Preferred Screening Test Research Articles

Abstract 4787: Preference for multi-target stool DNA for colorectal cancer screening among Alaska Native people in rural/remote communities

Abstract Background: The Alaska Tribal Health System is working on increasing colorectal cancer (CRC) screening rates among Alaska Native people, who have the highest CRC rates in the world. Most remote Alaska Native communities are not connected to the road system, which severely limits access to screening colonoscopy. As part of a clinical trial, Alaska Native patients were offered either colonoscopy or the at-home multi-target stool DNA test (mt-sDNA; Cologuard®). Patients had never been offered mt-sDNA before and it was unknown what they would think about the new test option. Both tests were provided at no cost to patients. Methods: From April 2022 to July 2023, 194 patients who chose mt-sDNA for screening received a follow-up phone survey asking whether they were aware that they could have had colonoscopy instead, their reasons for choosing mt-sDNA, and the factors influencing their choice of mt-sDNA over colonoscopy. Patients answered the survey before receiving results of their mt-sDNA test in order to capture initial screening test preferences. Results: A total of 115 (59%) Alaska Native patients participated in the survey; 56% men and 44% women. About 70% were ages 45 to 60 years while the remaining 30% were 61 to 75 years old. The majority (80%) were aware that they had the option to undergo colonoscopy for CRC screening instead of mt-sDNA. Key themes for mt-sDNA preference included not having to travel, less time commitment, and greater convenience. Many patients expressed financial concerns arising from the costs of air travel and accommodation required to access screening colonoscopy even though the procedure itself was covered. Additionally, patients highlighted existing obligations such as childcare and work responsibilities which made the use of mt-sDNA at home more appealing. Many respondents also shared negative perceptions of colonoscopy procedure including fear, embarrassment, and discomfort as reasons why they preferred mt-sDNA instead. Conclusions: These findings demonstrate the multifaceted factors influencing the preference for at-home mt-sDNA CRC screening among Alaska Native individuals. Challenges such as limited access to medical facilities, financial burdens, and personal commitments have significant bearing on the screening decision-making process. Moreover, the emotional aspect of fear and discomfort associated with colonoscopy plays a role in shaping these preferences. CRC screening programs need to be aware of patient needs and preferences when deciding which screening methods to offer to increase screening rates and result in improved colorectal health outcomes. Citation Format: Diana Redwood. Preference for multi-target stool DNA for colorectal cancer screening among Alaska Native people in rural/remote communities [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4787.

A107 ANALYSIS OF THE EFFICACY IN TRANSITIONING FROM FOBT TO FIT FOR COLORECTAL CANCER SCREENING AT A SINGLE CENTRE IN ONTARIO

Abstract Background Colonoscopy is the gold standard for detecting colorectal cancer (CRC) and advanced lesions, but is an invasive and carries some risks, with limited availability and accessibility. Alternatively, the fecal occult blood test (FOBT) and fecal immunochemical test (FIT) are both non-invasive, cost-effective screening tests that can also be used to detect CRC, advanced lesions, and polyps, identifying individuals to be prioritized to undergo colonoscopy. FOBT screens for small amounts of blood in stool by detecting heme through a chemical reaction. FIT confirms the presence of blood in stool by using antibodies to detect hemoglobin. Prior to 2019, Ontario employed FOBT as the preferred method for CRC screening in eligible individuals. In early 2019, Ontario transitioned to FIT as the preferred screening test, due its established superior test performance for identifying patients with high risk lesions for colon cancer. Aims This single-centre retrospective study analyzed the change in efficacy of detecting advanced lesions, when transitioning from FOBT to FIT, as identified on subsequent colonoscopy Methods A retrospective chart review was conducted of approximately 1000 patients undergoing colonoscopy for FOBT or FIT at Cambridge Memorial Hospital, covering the period of transition from FOBT to FIT. Colonoscopies were performed by 10 endoscopists. Patients were stratified into 2 groups based on fecal test type, FOBT (N = 344) and FIT (N = 572). Overall and individual proportions of cancer, polyps, adenomas, advanced adenomas (AA), and sessile serrated adenomas (SSA) detection in the subsequent colonoscopies were calculated for both groups. The efficacy of both tests was then assessed using statistical analysis. Results In total, 344 patients were included for FOBT analysis and results included: cancer (5.52%), any polyp (56.69%), adenoma (43.6%), AA (20.64), and SSA (6.1%). In contrast, 572 patients were included for analysis of FIT group and results included: cancer (3.85%), any polyp (83.22%), adenoma (76.92%), AA (43.01), and SSA (12.94%). Cancer detection was similar in the 2 groups. There was significant improvement in polyp, adenoma, advanced adenoma, and sessile serrated adenoma detection with FIT compared to FOBT. This improvement was consistent in all endoscopists, but more pronounced in endoscopists with lower detection rates in FOBT cases. Conclusions The use of FIT as a screening stool test, as compared to FOBT, was associated with a significantly improved detection for polyps, adenomas, AA, and SSA, confirming greater accuracy and sensitivity of FIT as a screening tool. This result confirms the premise, at least at a single institution, that by switching to FIT, Ontario has improved colon cancer screening and prevention with more efficient and higher yield utilization of a limited and costly health care resource Funding Agencies None

