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Symer MM, Zheng X, Pua BB, Sedrakyan A, Milsom JW. Contemporary Assessment of Adhesiolysis and Resection for Adhesive Small Bowel Obstruction in the State of New York. Surg Innov 2024:15533506241240580. [PMID: 38498843 DOI: 10.1177/15533506241240580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Adhesive small bowel obstruction (aSBO) is a common surgical problem, with some advocating for a more aggressive operative approach to avoid recurrence. Contemporary outcomes in a real-world setting were examined. STUDY DESIGN A retrospective cohort study was performed using the New York Statewide Planning and Research Cooperative database to identify adults admitted with aSBO, 2016-2020. Patients were stratified by the presence of inflammatory bowel disease (IBD) and cancer history. Diagnoses usually requiring resection were excluded. Patients were categorized into four groups: non-operative, adhesiolysis, resection, and 'other' procedures. In-hospital mortality, major complications, and odds of undergoing resection were compared. RESULTS 58,976 patients were included. 50,000 (84.8%) underwent non-operative management. Adhesiolysis was the most common procedure performed (n = 4,990, 8.46%), followed by resection (n = 3,078, 5.22%). In-hospital mortality in the lysis and resection groups was 2.2% and 5.9% respectively. Non-IBD patients undergoing operation on the day of admission required intestinal resection 29.9% of the time. Adjusted odds of resection were highest for those with a prior aSBO episode (OR 1.29 95%CI 1.11-1.49), delay to operation ≥3 days (OR1.78 95%CI 1.58-1.99), and non-New York City (NYC) residents being treated at NYC hospitals (OR1.57 95%CI 1.19-2.07). CONCLUSION Adhesiolysis is currently the most common surgery for aSBO, however nearly one-third of patients will undergo a more extensive procedure, with an increased risk of mortality. Innovative therapies are needed to reduce the risk of resection.
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Affiliation(s)
- Matthew M Symer
- Department of Surgery, Division of Colon and Rectal Surgery, NYU Long Island School of Medicine, Mineola, NY, USA
| | - Xinyan Zheng
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Bradley B Pua
- Department of Radiology, Division of Vascular and Interventional Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Art Sedrakyan
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Jeffrey W Milsom
- Department of Surgery, Division of Colon and Rectal Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
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Zhu L, Huang J, Jin C, Zhou A, Chen Y, Zhang B, Venuta F, Pua BB, Shen Y. Retrospective cohort study on the correlation analysis among peri-procedural factors, complications, and local tumor progression of lung tumors treated with CT-guided microwave ablation. J Thorac Dis 2023; 15:6915-6927. [PMID: 38249890 PMCID: PMC10797391 DOI: 10.21037/jtd-23-1799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024]
Abstract
Background Despite adherence to guidelines, recurrence of lesions remains possible in lung tumor microwave ablation (MWA) even when termination is enabled by 5-10 mm ground glass changes. Limited evidence exists regarding the correlation between timely management of perioperative complications (including pneumothorax, pleural effusion, hemorrhage, cavity formation, and infection) and local tumor progression. This retrospective study aimed to investigate the relationship among peri-procedural factors, complications, and local tumor progression in 164 cases of lung tumors treated with computed tomography-guided MWA (CT-MWA), and improve the local prognosis and reduce the complication rate of CT-guided lung tumor ablation. Methods We reviewed 164 consecutive patients who underwent CT-MWA at Fudan University Shanghai Cancer Center's Minimally Invasive Therapy Center for lung cancer from September 2019 to May 2020. Correlative analysis was performed between peri-procedural factors, complications and outcomes (local tumor progression rates). Patients who have had prior surgery or previous MWA were excluded. Ablation was the first treatment of choice, and all patients who have had other treatments were excluded. Patients were followed every 3 months with CT. Outcomes of ablation including complications and local tumor progression were evaluated. Peri-procedural factors included demographical factors, tumor features, ablation parameters, management of intra-procedural pneumothorax, and CT features. Complications included pneumothorax, post-procedural refractory infection, and pleural effusion. Results The study included 98 males and 68 females, with an average age of 56.1 years. Local tumor progression rate was negatively correlated with intra-procedural management of pneumothorax (R=-0.550, P=0.0003) and Hounsfield unit (HU) difference between HU before and after procedure (R=-0.855, P=0.006), and positively correlated with the average HU value of immediate post-procedural CT at the measurement points (R=0.857, P=0.00002). The correlation analysis results also showed a positive correlation between infection after procedure and pneumothorax (R=0.340, P=0.0001). Conclusions A greater difference between HU before and after the procedure or a decrease in CT values immediately after ablation may predict a higher rate of local complete ablation. Prompt management of intraoperative pneumothorax may lower local tumor progression rates and decrease incidence of post-procedural infection.
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Affiliation(s)
- Liming Zhu
- Department of Oncology, Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Jiaxi Huang
- Department of Pediatric Cardiothoracic Surgery, Children’s Hospital of Fudan University, Shanghai, China
| | - Chunhui Jin
- Department of Oncology, Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Acheng Zhou
- Department of Oncology, Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Ying Chen
- Department of Oncology, Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Baonan Zhang
- Department of Oncology, Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Wuxi, China
| | - Federico Venuta
- Università di Roma “Sapienza”, Cattedra di Chirurgia Toracica, Policlinico Umberto I, Rome, Italy
| | - Bradley B. Pua
- Division of Interventional Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | - Yehua Shen
- Minimally Invasive Therapy Center, Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Pua BB, O'Neill BC, Ortiz AK, Wu A, D'Angelo D, Cahill M, Groner LK. Results from Lung Cancer Screening Outreach Utilizing a Mobile CT Scanner in an Urban Area. J Am Coll Radiol 2023:S1546-1440(23)00936-5. [PMID: 37984766 DOI: 10.1016/j.jacr.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/20/2023] [Accepted: 10/12/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Lung cancer screening using low-dose (LD) CT reduces lung cancer-specific and all-cause mortality in high-risk individuals, although significant barriers to screening remain. We assessed the outreach of a mobile lung cancer screening program to increase screening accessibility and early detection of lung cancer. METHODS We placed a mobile CT unit in a high-traffic area in New York City and offered free screening to all eligible patients. Characteristics of the mobile screening cohort were compared with those of our hospital-based screening cohort. RESULTS Between December 9, 2019, and January 30, 2020, a total of 216 patients underwent mobile LDCT screening. Compared with the hospital-based screening cohort, mobile screening participants were significantly more likely to be younger, be uninsured, and have lower smoking intensity and were less likely to meet 2013 US Preventive Services Task Force guidelines (but would meet their 2021 guidelines) and self-identify as White race and Hispanic ethnicity. Asian New Yorkers were substantially underrepresented in both hospital and mobile screening cohorts, compared with their level of representation in New York City. Two patients were diagnosed with lung cancer and were treated. Potentially clinically significant non-lung cancer findings were identified in 28.2%, most commonly moderate-severe coronary artery calcification and emphysema. CONCLUSIONS Mobile LDCT screening is useful and effective in detecting lung cancer and other significant findings and may engage a distinct high-risk patient demographic. Disproportionately low screening rates among certain high-risk populations highlight the imperative of implementing strategies aimed at understanding health behaviors and access barriers for diverse populations. Effective care-navigation services, facilitating high-quality care for all patients, are critical.
