Lung Cancer: AI Can Reduce False Positives on Low-Dose CT Screening

MedicalResearch.com Interview with:

Panayiotis (Takis) Benos, Ph.D.Professor and Vice Chair for Academic AffairsDepartment of Computational and Systems BiologyAssociate Director, Integrative Systems Biology ProgramDepartment of Computational and Systems Biology, SOM andDepartments of Biomedical Informatics and Computer ScienceUniversity of Pittsburgh

Dr. Benos

Panayiotis (Takis) Benos, Ph.D.
Professor and Vice Chair for Academic Affairs
Department of Computational and Systems Biology
Associate Director, Integrative Systems Biology Program
Department of Computational and Systems Biology, SOM and
Departments of Biomedical Informatics and Computer Science
University of Pittsburgh 

 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Low-dose computed tomography (LDCT) scans is the main method used for early lung cancer diagnosis.  Early lung cancer diagnosis significantly reduces mortality.  LDCT scans identify nodules in the lungs of 24% of the people in the high-risk population, but 96% of these nodules are benign.  Currently there is no accurate way to discriminate benign from malignant nodules and hence all people with identified nodules are subjected to follow up screens or biopsies.  This increases healthcare costs and creates more anxiety for these individuals.  By analyzing a compendium of low-dose computed tomography scan data together with demographics and other clinical variables we were able to develop a predictor that offers a promising solution to this problem. 

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Lung Cancer: Screening Model Including Low-Dose CT Can Improve Risk Prediction

MedicalResearch.com Interview with:

Martin C. Tammemägi   PhDSenior Scientist | Cancer Care Ontario | Prevention & Cancer Control | Scientific Lead | Lung Cancer Screening Pilot for People at High RiskProfessor (Epidemiology) | Brock University | Department of Health SciencesOntario  Canada

Dr. Tammemägi

Martin C. Tammemägi PhD
Senior Scientist
Cancer Care Ontario | Prevention & Cancer Control
Scientific Lead
Lung Cancer Screening Pilot for People at High Risk
Professor (Epidemiology) | Brock University Department of Health Sciences
Ontario, Canada

MedicalResearch.com: What is the background for this study?

Response: Some prediction models can accurately predict lung cancer risk (probability of developing lung cancer during a specified time). Good model predictors include sociodemographic, medical and exposure variables. In recent years, low dose computed tomography (LDCT) lung cancer screening has become widespread in trials, pilots, demonstration studies, and public health practice.

It appears that screening results provides added valuable, independent predictive information regarding future lung cancer risk, aside from the lung cancers directly detected from the diagnostic investigations resulting from positive screens. Continue reading

Radiomics Plus Machine Learning Can Optimize Prostate Cancer Classification

MedicalResearch.com Interview with:

Gaurav Pandey, Ph.D. Assistant Professor Department of Genetics and Genomic Sciences Icahn Institute of Data Science and Genomic Technology Icahn School of Medicine at Mount Sinai, New York 

Dr. Pandey

Gaurav Pandey, Ph.D.
Assistant Professor
Department of Genetics and Genomic Sciences
Icahn Institute of Data Science and Genomic Technology
Icahn School of Medicine at Mount Sinai, New York 

MedicalResearch.com: What is the background for this study?

 Response: Multiparametric magnetic resonance imaging (mpMRI) has become increasingly important for the clinical assessment of prostate cancer (PCa), most routinely through PI-RADS v2, but its interpretation is generally variable due to its relatively subjective nature.

Radiomics, a methodology that can analyze a large number of features of images that are difficult to study solely by visual assessment, combined with machine learning methods have shown potential for improving the accuracy and objectivity of mpMRI-based prostate cancer assessment. However, previous studies in this direction are generally limited to a small number of classification methods, evaluation using the AUC score only, and a non-rigorous assessment of all possible combinations of radiomics and machine learning methods. Continue reading

Rheumatoid Arthritis: Study Finds No Benefit to MRI-Guided Treatment

MedicalResearch.com Interview with:

Signe Møller-Bisgaard MD, PhD Rigshospitalet Center for Rheumatology and Spine Diseases Copenhagen Center for Arthritis Research 

Dr. Møller-Bisgaard

Signe Møller-Bisgaard MD, PhD
Rigshospitalet
Center for Rheumatology and Spine Diseases
Copenhagen Center for Arthritis Research 

MedicalResearch.com: What is the background for this study? 

