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Molecular Breast Imaging and Digital Breast Tomosynthesis for Dense Breast Screening: The Density MATTERS Trial
No full textBackground Molecular breast imaging (MBI) relies on the functional uptake of a radiotracer, technetium 99m sestamibi, to reveal cancers that are occult on mammograms due to breast density. Purpose To assess the performance of screening MBI as a supplement to digital breast tomosynthesis (DBT) in women with dense breasts. Materials and Methods In this prospective, multiyear, multicenter trial from five sites, women with dense breasts were prospectively enrolled from 2017 to 2022 and underwent two annual screening rounds of DBT and MBI to assess the incremental cancer detection rate (CDR, reported as cancers per 1000 screenings) of supplemental MBI and to compare other performance metrics of DBT and MBI. Results A total of 2978 participants were included. Participants had a mean age of 56.8 years ± 9.3 (SD) and a mean lifetime Tyrer-Cuzick risk of 12.0% ± 7.9 (SD). At year 1, the CDR was 5.0‰ (15 of 2978 participants) with DBT and 11.8‰ (35 of 2978 participants) with DBT plus prevalence screening MBI (incremental CDR, 6.7‰ [95% CI: 4.2, 10.6]; P \u3c .001); the invasive CDR was 3.0‰ (nine of 2978 participants) with DBT and 7.7‰ (23 of 2978 participants) with DBT plus prevalence screening MBI (invasive incremental CDR, 4.7‰ [95% CI: 2.7, 8.1]; P \u3c .001). At year 2, the CDR was 5.8‰ (15 of 2590 participants) with DBT and 9.3‰ (24 of 2590 participants) with DBT plus incidence screening MBI (incremental CDR, 3.5‰ [95% CI: 1.7, 6.8]; P = .001); the invasive CDR was 1.5‰ (four of 2590 participants) with DBT and 3.9‰ (10 of 2590 participants) with DBT plus incidence screening MBI (invasive incremental CDR, 2.3‰ [95% CI: 0.9, 5.3]; P = .048). The year 1 recall rate was 8.6% (255 of 2978 participants) with DBT and 17.9% (534 of 2978 participants) with DBT plus prevalence screening MBI (difference, 9.4% [95% CI: 8.4, 10.5]). The year 2 recall rate was 8.9% (231 of 2590 participants) with DBT and 13.8% (356 of 2590 participants) with DBT plus incidence screening MBI (difference, 4.8% [95% CI: 4.1, 5.7]). Twenty-nine participants had cancers detected only with MBI: 21 (72%) had invasive cancers (median size, 0.9 cm), 26 (90%) had node-negative cancers, and six (20%) had advanced cancers. The interval cancer rate was 0.7‰ (two of 2978 participants) in year 1 and 0.8‰ (two of 2590 participants) in year 2. Conclusion The addition of MBI to DBT screening increased invasive cancer detection by 2.5-fold and modestly increased the recall rate at the second screening round. © RSNA, 2025 See also the editorial by Fowler in this issue
Optimizing lung SBRT delivery: A hybrid approach combining dynamic conformal arc (DCA) and volumetric modulated arc therapy (VMAT) techniques
No full textPURPOSE: This study introduces and evaluates a hybrid dynamic conformal arc-volumetric modulated arc therapy (hDCA-VMAT) technique for lung stereotactic body radiotherapy (SBRT). The goal is to combine the planning efficiency of VMAT with the delivery robustness of dynamic conformal arc (DCA) techniques, particularly for low-density lung targets where motion and dose calculation uncertainties pose challenges.
METHODS: Twenty-four previously treated lung SBRT cases were retrospectively replanned using hDCA-VMAT, conventional VMAT, and aperture controlled VMAT (VMAT_AC). hDCA-VMAT plans were initiated with a manually created DCA plan, followed by limited inverse optimization with constrained aperture modulation. Plans were created in Eclipse v16.1 and calculated using the AcurosXB algorithm. Dosimetric plan quality, beam complexity, and delivery efficiency were assessed. Complexity was quantified using aperture-based metrics (e.g., average leaf pair opening, beam area, modulation index). Pretreatment delivery accuracy was evaluated via EPID-based gamma analysis at 3%/1, 2%/1, and 1%/1 mm Gamma criteria.
