1
|
Fitzpatrick MJ, Sohani AR, Ly A. Uses and limitations of small-volume biopsies for the diagnosis of lymphoma. Cytopathology 2024. [PMID: 38462899 DOI: 10.1111/cyt.13372] [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: 01/04/2024] [Revised: 02/14/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
Although surgical biopsy remains the gold standard for the diagnosis of lymphoma, small-volume biopsies including fine-needle aspiration and core needle biopsy are increasingly being used as a first line diagnostic tool. Small-volume biopsies are safe, rapid and cost effective; however, diagnostic utility varies by lymphoma subtype. It is important for pathologists and clinicians to recognize both the strengths and limitations of such biopsies.
Collapse
Affiliation(s)
- Megan J Fitzpatrick
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Foy BH, Stefely JA, Bendapudi PK, Hasserjian RP, Al-Samkari H, Louissaint A, Fitzpatrick MJ, Hutchison B, Mow C, Collins J, Patel HR, Patel CH, Patel N, Ho SN, Kaufman RM, Dzik WH, Higgins JM, Makar RS. Computer vision quantitation of erythrocyte shape abnormalities provides diagnostic, prognostic, and mechanistic insight. Blood Adv 2023; 7:4621-4630. [PMID: 37146262 PMCID: PMC10448422 DOI: 10.1182/bloodadvances.2022008967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/07/2023] Open
Abstract
Examination of red blood cell (RBC) morphology in peripheral blood smears can help diagnose hematologic diseases, even in resource-limited settings, but this analysis remains subjective and semiquantitative with low throughput. Prior attempts to develop automated tools have been hampered by their poor reproducibility and limited clinical validation. Here, we present a novel, open-source machine-learning approach (denoted as RBC-diff) to quantify abnormal RBCs in peripheral smear images and generate an RBC morphology differential. RBC-diff cell counts showed high accuracy for single-cell classification (mean AUC, 0.93) and quantitation across smears (mean R2, 0.76 compared with experts, interexperts R2, 0.75). RBC-diff counts were concordant with the clinical morphology grading for 300 000+ images and recovered the expected pathophysiologic signals in diverse clinical cohorts. Criteria using RBC-diff counts distinguished thrombotic thrombocytopenic purpura and hemolytic uremic syndrome from other thrombotic microangiopathies, providing greater specificity than clinical morphology grading (72% vs 41%; P < .001) while maintaining high sensitivity (94% to 100%). Elevated RBC-diff schistocyte counts were associated with increased 6-month all-cause mortality in a cohort of 58 950 inpatients (9.5% mortality for schist. >1%, vs 4.7% for schist; <0.5%; P < .001) after controlling for comorbidities, demographics, clinical morphology grading, and blood count indices. RBC-diff also enabled the estimation of single-cell volume-morphology distributions, providing insight into the influence of morphology on routine blood count measures. Our codebase and expert-annotated images are included here to spur further advancement. These results illustrate that computer vision can enable rapid and accurate quantitation of RBC morphology, which may provide value in both clinical and research contexts.
Collapse
Affiliation(s)
- Brody H. Foy
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Systems Biology, Harvard Medical School, Boston, MA
| | - Jonathan A. Stefely
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Blood Transfusion Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Pavan K. Bendapudi
- Blood Transfusion Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robert P. Hasserjian
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Hanny Al-Samkari
- Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Abner Louissaint
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Megan J. Fitzpatrick
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Bailey Hutchison
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Christopher Mow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Mass General Brigham Enterprise Research IS, Boston, MA
| | - Julia Collins
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Hasmukh R. Patel
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Chhaya H. Patel
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Nikita Patel
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Samantha N. Ho
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Richard M. Kaufman
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Walter H. Dzik
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Blood Transfusion Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - John M. Higgins
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Systems Biology, Harvard Medical School, Boston, MA
| | - Robert S. Makar
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Blood Transfusion Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
3
|
Fitzpatrick MJ, Sundaram V, Ly A, Abramson JS, Balassanian R, Cheung MC, Cook SL, Falchi L, Frank AK, Gupta S, Hasserjian RP, Lin O, Long SR, Menke JR, Mou E, Reed DR, Ruiz-Cordero R, Volaric AK, Wang L, Wen KW, Xie Y, Zadeh SL, Gratzinger D. Small volume biopsy diagnostic yield at initial diagnosis versus recurrence/transformation of follicular lymphoma: A retrospective Cyto-Heme Interinstitutional Collaborative study. Cancer Cytopathol 2023; 131:279-288. [PMID: 36573933 PMCID: PMC10557381 DOI: 10.1002/cncy.22676] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/28/2022] [Accepted: 11/01/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Few studies have evaluated diagnostic yield of small volume biopsies (SVB) for the diagnosis and management of follicular lymphoma (FL). METHODS The authors performed a multi-institutional retrospective analysis of SVBs including fine-needle aspiration (FNA) and needle core biopsy (NCB) for initial FL diagnosis and suspected recurrence or transformation of FL. A total of 676 workups beginning with SVB were assessed for the mean number of biopsies per workup, the proportion of workups requiring multiple biopsies, and the proportion with a complete diagnosis including grade, on initial biopsy. RESULTS Compared to workups performed for question transformation/recurrence, those done for initial FL diagnosis were significantly more likely to require multiple biopsies (p < .01), had a higher mean number of biopsies per workup (1.7 vs. 1.1, absolute standardized difference = 1.1), and a lower complete diagnosis rate at initial biopsy (39% vs. 56%). At initial FL diagnosis, NCB +/- FNA was associated with fewer biopsies per workup compared to FNA +/- CB (1.2 vs. 1.9), fewer workups requiring multiple biopsies (23% vs. 83%), and a higher complete diagnosis rate (71% vs. 18%). In contrast, during assessment for transformation/recurrence, NCB and FNA showed a similar mean number of biopsies per workup (1.2 vs. 1.2) and few workups required multiple biopsies (6% vs. 19%). CONCLUSIONS SVB at initial FL diagnosis often required additional biopsies to establish a complete diagnosis. In contrast, when assessing for transformed/recurrent FL, additional biopsies were generally not obtained regardless of SVB type, suggesting that in these clinical settings SVB may be sufficient for clinical decision-making.
