Citations

Background Health disparities among minority groups, especially African Americans, can limit their access to quality medical care and lead to disproportionate medical management and disease outcomes. The aim of this study was to compare the COVID-19-related change in mammogram volumes and cancer detection at two affiliated academic breast centers, one that serves a predominantly African American patient population and one that serves a predominantly non-African American patient population. Materials and methods For the purpose of anonymity, racial demographics were collected and the center with a higher African American patient population was designated as institution A, while the center with a higher non-African American patient population was designated as institution B. Careful selection of the two breast centers was instituted in order to limit the impact of potential confounders other than race. An Institutional Review Board (IRB) exemption was obtained and two Mammography Quality Standards Act (MQSA) reports were generated; one for March 2020 through September 2020, during the height of the COVID-19 pandemic, and one for March 2019 through September 2019 to serve as the pre-pandemic control group. The i2b2 Query Analysis Tool® was used to obtain racial demographic data and compare the percent change in screening and diagnostic mammograms, image-guided biopsies, total cancers diagnosed by imaging, and percent of minimal cancers for both institutions. Results Screening mammograms and breast cancer detection decreased in 2020 compared to 2019 at both institutions. However, the percent change from 2019 to 2020 was greater at institution A than at institution B. Percent minimal cancers, an indicator of early-stage breast cancer also decreased more drastically at institution A than at institution B. Interestingly, the total number of diagnostic exams and image-guided biopsies increased in 2020 at institution B, whereas both decreased at institution A. Conclusion The COVID-19 pandemic may lead to worsening racial disparities in breast cancer screening. In an effort to narrow future disparity, it is crucial for radiologists and other health care providers to be aware of this inequality and educate all women on the importance of obtaining routine screening mammography. More studies are needed.

Abstract BACKGROUND: Endpoints in clinical trials using novel treatments are evaluated by RANO criteria, which provide an estimate of tumor size from two-dimensional measurements along the most prominent axial slice. However, pediatric low-grade gliomas (pLGG) commonly have variegated shapes with solid and cystic components, potentially resulting in misevaluation of true tumor volume and thus, ultimately, trial outcome. OBJECTIVES: We aim to characterize treatment response through volumetric assessment of progressive/recurrent pLGGs treated with single-agent everolimus on PNOC001 clinical trial. We seek to identify clinically relevant criteria that provide added value to response assessment beyond 2D measurements. METHODS: In a cohort of 44 patients we performed 3D-segmentation of solid, cystic and whole tumor within our PACS-framework and compared results to previously carried-out central imaging review by RANO criteria which had yielded 15 PD, 27 SD, 2 PR and 0 CR. RESULTS: 8 tumors were solid only and 36 had a mixed solid-cystic appearance. When evaluating the entire tumor (i.e. solid and cystic components combined) and using the same RANO cutoff criteria, one case changed from PR to SD, one changed from SD to PR, 3 changed from SD to PD, and 7 changed from PD to SD, resulting in an overall discordance of 27% of cases. CONCLUSION: We propose that incorporation of volumetrics into response assessment provides additional and potentially more accurate information beyond RANO-based measurements. It is crucial to note that the above-reported changes represent numerical discrepancies as opposed to true-to-reality changes in clinical outcome. Determining representative thresholds for the deployment of volumetric measures in clinical trials will be critical. Future work will include data from the PNOC002 clinical trial and evaluate inter-reader agreement and reader discordance. With the availability of PACS-based 3D-tools in neuroradiology practice, well-defined volumetric criteria could be incorporated prospectively into treatment response analysis in clinical trials.

