Presence Of Primary Malignancy Research Articles

Diagnostic efficacy of image-guided core needle biopsy of suspected malignant osseous lesions: a retrospective cohort study from a single academic institution.

To evaluate diagnostic yield and accuracy of image-guided core needle biopsy (ICNB) of suspected malignant osseous lesions in a large cohort of adults, evaluate what factors influence these measures, and offer technical recommendations to optimize yield. A retrospective analysis of 2321 ICNBs performed from 2010 to 2021 was completed. The diagnostic yield and accuracy of the biopsies as well as a series of patient, lesion-related, and technical factors were retrospectively analyzed. Multivariate statistical analysis was performed to evaluate what factors were associated with yield and accuracy. Different cutoff values of total core length and core number were then tested to determine threshold values in relation to increased diagnostic yield. Diagnostic yield was 98.2% (2279/2321) and accuracy was 97.6% (120/123). Increased total core length (odds ratio [OR] = 2.34, 95% confidence interval [CI] (1.41-3.90), p= 0.001), core number (OR = 1.51, 95% CI (1.06-2.16), p= 0.02) and presence of primary malignancy (OR = 2.81, 95% CI (1.40-5.62), p= 0.004) were associated with improved yield. Lesion location in an extremity (OR = 0.27, 95% CI (0.11-0.68), p= 0.006) and using fluoroscopic imaging guidance (OR = 0.33, 95% CI (0.12-0.90), p= 0.03) were associated with lower yield. Cutoff thresholds in relation to increased diagnostic yield were found to be 20 mm total core length (marginal OR = 4.16, 95% CI = (2.09-9.03), p < 0.001), and three total cores obtained (marginal OR = 2.78, 95% CI (1.34-6.54), p= 0.005). None of the analyzed factors influenced diagnostic accuracy. ICNB has a high rate of diagnostic yield and accuracy. Several factors influence diagnostic yield; 20 mm core length and three total cores optimize yield. Image-guided core needle biopsy of suspected malignant osseous lesions is a safe procedure with a very high rate of diagnostic yield and accuracy. Obtaining 20 mm total core length and three total cores optimizes diagnostic yield. • In a retrospective cohort study, image-guided core needle biopsy of suspected osseous malignant lesions in adults was found to have very high rates of diagnostic yield and accuracy. • Increased total core length and core number of biopsies were each associated with increased diagnostic yield, and these relationships reached thresholds at 20 mm total core length and three total cores obtained. • The presence of a known primary malignancy was also associated with increased yield while using fluoroscopic imaging guidance and lesion location in an extremity were associated with decreased yield.

Characteristics and Treatment Patterns of Patients with Deep Vein Thrombosis and/or Pulmonary Embolism in the US Hospital Setting

Introduction:Current practice guidelines in the United States (US) recommend that anticoagulation treatment for deep vein thrombosis (DVT) and/or pulmonary embolism (PE) is initiated with parenteral administration of low-molecular-weight heparin (LMWH), fondaparinux or low-dose unfractionated heparin (UFH), followed by the use of warfarin or other vitamin K antagonist therapies (Kearon et al Chest 2012). Given the relatively recent introduction of novel oral anticoagulants (NOACs), it is essential to understand the demographic and clinical characteristics of DVT/PE patients receiving these therapies. The objective of this study was to evaluate characteristics and treatment patterns of patients with DVT and/or PE in the US hospital setting.Methods:This retrospective observational cohort study used hospital administrative claims data spanning 11/1/2011-12/31/2013 from more than 600 hospitals. Patients ≥18 years old with a primary discharge diagnosis of DVT and/or PE in the inpatient setting during the identification period (11/1/2012-12/31/2013) were selected. The first-observed hospitalization for DVT/PE during the identification period was defined as the index hospitalization, and thus the principal event for analysis. Patients with a secondary diagnosis of atrial fibrillation, atrial flutter, cardiomyopathy, or a coagulation disorder during the index hospitalization were excluded. Patients needed to have had a complete hospital stay defined as (1) observed admission and discharge dates and (2) a discharge status other than expired or unknown. Patients were categorized into mutually-exclusive treatment cohorts based on the anticoagulant (AC) treatment regimen received during the index hospitalization, including lack of receipt of any AC treatment. Parenteral anticoagulant (PAC) therapy was defined as LMWH, fondaparinux or UFH. Demographic, hospital, and clinical characteristics were assessed during the index hospitalization. A logistic regression was conducted to assess the likelihood of receiving rivaroxaban with PAC and/or warfarin (vs. rivaroxaban alone) adjusting for the following covariates: age, sex, race, geographic region, payer type, primary or secondary diagnosis of DVT and/or PE, history of DVT/PE, discharge status, receipt of thrombolytic drugs, presence of primary malignancy, presence of renal disease, attending provider specialty, hospital setting, and hospital size.Results:In this study, 46,214 patients met the selection criteria (mean age: 61 years; 53% female). Sixty-eight percent of all patients were white and 50% were Medicare beneficiaries. The majority of patients received a primary diagnosis of PE during the index hospitalization (54%), followed by those with a primary diagnosis of DVT without mention of PE (38%) and primary diagnosis of DVT and secondary PE (8%). The most common AC treatment during the index hospitalization was PAC + warfarin (70%), PAC alone (16%), PAC + rivaroxaban (6%), PAC + warfarin + rivaroxaban (4%), warfarin alone (1%), rivaroxaban alone (1%), and no AC therapy (2%). Among the patients who received rivaroxaban, more than 90% additionally received PAC. The mean [SD] Deyo-Charlson Comorbidity Index scores were lowest for the cohorts receiving rivaroxaban (rivaroxaban alone, 1.1 [1.7]; PAC + rivaroxaban, 1.2 [1.8]; and PAC + warfarin + rivaroxaban cohorts, 1.2 [1.6]). In logistic regression analyses, patients with a primary PE diagnosis (odds ratio (OR): 1.49; 95% CI 1.17-1.88), a primary DVT diagnosis with a secondary PE diagnosis (OR 2.07; 95% CI 1.31-3.26), receipt of thrombolytic drugs (OR: 12.45; 95% CI 3.95-39.23), presence of renal disease (OR: 1.61; 95% CI 1.02-2.54), and receipt of care in an urban hospital (OR: 1.53; 95% CI 1.16-2.00) were significantly more likely to receive rivaroxaban with PAC and/or warfarin compared to rivaroxaban alone.Conclusion:This study evaluated characteristics and treatment patterns among patients with DVT and/or PE in the US hospital setting, following the introduction of the NOACs. Our findings indicate that the standard of care (PAC + warfarin) remains the dominant treatment regimen despite the availability of newer NOACs. Future studies of treated patients with DVT and/or PE should examine whether these preliminary observations of treatment patterns change with increased clinical experience with NOACs. DisclosuresLim:Boehringer Ingelheim Pharmaceuticals Inc.: Employment. Sander:Boehringer Ingelheim Pharmaceuticals Inc.: Employment.

