Molecular Solid Tumor Algorithm – Simplified Patient-Centric/Cost-Effective Approach by Pathologists

Introduction/Objective

The process from the time the patient is diagnosed with cancer and receives their first treatment is complex and time-consuming. It requires adherence to national comprehensive cancer network (NCCN) guidelines; is challenged with limited tissue, how and when to order tests, and reimbursement timelines with pre- authorizations. We evaluated the role of the pathologists, who are an integral part of patient care, along with oncologists and surgeons.

Methods/Case Report

254 cases from various types of solid tumors (paraffin-embedded blocks) were collected from several pathology departments. Tests (two panels NGS-DNA/RNA expression, FISH, PD-L1, and IHC) were ordered as early as on the day of diagnosis to as late as 18 months following the diagnosis. Cancer cases reviewed were Colo-Rectal (72), Lung (48), Breast (24), Gastric (10), CNS (8), Melanoma (4), Head/Neck (20), GU (16), Sarcomas (8), Thyroid (6), Hepatic (8), Female Genital Tract (7) and Unknown Primary (23).

Results (if a Case Study enter NA)

We evaluated pathology reports, identified blocks, reviewed H&E slides, utilized NCCN guidelines in collaboration with oncologists. Tests were ordered using established billing criteria. Following tests were performed: PD-L1 (190 - 75%), FISH (50 - 20%), and NGS – two simple panel approach (215 - 85%). Using the aforesaid methods, our NGS results were successful in >95%. We were able to identify actionable and prognostic mutations in >80% of tumors.

Conclusion

Our algorithm has been designed considering NCCN guidelines and are updated frequently with new therapeutic targets and actionable mutations. The emphasis is to conserve diagnostic tissue and ensure timely ordering of tests as medically necessary. This can be adopted by pathologists in conjunction with clinical information, pathology reports, and be used as a part of diagnostic workups to reduce delays in treatment, avoid tissue loss, utilize current billing (inpatient/outpatient) practices, pre-authorization and eventually improving patient care as well as reduce overall healthcare costs.

Investigation of the performance of digital mammographic X-ray equipment: determination of noise equivalent quanta (NEQQC) and detective quantum efficiency (DQEQC) compared with the automated analysis of CDMAM test images with CDCOM and CDIC programs

PURPOSE

The purpose of this study was to determine the values for noise equivalent quanta, detective quantum efficiency, modulation transfer function, noise power spectrum, and the values for the parameters for automated CDMAM test phantom analyses required to achieve satisfactory quality of digital mammograms.

MATERIALS AND METHODS

During the course of tests according to PAS 1054 (8 CR and 12 DR systems), test images were made with a test phantom insertion plate containing two lead edges in nearly horizontal and vertical directions. Only original data were processed with a program that was developed at the Cologne University of Applied Sciences (FH-Köln). All equipment systems complied with the requirements regarding visual recognition of gold-plated mammo detail test objects. CDMAM test images were also evaluated using the CDIC (CUAS) and CDCOM (EUREF) programs.

RESULTS

CDMAM test images show comparable values for the parameters, precision, sensitivity and specificity. DR systems require about half the dose used for CR systems for similar results. The NEQ values achieved with the dose used for the CDMAM test images show larger scatter ranges. The MTF of the different equipment system types differ significantly from each other.

CONCLUSION

Visual evaluation of CDMAM test images can be replaced by automated evaluation. Limiting values were determined for each parameter. Automated evaluation of CDMAM test phantom images should be used to determine the physical parameter NEQQC. This method is much more sensitive to noise and sharpness influences and has a higher validity than diagnostic methods. Automated evaluation objectivizes testing.

[A retrospective efficacy and safety study of UVB-TL01 phototherapy and PUVA therapy in palmoplantar psoriasis]

BACKGROUND

Topical therapy is generally insufficient in palmoplantar psoriasis. UVBTL01 phototherapy is a therapeutic alternative and we conducted a retrospective study of the efficacy and safety of this approach and of PUVA therapy in palmoplantar psoriasis.

PATIENTS AND METHODS

All patients treated with UVBTL01 or PUVA therapy from November 2001 to April 2008 were included in the study. Phototherapy was given three times a week. Evaluation was performed after 20 sessions, again after 30 sessions and then at the end of the treatment. Therapeutic outcome was classed as "failure", "slight improvement" or "improvement or clear skin".

RESULTS

UVBTL01 phototherapy and PUVA therapy were effective, with "improvement or clear skin" in respectively 52% and 61% of cases and "slight improvement" in 16% and 23% of cases at the end of the treatment. With UVBTL01, adverse effects occurred in 20% of cases (erythema 18%, first-degree burns 7%) and treatment was discontinued as a result in only 4% of cases. Adverse effects occurred in 50% in patients on PUVA therapy, mainly due to methoxypsoralen intake.

CONCLUSION

UVBTL01 phototherapy and PUVA therapy are efficacious treatments in palmoplantar psoriasis; UVBTL01 phototherapy involves fewer constraints and has fewer adverse effects.

[Comparison of two automatic evaluation methods on Images of the CDMAM test phantom]

PURPOSE

To test the sensitivity of automatic methods for evaluating CDMAM test images with respect to noise.

MATERIALS AND METHODS

CDMAM test images were analyzed with two computer programs. The images were made with different tube loads [mAs]. The other exposure conditions remained constant. They were analyzed with the CDCOM program, which is offered by the EUREF as a free download, and with the CDMAM Image Checker (CDIC), which was developed by the authors.

