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[PMID]:28453605
[Au] Autor:Krishnan A; Xu T; Hutfless S; Park A; Stasko T; Vidimos AT; Leshin B; Coldiron BM; Bennett RG; Marks VJ; Brandt R; Makary MA; Albertini JG; and the American College of Mohs Surgery Improving Wisely Study Group
[Ad] Endereço:Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
[Ti] Título:Outlier Practice Patterns in Mohs Micrographic Surgery: Defining the Problem and a Proposed Solution.
[So] Source:JAMA Dermatol;153(6):565-570, 2017 Jun 01.
[Is] ISSN:2168-6084
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Outlier physician practices in health care can represent a significant burden to patients and the health system. Objective: To study outlier physician practices in Mohs micrographic surgery (MMS) and the associated factors. Design, Setting, and Participants: This retrospective analysis of publicly available Medicare Part B claims data from January 2012 to December 2014 includes all physicians who received Medicare payments for MMS from any practice performing MMS on the head and neck, genitalia, hands, and feet region of Medicare Part B patients. Main Outcomes and Measures: Characteristics of outlier physicians, defined as those whose mean number of stages for MMS was 2 standard deviations greater than the mean number for all physicians billing MMS. Logistic regression was used to study the physician characteristics associated with outlier status. Results: Our analysis included 2305 individual billing physicians performing MMS. The mean number of stages per MMS case for all physicians practicing from January 2012 to December 2014 was 1.74, the median was 1.69, and the range was 1.09 to 4.11. Overall, 137 physicians who perform Mohs surgery were greater than 2 standard deviations above the mean (2 standard deviations above the mean = 2.41 stages per case) in at least 1 of the 3 examined years, and 49 physicians (35.8%) were persistent high outliers in all 3 years. Persistent high outlier status was associated with performing Mohs surgery in a solo practice (odds ratio, 2.35; 95% CI, 1.25-4.35). Volume of cases per year, practice experience, and geographic location were not associated with persistent high outlier status. Conclusions and Relevance: Marked variation exists in the number of stages per case for MMS for head and neck, genitalia, hands, and feet skin cancers, which may represent an additional financial burden and unnecessary surgery on individual patients. Providing feedback to physicians may reduce unwarranted variation on this metric of quality.
[Mh] Termos MeSH primário: Cirurgia de Mohs/métodos
Padrões de Prática Médica/estatística & dados numéricos
Neoplasias Cutâneas/cirurgia
[Mh] Termos MeSH secundário: Feminino
Neoplasias de Cabeça e Pescoço/patologia
Neoplasias de Cabeça e Pescoço/cirurgia
Seres Humanos
Modelos Logísticos
Masculino
Medicare Part B
Cirurgia de Mohs/normas
Cirurgia de Mohs/estatística & dados numéricos
Padrões de Prática Médica/normas
Qualidade da Assistência à Saúde
Estudos Retrospectivos
Neoplasias Cutâneas/patologia
Estados Unidos
Neoplasias Urogenitais/patologia
Neoplasias Urogenitais/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1001/jamadermatol.2017.1450


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[PMID]:29226713
[Au] Autor:Deme D; Telekes A
[Ad] Endereço:Onkológiai Osztály, Szent Lázár Megyei Kórház Salgótarján, Füleki út 54-56., 3100.
[Ti] Título:[Prognostic importance of lactate dehydrogenase (LDH) in oncology].
[Ti] Título:A laktátdehidrogenáz (LDH) prognosztikai jelentosége az onkológiában..
[So] Source:Orv Hetil;158(50):1977-1988, 2017 Dec.
[Is] ISSN:0030-6002
[Cp] País de publicação:Hungary
[La] Idioma:hun
[Ab] Resumo:Glycolysis is increased in most of the malignant cells, providing the largest proportion of energy needed for cell proliferation. Lactate dehydrogenase (LDH) catalyses the reversible process of pyruvate to lactate in anaerobic condition. LDHA isoenzyme expressed mainly by malignant cells, significantly increases lactate formation. Lactate induces the proliferation of oxygenated malignant cells, angiogenesis, and inhibits the innate and adaptive immune responses. Baseline serum LDH elevation correlates with shorter survival. The authors review the relevant studies exploring the correlation between LDH elevation and the prognosis of malignant diseases. Orv Hetil. 2017; 158(50): 1977-1988.