Collapse
Affiliation(s)
- Megan J Fitzpatrick
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Vandana Sundaram
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeremy S Abramson
- Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ronald Balassanian
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Matthew C Cheung
- Division of Hematology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Stephen L Cook
- Department of Laboratory Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Lorenzo Falchi
- Department of Hematology/Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Annabel K Frank
- Department of Hematology/Oncology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Srishti Gupta
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Robert P Hasserjian
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Steven R Long
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Joshua R Menke
- Department of Pathology, Stanford University Hospital, Stanford, California, USA
| | - Eric Mou
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, The University of Iowa, Iowa City, Iowa, USA
| | - Daniel R Reed
- Section on Hematology/Oncology, Wake Forest Baptist Health Comprehensive Cancer Center, Winston-Salem, North Carolina, USA
| | - Roberto Ruiz-Cordero
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Ashley K Volaric
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
- Department of Pathology, Stanford University Hospital, Stanford, California, USA
| | - Linlin Wang
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Kwun Wah Wen
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Yi Xie
- Department of Pathology, University of California San Francisco Hospital, San Francisco, California, USA
| | - Sara L Zadeh
- Department of Pathology, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Dita Gratzinger
- Department of Pathology, Stanford University Hospital, Stanford, California, USA
| |
Collapse
|
4
|
Abstract
Genetic characterization of myeloma at diagnosis by interphase fluorescence in situ hybridization and next-generation sequencing (NGS) can assist with risk stratification and treatment planning. Measurable residual disease (MRD) status after treatment, as evaluated by next-generation flow cytometry or NGS on bone marrow aspirate material, is one of the most important predictors of prognosis. Less-invasive tools for MRD assessment such as liquid biopsy approaches have also recently emerged as potential alternatives.
Collapse
|
5
|
Volaric AK, Lin O, Zadeh SL, Gupta S, Reed DR, Fitzpatrick MJ, Ly A, Hasserjian RP, Balassanian R, Frank AK, Long S, Ruiz-Cordero R, Wang L, Wen KW, Xie Y, Mou E, Falchi L, Cook S, Menke JR, Natkunam Y, Gratzinger D. Diagnostic Discrepancies in Small-volume Biopsy for the Initial Diagnosis, Recurrence, and Transformation of Follicular Lymphoma: A Multi-Institutional Collaborative Study. Am J Surg Pathol 2023; 47:212-217. [PMID: 36537240 PMCID: PMC10464531 DOI: 10.1097/pas.0000000000001985] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Small-volume biopsies (SVBs) including fine-needle aspiration (FNA), cell block, and needle core biopsies (NCB) are increasingly utilized to diagnose and guide the clinical management of lymphoma. We established a multi-institutional interdisciplinary collaboration of cytopathologists, hematopathologists, and oncologists focused on the role of SVB in the management of patients with follicular lymphoma (FL). To assess the performance characteristics of SVB in this setting, we evaluated all consecutive SVBs performed for clinical indications of initial diagnosis, recurrence, or transformation of FL over a 5-year period and focused on the 182 that had at least one subsequent biopsy within 3 months as part of the same clinical work-up. The most common outcome of a subsequent biopsy as part of the same clinical work-up was a more specific diagnosis usually assigning the pathologic grade (111/182, 61%), followed by a complete agreement with the SVB (24/182, 13%), and change from nondiagnostic on initial biopsy to diagnostic on subsequent biopsy (21/182, 12%). A minority resulted in a diagnostic change from benign to lymphoma (17/182, 9%), a change in FL grade (5/182, 3%), or change in the lymphoma diagnostic category (4/182, 2%). There were no cases where an initial diagnosis of lymphoma was overturned. The distribution of discrepancies was similar across initial SVB types (FNA, FNA + cell block, NCB with or without FNA). Tissue limitations were noted in a minority of cases (53/182, 29%) and were enriched among initially nondiagnostic biopsies (16/21, 76%). Flow cytometry immunophenotyping was performed in the majority of cases both at the first and last biopsy (147/182, 81%). SVB can be a powerful method to detect FL in various clinical indications, with discrepant cases mostly resulting from a refinement in the initial diagnosis.