Diagnostic cut-off values for the urinary corticoid:creatinine ratio for the diagnosis of canine Cushing's syndrome using an automated chemiluminescent assay.

Cushing's syndrome is one of the most common endocrinopathies in dogs. The preferred screening test for spontaneous Cushing's syndrome is the low-dose dexamethasone suppression test (LDDST). The diagnostic value of urinary cortisol:creatinine ratios (UCCR) is questionable. The aim of this study was to determine diagnostic cut-off values for UCCR testing in comparison with LDDST as a clinical reference standard and to calculate the sensitivity and specificity. Data from 2018 to 2020 were obtained retrospectively from a commercial laboratory. Both LDDST and UCCR were measured by automated chemiluminescent immunoassay (CLIA). The maximum interval between both tests was 14 days. The optimal cut-off value for UCCR testing was calculated by the Youden index. The sensitivity and specificity of these cut-off values for the UCCR test and LDDST were assessed by Bayesian latent class models (BLCMs). This study included 324 dogs with both UCCR test and LDDST results. The optimal UCCR cut-off value, calculated by the Youden index, was 47.4 × 10-6 . Any UCCR <40 × 10-6 was interpreted as a negative result, 40-60 × 10-6 as values in a gray zone, and >60 × 10-6 as positive. Using the cut-off of 60 × 10-6 , BLCM showed 91% (LDDST) and 86% (UCCR test) sensitivity and a specificity of 54% (LDDST) and 63% (UCCR test). Considering an 86% sensitivity and a 63% specificity, UCCR testing may be considered a first-line investigation to rule out Cushing's syndrome using CLIA analysis. Urine samples can be collected noninvasively at home by the owner, reducing the potential impact of stress.

Gebelerin oral glukoz tarama testi tercihleri ile sağlık okuryazarlığı ve perinatal anksiyete düzeyleri arasındaki ilişki

Aim: This research aimed to determine the relationship between pregnant women's oral glucose screening test preferences and their health literacy and perinatal anxiety levels.Material and Method: The study is descriptive and cross-sectional. The sample of the study consisted of 120 pregnant women who applied to a university hospital between June and July 2022, were accepted to participate in the study, had no Turkish speaking problems, no pregestational diabetes diagnosis, no vision and hearing problems, no mental health problems, and were literate. The data were collected using face-to-face interviews with pregnant women including a questionnaire asking about the introductory characteristics of pregnant women, Turkish Health Literacy Scale-32 (TSOY-32), and Perinatal Anxiety Screening Scale (PASS). The obtained data were analyzed using one-way analysis of variance, correlation analysis, and chi-square tests.Results: 52.5% of pregnant women believed that they do not need to have an OGT. While the effect of health personnel in this decisions is 66.1%, the effect of the closed environment is 22.9%. A statistically significant negative correlation at p&amp;lt;.05 level was found between the Turkish health literacy scale and the Perinatal anxiety screening scale scores. Participants' believes on the necessity of OGTT test has no effect on their TSOY-32 scores or PASS scores. There is no association between the preference of women and the sub-dimensions of TSOY-32 and the PASS.Conclusion: The health literacy and perinatal anxiety levels of the pregnant women in the sample group did not affect their OGTT preferences. They stated that healthcare professionals were primarily influential in their decisions on OGTT preferences.

