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Evaluating indeterminate bone lesions and lymph nodes on PSMA-PET: a multidisciplinary consensus algorithm and 1-year implementation results

Woo, Sungmin; Tong, Angela; Becker, Anton S; Friedman, Kent P; Leithner, Doris; Charbel, Charlotte; Mayerhoefer, Marius E; Kostakoglu Shields, Lale; Wysock, James S; Tan, Wei Phin; Pak, Jamie S; Lepor, Herbert; Aghdam, Nima; Mahadevan, Anand; Economides, Minas P; Deng, Fang-Ming; Taneja, Samir S; Zelefsky, Michael J; Wise, David R; Vargas, Hebert A
OBJECTIVE:Indeterminate lesions on prostate-specific membrane antigen (PSMA)-PET are challenging to address. We aimed to develop, implement, and evaluate a multidisciplinary consensus algorithm that integrates existing interpretation systems with multimodality imaging and clinicopathological information for interpreting indeterminate bone and lymph node lesions on PSMA-PET. MATERIALS AND METHODS/METHODS:This was a retrospective single-center study on a prospectively implemented algorithm. We included all consecutive prostate cancer patients whose PSMA-PET findings for indeterminate bone lesions or lymph nodes were discussed at a multidisciplinary tumor board (MDT) in 2024-2025. An algorithm determining the level of suspicion for metastasis was developed in a multidisciplinary fashion, incorporating lesion location, conventional imaging features, PSMA-PET characteristics, and clinicopathological information. The application of the algorithm and outcomes were documented, compared against a composite reference standard. Comparisons were made with PSMA-RADS and PROMISE V2 PSMA-expression scores. RESULTS:81 patients (median age 68, interquartile range 64-75) were included. Algorithm results were benign (48.1% [39/81]), equivocal (4.9% [4/81]), metastasis (40.7% [33/81]), and mixed (benign and metastatic lesions, 6.2% [5/81]). The algorithm was correct in 94.1% (64 of 68 patients with a sufficient reference standard). The algorithm was discordant with PSMA-RADS in 54.3% (44/81) and with PROMISE V2 PSMA-expression score in 71.6% (58/81). The frequency of equivocal lesions was lower using the algorithm (4.9% [4/81]) compared with PSMA-RADS (53.1% [43/81]) and PSMA-expression score (64.2% [52/81]). CONCLUSION/CONCLUSIONS:A multidisciplinary consensus algorithm for interpreting indeterminate bone lesions and lymph nodes on PSMA-PET was developed and implemented. Integrating clinicopathological information and multimodality imaging in an MDT setting reduced equivocal interpretations. KEY POINTS/CONCLUSIONS:Question While prostate-specific membrane antigen (PSMA)-PET has become essential in the management of prostate cancer, indeterminate bone lesions and lymph nodes remain challenging to address. Findings A multidisciplinary algorithm for interpreting indeterminate bone lesions and lymph nodes on PSMA-PET, incorporating clinicopathological information and multimodality imaging, reduced the frequency of equivocal interpretations. Clinical relevance An algorithm for interpreting indeterminate bone lesions and lymph nodes on PSMA-PET, incorporating clinicopathological information and multimodality imaging in a multidisciplinary tumor board setting, decreases the frequency of equivocal interpretations and can potentially help management decisions.
PMID: 41493546
ISSN: 1432-1084
CID: 5980782

Noninvasive BCL6 Preoperative Screening and Anatomic Patterns of Endometriosis in Patients with Unexplained Infertility

Khoyloo, Farrah; Nezhat, Camran; Najmi, Zahra; Harding, Quincy; Zarroug, Dahnia; Tsuei, Angie; Nezhat, Farr
PMCID:12787122
PMID: 41517625
ISSN: 2077-0383
CID: 5981522

Editorial: Defining the Role of Pressurized Intraperitoneal Aerosolized Chemotherapy (PIPAC) [Editorial]