ABSTRACT Introduction Watching videos on YouTube™ (http://www.youtube.com) to learn about diseases and treatments is becoming more popular. Objective This cross-sectional study evaluated the quality of YouTube™ videos on Premenstrual Dysphoric Disorder (PMDD). Methods YouTube™ was searched for “premenstrual dysphoric disorder” and the fifty most viewed videos were analyzed. Three quality measures were used: Global Quality Scores, JAMA benchmark, and DISCERN. Other features recorded included video duration, views, likes, dislikes, and subscribers. Spearman correlation was calculated to understand the relationship between quality and those features. Source of upload, target audience, distinction between PMS and PMDD, and inclusion of Diagnostic and Statistical Manual 5 (DSM-5) criteria of PMDD were recorded. Results The fifty videos had 2,004,266 views. No statistically significant associations were found between video quality and other features. Mean JAMA, GQS, and DISCERN were 1.96/4 (SD=0.45), 2.26/5 (0.94), and 29.5/80 (8.2), respectively. The majority (48%) of videos described symptoms and treatment. 14% gave DSM-5 for PMDD. The target audience were patients for 82%. The common sources of upload were individual users (34%), professional organizations (16%), healthcare professionals (12%), and academic organizations (10%). 20% mentioned the importance of tracking symptoms in a menstrual diary. 28% distinguished PMDD from Premenstrual Syndrome (PMS). 30% of the videos included personal narratives, 20% included descriptions from medical doctors, and 12% included both. Conclusions The overall quality of the videos is poor based on the three measures. Since the quality of videos remains unregulated and they are easily accessible, inaccurate information can be disseminated quickly. The study revealed a need for more objective biopsychosocial information on the diagnosis, clinical presentation, and treatment options on the video platform. Currently, healthcare professionals and academic institutions post only a minority of videos. To increase credible information, healthcare professionals and academic organizations can increase the number and quality of videos they make for YouTube™. Disclosure No

ABSTRACT Introduction Women in healthcare are faced with unique challenges that may increase their risk of infertility including irregular work hours, occupational hazards due to radiation or chemicals, and advanced maternal age. Objective We sought to investigate live birth rates of female healthcare workers presenting with infertility compared to their non-healthcare counterparts. Methods After obtaining IRB approval, a retrospective review of all hospital employees (and their partners) presenting for a fertility evaluation between 2013-2019 was conducted. Patient age, BMI, history of previous live birth, occupation, use of assisted reproductive technology and female fertility factor were recorded. Couples with at least 12 months of follow up from initial presentation as well as a documented semen analysis were included in the study. Normal semen parameters were defined by the World Health Organization 2010 criteria. Logistic regression analysis was conducted to identify factors associated with increased likelihood of live birth. Results Of the 934 female partners identified, 445 were healthcare workers and 489 non-healthcare workers. Female age, female BMI, smoking status, and history of previous live birth were not statistically significant between groups. No differences in male partner age, male BMI, semen parameters and presence of male factor were noted. Live birth rate was greater in female health care workers compared to non-healthcare workers, 76.1 vs. 69.6%, respectively, p=0.042. Conclusions In this cohort of hospital employees, female healthcare workers had a higher live birth rate despite no differences in age, BMI, rate of female factor infertility, use of assisted reproductive technology, or male partner factors. While no differences in fertility were noted for female health care workers in this study, further research is needed to identify subgroups within the healthcare population that may be at greater risk for infertility. Disclosure No

Background Membranous nephropathy (MN) is a common cause of proteinuria in patients receiving a hematopoietic stem cell transplant (HSCT). The target antigen in HSCT-associated MN is unknown. Methods We performed laser microdissection and tandem mass spectrometry (MS/MS) of glomeruli from 250 patients with PLA2R-negative MN to detect novel antigens in MN. This was followed by immunohistochemical (IHC)/immunofluorescence (IF) microscopy studies to localize the novel antigen. Western blot analyses using serum and IgG eluted from frozen biopsy specimen to detect binding of IgG to new 'antigen'. Results MS/MS detected a novel protein, protocadherin FAT1 (FAT1), in nine patients with PLA2R-negative MN. In all nine patients, MN developed after allogeneic HSCT (Mayo Clinic discovery cohort). Next, we performed MS/MS in five patients known to have allogeneic HSCT-associated MN (Cedar Sinai validation cohort). FAT1 was detected in all five patients by MS/MS. The total spectral counts for FAT1 ranged from 8 to 39 (mean±SD, 20.9±10.1). All 14 patients were negative for known antigens of MN, including PLA2R, THSD7A, NELL1, PCDH7, NCAM1, SEMA3B, and HTRA1. Kidney biopsy specimens showed IgG (2 to 3+) with mild C3 (0 to 1+) along the GBM; IgG4 was the dominant IgG subclass. IHC after protease digestion and confocal IF confirmed granular FAT1 deposits along the GBM. Lastly, Western blot analyses detected anti-FAT1 IgG and IgG4 in the eluate obtained from pooled frozen kidney biopsy tissue and in the serum of those with FAT1-asssociated MN, but not from those with PLA2R-associated MN. Conclusions FAT1-associated MN appears to be a unique type of MN associated with HSCT. FAT1-associated MN represents a majority of MN associated with HSCT.

