 2014 from the French nationwide hospitals database. For each procedure, we identified three groups of hospitals according to volume trend (increased, decreased, or no change). In-hospital mortality, reoperation, and unplanned hospital readmission within 30 days were compared between groups using Cox regressions, taking into account clustering of patients within hospitals and potential confounders. Individual hospital learning effect was investigated by considering the interaction between hospital groups and procedure year. Results Over 5 years, 759,928 patients from 694 hospitals were analysed. Patients’ mortality in hospitals with procedure volume increase or decrease over time did not clearly differ from those in hospitals with unchanged volume across the studied procedures (e.g., Hazard Ratios [95%] of 1.04 [0.93-1.17] and 1.08 [0.97-1.21] respectively for colectomy). Furthermore, patient outcomes did not improve or deteriorate in hospitals with increased or decreased volume of procedures over time (e.g., 1.01 [0.95-1.08] and 0.99 [0.92-1.05] respectively for colectomy). Conclusions Trend in hospital volume over time does not appear to influence patient outcomes based on real-world data.

Rethinking Malignancy Risk in Indeterminate Thyroid Nodules with Positive Molecular Studies: Southern California Permanente Experience

2019 ◽  
Vol 161 (3) ◽  
pp. 419-423 ◽  
Author(s):  
David S. Cohen ◽  
Jane E. Tongson-Ignacio ◽  
Christopher M. Lolachi ◽  
Vanessa S. Ghaderi ◽  
Babak Jahan-Parwar ◽  
...  
Keyword(s):  
High Risk ◽  
Thyroid Surgery ◽  
Southern California ◽  
Thyroid Nodules ◽  
Genetic Mutation ◽  
Molecular Testing ◽  
Significant Finding ◽  
Kras Mutations ◽  
Risk Of Malignancy ◽  
Undetermined Significance

Objectives To recognize that thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS; Bethesda III) have different risks of malignancy based on genetic mutation and to consider molecular testing of nodules with AUS/FLUS to help avoid unnecessary morbidity or cost. Study Design Retrospective cohort study. Setting Multiple locations within Southern California Permanente Medical Group. Subjects and Methods Patients included those with indeterminate thyroid nodules and AUS/FLUS on 2 separate fine-needle aspirations with positive ThyGenX testing from 2014 to 2017 who underwent thyroid surgery. Patients were classified as having benign or malignant disease. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features was considered benign. Results A total of 231 patients had repeat AUS/FLUS with positive molecular testing and surgery. The most frequent type of malignancy was papillary carcinoma, followed by follicular carcinoma. The overall prevalence of malignancy in nodules with mutations was 74.0%, although there was considerable variation: BRAF = 100%, RET = 100%, PAX8-PPARγ = 84.6%, HRAS = 70.7%, NRAS = 63.4%, and KRAS = 33%—a statistically significant finding ( P < .001). Conclusions Not all molecular mutations in thyroid nodules with AUS/FLUS have a high risk of malignancy. Of note, patients with BRAF and RET mutations in our population had a 100% risk of malignancy. Patients with PAX, HRAS, or NRAS mutations had a high risk of malignancy, while patients with KRAS mutations had a lower risk of malignancy. Further studies are needed to determine if the presence of certain molecular mutations can help personalize care and aid in the decision for thyroid surgery.

scholarly journals Assessment of Nondiagnostic Ultrasound-Guided Fine Needle Aspirations of Thyroid Nodules

2002 ◽  
Vol 87 (11) ◽  
pp. 4924-4927 ◽  
Author(s):  
Erik K. Alexander ◽  
Jenny P. Heering ◽  
Carol B. Benson ◽  
Mary C. Frates ◽  
Peter M. Doubilet ◽  
...  
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Significant Risk ◽  
Needle Aspiration ◽  
Multivariable Model ◽  
Ultrasound Guided ◽  
Significant Independent Predictor ◽  
Fine Needle ◽  
Risk Of Malignancy

