Subsequent Clinical Management Research Articles

Vertebral body fractures of unknown origin in cancer patients receiving MDCT: reporting by radiologists and awareness by clinicians.

BackgroundTo evaluate prevalence, radiological reporting and clinical management of pathologic vertebral body fractures (VBFs) of unknown origin in cancer patients receiving computed tomography (CT) examinations.MethodsWe investigated all CT examinations (over 1 year) of male and female patients with an underlying malignancy and an increased risk of osteoporosis (age 55–79 years) for the presence of VBFs. We evaluated midline sagittal CT-reformations of the spine for prevalence, fracture type, severity and location, the accuracy and style of radiological reporting, subsequent clinical management and documentation in hospital discharge letters.Results848 patients were investigated. We found 143 VBFs in 94 (11 %) patients. 6, 49, and 45 % were grade 1, grade 2, and grade 3 fractures, respectively, while 20, 66, and 14 % were wedge, biconcave and crush fractures, respectively. 32 (34 %) radiological reports correctly classified VBFs as fractures, 25 (27 %) reports recognized VBFs, but did not type them, and VBFs were not described in 37 (39 %) reports. In 3 (3 %) patients further clinical work-up of VBFs was performed, while only 8 (9 %) hospital discharge letters contained the information of the presence of pathologic VBFs of unknown origin.ConclusionsVBFs of unknown origin appear frequently in cancer patients, however, clinical management and documentation was found in only few cases. Moreover, especially in cancer patients consistent radiological reporting of VBFs seems important, as aetiology of VBFs could be from osteoporosis, disease progression or oncological therapy, however, reporting is still performed inconsistently.

Chemotherapy-induced peripheral neuropathic pain

### Key points Chemotherapy-induced peripheral neuropathy (CIPN) is due to the toxicity of the chemotherapeutic drugs and mainly affects the peripheral nervous system. More than 50% of patients are surviving longer than 10 yr since their diagnosis of cancer and a good proportion of them have either disease-related or treatment-related chronic pain. The severity of the resultant neuropathy depends on the drugs used, duration of treatment, or nerve damage either by cancer itself or due to any pre-existing conditions such as diabetic or alcoholic neuropathy. There are no major differences in the incidence between the sexes. The objective of the article is to discuss the nature of the peripheral neuropathy associated with chemotherapeutic agents, their clinical features, evaluation, and subsequent clinical management. The drugs most commonly associated with CIPN are platinum compounds (cisplatin, carboplatin, and oxaliplatin), taxanes (paclitaxel, docetaxel), vinca alkaloids (vincristine, vinblastine), epothilones (ixabepilone), bortezomib, and thalidomide along with its analogues. Combination of two or more of these agents can result in higher possibility of developing peripheral neuropathy. For example, when combined with cisplatin or carboplatin, paclitaxel neuropathy may be encountered in 70% of patients. ### Platinum compounds These are commonly used for lung, ovarian, and bowel cancers and the mechanism of action is by interacting with …

Does knowledge of fetal outcome influence the interpretation of intrapartum cardiotocography and subsequent clinical management? A multicentre European study.

To investigate whether knowledge of fetal outcome influences retrospective interpretation of cardiotocographic tracings and subsequent management recommendations. Prospective online study. Seven university hospitals in five European countries. Forty-two intrapartum tracings from women with singleton pregnancies and uneventful antepartum courses. Using an online questionnaire, 123 healthcare professionals interpreted 42 tracings without any knowledge of fetal outcome and provided management recommendations according to the National Institute of Clinical Excellence guidelines (intrapartum care). Two months later, 93 of the 123 participants re-interpreted the same re-ordered tracings, this time with information on the newborn's umbilical artery pH. Comparison of the evaluation of tracing features, overall tracing classification, and management recommendations between the initial analysis and re-interpretation. In newborns with umbilical artery pH ≤ 7.05, knowledge of the pH value led to significant changes in the evaluation of all basic tracing features. In this group, classification of tracings as 'normal' decreased 76% (8.8-2.1%, P < 0.001), whereas classification as 'pathologic' increased 51% (44.7-67.5%, P < 0.001). In newborns with pH 7.06-7.19, classification of tracings as 'normal' decreased 36% (22.4-14.4%, P < 0.001), and in those with pH ≥ 7.20, classification of tracings as 'pathologic' decreased 40% (23.4-14.1%, P < 0.001). In the group of newborns with umbilical artery pH ≤ 7.05, the recommendations 'no attention needed' decreased 75% (10.2-2.6%, P < 0.001), and the number of recommendations 'rapid reversal of hypoxic cause or immediate delivery' increased 70.3% (42.1-71.7%, P < 0.001). When provided with information on adverse fetal outcome, healthcare professionals provide a more pessimistic evaluation of basic tracing features, overall classification, and clinical management recommendations. Knowledge of adverse fetal outcome leads to more pessimistic CTG evaluation and management recommendations.