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Affiliation(s)
- Bradley B Pua
- Division of Interventional Radiology, Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York; Associate Professor of Radiology; Associate Professor of Radiology in Cardiothoracic Surgery; Division Chief, Interventional Radiology; Director, Lung Cancer Screening Program/Radiology Consultation Service.
| | - Brooke C O'Neill
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Ana K Ortiz
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Alan Wu
- Division of Biostatistics, Department of Population Health Sciences, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Debra D'Angelo
- Division of Biostatistics, Department of Population Health Sciences, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Meghan Cahill
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Lauren K Groner
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York; Assistant Professor of Radiology, Division of Cardiothoracic Imaging
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Jiang LG, Cahill M, Chansakul A, Steel PAD, Sullivan D, Pua BB. A Collaborative Emergency Medicine and Radiology Pulmonary Nodule Program: Identification of Associated Efficacy and Outcomes. J Am Coll Radiol 2023; 20:796-803. [PMID: 37422161 DOI: 10.1016/j.jacr.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/13/2023] [Accepted: 04/17/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE Incidental radiologic findings are commonplace, but the episodic nature of emergency department (ED) care makes it challenging to ensure that patients obtain appropriate follow-up. Rates of follow-up range from 30% to 77%, with some studies demonstrating that more than 30% have no follow-up at all. The aim of this study is to describe and analyze the outcomes of a collaborative emergency medicine and radiology initiative to establish a formal workflow for the follow-up of pulmonary nodules identified during ED care. METHODS A retrospective analysis was performed of patients referred to the pulmonary nodule program (PNP). Patients were divided into two categories: those with follow-up and those who do not have post-ED follow-up. The primary outcome was determining follow-up rates and outcomes, including patients referred for biopsy. The characteristics of patients who completed follow-up compared with those lost to follow-up were also examined. RESULTS A total of 574 patients were referred to the PNP. Initial follow-up was established in 390 (69.1%); 30.8% were considered lost to follow-up, and more than half of these patients did not respond to initial contact. There were minimal differences in characteristics between patients in these two categories. Of the 259 patients who completed PNP follow-up, 26 were referred for biopsy (13%). CONCLUSIONS The PNP provided effective transitions of care and potentially improved patient health care. Strategies to further enhance follow-up adherence will provide iterative improvement of the program. The PNP provides an implementation framework for post-ED pulmonary nodule follow-up in other health care systems and can be modified for use with other incidental diagnostic findings.
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Affiliation(s)
- Lynn G Jiang
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York.
| | - Meghan Cahill
- Department of Radiology, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Aisara Chansakul
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Peter A D Steel
- Department of Emergency Medicine, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Deirdre Sullivan
- Department of Radiology, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
| | - Bradley B Pua
- Department of Radiology, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York
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Urakawa S, Holzwanger DJ, Hirashita T, Lowenfeld L, Garrett KA, Pua BB, Milsom JW. Novel percutaneous access to the large intestine using a double-balloon endoluminal platform for excision of a large polyp. Endoscopy 2022; 54:E331-E333. [PMID: 34282589 DOI: 10.1055/a-1516-3533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Shinya Urakawa
- Section of Colon and Rectal Surgery, Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Daniel Joseph Holzwanger
- Department of Interventional Radiology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Teijiro Hirashita
- Section of Colon and Rectal Surgery, Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Lea Lowenfeld
- Section of Colon and Rectal Surgery, Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Kelly A Garrett
- Section of Colon and Rectal Surgery, Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Bradley B Pua
- Department of Interventional Radiology, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
| | - Jeffrey W Milsom
- Section of Colon and Rectal Surgery, Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, New York, USA
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Cramer P, Pua BB. The Latest on Lung Ablation. Semin Intervent Radiol 2022; 39:285-291. [PMID: 36062233 PMCID: PMC9433157 DOI: 10.1055/s-0042-1753526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Lung cancer is the second most common cancer in both men and women. Despite smoking cessation efforts and advances in lung cancer detection and treatment, long-term survival remains low. For early-stage primary lung carcinoma, surgical resection offers the best chance of long-term survival; however, only about one-third of patients are surgical candidates. For nonsurgical candidates, minimally invasive percutaneous thermal ablation therapies have become recognized as safe and effective treatment alternatives, including radiofrequency ablation, microwave ablation, and cryoablation. Lung ablation is also an acceptable treatment for limited oligometastatic and oligorecurrent diseases. This article discusses the technologies and techniques available for tumor ablation of thoracic malignancies, as well as new treatments on the horizon.
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Affiliation(s)
- Peyton Cramer
- Division of Interventional Radiology, Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Bradley B. Pua
- Division of Interventional Radiology, Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
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7
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Wadhwa V, Pua BB, Kadenhe‐Chiweshe AV, Rosenblatt SD. Intralesional Therapies for Vascular Malformations of the Head and Neck. J Oral Pathol Med 2022; 51:844-848. [DOI: 10.1111/jop.13287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Vibhor Wadhwa
- Division of Interventional Radiology Weill Cornell Medicine New York NY USA
| | - Bradley B. Pua
- Division of Interventional Radiology Weill Cornell Medicine New York NY USA
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Blackmon SH, Sterner RM, Eiken PW, Vogl TJ, Pua BB, Port JL, Dupuy DE, Callstrom MR. Technical and safety performance of CT-guided percutaneous microwave ablation for lung tumors: an ablate and resect study. J Thorac Dis 2022; 13:6827-6837. [PMID: 35070367 PMCID: PMC8743408 DOI: 10.21037/jtd-21-594] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022]
Abstract
Background Percutaneous image-guided thermal ablation has an increasing role in the treatment of primary and metastatic lung tumors. Achieving acceptable clinical outcomes requires better tools for pre-procedure prediction of ablation zone size and shape. Methods This was a prospective, non-randomized, single-arm, multicenter study conducted by Medtronic (ClinicalTrials.gov ID: NCT02323854). Subjects scheduled for resection of metastatic or primary lung nodules underwent preoperative percutaneous microwave ablation. Ablation zones as measured via CT imaging following ablation immediately and before resection surgically versus predicted ablation zones as prescribed by the investigational system software were compared. This CT scan occurred after the ablation was finished but the antenna still in position. Time (minutes) from antenna placement to removal was 23.7±13.1 (n=14); median: 21.0 (range, 6.0 to 48.0). The definition of the secondary endpoint of complete ablation was 100% non-viable tumor cells based on nicotinamide adenine dinucleotide hydrogen (NADH) staining. Safety endpoints were type, incidence, and severity of adverse events. Results Fifteen patients (mean age 58.9 years; 67% male; 33% female) were enrolled in the study, 33.3% (5/15) with previous thoracic surgery, 73% (11/15) with metastasis, and 27% (4/15) with primary lung tumors. All underwent percutaneous microwave ablation followed by surgical resection the same day. Complete ablation was detected in 54.4% (6/11), incomplete ablation in 36.4% (4/11), and delayed necrosis in 9.1% (1/11). There were no device-related adverse events. Ablation zone volume was overestimated in all patients. Conclusions Histological complete ablation was observed in 55% of subjects. CT scanning less than an hour after ablation and tissue shrinkage may account for the smaller zone of ablation observed compared to predicted by the investigational system software.