Response: The background was that to avoid long-term consequences of rheumatoid arthritis (RA) such as progressive joint damage progression leading to functional impairment and loss of quality of life, it is essential for patients with RA to achieve clinical remission, which is a disease state with no clinical signs and symptoms of disease activity. But despite treating our patients according to current clinical recommendations using targeted treatment strategies, so that the patients reach a state of remission, joint damage progression still occurs in one out of four patients. We knew, that MRI inflammatory findings such as synovitis and bone marrow edema are present in patients in clinical remission and are of prognostic value. In particular bone marrow edema has shown to be a strong predictor of erosive joint damage progression.

In the IMAGINE-RA randomized clinical trial we therefore wanted to investigate if an MRI treat-to-target strategy targeting absence of bone marrow edema versus a conventional disease activity-guided treat-to-target strategy would improve clinical and radiographic outcome in rheumatoid arthritis patients in clinical remission.  Continue reading

Self-Compression During Mammography Evaluated

MedicalResearch.com Interview with:
"Kiki Gets a Mammogram" by kristiewells is licensed under CC BY-NC-SA 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by-nc-sa/2.0Philippe Henrot, MD
Radiology Department
Institut de Cancerologie de Lorraine
Vandoeuvre-les-Nancy 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The initial observation was that daily practice of mammography shows a substantial proportion of women that report a negative experience after having a mammogram. Compression of the breast before delivering X-rays is mandatory to achieve the best image quality and to detect small cancers. Unfortunately, compression is uncomfortable, even sometimes painful.

We took into consideration a study of PJ Kornguth et al. published in 1993 reporting the self-compression technique. In this study one breast was compressed by the radiographer and the other with self-compression. The author reported a high level of patient satisfaction, and a lower discomfort, without compromising image quality. We performed a multicenter prospective randomized trial to demonstrate the feasibility of the self-compression technique in condition similar to routine screening or follow-up, compared with standard compression. The primary outcome was to demonstrate that self-compression did not lead to compress the breast less than standard compression, and that was done. The secondary outcomes were to evaluate pain, compression force and image quality.

The results indicated that compression force was higher when the women controlled themselves the compression of their breast, and the pain measured on a visual analogue scale was lower. Moreover, image quality was not compromised compared with standard compression.  Continue reading

Safety of MRIs in Patients with Tattoos

MedicalResearch.com Interview with:

Dr. Martina Callaghan PhD Head of Physics & Senior Lecturer Wellcome Centre for Human Neuroimaging Institute of Neurology University College London London  

Dr. Callaghan

Dr. Martina Callaghan PhD
Head of Physics & Senior Lecturer
Wellcome Centre for Human Neuroimaging
Institute of Neurology
University College London
London

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: As mirrors the situation in the general population, we found that an increasing number of volunteers who were seeking to enter cognitive neuroscience studies at our Centre had tattoos. However, the magnetic fields used in magnetic resonance imaging (MRI) pose a potential safety risk for people with tattoos. A number of case reports have described such incidents.  However, as these describe isolated cases retrospectively, there was not enough information to objectively assess the risk of tattoo-related adverse reactions for persons having an MRI scan.  Therefore, in 2011, we decided to embark upon this first prospective study to quantitatively assess this risk.

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Computer Simulation Study Favors Tomosynthesis over Digital Mammography

MedicalResearch.com Interview with:

Aldo Badano, Ph.D. Deputy Director, Division of Imaging, Diagnostics, and Software Reliability Office of Science and Engineering Laboratories Center for Devices and Radiological Health Silver Spring, MD 20993

Aldo Badano, Ph.D.
Deputy Director, Division of Imaging, Diagnostics, and Software Reliability
Office of Science and Engineering Laboratories
Center for Devices and Radiological Health Silver Spring, MD 20993 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Expensive and lengthy clinical trials can delay regulatory evaluation of innovative technologies, affecting patient access to high-quality medical products. Although computational modeling is increasingly being used in product development, it is rarely at the center of regulatory applications.