Psychosocial, behavioral, and communication factors associated with completion of the mt-sDNA test for colorectal cancer screening.

60 Background: Colorectal cancer (CRC) screening has been shown to reduce CRC incidence and mortality. Several CRC screening modalities are guideline recommended for average-risk adults aged 45-75 years. CRC screening is underutilized in the US and access to facility-based options, such as colonoscopy, represents a potential barrier. Home-based stool tests are guideline-endorsed and offer a convenient, accessible, scalable option for CRC screening. Thus, understanding the factors that influence completion of stool-based CRC screening is important to guide interventions to improve adherence. We developed a survey, informed by behavioral theory, to identify psychosocial, behavioral and communication factors associated with completion of mt-sDNA screening. Methods: The survey instrument was finalized through expert review, quality testing, and cognitive testing. Adults aged 45-75 years, with a US postal address, who received a valid order for mt-sDNA and whose kit was shipped between 5/21-9/21 were eligible for sampling. RTI administered the survey between 3/22-6/22. Participants had the option to complete electronic or paper surveys. We fit a multivariable logistic regression to identify factors significantly associated with mt-sDNA test completion. Results: Of 17,370 individuals invited to participate, 2,973 completed the survey (AAPOR RR3 = 21.7%); 77.3% of the sample completed the mt-sDNA test. Responders and non-responders did not differ significantly by sex or age. Controlling for demographic characteristics and insurance status, the odds of mt-sDNA test completion were significantly higher among participants who reported greater perceived test effectiveness (OR = 1.20), greater ease (OR = 4.06), and greater comfort in test use (OR = 1.18). Odds of test completion were significantly higher among participants who reported their healthcare provider discussed the mt-sDNA test with them (OR = 2.01) and involved them a great deal in decision making about CRC screening (OR = 1.29). Participants who expressed greater worry about developing CRC were less likely to return their mt-sDNA kit (OR = 0.81). Conclusions: To improve population adherence to CRC screening recommendations, efforts are needed to ensure patients understand the attributes and effectiveness of available test options and feel adequately prepared to complete their preferred screening test. Additionally, healthcare providers must be appropriately prepared and resourced to educate and to engage patients in shared decision-making about CRC screening.

Cytology compared with Hybrid Capture 2 human papilloma virus cervical cancer screening in HIV positive and HIV negative South African women

ObjectivesCervical cancer is preventable and caused by persistent infection with oncogenic human papilloma virus (HPV) types. HPV screening is more sensitive and is the preferred screening test. HPV screening data...

S290 Is Fecal Immunochemical Test (FIT) the Answer to Increasing Colorectal Cancer Screening (CRC) Uptake in the Filipino Community? Results From a Conjoint Analysis Survey