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Affiliation(s)
- Shanda H Blackmon
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Rosalie M Sterner
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - Bradley B Pua
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Jeffrey L Port
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Damian E Dupuy
- Department of Diagnostic Imaging, the Warren Alpert Medical School of Brown University, Providence, RI, USA
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Escalon JG, Sullivan D, Pua BB, Girvin F, Verzosa Weisman S, Steinberger S, Toy D, Groner L, Legasto AC, Gruden JF. Management of Incidental Pulmonary Nodules: Influencing Patient Care Through Subspecialized Imaging Review. Curr Probl Diagn Radiol 2021; 51:524-528. [PMID: 34974882 DOI: 10.1067/j.cpradiol.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/18/2021] [Accepted: 11/07/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate whether thoracic radiologist review of computed tomography-detected incidental pulmonary nodules initially reported by non-thoracic imagers would change management recommendations. MATERIALS AND METHODS The Radiology Consultation Service identified 468 computed tomography scans (one per patient) performed through the adult emergency department from August 2018 through December 2020 that mentioned the presence of a pulmonary nodule. Forty percent (186/468) were read by thoracic radiologists and 60% (282/468) were read by non-thoracic radiologists. The Radiology Consultation Service contacted all patients in order to assess risk factors for lung malignancy. Sixty-seven patients were excluded because they were unreachable, declined participation, or were actively followed by a pulmonologist or oncologist. A thoracic radiologist assessed the nodule and follow up recommendations in all remaining cases. RESULTS A total of 215 cases were re-reviewed by thoracic radiologists. The thoracic radiologist disagreed with the initial nodule recommendations in 38% (82/215) of cases and agreed in 62% (133/215) of cases. All discordant cases resulted in a change in management by the thoracic radiologist with approximately one-third (33%, 27/82) decreasing imaging utilization and two-thirds (67%, 55/82) increasing imaging utilization. Nodules were deemed benign and follow up eliminated in 11% (9/82) of discordant cases. DISCUSSION Our study illustrates that nodule review by thoracic radiologists results in a change in management in a large percentage of patients. Continued research is needed to determine whether subspecialty imaging review results in increased or more timely lung cancer detection.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY.
| | - Deirdre Sullivan
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Bradley B Pua
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Francis Girvin
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | | | - Sharon Steinberger
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Dennis Toy
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Lauren Groner
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Alan C Legasto
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - James F Gruden
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
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10
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Escalon JG, Crawford CB, Tang E, Cahill M, Toy D, Sullivan D, Pua BB. Communication of CT Lung Screening Results: Referring Providers' and Patients' Preferences. J Am Coll Radiol 2021; 18:1447-1450. [PMID: 34252372 DOI: 10.1016/j.jacr.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/09/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Joanna G Escalon
- Cardiothoracic Imaging Fellowship Director, Director of Thoracic MRI, Department of Radiology, New York-Presbyterian/Weill Cornell Medicine, New York, New York.
| | - Carolyn B Crawford
- Department of Radiology, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Eve Tang
- EmblemHealth, New York, New York
| | - Meghan Cahill
- Department of Radiology, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Dennis Toy
- Department of Radiology, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Deirdre Sullivan
- Department of Radiology, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Bradley B Pua
- Director of the Lung Cancer Screen Program, Chief of the Division of Interventional Radiology, Director of the Radiology Consultation Service, Department of Radiology, New York-Presbyterian/Weill Cornell Medicine, New York, New York
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11
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Altorki NK, McGraw TE, Borczuk AC, Saxena A, Port JL, Stiles BM, Lee BE, Sanfilippo NJ, Scheff RJ, Pua BB, Gruden JF, Christos PJ, Spinelli C, Gakuria J, Uppal M, Binder B, Elemento O, Ballman KV, Formenti SC. Neoadjuvant durvalumab with or without stereotactic body radiotherapy in patients with early-stage non-small-cell lung cancer: a single-centre, randomised phase 2 trial. Lancet Oncol 2021; 22:824-835. [PMID: 34015311 DOI: 10.1016/s1470-2045(21)00149-2] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previous phase 2 trials of neoadjuvant anti-PD-1 or anti-PD-L1 monotherapy in patients with early-stage non-small-cell lung cancer have reported major pathological response rates in the range of 15-45%. Evidence suggests that stereotactic body radiotherapy might be a potent immunomodulator in advanced non-small-cell lung cancer (NSCLC). In this trial, we aimed to evaluate the use of stereotactic body radiotherapy in patients with early-stage NSCLC as an immunomodulator to enhance the anti-tumour immune response associated with the anti-PD-L1 antibody durvalumab. METHODS We did a single-centre, open-label, randomised, controlled, phase 2 trial, comparing neoadjuvant durvalumab alone with neoadjuvant durvalumab plus stereotactic radiotherapy in patients with early-stage NSCLC, at NewYork-Presbyterian and Weill Cornell Medical Center (New York, NY, USA). We enrolled patients with potentially resectable early-stage NSCLC (clinical stages I-IIIA as per the 7th edition of the American Joint Committee on Cancer) who were aged 18 years or older with an Eastern Cooperative Oncology Group performance status of 0 or 1. Eligible patients were randomly assigned (1:1) to either neoadjuvant durvalumab monotherapy or neoadjuvant durvalumab plus stereotactic body radiotherapy (8 Gy × 3 fractions), using permuted blocks with varied sizes and no stratification for clinical or molecular variables. Patients, treating physicians, and all study personnel were unmasked to treatment assignment after all patients were randomly assigned. All patients received two cycles of durvalumab 3 weeks apart at a dose of 1·12 g by intravenous infusion over 60 min. Those in the durvalumab plus radiotherapy group also received three consecutive daily fractions of 8 Gy stereotactic body radiotherapy delivered to the primary tumour immediately before the first cycle of durvalumab. Patients without systemic disease progression proceeded to surgical resection. The primary endpoint was major pathological response in the primary tumour. All analyses were done on an intention-to-treat basis. This trial is registered with ClinicalTrial.gov, NCT02904954, and is ongoing but closed to accrual. FINDINGS Between Jan 25, 2017, and Sept 15, 2020, 96 patients were screened and 60 were enrolled and randomly assigned to either the durvalumab monotherapy group (n=30) or the durvalumab plus radiotherapy group (n=30). 26 (87%) of 30 patients in each group had their tumours surgically resected. Major pathological response was observed in two (6·7% [95% CI 0·8-22·1]) of 30 patients in the durvalumab monotherapy group and 16 (53·3% [34·3-71·7]) of 30 patients in the durvalumab plus radiotherapy group. The difference in the major pathological response rates between both groups was significant (crude odds ratio 16·0 [95% CI 3·2-79·6]; p<0·0001). In the 16 patients in the dual therapy group with a major pathological response, eight (50%) had a complete pathological response. The second cycle of durvalumab was withheld in three (10%) of 30 patients in the dual therapy group due to immune-related adverse events (grade 3 hepatitis, grade 2 pancreatitis, and grade 3 fatigue and thrombocytopaenia). Grade 3-4 adverse events occurred in five (17%) of 30 patients in the durvalumab monotherapy group and six (20%) of 30 patients in the durvalumab plus radiotherapy group. The most frequent grade 3-4 events were hyponatraemia (three [10%] patients in the durvalumab monotherapy group) and hyperlipasaemia (three [10%] patients in the durvalumab plus radiotherapy group). Two patients in each group had serious adverse events (pulmonary embolism [n=1] and stroke [n=1] in the durvalumab monotherapy group, and pancreatitis [n=1] and fatigue [n=1] in the durvalumab plus radiotherapy group). No treatment-related deaths or deaths within 30 days of surgery were reported. INTERPRETATION Neoadjuvant durvalumab combined with stereotactic body radiotherapy is well tolerated, safe, and associated with a high major pathological response rate. This neoadjuvant strategy should be validated in a larger trial. FUNDING AstraZeneca.