¹¹C-Choline PET/CT in Recurrent Prostate Cancer and Nonprostatic Neoplastic Processes.

Choline positron emission tomography (PET)/computed tomography (CT), with both carbon 11 ((11)C) choline and fluorine 18 ((18)F) choline, is an increasingly used tool in the evaluation of patients with biochemically recurrent prostate cancer. It has allowed detection and localization of locally recurrent and metastatic lesions that were difficult or impossible to identify using more conventional modalities. Many of the patients followed for their prostate cancer are elderly and have a higher rate of nonprostate cancer lesions or malignancies. As our experience with choline PET/CT has grown, it has become apparent that many of these nonprostate cancer processes, both benign and malignant, can be detected. Invasive thymoma, renal cell carcinoma, papillary thyroid carcinoma, and parathyroid adenoma are a few of the processes that have been incidentally detected with (11)C-choline PET/CT at our institution and have significantly altered subsequent clinical management of the patient. Although most of the secondary lesions are detected due to their increased (11)C-choline avidity, several have been detected due to their decreased or lack of avidity in the background of a highly avid organ. For instance, large liver masses that are relatively non-choline-avid create large activity defects in the otherwise highly active liver. Familiarity with normal (11)C-choline physiologic activity, the most common prostate metastatic patterns, and imaging characteristics of secondary lesions is essential for the detection and correct diagnosis of such lesions so that proper follow-up and management can be recommended.

Does knowledge of fetal outcome influence the interpretation of intrapartum cardiotocography and subsequent clinical management? A multicentre European study

Does knowledge of fetal outcome influence the interpretation of intrapartum cardiotocography and subsequent clinical management? A multicentre European study

A comparison of non-invasive imaging modalities: Infrared thermography, spectrophotometric intracutaneous analysis and laser Doppler imaging for the assessment of adult burns

BackgroundCurrently, the only evidence-based adjunct to clinical evaluation of burn depth is laser Doppler imaging (LDI), although preliminary studies of alternative imaging modalities with instant image acquisition are promising. This is a study to investigate the accuracy of infrared thermography (IRT) and spectrophotometric intracutaneous analysis (SIA) for burn depth assessment, and compare this to the current gold standard: LDI. We include a comparison of the three modalities in terms of cost, reliability and usability. MethodsWe recruited 20 patients with burns presenting to the Chelsea and Westminster Adult Burns Service. Between 48h and 5 days afterburn we recorded imaging using moorLDI2-BI-VR (LDI), FLIR E60 (IRT) and Scanoskin™ (SIA). Subsequent clinical management and outcome was as normal, and not affected by the extra images taken. Results24 burn regions were grouped according to burn wound healing: group A healed within 14 days, group B within 14–21 days, and group C took more than 21 days or underwent grafting. Both LDI and IRT accurately determined healing potential in groups A and C, but failed to distinguish between groups B and C (p>0.05). Scanoskin™ interpretation of SIA was 100% consistent with clinical outcome. ConclusionFLIR E60 and Scanoskin™ both present advantages to moorLDI2-BI-VR in terms of cost, ease-of-use and acceptability to patients. IRT is unlikely to challenge LDI as the gold standard as it is subject to the systematic bias of evaporative cooling. At present, the LDI colour-coded palette is the easiest method for image interpretation, whereas Scanoskin™ monochrome colour-palettes are more difficult to interpret. However the additional analyses of pigment available using SIA may help more accurately indicate the depth of burn compared with perfusion alone. We suggest development of Scanoskin™ software to include a simplified colour-palette similar to LDI and additional work to further investigate the potential of SIA as an alternative to the current gold standard.