Introduction: Asian Americans are the fastest growing major racial/ethnic group in the US, with Filipinos comprising the 3rd largest group. While >80% of Filipinos are proficient in English, and have insurance rates, education levels, and incomes that exceed the general US population, they have lower CRC screening rates and worse CRC outcomes vs. non-Hispanic Whites. To begin to address this disparity, we used conjoint analysis to understand Filipinos’ preferences for the different CRC screening test options. Methods: To quantify Filipinos’ preferences for CRC screening tests, we conducted a choice-based conjoint analysis survey for individuals ≥40yo at average risk for CRC who had not undergone prior screening. From 4/29-11/7/21, we recruited Filipinos at an academic medical center and through a national survey research firm (Cint). Using the conjoint data, we performed simulations to determine each individual’s preferred screening test; for this analysis, we focused on the proportion of people who preferred annual FIT or colonoscopy every 10 years as both are tier 1 tests according to the US Multi-Society Task Force (MSTF) on CRC. We then performed logistic regression to explore whether demographics predicted decision making on FIT vs colonoscopy; variables with p< .20 from bivariate analyses were included as covariates in the regression model. Results: Overall, 105 participants completed the survey; most respondents were female (74.3%) and aged 40-49y (84.8%). Moreover, 64.8% of participants stated they planned to get screened for CRC and they reported high self-perceived benefits of CRC screening (median 4.4, IQR 3.8-4.8; 1-5 scale, higher=more beneficial). When performing simulations using the conjoint data for the US MSTF tier 1 tests, we found that 66.7% of respondents preferred an annual FIT while 33.3% preferred a colonoscopy every 10 years (Figure). In a regression analysis that accounted for sex, marital status, household income, employment status, and geographic region, no variables were significantly associated with individual's preference for FIT over colonoscopy (Table). Conclusion: We found that 2 in 3 Filipinos prefer annual FIT over colonoscopy for their CRC screening and that demographics poorly predict individual decision making. To improve CRC screening uptake in the Filipino community, our data suggest that community-based interventions should either focus primarily on FIT or employ a choice-based approach (ie, FIT or colonoscopy).Figure 1.: Data from simulations using conjoint analysis data assessing the proportion of respondents who would prefer each MSTF tier 1-recommended test (N=105) Table 1. - Regression analysis on preferring FIT every year over colonoscopy every 10 years for CRC screening; screening test preferences were determined through simulations from conjoint analysis-derived data (N=105) Variable Prefers FIT every year for CRC screening n (% of row) aOR [95% CI] Sex: Male 21 (77.8%) Reference Female 49 (62.8%) 0.61 (0.20, 1.86) Marital status: Married or living with a partner 53 (62.4%) Reference Not married 17 (85.0%) 2.65 (0.61, 11.44) Total household income: ≤$100,000 34 (79.1%) reference >$100,000 31 (62.0%) 0.72 (0.24, 2.20) Prefer not to say 5 (41.7%) 0.23 (0.05, 1.12) Employment status: Unemployed, on disability, on leave of absence from work, retired, or a homemaker 19 (82.6%) reference Employed or student 51 (62.2%) 0.36 (0.10, 1.31) US region: Northeast/South/ Midwest 15 (83.3%) reference West 55 (63.2%) 0.70 (0.15, 3.21) Has non-first degree relative or friend diagnosed with CRC 11 (44.0%) 0.42 (0.15, 1.16)

Patient Preferences for Colorectal Cancer Screening Tests in Light of Lowering the Screening Age to 45 Years

In 2021, the US Preventive Services Task Force lowered the colorectal cancer (CRC) screening age to 45 years. We used conjoint analysis, a method that assesses complex decision making, to update our understanding on people's CRC screening test preferences in the context of new guidelines. We conducted a conjoint analysis survey among unscreened individuals ≥40 years at average risk for CRC to determine the relative importance of screening test attributes in their decision making (eg, modality, effectiveness at reducing CRC risk, bowel prep). We also performed simulations to estimate the proportion of people who would prefer each US Multi-Society Task Force (MSTF) on CRC-recommended test. The analyses were stratified among those aged 40-49 years (newly or soon-to-be eligible for screening) and ≥50 years (have been eligible). Overall, 1000 participants completed the conjoint analysis (40-49 years, n= 456; ≥50 years, n= 544). When considering all 5 US MSTF-recommended tests, there were differences in test preferences between age groups (P= .019), and the most preferred test was a fecal immunochemical test (FIT)-fecal DNA every 3 years: 40-49 years, 34.6%; ≥50 years, 37.3%. When considering only the US MSTF tier 1 tests, most 40- to 49- (68.9%) and ≥50-year-olds (77.4%; P= .004) preferred an annual FIT over a colonoscopy every 10 years. Our findings suggest that more than one-third of people may want to do a FIT-fecal DNA every 3 years for their CRC screening. When only considering US MSTF tier 1 tests, three-fourths of people may prefer an annual FIT over colonoscopy. Further research examining CRC screening test preferences among broader populations is warranted to inform and enhance screening programs.

THE BETHESDA SYSTEM FOR REPORTING THYROID CYTOPATHOLOGY WITH HISTOPATHOLOGIC CORRELATION: A RETROSPECTIVE STUDY AT A TERTIARY CARE HOSPITAL OF LOWER ASSAM

