Increase In Detection Rate Research Articles

Exploring the value of arterial spin labeling and six diffusion MRI models in differentiating solid benign and malignant renal tumors

ObjectiveTo explore the value of three-dimensional arterial spin labeling (ASL) and six diffusion magnetic resonance imaging (MRI) models in differentiating solid benign and malignant renal tumors.MethodsThis retrospective study included 89 patients with renal tumors. All patients underwent ASL and ZOOMit diffusion-weighted imaging (DWI) examinations and were divided into three groups: clear cell renal cell carcinoma (ccRCC), non-ccRCC, and benign renal tumors (BRT). The mean and peak renal blood flow (RBFmean and RBFpeak) from ASL and fourteen diffusion parameters from mono-exponential DWI (Mono_DWI), intravoxel incoherent motion (IVIM), diffusion kurtosis imaging (DKI), stretched exponential model (SEM), fractional order calculus (FROC), and continuous-time random-walk (CTRW) model were analyzed. Binary logistic regression was used to determine the optimal parameter combinations. The diagnostic performance of various MRI-derived parameters and their combinations was compared.ResultsAmong the six diffusion models, the SEM model achieved the highest performance in differentiating ccRCC from non-ccRCC (area under the receiver operating characteristic curve [AUC] 0.880) and from BRT (AUC 0.891). IVIM model achieved the highest AUC (0.818) in differentiating non-ccRCC from BRT. Among all the MRI-derived parameters, RBFpeak combined with DKI_MK yielded the highest AUC (0.970) in differentiating ccRCC from non-ccRCC, and the combination of RBFpeak, SEM_DDC, and FROC_μ yielded the highest AUC (0.992) for differentiating ccRCC from BRT.ConclusionASL and all diffusion models showed similar diagnostic performance in differentiating ccRCC from non-ccRCC or BRT, while the IVIM model performed better in distinguishing non-ccRCC from BRT. Combining ASL with diffusion models can provide additional value in predicting ccRCC.Relevance statementConsidering the increasing detection rate of incidental renal masses, accurate discrimination of benign and malignant renal tumors is crucial for decision-making. Combining ASL with diffusion MRI models offers a promising solution to this clinical issue.Key PointsAll assessed models were effective for differentiating ccRCC from non-ccRCC or BRT.ASL and all diffusion models showed similar performance in differentiating ccRCC from non-ccRCC or BRT.Combining ASL with diffusion models significantly improved diagnostic efficacy in predicting ccRCC.IVIM model could better differentiate non-ccRCC from BRT.Graphical

Esophagogastroduodenoscopy Quality Improvement and the Role of Topical Antiperistaltic Agents: A Systematic Review and Meta-Analysis.

Gastric cancer (GC) represents one of the most lethal forms of cancer.When identified at an early stage, conventional treatment can be curative. The key to identifying GC at an early stage ishigh-quality esophagogastroduodenoscopy (EGD). This has led to an increased focus on quality standards in EGD to improve the detection rates of early GC and its premalignant lesions (PMLs), such as atrophic gastritis. In Asia, the routine use of antiperistaltic (antispasmodic) agents is advocated to improve the quality of mucosal visualization during diagnostic EGD. The rationale is that the cessation of peristalsis should yield a more stable intragastric visual field to enhance the detection of early GC. Hyoscine and glucagon are commonly used as antiperistaltic agents. Both, however, must be given either intravenously or via intramuscular injection. They both also have potentially serious systemic side effects, which can limit their routine use, particularly in the elderly or co-morbid patients. As a result of these side effects, there is growing interest in using peppermint oil or L-menthol topically as anti-peristaltic agents. As these agents are applied topically (either via direct spraying during the EGD or consumed as a premedication before the EGD), they are associated with fewer adverse events than systemically applied agents. This study aimed to synthesize, for the first time, the available data on the use of topically applied anti-peristaltic agents to decrease or stop peristalsis during diagnostic EGDs.This study is a systematic review and meta-analysis of published randomized controlled trials. Its reporting is per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. This study was registered prospectively with the PROSPERO register, registration number CRD42024601488. This systematic review and meta-analysis encompassed five high-quality randomized controlled trials with a low risk of bias. All included studies were conducted in Asian countries between 2011 and 2022. They comprised 538 patients, with a mean age of 62.7. Four of the included studies look at topically applied L-menthol at 160 mg, while one study looked at the role of 160 mg of phloroglucinol administered as a 20 mL oral premedication liquid 15 minutes before the EGD. All included trials involved diagnostic EGDs and reported their primary outcomes using the same scoring systems. The primary outcome of interest for this study was the efficacy of the antiperistaltic agents at stopping peristalsis for the duration of a diagnostic EGD. We found an odds ratio of 4.22 with a 95% confidence interval ranging from 2.47 to 7.21, favoring the antiperistaltic agents in terms of attaining a peristalsis score of 1 after administration. This systematic review and meta-analysis represent the most up-to-date review on topical antiperistaltic agents during diagnostic EGD. We found that topical antiperistaltic agents effectively decrease or stop peristalsis during an EGD, and these effects persist for the duration of the EGD. Larger-scale studies willbe required to determine whether their routine usetranslates into increased detection rates of early GC and its PMLs.