Brown, Zachary J
PMID: 41201526
ISSN: 1534-4681
CID: 5960362

RSV vaccination in pregnancy and social determinants of health 

Lantigua-Martinez, Meralis; Goldberger, Cody; Vertichio, Rosanne; Kim, Julia; Heo, Hye; Roman, Ashley S
OBJECTIVE:Social determinants of health (SDOH) may impact the incidence of Respiratory Syncytial Virus (RSV) infection and the uptake of vaccinations in pregnancy. The objective of this study is to identify contributors to disparities in RSV vaccination in pregnancy. DESIGN/METHODS:This is a retrospective cohort study of patients delivering at term within three hospitals during February and March 2024, comparing pregnant patients identified as receiving vs not receiving RSV vaccinations. This period and gestational age were chosen to include patients who would have qualified for RSV vaccination administration. Vaccination status was extracted from standardized admission templates where these variables were recorded as discrete fields. Patients without RSV vaccination information were excluded. Sociodemographic factors, COVID vaccination status, and delivery campus were evaluated. Outcomes were analyzed using chi-squared, t-test, and McNemar test. RESULT/RESULTS:2181 patients met inclusion criteria and RSV vaccination information was available for 1548 patients (71%) with a 14% vaccination rate. Compared to those not vaccinated (n=1332), RSV vaccinated patients (n=216) were more likely to be older (30.7 vs 34.8, p<0.001), have private insurance (42% vs 85%, p<0.001), speak English (82% vs 95%, p<0.001), and deliver at our regional perinatal center (26% vs 77%, p<0.001). 50% of RSV vaccinated patients had a history of COVID vaccination compared to 33% of those not vaccinated against RSV (p<0.001). CONCLUSIONS:SDOH were associated with differences in RSV vaccination status. In addition, patients without RSV vaccination were less likely to have had COVID vaccination. These findings highlight the need to address SDOH to increase vaccination rates for vulnerable populations.
PMID: 40154531
ISSN: 1098-8785
CID: 5817622

Joint Effect of Body Mass Index and Obstructive Sleep Apnea on Preeclampsia Risk

Mensah, Nana; Fassett, Michael John; Peltier, Morgan; Shi, Jiaxiao M; Chiu, Vicki Y; Khadka, Nehaa; Getahun, Darios
OBJECTIVE:Preeclampsia remains one of the leading causes of perinatal mortality worldwide. Little is known of the modifiable risk factors that can be identified and addressed early in pregnancy to reduce the risk of preeclampsia and its associated adverse outcomes. We sought to determine if there is a synergistic effect of pre-pregnancy body-mass index and obstructive sleep apnea on the risk of preeclampsia. STUDY DESIGN/METHODS:We conducted a retrospective cohort study of singleton pregnancies delivered in Kaiser Permanente Southern California hospitals between January 1, 2010, and December 31, 2020 (n=342,349). Preeclampsia and sleep apnea were ascertained using clinical diagnosis codes. Body-mass index in kg/m2 measured during prenatal care visits was categorized as normal (18.5 to 24.9), overweight (25 to 29.9), and obese (≥30). Multivariable logistic regression was used to estimate adjusted relative risks (adjusted RR) and 95% confidence intervals (CI). RESULTS:Compared to normal weight in a pregnancy, overweight (adjusted RR: 1.6; 95% CI: 1.5, 1.7) and obese body mass index (adjusted RR: 2.5; 95% CI: 2.4, 2.6) were associated with an increased risk of preeclampsia. Independent of pre-pregnancy body-mass index, a pregnancy with obstructive sleep apnea was associated with an increased risk of preeclampsia (adjusted RR: 2.2; 95% CI: 1.8, 2.6). Compared to normal weight without the diagnosis of obstructive sleep apnea in a pregnancy, overweight (adjusted RR: 4.6; 95% CI: 2.9, 7.4) and obese body mass index (adjusted RR: 3.8; 95% CI: 3.2, 4.6) with the diagnosis of obstructive sleep apnea were associated with an increased risk of preeclampsia. CONCLUSIONS:Obstructive sleep apnea and elevated body-mass index have independent and additive relationship with preeclampsia. Overweight women at-risk of preeclampsia should be advised of a higher likelihood of developing preeclampsia when both conditions occur together and may benefit from close monitoring and early interventions for these modifiable risk factors.
PMID: 40194541
ISSN: 1098-8785
CID: 5823662