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Affiliation(s)
- Nasser K Altorki
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA.
| | - Timothy E McGraw
- Department of Biochemistry, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Alain C Borczuk
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Ashish Saxena
- Division of Hematology Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Jeffrey L Port
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Brendon M Stiles
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Benjamin E Lee
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Nicholas J Sanfilippo
- Department of Radiation Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Ronald J Scheff
- Division of Hematology Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Bradley B Pua
- Department of Radiology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - James F Gruden
- Department of Radiology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Paul J Christos
- Department of Population Health Sciences, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Cathy Spinelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Joyce Gakuria
- Department of Cardiothoracic Surgery, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Manik Uppal
- Department of Physiology and Biophysics, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Bhavneet Binder
- Department of Physiology and Biophysics, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Olivier Elemento
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Karla V Ballman
- Department of Population Health Sciences, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | - Silvia C Formenti
- Department of Radiation Oncology, Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
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12
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Lee KS, Talenfeld AD, Browne WF, Holzwanger DJ, Harnain C, Kesselman A, Pua BB. Role of interventional radiology in the treatment of COVID-19 patients: Early experience from an epicenter. Clin Imaging 2020; 71:143-146. [PMID: 33259979 PMCID: PMC7642741 DOI: 10.1016/j.clinimag.2020.10.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To highlight the role of interventional radiology (IR) in the treatment of patients hospitalized with coronavirus disease 2019 (COVID-19). METHODS Retrospective review of hospitalized patients who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and had one or more IR procedures at a tertiary referral hospital in New York City during a 6-week period in April and May of 2020. RESULTS Of the 724 patients admitted with COVID-19, 92 (12.7%) underwent 124 interventional radiology procedures (79.8% in IR suite, 20.2% at bedside). The median age of IR patients was 63 years (range 24-86 years); 39.1% were female; 35.9% in the intensive care unit. The most commonly performed IR procedures were central venous catheter placement (31.5%), inferior vena cava filter placement (9.7%), angiography/embolization (4.8%), gastrostomy tube placement (9.7%), image-guided biopsy (10.5%), abscess drainage (9.7%), and cholecystostomy tube placement (6.5%). Thoracentesis/chest tube placement and nephrostomy tube placement were also performed as well as catheter-directed thrombolysis of massive pulmonary embolism and thrombectomy of deep vein thrombosis. General anesthesia (10.5%), monitored anesthesia care (18.5%), moderate sedation (29.8%), or local anesthetic (41.1%) was utilized. There were 3 (2.4%) minor complications (SIR adverse event class B), 1 (0.8%) major complication (class C), and no procedure-related death. With a median follow-up of 4.3 months, 1.1% of patients remain hospitalized, 16.3% died, and 82.6% were discharged. CONCLUSION Interventional radiology participated in the care of hospitalized COVID-19 patients by performing a wide variety of necessary procedures.
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Affiliation(s)
- Kyungmouk Steve Lee
- Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY 10065, United States of America.
| | - Adam D Talenfeld
- Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY 10065, United States of America.
| | - William F Browne
- Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY 10065, United States of America.
| | - Daniel J Holzwanger
- Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY 10065, United States of America.
| | - Christopher Harnain
- Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY 10065, United States of America.
| | - Andrew Kesselman
- Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY 10065, United States of America.
| | - Bradley B Pua
- Department of Radiology, Weill Cornell Medicine, 525 East 68th Street, Box 141, New York, NY 10065, United States of America.
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13
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Kesselman A, Lamparello NA, Malhotra A, Winokur RS, Pua BB. Endovascular simulation as a supplemental training tool during the COVID-19 national emergency. Clin Imaging 2020; 67:72-73. [PMID: 32526661 PMCID: PMC7833009 DOI: 10.1016/j.clinimag.2020.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/15/2020] [Accepted: 05/27/2020] [Indexed: 11/22/2022]
Abstract
The ongoing COVID pandemic raises many concerns as our healthcare system is pushed to its limits and as a consequence, Interventional Radiology training may be compromised. Endovascular simulators allow trainees many benefits to build and maintain endovascular skills in a safe environment. Our experience demonstrates a methodology to maintain IR training with use of didactic and simulation supplementation during the COVID-19 pandemic, which may be helpful for incorporation at other institutions facing similar challenges.
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Affiliation(s)
- Andrew Kesselman
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, United States of America.
| | - Nicole A Lamparello
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, United States of America
| | - Anuj Malhotra
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, United States of America
| | - Ronald S Winokur
- Department of Radiology, Division of Interventional Radiology, Thomas Jefferson University Hospital, United States of America
| | - Bradley B Pua
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, United States of America
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14
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Lamparello NA, Choi S, Charalel R, Lee KS, Kesselman A, Scherer K, Harnain CM, Browne WF, Shiffman M, Holzwanger DJ, Pua BB. Transforming Positive Pressure IR Suites to Treat COVID-19 Patients. J Vasc Interv Radiol 2020; 31:1496-1499. [PMID: 32747141 PMCID: PMC7324314 DOI: 10.1016/j.jvir.2020.06.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023] Open
Affiliation(s)
- Nicole A Lamparello
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - Sarah Choi
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - Resmi Charalel
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065; Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Kyungmouk Steve Lee
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - Andrew Kesselman
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - Kimberly Scherer
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - Christopher M Harnain
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - William F Browne
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - Marc Shiffman
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - Daniel J Holzwanger
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
| | - Bradley B Pua
- Department of Radiology, Division of Interventional Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, 525 E. 68th St., Payson Pavilion 512, New York, NY 10065
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15
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Callstrom MR, Woodrum DA, Nichols FC, Palussiere J, Buy X, Suh RD, Abtin FG, Pua BB, Madoff DC, Bagla SL, Papadouris DC, Fernando HC, Dupuy DE, Healey TT, Moore WH, Bilfinger TV, Solomon SB, Yarmohammadi H, Krebs HJ, Fulp CJ, Hakime A, Tselikas L, de Baere T. Multicenter Study of Metastatic Lung Tumors Targeted by Interventional Cryoablation Evaluation (SOLSTICE). J Thorac Oncol 2020; 15:1200-1209. [PMID: 32151777 DOI: 10.1016/j.jtho.2020.02.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the safety and local recurrence-free survival in patients after cryoablation for treatment of pulmonary metastases. METHODS This multicenter, prospective, single-arm, phase 2 study included 128 patients with 224 lung metastases treated with percutaneous cryoablation, with 12 and 24 months of follow-up. The patients were enrolled on the basis of the outlined key inclusion criteria, which include one to six metastases from extrapulmonary cancers with a maximal diameter of 3.5 cm. Time to progression of the index tumor(s), metastatic disease, and overall survival rates were estimated using the Kaplan-Meier method. Complications were captured for 30 days after the procedure, and changes in performance status and quality of life were also evaluated. RESULTS Median size of metastases was 1.0 plus or minus 0.6 cm (0.2-4.5) with a median number of tumors of 1.0 plus or minus 1.2 cm (one to six). Local recurrence-free response (local tumor efficacy) of the treated tumor was 172 of 202 (85.1%) at 12 months and 139 of 180 (77.2%) at 24 months after the initial treatment. After a second cryoablation treatment for recurrent tumor, secondary local recurrence-free response (local tumor efficacy) was 184 of 202 (91.1%) at 12 months and 152 of 180 (84.4%) at 24 months. Kaplan-Meier estimates of 12- and 24-month overall survival rates were 97.6% (95% confidence interval: 92.6-99.2) and 86.6% (95% confidence interval: 78.7-91.7), respectively. Rate of pneumothorax that required pleural catheter placement was 26% (44/169). There were eight grade 3 complication events in 169 procedures (4.7%) and one (0.6%) grade 4 event. CONCLUSION Percutaneous cryoablation is a safe and effective treatment for pulmonary metastases.