[Mh] Termos MeSH primário: Biomarcadores Tumorais/sangue
L-Lactato Desidrogenase/sangue
Neoplasias Urogenitais/enzimologia
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Oncologia
Prognóstico
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Biomarkers, Tumor); EC 1.1.1.27 (L-Lactate Dehydrogenase)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171212
[St] Status:MEDLINE
[do] DOI:10.1556/650.2017.30890


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[PMID]:29020592
[Au] Autor:Lemery S; Keegan P; Pazdur R
[Ad] Endereço:From the Office of Hematology and Oncology Products (S.L., P.K.) and the Oncology Center of Excellence (R.P.), Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD.
[Ti] Título:First FDA Approval Agnostic of Cancer Site - When a Biomarker Defines the Indication.
[So] Source:N Engl J Med;377(15):1409-1412, 2017 Oct 12.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Anticorpos Monoclonais Humanizados/uso terapêutico
Antineoplásicos/uso terapêutico
Biomarcadores Tumorais
Neoplasias Encefálicas/tratamento farmacológico
Neoplasias Colorretais/tratamento farmacológico
Neoplasias do Sistema Digestório/tratamento farmacológico
Aprovação de Drogas
Instabilidade de Microssatélites
Síndromes Neoplásicas Hereditárias/tratamento farmacológico
Receptor de Morte Celular Programada 1/antagonistas & inibidores
[Mh] Termos MeSH secundário: Adulto
Antígeno B7-H1/metabolismo
Neoplasias da Mama/tratamento farmacológico
Criança
Neoplasias Colorretais/patologia
Feminino
Seres Humanos
Masculino
Metástase Neoplásica/tratamento farmacológico
Receptor de Morte Celular Programada 1/metabolismo
Estados Unidos
United States Food and Drug Administration
Neoplasias Urogenitais/tratamento farmacológico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antibodies, Monoclonal, Humanized); 0 (Antineoplastic Agents); 0 (B7-H1 Antigen); 0 (Biomarkers, Tumor); 0 (CD274 protein, human); 0 (PDCD1 protein, human); 0 (Programmed Cell Death 1 Receptor); DPT0O3T46P (pembrolizumab)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171012
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMp1709968


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[PMID]:28751268
[Au] Autor:Figueira MI; Cardoso HJ; Correia S; Maia CJ; Socorro S
[Ad] Endereço:CICS-UBI - Health Sciences Research Centre, University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilhã, Portugal.
[Ti] Título:The stem cell factor (SCF)/c-KIT system in carcinogenesis of reproductive tissues: What does the hormonal regulation tell us?
[So] Source:Cancer Lett;405:10-21, 2017 Oct 01.
[Is] ISSN:1872-7980
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:The tyrosine kinase receptor c-KIT and its ligand, the stem cell factor (SCF) are expressed in several tissues of male and female reproductive tract, playing an important role in the regulation of basic biological processes. The activation of c-KIT by SCF controls, cell survival and death, cell differentiation and migration. Also, the SCF/c-KIT system has been implicated in carcinogenesis of reproductive tissues due to its altered expression pattern or overactivation in consequence of gain-of-functions mutations. Over the years, it has also been shown that hormones, the primary regulators of reproductive function and causative agents in the case of hormone-dependent cancers, are also able to control the SCF/c-KIT tissue levels. Therefore, it is liable to suppose that disturbed SCF/c-KIT expression driven by (de)regulated hormone actions can be a relevant step towards carcinogenesis. The present review describes the SCF and c-KIT expression in cancers of reproductive tissues, discussing the implications of the hormonal regulation of the SCF/c-KIT system in cancer development. Understanding the relationship between hormonal imbalance and the SCF/c-KIT expression and activity would be relevant in the context of novel therapeutic approaches in reproductive cancers.