Within this context, the VICTRE project attempted to replicate a previously conducted imaging clinical trial using only computational models. The VICTRE trial involved no human subjects and no clinicians. All trial steps were conducted in silico. The fundamental question the article addresses is whether in silico imaging trials are at a mature development stage to play a significant role in the regulatory evaluation of new medical imaging systems. The VICTRE trial consisted of in silico imaging of 2986 virtual patients comparing digital mammography (DM) and digital breast tomosynthesis (DBT) systems.

The improved lesion detection performance favoring DBT for all breast sizes and lesion types was consistent with results from a comparative trial using human patients and radiologists.  Continue reading

Women Benefit from Mammography Screening Beyond Age 75 

MedicalResearch.com Interview with:
Stamatia Destounis MD, FACR, FSBI, FAIUM
Elizabeth Wende Breast Care
Clinical Professor University of Rochester Imaging Sciences
Rochester, NY 14620 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:  The current breast cancer screening recommendations in the United States are unclear regarding when to stop screening. Several societies with published recommendations conflict in regard to when to discontinue screeningmammography. There is little evidence studying the benefit of annual mammography in the population of women 75 and older.

Due to this, we felt that it was a very important and timely topic to investigate, with the goal of providing further guidance on why screening mammography may be beneficial in this older population.

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Newer MRIs May Predict Alzheimer’s Disease Before Any Symptoms

MedicalResearch.com Interview with:

Cyrus A. Raji, MD PhD Asst Prof of Radiology, Mallinckrodt Institute of Radiology Neuroradiology Faculty and the Neuoimaging Laboratories  Washington University School of Medicine St. Louis

Dr. Raji

Cyrus A. Raji, MD PhD
Asst Prof of Radiology, Mallinckrodt Institute of Radiology
Neuroradiology Faculty and the Neuoimaging Laboratories
Washington University School of Medicine
St. Louis

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Alzheimer’s disease is the most common cause of dementia and every patient suspected of having this disorder receives an MRI scan of the brain.

MRI scans of the brain in dementia are currently limited to evaluating for structural lesions that could be leading to memory loss such as stroke or tumor. What this study sought to accomplish was to determine if a newer type of MRI scan called diffusion tensor imaging (DTI) can predict who will experience cognitive decline and dementia. We found that DTI can predict persons who will demented 2.6 years before the earliest onset of symptoms.

This study was done in 61 individuals, 30 converters and 31 non-converters, from the Alzheimer’s Disease Neuroimaging Initiative and we found that DTI metrics could predict dementia 2.6 years later with 89-95% accuracy.

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Pulsed Radiofrequency For Acute Back Pain and Sciatica

MedicalResearch.com Interview with:

Probe being applied to nerve root. Credit: Radiological Society of North America

Probe being applied to nerve root.
Credit: Radiological Society of North America

Alessandro Napoli MD PhD
Department of Radiological, Oncological and Pathological Sciences
Sapienza University of Rome 

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Disc Herniation in the lumbar region can create intense pain in the lower back and along the leg as a result of nerve compression. People suffering disc herniation may either experience a spontaneous relief from the pain or requiring further medical actions in order to improve quality of life and going back to work and daily activities. When the pain is not responding to usual conservative care (both physical and pharmacological therapy) surgery is often considered a valid option.However, most of the people (despite the intense pain) would possibly avoid surgery. For this reason, Interventional percutaneous therapies such as intraforaminal injection of steroid have become more popular. Pulsed radiofrequency is a percutaneous therapy that may have the potential to rapidly relief the pain in a long lasting way by means of single 10 minutes procedure. We decided to undertook a randomized clinical trial to test the clinical benefit of pulsed radiofrequency therapy using intraforaminal injection as a control group. in both groups percutaneous approach was guided under precise guidance of CT images.

Pulsed radiofrequency group patients experience a faster and more durable pain control during the 1 year period follow up. Incidence of retreatment or cross-over was significantly higher in the injection only group.

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AI: Deep Learning Algorithms Can Detect Critical Head CT Findings

MedicalResearch.com Interview with:
Qure-ai.jpgSasank Chilamkurthy

AI Scientist,
Qure.ai

MedicalResearch.com: What is the background for this study?

Response: Head CT scan is one of the most commonly used imaging protocols besides chest x-ray. They are used for patients with symptoms suggesting stroke, rise in intracranial pressure or head trauma. These manifest in findings like intracranial haemorrhage, midline shift or fracture.