PWE-298 Ct usage for the detection of post-operative colorectal complications: impact on radiological and surgical services

Introduction Detecting surgical complications early is a persistent challenge. The aim of this study was to evaluate the use of abdominal and pelvic computed tomography (CTAP) in postoperative colorectal patients, exploring the impact on subsequent clinical management and on hospital resources. Method Data were collected on all patients undergoing elective colorectal surgery within an enhanced recovery programme over a two-year period (January 2011–December 2012). Those patients who had a diagnostic postoperative CTAP during their first admission were identified and their case notes analysed. Results Three hundred and fifty patients were identified, of which 166 (47%) had undergone laparoscopic procedures. Thirty-nine patients (11%) had a total of 40 diagnostic postoperative CTAP scans. Of these, 15 (38%) had had laparoscopic operations. Median time to imaging was 8 days post-operation. Anastomotic leak was noted in 5 patients undergoing scans (13%); 2 had percutaneous drainage and 3 were managed conservatively with intravenous antibiotics. Collections were identified in 10 patients (25%) of which 1 patient returned to theatre, 3 had percutanous drainage and 6 were managed conservatively. Bowel obstruction was reported in 3 patients (7%) and paralytic ileus in 14 (37%). One patient had a second scan due to further clinical deterioration which suggested likely ischaemic bowel changes, resulting in a return to theatre. No intra-abdominal complications were reported in seven patients (18%). Three patients returned to theatre without any imaging. Conclusion There was a high threshold for imaging colorectal patients in the postoperative period with 11% undergoing scans. There was no difference in the proportion undergoing scans between laparoscopic and open procedures. Septic pathology (leak or collection) was identified in a significant proportion (38%) but only 1.4% (5/350) of the overall number underwent radiological intervention. This study shows that CTAP is useful in detecting postoperative complications but has minimal impact on radiological services. Disclosure of interest None Declared.

The Perioperative Management of Pain in Patients Who Are Addicted to Heroin

Heroin addicts admitted to the hospital for surgery should be treated as high-risk patients because these patients face a significantly higher risk of experiencing severe drug withdrawal symptoms and of pain management complications during hospitalization. The lack of proper pain management often suffered by heroin addicts during hospitalization has been attributed to care providers' insufficient knowledge regarding opioid medications and their addicting effects as well as fears that opioid medications may cause addiction symptoms to reemerge. The objective of this article is to illustrate the pain management process across the entire hospitalization period for heroin-addicted patients undergoing surgical procedures. This process includes management of the heroin-related physical and psychological reactions from surgery, of the mechanism of pain induced specifically from surgery, and of the heroin addiction during the surgical procedure and subsequent clinical management and nursing care. It is hoped that this article assists healthcare providers to better understand the need for the proper pain management and care of heroin-addicted surgical patients over the entire period of hospitalization and thus the enhancement of the overall quality and safety of patient care management procedures.

G96(P) Optimising facial imaging for trauma in a paediatric emergency department (ed)

Aims In the context of trauma, plain facial X-rays do not represent the gold standard imaging modality, as many patients with equivocal findings will require further imaging with facial CT views. The aim of this project was to review the use of facial X-rays of patients seen in a paediatric ED following trauma, to ascertain the degree of correlation between clinical signs and radiological findings. Methods Retrospective review. All facial X-rays performed within the ED over a 1 year period (09/2012–09/2013) were identified from the hospital PACS system. Clinical details were obtained from the ED notes and compared with the X-ray report from a consultant radiologist. Results See Figure 1 below. Conclusions The vast majority of facial X-rays performed in our ED showed no evidence of fracture. A negative X-ray may be falsely reassuring as, in some cases, clinical suspicion of bony injury was high, but no further investigation/referral was made. In other cases, a facial CT was performed despite a negative facial X-ray. Therefore, in general, facial X-rays and their interpretation by ED clinicians do not appear to make a significant difference to the subsequent clinical management of patients. If suspicion of fracture is high then CT would be a better imaging modality, as where suspicion remains high an equivocal plain X-ray result would not confidently exclude facial bone fracture. On the basis of this we have developed a new clinical guideline which stratifies patients into 3 management paths according to clinical signs and symptoms: Our intention is to reduce the number of unnecessary facial X-rays, and practice will be re-audited one year post- implementation.

Can malignant thyroid nodules be distinguished from benign thyroid nodules in children and adolescents by clinical characteristics? A review of 89 pediatric patients with thyroid nodules.