[Mh] Termos MeSH primário: Neoplasias da Mama/metabolismo
Carcinogênese/metabolismo
Hormônios Esteroides Gonadais/fisiologia
Proteínas Proto-Oncogênicas c-kit/metabolismo
Fator de Células-Tronco/metabolismo
Neoplasias Urogenitais/metabolismo
[Mh] Termos MeSH secundário: Mama/metabolismo
Neoplasias da Mama/genética
Feminino
Seres Humanos
Masculino
Próstata/metabolismo
Proteínas Proto-Oncogênicas c-kit/genética
Fator de Células-Tronco/genética
Testículo/metabolismo
Neoplasias Urogenitais/genética
Útero/metabolismo
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Gonadal Steroid Hormones); 0 (Stem Cell Factor); EC 2.7.10.1 (Proto-Oncogene Proteins c-kit)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170920
[Lr] Data última revisão:
170920
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170729
[St] Status:MEDLINE


  5 / 3336 MEDLINE  
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[PMID]:28719723
[Au] Autor:Périer A; Savey L; Marcelin AG; Serve P; Saadoun D; Barete S
[Ad] Endereço:Sorbonne University, UPMC University of Paris 6, Unité fonctionnelle de Dermatologie, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France, and Médecine Interne, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.
[Ti] Título:De Novo Human Herpesvirus 8 Tumors Induced by Rituximab in Autoimmune or Inflammatory Systemic Diseases.
[So] Source:Arthritis Rheumatol;69(11):2241-2246, 2017 Nov.
[Is] ISSN:2326-5205
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Human herpesvirus 8 (HHV-8), also known as Kaposi's sarcoma (KS)-associated herpesvirus, is involved in KS and other tumors, including multicentric Castleman's disease and primary effusion lymphoma. Rituximab (RTX) is currently used for the treatment of several autoimmune or inflammatory diseases and humoral organ transplant rejection. De novo HHV-8 tumors induced by RTX used for these indications have not been reported previously. This study was undertaken to evaluate de novo HHV-8 tumors induced by RTX. METHODS: In this retrospective study, we investigated the clinical, virologic, and pathologic features of 5 HIV-negative male patients with HHV-8 tumors induced by RTX therapy. RESULTS: Patients were all immunocompromised by previous treatments, which consisted of steroids and/or immunosuppressive agents, and received RTX for insufficient response, disease progression, or transplant rejection. They developed HHV-8 tumors a median of 4 months after beginning treatment with RTX (range 3-13 months). Four patients had at least 1 risk factor for HHV-8, including a high Fitzpatrick skin phototype (of >3) (n = 3) and homosexuality (n = 1). Four patients developed KS (all 4 had skin lesions and 2 had visceral involvement), and 1 patient developed a solid primary effusion lymphoma. RTX was discontinued in all patients, and immunosuppressants were reduced when feasible. After a median follow-up of 20 months, 2 patients died. Remission of KS was complete in 1 patient and partial in 1 patient, and 1 patient had progression. CONCLUSION: Our findings indicate that patients who have a high skin phototype and are at risk of HHV-8 should be carefully screened for HHV-8 before RTX therapy. The safety of RTX, especially in nonlymphomatous disorders, should be carefully evaluated in patients at risk of HHV-8 tumors.
[Mh] Termos MeSH primário: Fatores Imunológicos/efeitos adversos
Neoplasias Intestinais/induzido quimicamente
Neoplasias Pulmonares/induzido quimicamente
Linfoma de Efusão Primária/induzido quimicamente
Rituximab/efeitos adversos
Sarcoma de Kaposi/induzido quimicamente
Neoplasias Cutâneas/induzido quimicamente
Neoplasias Urogenitais/induzido quimicamente
[Mh] Termos MeSH secundário: Adulto
Idoso
Doenças Autoimunes/tratamento farmacológico
Rejeição de Enxerto/tratamento farmacológico
Transplante de Coração
Herpesvirus Humano 8
Seres Humanos
Neoplasias Intestinais/virologia
Nefropatias/tratamento farmacológico
Neoplasias Pulmonares/virologia
Linfoma de Efusão Primária/virologia
Masculino
Meia-Idade
Vasculite Retiniana/tratamento farmacológico
Estudos Retrospectivos
Sarcoma de Kaposi/virologia
Neoplasias Cutâneas/virologia
Neoplasias Urogenitais/virologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Immunologic Factors); 4F4X42SYQ6 (Rituximab)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171106
[Lr] Data última revisão:
171106
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170719
[St] Status:MEDLINE
[do] DOI:10.1002/art.40217


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[PMID]:28608721
[Au] Autor:Xiao X; Hu R; Deng FM; Shen SS; Yang XJ; Wu CL
[Ti] Título:Practical Applications of Immunohistochemistry in the Diagnosis of Genitourinary Tumors.
[So] Source:Arch Pathol Lab Med;141(9):1181-1194, 2017 Sep.