RESULTS

The determination of the sensitivity in one image always delivers the same result when the same type of computer program is used. This means that the precision of both programs is sufficient. The dose sensitivity of CDIC is two times higher than the sensitivity of CDCOM. However, the required entrance dose (ESAK) for a faultless evaluation with the CDIC program is in the range of 10 mGy. The nominal sensitivity values for the CDCOM program attain a higher level. Differences in dose of more than 5 % should be detectable by both programs.

CONCLUSION

Methods that dispense with visual inspections to determine the performance of X-ray units for mammography can be applied in the acceptance test or the yearly constancy tests according to the German X-ray directive ( section sign 16). The CDCOM program cannot be characterized fully because the data is not complete. Finally the detection methods are not clear. Therefore, the CDCOM program can be called a black box method, while the CDIC has to be called an open source method (general public license).

Planning of a community-based approach to injury control and safety promotion in a rural community

This paper describes the planning of a community-based approach to injury control and safety promotion, the Kolan Injury Prevention Program. The process involved the establishment of a local steering committee, 11 months of injury surveillance, a critical review of the evidence base, community consultations and assessment of community resources. There were 412 recorded injury cases during the surveillance period, with higher rates among men, manual workers, those aged 15-34 years, sport/leisure activities and around the home and farm. Salient issues for residents included a lack of access to safety information and skills, particularly with regard to first aid and bush fire for isolated residents and rurally inexperienced new residents. While injury prevention was identified as an important issue for the community, the rapidly changing size and nature of the community and its infrastructure made this a particularly challenging issue. Challenges included limited availability of volunteers from key sectors, lack of formal data collection systems, difficulties in mobilising support for a broad issue like injury, limited communication networks and the negative impact of distance and role uncertainty on community ownership of the program. This case study illustrates the steps involved in an effective community-based needs assessment addressing injury prevention. Such an approach, if carried out systematically, will help ensure that the strategies and programs developed will be both appropriate and likely to obtain the support of the local community.

A study of postdiagnosis breast cancer concerns for women living in rural and remote Queensland. Part II: Support issues

This paper presents the recent findings from a study on the postdiagnosis support needs of women with breast cancer living in rural and remote Queensland. The findings presented in this discussion focus on support needs from the perspective of the women experiencing breast cancer as well as health service providers. The tyranny of distance imposes unique hardships, such as separation from family and friends, during a time of great vulnerability for treatment, the need to travel long distances for support and follow-up services, and extra financial burdens, which can combine to cause strains on the marital relationship and family cohesion. Positive indications are, however, that the rural communities operate on strong, informal networks of support. This network of family, friends and community can, and does, play an active role in the provision of emotional and practical support.

A study of postdiagnosis breast cancer concerns for women living in rural and remote Queensland. Part I: Personal concerns

The findings presented in this paper are part of a research project designed to provide a preliminary indication of the support needs of postdiagnosis women with breast cancer in remote and isolated areas in Queensland. This discussion will present data that focuses on the women's expressed personal concerns. For participants in this research a diagnosis of breast cancer involves a confrontation with their own mortality and the possibility of a reduced life span. This is a definite life crisis, creating shock and needing considerable adjustment. Along with these generic issues the participants also articulated significant issues in relation to their experience as women in a rural setting. These concerns centred around worries about how their partner and families cope during their absences for treatment, the additional burden on the family of having to cope with running the property or farm during the participant's absence or illness, added financial strain brought about by the cost of travel for treatment, maintenance of properties during absences, and problems created by time off from properties or self-employment. These findings accord with other reports of health and welfare services for rural Australian and the generic literature on psycho-oncology studies of breast cancer.

The value of using a prenatal education planning model: application to an aboriginal community

A conceptual model for planning adolescent prenatal programs was developed that anticipated future trends, was easily modifiable, and fostered community self-direction (Loos & Morton, 1996). However, the model's reliability with diverse groups in atypical settings required testing. Validation of its reliability focused on adolescent Aboriginal women living in an isolated northern community. Use of the model helped identify modifications in program design, implementation, and evaluation to meet the ethno-cultural, socioeconomic, and age-related needs differences of this population, suggesting that this model is an effective tool for program development.

Caregivers of persons with Alzheimer's disease: some neglected implications of the experience of personal loss and grief

This article questions some traditional conceptualizations of caregivers of persons with Alzheimer's disease and related dementias (AD). The phenomenology of caregiving in rural and isolated regions of northern Canada is examined within a framework developed from the constructs of personal loss and grief. Sixty-eight caregivers for persons with AD shared their thoughts and feelings about personal losses perceived to have occurred in their lives with the advent of the caregiving role. Four themes were identified suggesting a role perceived by caregivers as one in which they become subsumed to the needs of the person in care. Diminution of self in the caregiver role has been neglected in the literature.

The client's view of hospitalization during pregnancy

The thoughts and feelings expressed by the prenatal hospitalized client are important considerations for care, yet few investigations of this subject have been reported. A qualitative study using descriptive exploratory methods (a questionnaire and tape recorded interview) addressed these questions using a phenomenological approach. The sample comprised 11 women at 26-38 weeks' gestation. Results revealed experiences of loneliness, boredom, and powerlessness. The findings imply that the emotional needs of this particular group may not be met by current nursing interventions.