Thyroid nodules are less common in children than adults, but the risk of malignancy in thyroid nodules is much higher in children. The ability to characterize pediatric thyroid nodules has improved with the use of ultrasound-guided fine-needle aspiration, the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) classification system, and expanded molecular testing. Nevertheless, stratification criteria to predict thyroid malignancy in children are poorly defined. Our objective was to determine if clinical presentation and molecular genetics could predict malignancy in pediatric thyroid nodules. Retrospective chart review of patients ≤18 years of age at the Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center with the diagnosis of a thyroid nodule from January 2007 to January 2012 was conducted. Eighty-nine subjects fulfilled the inclusion criteria: 1) thyroid nodule ≥0.8 cm and biopsy (n=76), or 2) thyroid nodule ≥0.8 cm, no biopsy, and ultrasound follow-up for at least 2 years (n=13). Twenty-four (27%) of 89 patients were diagnosed with thyroid cancer (50% papillary thyroid carcinoma [PTC], 50% follicular variant of papillary thyroid carcinoma [FVPTC]). Features associated with malignancy included larger nodule size, palpable nodule, or palpable lymphadenopathy. There were no differences in presenting features between patients with PTC and those with FVPTC. Thyroid malignancy was diagnosed in all nine patients with a molecular abnormality (BRAF, RAS, RET/PTC, PAX8/PPARγ). Clinical features, FNA cytology, and molecular genetics are valuable tools to discriminate benign from malignant nodules in pediatric patients. This information is important to direct subsequent clinical management.

Transcatheter coiling of saphenous vein graft to coronary sinus after coronary artery bypass surgery

Unintended graft anastamosis to coronary veins after coronary artery bypass surgery is an extraordinarily rare complication. The following case report involves the unintended grafting of a saphenous vein to the coronary sinus rather than the intended arterial target during coronary artery bypass surgery, and the subsequent physiologic consequences and clinical management.

Human papillomavirus testing 2007-2012: co-testing and triage utilization and impact on subsequent clinical management.

In the United States, high-risk human papillomavirus (HPV) testing is recommended for women with atypical squamous cells of unknown significance (ASC-US) cytology, and co-testing with cytology and HPV is a recommended option for screening women aged ≥ 30 years. No population-based data are available to examine utilization of HPV testing in the United States. Using the New Mexico HPV Pap Registry data resource, we describe population trends (2007-2012) in utilization and positivity rates for HPV testing as a routine co-testing screening procedure and for triage of ASC-US and other cytologic outcomes. For women aged 30-65 years co-testing increased from 5.2% in 2007 to 19.1% in 2012 (p < 0.001). Overall 82% of women with ASC-US cytology who did not receive co-testing also had an HPV test. HPV positivity was age and cytology result dependent but did not show time trends. For women with negative cytology, 64% received an additional screening test within 3 years if no co-test was done or if it was positive, but this was reduced to 47% with a negative co-test. Reflex HPV testing for ASC-US cytology is well established and occurs in most women. Evidence for reflex testing is also observed following other abnormal cytology outcomes. Co-testing in women aged 30-65 years has more than tripled from 2007 to 2012, but was still only used in 19.1% of women aged 30-65 years attending for screening in 2012. Women receiving co-testing had longer repeat screening intervals, but rescreening within 3 years is still very common even with co-testing.

The diagnostic accuracy of percutaneous renal needle core biopsy and its potential impact on the clinical management of renal cortical neoplasms.

While biopsies are now increasingly being performed for the diagnosis of renal cortical neoplasms, the influence of the rendered pathological diagnoses on the clinical management is only rarely documented. To report our experience with consecutively performed renal biopsies and the potential impact of the diagnosis on subsequent clinical management. Material from needle biopsies performed consecutively at our institution between 2006 and 2011 was reviewed. The influence of the reported pathology results on the clinical management was determined from patient follow-up medical record review. In total, 218 percutaneous biopsies for renal masses were performed during this period. Among them, 181 (83%) yielded neoplastic tissue, including 81 clear cell renal cell carcinomas, 29 low-grade oncocytic neoplasms, 7 papillary renal cell carcinomas, 5 clear cell papillary renal cell carcinomas, 5 angiomyolipomas, and 14 urothelial carcinomas. Fourteen additional cases (6%) contained lesional material from clinically known nonneoplastic processes, for a total diagnostic yield of 89%. Twenty-three (11%) were nonrepresentative of lesional tissue. In 10 of these, repeat biopsies or resections established the diagnosis of renal tumors. Biopsy diagnosis was confirmed in 29 of 30 cases (97%) on subsequent nephrectomy. Following the biopsy diagnosis, there were significant differences in the clinical management; overall, 79% of clear cell renal cell carcinomas received therapeutic interventions, and 17% were put on active surveillance. In contrast, 77% of the benign or low-grade lesions were put on active surveillance. Accurate and specific diagnosis can be rendered on renal core biopsy in most renal tumors, and the biopsy diagnosis can have a definitive role in their clinical management.