[Is] ISSN:1543-2165
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:CONTEXT: - Pathologic diagnosis of tumors in the genitourinary system can be challenging based on morphology alone, particularly when diagnostic material is limited, such as in core biopsies. Immunohistochemical stain can be a useful tool to aid in the diagnosis. OBJECTIVE: - To provide an update on practical applications and interpretation of immunohistochemical stains in the diagnosis of tumors in prostate, kidney, bladder, and testis. We particularly focus on difficult differential diagnoses, providing our insights in frequently encountered challenging situations. Commonly used immunohistochemical panels are discussed. DATA SOURCES: - Review of literature and our own experience. CONCLUSION: - Immunohistochemical stain is a valuable tool in the diagnosis of genitourinary tumors when appropriately used.
[Mh] Termos MeSH primário: Biomarcadores Tumorais/análise
Imuno-Histoquímica/métodos
Neoplasias Urogenitais/diagnóstico
[Mh] Termos MeSH secundário: Feminino
Seres Humanos
Masculino
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Biomarkers, Tumor)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170614
[St] Status:MEDLINE
[do] DOI:10.5858/arpa.2016-0530-RA


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[PMID]:28431528
[Au] Autor:Heilmann RM; McNiel EA; Grützner N; Lanerie DJ; Suchodolski JS; Steiner JM
[Ad] Endereço:College of Veterinary Medicine, University of Leipzig, An den Tierkliniken 23, DE-04103, Leipzig, Germany. Romy.Heilmann@kleintierklinik.uni-leipzig.de.
[Ti] Título:Diagnostic performance of the urinary canine calgranulins in dogs with lower urinary or urogenital tract carcinoma.
[So] Source:BMC Vet Res;13(1):112, 2017 Apr 21.
[Is] ISSN:1746-6148
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Onset of canine transitional cell carcinoma (TCC) and prostatic carcinoma (PCA) is usually insidious with dogs presenting at an advanced stage of the disease. A biomarker that can facilitate early detection of TCC/PCA and improve patient survival would be useful. S100A8/A9 (calgranulin A/B or calprotectin) and S100A12 (calgranulin C) are expressed by cells of the innate immune system and are associated with several inflammatory disorders. S100A8/A9 is also expressed by epithelial cells after malignant transformation and is involved in the regulation of cell proliferation and metastasis. S100A8/A9 is up-regulated in human PCA and TCC, whereas the results for S100A12 have been ambiguous. Also, the urine S100A8/A9-to-S100A12 ratio (uCalR) may have potential as a marker for canine TCC/PCA. Aim of the study was to evaluate the diagnostic accuracy of the urinary S100/calgranulins to detect TCC/PCA in dogs by using data and urine samples from 164 dogs with TCC/PCA, non-neoplastic urinary tract disease, other neoplasms, or urinary tract infections, and 75 healthy controls (nested case-control study). Urine S100A8/A9 and S100A12 (measured by species-specific radioimmunoassays and normalized against urine specific gravity [S100A8/A9 ; S100A12 ], urine creatinine concentration, and urine protein concentration and the uCalR were compared among the groups of dogs. RESULTS: S100A8/A9 had the highest sensitivity (96%) and specificity (66%) to detect TCC/PCA, with specificity reaching 75% after excluding dogs with a urinary tract infection. The uCalR best distinguished dogs with TCC/PCA from dogs with a urinary tract infection (sensitivity: 91%, specificity: 60%). Using a S100A8/A9 ≥ 109.9 to screen dogs ≥6 years of age for TCC/PCA yielded a negative predictive value of 100%. CONCLUSIONS: S100A8/A9 and uCalR may have utility for diagnosing TCC/PCA in dogs, and S100A8/A9 may be a good screening test for canine TCC/PCA.