Abstract IA004: Early cancer dissemination: Circulating tumor cells in ductal carcinoma in situ patients

Abstract Raised awareness about the importance of early breast cancer diagnostics has led to an increased detection rate of ductal carcinoma in situ (DCIS) through mammographic screening. DCIS, often termed as 'Stage 0' carcinoma, is characterized by neoplastic cells confined within the basement membrane. Despite the significant treatment efforts for most DCIS patients, the 20-year breast cancer mortality rate post-diagnosis, with or without treatment, remains at 3.3%. To deepen the understanding of breast cancer oncogenesis, recent studies have highlighted the clonal diversity within the DCIS tumor microenvironment and the presence of disseminated tumor cells in DCIS patients. Nonetheless, significant gaps persist in identifying diagnostic characteristics that predict which DCIS patients are more likely to experience progression or recurrence. Ultimately, this project aims to enhance DCIS patient stratification through the high-throughput isolation and analysis of circulating biomarkers. In this study, we establish a novel workflow that addresses the limitations of traditional tissue-based diagnostics by transitioning to liquid biopsies. This research not only builds upon emerging evidence of early breast cancer cell dissemination during carcinogenesis but also explores the utility of circulating tumor cells (CTCs) as biomarkers in DCIS. The use of the labyrinth, a high-throughput inertial microfluidic device, has shown success in isolating CTCs based on their larger size relative to white blood cells. Unlike antigen- based isolation methods, inertial microfluidic devices can capture heterogeneous CTCs with varying surface proteins. Leveraging this technology, we successfully isolated and identified CTCs in DCIS patients. Furthermore, single-cell RNA sequencing of the isolated DCIS CTCs allowed us to identify prognostically significant signatures. Overall, our study presents a workflow capable of identifying characteristics associated with a greater risk of progression, thus contributing valuable insights into the stratification and management of DCIS patients. Citation Format: Sunitha Nagrath, Neha Nagpal, Brittany Rupp, Yan Hong, Fariba Behbod, Max Wicha. Early cancer dissemination: Circulating tumor cells in ductal carcinoma in situ patients [abstract]. In: Proceedings of the AACR Special Conference: Liquid Biopsy: From Discovery to Clinical Implementation; 2024 Nov 13-16; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(21_Suppl):Abstract nr IA004.

A Prospective Observational Study on Analyzing Lung Cancer Gene Mutation Variant Allele Frequency (VAF) and Its Correlation with Treatment Efficacy.

A few studies have reported on the variability of the variant allele frequency (VAF) of gene mutations and the relationship between VAF and the therapeutic effect of molecular-targeted drugs. This joint study was conducted from May 2020 to January 2022 between St. Marianna University School of Medicine and the DNA Chip Research Institute. Cytology samples were used to verify the usefulness of a lung cancer compact panel test, which is a high-sensitivity next-generation sequencing (NGS) gene panel test. We analyzed the distribution of VAF and the duration of the initial molecular-targeted drug administration in patients with advanced-stage epidermal growth factor receptor (EGFR) mutations. Of the 196 patients diagnosed with non-small cell carcinoma (NSCLC), gene mutations were detected in 114 (58.2%) cases and in 68.7% of patients with adenocarcinomas (an increased detection rate). A VAF of 30% or more for DNA mutations was confirmed in 35 patients (33.7%), 10% to <30% in 38 (36.5%), and <10% in 31 (29.8%), including 18 patients (17.3%) with <6%, which is considered the lower limit of the LOD for other companion diagnostic kits. EGFR mutations were detected in 59 patients (30%), of whom 35 were in an advanced stage and received molecular-targeted drugs as their initial treatment. Groups A and B comprised patients with a VAF of ≥10% and <10%, respectively, with 27 patients (median VAF 30.6%, range 11.4-77%) in group A and 8 (median VAF 5.4%, range 0.1-8.5%) in group B. The duration of the administration of molecular-targeted drugs was 17 months (range 3-42 months) in group A and 14 months (range 1-45 months) in group B, with no statistically significant difference between the two groups (p-value = 0.7). Twenty-seven percent of patients had a VAF < 10%. Even in patients with a low VAF for gene mutations, sufficient therapeutic effects were observed with molecular-targeted drugs, suggesting the importance of detecting mutations using a highly sensitive method at initial diagnosis. Further prospective validation studies of a larger number of cases are warranted.