SPECT/CT in infection and inflammation

Nuclear medicine procedures are part of the evaluation armamentarium used in patients with suspected or confirmed infection. The strength of functional imaging modalities rests on their being non-invasive tests that provide pathophysiological information early in the course of disease. Their limitations, related to a somewhat low specificity of radiotracers and image resolution, have largely been overcome over the last 15 years following the introduction of the hybrid SPECT/CT technology. SPECT/CT is redefining the diagnostic workup of patients with suspected or known infectious and inflammatory processes involving the musculoskeletal system as well as those with infectious and inflammatory disease located in various soft-tissue sites. Furthermore, it has been shown that in addition to improving diagnostic accuracy (by adding specificity to the inherent high sensitivity of single-photon emission tomography), SPECT/CT leads to changes in the subsequent clinical management of patients. The main indications for SPECT/CT in infection, as well as updated literature data on this topic, are presented in the following review.

Sessile serrated polyps at screening colonoscopy: have they been under diagnosed?

The sessile serrated adenoma/polyp (SSA/P) is increasingly recognized as an important precursor to colorectal cancer (CRC) and may contribute to proximal postcolonoscopy CRCs. Hyperplastic polyps (HPs) generally follow a more benign course than do SSA/Ps, but they have a similar histologic appearance. Our aims were to identify patient and polyp factors associated with reclassification of HPs as SSA/Ps during a central pathology review and to characterize and compare their subsequent clinical management with other polyps. From 2003 to 2008, we prospectively enrolled asymptomatic persons aged 50-74 years in a study of screening colonoscopy. Because criteria for SSA/P diagnosis evolved over our study period, we initiated a second review of all HPs >5 mm in size in 2011, with reclassification of polyps if indicated. Rates of subsequent colonoscopies, polypectomies, and CRCs were identified. We enrolled 2,527 persons who underwent colonoscopy in whom 111 had HPs >5 mm. Thirty-two of the 111 participants (28.8%) with HPs >5 mm had their polyps reclassified as SSA/Ps. There were no significant differences in patient characteristics between those with reclassified SSA/Ps and those who had HPs >5 mm. SSA/Ps were more likely to be proximal (P<0.001) and larger (P<0.007) than the HPs. In all, 48.3% of those with high-risk adenomas received appropriate follow-up compared with 26.1% of those with high-risk SSA/Ps. Almost 1/3 of recently diagnosed HPs >5 mm were reclassified as SSA/Ps. Patients previously diagnosed with larger HPs in the proximal colon may benefit from a pathologic review to ensure appropriate diagnosis and follow-up.

Incidental findings in abdominal ultrasound. Characteristics and clinical interpretation

Abdominal ultrasound is a common diagnostic procedure in internal medicine. The correct interpretation of incidental findings can be difficult at times and often results in expensive and sometimes invasive follow-up examinations. Therefore, detailed knowledge of incidental findings on abdominal ultrasound is of utmost clinical and economical importance. Incidental findings are often benign, however, an accurate evaluation and correct diagnosis is crucial for the subsequent clinical management. To this end B-mode ultrasonography is complemented by color flow Doppler sonography and contrast-enhanced ultrasonography to add dynamic information on blood flow and vessel formation. This article presents frequent incidental findings of the major abdominal organs and vessels, and describes the sonographic and clinical management to find the correct diagnosis.

E-074 Emergency Carotid Artery Stenting in Acute Ischemic Stroke

Introduction/purposeRecanalization of occluded arteries is crucial for good functional outcome of acute stroke patients with large vessel occlusion. Endovascular treatment, particularly mechanical thrombectomy, plays an increasing role to achieve rapid...