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Affiliation(s)
| | | | | | - Jean Palussiere
- Department of Interventional Radiology, Institut Bergonie, Bordeaux, France
| | - Xavier Buy
- Department of Interventional Radiology, Institut Bergonie, Bordeaux, France
| | - Robert D Suh
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Fereidoun G Abtin
- Department of Radiological Sciences, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Bradley B Pua
- Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - David C Madoff
- Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | - Sandeep L Bagla
- Cardiovascular and Interventional Radiology Department, Inova Alexandria Hospital, Alexandria, Virginia
| | - Dimitrios C Papadouris
- Cardiovascular and Interventional Radiology Department, Inova Alexandria Hospital, Alexandria, Virginia
| | - Hiran C Fernando
- Department of Surgery, Inova Alexandria Hospital, Alexandria, Virginia
| | - Damian E Dupuy
- Department of Diagnostic Imaging, Alpert Medical School at Brown University, Providence, Rhode Island
| | - Terrance T Healey
- Department of Diagnostic Imaging, Alpert Medical School at Brown University, Providence, Rhode Island
| | - William H Moore
- Departments of Radiology and Surgery, State University of New York at Stony Brook, University Hospital, Stony Brook, New York
| | - Thomas V Bilfinger
- Departments of Radiology and Surgery, State University of New York at Stony Brook, University Hospital, Stony Brook, New York
| | - Stephen B Solomon
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Hooman Yarmohammadi
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Henry J Krebs
- Department of Radiology, Cancer Treatment Centers of America, Atlanta, Georgia
| | - Charles J Fulp
- Department of Radiology, Cancer Treatment Centers of America, Atlanta, Georgia
| | - Antoine Hakime
- Department of Interventional Radiology, Gustave Roussy-Cancer Campus, Villejuif, France
| | - Lambros Tselikas
- Department of Interventional Radiology, Gustave Roussy-Cancer Campus, Villejuif, France
| | - Thierry de Baere
- Department of Interventional Radiology, Gustave Roussy-Cancer Campus, Villejuif, France
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16
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Abstract
Percutaneous ablation can deliver effective anticancer therapy with minimal side effects; however, undertreatment can lead to disease recurrence and overtreatment can lead to unnecessary complications. Ablation planning software can support the procedure during the planning, treatment, and follow-up phases. In this review, 2 examples of microwave ablation software are described with attention to how the software can influence procedural choices. In the future, ablation software will entail larger source datasets and more refined algorithms to better model the in vivo ablation zone. Moreover, ablation simulation has the potential to augment clinical care beyond the interventional suite, such as procedural demonstration for patients, clinical consultation with referring providers, documentation for the medical record, and educational simulation for trainees.
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Affiliation(s)
- Gray R Lyons
- Department of Radiology, Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY
| | - Bradley B Pua
- Department of Radiology, Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY.
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17
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Cornman-Homonoff J, Miller ZA, Smirniotopoulos J, May BJ, Winokur RS, Pua BB, Schiffman MH. Preoperative Percutaneous Microwave Ablation of Long Bone Metastases Using a Parallel Medullary Approach for Reduction of Operative Blood Loss. J Vasc Interv Radiol 2018. [PMID: 28645506 DOI: 10.1016/j.jvir.2017.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Joshua Cornman-Homonoff
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 E. 68th St., Box 141, New York, NY 10065
| | - Zoe A Miller
- Department of Interventional Radiology, University of Miami Miller School of Medicine, Miami, Florida
| | - John Smirniotopoulos
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 E. 68th St., Box 141, New York, NY 10065
| | - Benjamin J May
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 E. 68th St., Box 141, New York, NY 10065; Division of Interventional Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 E. 68th St., Box 141, New York, NY 10065
| | - Ronald S Winokur
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 E. 68th St., Box 141, New York, NY 10065; Division of Interventional Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 E. 68th St., Box 141, New York, NY 10065
| | - Bradley B Pua
- Division of Interventional Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 E. 68th St., Box 141, New York, NY 10065
| | - Marc H Schiffman
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 E. 68th St., Box 141, New York, NY 10065
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18
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Jo JE, Tang EY, Pua BB. The role of antibiotics in preventing totally implantable venous access device (TIVAD) infections; is there a population that would benefit? Clin Imaging 2018; 51:213-216. [PMID: 29864730 DOI: 10.1016/j.clinimag.2018.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/02/2018] [Accepted: 05/21/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess the role for prophylactic antibiotics in preventing totally implantable venous access device (TIVAD) infections and identify populations that may benefit from antibiotics. METHODS 1284 patients undergoing TIVAD placement were retrospectively reviewed to determine association between infection rate, prophylactic antibiotics, and clinical data including white blood cell (WBC) count, platelets, and coagulation profile. Patients were further sub-categorized based on hospital admission status and leukopenia. Patients who received antibiotics were compared to those who did not using chi-square test or Fisher's exact tests and Student's t-tests. Additionally, multivariable logistic regression analysis was used to determine factors associated with infections. RESULTS A total of 7 infections were identified with an infection rate of 0.5%. 1010 patients received antibiotics (78.7%), and infection rate in these patients was 0.7% compared to 0% in patients who did not receive antibiotics. 21 patients were under the age of 18, eight of which received antibiotics. No infections occurred in the pediatric group. Upon multivariate analysis, developing TIVAD infection was significantly associated with inpatient placement (p < 0.0001, OR 29.1, 95% CI 3.1-272.1), while utilization of double lumen ports was not (OR 3.0, 95% CI 0.5-17.4). There were no significant associations between infections and antibiotic use (p = 0.36), leukopenia (p = 0.47), pediatric patients (p = 1) or other demographic or laboratory data. CONCLUSION Routine use of prophylactic antibiotics with TIVAD placement should be avoided. Antibiotics may not benefit even those with greater risk for infection.
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Affiliation(s)
- Jonathan E Jo
- Department of Interventional Radiology, New York-Presbyterian Hospital, Weill Cornell Medical College, 1305 York Avenue, 3rd Floor, New York, NY 10021, United States.
| | - Eve Y Tang
- Department of Interventional Radiology, New York-Presbyterian Hospital, Weill Cornell Medical College, 1305 York Avenue, 3rd Floor, New York, NY 10021, United States.
| | - Bradley B Pua
- Division of Interventional Radiology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, 525 E 68th Street, Payson 521, New York, NY 10065, United States.