Seven-year Safety and Efficacy of Somapacitan in Children With GH Deficiency: Final Results From REAL 3

Sävendahl, Lars; Battelino, Tadej; Højby, Michael; Leunbach, Tina; Saenger, Paul; Silverman, Lawrence; Horikawa, Reiko
BACKGROUND/UNASSIGNED:Somapacitan is a once-weekly GH treatment that has shown efficacy and safety profiles equivalent to daily GH in children with GH deficiency (GHD). OBJECTIVE/UNASSIGNED:To investigate long-term safety, efficacy, and treatment burden associated with somapacitan after 7 years (364 weeks) of treatment. METHODS/UNASSIGNED:REAL 3 (NCT02616562) was a phase 2, randomized, open-label trial investigating the efficacy and safety of somapacitan vs daily GH in children with GHD. After 156 weeks, participants entered a 208-week safety extension. Children in cohort I (age 2.5-10.0 years) previously completed 3 years in the trial; cohort II (age <2.5 years) and cohort III (age 9.0-17.0 years) entered the trial at week 156 for safety-only assessment. All participants received somapacitan 0.16 mg/kg/week. Height velocity (HV), HV SD score (SDS), height SDS, IGF-I SDS, incidence of adverse events (AEs), and treatment burden were assessed. RESULTS/UNASSIGNED:Overall, 43 participants (73%) in cohort I, 1 participant (100%) in cohort II, and 11 participants (69%) in cohort III completed the 208-week safety extension. Consistent increments in HV and HV SDS were seen in cohort I, and height SDSs at week 364 were close to 0. The incidence of AEs was aligned with previous investigations across all cohorts; 3 serious AEs in cohort I were considered probably/possibly related to treatment. Treatment burden was reduced in children who switched from daily GH to somapacitan. CONCLUSION/UNASSIGNED:After 7 years of treatment, children with GHD receiving somapacitan experienced consistent increases in height SDS and reduced treatment burden. No new safety concerns were identified.
PMCID:12699150
PMID: 41394116
ISSN: 2472-1972
CID: 5979012

Implant Choices and the Role of Bone Grafting in Osteotomies Around the Knee

Messina, James C; Chen, Larry; Jazrawi, Laith
Osteotomies around the knee are an effective procedure that shifts the weight-bearing axis from the pathologic side to the uninvolved side to alleviate pain, unload cartilage transplantations, slow down the progression of arthritis, and protect ligament reconstructions. The advancement in plates from nonlocking to locking have increased the stability of constructs to allow for early mobilization and maintained corrections. Further developments with patient-specific instrumentation have made these techniques more reproducible and accurate. Bone grafting and biologics remain a topic of debate but likely a helpful adjuvant in the context of larger corrections or joint preservation surgeries.
PMID: 41207752
ISSN: 1556-228x
CID: 5965622

Overscreening of patients on glucagon-like peptide-1 receptor agonists: A second "epidemic" of thyroid cancer overdiagnosis?