Application of small-sized magnetically controlled capsule gastroscopy in upper gastrointestinal diseases screening in asymptomatic individuals.

To explore the application of small-sized magnetically controlled capsule gastroscopy (MCCG) in upper gastrointestinal diseases screening in asymptomatic individuals. A retrospective analysis of the clinical data of 2163 asymptomatic individuals who underwent small-sized MCCG at our center from September 2022 to December 2023. The detection of submucosal tumors, polyps and ulcers in the upper gastrointestinal tract, the tolerance and safety of the subjects were statistically analyzed. Suspected submucosal tumors in the upper gastrointestinal tract were detected in 34 (1.57%) of 2136 subjects, with a higher incidence in females and no observed age difference. Polyps were detected in 328 subjects (15.16%), with a higher incidence in females and an increased detection rate with increasing age. Ulcers were detected in 27 subjects (1.25%), with a higher incidence in males and no observed age difference. There was no significant discomfort in all subjects, and no adverse event or capsule retention occurred. Small-sized MCCG can be used for focal lesion screening in the upper gastrointestinal tract and is comfortable and safe, making it a safe and efficient method for examining upper gastrointestinal diseases in the physical examination population.

Dynamic sequential cross-sectional scanning increases detection rate of congenital heart disease in sonographers: a prenatal ultrasound training program

BackgroundPrenatal ultrasound is the preferred modality for diagnosing fetal congenital heart disease. Given issues of physician proficiency and hospital distribution, we propose a dynamic sequential cross-sectional scanning (SCS) to explore the feasibility of cardiac screening by sonographers with less than 5 years of experience in ultrasound.Materials and methodsTwenty residents were randomly divided into two groups, receiving training in the American Institute of Ultrasound in Medicine (AIUM) fetal echocardiography and the SCS method. According to the needs of training, the professional staff developed the theoretical knowledge question bank, the CHD ultrasonic video disease bank, and the assessment scale. Trainees completed the pre-training examination, theory and skill operation training, and post-training assessment. For the two groups, the theoretical knowledge, skill operation and disease diagnosis were analyzed statistically before and after training.ResultsAfter training, the trainees in both groups had significantly improved knowledge and diagnostic abilities, their diagnostic thinking about CHD was clear, and they could identify major or even all structural abnormalities and make a definite diagnosis. In terms of skill operation, both groups could complete all required scanning within the specified time. The scanning time of the SCS group was significantly lower than that of the AIUM group, and the effect of the receptor site in the AIUM group was significantly higher than that in the SCS group.ConclusionSCS can be used as a new rapid fetal cardiac scanning method and try to popularize among echocardiographer.

Difficult choledocholithiasis. Literature review

The incidence of stones in the common bile duct in patients with symptomatic gallstone disease varies significantly and depends on age, ranging from 5% to 33%. In 85—90% of cases, choledocholithiasis is effectively treated with endoscopic papillotomy (EPT) and lithoextraction, which is currently considered the standard method for managing this pathology. However, in 10—15% of cases, choledocholithiasis is technically challenging for endoscopic treatment, requiring alternative methods and specialized equipment. This research examines the epidemiological aspects related to the increasing detection rate of choledocholithiasis, which is attributed to advancements in modern diagnostic techniques. Particular emphasis is placed on etiological factors such as genetics, obesity, and dietary habits that enhance bile lithogenicity. The pathogenesis section elucidates the mechanisms underlying primary and secondary stone formation in the bile ducts and their physiological impacts, including such complications as acute cholangitis, biliary sepsis, cholestatic hepatitis, and biliary cirrhosis of the liver. Distinct focus is placed on the criteria for difficult choledocholithiasis, encompassing stone characteristics, location, altered biliary anatomy, and the patient’s general condition. Diagnostic techniques include laboratory and instrumental investigations, particularly ultrasound, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, and endoscopic ultrasound. The treatment section emphasizes the importance of timely stone removal to prevent complications. Modern treatment options are discussed, including both conservative and surgical methods such as endoscopic procedures and laparoscopic surgeries. The significance of an interdisciplinary approach to the diagnosis and treatment of choledocholithiasis and its many manifestations is emphasized. Difficult choledocholithiasis remains a relevant issue in hepatobiliary surgery, and its effective treatment requires an individualized and multidisciplinary approach, involving endoscopic and laparoscopic technologies.