Scans with these critical findings need to be read immediately. But radiologists evaluate the scans on first-come-first-serve basis or based on stat/routine markers set by clinicians. If the scans with critical findings are somehow pushed to the top of radiologists’ work list, it could substantially decrease time to diagnosis and therefore decrease mortality and morbidity associated with stroke/head trauma.

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Fibromyalgia: Scan Reveals Increased Brain Activation in Pain, Emotion and Affect Areas

MedicalResearch.com Interview with:
Daniel S. Albrecht, Ph.D.

Research Fellow, Department of Radiology
Harvard Medical School

MedicalResearch.com: What is the background for this study? Can you briefly describe what is meant by fibromyalgia?

Response: Fibromyalgia (FM) is a poorly understood chronic condition characterized by widespread musculoskeletal pain, fatigue, unrefreshing sleep, memory deficits and attention difficulties, among other symptoms. FM affects an estimated 4 million adults in the U.S., but despite this prevalence, effective therapies for treating FM are lacking.

This combined MR/PET image highlights areas of the brain in which patients with fibromyalgia were found to have increased glial activation, compared with unaffected control volunteers. Credit: Marco Loggia, PhD, Martinos Center for Biomedical Imaging, Massachusetts General Hospital

This combined MR/PET image highlights areas of the brain in which patients with fibromyalgia were found to have increased glial activation, compared with unaffected control volunteers.
Credit: Marco Loggia, PhD, Martinos Center for Biomedical Imaging, Massachusetts General Hospital

Part of the reason for the paucity of effective therapeutics is insufficient knowledge of the underlying mechanisms contributing to FM. Previous work from co-senior author of the current manuscript, Eva Kosek, MD, PhD, and collaborators at the Karolinska Institute in Sweden found elevated inflammatory molecules in the cerebrospinal fluid of FM patients, which could be reflective of brain neuroinflammation in these patients. However, no study had directly assessed the presence of neuroinflammation in the brain of FM patients.

Co-senior author of the study, Marco Loggia, PhD, and collaborators showed in a 2015 Brain publication that individuals with chronic low back pain (cLBP) exhibit evidence of brain neuroinflammation, specifically activation of glial cells. Our team utilized simultaneous MR/PET imaging to image brain levels of the 18 kDa translocator protein (TSPO), which is widely used as a marker of glial activation due to vast upregulation of TSPO in glial cells, e.g. microglia and astrocytes, in preclinical models of inflammation and neurological disease. Dr. Loggia sought to extend these finding in cLBP to FM, hypothesizing that activation of glial cells may also be associated with FM pathology. To this end, we used the same TSPO PET tracer to image 20 FM patients and 16 healthy controls.

During a conference where I was presenting preliminary results of the fibromyalgia study, Dr. Loggia met with Dr. Kosek and discovered that, across the Atlantic, her group was performing a very similar study, imaging 11 FM patients and 11 controls with the same TSPO PET compound. They decided to form a collaboration, and logistic talks began to determine the best strategy to combine and analyze the separate datasets. In addition to PET imaging with the TSPO tracer, which is suggested to reflect activated microglia and astrocytes, Dr. Kosek’s group also collected PET scans using a tracer thought to bind specifically to astrocytes rather than microglia. This tracer was used in order to discern the relative contributions of microglia and astrocytes to any observed differences in TSPO PET signal.

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“Head CT Choice” Educates Parents of Children with Mild Head Injury

MedicalResearch.com Interview with:

Erik P. Hess MD MSc Professor and Vice Chair for Research Department of Emergency Medicine UAB Medicine | The University of Alabama at Birmingham Birmingham Alabama 35249

Dr. Hess

Erik P. Hess MD MSc
Professor and Vice Chair for Research
Department of Emergency Medicine
UAB Medicine
he University of Alabama at Birmingham
Birmingham Alabama 35249

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: 450,000 children present to U.S emergency departments each year for evaluation of head trauma.  Physicians obtain head computed tomography (CT) scans in 37%-50% of these patients, with less than 10% showing evidence of traumatic brain injury and only 0.2% that require neurosurgical treatment.

In order to avoid unnecessary CT scans and to limit radiation exposure, the Pediatric Emergency Care Applied Research Network (PECARN) developed clinical prediction rules that consist of 6 readily available factors that can be assessed from the history and physical examination.  If none of these risk factors are present, a CT scan is not indicated.

