The challenge in diagnosing cardiac tumors to avoid unnecessary cardiac surgery.
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ABSTRACT:
SUBMITTER: Joseph G
PROVIDER: S-EPMC7495774 | biostudies-literature | 2020 Sep
REPOSITORIES: biostudies-literature
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The challenge in diagnosing cardiac tumors to avoid unnecessary cardiac surgery.
Joseph Gowsini G Zelechowski Marek Wojciech MW Gronlund Jens J Zaremba Tomas T
Clinical case reports 20200611 9
Cardiac magnetic resonance in cardiac mass: Cardiac magnetic resonance (CMR) should be considered in the evaluation of patients with cardiac mass. Especially, when the diagnosis is not certain, CMR could provide paramount information that could be helpful for the decision on cardiac surgery. ...[more]
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Project description:Background:Acute kidney injury (AKI) following cardiac surgery leads to increased morbidity and mortality. Characterization and validation of early biomarkers of AKI may ultimately facilitate early therapeutic intervention. We have previously identified that elevated urinary hepcidin-25 is inversely and independently associated with the development of AKI in adult cardiac surgery patients. Hepcidin-25 is an antimicrobial peptide that sequesters iron intracellularly, and its elevation following human ischemia reperfusion injury may represent a renoprotective response to minimize renal injury. Objective:Our goal was to validate urinary hepcidin-25 as a non-invasive biomarker in an independent cardiac surgery cohort, within the context of clinical AKI predictors. Design:Prospective observational cohort study. Setting:Adult cardiac surgery program at St. Boniface Hospital, Winnipeg, Manitoba, Canada. Patients:Adult cardiac surgery patients undergoing cardiopulmonary bypass (CPB), n = 306. Measurements:Urine hepcidin-25, measured on post-operative day (POD) 1. Methods:A prospective, observational cohort of adult CPB patients (n = 306) was collected with serial perioperative urine samples. Urine hepcidin-25 at POD 1 was measured by competitive ELISA. Its diagnostic performance was evaluated in conjunction with clinical parameters and the Thakar clinical prediction score, using multivariate logistic regression. Results:Urinary hepcidin-25 is elevated following cardiac surgery in AKI and non-AKI patients. Elevated urinary hepcidin-25 concentration was inversely associated with AKI on both univariate (odds ratio [OR]: 0.61, 95% confidence interval [CI]: 0.45-0.83, P = .002) and multivariate analysis (OR: 0.67, 95% CI: 0.50-0.95, P = .02). A combined model with clinical risk factors demonstrated that baseline estimated glomerular filtration rate (eGFR), diabetes mellitus, and urinary hepcidin-25 concentration had an overall area under the curve (AUC) of 0.82 (0.75-0.88) for predicting subsequent AKI development, which was superior to clinical prediction alone as determined by the Thakar score. Limitations:(1) A single-center observational study. (2) Polyclonal antibody-based competitive ELISA. Conclusion:Hepcidin-25 is inversely associated with AKI in a multivariate model when combined with eGFR and diabetes mellitus, with an overall AUC of 0.82. Notably, urinary hepcidin-25 improves on clinical AKI prediction compared to the Thakar score alone.
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Project description:Background: Stimulator of interferon genes (STING)-associated vasculopathy with onset in infancy (SAVI) was first described in 2014 as a type I interferonopathy resulting from heterozygous mutations in the transmembrane protein 173 (TMEM173) gene. SAVI is characterized by the neonatal onset of systemic inflammation, severe cutaneous vasculopathy, and interstitial lung disease. Janus kinase inhibitors are considered effective therapeutics. We sought to describe 2 patients who were diagnosed with SAVI only at postmortem to increase awareness of this disorder. Methods: Clinical data were collected, and Sanger sequencing of the TMEM173 gene was performed in 2 patients suspected of SAVI. This article reviews details of these cases and lessons learned from clinical review and postmortem studies. Results: Two male children shared similar manifestations, including recurrent skin abscesses in winter, skin lesions, and recurrent respiratory tract infections, since birth. Computed tomography of the chest revealed pulmonary fibrosis, but no mutations in relevant genes (including ABCA3 and SFTPC) were discovered in patient 1 (P1). Joint pain was significant in P2 and he was diagnosed with arthritis. Antibiotic treatment yielded little improvement and did not prevent progression. Finally, P1 and P2 died of respiratory and circulatory failure in 2016 and 2012, respectively. In 2018, mutations (P1: c.463G>A, p.V155M; and P2: c.461A>G, p.N154S) in exon 5 of the TMEM173 gene were discovered, confirming the diagnosis of SAVI. Conclusions: The experience with these 2 patients suggests that SAVI should be considered in children with systemic inflammation, chilblain skin lesions, and pulmonary fibrosis, and TMEM173 gene analysis can be beneficial in the diagnosis of SAVI.
