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Flory A, Ruiz-Perez CA, Clavere-Graciette AG, Rafalko JM, O'Kell AL, Flesner BK, McLennan LM, Hicks SC, Nakashe P, Phelps-Dunn A, DiMarzio LR, Warren CD, Cohen TA, Chibuk J, Chorny I, Grosu DS, Tsui DWY, Tynan JA, Kruglyak KM. Clinical validation of a blood-based liquid biopsy test integrating cell-free DNA quantification and next-generation sequencing for cancer screening in dogs. J Am Vet Med Assoc 2024; 262:665-673. [PMID: 38324993 DOI: 10.2460/javma.23.10.0564] [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: 10/17/2023] [Accepted: 01/05/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To validate the performance of a novel, integrated test for canine cancer screening that combines cell-free DNA quantification with next-generation sequencing (NGS) analysis. SAMPLE Retrospective data from a total of 1,947 cancer-diagnosed and presumably cancer-free dogs were used to validate test performance for the detection of 7 predefined cancer types (lymphoma, hemangiosarcoma, osteosarcoma, leukemia, histiocytic sarcoma, primary lung tumors, and urothelial carcinoma), using independent training and testing sets. METHODS Cell-free DNA quantification data from all samples were analyzed using a proprietary machine learning algorithm to determine a Cancer Probability Index (High, Moderate, or Low). High and Low Probability of Cancer were final result classifications. Moderate cases were additionally analyzed by NGS to arrive at a final classification of High Probability of Cancer (Cancer Signal Detected) or Low Probability of Cancer (Cancer Signal Not Detected). RESULTS Of the 595 dogs in the testing set, 89% (n = 530) received a High or Low Probability result based on the machine learning algorithm; 11% (65) were Moderate Probability, and NGS results were used to assign a final classification. Overall, 87 of 122 dogs with the 7 predefined cancer types were classified as High Probability and 467 of 473 presumably cancer-free dogs were classified as Low Probability, corresponding to a sensitivity of 71.3% for the predefined cancer types at a specificity of 98.7%. CLINICAL RELEVANCE This integrated test offers a novel option to screen for cancer types that may be difficult to detect by physical examination at a dog's wellness visit.
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Affiliation(s)
- Andi Flory
- 1Medical and Clinical Affairs, PetDx, La Jolla, CA
| | | | | | | | | | | | | | | | | | | | | | | | - Todd A Cohen
- 1Medical and Clinical Affairs, PetDx, La Jolla, CA
| | - Jason Chibuk
- 1Medical and Clinical Affairs, PetDx, La Jolla, CA
| | - Ilya Chorny
- 2Information Technology, PetDx, La Jolla, CA
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McCleary-Wheeler AL, Fiaux PC, Flesner BK, Ruiz-Perez CA, McLennan LM, Tynan JA, Hicks SC, Rafalko JM, Grosu DS, Chibuk J, O'Kell AL, Cohen TA, Chorny I, Tsui DWY, Kruglyak KM, Flory A. Next-generation sequencing-based liquid biopsy may be used for detection of residual disease and cancer recurrence monitoring in dogs. Am J Vet Res 2023:1-8. [PMID: 38150822 DOI: 10.2460/ajvr.23.07.0163] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/09/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the performance of a next-generation sequencing-based liquid biopsy test for cancer monitoring in dogs. SAMPLES Pre- and postoperative blood samples were collected from dogs with confirmed cancer diagnoses originally enrolled in the CANcer Detection in Dogs (CANDiD) study. A subset of dogs also had longitudinal blood samples collected for recurrence monitoring. METHODS All cancer-diagnosed patients had a preoperative blood sample in which a cancer signal was detected and had at least 1 postoperative sample collected. Clinical data were used to assign a clinical disease status for each follow-up visit. RESULTS Following excisional surgery, in the absence of clinical residual disease at the postoperative visit, patients with Cancer Signal Detected results at that visit were 1.94 times as likely (95% CI, 1.21 to 3.12; P = .013) to have clinical recurrence within 6 months compared to patients with Cancer Signal Not Detected results. In the subset of patients with longitudinal liquid biopsy samples that had clinical recurrence documented during the study period, 82% (9/11; 95% CI, 48% to 97%) had Cancer Signal Detected in blood prior to or concomitant with clinical recurrence; in the 6 patients where molecular recurrence was detected prior to clinical recurrence, the median lead time was 168 days (range, 47 to 238). CLINICAL RELEVANCE Next-generation sequencing-based liquid biopsy is a noninvasive tool that may offer utility as an adjunct to current standard-of-care clinical assessment for cancer monitoring; further studies are needed to confirm diagnostic accuracy in a larger population.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jason Chibuk