Collapse
Affiliation(s)
- Ashley K. Volaric
- Department of Pathology, Stanford University, Stanford, CA
- Department of Pathology and Laboratory Medicine, University of Virginia Medical Center, Charlottesville, VA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sara L. Zadeh
- Department of Pathology and Laboratory Medicine, University of Virginia Medical Center, Charlottesville, VA
| | - Srishti Gupta
- Department of Pathology and Laboratory Medicine, University of Virginia Medical Center, Charlottesville, VA
| | - Daniel R. Reed
- Section on Hematology/Oncology, Wake Forest Baptist Health Comprehensive Cancer Center, Winston-Salem, NC
| | | | - Amy Ly
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | | | - Ronald Balassanian
- Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Annabel K. Frank
- Department of Hematology/Oncology, University of California San Francisco, San Francisco, CA
| | - Steven Long
- Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Roberto Ruiz-Cordero
- Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Linlin Wang
- Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Kwun Wah Wen
- Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Yi Xie
- Departments of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Eric Mou
- Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa Health Care, Iowa City, IA
| | - Lorenzo Falchi
- Department of Hematologic Malignancies, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen Cook
- Department of Pathology, Veteran Affairs Medical Center, San Francisco, CA
| | | | | | | |
Collapse
|
6
|
Fitzpatrick MJ, Boiocchi L, Fathi AT, Brunner AM, Hasserjian RP, Nardi V. Correlation of p53 immunohistochemistry with
TP53
mutational status and overall survival in newly diagnosed acute myeloid leukemia. Histopathology 2022; 81:496-510. [DOI: 10.1111/his.14726] [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: 05/13/2022] [Revised: 06/28/2022] [Accepted: 07/10/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Leonardo Boiocchi
- Department of Pathology and Laboratory Medicine Memorial Sloan Kettering Cancer Center New York NY USA
| | - Amir T. Fathi
- Department of Hematology/Oncology Massachusetts General Hospital Boston MA USA
| | - Andrew M. Brunner
- Department of Hematology/Oncology Massachusetts General Hospital Boston MA USA
| | | | - Valentina Nardi
- Department of Pathology Massachusetts General Hospital Boston MA USA
| |
Collapse
|
7
|
Dougan M, Anderson MA, Abramson JS, Fitzpatrick MJ. Case 14-2022: A 57-Year-Old Man with Chylous Ascites. N Engl J Med 2022; 386:1834-1844. [PMID: 35544390 DOI: 10.1056/nejmcpc2115856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Michael Dougan
- From the Departments of Medicine (M.D., J.S.A.), Radiology (M.A.A.), and Pathology (M.J.F.), Massachusetts General Hospital, and the Departments of Medicine (M.D., J.S.A.), Radiology (M.A.A.), and Pathology (M.J.F.), Harvard Medical School - both in Boston
| | - Mark A Anderson
- From the Departments of Medicine (M.D., J.S.A.), Radiology (M.A.A.), and Pathology (M.J.F.), Massachusetts General Hospital, and the Departments of Medicine (M.D., J.S.A.), Radiology (M.A.A.), and Pathology (M.J.F.), Harvard Medical School - both in Boston
| | - Jeremy S Abramson
- From the Departments of Medicine (M.D., J.S.A.), Radiology (M.A.A.), and Pathology (M.J.F.), Massachusetts General Hospital, and the Departments of Medicine (M.D., J.S.A.), Radiology (M.A.A.), and Pathology (M.J.F.), Harvard Medical School - both in Boston
| | - Megan J Fitzpatrick
- From the Departments of Medicine (M.D., J.S.A.), Radiology (M.A.A.), and Pathology (M.J.F.), Massachusetts General Hospital, and the Departments of Medicine (M.D., J.S.A.), Radiology (M.A.A.), and Pathology (M.J.F.), Harvard Medical School - both in Boston
| |
Collapse
|
8
|
Fitzpatrick MJ, Nardi V, Sohani AR. Plasma cell myeloma: role of histopathology, immunophenotyping, and genetic testing. Skeletal Radiol 2022; 51:17-30. [PMID: 33687521 DOI: 10.1007/s00256-021-03754-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 02/02/2023]
Abstract
Myeloma is a malignant neoplasm of plasma cells with complex pathogenesis. Diagnosis and risk stratification require the integration of histology, radiology, serology, and genetic data. Bone marrow biopsies are essential for myeloma diagnosis by providing material for histologic and cytologic assessment as well as immunophenotypic and genetic studies. Flow cytometry and genetic studies are, in particular, becoming increasingly important for diagnosis, risk stratification, and assessment of treatment response. Myeloma has traditionally been characterized by recurrent cytogenetic abnormalities that can be divided into two subtypes: hyperdiploid, characterized by trisomies, and non-hyperdiploid, characterized by translocations involving chromosome 14. These abnormalities are thought to be primary events, initiating a premalignant state, which progresses to myeloma through the acquisition of secondary mutations. The emergence of next-generation sequencing has led to the discovery of numerous mutations and gene fusions that comprise the heterogenous genomic landscape of myeloma. As the underlying pathogenesis of myeloma continues to be delineated, possible therapeutic targets have also emerged. Herein, we describe the importance of histology, immunophenotype, and mutational analysis in the assessment of myeloma.
Collapse
Affiliation(s)
- Megan J Fitzpatrick
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, WRN 219, Boston, MA, 02114, USA
- Department of Pathology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, WRN 219, Boston, MA, 02114, USA
- Department of Pathology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, WRN 219, Boston, MA, 02114, USA.
- Department of Pathology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| |
Collapse
|
9
|
Mou E, Falchi L, Sundaram V, Abramson JS, Balassanian R, Beygi S, Fitzpatrick MJ, Frank AK, Gupta S, Lin O, Long SR, Menke JR, Reed DR, Ruiz-Cordero R, Volaric AK, Xie Y, Wang L, Wen KW, Zadeh SL, Natkunam Y, Cheung MC, Gratzinger D. Impact of initial biopsy type on the time to final diagnostic biopsy in patients with follicular lymphoma and suspected histologic transformation. Leuk Lymphoma 2021; 62:2864-2872. [PMID: 34176413 DOI: 10.1080/10428194.2021.1941936] [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: 10/21/2022]
Abstract
Diagnosis of histologic transformation (HT) of follicular lymphoma (FL) requires tissue biopsy. While surgical biopsy represents the gold standard, less invasive procedures such as fine-needle aspiration biopsy (FNAB) and core needle biopsy (CNB) are frequently performed. In this retrospective multi-institutional study including 269 patients with FL and suspected HT, the median time from initial clinical suspicion to final diagnostic biopsy was similar whether the workup began with FNAB, CNB, or surgical biopsy (4, 9, and 6 days, respectively; p=.27), despite more subsequent biopsies performed following initial FNAB. Periprocedural complications were uniformly minimal. Biopsy-proven HT was more common in the initial surgery group and in workups including positron emission tomography/computed tomography (PET/CT). Our findings, derived from US academic centers with specialized procedural and pathology expertise, suggest that FNAB, CNB, and surgical biopsy are all viable initial diagnostic procedures that can inform clinical decision-making in select FL patients with suspected HT.
