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2014 CUA Abstracts

ABSTRACT: Background: The incidence of small renal masses (SRMs) has increased in recent years in line with increased in abdominal imaging. SRMs are defined as enhancing solid lesions measuring ? 4cm. We present our experience with percutaneous renal tumour biopsy (RTB) of SRMs, which to our knowledge, is the largest to date. Methods: We reviewed our database to ascertain the incidence of benign, malignant and non-diagnostic biopsies of SRMs performed at our institution from 2001 to July 2013. A total of 519 RTBs were performed (496 SRMs). The diagnostic rate was compared over time. The accuracy of the biopsies was correlated with the definitive pathology in the cases where the biopsy led to surgery. Results: The mean size of the 519 biopsied lesions was 2.5 (±0.9) cm. The diagnostic rate at the first biopsy was 89.1% (442/496). Of the diagnostic biopsies, 116 (26.2%) were benign and 326 (73.7%) were malignant. Of the 54 non-diagnostic biopsies, 23 (42.6%) had a repeat biopsy. A diagnosis was obtained in 19 cases (82.6%; 8 [42.1%] benign, 11 [57.9%] malignant). Therefore RTB led to a diagnosis in 461 of the 496 SRMs (92.9%). Over time, there was a decrease in the rate of non-diagnostic biopsies from 15.0% to 6.0% (p>0.05). Of the available surgical pathology, there was agreement between histology in 92.5% (125/135). For the conventional cell carcinoma (n=85), there was concordance between histology and grade in 97.6% (83/85) and 96.1% (74/77), respectively. Conclusions: RTB of SRMs provided a diagnosis in 92.9% of the cases. Surgery was avoided in more than 23% of patients following RTB because of benign histology. The rate of non-diagnostic biopsies diminished over time. Finally, there was a high correlation between the biopsy and the final pathology with regards to both histology and grade. In an era where overdiagnosis and overtreatment of favourable cancers is gaining attention, routine RTB for SRM leads to diminished intervention and, going forward ,personalization of care.

SUBMITTER: Richard P

PROVIDER: S-EPMC4095672 | biostudies-literature | 2014 Jan

REPOSITORIES: biostudies-literature

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Project description:Introduction and Objectives: Optimizing targeted therapy in patients with metastatic renal cell carcinoma (RCC) would improve clinical outcomes but patient derived xenograft (PDX) models are lacking. We present a novel pre-clinical model that is superior to nude mice for accommodating RCC PDXs. This preclinical model implants RC PDXs into the chorioallantoic membrane (CAM) of avian embryos and is a patient-specific platform that could be advantageous for physicians in the future when deciding what treatment options are best for their patients. This drug panelling platform is rapid, cost-effective, and relies on the highly angiogenic CAM to support RCC PDXs. Methods: Commercial and patient derived RCC cell lines, were grown to full confluence and transduced to generate fluorescently labeled versions of each cell line. Cells were implanted into the CAM. Tumors were treated every two days by applying 10 μL (10 μM) of indicated drug onto the tumor onplant. The drugs that were paneled include Sunitinib, Sorafenib, Pazopanib, Axitinib and a vehicle treatment. After 7–8 days of incubation post-implantation, tumor take rate was determined by the presence of tumor growth in the CAM using a fluorescent stereoscope. Results: The highest tumor take rates were observed in the vehicle treatments of the embryos, ranging from 50–86%. Both commercial and primary cell lines saw a reduction in tumor take rate with the application of various anti-angiogenic drugs. Specifically, XP121 tumors were resistant to Sorafenib; 786-0, XP121; XP206 were resistant to Pazopanib; T258, XP121 were resistant to Sunitinib; and lastly, T258 tumors were resistant to Axitinib (Table 1). Conclusions: RCC PDXs onplanted in the CAM of avian embryos offer a robust and cost-effective platform to predict sensitivity/resistance to targeted therapies. When evaluating several patient-derived RCC cell lines, drug paneling revealed other alternative treatment options for these PDXs. More importantly, RCC PDXs that were shown to be Sunitinib-resistant in both the patient and in mouse-based PDXs, also produced the same resistance phenotype in the CAM.

Project description:Rationale: Learning styles (LS) of medical residents change over time from the more passive Assimilator toward more active preferences like Accommodator or Converger. We have shown pharmacy residents to be predominantly Assimilators at the start of their residency program. Whether learning styles of pharmacy residents change after they enter practice has never been studied. Objective: To describe the evolution of learning styles of pharmacy residents as they transition from residency into practice. Study Design and Methods: Prospective observational survey and semi-structured interviews. A complete provincial cohort of former pharmacy residents (n=28) who had their LS characterized during their residency and were now 1 year post-residency were invited to repeat the Pharmacists’ Inventory of Learning Styles (PILS). Interviews were administered to consenting participants to gain additional insights. Results: 27 residents (96%) completed the PILS survey and 16 (59%) completed the interview. 13 (48%) changed their dominant LS and 20 (74%) changed their secondary LS. Six (22%) participants did not change either LS. The overall proportion of dominant Assimilators (59%) and Convergers (26%) remained similar to baseline (52% and 26%, respectively), meaning participants had adopted and abandoned different learning styles in similar numbers. Change in LS was associated with receiving preceptor training (p<0.05). Of the 12 preceptors interviewed, 58% stated that they had adjusted their teaching practices based on knowledge of their LS. Conclusions: Change in dominant and/or secondary learning style is common after 1 year in practice compared to during pharmacy practice residency. There is no overall direction to the shifts, however, with residents transitioning in and out of more active learning styles with similar frequency. Overall after a year in practice, the cohort of former residents we studied remained mostly Assimilators, who prefer passive learning approaches. These results contrast with medical students, who adopt more active preferences like Accommodator.

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2014 CUA Abstracts

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