- Medical and Clinical Affairs, PetDx, La Jolla, CA
| | | | - Todd A Cohen
- Medical and Clinical Affairs, PetDx, La Jolla, CA
| | | | | | | | - Andi Flory
- Medical and Clinical Affairs, PetDx, La Jolla, CA
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Kruglyak KM, O'Kell AL, Cohen TA, Marshall MA, Ruiz-Perez CA, Marass F, Tynan JA, Hicks SC, Lytle KM, Phelps-Dunn A, Brandstetter G, Warren CD, DiMarzio LR, Rosentel MC, Wong LK, McLennan LM, Rafalko JM, Grosu DS, Chibuk J, Chorny I, McCleary-Wheeler AL, Flory A, Tsui DWY. Detection of Age-Related Somatic Alterations in Canine Blood Using Next-Generation Sequencing-Based Liquid Biopsy: An Analysis of over 4800 Dogs. Vet Sci 2023; 10:455. [PMID: 37505860 PMCID: PMC10384417 DOI: 10.3390/vetsci10070455] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023] Open
Abstract
Age-related somatic genomic alterations in hematopoietic cell lines have been well characterized in humans; however, this phenomenon has not been well studied in other species. Next-generation sequencing-based liquid biopsy testing for cancer detection was recently developed for dogs and has been used to study the genomic profiles of blood samples from thousands of canine patients since 2021. In this study, 4870 client-owned dogs with and without a diagnosis or suspicion of cancer underwent liquid biopsy testing by this method. Copy number variants detected exclusively in genomic DNA derived from white blood cells (WBC gDNA-specific CNVs) were observed in 126 dogs (2.6%; 95% CI: 2.2-3.1); these copy number variants were absent from matched plasma cell-free DNA, and from tumor tissue in dogs with concurrent cancer. These findings were more common in older dogs and were persistent in WBC gDNA in over 70% of patients, with little to no change in the amplitude of the signal across longitudinal samples. Many of these alterations were observed at recurrent locations in the genome across subjects; the most common finding was a partial loss on CFA25, typically accompanied by a partial gain on the same chromosome. These early findings suggest that age-related somatic alterations may be present at an appreciable frequency in the general canine population. Further research is needed to determine the clinical significance of these findings.
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Affiliation(s)
| | | | - Todd A Cohen
- Medical & Clinical Affairs, PetDx, La Jolla, CA 92037, USA
| | | | | | | | - John A Tynan
- Research Programs, PetDx, La Jolla, CA 92037, USA
| | - Susan C Hicks
- Analytical Production, PetDx, La Jolla, CA 92037, USA
| | | | | | | | | | | | | | - Lilian K Wong
- Medical & Clinical Affairs, PetDx, La Jolla, CA 92037, USA
- Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR 97331, USA
| | | | - Jill M Rafalko
- Medical & Clinical Affairs, PetDx, La Jolla, CA 92037, USA
| | - Daniel S Grosu
- Medical & Clinical Affairs, PetDx, La Jolla, CA 92037, USA
| | - Jason Chibuk
- Medical & Clinical Affairs, PetDx, La Jolla, CA 92037, USA
| | - Ilya Chorny
- Information Technology, PetDx, La Jolla, CA 92037, USA
| | | | - Andi Flory
- Medical & Clinical Affairs, PetDx, La Jolla, CA 92037, USA
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O'Kell AL, Lytle KM, Cohen TA, Wong LK, Sandford E, Rafalko JM, Brandstetter G, DiMarzio LR, Phelps-Dunn A, Rosentel MC, Warren CD, McCleary-Wheeler AL, Fiaux PC, Marass F, Marshall MA, Ruiz-Perez CA, Kruglyak KM, Tynan JA, Hicks SC, Grosu DS, Chibuk J, Chorny I, Tsui DWY, Flory A. Clinical experience with next-generation sequencing-based liquid biopsy testing for cancer detection in dogs: a review of 1,500 consecutive clinical cases. J Am Vet Med Assoc 2023; 261:827-836. [PMID: 36965477 DOI: 10.2460/javma.22.11.0526] [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: 11/29/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE To review ordering patterns, positivity rates, and outcome data for a subset of consecutive samples submitted for a commercially available, blood-based multicancer early-detection liquid biopsy test for dogs using next-generation sequencing at 1 laboratory. SAMPLE 1,500 consecutively submitted blood samples from client-owned dogs with and without clinical suspicion and/or history of cancer for prospective liquid biopsy testing between December 