Collapse
Affiliation(s)
- Eric Mou
- Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa, Iowa City, IA, USA.,Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lorenzo Falchi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vandana Sundaram
- Quantitative Science Unit, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Ronald Balassanian
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Sara Beygi
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Annabel Kate Frank
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Srishti Gupta
- Department of Pathology, University of Virginia, Charlottesville, VA, USA.,Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Oscar Lin
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Steven R Long
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA.,Department of Pathology, Stanford University, Stanford, CA, USA
| | - Joshua R Menke
- Department of Pathology, Stanford University, Stanford, CA, USA
| | - Daniel R Reed
- Section of Hematology and Oncology, Wake Forest Baptist Medical Comprehensive Cancer Center.,Division of Hematology and Oncology, University of Virginia, Charlottesville, VA, USA
| | - Roberto Ruiz-Cordero
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA
| | - Ashley K Volaric
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA.,Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Yi Xie
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Linlin Wang
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kwun Wah Wen
- Department of Pathology, University of California San Francisco, San Francisco, CA, USA.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Sara L Zadeh
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
| | | | - Matthew C Cheung
- Division of Hematology, Sunnybrook Odette Cancer Centre, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Dita Gratzinger
- Department of Pathology, Stanford University, Stanford, CA, USA.,Department of Pathology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | | |
Collapse
|
10
|
Fitzpatrick MJ, Sayed S, Moloo Z, Kayembe MKA, Roberts DJ, Pham TA, Xi L, Raffeld M, Louissaint A, Sohani AR. Clinicopathologic Features of Peripheral T-Cell Lymphoma in Sub-Saharan Africa. Am J Clin Pathol 2021; 156:42-55. [PMID: 33527979 DOI: 10.1093/ajcp/aqaa201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/28/2022] Open
Abstract
OBJECTIVES Peripheral T-cell lymphomas (PTCLs) are heterogeneous, clinically aggressive, and rare. Subtype distribution varies by geographic location; however, data from sub-Saharan Africa (SSA) are lacking. We sought to elucidate clinicopathologic features of PTCL in SSA. METHODS We reviewed PTCL consultation cases from three SSA countries. PTCL subtype was determined per 2017 World Health Organization classification. Cases with sufficient material were evaluated by polymerase chain reaction for human T-cell leukemia virus type 1 (HTLV-1) and T-cell receptor γ (TCRG) rearrangement. RESULTS Among 32 cases, median age was 45 years and male-to-female ratio was 1.7. Thirty (94%) of 32 cases required additional workup for subclassification. PTCL, not otherwise specified (PTCL-NOS) was the most common subtype (13/32, 41%), followed by PTCL with T-follicular helper phenotype (6/32, 19%) and systemic anaplastic large cell lymphoma (6/32, 19%). Four (16%) of 25 cases were Epstein-Barr virus positive (EBV+) (2/2 extranodal natural killer/T-cell lymphoma, 1/13 PTCL-NOS, and 1/4 angioimmunoblastic T-cell lymphoma with EBV+ immunoblasts). Two (15%) of 13 patients with PTCL-NOS were human immunodeficiency virus positive. No cases with evaluable DNA (0/15) were HTLV-1 positive, and 9 of 10 showed clonal TCRG rearrangements. CONCLUSIONS In comparison to Western studies, PTCLs from SSA show similar subtype distribution and male predominance but a younger age at diagnosis. Appropriate diagnosis of PTCL requires extensive ancillary testing not readily available in low-income countries, including much of SSA.
Collapse
Affiliation(s)
- Megan J Fitzpatrick
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shahin Sayed
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Zahir Moloo
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | | | - Drucilla J Roberts
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Thu-Anh Pham
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Liqiang Xi
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Raffeld
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Abner Louissaint
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
11
|
Podberezin M, Fitzpatrick MJ, Hariri LP, Sholl L. Malignant peritoneal mesothelioma presenting as a splenic mass. Pathol Res Pract 2020; 216:153273. [PMID: 33161309 DOI: 10.1016/j.prp.2020.153273] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Mark Podberezin
- Department of Pathology and Laboratory Medicine, Lahey Hospital and Medical Center, Burlington, MA, United States.
| | - Megan J Fitzpatrick
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Lida P Hariri
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Lynette Sholl
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| |
Collapse
|
12
|
Fitzpatrick MJ, Porter WP, Pauli JN, Kearney MR, Notaro M, Zuckerberg B. Future winters present a complex energetic landscape of decreased costs and reduced risk for a freeze-tolerant amphibian, the Wood Frog (Lithobates sylvaticus). Glob Chang Biol 2020; 26:6350-6362. [PMID: 32871618 DOI: 10.1111/gcb.15321] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/21/2020] [Accepted: 08/04/2020] [Indexed: 06/11/2023]
Abstract
Winter climate warming is rapidly leading to changes in snow depth and soil temperatures across mid- and high-latitude ecosystems, with important implications for survival and distribution of species that overwinter beneath the snow. Amphibians are a particularly vulnerable group to winter climate change because of the tight coupling between their body temperature and metabolic rate. Here, we used a mechanistic microclimate model coupled to an animal biophysics model to predict the spatially explicit effects of future climate change on the wintering energetics of a freeze-tolerant amphibian, the Wood Frog (Lithobates sylvaticus), across its distributional range in the eastern United States. Our below-the-snow microclimate simulations were driven by dynamically downscaled climate projections from a regional climate model coupled to a one-dimensional model of the Laurentian Great Lakes. We found that warming soil temperatures and decreasing winter length have opposing effects on Wood Frog winter energy requirements, leading to geographically heterogeneous implications for Wood Frogs. While energy expenditures and peak body ice content were predicted to decline in Wood Frogs across most of our study region, we identified an area of heightened energetic risk in the northwestern part of the Great Lakes region where energy requirements were predicted to increase. Because Wood Frogs rely on body stores acquired in fall to fuel winter survival and spring breeding, increased winter energy requirements have the potential to impact local survival and reproduction. Given the geographically variable and intertwined drivers of future under-snow conditions (e.g., declining snow depths, rising air temperatures, shortening winters), spatially explicit assessments of species energetics and risk will be important to understanding the vulnerability of subnivium-adapted species.