[Mh] Termos MeSH primário: Doenças do Cão/diagnóstico
Complexo Antígeno L1 Leucocitário/urina
Neoplasias Urogenitais/veterinária
Neoplasias Urológicas/veterinária
[Mh] Termos MeSH secundário: Animais
Biomarcadores/urina
Calgranulina A/análise
Calgranulina B/urina
Carcinoma de Células de Transição/diagnóstico
Carcinoma de Células de Transição/urina
Carcinoma de Células de Transição/veterinária
Estudos de Casos e Controles
Creatinina/urina
Doenças do Cão/urina
Cães
Feminino
Masculino
Neoplasias da Próstata/diagnóstico
Neoplasias da Próstata/urina
Neoplasias da Próstata/veterinária
Proteinúria/urina
Proteinúria/veterinária
Radioimunoensaio/veterinária
Neoplasias Urogenitais/diagnóstico
Neoplasias Urogenitais/urina
Doenças Urológicas/diagnóstico
Doenças Urológicas/urina
Doenças Urológicas/veterinária
Neoplasias Urológicas/diagnóstico
Neoplasias Urológicas/urina
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Biomarkers); 0 (Calgranulin A); 0 (Calgranulin B); 0 (Leukocyte L1 Antigen Complex); AYI8EX34EU (Creatinine)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171024
[Lr] Data última revisão:
171024
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170423
[St] Status:MEDLINE
[do] DOI:10.1186/s12917-017-1032-5


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[PMID]:28427506
[Au] Autor:González Del Alba A; Arranz JÁ; Puente J; Méndez-Vidal MJ; Gallardo E; Grande E; Pérez-Valderrama B; González-Billalabeitia E; Lázaro-Quintela M; Pinto Á; Lainez N; Piulats JM; Esteban E; Maroto Rey JP; García JA; Suárez C
[Ad] Endereço:Medical Oncology Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
[Ti] Título:Recent advances in genitourinary tumors: A review focused on biology and systemic treatment.
[So] Source:Crit Rev Oncol Hematol;113:171-190, 2017 May.
[Is] ISSN:1879-0461
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Updated information published up to 2016 regarding major advances in renal cancer, bladder cancer, and prostate cancer is here presented. Based on an ever better understanding of the genetic and molecular alterations that govern the initial pathogenic mechanisms of tumor oncogenesis, an improvement in the characterization and treatment of urologic tumors has been achieved in the past year. According to the Cancer Genome Atlas (ATLAS) project, alterations in the MET pathway are characteristics of type 1 papillary renal cell carcinomas, and activation of NRF2-ARE pathway is associated with the biologically distinct type 2. While sunitinib and pazopanib continue to be the standard first-line treatment in metastatic renal cell carcinoma of clear cell histology, nivolumab and cabozantinib are now the agents of choice in the second-line setting. In relation to urothelial bladder carcinoma, new potential molecular targets such as FGFR3, PI3K/AKT, RTK/RAS, CDKN2A, ARIDIA, ERBB2 have been identified. Response to adjuvant cisplatin-based chemotherapy appears to be related to basal, luminal, and p53-like intrinsic subtypes. A phase II study with eribulin and a maintenance phase II trial with vinflunine have shown promising results. Similarly, the use of the check point inhibitors in advanced disease is likely to revolutionize the management of patients who have progressed after cisplatin-based chemotherapy. In prostate cancer, seven mutually exclusive molecular subtypes have been identified by the TCGA project. Chemotherapy has been consolidated as a key treatment for castration-sensitive metastatic prostate cancer, and abiraterone, enzalutamide, cabazitaxel, and radium-223 remain standard therapeutic options for men with metastatic castration-resistant prostate cancer. All this progress will undoubtedly contribute to the development of new treatments and therapeutic strategies that will improve the survival and quality of life of our patients.
[Mh] Termos MeSH primário: Antineoplásicos/uso terapêutico
Neoplasias Urogenitais/tratamento farmacológico
[Mh] Termos MeSH secundário: Antineoplásicos/farmacologia
Seres Humanos
Masculino
Neoplasias Urogenitais/metabolismo
Neoplasias Urogenitais/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antineoplastic Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170422
[St] Status:MEDLINE


  9 / 3336 MEDLINE  
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[PMID]:28418451
[Au] Autor:Halpern JA; Chughtai B; Ghomrawi H
[Ad] Endereço:Department of Urology, Weill Cornell Medicine, New York, New York.
[Ti] Título:Cost-effectiveness of Common Diagnostic Approaches for Evaluation of Asymptomatic Microscopic Hematuria.
[So] Source:JAMA Intern Med;177(6):800-807, 2017 Jun 01.