Background: Fine needle aspiration is currently the preferred screening test for guiding the diagnosis and treatment of thyroid nodules as it is quick, assessible, inexpensive, relatively painless with quite accurate diagnosis. The Bethesda system for reporting thyroid cytopathology (TBSRTC) was introduced in 2007 in an attempt to standardize international terminology and to categorize morphological criteria in ne-needle aspirations (FNAs) from patients with thyroid nodules. It introduced 6 diagnostic categories for FNA results and assigns a malignancy risk and recommendations for patient management for each category. To categorize theObjectives: thyroid swelling following The Bethesda system for reporting Thyroid Cytopathology (TBSRTC) and to correlate with nal histopathological reports wherever available. : 99 patients underwent FNAC in our institute from the period of January 2019 to July 2020,Materials and Methods and were categorized according to the Bethesda system for reporting thyroid cytopathology. Results: The 99 cases taken up for FNAC were categorized according to The Bethesda system for reporting Thyroid Cytopathology (TBSRTC) as Non-diagnostic or unsatisfactory at 6.06%, Benign at 81.81%, Atypia of undetermined signicance at 0%, Suspicious for a follicular neoplasm at 4.04%, Suspicious for malignancy at 2.02%, Malignant at 6.06%. The sensitivity, specicity, positive predictive value (PPN), negative predictive value (NPN), and accuracy of FNAC in diagnosing thyroid malignancy were calculated as 66.67%, 100%, 100%, 93.33% and 94.12% respectively. The BethesdaConclusion: system for reporting Thyroid Cytopathology (TBSRTC) helps in standardization of thyroid ne needle aaspiration reporting. This leads to timely and adequate intervention for the patient and also minimizes unnecessary thyroid surgeries

When and How Would You Screen This Patient for Cervical Cancer? : Grand Rounds Discussion From Beth Israel Deaconess Medical Center.

Successful screening programs based on cervical cytology have dramatically reduced the incidence of cervical cancer in the United States. Human papillomavirus immunization is poised to reduce it further as an increasing percentage of vaccinated women reach adulthood. A recent guideline from the American Cancer Society advises that cervical cancer screening begin at age 25 and that high-risk human papillomavirus testing is the preferred screening test. The U.S. Preventive Services Task Force recommends screening begin at age 21 and that cytology remain incorporated into screening. Here, 2 experts debate how to apply these guidelines to Ms. L, a 22-year-old woman who has never undergone cervical cancer screening.

Tumor board presentation of a woman with metastatic, hormone receptor‐positive, mismatch repair‐deficient endometrial cancer

Tumor board presentation of a woman with metastatic, hormone receptor‐positive, mismatch repair‐deficient endometrial cancer

CLINICIANS DILEMMA: FALSELY UNDETECTED TSH LEVELS DUE TO TSH ISOFORM ON POPULAR COMMERCIAL IMMUNOASSAY IN INDIAN SUBJECT AND RETROSPECTIVE ANALYSIS

Introduction: TSH is one of the most routinely measured tests the clinical laboratory to diagnose and monitor thyroid diseases. TSH as the preferred screening test as recommended by The American Thyroid Association and the American Association of Clinical Endocrinologists for diagnosing thyroid dysfunction. Third-generation Ultra serum TSH assays have a functional sensitivity of 0.001 uIU/mL and have been considered highest among biochemical assay for assessing thyroid disorders. However, as observed in many clinical laboratories sometimes results of TSH assays are discordant among different immunoassay platforms.&#x0D; Case Report: TSH values of a 56 years old male on Siemens Attelica while TSH was found to be elevated on Abbott Architect 1000 and Beckman Coulter DXI800. Retrospective analysis revealed few other cases (8/190) approx. 4.2 % showed discordant TSH values. This was found to be possibly because of mutation in TSH beta region (R55G).&#x0D; Conclusion: Our present study suggest that these individuals who shows &lt;0.001 values on Siemens Attelica must be tested with other platforms to assure appropriate management of disease. Further, clinicians and laboratory staff need to be aware about TSH variants along with other reported interferences.