Collapse
Affiliation(s)
- Megan J Fitzpatrick
- Department of Forest and Wildlife Ecology, University of Wisconsin-Madison, Madison, WI, USA
- Department of Integrative Biology, University of Wisconsin-Madison, Madison, WI, USA
| | - Warren P Porter
- Department of Integrative Biology, University of Wisconsin-Madison, Madison, WI, USA
| | - Jonathan N Pauli
- Department of Forest and Wildlife Ecology, University of Wisconsin-Madison, Madison, WI, USA
| | - Michael R Kearney
- School of BioSciences, The University of Melbourne, Parkville, Vic., Australia
| | - Michael Notaro
- Nelson Institute Center for Climatic Research, University of Wisconsin-Madison, Madison, WI, USA
| | - Benjamin Zuckerberg
- Department of Forest and Wildlife Ecology, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
13
|
Miller TE, Garcia Beltran WF, Bard AZ, Gogakos T, Anahtar MN, Astudillo MG, Yang D, Thierauf J, Fisch AS, Mahowald GK, Fitzpatrick MJ, Nardi V, Feldman J, Hauser BM, Caradonna TM, Marble HD, Ritterhouse LL, Turbett SE, Batten J, Georgantas NZ, Alter G, Schmidt AG, Harris JB, Gelfand JA, Poznansky MC, Bernstein BE, Louis DN, Dighe A, Charles RC, Ryan ET, Branda JA, Pierce VM, Murali MR, Iafrate AJ, Rosenberg ES, Lennerz JK. Clinical sensitivity and interpretation of PCR and serological COVID-19 diagnostics for patients presenting to the hospital. FASEB J 2020; 34:13877-13884. [PMID: 32856766 PMCID: PMC7461169 DOI: 10.1096/fj.202001700rr] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/15/2022]
Abstract
The diagnosis of COVID-19 requires integration of clinical and laboratory data. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic assays play a central role in diagnosis and have fixed technical performance metrics. Interpretation becomes challenging because the clinical sensitivity changes as the virus clears and the immune response emerges. Our goal was to examine the clinical sensitivity of two most common SARS-CoV-2 diagnostic test modalities, polymerase chain reaction (PCR) and serology, over the disease course to provide insight into their clinical interpretation in patients presenting to the hospital. We conducted a single-center, retrospective study. To derive clinical sensitivity of PCR, we identified 209 PCR-positive SARS-CoV-2 patients with multiple PCR test results (624 total PCR tests) and calculated daily sensitivity from date of symptom onset or first positive test. Clinical sensitivity of PCR decreased with days post symptom onset with >90% clinical sensitivity during the first 5 days after symptom onset, 70%-71% from Days 9 to 11, and 30% at Day 21. To calculate daily clinical sensitivity by serology, we utilized 157 PCR-positive patients with a total of 197 specimens tested by enzyme-linked immunosorbent assay for IgM, IgG, and IgA anti-SARS-CoV-2 antibodies. In contrast to PCR, serological sensitivity increased with days post symptom onset with >50% of patients seropositive by at least one antibody isotype after Day 7, >80% after Day 12, and 100% by Day 21. Taken together, PCR and serology are complimentary modalities that require time-dependent interpretation. Superimposition of sensitivities over time indicate that serology can function as a reliable diagnostic aid indicating recent or prior infection.
Collapse
Affiliation(s)
- Tyler E. Miller
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | | | - Adam Z. Bard
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Tasos Gogakos
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Melis N. Anahtar
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | | | - Diane Yang
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Julia Thierauf
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Adam S. Fisch
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Grace K. Mahowald
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Megan J. Fitzpatrick
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Valentina Nardi
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Jared Feldman
- Ragon Institute of MGH, MIT, and HarvardCambridgeMAUSA
| | | | | | - Hetal D. Marble
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Lauren L. Ritterhouse
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Sara E. Turbett
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Julie Batten
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | | | - Galit Alter
- Ragon Institute of MGH, MIT, and HarvardCambridgeMAUSA
| | | | - Jason B. Harris
- Division of Infectious DiseasesDepartment of PediatricsMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Jeffrey A. Gelfand
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Mark C. Poznansky
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Bradley E. Bernstein
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - David N. Louis
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Anand Dighe
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Richelle C. Charles
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Edward T. Ryan
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - John A. Branda
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Virginia M. Pierce
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
- Division of Infectious DiseasesDepartment of PediatricsMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Mandakolathur R. Murali
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
- Division of Allergy and ImmunologyDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - A. John Iafrate
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Eric S. Rosenberg
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
- Division of Infectious DiseasesDepartment of MedicineMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| | - Jochen K. Lennerz
- Department of PathologyMassachusetts General Hospital/Harvard Medical SchoolBostonMAUSA
| |
Collapse
|
14
|
Fitzpatrick MJ, Hernandez-Barco YG, Krishnan K, Casey B, Pitman MB. Evaluating triage protocols for endoscopic ultrasound-guided fine needle biopsies of the pancreas. J Am Soc Cytopathol 2020; 9:396-404. [PMID: 32620535 DOI: 10.1016/j.jasc.2020.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 03/26/2020] [Revised: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Pancreatic endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) acquires both direct smear and small core biopsy specimens. The triage protocols for pancreatic FNBs to cytopathology (CP) or gastrointestinal surgical pathology (GIP) are controversial and vary by institution. MATERIAL AND METHODS Pancreatic EUS-FNBs obtained with the SharkCore FNB were reviewed from January 2014 to June 2019. The specimen characteristics and pathology data, including tissue triage, were obtained from the electronic medical records. We assessed the diagnostic yield, defined as malignant, specific neoplastic, or benign, and the operating characteristics at the time of rapid on-site evaluation (ROSE) and final diagnosis. RESULTS We reviewed 324 pancreatic FNBs from 313 patients. Of the 324 FNBs, 260 (80%) obtained concurrent direct smear and core biopsy specimens, 30 (12%) of which were divided between CP and GIP. Of the 51 core-only specimens, 47 (92%) were reviewed by CP and 4 (8%) by GIP. ROSE improved the overall diagnostic yield by 10% and accuracy by 9%. When core specimens were reviewed independently, the diagnostic accuracy was 93% for CP (n = 248) and 100% for GIP (n = 33). All false-negative results of the CP-reviewed cores were due to sampling error. Concurrent smear review improved EUS-FNB performance, increasing the negative predictive value by 10% and accuracy by 3% compared with core review alone. CONCLUSIONS CP and GIP can accurately interpret pancreatic EUS-FNB specimens. However, triage of concurrent EUS-FNB-acquired smear and core specimens to CP may be most efficient as CPs are trained to assess adequacy at the time of ROSE, as well as interpret all parts of the biopsy, minimizing the risk of discordant pathology reports.