Impact of artificial intelligence assistance on pulmonary nodule detection and localization in chest CT: a comparative study among radiologists of varying experience levels

The study aimed to evaluate the impact of AI assistance on pulmonary nodule detection rates among radiology residents and senior radiologists, along with assessing the effectiveness of two different commercialy available AI software systems in improving detection rates and LungRADS classification in chest CT. The study cohort included 198 participants with 221 pulmonary nodules. Residents’ mean detection rate increased significantly from 64 to 77% with AI assist, while seniors’ detection rate remained largely unchanged (85% vs. 86%). Residents showed significant improvement in segmental nodule localization with AI assistance, seniors did not. Software 2 slightly outperformed software 1 in increasing detection rates (67–77% vs. 80–86%), but neither significantly affected LungRADS classification. The study suggests that clinical experience mitigates the need for additional AI software, with the combination of CAD with residents being the most beneficial approach. Both software systems performed similarly, with software 2 showing a slightly higher but non-significant increase in detection rates.

Is There a Role for FAPI PET in Urological Cancers?

This work aims to investigate the utility of positron emission tomography/computed tomography (PET/CT) with fibroblast activation protein inhibitors (FAPI) in urological neoplasms, including prostate cancer, urothelial carcinoma, and renal cell carcinoma. Although the available data are very preliminary, FAPI PET showed potential for detecting primary prostate cancer with low prostate-specific membrane antigen expression, while prostate-specific membrane antigen PET/CT outperformed FAPI PET/CT in detecting biochemical recurrence. In urothelial carcinoma, FAPI PET/CT demonstrated increased detection rates compared with deoxy-2-[18F]fluoro-D-glucose PET/CT, in particular in small lymph node metastases, whose identification is still an unmet clinical need. Limited data are available for renal cell carcinoma. In conclusion, FAPI PET emerges as a promising imaging modality for urological neoplasms, in particular bladder cancer. Further research is warranted to establish its role in guiding therapeutic decisions and as a potential novel theranostic agent.

Effectiveness of internal controls mechanisms in preventing and detecting fraud

This review examines the effectiveness of internal control mechanisms in preventing and detecting fraud within organizations. Internal control mechanisms are essential components of corporate governance, designed to safeguard assets, ensure the accuracy of financial records, and promote operational efficiency. The study begins by defining internal controls and their critical role in fraud prevention and detection, highlighting the significance of a robust control environment. The components of the internal control environment, risk assessment, control activities, information and communication, and monitoring activities are discussed to provide a comprehensive understanding of their structure and function. Preventive controls, such as segregation of duties, authorization processes, and access controls, are analyzed to assess their role in minimizing the risk of fraud occurrence. Case studies and examples of organizations with effective preventive measures are presented to illustrate best practices. The challenges and limitations faced by organizations in implementing preventive controls are also explored. Detective controls, including reconciliation processes, internal audits, and whistleblower hotlines, are evaluated for their ability to identify and expose fraudulent activities. The review reviews case studies demonstrating the success of detective controls in uncovering fraud and discusses the obstacles organizations encounter in maintaining effective detection mechanisms. The evaluation section of the study focuses on metrics and indicators used to assess the effectiveness of internal controls, such as the reduction in fraud incidents and increased detection rates. Tools and techniques for evaluation, including internal and external audits, are examined to understand their role in ensuring control effectiveness. The review concludes by offering best practices for enhancing internal control mechanisms, emphasizing continuous monitoring, employee training, and the adoption of advanced technologies. The critical role of management in fostering a culture of ethical behavior and supporting internal audit functions is underscored. Recommendations for organizations and directions for future research are provided to guide ongoing efforts in fraud prevention and detection. Keywords: Fraud Prevention, Internal Control, Detective Control.

Enormous ectopic liver tissue at the gastrohepatic ligament: a rare entity at Muhimbili National Hospital, Tanzania

BackgroundEctopic liver tissue (ELT) is a developmental abnormality in which liver tissue develops at an extrahepatic site without connection to the true liver. It is a rare entity with an incidence of 0.24–0.56% according to data described in laparoscopic or autopsy studies. The detailed mechanism behind the development of ELT is poorly understood. ELT predominantly has an asymptomatic nature, even by means of radiological studies the diagnosis of ELT without surgery or autopsy is difficult. ELT has been reported mostly to be found frequently on the gallbladder and rarely on the gastrohepatic ligament. ELT has increased the potential risk of HCC which makes the resection crucial. Due to its variations anatomically, ELT recognition should gain clinical importance and surgeons need to be aware of these possible disparities.Case presentation.We present a 59-year-old female from Western Tanzania was presented to us with 2-month history of painless upper abdominal swelling. An abdominal CT scan was performed, and it revealed a large mass located at the gastrohepatic region with blood supply mainly from the left hepatic artery and omentum. Technically difficult excision of 17 × 12 cm tumor at gastrohepatic ligament was performed, with uneventful recovery. Post-operative histology results revealed capsulated hepatic parenchyma without the biliary components and limited sinusoids with tissue degeneration. To date, no complications happened during follow-up for one year.ConclusionELT is a rare entity with a predominantly asymptomatic nature. Preoperatively diagnosis is difficult even with images. It has anatomical variation and is hardly found along the gastrohepatic ligament. ELT has increased the potential risk of HCC which makes the resection crucial. Increased awareness of this congenital anomaly may result in increased detection rates.