Prikaz HPV testiranja kao primarnog skrininga raka grlića materice

Cytology-based cervical cancer screening achieved undisputable success in reducing the incidence and mortality of cervical cancer in many countries of the world, especially high-income countries. However, in lowand middle-income countries substantial reductions in cervical cancer incidence rates have not been achieved, mainly due to the difficulties in realization of complex conditions for implementing high quality cytology-based cervical cancer screening programs. Most international guidelines, including the World Health Organisation (WHO) Global Strategy, now recommend high-risk human papillomavirus (hrHPV) testing as the preferred cervical screening test, for several reasons, primarily due to its sensitivity, less subjectivity in diagnosis and possibility of easier program organization and implementation. The advantages of primary hrHPV screening include higher sensitivity of technology compared to cytology based examinations, and increased specificity in populations where large proportions of women have been vaccinated against the human papillomavirus (HPV), while the high-negative predictive value enables prolongation of screening intervals to 7 to 10 years, which increases the cost effectiveness of the screening programme, when applied at population level. Also, primary hrHPV screening for cervical cancer can be carried out by self-taken samples which increases the feasibility of such cervical cancer screening programme. However, implementing primary hrHPV cervical cancer screening requires at the same time organised system of monitoring the implementation of the program, coordination and quality assurance of all processes within the implementation of cervical cancer screening.Effective hrHPV primary cervical cancer screening programme requires the triage of hrHPV positive women to maximise the detection of clinically relevant cervical lesions for further investigation. Most of the countries that introduced hrHPV primary cervical cancer screening use visual inspection with acetic acid (VIA), cytology based examination or HPV geno-typing with cytology for triage testing. The choice of triage strategy depends on various factors, including availability of resources, effectiveness and cost of procedures to recall women for triage testing as well as the capacity and quality of existing health services to deliver the triage tests. Implementation of self-sampling also requires a number of issues to be addressed, including communication to motivate participation and to inform women about the self-sampling procedure, delivery of the self-sampling kits and return of the samples to the laboratories, laboratory procedures, communication of results, recalling screen-positive women for further examination and triage and motivating them to attend for follow-up and treatment. Finally, the introduction primary screening for HPV on the mucous membrane of the cervix should be accompanied by awareness-raising programs to improve the information and knowledge of women and the entire population about the importance of the cervical cancer screening, which would improve the results of population based cervical cancer screening programs and increase the women's participation.

The Impact of 4 Risk Communication Interventions on Cancer Screening Preferences and Knowledge.

The US Preventive Services Task Force has changed their screening recommendations, encouraging informed patient choice and shared decision making as a result of emerging evidence. We aimed to compare the impact of a didactic intervention, a descriptive harms intervention, a narrative intervention, and a new risk communication strategy titled Aiding Risk Information learning through Simulated Experience (ARISE) on preferences for a hypothetical beneficial cancer screening test (one that reduces the chance of cancer death or extends life) versus a hypothetical screening test with no proven physical benefits. A total of 3386 men and women aged 40 to 70 completed an online survey about prostate or breast cancer screening. Participants were randomly assigned to either an unbeneficial test condition (0 lives saved due to screening) or a beneficial test condition (1 life saved due to screening). Participants then reviewed 4 informational interventions about either breast (women) or prostate (men) cancer screening. First, participants were provided didactic information alongside an explicit recommendation. This was followed by a descriptive harms intervention in which the possible harms of overdetection were explained. Participants then viewed 2 additional interventions: a narrative and ARISE (an intervention in which participants learned about probabilities by viewing simulated outcomes). The order of these last 2 interventions was randomized. Preference for being screened with the test and knowledge about the test were measured. With each successive intervention, preferences for screening tests decreased an equivalent amount for both a beneficial and unbeneficial test. Knowledge about the screening tests was largely unimpacted by the interventions. Presenting detailed risk and benefit information, narratives, and ARISE reduced preferences for screening regardless of the net public benefit of screening.

PM 7/121 (2) ‘Candidatus Liberibacter africanus’, ‘Candidatus Liberibacter americanus’ and ‘Candidatus Liberibacter asiaticus’

Specific scopeThis Standard describes a diagnostic protocol for ‘Candidatus Liberibacter africanus’, ‘Candidatus Liberibacter americanus’ and ‘Candidatus Liberibacter asiaticus’.1This Standard should be used in conjunction with PM 7/76 (5) Use of EPPO diagnostic protocols.Specific approval and amendmentFirst approved in 2014–09. Revised in 2021–04.

Applicability of Transthoracic Contrast Echocardiography for the Diagnosis and Treatment of Idiopathic Pulmonary Arteriovenous Malformations.