Collapse
Affiliation(s)
- Megan J Fitzpatrick
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts.
| | | | - Kumar Krishnan
- Department of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Brenna Casey
- Department of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts
| | - Martha B Pitman
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| |
Collapse
|
15
|
Yu Z, Theodosakis N, Fitzpatrick MJ, Foreman RK, Mackool B. A 39-Year-Old Male Congenital Tricuspid Atresia Patient Who Presented with a New Axillary Lesion after an Orthotopic Heart Transplant. Dermatopathology (Basel) 2019; 6:220-224. [PMID: 31828063 DOI: 10.1159/000503661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/02/2019] [Accepted: 09/10/2019] [Indexed: 12/18/2022] Open
Abstract
Mucormycosis is a rare and aggressive fungal infection, most often caused by species of the Mucor, Rhizomucor, Rhizopus, Absidia, and Cunninghamella genera. The condition most commonly affects patients with uncontrolled diabetes, HIV/AIDS, malignancy, and those receiving long-term immunosuppressive therapy. We report the case of a 39-year-old male with biopsy-proven cutaneous mucormycosis of the left axilla 4 months after an orthotopic heart transplant for congenital tricuspid atresia.
Collapse
Affiliation(s)
- Zizi Yu
- Harvard Medical School, Boston, Massachusetts, USA
| | - Nicholas Theodosakis
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Megan J Fitzpatrick
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ruth K Foreman
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bonnie Mackool
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
16
|
Fitzpatrick MJ, Zuckerberg B, Pauli JN, Kearney MR, Thompson KL, Werner LC, Porter WP. Modeling the distribution of niche space and risk for a freeze‐tolerant ectotherm,
Lithobates sylvaticus. Ecosphere 2019. [DOI: 10.1002/ecs2.2788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Megan J. Fitzpatrick
- Department of Forest and Wildlife Ecology 1630 Linden Drive Madison Wisconsin 53706 USA
| | - Benjamin Zuckerberg
- Department of Forest and Wildlife Ecology 1630 Linden Drive Madison Wisconsin 53706 USA
| | - Jonathan N. Pauli
- Department of Forest and Wildlife Ecology 1630 Linden Drive Madison Wisconsin 53706 USA
| | - Michael R. Kearney
- School of BioSciences The University of Melbourne Parkville Victoria 3010 Australia
| | - Kimberly L. Thompson
- Department of Forest and Wildlife Ecology 1630 Linden Drive Madison Wisconsin 53706 USA
| | - Lawrence C. Werner
- Department of Integrative Biology University of Wisconsin‐Madison 250 North Mills Street Madison Wisconsin 53706 USA
| | - Warren P. Porter
- Department of Integrative Biology University of Wisconsin‐Madison 250 North Mills Street Madison Wisconsin 53706 USA
| |
Collapse
|
17
|
Fitzpatrick MJ, Hernandez-Barco YG, Krishnan K, Brugge W, Casey B, Pitman MB. Diagnostic yield of the SharkCore EUS-guided fine-needle biopsy. J Am Soc Cytopathol 2019; 8:212-219. [PMID: 31076375 DOI: 10.1016/j.jasc.2019.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 01/13/2019] [Revised: 02/12/2019] [Accepted: 03/01/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the standard diagnostic procedure for many intrathoracic and intra-abdominal lesions. Next-generation fine-needle biopsies (FNBs) can increase diagnostic yield by procuring tissue suitable for histological processing. We evaluate the diagnostic yield and operating characteristics of the SharkCore (SC; Medtronic Corp., Minneapolis, MN) FNB in a tertiary referral facility. MATERIALS AND METHODS We performed a single-center retrospective review of SC-FNB-acquired tissue between January 2014 and March 2018. Patient demographic data, endoscopic features, and pathology data were obtained from the electronic medical record. Diagnostic yield was assessed by the ability to obtain a definitive diagnosis, defined as malignant or benign interpretations. Operating characteristics were also calculated. RESULTS A total of 179 lesions were sampled with the SC-FNB in 157 patients (mean age: 63 years, 57% male). Of these, 31 lesions were concomitantly sampled with a conventional FNA needle. Most lesions were pancreatic (49%). Diagnostic yield was 86%, which was independent of lesion location, lesion size and needle gauge. Diagnostic accuracy was highest when both histology and cytology specimens were analyzed concurrently (96.5%). In patients with a history of chronic pancreatitis, accuracy, sensitivity, and negative predictive value were reduced (71.4%, 20.0%, and 69.2%, respectively). Rapid onsite evaluation (ROSE) occurred in 64.8% of cases and was more likely to be diagnostic at the time of rapid evaluation if SC-acquired tissue was utilized versus FNA-acquired tissue (P = 0.03); however, final diagnostic yield did not differ between needles (P = 0.13). CONCLUSIONS SC-FNB shows high diagnostic yield and accuracy and provides diagnostic tissue for ROSE. SC-FNB is an effective alternative to conventional FNA.