Survival Patterns Based on First-site–specific Visceral Metastatic Prostate Cancer: Are Outcomes of Visceral Metastases the Same?

Background and objectiveVisceral metastatic disease in prostate cancer patients conveys a poor prognosis. Using advanced imaging techniques, studies have demonstrated increasing detection rates of visceral metastasis. Visceral metastases are now seen in up to 30–60% of prostate cancer patients. Survival patterns of site-specific visceral metastasis are described poorly in the literature. Here, we sought to investigate survival patterns in prostate cancer patients according to their first detected site of visceral metastasis. MethodsRetrospectively, we identified 203 prostate cancer patients with visceral metastases from the Mayo Clinic Advanced Prostate Cancer Registry. Patients were divided into three groups according to the first site of visceral metastases detected: lung, brain, or liver. Visceral metastases were detected primarily on either metabolic imaging (C-11 choline) or prostate-specific membrane antigen positron emission tomography computed tomography (CT) scan. Confirmation of visceral metastasis diagnosis was established with either biopsy when feasible or focused conventional imaging, including focused CT or magnetic resonance imaging. Overall survival and cancer-specific survival were estimated using the Kaplan-Meier method. Univariate and multivariate Cox regression model was conducted to assess different variables that affect overall and cancer-specific survival. Key findings and limitationsOver a median (interquartile range) follow-up duration of 16.2 (3.9–49.8) mo, the overall and cancer-specific survival of the entire cohort suggests better survival patterns in patients with first-site lung metastases than in patients with first-site brain or liver metastases (p < 0.0001). In univariate and multivariate analyses of factors impacting patients’ overall and cancer-specific survival, a high prostate-specific antigen level at diagnosis of visceral metastasis, concomitant bone and lymph node disease, and more than four visceral metastases were associated with poor overall and cancer-specific survival (p < 0.05). On the contrary, first-site lung metastasis was associated with improved overall and cancer-specific survival, compared with first-site liver and brain metastases (p < 0.001). Conclusions and clinical implicationsThese data suggest that prostate cancer patients with visceral metastatic disease have varying survival patterns according to first-site detected visceral metastasis. In our cohort, patients with first-site lung metastasis demonstrated better survival outcomes than patients with first-site brain or liver metastasis. Patient summaryOur study explored the survival outcomes among patients with visceral metastatic prostate cancer employing cutting-edge imaging methods. Prostate cancer patients with metastases to different organs have different survival rates. Patients with cancer spreading to the lungs first showed better survival than those with cancer spreading to the brain or liver first.

The Impact of an Educational 3D Virtual Reality Video Method on Bowel Preparation for Colonoscopy: First Results

Objective. Adequate bowel preparation is essential for diagnostic, screening, surveillance, and therapeutic colonoscopy. 3D virtual reality (3D-VR) has the characteristics of depth, interactivity and visuality and is widely used in medicine, so it can be used for patient education and training. The aim of our study is to determine the impact of using 3D virtual reality video for patients education on bowel preparation before colonoscopy. Materials and methods. A prospective, blind, randomized clinical trial was launched at the Republican Vilnius University Hospital (RVUL) on 07.03.2021, which included 50 outpatients who had indications for colonoscopy until 28.02.2022. Patients were randomly assigned to control and experimental groups. The first group was given the bowel preparation information in the standard form used by RVUL – in writing, and the second – in a 3D virtual reality video. The content of the information provided to both groups was the same. The quality of bowel preparation was assessed based on the Boston and Ottawa bowel preparation scales. Results. Of the 50 outpatients who participated in the study, 26 were assigned to the control group, 24 to the study group. The patients of both groups were identical in terms of sex, age, body mass index, comorbidities. The mean (SD) BBPS score was statistically significantly lower in the control group compared to the 3D-VR video group (5.96(±1) vs. 7.58(±1.47); p &lt; 0.001). The mean (SD) scores of OBPS were higher in the control group (6.58(±2.44) than in the study group 1.83(±2.32); p &lt; 0.001). The rate of adequate bowel preparation in the 3D-VR video group was higher than in the control group (18(69.23%) vs. 23(95.83%); the difference was statistically significant (p = 0.024)). The rate of terminal ileum intubation in the control group was 50% compared to 83.33% in the 3D-VR video group (p = 0.02).The mean (SD) colonoscopy time was statistically significantly shorter in the 3D-VR video group 23.04(±3.66) minutes and 16.5(±4.28) minutes, p = &lt;0.001. Conclusions. Patients who were informed by 3D-VR method before colonoscopy had statistically significantly better bowel preparation, as well as reduced procedure time and possibly increased detection rates of polyps and adenomas.