Objective: To explore the preferred test to screen for pulmonary arteriovenous malformations (PAVMs) and to predict the probability of interventional embolization.Methods: We performed a retrospective observational study evaluating patients with idiopathic PAVMs from 2009 to 2019. After clinical evaluation, a total of 105 patients were studied, including 71 patients with positive digital subtraction pulmonary angiography (DSPA) findings and 34 with negative DSPA findings. The following patient data were assessed: blood test, chest radiograph, transthoracic contrast echocardiography (TTCE), and DSPA findings.Results: The majority of patients with idiopathic PAVMs were female (66.2% with positive DSPA findings). We found a good κ-coefficient of 0.77 with strong consistency for inter observer agreement concerning the pulmonary right-to-left shunt (RLS) grade on TTCE, which was superior to conventional chest radiographs. The positive predictive value (PPV) of the radiographic features for PAVMs on DSPA was 0.83 (95% CI 0.64–1.0) and 0.44 for the possibility of embolization (95% CI 0.19–0.70). The PPV of the shunt grade of PAVMs on DSPA was 0.14 (95% CI 0.01–0.29) for grade 1, 0.74 (95% CI 0.60–0.88) for grade 2, and 0.97 (95% CI 0.92–1.0) for grade 3. The PPVs of pulmonary shunt grades 2 and 3 on TTCE for the possibility of embolization for PAVMs were 0.21 (95% CI, 0.05–0.36) and 0.87 (95% CI, 0.79–0.99), respectively.Conclusion: TTCE is the preferred screening test for PAVMs. The pulmonary RLS grade on TTCE not only identifies the likelihood of PAVMs but also predicts the probability for embolization.

Aldosterone-producing adenoma associated with non-suppressed renin: a case series.

Although the aldosterone/renin ratio (ARR) is the preferred screening test for primary aldosteronism (PA), patients with non-suppressed renin and a falsely negative ARR on non-interfering medications have occasionally been reported. This report describes the clinical characteristics and outcomes of seven patients with proven aldosterone-producing adenoma (APA) and non-suppressed renin.Chart review of seven PA patients with an APA and a non-suppressed plasma renin concentration (PRC > 8.4 mU/L) was undertaken to collect data on anthropometric and biochemical characteristics, diagnostic evaluation and postsurgical outcomes.Seven patients (two women and five men) with a proven APA had median (range) PRC, plasma aldosterone and ARR of 20 (9-43) mU/L, 750 (270-1940) pmol/L and 45 (8-62, normal <70), respectively, on non-interfering medications. Six patients had two consecutive ARR measurements and in five of them both were normal. Renal artery stenosis was carefully excluded in all patients. Further evaluation for PA was pursued because of high clinical suspicion (either hypokalaemia and/or a known adrenal mass lesion on imaging). All underwent adrenal vein sampling confirming unilateral PA which was managed by unilateral adrenalectomy. Postsurgical follow-up data either confirmed or were highly suggestive of cure of PA.Strict control of factors known to influence the ARR is crucial to avoid false-negative results. Other causes that could explain a non-suppressed renin should be excluded. In patients with a consistently non-suppressed renin further diagnostic workup for PA should be considered if clinical suspicion remains high.

Correlation Between Perfusion Abnormalities Extent in Ventilation/Perfusion SPECT/CT with Hemodynamic Parameters in Patients with Chronic Thromboembolic Pulmonary Hypertension

Objectives:Chronic thromboembolic pulmonary hypertension (CTEPH) is a type of pulmonary hypertension with persistent pulmonary vascular obstruction and exercise intolerance, which may benefit from pulmonary endarterectomy (PEA). Ventilation/perfusion (V/Q) scan is the preferred screening test of CTEPH, which can be used to assess the anatomical extent of the disease. This study aimed to analyze the correlation between the extent of mismatched Q defects in V/Q single photon emission computed tomography/computed tomography (SPECT/CT) with preoperative clinical and hemodynamic parameters in patients with CTEPH.Methods:A total of 102 patients with CTEPH prior to PEA having V/Q SPECT/CT scans were retrospectively reviewed. Age, gender, New York Heart Association classification, intraoperative right-sided heart catheterization (mPAP and PVR), and 6-minute walk test (6MWT) findings were obtained from clinical records of patients.Results:Linear regression analysis showed a significant but weak correlation between the preoperative mPAP and PVR with the extent of mismatched Q defects in V/Q SPECT/CT (rs=0.09474 with p=0.0016 and rs=0.045 with p=0.045, respectively). No significant correlation was found between 6MWT and extent of mismatched Q defects in V/Q SPECT/CT (p>0.05).Conclusion:A quantitative assessment of Q defects on V/Q SPECT/CT might provide information about hemodynamic parameters in patients with CTEPH.