If either of 2 high risk factors such as signs of a skull fracture are present, CT scanning is indicated.

If 1 or 2 non-high risk factors are present, then either CT scanning or observation are recommended, depending on considerations such as parental preference, clinician experience and/or symptom progression.

In this study we designed a parent decision aid, “Head CT Choice” to educate the parent about the difference between a concussion – which does not show up on a CT scan – and a more serious brain injury causing bleeding in or around the brain.  The decision aid also shows parents their child’s risk for a serious brain injury – less than 1% risk in the majority of patients in our trial – what to observe their child at home for should they opt not to obtain a CT scan, and the advantages and disadvantages of CT scanning versus home observation.

In our trial, we did not observe a difference in the rate of head CT scans obtained in the ED but did find that parents who were engaged in shared decision-making using Head CT Choice were more knowledgeable about their child’s risk for serious brain injury, has less difficulty making the decision because they were clearer about the advantages and disadvantages of the diagnostic options, and were more involved in decision-making by their physician.  Parents also less frequently sought additional testing for their child within 1 week of the emergency department visit.

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Using Tau PET Scan to Distinguish Alzheimer Disease from Other Neurodegenerative Disorders

MedicalResearch.com Interview with:
PET scanner Wikipedia imageRik Ossenkoppele
PhD
Lund University & VU University Medical Center
Oskar Hansson – Lund University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: [18F]flortaucipir is a relatively novel PET tracer that can be used to detect tau pathology in the living human brain. Previous studies have shown a robust signal in patients with Alzheimer’s disease, but in patients with other types of dementia the signal was more variable.

We aimed to assess the ability of [18F]flortaucipir PET to distinguish Alzheimer’s disease from other neurodegenerative disease in more than 700 study participants. T

he main finding was that [18F]flortaucipir discriminated Alzheimer’s disease patients from patients with other neurodegenerative diseases with high accuracy. Furthermore, [18F]flortaucipir PET outperformed established MRI markers and showed higher specificity than amyloid-β PET.  Continue reading

Coronary CT Angiography May Be Best Approach to Chest Pain

MedicalResearch.com Interview with:

Prof David Newby FRSE FMedSci Personal Chair - BHF John Wheatley Chair of Cardiology University of Edinburgh

Prof. Newby

Prof David Newby FRSE FMedSci
Personal Chair – BHF John Wheatley Chair of Cardiology
University of Edinburgh

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There are many tests that can try and determine whether a patient has heart disease. All are imperfect and do not directly see if the heart arteries are diseased.

This study used a CT heart scan to see if there was any heart disease in patients who presented to the outpatient clinic with chest pains that could be due to coronary heart disease. The doctor use the scan result to decide whether they had heart disease and how to manage the patient.

The study has found that if you use a CT heart scan then you are less likely to have a heart attack in the future. In the first year, you may require treatment with an angiogram and heart surgery (stent or heart bypass) but after the first year, you are less likely to need these treatments because the disease has already been treated promptly.

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Routine Mammography Screening Recommendations Do Not Apply To Women With History of Breast Cancer

MedicalResearch.com Interview with:

Lisa A Newman, MD Director of the Breast Oncology Program for the multi-hospital  Henry Ford  Health System

Dr. Newman

Lisa A Newman, MD
Director of the Breast Oncology Program for the multi-hospital
Henry Ford  Health System

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: In 2009 the United States Preventive Services Task Force published a guideline recommending that American women at average risk for breast cancer defer undergoing screening mammography until they reach the age of 50 years. Prior to this publication, women were widely-encouraged to initiate annual mammography at age 40 years. Women that have a history of breast cancer are automatically considered to be at increased risk for developing a new breast cancer, and so routine screening mammography guidelines do not apply to them. These women require annual mammography regardless of age, unless they have undergone a bilateral mastectomy.

We utilized data from Michigan Blue Cross/Blue Shield to evaluate patterns of mammography utilization among women age 40-49 years, comparing rates before versus after 2009, when the USPSTF guideline was published. We analyzed women that had a prior history of breast cancer separately from those that had no history of breast cancer, and we excluded women that underwent bilateral mastectomy.