Increased NGS testing and real-world clinical usage of targeted therapy: All dressed up, nowhere to go.

e13758 Background: National and International recommendations mandate panel- based biomarker testing for all advanced cases of NSCLC. However, analogous to uptake of many other state of the art cancer management strategies, the uptake of NGS based testing and subsequent targeted therapy varies greatly across socio-demographic groups, explained by awareness and economic restraints. This study investigates the potential differences in uptake of NGS based testing and precision medicine in advanced NSCLC patients from India. Methods: This is a single center non-interventional study where retrospective review of patient data of biomarker driven advanced NSCLC patients was carried out. The records were recovered from electronic health records of the hospital. Single gene testing for EGFR and ALK are performed using Roche Cobas V2 and D5F3 Ventana systems respectively. A machine learning algorithm: Classification and Regression Tree (CART) was employed. Results: A total of 5894 patients of advanced NSCLC were identified. Of these 33% received NGS based biomarker testing at diagnosis. The proportion of patients who received NGS tests increased over calendar time from 2014-2023, with an average increment of 15.8% every year, and peak increase in 2022 of 51%. NGS based testing yielded a positive result in 80% cases with a median turnaround time of 18.2+/-3 days. NGS detected 10.2% cases more in EGFR, 3.2% cases less in ALK, 3.1% more in ROS1. Overall NGS was able to detect 37.8% extra cases of biomarker driven cases. Among the biomarker driven, uptake of targeted therapy was 65% for MET, 83% for ROS1, 52% for RET, 17.6% for ERBB2, 63% for BRAF V600E, 75% for EGFR and 79% for ALK at any given point in the disease. None of the G12C KRAS received selective treatment owing to drug unavailability in the country. Applying the CART model, targeted therapy was received by patients younger than 68 years of age, male gender, with ECOG status 0-2, and absence of brain metastases at diagnosis. Patients with brain metastases at diagnosis, females and those &gt;69 years of age were less likely to opt for TKI(p&lt;0.02*). Conclusions: This is the largest cohort from India reporting real world uptake of NGS based biomarker testing and targeted therapy. There is a clear disparity in terms of gender and age group, possibly attributable to social stigmata and taboos prevailing in rural parts of the country. Despite increased detection rates, access to targeted therapy is still a concern owing to inaccessibility to drugs/ lack of global clinical trials in India as well as lack of patient support programs/groups.

Comparison of post-operative transesophageal and transthoracic echocardiogram findings following atrioventricular septal defect repair.

Success of atrioventricular septal defect repair is defined by post-operative atrioventricular valve function and presence of residual intracardiac shunting. We evaluated differences in interpretation of atrioventricular valve function and residual defects between transesophageal and transthoracic echocardiography in a contemporary cohort of infants undergoing atrioventricular septal defect repair. Among 106 patients, we identified an increase in left and right atrioventricular valve regurgitation, right atrioventricular valve inflow gradient, and increased detection rate of residual intracardiac shunting on transthoracic compared to transesophageal echocardiograms, although residual shunts identified only on transthoracic echocardiogram were not haemodynamically significant. Findings may help inform expectation of post-operative transthoracic echocardiogram findings based on intraoperative assessment.

Abstract PS06-02: Circulating tumor DNA (ctDNA) monitoring of estrogen receptor-positive, human epidermal growth factor receptor 2-negative (ER+/HER2-) high risk breast cancer during adjuvant endocrine therapy