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19
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Lyons GR, Askin G, Pua BB. Clinical Outcomes after Pulmonary Cryoablation with the Use of a Triple Freeze Protocol. J Vasc Interv Radiol 2018; 29:714-721. [DOI: 10.1016/j.jvir.2017.12.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 12/18/2017] [Accepted: 12/31/2017] [Indexed: 12/12/2022] Open
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20
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Suresh S, Salama GR, Ramjit A, Mahfoud Z, Lee KS, Pua BB. CT-Guided Fine-Needle Aspiration Biopsy of Pulmonary Nodules 8 mm or Less Has a Higher Diagnostic Accuracy than Positron Emission Tomography–CT. J Vasc Interv Radiol 2018; 29:520-523. [DOI: 10.1016/j.jvir.2017.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/07/2017] [Accepted: 10/07/2017] [Indexed: 11/30/2022] Open
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21
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Sailer V, Schiffman MH, Kossai M, Cyrta J, Beg S, Sullivan B, Pua BB, Lee KS, Talenfeld AD, Nanus DM, Tagawa ST, Robinson BD, Rao RA, Pauli C, Bareja R, Beltran LS, Sigaras A, Eng KW, Elemento O, Sboner A, Rubin MA, Beltran H, Mosquera JM. Bone biopsy protocol for advanced prostate cancer in the era of precision medicine. Cancer 2017; 124:1008-1015. [PMID: 29266381 DOI: 10.1002/cncr.31173] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/07/2017] [Accepted: 11/10/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Metastatic biopsies are increasingly being performed in patients with advanced prostate cancer to search for actionable targets and/or to identify emerging resistance mechanisms. Due to a predominance of bone metastases and their sclerotic nature, obtaining sufficient tissue for clinical and genomic studies is challenging. METHODS Patients with prostate cancer bone metastases were enrolled between February 2013 and March 2017 on an institutional review board-approved protocol for prospective image-guided bone biopsy. Bone biopsies and blood clots were collected fresh. Compact bone was subjected to formalin with a decalcifying agent for diagnosis; bone marrow and blood clots were frozen in optimum cutting temperature formulation for next-generation sequencing. Frozen slides were cut from optimum cutting temperature cryomolds and evaluated for tumor histology and purity. Tissue was macrodissected for DNA and RNA extraction, and whole-exome sequencing and RNA sequencing were performed. RESULTS Seventy bone biopsies from 64 patients were performed. Diagnostic material confirming prostate cancer was successful in 60 of 70 cases (85.7%). The median DNA/RNA yield was 25.5 ng/μL and 16.2 ng/μL, respectively. Whole-exome sequencing was performed successfully in 49 of 60 cases (81.7%), with additional RNA sequencing performed in 20 of 60 cases (33.3%). Recurrent alterations were as expected, including those involving the AR, PTEN, TP53, BRCA2, and SPOP genes. CONCLUSIONS This prostate cancer bone biopsy protocol ensures a valuable source for high-quality DNA and RNA for tumor sequencing and may be used to detect actionable alterations and resistance mechanisms in patients with bone metastases. Cancer 2018;124:1008-15. © 2017 American Cancer Society.
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Affiliation(s)
- Verena Sailer
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.,Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York Presbyterian, New York, New York
| | - Marc H Schiffman
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Myriam Kossai
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.,Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York Presbyterian, New York, New York
| | - Joanna Cyrta
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.,Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York Presbyterian, New York, New York
| | - Shaham Beg
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.,Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York Presbyterian, New York, New York
| | - Brian Sullivan
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - Bradley B Pua
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | | | - Adam D Talenfeld
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | - David M Nanus
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian, New York, New York.,Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Scott T Tagawa
- Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian, New York, New York.,Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Brian D Robinson
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.,Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York Presbyterian, New York, New York
| | - Rema A Rao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.,Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York Presbyterian, New York, New York
| | - Chantal Pauli
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.,Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York Presbyterian, New York, New York
| | - Rohan Bareja
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York Presbyterian, New York, New York.,Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Luis S Beltran
- Department of Radiology, NYU Langone Medical Center, New York, New York
| | - Alexandros Sigaras
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York Presbyterian, New York, New York
| | - Kenneth Wa Eng
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York Presbyterian, New York, New York.,Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian, New York, New York.,Department of Physiology and Biophysics, Weill Cornell Medicine, New York, New York
| | - Olivier Elemento
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.,Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York Presbyterian, New York, New York.,Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York.,Department of Physiology and Biophysics, Weill Cornell Medicine, New York, New York
| | - Andrea Sboner
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.,Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York Presbyterian, New York, New York.,Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Mark A Rubin
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.,Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York Presbyterian, New York, New York.,Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian, New York, New York
| | - Himisha Beltran
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York Presbyterian, New York, New York.,Sandra and Edward Meyer Cancer Center, Weill Cornell Medicine and New York Presbyterian, New York, New York.,Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Juan Miguel Mosquera
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.,Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine and New York Presbyterian, New York, New York
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Pua BB, Muhs BE, Maldonado T, Ben-Arie E, Sheehan P, Gagne PJ. Total-Contact Casting as an Adjunct to Promote Healing of Pressure Ulcers in Amputees. Vasc Endovascular Surg 2016; 40:135-40. [PMID: 16598362 DOI: 10.1177/153857440604000208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Partial foot amputations have become increasingly prevalent among long-lived diabetic patients. These patients have lower extremity neuropathy and are prone to ulceration at their amputation site. These ulcers are difficult to heal, and they place a significant financial and resource burden on the healthcare system. We examined the efficacy of total-contact casts (TCC) in diabetic amputees with nonhealing partial foot amputation site neuropathic ulcers. Data were collected retrospectively on all patients with amputations who were treated with a total-contact cast between December 2000 and December 2003. Seventeen patients (13 men, 4 women) with amputation site ulceration were identified. All patients were diagnosed with neuropathy secondary to diabetes and none had wound healing compromised by ischemia. The initial ulcer averaged 1,169 mm2 with a depth of 2.77 mm. Patients were treated with an average of 7.9 cast applications over 8.4 weeks; 47% (8/17) of ulcers healed, but 29% (5/17) of patients were unable to complete their recommended treatment course secondary to complications from the TCC. Of the patients who were able to complete their treatment course, the healing rate was 66.7% (8/12). The recurrence rate for healed ulcers was 63% (5/8). Partial foot amputations with neuropathic ulcers present a very difficult problem to the vascular surgeon. Patient compliance and underlying medical comorbidities limit the success rate. In patients who can complete a TCC treatment course, good short term results can be expected. However, recurrence rates are high following discontinuation of mechanical TCC off-loading.
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Affiliation(s)
- Bradley B Pua
- Department of Surgery, New York University School of Medicine, New York, NY 10016, USA
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Pua BB. Redefining radiology through clinical imaging. Clin Imaging 2016; 40:275. [DOI: 10.1016/j.clinimag.2016.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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24
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Chetlen AL, Mendiratta-Lala M, Probyn L, Auffermann WF, DeBenedectis CM, Marko J, Pua BB, Sato TS, Little BP, Dell CM, Sarkany D, Gettle LM. Conventional Medical Education and the History of Simulation in Radiology. Acad Radiol 2015; 22:1252-67. [PMID: 26276167 DOI: 10.1016/j.acra.2015.07.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 05/29/2015] [Accepted: 07/08/2015] [Indexed: 01/22/2023]
Abstract
Simulation is a promising method for improving clinician performance, enhancing team training, increasing patient safety, and preventing errors. Training scenarios to enrich medical student and resident education, and apply toward competency assessment, recertification, and credentialing are important applications of simulation in radiology. This review will describe simulation training for procedural skills, interpretive and noninterpretive skills, team-based training and crisis management, professionalism and communication skills, as well as hybrid and in situ applications of simulation training. A brief overview of current simulation equipment and software and the barriers and strategies for implementation are described. Finally, methods of measuring competency and assessment are described, so that the interested reader can successfully implement simulation training into their practice.