28, 2021, and June 28, 2022. PROCEDURES We performed a retrospective observational study, reviewing data from 1,500 consecutive clinical samples submitted for liquid biopsy testing. Outcome data were obtained via medical record review, direct communication with the referring clinic, and/or a patient outcome survey through October 16, 2022. RESULTS Sixty-four percent (910/1,419) of reportable samples were submitted for cancer screening, 26% (366/1,419) for aid in diagnosis, and 10% (143/1,419) for other indications. The positivity rate was 25.4% (93/366) in aid-in-diagnosis patients and 4.5% (41/910) in screening patients. Outcome data were available for 33% (465/1,401) of patients, and outcomes were classifiable for 428 patients. The relative observed sensitivity was 61.5% (67/109) and specificity was 97.5% (311/319). The positive predictive value was 75.0% (21/28) for screening patients and 97.7% (43/44) for aid-in-diagnosis patients, and the time to diagnostic resolution following a positive result was < 2 weeks in most cases. CLINICAL RELEVANCE Liquid biopsy using next-generation sequencing represents a novel tool for noninvasive detection of cancer in dogs. Real-world clinical performance meets or exceeds expectations established in the test's clinical validation study.
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Affiliation(s)
| | | | - Todd A Cohen
- 1PetDx, Medical & Clinical Affairs, La Jolla, CA
| | - Lilian K Wong
- 1PetDx, Medical & Clinical Affairs, La Jolla, CA
- 3Carlson College of Veterinary Medicine, Oregon State University, Corvallis, OR
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jason Chibuk
- 1PetDx, Medical & Clinical Affairs, La Jolla, CA
| | - Ilya Chorny
- 5PetDx, Information Technology, La Jolla, CA
| | | | - Andi Flory
- 1PetDx, Medical & Clinical Affairs, La Jolla, CA
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Tsui DW, O'Kell AL, Cohen TA, Lytle KM, Kruglyak KM, Marshall MA, Ruiz-Perez CA, Tynan JA, Hicks SC, Rafalko JM, Grosu DS, Chibuk J, Chorny I, McCleary-Wheeler AL, Flory A. Abstract A028: Incidental detection of age-related somatic genomic alterations in blood samples from dogs with and without cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.agca22-a028] [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] [Indexed: 01/19/2023]
Abstract
Abstract
The concept of age-related somatic alterations in the blood or bone marrow of humans, commonly referred to as clonal hematopoiesis of indeterminate potential (CHIP) or age-related clonal hematopoiesis (ARCH), has been well characterized. In humans, these abnormalities tend to be associated with advanced age, often exhibit consistent signal over time, and typically involve recurrent locations in the genome. Though these somatic alterations may be associated with an increased risk of cancer, they do not originate from the tumor when cancer is concurrently present in the body. This study describes early findings that suggest similar age-related somatic alterations may also be present in dogs. Recently, next-generation sequencing-based liquid biopsy testing was developed for cancer detection in dogs. The clinical validation of this test involved 1,100 cancer-diagnosed and presumably cancer-free client-owned dogs. The test has also been performed commercially in thousands of additional dogs since 2021. This recent ability to test large numbers of dogs using liquid biopsy affords an unprecedented opportunity to study the genomic profiles of a broad population of canine subjects. Blood samples from over three thousand dogs ranging in age from 1 to >15 years were used in this analysis. Cell-free DNA (cfDNA) was extracted from the plasma, and genomic DNA (gDNA) was extracted from the white blood cells present in the buffy coat. Both cfDNA and gDNA were analyzed using next-generation sequencing to identify somatic genomic alterations. In a subset of patients, tumor tissue was also available for evaluation. Recurrent variants (e.g., involving CFA6 and CFA25, among others) were identified in the gDNA of a small fraction of patients. These findings occurred more commonly in older dogs and were typically persistent in gDNA across subsequent timepoints (when available) with no significant change in signal over time. When a clinical cancer evaluation was pursued, the majority of dogs with these findings had no evidence of cancer. For those in which cancer was identified, and tumor tissue was available for testing, the genomic profiles of the tumor tissue and gDNA were uncorrelated in almost all cases, suggesting the concomitant presence of age-related somatic alterations was incidental to the patient’s cancer. Additionally, regardless of whether cancer was present in the patient, the variants detected in gDNA were typically not encountered in cfDNA. These findings may be early evidence for the existence of age-related somatic alterations in dogs that potentially resemble the phenomenon of CHIP/ARCH previously observed in humans. Additional studies are ongoing to determine if these incidental findings may represent a risk factor for cancer development in dogs.