Abstract Background: ctDNA monitoring during adjuvant endocrine therapy provides an opportunity to detect molecular relapse before clinically apparent recurrence. The rate and dynamics of ctDNA positivity and the frequency of asymptomatic but imaging detectable metastatic disease at the time of ctDNA detection remain unknown in high-risk ER+/HER2- breast cancers. We present results of ctDNA positivity rates in 508 and imaging results in ctDNA+ patients from a prospective, multicenter, randomized ctDNA surveillance and intervention trial, DARE (NCT04567420). Patients and methods: Patients receiving adjuvant endocrine therapy for &amp;gt; 6 months but &amp;lt; 7 years, with either (i) risk of recurrence &amp;gt; 15% calculated by PREDICT, RSPC, or CTS5, or (ii) &amp;gt; 4 positive axillary lymph nodes, or (iii) primary tumor &amp;gt; 5 cm, or (iv) 1-3 positive nodes with grade 3 histology, or &amp;gt; 3 cm tumor, or Oncotype Dx RS &amp;gt; 26, MammaPrint high risk, EndoPredict &amp;gt; 4, Prosigna score &amp;gt; 60 were eligible for ctDNA surveillance with the SignateraTM assay (Natera Inc.) every 4-6 months during routine follow up visits. ctDNA+ patients underwent systemic staging with imaging and randomized to continuation of adjuvant therapy versus switching to fulvestrant plus palbociclib if there was no evidence of distant metastatic disease. The primary objectives are to assess the incidence of ctDNA positivity in the surveillance phase and to assess if palbociclib plus fulvestrant improves relapse-free survival in 100 randomized patients. This is an updated, protocol-driven interim report to determine if screening eligibility criteria needs to be revised to keep randomization rate &amp;gt; 15% of the screened population. Results: The trial is open at 15 sites and enrolled 508 patients between May 2021 and June 2023; 882 plasma ctDNA tests were performed successfully in 364 patients (72%). The most common reason for failure to generate a personalized ctDNA assay was insufficient tissue submitted, 78% of failed tests were due to preanalytical failure, the technical failure rate was 22%. Thirty patients, 8.2% of those with results available, had &amp;gt;1 positive ctDNA result, the overall positivity rate across all assays was 3.4% (n=30/882). Patient characteristics are shown in the table (not all patients have complete data), 47% of ctDNA+ cases had &amp;gt;4 + lymph nodes. ctDNA positivity rate in the first test was 3.8%, and anytime ctDNA detection rate among those with serial testing was 7.2%. Among ctDNA+ patients, the first ctDNA draw was positive in 23 of 30 cases (77%) with 36.5 months median time (range 6-102 months) from surgery to testing. Using 12 months interval brackets from surgery to 1st ctDNA positivity, annual detection rates were 2,3% (1/44), 8.5% (7/82), 10.8% (9/83), 7.5% (4/53), 13,2% (5/38), and 6.2% (4/64), at 1st, 2nd, 3rd, 4th and &amp;gt; 5th year post-surgery, respectively, due to small sample sizes, 95% confidence broadly overlap. Five ctDNA+ patients (16.7%) had asymptomatic, imaging-detectable metastatic disease, 22 ctDNA+ patients were randomized, the goal is to accrue a total of 100 patients. Conclusions: ctDNA surveillance of ER+/HER2- breast cancers during adjuvant endocrine therapy indicate 8.3% detection rate at patient level and 3.4% at assay level. Serial screening increases detection rates as 23% of positive ctDNA tests occurred after an initial negative result. 83% of ctDNA+ patients had true molecular relapse without imaging detectable metastatic disease. Eligibility for screening on the trial is now restricted to patients with &amp;gt;4 + lymph nodes, randomization is open for any patients who are ctDNA+ including routine commercial screening. Table of patient characteristics with ctDNA result (n=364) ctDNA+ (n=30) Age &amp;lt; 50 29% 23% Age &amp;gt;50 71% 77% PR + 78% 73% PR - 7% 17% HER2 IHC negative 79% 77% Grade 1 8% 7% Grade 2 53% 50% Grade 3 29% 37% T 1 19% 17% T2 43% 43% T3 27% 27% T4 2% 7% 0 +nodes 12% 12% 1 +node 24% 10% 2 +nodes 15% 13% 3 +nodes 8% 13% &amp;gt;4 +nodes 0 47% Citation Format: Lajos Pusztai, Ekaterina Kalashnikova, Evthokia Hobbs, Ursa Brown-Glaberman, Monica Mita, Paula Klein, Fengting Yan, Sima Ehsani, Wajeeha Razaq, Alison Stopeck, Manali Bhave, Michelle Loch, Sagar Sardesai, Evanthia Roussos Torres, Mark Burkard, Femi Okubanjo, Eric Gauthier, Angel Rodriguez, Minetta Liu, Peter Kabos. Circulating tumor DNA (ctDNA) monitoring of estrogen receptor-positive, human epidermal growth factor receptor 2-negative (ER+/HER2-) high risk breast cancer during adjuvant endocrine therapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS06-02.

Implementation of a primary-tertiary shared care model to improve the detection of familial hypercholesterolaemia (FH): a mixed methods pre-post implementation study protocol

IntroductionFamilial hypercholesterolaemia (FH) is an autosomal dominant inherited disorder of lipid metabolism and a preventable cause of premature cardiovascular disease. Current detection rates for this highly treatable condition are low....