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25
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Winokur RS, Du JY, Pua BB, Talenfeld AD, Sista AK, Schiffman MA, Trost DW, Madoff DC. Characterization of In Vivo Ablation Zones Following Percutaneous Microwave Ablation of the Liver with Two Commercially Available Devices: Are Manufacturer Published Reference Values Useful? J Vasc Interv Radiol 2014; 25:1939-1946.e1. [DOI: 10.1016/j.jvir.2014.08.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/04/2014] [Accepted: 08/13/2014] [Indexed: 12/22/2022] Open
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26
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Tang ER, Schreiner AM, Pua BB. Advances in lung adenocarcinoma classification: a summary of the new international multidisciplinary classification system (IASLC/ATS/ERS). J Thorac Dis 2014; 6:S489-501. [PMID: 25349701 DOI: 10.3978/j.issn.2072-1439.2014.09.12] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 08/26/2014] [Indexed: 11/14/2022]
Abstract
Due to advances in the understanding of lung adenocarcinoma since the advent of its 2004 World Health System classification, an international multidisciplinary panel [sponsored by the International Association for the Study of Lung Cancer (IASLC), American Thoracic Society (ATS), and European Respiratory Society (ERS)] has recently updated the classification system for lung adenocarcinoma, the most common histologic type of lung cancer. Here, we summarize and highlight the new criteria and terminology, certain aspects of its clinical relevance and its potential treatment impact, and future avenues of research related to the new system.
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Affiliation(s)
- Elizabeth R Tang
- 1 Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA ; 2 Department of Pathology, 3 Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Andrew M Schreiner
- 1 Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA ; 2 Department of Pathology, 3 Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
| | - Bradley B Pua
- 1 Department of Radiology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, USA ; 2 Department of Pathology, 3 Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, 525 East 68th Street, New York, NY 10065, USA
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27
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Abstract
Combination of minimally invasive treatment modalities is being increasingly utilized to improve local tumor control and overall survival. In the liver, the combination of embolization and ablation results in equivalent overall survival and intrahepatic disease progression as surgical resection for lesions smaller than 7 cm. Ablation alone for small renal masses up to 4 cm results in excellent local tumor control and lack of residual enhancement to suggest viable tumor. A small number of studies have been performed combining embolization and ablation, which result in high rates of local tumor control for tumors smaller than 5 cm. Based on this small cohort, combined embolization and ablation may be most indicated for central or mixed tumors where ablation alone suffers from the greatest degree of "heat sink" effect. This article reviews the theory, methods, and outcomes of combining percutaneous ablative and embolic modalities in the treatment of renal masses.
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Affiliation(s)
- Ronald S Winokur
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - Bradley B Pua
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - David C Madoff
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
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28
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Abstract
Palliative care aims to optimize comfort and function when cure is not possible. Image-guided interventions for palliative treatment of lung cancer is aimed at local control of advanced disease in the affected lung, adjacent mediastinal structures, or distant metastatic sites. These procedures include endovascular therapy for superior vena cava syndrome, bronchial artery embolization for hemoptysis associated with lung cancer, and ablation of osseous metastasis. Pathophysiology, clinical presentation, indications of these palliative treatments, procedural techniques, complications, and possible future interventions are discussed in this article.
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Affiliation(s)
- Emi Masuda
- Division of Interventional Radiology, Department of Radiology, New York Presbyterian - Weill Cornell Medical College, New York, New York
| | - Akhilesh K Sista
- Division of Interventional Radiology, Department of Radiology, New York Presbyterian - Weill Cornell Medical College, New York, New York
| | - Bradley B Pua
- Division of Interventional Radiology, Department of Radiology, New York Presbyterian - Weill Cornell Medical College, New York, New York
| | - David C Madoff
- Division of Interventional Radiology, Department of Radiology, New York Presbyterian - Weill Cornell Medical College, New York, New York
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29
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Abstract
Access route considerations in percutaneous intrathoracic biopsy or ablation offers its own unique set of challenges, with special consideration toward reducing the rate of pneumothorax. This review highlights several novel and atypical methods to improve access to intrathoracic lesions through a series of representative cases. These methods include patient positioning, curved needles, hydrodissection, induced/artificial pneumothorax, and use of specialized equipment functions. No intrathoracic lesion should be considered "inaccessible" either for biopsy or treatment by percutaneous approaches without consideration of performing these adjunctive techniques.
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Affiliation(s)
- Bradley B Pua
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - David Li
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - Brian W Sullivan
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - David C Madoff
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
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30
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Abstract
Computed tomography-guided percutaneous needle biopsy of the lung is an indispensable tool in the evaluation of pulmonary abnormalities due to its high diagnostic accuracy in the detection of malignancy. Percutaneous biopsy in the lung plays a critical role in obtaining pathologic proof of malignancy, guiding staging and planning treatment. This article reviews biopsy techniques and their related efficacy and complications.
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Affiliation(s)
- Ronald S Winokur
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - Bradley B Pua
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - Brian W Sullivan
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
| | - David C Madoff
- Division of Interventional Radiology, Weill Cornell Medical College, New York, New York
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31
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Abstract
Renal arterial embolization (RAE) performed for the treatment of renal masses has been proven to be a safe and effective technique, with several decades of experience. RAE is well tolerated with few complications, particularly if the time interval from embolization to surgery is reduced to less than 48 hours. Review of the literature suggests that RAE is also extremely effective for palliation of symptoms in the setting of nonoperative advanced stage renal cell carcinoma. In addition, this technique plays a large role in the management of angiomyolipomas that are symptomatic or at risk of spontaneous rupture. To date, RAE has not been evaluated in a randomized controlled setting, which has contributed to its underutilization. All of these potential benefits warrant the need for prospective studies for further validation.
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Affiliation(s)
- David Li
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
| | - Bradley B Pua
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
| | - David C Madoff
- Division of Interventional Radiology, Department of Radiology, Weill Cornell Medical College, New York, New York
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32
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Abstract
Incidence and mortality trends attributed to kidney cancer exhibit marked regional variability, likely related to demographic, environmental, and genetic factors. Efforts to identify reversible factors, which lead to the development of renal cell carcinoma (RCC), have led not only to a greater understanding of the etiology of RCC but also the genetic and histologic characteristics of renal tumors. This article describes this evolution by discussing contemporary RCC incidence and mortality data, the risk factors for development of RCC, the histologic features, and anatomic and integrated staging systems that guide treatment.
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Affiliation(s)
- Carole A Ridge
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Bradley B Pua
- Division of Interventional Radiology, Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - David C Madoff
- Division of Interventional Radiology, Department of Radiology, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York
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33
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Lee KS, Pua BB. Alternative to surgery in early stage NSCLC-interventional radiologic approaches. Transl Lung Cancer Res 2013; 2:340-53. [PMID: 25806253 DOI: 10.3978/j.issn.2218-6751.2013.10.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/24/2013] [Indexed: 12/22/2022]
Abstract
Interventional radiologists have a variety of techniques in their armamentarium to treat pulmonary tumors. While most therapies are targeted to metastasis or palliation, percutaneous thermal ablation represents a potential therapy for not only palliation, but to treat inoperable early stage disease. Although radiofrequency ablation (RFA) is the most studied of these ablative techniques, newer technologies of thermal ablation, such as microwave and cryoablation have emerged as additional options. In this article, we will review the three different thermal ablative modalities, including patient selection, technique, outcomes, complications, and imaging follow-up. A brief discussion of state of the art techniques such as irreversible electroporation (IRE) and catheter directed therapies will also be included.
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Affiliation(s)
- Kyungmouk Steve Lee
- Division of Interventional Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10065, USA
| | - Bradley B Pua
- Division of Interventional Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10065, USA
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34
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Pua BB, Mir DI, Gulati CM, Madoff DC. Transbronchial treatment of a bleeding pulmonary mycetoma refractory to arterial embolization. J Vasc Interv Radiol 2013; 24:1583-5. [PMID: 24070516 DOI: 10.1016/j.jvir.2013.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 06/05/2013] [Accepted: 06/06/2013] [Indexed: 10/26/2022] Open
Affiliation(s)
- Bradley B Pua
- Department of Radiology (B.B.P., D.I.M., D.C.M.) Division of Interventional Radiology
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35
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Abstract
A large number of adrenal tumors are now identified either incidentally or associated with a metastatic workup for cancer. While the vast majority of these lesions are benign, those that prove to be primary or secondary cancers are traditionally treated with surgical resection. A wide variety of alternative, less invasive therapies exist. One of these, thermal ablation, is examined herein.