Citation Format: Dana W.Y. Tsui, Allison L. O'Kell, Todd A. Cohen, Katherine M. Lytle, Kristina M. Kruglyak, Maggie A. Marshall, Carlos A. Ruiz-Perez, John A. Tynan, Susan C. Hicks, Jill M. Rafalko, Daniel S. Grosu, Jason Chibuk, Ilya Chorny, Angela L. McCleary-Wheeler, Andi Flory. Incidental detection of age-related somatic genomic alterations in blood samples from dogs with and without cancer [abstract]. In: Proceedings of the AACR Special Conference: Aging and Cancer; 2022 Nov 17-20; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_1):Abstract nr A028.
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McCleary-Wheeler AL, Kruglyak KM, Hernandez GE, Nakashe P, McLennan LM, Jennings T, Rafalko JM, Holtvoigt LE, Grosu DS, Chibuk J, Hicks SC, Tynan JA, Chorny I, Tsui DWY, Flory A. Abstract A16: Liquid biopsy for the detection and characterization of canine lymphoma. Blood Cancer Discov 2022. [DOI: 10.1158/2643-3249.lymphoma22-a16] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
Lymphoma is the most common hematologic malignancy in dogs, with some subtypes being highly similar to their human counterparts in terms of molecular, pathologic, and biologic features. Despite the rapid growth in our understanding of canine lymphoma, tools for early detection, personalized therapy, and treatment monitoring are still lacking. Blood-based liquid biopsy using next-generation sequencing (NGS) of cell-free DNA is gaining adoption in human medicine and is now available for canine patients. This non-invasive tool affords new opportunities to profile the genomic landscape of naturally occurring canine lymphomas across large cohorts of patients, and given the high homology (>90%) between human and canine cancer genomes, findings in canine lymphomas may afford unique opportunities for comparative oncology studies for the benefit of both species. One hundred sixteen dogs diagnosed with lymphoma (63 intermediate to large B-cell, 21 intermediate to large T-cell, 6 T-zone, and 26 unphenotyped) were included in this analysis, enrolled as part of a larger liquid biopsy clinical validation study. Lymphomas with inconclusive immunophenotype or other types of indolent lymphomas were excluded. A blood sample was collected from each dog following diagnosis and prior to undergoing therapy to evaluate the ability of liquid biopsy to non-invasively detect the presence and characterize the genomic signature of the cancer. In a subset of patients, longitudinal blood samples and clinical outcomes were also collected. Of all lymphoma-diagnosed dogs, 56% were purebred (representing 32 distinct breeds); 57% were male; median age was 8 years; and median weight was 28.4kg. The overall detection rate for lymphoma by liquid biopsy was 92.2% (107/116); with detection rates of 57% for localized/regional disease (Stages I and II) and 95% for disseminated/metastatic disease (Stages III, IV, and V). By immunophenotype, the detection rate for B-cell lymphoma was 97%, T-cell 91%, T-zone 50%, and unphenotyped 92%. A variety of genomic alterations were identified in patients with positive liquid biopsy results, including single nucleotide variants in common oncogenes and tumor suppressor genes, and copy number variants across the genome (including CNVs previously described in tumor tissue of canine lymphoma patients). In patients with longitudinal samples, the presence or absence of cancer signal appeared to be closely related to remission status at corresponding time points. A novel NGS-based liquid biopsy tool has demonstrated the ability to identify genomic alterations in blood samples of dogs with lymphoma, including alterations previously described in human and canine lymphoma tissue. This technology may also provide a non-invasive method for longitudinal monitoring of treatment response in dogs with lymphoma. These findings, and the high degree of homology between the human and canine disease, support the utility of liquid biopsy for the study of canine lymphoma as a comparative oncology model for accelerated biomarker discovery and therapeutic development.