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Project description:Concurrent adrenalectomy during renal surgery for renal cell carcinoma was once routine. More recent data suggest that adrenalectomy should be reserved for tumors 7 cm or greater, particularly those involving the upper pole. We evaluated the radiographic and pathological incidence of adrenal involvement in patients undergoing renal surgery for renal cell carcinoma 7 cm or greater.Patients who underwent renal surgery for tumors 7 cm or greater between 1999 and 2008 were identified from our kidney cancer registry. We used Fisher's exact test to determine whether radiographic tumor site predicted adrenal involvement. The Kaplan-Meier method and Cox proportional hazard regression models were used to analyze the impact of adrenal resection on outcome.Of 1,650 patients we identified 179 patients who underwent surgery for renal cell carcinoma 7 cm or greater. Of these patients 91 underwent concurrent total ipsilateral adrenalectomy at renal surgery with pathological adrenal involvement confirmed in 4 (4.4%). Upper pole site did not predict involvement (p = 0.83). Preoperative adrenal imaging was 100% sensitive and 92% specific to detect adrenal involvement by renal cell carcinoma with 100% negative predictive value. No survival advantage was noted on multivariate analysis when comparing patients who underwent adrenal resection to 88 in whom the adrenal gland was spared (p = 0.38).Synchronous ipsilateral adrenal involvement with renal cell carcinoma is rare even in cases of large and/or upper pole tumors, making routine adrenalectomy unnecessary. Preoperative adrenal imaging is highly sensitive and should inform the decision to perform adrenalectomy more than tumor size or site.
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Project description:ObjectivesDue to its high sensitivity, DCE MRI of the breast (bMRI) is increasingly used for both screening and assessment purposes. The high number of detected lesions poses a significant logistic challenge in clinical practice. The aim was to evaluate a temporally and spatially resolved (4D) radiomics approach to distinguish benign from malignant enhancing breast lesions and thereby avoid unnecessary biopsies.MethodsThis retrospective study included consecutive patients with MRI-suspicious findings (BI-RADS 4/5). Two blinded readers analyzed DCE images using a commercially available software, automatically extracting BI-RADS curve types and pharmacokinetic enhancement features. After principal component analysis (PCA), a neural network-derived A.I. classifier to discriminate benign from malignant lesions was constructed and tested using a random split simple approach. The rate of avoidable biopsies was evaluated at exploratory cutoffs (C1, 100%, and C2, ≥ 95% sensitivity).ResultsFour hundred seventy (295 malignant) lesions in 329 female patients (mean age 55.1 years, range 18-85 years) were examined. Eighty-six DCE features were extracted based on automated volumetric lesion analysis. Five independent component features were extracted using PCA. The A.I. classifier achieved a significant (p < .001) accuracy to distinguish benign from malignant lesion within the test sample (AUC: 83.5%; 95% CI: 76.8-89.0%). Applying identified cutoffs on testing data not included in training dataset showed the potential to lower the number of unnecessary biopsies of benign lesions by 14.5% (C1) and 36.2% (C2).ConclusionThe investigated automated 4D radiomics approach resulted in an accurate A.I. classifier able to distinguish between benign and malignant lesions. Its application could have avoided unnecessary biopsies.Key points• Principal component analysis of the extracted volumetric and temporally resolved (4D) DCE markers favored pharmacokinetic modeling derived features. • An A.I. classifier based on 86 extracted DCE features achieved a good to excellent diagnostic performance as measured by the area under the ROC curve with 80.6% (training dataset) and 83.5% (testing dataset). • Testing the resulting A.I. classifier showed the potential to lower the number of unnecessary biopsies of benign breast lesions by up to 36.2%, p < .001 at the cost of up to 4.5% (n = 4) false negative low-risk cancers.
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2020-10-20 | GSE159612 | GEO
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