Raghunathan, Rajam; Jacobs, Anna; Gajic, Zoran; Castiglioni, Sofia; Dawood, Nardeen; Arthurs, Likolani; Ranjbar, Suedeh; Rothberger, Gary D; Seib, Carolyn D; Prescott, Jason; Allendorf, John; Liou, Rachel; Suh, Insoo; Patel, Kepal N
BACKGROUND:Guidelines do not recommend routine screening for thyroid nodules when starting a glucagon-like peptide-1 receptor agonist. Patients, however, increasingly present with incidental nodules from imaging ordered at glucagon-like peptide-1 receptor agonist initiation. METHODS:This retrospective case-control study examined patients in a single academic health system from 1 January 2019 to 31 December, 2024 who underwent thyroid ultrasound, fine-needle aspiration biopsy, molecular testing, and/or surgery with glucagon-like peptide-1 receptor agonist initiation compared with patients not prescribed a glucagon-like peptide-1 receptor agonist. Patient, prescription, and intervention data were collected. Chart review was also performed for a subset of patients. RESULTS:From 2019 to 2024, 2,523 patients prescribed a glucagon-like peptide-1 receptor agonist underwent thyroid ultrasound; from 2020 to 2023, there was a higher growth rate of ultrasound scans ordered for them. A random sample of 415 patients prescribed a glucagon-like peptide-1 receptor agonist showed that most ultrasounds were ordered for "thyroid nodules" by the endocrinologist who prescribed glucagon-like peptide-1 receptor agonist. In this subset, 757 nodules were detected on ultrasound; 10.6% (80/757) had fine-needle aspiration biopsy. Cytology showed 3.8% were Bethesda I (3/80), 72.5% Bethesda II (58/80), 15% Bethesda III (12/80), 0% Bethesda IV (0/80), 2.5% Bethesda V (2/80), and 6.6% Bethesda VI (5/80). Of 15 indeterminate nodules, 11 had molecular testing: 5 were positive or suspicious, including fusions, alterations, RAS and BRAF mutations. Sixteen patients had thyroid surgery after glucagon-like peptide-1 receptor agonist initiation (8 total thyroidectomies, 8 hemithyroidectomies, 1 completion). Final pathology demonstrated 6 benign, 10 malignant, 1 NIFTP. The rate of malignancy in the subset was 2.4% (10/415). CONCLUSION/CONCLUSIONS:The malignancy rate in patients prescribed a glucagon-like peptide-1 receptor agonist remains low, but ultrasound screening rates increased for a period. Strong clinical suspicion should govern screening.
PMID: 41371825
ISSN: 1532-7361
CID: 5977492

Temperature and Rainfall Associate With Patterns of Parasitism in Free-Ranging Capuchin Monkeys (Cebus imitator)

Henriquez, Megan C; Campos, Fernando A; Hamou, Hadjira; Churcher, Jessica; Hass, Joelle; Buehler, Margaret; Westphal, Darice; Morales, Suheidy Romero; Kutz, Susan J; Jack, Katharine M; Swedell, Larissa; Melin, Amanda D
Ecological variables such as climate and habitat composition can impact the infection patterns of gastrointestinal parasites in animal host populations by affecting host behavior and parasite survivability and distribution in the external environment. Data from wild primate populations provide insights into these processes. To contribute new insights from a well-characterized population, we collected 200 fecal samples from five groups of Costa Rican capuchin monkeys from August 2020 to August 2021 and screened them for gastrointestinal parasites. We estimated annual home range sizes for the groups and used satellite imagery to measure forest productivity (via Normalized Difference Vegetation Index) and forest cover within their home ranges. We also measured total monthly rainfall and average monthly temperature at the field site to explore the effects of local climate on parasitism. We used Bayesian regression models to examine the effects of these ecological variables on parasite richness, fecal parasite density, and parasite presence. We found that rainfall, and to a lesser extent, temperature, affected the presence and fecal density of certain parasitic taxa. The presence of the soil-transmitted helminth Strongyloides decreased in both hotter and rainier months, and hosts shed fewer Strongyloides eggs during hotter months. Infections with indirectly transmitted parasites (e.g., Prosthenorchis sp., Hymenolepis sp.) were more common during drier months. This corresponds with times when fruit availability is lower and invertebrate consumption is higher at this site. These findings highlight the relationship between climate and patterns of parasitic infection in hosts, likely reflecting changes in host diet, behavior, and parasite abundance.
PMID: 41486983
ISSN: 1098-2345
CID: 5980552

Infected products of conception in obstructed hemivagina after medical management of early pregnancy loss: A case report [Case Report]

Dinelli, John; Espino, Kevin; Casey, Frances
Obstructed hemivagina and ipsilateral renal anomaly is a Mullerian anomaly with variable presentations. A patient with this syndrome had a superinfected fluid collection in an obstructed hemivagina after mifepristone and misoprostol administration for an embryonic demise, identifying a potential complication in this population.
PMID: 40998078
ISSN: 1879-0518
CID: 5967652