Disturbingly, we found that mammography utilization rates declined among women with a history of breast cancer as well as among those with no history of breast cancer in the post-2009 timeline.

This suggested to us that changes in screening recommendations may have had the unintended consequence of generating confusion and misunderstandings regarding the value of mammography among women that undeniably benefit from this imaging, such as those with a history of breast cancer.  Continue reading

How Common is Overdiagnosis of Lung Cancer with Low Dose CT Screening?

MedicalResearch.com Interview with:
“CT Scan” by frankieleon is licensed under CC BY 2.0Dr. Bruno Heleno MD PhD

Assistant Professor | Professor Auxiliar
NOVA Medical School | Faculdade de Ciências Médicas
Universidade Nova da Lisboa 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Danish Lung Cancer Screening Trial (DLCST) is a randomized controlled trial which enrolled 4104 participants (aged 50-70 years; current or former smokers; ≥20 pack years; former smokers must have quit <10 years before enrollment) to either 5 rounds of screening for lung cancer with low-dose CT-scans or to no screening.

After 10 years of follow-up, there was a 2.10 percentage points lung cancer absolute risk increase with low-dose CT-screening. Overdiagnosis, i.e. the detection of cancer that would not progress to symptoms or death, was estimated at 67.2% of the screen-detected cancers.

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Effects of Breast Density Notification Laws Vary By State

MedicalResearch.com Interview with:

Michal Horný PhD Assistant Professor Emory University School of Medicine, Department of Radiology and Imaging Sciences Emory University Rollins School of Public Health Department of Health Policy and Management Atlanta, GA 30322

Dr. Horný

Michal Horný PhD
Assistant Professor
Emory University School of Medicine, Department of Radiology and Imaging Sciences
Emory University Rollins School of Public Health
Department of Health Policy and Management
Atlanta, GA 30322

MedicalResearch.com: What is the background for this study?

Response: Increased breast tissue density is a common finding at screening mammography. Approximately 30-50% of women have so-called “dense breasts” but many of them are not aware of it. The problem is that the increased tissue density can potentially mask early cancers. In other words, if there is cancer hiding in dense breast tissue, it could be difficult to spot it.

To improve the awareness of breast tissue density, a patient group called Are You Dense Advocacy, Inc., started lobbying state and federal policymakers to pass laws mandating health care providers to notify women about their breast density assessments. As a result, 31 states have already enacted some form of legislation regarding dense breast tissue.

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Stress Echocardiography vs Coronary CT To Evaluate Chest Pain in ER

MedicalResearch.com Interview with:

Jeffrey M. Levsky, M.D., Ph.D. Associate Professor, Department of Radiology Associate Professor, Department of Medicine (Cardiology) Albert Einstein College of Medicine Montefiore Medical Center 

Dr. Levsky

Jeffrey M. Levsky, M.D., Ph.D.
Associate Professor, Department of Radiology
Associate Professor, Department of Medicine (Cardiology)
Albert Einstein College of Medicine
Montefiore Medical Center

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Millions of Americans are evaluated each year for acute chest pain in the Emergency Department.  There are multiple modalities that can be used to triage these patients and there have only been a few studies comparing different imaging methods.

We chose to study Stress Echocardiography and Coronary CT Angiography, two exams that have not been compared directly in this population.  We found that Stress Echocardiography was able to discharge a higher proportion of patients in a shorter amount of time as compared to Coronary CTA.  Continue reading

Amyloid PET Scan Useful in Memory Evaluation

MedicalResearch.com Interview with:
Arno de Wilde, MD / PhD candidate

Department of Neurology & Alzheimer Center
Amsterdam Neuroscience
VU University Medical Center
Amsterdam, the Netherlands

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous studies assessing the clinical utility of amyloid imaging used very selected research populations, limiting the translatability to clinical practice. In contrast, we used an unselected memory clinic cohort, offering amyloid PET to ALL patients visiting our memory clinic, and for the purpose of this study, we implemented amyloid PET in our routine diagnostic work-up. Our results demonstrate that amyloid PET has important consequences, in terms of diagnosis and treatment changes, for a significant number of patients within a situation that closely resembles clinical practice. I think that these results are an important step in ‘bridging the gap’ between using amyloid PET in a research setting versus daily clinical practice.

