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Wang S.,University of Pennsylvania | Kim S.J.,University of Ulsan | Poptani H.,University of Pennsylvania | Woo J.H.,University of Pennsylvania | And 7 more authors.
American Journal of Neuroradiology | Year: 2014

BACKGROUND AND PURPOSE: Differentiation of glioblastomas and solitary brain metastases is an important clinical problem because the treatment strategy can differ significantly. The purpose of this study was to investigate the potential added value of DTI metrics in differentiating glioblastomas from brain metastases. MATERIALS AND METHODS: One hundred twenty-eight patients with glioblastomas and 93 with brain metastases were retrospectively identified. Fractional anisotropy and mean diffusivity values were measured from the enhancing and peritumoral regions of the tumor. Two experienced neuroradiologists independently rated all cases by using conventional MR imaging and DTI. The diagnostic performances of the 2 raters and a DTI-based model were assessed individually and combined. RESULTS: The fractional anisotropy values from the enhancing region of glioblastomas were significantly higher than those of brain metastases (P < .01). There was no difference in mean diffusivity between the 2 tumor types. A classification model based on fractional anisotropy and mean diffusivity from the enhancing regions differentiated glioblastomas from brain metastases with an area under the receiver operating characteristic curve of 0.86, close to those obtained by 2 neuroradiologists using routine clinical images and DTI parameter maps (area under the curve = 0.90 and 0.85). The areas under the curve of the 2 radiologists were further improved to 0.96 and 0.93 by the addition of the DTI classification model. CONCLUSIONS: Classification models based on fractional anisotropy and mean diffusivity from the enhancing regions of the tumor can improve diagnostic performance in differentiating glioblastomas from brain metastases. Source

Soot L.,Providence Cancer Center | Weerasinghe R.,Providence Cancer Center | Wang L.,Medical Data Research Center | Nelson H.D.,Providence Cancer Center | Nelson H.D.,Oregon Health And Science University
American Journal of Surgery | Year: 2014

Background High rates of surgical breast biopsies in community hospitals have been reported but may misrepresent actual practice. Methods Patient-level data from 5,757 women who underwent breast biopsies in a large integrated health system were evaluated to determine biopsy types, rates, indications, and diagnoses. Results Between 2008 and 2010, 6,047 breast biopsies were performed on 5,757 women. Surgical biopsy was the initial diagnostic procedure in 16% (n = 942) of women overall and in 6% (72 of 1,236) of women with newly diagnosed invasive breast cancer. Invasive breast cancer was diagnosed in 72 women (8%) undergoing surgical biopsy compared with 1,164 (24%) undergoing core needle biopsy (P <.001, age adjusted). Main indications for surgical biopsies included symptomatic abnormalities, technical challenges, and patient choice. Conclusions Surgical biopsy was the initial diagnostic procedure in 16% of women with breast abnormalities, comparable with rates at academic centers. Rates could be improved by more careful consideration of indications. © 2014 Elsevier Inc. All rights reserved. Source

Jin R.,Medical Data Research Center | Grunkemeier G.L.,Medical Data Research Center
Annals of Thoracic Surgery | Year: 2013

Background: New York (NY) valve and valve/coronary artery bypass grafting (CABG) mortality risk models, developed from operations performed in 2007 to 2009, have just been published. These models were validated using NY data from 2004 to 2006. The authors stated that their models "should also be validated by testing them against non-New York populations." Thus, we validated the NY models with the Providence Health & Services-Swedish Health Services (PH&S-SHS) cardiac surgical data and also compared them with The Society of Thoracic Surgeons (STS) mortality risk models. Methods: The PH&S-SHS validation data set contained 4,021 isolated valve and 2,406 valve/CABG operations, performed from 2008 to 2012. The risk models (NY logistic and score models and the STS models) were recalibrated to equalize the expected and observed number of deaths. Discrimination was tested by C statistics and calibration by Hosmer-Lemeshow statistics. Results: PH&S-SHS operative mortality rates were 2.6% and 5.5% in the valve and valve/CABG operations, respectively, and were lower than the NY rates. The C statistics for the NY logistic valve and valve/CABG models were 0.777 and 0.727, respectively, and were very similar for the NY score models. Calibration was good for the NY valve model (p = 0.85), but not for the NY valve/CABG model (p = 0.01). The STS models had better discrimination than NY models and good calibration. Conclusions: The NY logistic and score models for valve operations fit the PH&S-SHS data well with acceptable discrimination and good calibration. The NY models for valve/CABG operations fit the PH&S-SHS data with acceptable discrimination and poor calibration. STS logistic regression models fit the PH&S-SHS data somewhat better. © 2013 The Society of Thoracic Surgeons. Source