Citation Format: Angela L McCleary-Wheeler, Kristina M Kruglyak, Gilberto E Hernandez, Prachi Nakashe, Lisa M McLennan, Thuy Jennings, Jill M Rafalko, Lauren E Holtvoigt, Daniel S Grosu, Jason Chibuk, Susan C Hicks, John A Tynan, Ilya Chorny, Dana WY Tsui, Andi Flory. Liquid biopsy for the detection and characterization of canine lymphoma [abstract]. In: Proceedings of the Third AACR International Meeting: Advances in Malignant Lymphoma: Maximizing the Basic-Translational Interface for Clinical Application; 2022 Jun 23-26; Boston, MA. Philadelphia (PA): AACR; Blood Cancer Discov 2022;3(5_Suppl):Abstract nr A16.
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McCullough RM, Almasri EA, Guan X, Geis JA, Hicks SC, Mazloom AR, Deciu C, Oeth P, Bombard AT, Paxton B, Dharajiya N, Saldivar JS. Non-invasive prenatal chromosomal aneuploidy testing--clinical experience: 100,000 clinical samples. PLoS One 2014; 9:e109173. [PMID: 25289665 PMCID: PMC4188614 DOI: 10.1371/journal.pone.0109173] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [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: 01/30/2014] [Accepted: 09/09/2014] [Indexed: 01/03/2023] Open
Abstract
Objective As the first laboratory to offer massively parallel sequencing-based noninvasive prenatal testing (NIPT) for fetal aneuploidies, Sequenom Laboratories has been able to collect the largest clinical population experience data to date, including >100,000 clinical samples from all 50 U.S. states and 13 other countries. The objective of this study is to give a robust clinical picture of the current laboratory performance of the MaterniT21 PLUS LDT. Study Design The study includes plasma samples collected from patients with high-risk pregnancies in our CLIA–licensed, CAP-accredited laboratory between August 2012 to June 2013. Samples were assessed for trisomies 13, 18, 21 and for the presence of chromosome Y-specific DNA. Sample data and ad hoc outcome information provided by the clinician was compiled and reviewed to determine the characteristics of this patient population, as well as estimate the assay performance in a clinical setting. Results NIPT patients most commonly undergo testing at an average of 15 weeks, 3 days gestation; and average 35.1 years of age. The average turnaround time is 4.54 business days and an overall 1.3% not reportable rate. The positivity rate for Trisomy 21 was 1.51%, followed by 0.45% and 0.21% rate for Trisomies 18 and 13, respectively. NIPT positivity rates are similar to previous large clinical studies of aneuploidy in women of maternal age ≥35 undergoing amniocentesis. In this population 3519 patients had multifetal gestations (3.5%) with 2.61% yielding a positive NIPT result. Conclusion NIPT has been commercially offered for just over 2 years and the clinical use by patients and clinicians has increased significantly. The risks associated with invasive testing have been substantially reduced by providing another assessment of aneuploidy status in high-risk patients. The accuracy and NIPT assay positivity rate are as predicted by clinical validations and the test demonstrates improvement in the current standard of care.