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bpMRI Can Be Used to Improve Prostate Cancer Risk

MedicalResearch.com Interview with:

Lars Boesen MD PhD Department of Urology Herlev Gentofte University Hospital Herlev

Dr. Boessen

Dr. Lars Boesen MD PhD
Department of Urology
Herlev Hospital

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: The current standard of care in prostate cancer diagnosis includes untargeted transrectal ultrasound-guided biopsies for all biopsy-naïve men with clinically suspicion of prostate cancer. However, this strategy that practically has remained unchanged for decades has limited diagnostic accuracy as significant cancers are missed or under-graded and insignificant cancers are unintendedly detected by the random sampling leading to possible overtreatment.

Multiparametric MRI in the diagnosis of prostate cancer has been studied extensively in recent years and has improved detection, localization, staging and risk stratification. It has been suggested that if multiparametric MRIs were used as a triage test prior to biopsies, a significant proportion of men might safely avoid prostate biopsies and the diagnostic ratio of significant vs. insignificant cancer could be improved compared to performing standard biopsies in all men. However, multiparametric MRIs are generally time-consuming (~40 min scan time), expensive and include intravenous contrast media. This reduces its feasibility for widespread clinical implementation in larger patient populations in the western community with its high PCa prevalence.

The development of a simpler and faster (~15 min) biparametric MRI protocol using less scan sequences and circumvents intravenous contrast-media seems to preserve adequate diagnostic accuracy in a detection setting and could facilitate dissemination of prostate MRI as a triage test before any biopsy.

Here we present a large prospective study that assesses the diagnostic accuracy of a novel biparametric MRI to rule out significant prostate cancer in N=1020 biopsy-naive men with clinically suspicion of prostate cancer.

We found that a low suspicion biparametric MRI had a very high negative predictive value (97%) for ruling out significant cancer on confirmatory biopsies. Furthermore, bpMRI suspicion scores were strongly associated with prostate cancer detection rates and restricting biopsies (targeted plus standard) to men with suspicious biparametric MRIs meant 30% could avoid prostate biopsies, improved significant prostate cancer diagnosis by 11%, and reduced insignificant prostate cancer diagnosis by 40% compared to our current diagnostic approach – standard biopsies for all men with clinically suspicion of prostate cancer.  Continue reading

Automated Bone Scan Index Correlates with Survival in Metastatic Prostate Cancer

MedicalResearch.com Interview with:

Andrew J. Armstrong, MD ScM FACP Associate Professor of Medicine, Surgery, Pharmacology and Cancer Biology Associate Director for Clinical Research in Genitourinary Oncology Duke Cancer Institute Divisions of Medical Oncology and Urology Duke University

Dr. Armstrong

Andrew J. Armstrong, MD ScM FACP
Associate Professor of Medicine, Surgery, Pharmacology and Cancer Biology
Associate Director for Clinical Research in Genitourinary Oncology
Duke Cancer Institute
Divisions of Medical Oncology and Urology
Duke University

MedicalResearch.com: What is the background for this study? What are the main findings? 

Response: Men with prostate cancer commonly develop bone metastases and undergo nuclear medicine bone scans. However, these scans are non-quantitative, and disease burden has been challenging to assess over time and to relate to clinical outcomes.

We developed a software program and measurement called the automated bone scan index that essentially reads a standard of care nuclear bone scan, provides a quantitative metric, and demonstrate in a phase 3 trial that this aBSI is highly associated with clinical outcomes including survival, time to symptomatic progression, and prostate cancer specific survival.

We accomplished this within a prospective phase 3 international trial of men with metastatic hormone resistant prostate cancer who were followed over a long period of time.  All bone scans were read and measured using the aBSI at baseline, and we found that the aBSI was highly prognostic.  This work validates prior smaller phase 2 BSI studies, and demonstrates both the feasibility and clinical utility for incorporating the aBSI into clinical practice to provide this important prognostic information to patients and providers.

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What’s the Prognosis If You Get Breast Cancer After a Negative Mammogram?