Handy Jr. J.R.,Providence Cancer Center | Asaph J.W.,Earle A Chiles Research Institute | Douville E.C.,Thoracic and Cardiovascular Surgery | Ott G.Y.,Thoracic and Cardiovascular Surgery | And 2 more authors.
European Journal of Cardio-thoracic Surgery | Year: 2010

Objective: We evaluated video-assisted thoracic surgery (VATS) and open (OPEN) lobectomy for lung cancer and impact upon 6-month postoperative (postop) functional health status and quality of life. Methods: In this retrospective analysis of prospective, observational data, anatomic lobectomy with staging thoracic lymphadenectomy was performed with curative intent for lung cancer. OPEN consisted of either thoracotomy (TH) or median sternotomy (MS). Technique was selected on the basis of anatomic imperative (OPEN: larger or central; VATS smaller or peripheral tumours) and/or surgical skills (VATS lobectomy initiated in 2001). All patients completed the Short Form 36 Health Survey (SF36) and Ferrans and Powers quality-of-life index (QLI) preoperatively (preop) and 6 months postop. Results: A total of 241 patients underwent lobectomy (OPEN, 192; VATS, 49). OPEN included MS 128 and TH 64. Comparison of MS and TH patient demographics, co-morbidities, pulmonary variables, intra-operative variables, stage and cell type, postop complications and 6-month clinical outcomes found no differences, allowing grouping together into OPEN. The VATS group had better pulmonary function testing (PFT), more adenocarcinoma and lower stage. The VATS and OPEN groups did not differ regarding operating time, postop complications and operative or 6-month mortality. The VATS group had less blood loss, transfusion, intra-operative fluid administration and shorter length of stay. Comparing within each group's preop to 6-month postop data, VATS patients were either the same or better in all SF36 categories (physical functioning, role functioning - physical, role functioning - emotional, social functioning, bodily pain, mental health, energy and general health). The OPEN group, however, was significantly worse in SF36 categories physical functioning, role functioning - physical and social functioning. The preop and 6 months postop VATS versus OPEN QLI scores were not different. At 6 months postop, hospital re-admission and use of pain medication was less in the VATS group. In addition, the VATS group had better preservation of preop performance status. Conclusions: VATS lobectomy for curative lung cancer resection appears to provide a superior functional health recovery compared with OPEN techniques. © 2009 European Association for Cardio-Thoracic Surgery. Source

Kurian A.A.,Providence Cancer Center | Wang L.,Medical Data Research Center | Grunkemeier G.,Medical Data Research Center | Bhayani N.H.,Providence Cancer Center | Swanstrom L.L.,Oregon Clinic GMIS Division
Annals of Surgery | Year: 2013

Objective: "The elderly" is an often used but poorly defined descriptor of surgical patients. Investigators have used varying subjectively determined age cutoffs to report outcomes in the elderly.We set out to use objective outcomes data to determine the "at-risk" elderly population. Methods: • Patients: 129,331 patients identified from the ACS-NSQIP database (2005- 2010) undergoing major gastrointestinal resections. • Outcome: Mortality. • Statistical methods: Locally weighted regression was used to fit the trend line of mortality over age. Receiver operating characteristic analysis was used to identify the "predictive age" for mortality. Results: Mortality steadily increases with age. On receiver operating characteristic analysis, there is a nonlinear transition zone (50-75 years of age) flanked by 2 linear zones on either end. The younger linear zone showed a low mortality increase (0.5% per decade). Larger mortality increase with age (5.3% per decade) was observed at the older age end. Similar patterns were observed for large-volume surgical subtypes, with clustering of a "critical age" beyond which mortality increases dramatically at 75 ±2 years. Receiver operating characteristic analysis identified the "optimum age" for mortality being 68.5 years (area under the curve = 0.72, sensitivity = 66.6%, and specificity = 65.5%). Conclusions: Mortality risk for major gastrointestinal surgical resections starts increasing at 50 years of age, and at 75 years of age, it starts increasing very rapidly. The optimum age of 68.5 years predicts mortality with the best combination of sensitivity and specificity. These ages should be used to standardize outcome data and focus perioperative resources to improve outcomes. © 2013 Lippincott Williams & Wilkins. Source

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