Imaging Pandora's Box: Incidental Findings in Elderly Patients Evaluated for Transcatheter Aortic Valve Replacement

ObjectiveTo determine the frequency and clinical impact of noncardiovascular incidental findings (IFs) detected on preoperative computed tomographic angiography (CTA) of the chest/abdomen/pelvis performed in elderly patients with severe aortic stenosis being considered for transcatheter aortic valve replacement (TAVR). Patients and MethodsThe CTA studies for 424 consecutive patients being evaluated for TAVR between January 1, 2009, through January 24, 2012, were reviewed for noncardiovascular IFs (62.0% male; median ± SD age, 82±8.3 years). The electronic medical record was reviewed to assess for subsequent clinical management and survival. ResultsPotentially pathologic IFs (PPIFs) were present in 285 patients (67.2%). The mean ± SD number of PPIFs per patient was 1.1±1.0 (range, 0-4). Factors associated with higher numbers of PPIFs were reduced ejection fraction (P=.02) and history of smoking (P=.06). Potentially pathologic incidental findings prompted clinical work-up in 39 patients (9.2%) and delayed or canceled treatment plans for aortic stenosis in 7 patients (1.7%). The number needed to image to diagnose a new malignancy or medical condition was 19. The number of PPIFs was predictive of poor overall survival before (hazard ratio, 1.58; 95% CI, 1.31-1.88) and after (hazard ratio, 1.45; 95% CI, 1.19-1.76) adjustment for baseline clinical variables (P<.001 for both). ConclusionThis investigation found that PPIFs are common in elderly patients undergoing TAVR-CTA scans and, once discovered, commonly generate further clinical evaluation. Higher numbers of PPIFs may be predictive of poorer survival, but further study is required to guide the appropriateness of pursuing diagnostic evaluations for asymptomatic PPIFs in this elderly population.

Inter‐ and intra‐observer agreement of non‐reassuring cardiotocography analysis and subsequent clinical management

To quantify inter- and intra-observer agreement of non-reassuring intrapartum cardiotocography (CTG) patterns and subsequent clinical management. Methodological study. University Medical Center. CTG patterns of 79 women beyond 37weeks of gestation with a singleton fetus in vertex position in first stage of labor in whom fetal blood sampling (FBS) had been performed. Nine observers assessed CTG patterns, which were formerly clinically classified as non-reassuring and indicative for FBS, according to the guidelines of the International Federation of Gynecology and Obstetrics modified for ST analysis. They also proposed clinical management strategies without and with insight into clinical parameters. Weighted kappa values (κw ) and proportions of agreement (Pa ) were calculated. Agreement on CTG classification and clinical management. Inter-observer agreement on CTG classification and on clinical management were poor for most observer categories (κw range 0.31-0.50 and 0.20-0.45, respectively). Observers agreed best on abnormal CTG patterns (Pa range 0.28-0.36) and on the clinical management option "continue monitoring" (Pa range 0.32-0.40). Intra-observer agreement was fair to good for most observers (κw 0.33-0.70). Insight into clinical parameters resulted in similar inter- and intra-observer agreement. There was poor inter-observer agreement and fair to good intra-observer agreement on classification and clinical management of intrapartum CTG patterns, which had been classified as non-reassuring and indicative for FBS during birth.

Current and Proposed Molecular Diagnostics in a Genitourinary Service Line Laboratory at a Tertiary Clinical Institution

The idea that detailed knowledge of molecular oncogenesis will drive diagnostic, prognostic, and therapeutic clinical decision making in an increasingly multidisciplinary practice of oncologic care has been anticipated for many years. With the recent rapid advancement in our understanding of the molecular underpinnings of genitourinary malignancies, this concept is now starting to take shape in the fields of prostate, kidney, bladder, testicular, and penile cancer. Such breakthroughs necessitate the development of robust clinical-grade assays that can be quickly made available for patients to facilitate diagnosis in challenging cases, risk-stratify patients for subsequent clinical management, select the appropriate targeted therapy from among increasingly diverse and numerous options, and enroll patients in advanced clinical trials. This rapid translation of basic and clinical cancer research requires a streamlined, multidisciplinary approach to clinical assay development, termed here the molecular diagnostics service line laboratory. In this review, we summarize the current state and explore the future of molecular diagnostics in genitourinary oncology to conceptualize a genitourinary service line laboratory at a tertiary clinical institution.