Parent and Pediatrician Preferences for Type 1 Diabetes Screening in the U.S.

OBJECTIVEThe purpose of this study was to use a discrete-choice experiment methodology to understand the relative importance of the attributes of screening tests for type 1 diabetes among parents and pediatricians in the U.S.RESEARCH DESIGN AND METHODSOnline surveys presented hypothetical screening test profiles from which respondents chose their preferred test profile. Survey attributes were based on likely screening test options and included the mode of administration, where and when the test was conducted, the type of education and monitoring available to lower the risk of diabetic ketoacidosis (DKA), and whether a treatment was available that would delay onset of insulin dependence. Data were analyzed using random-parameters logit models.RESULTSParents placed the highest relative importance on monitoring programs that could reduce the risk of DKA to 1%, followed by treatment to delay onset of insulin dependence by 1 or 2 years, and, finally, avoiding a $50 out-of-pocket cost. Pediatricians placed equal importance on monitoring programs that reduced a patient’s risk of DKA to 1% and on avoiding a $50 out-of-pocket cost for the screening test, followed by the option of a treatment to delay the onset of insulin dependence. The mode of administration and location and timing of the screening were much less important to parents and pediatricians.CONCLUSIONSParents and pediatricians preferred screening tests that were accompanied by education and monitoring plans to reduce the risk of DKA, had available treatment to delay type 1 diabetes, and had lower out-of-pocket costs.

Abstract PO-058: Barriers and facilitators to colorectal cancer screening: A Utah community- based study

Abstract There are disparities in colorectal cancer screening related to variations in patient- level factors including race, ethnicity, geography, and language. We conducted a survey among a diverse sample of adults eligible for colorectal cancer screening at three community health events in Salt Lake City, Utah to identify barriers and facilitators to screening. We report descriptive statistics and results of chi-squared testing to identify factors associated with the receipt of colorectal cancer screening. Of the 117 respondents, 37% were Caucasian, 17% African-American, 11% Asian, 3% American-Indian, and 1% Native Hawaiian/ Pacific Islander; 33% identified as Hispanic or Latino/a. Twenty-four percent of the study participants completed surveys in Spanish, the remainder in English. Half (50%) of the responders were ≤55 years, 37% were 56-69 years and 13% were ≥ 70 years. A majority (76%) attended college and 20% completed high school or less. Over half (51%) were employed at the time of the survey and 75% reported having health insurance. Sixty percent previously underwent colorectal cancer screening, most commonly with colonoscopy (57%) or a stool-based test (13%). Most patients (70%) reported that the number one reason they were screened was due to a physician recommendation. Screened patients reported that their preferred colorectal cancer screening test was colonoscopy (40%) or a stool-based test (24%). Forty percent of respondents did not undergo any kind of colorectal cancer screening. This was significantly associated with Spanish speaking (p=0.02) and lack of health insurance (p&amp;lt;0.01). We explored barriers to screening among those without colorectal cancer screening. With regards to stool-based testing, the most common barrier (23%) was not understanding how to do a test at home. Others were worried about handling their stool (15%), receiving a positive result (15%), or the cost of the test (15%). With regards to colonoscopy, the most common barriers were the bowel preparation (36%) and worry about discomfort or pain during the procedure (34%). The “not screened” group preferred screening by stool-based tests (49%). In conclusion, we found that among a racial, ethnic, educational, and economically diverse population of health event attendees, a substantial proportion did not receive colorectal cancer screening. These results indicate that there is a significant potential for improved screening in our community, particularly among the Spanish-speaking and uninsured populations. Future studies should evaluate cultural and language concordant interventions that can address identified barriers while promoting the observed facilitators. Citation Format: Svenja Pauleck, Sheetal Hardikar, Jordan Esplin, Maranda Pahlkotter, Andrea Williamson, Federica S. Brecha, Garrett Harding, Nathaniel Ferre, Nancy Ortiz, Robin Marcus, Mark Lewis, Jessica Cohen. Barriers and facilitators to colorectal cancer screening: A Utah community- based study [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-058.