Introduction: Uric acid (UA) level within carotid plaque specimens and its association with cerebrovascular events has not been detected or quantified. Systemically, serum uric acid (SUA) is a marker of inflammation and risk factor for atherosclerosis. However, its association with carotid plaque instability and subsequent cerebrovascular events remains unclear. Hypothesis: We hypothesized that UA may play a role in carotid artery atherosclerosis and stroke pathogenesis. In patients undergoing carotid endarterectomy (CEA), we aimed to determine whether UA is present differentially in carotid plaques of symptomatic versus asymptomatic patients and whether SUA is associated with cerebrovascular symptoms before surgery and major adverse cardiovascular events (MACE) in the follow-up to CEA. Methods: We prospectively collected 32 carotid plaques during CEA. We qualitatively assessed the presence of UA by using Gomori methenamine silver (GMS) staining and immunohistochemistry with anti-UA antibodies. We extracted and measured the quantity of UA in carotid plaques by using an enzymatic colorimetric assay. A retrospective analysis of a clinical database of 534 consecutive patients who underwent CEA was performed. We defined as symptomatic those patients with history of stroke, TIA and amaurosis fugax. Results: UA positive staining was detected in higher number of carotid plaques from symptomatic compared to asymptomatic patients on both staining, GMS [20 (86.9%) vs 2 (22.2%); p=0.001] and immunohistochemistry anti-UA [16 (69.5%) vs 1 (11.1%); p=0.004]. Moreover, we found a significantly higher concentration of UA in carotid plaque from symptomatic compared to asymptomatic patients [25.1 (9.5) μg/g vs 17.9 (3.8) μg/g; p=0.021]. SUA level in patients prior to CEA was significantly higher in the symptomatic compared to the asymptomatic group [6.0 (4.8-7.1) mg/dL vs 5.2 (4.4-6.3) mg/dL; p<0.001] and it was significantly higher in patients who developed MACE after CEA versus those that did not [6.0 (4.8-7.1) mg/dL vs 5.4 (4.5-6.6) mg/dL; p=0.021]. Conclusions: UA may provide a mechanistic explanation as systemic biomarker and potential tissue contributor for carotid plaque instability and subsequent cerebrovascular and cardiovascular symptoms.

Background. Nephrolithiasis in living kidney donors is concerning due to the potential impact on long-term postdonation kidney function. Methods. We performed a cohort study of living kidney donors from 2 centers with a baseline computed tomography scan and implantation renal biopsy. Donors (>5 y since donation) completed a follow-up survey or underwent chart review to assess eGFR and incident hypertension. Stone formers were classified as symptomatic if they had a past symptomatic episode or asymptomatic if only incidental radiographic kidney stones were identified during donor evaluation. We compared baseline clinical, imaging, and biopsy characteristics by stone former status including review of metabolic evaluations in stone formers. Long-term risks of renal complications (low eGFR and hypertension) by stone former status were evaluated. Results. There were 12 symptomatic and 76 asymptomatic stone formers among 866 donors. Overall, baseline clinical characteristics and implantation biopsy findings were similar between stone formers and non-stone formers. After a median follow-up of 10 y, stone former status was not associated with eGFR <60 mL/min/1.73 m2, eGFR <45 mL/min/1.73 m2, or hypertension. Conclusions. Both asymptomatic and symptomatic SF have favorable histology findings at baseline. Long-term kidney outcomes were favorable in select stone formers with no evident increased long-term risk for decreased kidney function or hypertension after donation.

We report a unique case of a post-menopausal female who presented with a lesion on the areola. A biopsy of the lesion demonstrated a pagetoid intraepithelial neoplasm suggesting a differential diagnosis of mammary Paget disease and pagetoid Bowen disease. Excision of the lesion confirmed the diagnosis of mammary Paget disease with typical histological appearance. This case is extremely rare since both keratin 7 and ERBB2 were negative, and there was no evidence of underlying in situ or invasive carcinoma.