Collapse
Affiliation(s)
- Megan J Fitzpatrick
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | | | - Kumar Krishnan
- Department of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - William Brugge
- Department of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Brenna Casey
- Department of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Martha B Pitman
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
18
|
Fitzpatrick MJ, Mathewson PD, Porter WP. Validation of a Mechanistic Model for Non-Invasive Study of Ecological Energetics in an Endangered Wading Bird with Counter-Current Heat Exchange in its Legs. PLoS One 2015; 10:e0136677. [PMID: 26308207 PMCID: PMC4550283 DOI: 10.1371/journal.pone.0136677] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/06/2015] [Indexed: 11/19/2022] Open
Abstract
Mechanistic models provide a powerful, minimally invasive tool for gaining a deeper understanding of the ecology of animals across geographic space and time. In this paper, we modified and validated the accuracy of the mechanistic model Niche Mapper for simulating heat exchanges of animals with counter-current heat exchange mechanisms in their legs and animals that wade in water. We then used Niche Mapper to explore the effects of wading and counter-current heat exchange on the energy expenditures of Whooping Cranes, a long-legged wading bird. We validated model accuracy against the energy expenditure of two captive Whooping Cranes measured using the doubly-labeled water method and time energy budgets. Energy expenditure values modeled by Niche Mapper were similar to values measured by the doubly-labeled water method and values estimated from time-energy budgets. Future studies will be able to use Niche Mapper as a non-invasive tool to explore energy-based limits to the fundamental niche of Whooping Cranes and apply this knowledge to management decisions. Basic questions about the importance of counter-current exchange and wading to animal physiological tolerances can also now be explored with the model.
Collapse
Affiliation(s)
- Megan J. Fitzpatrick
- Department of Zoology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail:
| | - Paul D. Mathewson
- Department of Zoology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Warren P. Porter
- Department of Zoology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| |
Collapse
|
19
|
Fitzpatrick MJ, Starkschall G, Balter P, Pan T. SU-FF-J-20: How to Explore Alternative 4D CT Image Binning. Med Phys 2005. [DOI: 10.1118/1.1997566] [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: 11/07/2022] Open
|
20
|
Abstract
A case of lower extremity compartment syndrome following plantaris tendon harvest for use as an upper extremity tendon graft is described. Compartment syndrome seems to be a rare complication after plantaris harvest, but expedient management is required to avert adverse sequelae. Exploration of the course of the plantaris tendon may be a viable alternative to the traditional lateral approach in attempting to reverse the condition.
Collapse
Affiliation(s)
- J S Taras
- Philadelphia Hand Center, Philadelphia, PA 19107, USA
| | | |
Collapse
|
21
|
Fitzpatrick MJ, Bunevich S, Jones S. The caregiver's careshop. A renewal experience for nursing staff. J Nurses Staff Dev 2001; 17:243-7. [PMID: 12759993 DOI: 10.1097/00124645-200109000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
What are some creative methodologies that staff development educators can use to nurture nursing staff while promoting caring and compassionate behaviors? The authors describe an innovative process used during a 1-day workshop designed to convey caring to nursing staff through a variety of experiences. The overall goal of the session is to provide caregivers with a variety of new "tools" to care for themselves as they deal with multiple stressors in their personal and professional lives.
Collapse
Affiliation(s)
- M J Fitzpatrick
- Grant/Riverside Methodist Hospitals, Oncology Services, Columbus, OH, USA.
| | | | | |
Collapse
|
22
|
Abstract
In an increasingly complex healthcare environment, the discipline of nursing is difficult to define. Although a designated "department of nursing" may be absent on the organizational chart, the functional elements of the discipline remain. Nursing leaders will benefit from a framework to define and operationalize the core elements of nursing. The authors offer a five-phase methodology to enable the creation of a strong nursing organization in the face of mergers, service lines, and complex reporting structures.
Collapse
Affiliation(s)
- M J Fitzpatrick
- Patient Care Services QI, Mt. Carmel Health Care System, Columbus, Ohio, USA.
| | | | | |
Collapse
|
23
|
Clarke-Stewart KA, Fitzpatrick MJ, Allhusen VD, Goldberg WA. Measuring difficult temperament the easy way. J Dev Behav Pediatr 2000; 21:207-20. [PMID: 10883881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
In this study, the authors introduce a new measure of infant temperament, the Pictorial Assessment of Temperament (PAT), and provide information about its psychometric qualities based on findings from a study of 132 mothers and infants. The PAT is a 10-item measure of "difficult" temperament that is quick and easy to use and avoids some of the inherent problems in existing paper-and-pencil measures of temperament (e.g., complexity of response choices, dependence on respondents' educational level and verbal skills). It has convergent validity with the Revised Infant Temperament Questionnaire and with observed behavior in a laboratory procedure, moderate reliability and stability over time, and moderate agreement between mothers' and fathers' reports. Predictive validity was demonstrated by significant associations with the children's later disruptive behavior, behavior problems, lack of sociability, and negativity in interactions with their mother. Parent characteristics (agreeableness, extraversion, neuroticism, sensitivity, depression) were not related to scores on the PAT, demonstrating its discriminant validity.