Abstract Thyroid nodules are common. Evaluation of patients with thyroid nodules typically includes fine needle aspiration biopsy (FNA), an approach that has proven to be accurate for the detection of thyroid cancer. Although the majority of biopsies are adequate for a cytological diagnosis, up to 20% will be insufficient or nondiagnostic. Current opinion suggests that such aspirates should be repeated, although no systematic study has investigated the usefulness of this approach, especially when ultrasound guidance is used to direct the initial FNA. We sought to define the predictors and optimal follow-up strategy for initial nondiagnostic ultrasound-guided FNAs of thyroid nodules. Data were collected for all patients at the Brigham and Women’s Hospital Thyroid Nodule Clinic between 1995–2000 who underwent ultrasound-guided FNA of a thyroid nodule. All patients with nondiagnostic cytology were advised to return for a repeat ultrasound-guided FNA. Patient age, gender, nodule size, cystic content, solitary vs. multinodular thyroid, and nodule location were documented and evaluated as possible predictors of a nondiagnostic biopsy in a multivariable model. The rate of diagnostic cytology obtained on repeat ultrasound-guided FNA was calculated. A total of 1128 patients with 1458 nodules were biopsied over a 6-yr period. A total of 1269 aspirations (950 patients) were diagnostic, and 189 (178 patients) were nondiagnostic. The cystic content of each nodule was the only significant independent predictor of nondiagnostic cytology (P &lt; 0.001). The fraction of specimens with initial nondiagnostic cytology increased with greater cystic content (P &lt; 0.001 for trend). A diagnostic ultrasound-guided FNA was obtained on the first repeat biopsy in 63% of nodules and was inversely related to increasing cystic content of each nodule (P = 0.03). One hundred and nineteen patients with 127 nodules returned for follow-up as advised, and malignancy was documented in 5%. Despite ultrasound-guided FNA, there remains a significant risk of initial nondiagnostic cytology, largely predicted by the cystic content of each nodule. Repeat aspiration is often successful and should be the standard approach to such nodules, given their risk of malignancy.

scholarly journals Propofol-based total intravenous anesthesia is associated with better survival than desflurane anesthesia in glioblastoma surgery

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255627
Author(s):  
Yi-Hsuan Huang ◽  
Zhi-Fu Wu ◽  
Meei-Shyuan Lee ◽  
Yu-Sheng Lou ◽  
Ke-Li Wu ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Patient Outcomes ◽  
Cox Regression ◽  
Postoperative Recurrence ◽  
Hazard Ratio ◽  
Anesthetic Techniques ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Propensity Matching ◽  
The Relationship

Background Previous research has shown that anesthetic techniques can influence patient outcomes following cancer surgery. However, the effects of anesthesia in patients undergoing glioblastoma surgery are still not known. We studied the relationship between the type of anesthesia and patient outcomes following elective glioblastoma surgery. Methods This was a retrospective cohort study of patients who underwent elective glioblastoma surgery between January 2008 and December 2018. Patients were grouped according to the anesthesia they received, desflurane or propofol. A Kaplan-Meier analysis was conducted, and survival curves were presented from the date of surgery to death. Univariable and multivariable Cox regression models were used to compare hazard ratios for death after propensity matching. Results A total of 50 patients (45 deaths, 90.0%) under desflurane anesthesia and 53 patients (38 deaths, 72.0%) under propofol anesthesia were included. Thirty-eight patients remained in each group after propensity matching. Propofol anesthesia was associated with improved survival (hazard ratio, 0.51; 95% confidence interval, 0.30–0.85; P = 0.011) in a matched analysis. Furthermore, patients under propofol anesthesia exhibited less postoperative recurrence than those under desflurane anesthesia (hazard ratio, 0.60; 95% confidence interval, 0.37–0.98; P = 0.040) in a matched analysis. Conclusions In this limited sample size, we observed that propofol anesthesia was associated with improved survival and less postoperative recurrence in glioblastoma surgery than desflurane anesthesia. Further investigations are needed to examine the influence of propofol anesthesia on patient outcomes following glioblastoma surgery.

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