Fine-needle aspiration biopsy of cervical lymph nodes: factors in predicting malignant diagnosis

The objective of the study was to determine the predicting factors in malignant diagnosis in ultrasonography guided fine-needle aspiration biopsy of cervical lymph nodes. Design is retrospective follow-up study. Ultrasonography guided fine-needle aspiration biopsies of cervical lymph nodes were performed in 290 patients. The mean age was 45.5 ± 14.4 years (range; 15-85). 207 (71.4%) and 83 (28.6%) were women and men, respectively. Cytopathologist was not present in any biopsy procedure. Factors in predicting malignancy were age, gender, presence of primary malignancy, localization (Level 1-6), hypoechogenicity with loss of echogenic hilum, microcalcification, cystic feature, minimum and maximum sizes, and index value (minimum size/maximum size). Factors were analyzed by univariate and multivariable tests. The mean minimum size and index value of the lymph nodes were 10.4 ± 5.5 mm and 0.58 ± 0.18, respectively. Age, gender, microcalcification, cystic feature, minimum size, and index value were poor predictors in malignancy. Predictors were presence of primary malignancy (p-< 0.001), the level of localization (p=0.001), and hypoechogenicity (p-< 0.001)- in malignancy. Microcalcification and cystic parts were specific US findings of metastasis of thyroid carcinoma; nevertheless cystic parts were seen more specific finding in the other malignancies. Malignant lymph nodes were often found in the presence of primary malignancy, mid neck and lower neck localizations as Level 3-6, and markedly hypoechoic lymph nodes. In 131 patients with a primary thyroid carcinoma, the predictors for malignancy were localization where the most often regions were Level 3, 4, and 6 and hypoechogenicity. Malignancy rate was relatively low in patients with thyroid malignancy than those with non thyroid malignancies in Level 5. Level 6 was the most difficult area for biopsy due to postoperative changes. Microcalcification was specific only in thyroid carcinoma, whereas cystic parts were more specific in the other malignancies

The Diagnostic Utility of Fine-Needle Aspiration Biopsy of Soft-Tissue Sarcomas in the Core Needle Biopsy Era

Abstract: Fine-needle aspiration biopsy (FNAB) is a widely accepted and established diagnostic technique in diagnosing the presence of primary malignancies, metastatic disease, and benign nonneoplastic lesions. However, its role in the evaluation of soft-tissue sarcomas has remained controversial, especially as the primary modality for establishing an initial diagnosis. Arguments in favor of using core needle biopsies (CNB) relate to the fact that such samples provide ample “tissue” for evaluating architectural patterns, as well as a source for performing ancillary studies. However, in the hands of experienced cytopathologists, FNAB in conjunction with ancillary studies (performed on tissue obtained in the form of cell blocks) has been shown to have a diagnostic yield nearly identical to CNB, with an accuracy rate approaching 95% for the diagnosis of malignancy. Additionally, as therapy and prognosis are heavily dependent on the grade and stage of the tumor, it has been shown that approximately 90% of soft-tissue sarcomas can be successfully subtyped and even graded by FNAB. There are, however, certain limitations of FNAB, especially in the workup of low-grade myxoid and spindle cell sarcomas and in their separation from borderline and benign lesions. In these select subgroups, CNB may be more advantageous. Also, in the absence of an on-site cytopathologist for immediate evaluation of the sample and triage of materials for ancillary studies, CNB is preferred, although FNAB can still identify benign soft-tissue lesions and malignancies of nonmesenchymal origin not requiring ancillary studies. This review will focus on the more commonly encountered soft-tissue sarcomas and highlight the advantages and limitations of FNAB in establishing their diagnosis.