Collapse
Affiliation(s)
- K A Clarke-Stewart
- Department of Psychology and Social Behavior, School of Social Ecology, University of California-Irvine, 92697, USA.
| | | | | | | |
Collapse
|
24
|
Bannerman DD, Fitzpatrick MJ, Anderson DY, Bhattacharjee AK, Novitsky TJ, Hasday JD, Cross AS, Goldblum SE. Endotoxin-neutralizing protein protects against endotoxin-induced endothelial barrier dysfunction. Infect Immun 1998; 66:1400-7. [PMID: 9529059 PMCID: PMC108066 DOI: 10.1128/iai.66.4.1400-1407.1998] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [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: 02/07/2023] Open
Abstract
Bacterial lipopolysaccharide induces tyrosine phosphorylation of paxillin, actin reorganization, and opening of the transendothelial paracellular pathway through which macromoles flux. In this study, lipid A was shown to be the bioactive portion of the lipopolysaccharide molecule responsible for changes in endothelial barrier function. We then studied whether endotoxin-neutralizing protein, a recombinant peptide that is derived from Limulus antilipopolysaccharide factor and targets lipid A, could block the effects of lipopolysaccharide on protein tyrosine phosphorylation, actin organization, and movement of 14C-bovine serum albumin across bovine pulmonary artery endothelial cell monolayers. In the presence of serum, a 6-h exposure to lipopolysaccharide (10 ng/ml) increased transendothelial 14C-albumin flux compared to the simultaneous media control. Coadministration of endotoxin-neutralizing protein (> or =10 ng/ml) with lipopolysaccharide (10 ng/ml) protected against lipopolysaccharide-induced barrier dysfunction. This protection was dose dependent, conferring total protection at endotoxin-neutralizing protein/lipopolysaccharide ratios of > or =10:1. Similarly, endotoxin-neutralizing protein was capable of blocking the lipopolysaccharide-induced endothelial cell responses that are prerequisite to barrier dysfunction, including tyrosine phosphorylation of paxillin and actin depolymerization. Finally, endotoxin-neutralizing protein cross-protected against lipopolysaccharide derived from diverse gram-negative bacteria. Thus, endotoxin-neutralizing protein offers a novel therapeutic intervention for the vascular endothelial dysfunction of gram-negative sepsis and its attendant endotoxemia.
Collapse
Affiliation(s)
- D D Bannerman
- Department of Pathology, VA Maryland Health Care System, University of Maryland School of Medicine, Baltimore 21201, USA
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Abstract
Numerous techniques have been described for the arthrodesis of various forefoot and midfoot joints. These techniques include the use of plates, screws, wires, staples, and Steinman pins. The ease of the dorsal approach in instituting these techniques has persuaded most orthopaedic surgeons to instrument the dorsal, or compression, side of the arthrodesis. By instrumenting the compression side, the deforming forces of the arthrodesis may cause distraction on the plantar side. The use of the tension band technique in foot arthrodeses changes the plantar distraction forces to a compressive force without necessitating the exposure of the plantar surface.
Collapse
Affiliation(s)
- P C Kupcha
- Delaware Orthopaedic Center, Wilmington 19810, USA
| | | |
Collapse
|
26
|
Abstract
Quality improvement teams have the ability to enhance processes that impact care delivery. Organizations must use a framework for documentation and communication of the team's work that is congruent with expectations by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and that nurse executives can apply the expectations to the activities of their departments. The author discusses one such framework, based on 1994 standards, and presents a team report form illustrating communication of the team's efforts using JCAHO terminology.
Collapse
|
27
|
Abstract
There are many reasons for developing in vitro tests of toxicity including cost, speed, studies of mechanisms, and studies utilizing human cells and tissues. The present study focuses on the development of in vitro tests to predict in vivo toxicity by comparing them to data from the literature. A broad spectrum of model toxic compounds was evaluated for toxicity on mouse skin JB6 cells in culture. These included mercuric chloride, sodium lauryl sulfate, formaldehyde, dimethyl sulfoxide, benzoyl peroxide, and ionomycin, all of which have been proven to be positive in the Draize test or in cutaneous toxicity studies. Cell viability was evaluated every 15 min for up to 1 hr, and then after 24 hr of treatment using the Trypan Blue exclusion method; morphological changes were evaluated using phase-contrast and transmission electron microscopy. Dose- and time-dependent cell death and morphological changes were observed at concentrations ranging from 10(-14) to 10(-2) M. Arbitrary rankings were assigned based on 1) IC50 value estimated from the present data, and 2) in vivo toxicity reported in the Registry of Toxic Effects of Chemical Substances. Good correlation between in vitro and in vivo toxicity based on arbitrary rankings was observed. Thus, these findings suggest that the JB6 cell culture model can be used for predicting in vivo toxicity. In the future, it may be possible to utilize this system for the study of intracellular ionized calcium ([Ca2+]i), and the expression of oncogenes as early indicators of toxicity.
Collapse
Affiliation(s)
- P T Jain
- Department of Pathology, University of Maryland School of Medicine, Baltimore 21201
| | | | | | | | | |
Collapse
|
28
|
Fitzpatrick MJ. Triathlon injuries. The swim-bike-run how-to for medical practitioners. Aust Fam Physician 1991; 20:953-8. [PMID: 1898286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The triathlon is becoming one of the favourite pastimes of many of our patients. It carries with it a likelihood of overuse injuries. For most of these conditions, treatment will follow the usual regimens, but a good understanding of the mechanics and training principles will give any practitioner more options in the management of these patients.
Collapse
|