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Affiliation(s)
- Bradley B Pua
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York 10021, USA
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36
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37
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Pua BB, Thornton RH, Solomon SB. Ablation of pulmonary malignancy: current status. J Vasc Interv Radiol 2010; 21:S223-32. [PMID: 20656232 DOI: 10.1016/j.jvir.2010.01.049] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 12/05/2009] [Accepted: 01/19/2010] [Indexed: 12/26/2022] Open
Abstract
Since the first reported use of radiofrequency ablation of the lung in 2000, the field of image-guided lung ablation has received a considerable amount of attention. Survival studies have demonstrated the potential utility of thermal ablation in the treatment of patients with early-stage primary and limited secondary pulmonary tumors with promising results. Diagnostic imaging studies have advanced the understanding of the expected immediate postablation appearance of treated lesions, leading the way for early detection of local tumor progression. These survival studies and the expected imaging follow-up of these patients are reviewed herein.
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Affiliation(s)
- Bradley B Pua
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, H-118, New York, NY 10021, USA
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38
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Abstract
Surgical resection remains the ideal treatment for hepatocellular carcinoma and metastasis to the liver. Many alternatives are available for treatment of nonsurgical candidates. Regardless of treatment, optimizing imaging in the pretreatment, treatment and post-treatment settings is critical in order to lower the rates of local tumor progression and maximize the effectiveness of treatment that may result in prolonged survival. This article summarizes some basic imaging techniques of primary and metastatic liver tumors with a focus on how to optimize their treatment with ablation.
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39
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Abstract
Radiofrequency ablation is an accepted method of therapy for unresectable liver cancer. Most recently, interest in using this technology for treatment of primary and metastatic lung tumors has increased. Early animal studies have led to numerous human trials that suggest that radiofrequency ablation can play a major role in treatment of both early-stage primary lung cancer and metastatic lesions. Technical aspects of this therapy as well as areas of further research are discussed.
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Affiliation(s)
- Bradley B Pua
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, H-118, New York, NY 10021, USA
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40
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Pua BB, Muhs BE, Parikh MS, Cayne N, Lamparello PJ. Interval gangrene complicating superficial femoral artery stent placement. J Vasc Surg 2005; 42:564-6. [PMID: 16171608 DOI: 10.1016/j.jvs.2005.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2005] [Accepted: 04/06/2005] [Indexed: 10/25/2022]
Abstract
Interval gangrene-necrosis of tissue proximal to a successful distal revascularization procedure-is an exceeding rare complication. To date, only nine cases have been reported in the literature, and all were secondary to traditional open bypass procedures. We report the first case, to our knowledge, of interval gangrene after endovascular stent placement in the superficial femoral artery. We believe that with the increasing utilization of endovascular techniques to treat limb ischemia, the serious complication of interval gangrene must be revisited. Assessment of collateral circulation, precise stent placement, and the appropriate choice of stents and stent grafts will become increasing important as more and more of these lesions are treated with endovascular techniques.
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Affiliation(s)
- Bradley B Pua
- Department of Surgery, New York University School of Medicine, 10016, USA
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41
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Pua BB, Muhs BE, Cayne NS, Dobryansky M, Jacobowitz GR. Bilateral gluteal compartment syndrome after elective unilateral hypogastric artery ligation and revascularization of the contralateral hypogastric artery during open abdominal aortic aneurysm repair. J Vasc Surg 2005; 41:337-9. [PMID: 15768018 DOI: 10.1016/j.jvs.2004.11.029] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Gluteal compartment syndrome is an uncommon entity that has been described in the literature after drug overdose and orthopedic procedures. We describe the first case of bilateral gluteal compartment syndrome that followed pelvic revascularization after the repair of an abdominal aortic aneurysm with bilateral common and internal iliac aneurysms. The patient was treated with aggressive fluid hydration and bilateral gluteal fasciotomies with resolution. The bilateral gluteal compartment syndrome was likely caused by increased pressure on the gluteal muscles, secondary to increased patient weight combined with a period of local ischemia to the watershed areas during iliac cross-clamp.
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Affiliation(s)
- Bradley B Pua
- Department of Surgery, New York University School of Medicine, NY 10016, USA
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Pua BB, Saunders PC, Lapietra A, Colvin SB, Collins J, Grossi EA. Transatrial dual chamber biventricular pacemaker-defibrillator placement in a patient with SVC obstruction. Pacing Clin Electrophysiol 2003; 26:2045-7. [PMID: 14516350 DOI: 10.1046/j.1460-9592.2003.00317.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A patient with severe congestive heart failure and obstruction of the superior vena cava required biventricular pacing and ICD therapy. Via right minithoracotomy, a transatrial approach for lead placement was successfully utilized to provide cardiac resynchronization and ICD placement. This technique for pacing lead placement is reviewed and its application for biventricular pacemaker-defibrillator placement is reported.
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Affiliation(s)
- Bradley B Pua
- Division of Cardiothoracic Surgery, New York University School of Medicine, New York, New York 10028, USA
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Lapietra A, Grossi EA, Pua BB, Esposito RA, Galloway AC, Derivaux CC, Glassman LR, Culliford AT, Ribakove GH, Colvin SB. Assisted venous drainage presents the risk of undetected air microembolism. J Thorac Cardiovasc Surg 2000; 120:856-62. [PMID: 11044310 DOI: 10.1067/mtc.2000.110183] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The proliferation of minimally invasive cardiac surgery has increased dependence on augmented venous return techniques for cardiopulmonary bypass. Such augmented techniques have the potential to introduce venous air emboli, which can pass to the patient. We examined the potential for the transmission of air emboli with different augmented venous return techniques. METHODS In vitro bypass systems with augmented venous drainage were created with either kinetically augmented or vacuum-augmented venous return. Roller or centrifugal pumps were used for arterial perfusion in combination with a hollow fiber oxygenator and a 40-micrometer arterial filter. Air was introduced into the venous line via an open 25-gauge needle. Test conditions involved varying the amount of negative venous pressure, the augmented venous return technique, and the arterial pump type. Measurements were recorded at the following sites: pre-arterial pump, post-arterial pump, post-oxygenator, and patient side. RESULTS Kinetically augmented venous return quickly filled the centrifugal venous pump with macrobubbles requiring continuous manual clearing; a steady state to test for air embolism could not be achieved. Vacuum-augmented venous return handled the air leakage satisfactorily and microbubbles per minute were measured. Higher vacuum pressures resulted in delivery of significantly more microbubbles to the "patient" (P <.001). The use of an arterial centrifugal pump was associated with fewer microbubbles (P =.02). CONCLUSIONS Some augmented venous return configurations permit a significant quantity of microbubbles to reach the patient despite filtration. A centrifugal pump has air-handling disadvantages when used for kinetic venous drainage, but when used as an arterial pump in combination with vacuum-assisted venous drainage it aids in clearing air emboli.
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Affiliation(s)
- A Lapietra
- Department of Surgery, Division of Cardiothoracic Surgery, New York University School of Medicine, New York, NY, USA
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