MedicalResearch.com Interview with:

Anne Marie McCarthy, PhD Department of Medicine Massachusetts General Hospital and Harvard Medical School Boston

Dr. McCarthy

Anne Marie McCarthy, PhD
Department of Medicine
Massachusetts General Hospital and Harvard Medical School
Boston

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Mammography is effective in reducing breast cancer mortality. However, it is not perfect, and approximately 15% of breast cancers are diagnosed despite a negative mammogram before the next recommended screening.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Using data from the NCI funded PROSPR (Population-Based Research Optimizing Screening through Personalized Regimens) Consortium, we determined the rates of cancer diagnosis within one year following a negative or positive screening mammogram. The rate of cancer diagnosis within one year of a negative mammogram was small (5.9 per 10,000 screenings), but those cancers were more likely to have poor prognosis than cancers diagnosed after a positive mammogram (43.8% vs. 26.9%). As expected, women with dense breasts were more likely to have cancer diagnosed within 1 year of a negative mammogram. However, breast density was not a good predictor of poor prognosis among women diagnosed with cancer after a negative mammogram. Younger women were more likely to be diagnosed with poor prognosis breast cancer after a negative screening mammogram.

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Digital Breast Tomosynthesis + Synthetic 2D Mammography Detects More Breast Cancers

MedicalResearch.com Interview with:
Dr. Solveig Hofvind, Dr. Philos.
Cancer Registry of Norway
Majorstuen, Oslo

MedicalResearch.com: What is the background for this study?

Response: To test out Digital Breast Tomosynthesis (DBT) in combination with synthethic images (SM) as a screening tool for breast cancer.

We screened the women in Oslo with DBT+SM using equipment from Hologic, while women in the neighboring counties were screened with Digital Mammography.

MedicalResearch.com: What are the main findings? 

Response: We found a 50% higher rate of screen-detected breast cancer among women screened with DBT+SM compared with  Digital Mammography

Both the rate of invasive breast cancer and ductal carcinoma in situ was higher. Tumors detected with DBT+SM were smaller and less aggressive compared to those detected with Digital Mammography.
.
We found no differences in recall rates between the two groups.

MedicalResearch.com: What should readers take away from your report?

Response: Screening with Digital Breast Tomosynthesis and Synthetic 2D Mammography detects more breast cancer as Digital Mammography. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: We need to follow the women for interval breast cancer, but also the rate of screen-detected breast cancer and the characteristics of the tumors in the next screening round. 

MedicalResearch.com: Is there anything else you would like to add?

Response: The pro and cons of implementing Digital Breast Tomosynthesis and Synthetic 2D Mammography in a screening setting need further investigation, according to cost-effectiveness, also in a financial perspective. 

Citations: 

Radiology. 2018 Mar 1:171361. doi: 10.1148/radiol.2018171361. [Epub ahead of print]

Digital Breast Tomosynthesis and Synthetic 2D Mammography versus Digital Mammography: Evaluation in a Population-based Screening Program.

Hofvind S1, Hovda T1, Holen ÅS1, Lee CI1, Albertsen J1, Bjørndal H1, Brandal SHB1, Gullien R1, Lømo J1, Park D1, Romundstad L1, Suhrke P1, Vigeland E1, Skaane P1. 

 

 

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MRI-Guided Prostate Biopsy Improves Precision Diagnosis of Cancer

MedicalResearch.com Interview with:

Veeru Kasivisvanathan MBBS BSc MRCS MSc PGCert Lead for CPD, Division of Surgery and Interventional Science, UCL Academic Section Committee, British Association of Urological Surgeons Twitter: @veerukasi PRECISION Study Coordinator https://clinicaltrials.gov/ct2/show/NCT02380027  

Dr. Kasivisvanathan

Veeru Kasivisvanathan MBBS BSc MRCS MSc PGCert
Lead for CPD, Division of Surgery and Interventional Science, UCL
Academic Section Committee, British Association of Urological Surgeons
Twitter: @veerukasi
PRECISION Study Coordinator
https://clinicaltrials.gov/ct2/show/NCT02380027  

MedicalResearch.com: What is the background for this study? What are the main findings? 

  • We knew that there were limitations in the standard of care pathway for the diagnosis of prostate cancer, TRUS biopsy which missed harmful cancers and over diagnosed harmless cancers.
  • Emerging reports in the literature showed that using an alternative diagnostic pathway, MRI and MRI-targeted biopsy, showed promising prostate cancer detection rates
  • In 2012 we set out in an international working group to design a study that could change clinical practice and replace the standard of care with a pathway involving MRI 

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