[Is] ISSN:2168-6114
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Asymptomatic microscopic hematuria (AMH) is highly prevalent and may signal occult genitourinary (GU) malignant abnormality. Common diagnostic approaches differ in their costs and effectiveness in detecting cancer. Given the low prevalence of GU malignant abnormality among patients with AMH, it is important to quantify the cost implications of detecting cancer for each approach. Objective: To estimate the effectiveness, costs, and incremental cost per cancer detected (ICCD) for 4 common diagnostic approaches evaluating AMH. Design, Setting, and Participants: A decision-analytic model-based cost-effectiveness analysis using inputs from the medical literature. PubMed searches were performed to identify relevant literature for all key model inputs, each of which was derived from the clinical study with the most robust data and greatest applicability. Analysis included adult patients with AMH on routine urinalysis with subgroups of high-risk patients (males, smokers, age ≥50 years) seen in the primary care or urologic referral setting. Interventions: Four diagnostic approaches were evaluated relative to the reference case of no evaluation: (1) computed tomography (CT) alone; (2) cystoscopy alone; (3) CT and cystoscopy combined; and (4) renal ultrasound and cystoscopy combined. Main Outcomes and Measures: At termination of the diagnostic period, cancers detected, costs (payer perspective), and ICCD per 10 000 patients evaluated for AMH. Results: Of the 4 diagnostic approaches analyzed, CT alone was dominated by all other strategies, detecting 221 cancers at a cost of $9 300 000. Ultrasound and cystoscopy detected 245 cancers and was most cost-effective with an ICCD of $53 810. Replacing ultrasound with CT detected just 1 additional cancer at an ICCD of $6 480 484. Ultrasound and cystoscopy remained the most cost-effective approach in subgroup analysis. The model was not sensitive to any inputs within the proposed ranges. Using probabilistic sensitivity analysis, ultrasound and cystoscopy was the dominant strategy in 100% of simulations. Conclusions and Relevance: The combination of renal ultrasound and cystoscopy is the most cost-effective among 4 diagnostic approaches for the initial evaluation of AMH. The use of ultrasound in lieu of CT as the first-line diagnostic strategy will optimize cancer detection and reduce costs associated with evaluation of AMH. Given our findings, we need to critically evaluate the appropriateness of our current clinical practices, and potentially alter our guidelines to reflect the most effective screening strategies for patients with AMH.
[Mh] Termos MeSH primário: Testes Diagnósticos de Rotina/economia
Hematúria/diagnóstico
Hematúria/economia
Neoplasias Urogenitais/diagnóstico
[Mh] Termos MeSH secundário: Idoso
Algoritmos
Análise Custo-Benefício
Testes Diagnósticos de Rotina/normas
Medicina Baseada em Evidências
Feminino
Hematúria/complicações
Hematúria/urina
Seres Humanos
Masculino
Meia-Idade
Neoplasias Urogenitais/economia
Neoplasias Urogenitais/urina
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170815
[Lr] Data última revisão:
170815
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170419
[St] Status:MEDLINE
[do] DOI:10.1001/jamainternmed.2017.0739


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[PMID]:28390533
[Au] Autor:Oldan JD; Shah SN; Rose TL
[Ad] Endereço:Nuclear Medicine, Department of Radiology, University of North Carolina School of Medicine, Chairman's Office, 2006 Old Clinic, CB# 7510, Chapel Hill, NC 27599, USA. Electronic address: Jorge_oldan@med.unc.edu.
[Ti] Título:Applications of PET/MR Imaging in Urogynecologic and Genitourinary Cancers.
[So] Source:Magn Reson Imaging Clin N Am;25(2):335-350, 2017 May.
[Is] ISSN:1557-9786
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Positron emission tomograph (PET)-magnetic resonance (MR) is a new modality combining PET and MR. In gynecologic cancers it can be used for staging of cervical and endometrial cancer, planning of radiation therapy in cervical cancer, assessing response to chemotherapy in ovarian cancer, and detection of recurrence in most gynecologic cancers. It is being explored for prostate cancer and other genitourinary cancers, but is still in experimental stages.
[Mh] Termos MeSH primário: Imagem por Ressonância Magnética/métodos
Imagem Multimodal/métodos
Tomografia por Emissão de Pósitrons/métodos
Neoplasias Urogenitais/diagnóstico por imagem
[Mh] Termos MeSH secundário: Feminino
Neoplasias dos Genitais Femininos/diagnóstico por imagem
Genitália Feminina/diagnóstico por imagem
Seres Humanos
Masculino
Sistema Urogenital/diagnóstico por imagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170410
[St] Status:MEDLINE



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