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Affiliation(s)
- Ron M. McCullough
- Clinical Science, Sequenom Laboratories, San Diego, California, United States of America
- * E-mail:
| | - Eyad A. Almasri
- Clinical Science, Sequenom Laboratories, San Diego, California, United States of America
| | - Xiaojun Guan
- Clinical Science, Sequenom Laboratories, San Diego, California, United States of America
| | - Jennifer A. Geis
- Clinical Science, Sequenom Laboratories, San Diego, California, United States of America
| | - Susan C. Hicks
- Clinical Science, Sequenom Laboratories, San Diego, California, United States of America
| | - Amin R. Mazloom
- Clinical Science, Sequenom Laboratories, San Diego, California, United States of America
| | - Cosmin Deciu
- Clinical Science, Sequenom Laboratories, San Diego, California, United States of America
| | - Paul Oeth
- Clinical Science, Sequenom Laboratories, San Diego, California, United States of America
| | - Allan T. Bombard
- Clinical Science, Sequenom Laboratories, San Diego, California, United States of America
| | - Bill Paxton
- Clinical Science, Sequenom Laboratories, San Diego, California, United States of America
| | - Nilesh Dharajiya
- Clinical Science, Sequenom Laboratories, San Diego, California, United States of America
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Li LT, Hicks SC, Davila JA, Kao LS, Berger RL, Arita NA, Liang MK. Circular closure is associated with the lowest rate of surgical site infection following stoma reversal: a systematic review and multiple treatment meta-analysis. Colorectal Dis 2014; 16:406-16. [PMID: 24422861 DOI: 10.1111/codi.12556] [Citation(s) in RCA: 25] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 09/20/2013] [Indexed: 02/08/2023]
Abstract
AIM Stoma reversal is frequently complicated by surgical site infection (SSI). To reduce SSI, several techniques for skin closure have been studied, with no agreement on which is best. The aim of this study was to identify the skin closure technique associated with the lowest rate of SSI following stoma reversal. METHOD We systematically searched MEDLINE (PubMed and OvidSP), Scopus and clinical registries from 1 January 1980 to 24 March 2012, and included original reports on adult patients following stoma reversal. A network of treatments was created to map the comparisons between skin closure techniques, including primary closure, primary closure with a drain, secondary closure, delayed primary closure, loose primary closure and circular closure. Pairwise meta-analyses were performed for all available direct comparisons of closure types and heterogeneity was assessed. A multiple-treatments meta-analysis was conducted to estimate relative treatment effects between competing closure types (reported as an odds ratio with 95% credible interval, and a probability that each treatment is best). Several sensitivity analyses were performed. RESULTS Fifteen studies were identified with a total of 2921 cases of stoma reversal. Overall, study quality was poor with observed low (one study), moderate (seven studies) and high (seven studies) risk of bias. Circular closure was associated with the lowest SSI risk (OR 0.12; 95% CI 0.02-0.40) and was the best of six skin closure techniques (probability of being best = 68.9%). Circular closure remained the best after sensitivity analyses. CONCLUSION This study showed that circular closure is the best skin closure technique after stoma reversal in terms of SSI rate, but the quality of supporting evidence is limited, precluding definite conclusions.
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Affiliation(s)
- L T Li
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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Hicks SC. Otitis externa: are we giving adequate care? J R Coll Gen Pract 1983; 33:581-3. [PMID: 6631803 PMCID: PMC1973008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
A series of 26 patients with diagnosis of otitis externa were given treatment consisting of either drops only or manual aural toilet followed by aural drops. The efficacy in terms of resolution of symptoms and clinical signs were compared. In all but the most minor of cases, adequate curative treatment had to consist of complete aural toilet as well as aural drops. It was also shown that without aural toilet and visualization of the tympanum, more serious middle ear pathology could be missed.This study indicates that unless the patient is given the opportunity to have his ears properly cleaned, the general practitioner may not only be giving inadequate and ineffective treatment, but he may also be missing serious ear disease.
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Hicks SC. Making the olympic team. Nurs Outlook 1969; 17:47. [PMID: 5192749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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