Web-based Deep Learning System for Malaria Parasite Detection in Granular Blood Samples

Abstract: Malaria is a serious health concern for modern humans, affecting people of all ages. Infected mosquitoes carry the fatal parasites responsible for malaria. Malaria can be diagnosed by examining a sample of the patient's blood under a microscope for parasites. The project comprises creating a web tool that employs deep learning to detect malaria parasites in blood smear photos. Convolutional neural network (CNN) models such as ResNet50, VGG19, and Customized CNN can be used to collect and categorize a set of blood smear images in order to identify patterns and characteristics. Convolutional layers, maxpooling layers, entirely linked layers, and a SoftMax layer are all utilized to create a Convolutional Neural Network (CNN) model. This technique can improve the accuracy of parasite diagnosis, increase detection rates, and reduce the disease's impact on global health.

Added Value of [18F]PSMA-1007 PET/CT and PET/MRI in Patients With Biochemically Recurrent Prostate Cancer: Impact on Detection Rates and Clinical Management.

Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) can change management in a large fraction of patients with biochemically recurrent prostate cancer (BCR). To investigate the added value of PET to MRI and CT for this patient group, and to explore whether the choice of the PET paired modality (PET/MRI vs. PET/CT) impacts detection rates and clinical management. Retrospective. 41 patients with BCR (median age [range]: 68 [55-78]). 3T, including T1-weighted gradient echo (GRE), T2-weighted turbo spin echo (TSE) and dynamic contrast-enhanced GRE sequences, diffusion-weighted echo-planar imaging, and a T1-weighted TSE spine sequence. In addition to MRI, [18F]PSMA-1007 PET and low-dose CT were acquired on the same day. Images were reported using a five-point Likert scale by two teams each consisting of a radiologist and a nuclear medicine physician. The radiologist performed a reading using CT and MRI data and a joint reading between radiologist and nuclear medicine physician was performed using MRI, CT, and PET from either PET/MRI or PET/CT. Findings were presented to an oncologist to create intended treatment plans. Intrareader and interreader agreement analysis was performed. McNemar test, Cohen's κ, and intraclass correlation coefficients. A P-value <0.05 was considered significant. 7 patients had positive findings on MRI and CT, 22 patients on joint reading with PET/CT, and 18 patients joint reading with PET/MRI. For overall positivity, interreader agreement was poor for MR and CT (κ = 0.36) and almost perfect with addition of PET (PET/CT κ = 0.85, PET/MRI κ = 0.85). The addition of PET from PET/CT and PET/MRI changed intended treatment in 20 and 18 patients, respectively. Between joint readings, intended treatment was different for eight patients. The addition of [18F]PSMA-1007 PET/MRI or PET/CT to MRI and CT may increase detection rates, could reduce interreader variability, and may change intended treatment in half of patients with BCR. 3 TECHNICAL EFFICACY: Stage 3.

Integrating satellite-based forest disturbance alerts improves detection timeliness and confidence

Satellite-based near-real-time forest disturbance alerting systems have been widely used to support law enforcement actions against illegal and unsustainable human activities in tropical forests. The availability of multiple optical and radar-based forest disturbance alerts, each with varying detection capabilities depending mainly on the satellite sensor used, poses a challenge for users in selecting the most suitable system for their monitoring needs and workflow. Integrating multiple alerts holds the potential to address the limitations of individual systems. We integrated radar-based RAdar for Detecting Deforestation (RADD) (Sentinel-1), and optical-based Global Land Analysis and Discovery Sentinel-2 (GLAD-S2) and GLAD-Landsat alerts using two confidence rulesets at ten 1° sites across the Amazon Basin. Alert integration resulted in faster detection of new disturbances by days to months, and also shortened the delay to increased confidence. An increased detection rate to an average of 97% when combining alerts highlights the complementary capabilities of the optical and cloud-penetrating radar sensors in detecting largely varying drivers and environmental conditions, such as fires, selective logging, and cloudy circumstances. The most improvement was observed when integrating RADD and GLAD-S2, capitalizing on the high temporal observation density and spatially detailed 10 m Sentinel-1 and 2 data. We introduced the highest confidence class as an addition to the low and high confidence classes of the individual systems, and showed that this displayed no false detection. Considering spatial neighborhood during alert integration enhanced the overall labeled alert confidence level, as nearby alerts mutually reinforced their confidence, but it also led to an increased rate of false detections. We discuss implications of this study for the integration of multiple alert systems. We demonstrate that alert integration is an important data preparation step to make use of multiple alerts more user-friendly, providing stakeholders with reliable and consistent information on new forest disturbances in a timely manner. Google Earth Engine code to integrate various alert datesets is made openly available.