RESULTS: All techniques produced clinically acceptable plans. Target coverage and conformity indices were comparable, but hDCA-VMAT plans demonstrated reduced mid-dose spread and significantly lower modulation. hDCA-VMAT achieved the lowest modulation factor (2.1 ± 0.52) and shortest beam on time (1.74 ± 0.46 min), a 27%-30% reduction compared to VMAT and VMAT_AC. Beam complexity metrics confirmed larger, more circular apertures for hDCA-VMAT. Gamma pass rates were significantly higher for hDCA-VMAT across all criteria, particularly under stringent 1%/1 mm criteria.
CONCLUSION: The hDCA-VMAT technique offers a practical, streamlined approach for lung SBRT planning that reduces modulation while maintaining high plan quality. By initiating with a DCA plan and applying limited optimization only when necessary, hDCA-VMAT minimizes planning complexity and improves delivery efficiency. These benefits are especially relevant for treating low-density lung tumors, where robustness to motion and delivery accuracy are critical
GPT2 mediates glutamine metabolism-driven metabolic alterations in platinum-resistant ovarian cancer cells
No full textMetabolic reprogramming is recognized as a hallmark of cancer frequently associated with drug resistance in ovarian cancer. This is problematic as ovarian cancer is one of the deadliest gynecologic cancers with platinum resistance contributing to poor survival. However, the mechanism by which ovarian cancer cell metabolism contributes to platinum resistance is not well understood. Herein, metabolic signatures were determined in platinum-resistant ovarian cancer cell lines compared to the more platinum-sensitive parental lines. Chemoresistant ovarian cancer cells showed increased oxidative phosphorylation (OXPHOS) compared to chemosensitive cells. This was associated with elevated levels of glutaminolysis and tricarboxylic acid (TCA)-related metabolites supporting their dependence on OXPHOS. Key enzymes involved in glutaminolysis, specifically, glutamic-pyruvic transaminase 2 (GPT2), were upregulated in chemoresistant compared to chemosensitive cells. Interestingly, high GPT2 gene expression is associated with worse prognosis in ovarian cancer patients, adding translational relevance to the pre-clinical findings. GPT2 knockout in chemoresistant cells restored the metabolic phenotype to that of the sensitive cells and reversed drug resistance. These data suggest that GPT2 is a critical link between glutaminolysis, the TCA cycle, and OXPHOS and is a potential target to attenuate the increased metabolic activity associated with a chemoresistant phenotype
Radical nephroureterectomy vs kidney sparing surgery for upper tract urothelial carcinoma in solitary kidney patients: a multi-institutional analysis of the ROBUUST 2.0 registry
No full textPURPOSE: Radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) in solitary kidney patients is a rare and underreported scenario. This study aims to compare the outcomes of UTUC solitary kidney patients becoming anephric after RNU to those of patients undergoing kidney-sparing surgery (KSS).
METHODS: Data from patients with a solitary kidney were retrieved from the ROBUUST 2.0 database, a global, multicenter registry containing data on patients who underwent curative surgery for UTUC. Baseline patient demographics, disease characteristics, and surgical features were compared between RNU and KSS. Kaplan-Meier methods were used to estimate recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS) in patients undergoing RNU, with 3-year and 5-year cutoffs applied.
RESULTS: Thirty-nine patients (76.5%) underwent RNU, whereas 12 (23.5%) underwent KSS. Despite a comparable preoperative renal function, the distribution of CKD stages differed significantly between the groups (p = 0.019). Despite a similar rate of postoperative complications, patients undergoing RNU experienced a significantly higher median LOS (p \u3c 0.001). Among RNU patients, OS was 83.9%, CSS was 96.9%, RFS was 71.8%, and MFS was 84.4% at the 3-year follow-up. After 5 years post-surgery, OS was 73.4%, CSS was 83.1%, RFS was 59.9%, and MFS was 78.5% in the same cohort.
CONCLUSIONS: UTUC solitary kidney patients undergoing RNU or KSS face a substantial perioperative burden. Despite these challenges, our cohort demonstrated favorable oncological outcomes comparable to those reported in the existing literature
Mortality and Additional Treatment Rates in Pathologically High-Risk Prostate Cancer With Prostate-Specific Antigen Persistence at Robot-Assisted Radical Prostatectomy: Long-Term Report From Single Tertiary Referral Center
No full textBACKGROUND: Long-term cancer control efficacy of robotic-assisted laparoscopic prostatectomy (RALP) in men with pathologically high-risk prostate cancer and prostate-specific antigen (PSA) persistence remains poorly addressed in the literature. Our aim was to evaluate long-term survival and additional treatment (AT) rates in these individuals.
METHODS: We included 803 patients who underwent RALP for pathologically high-risk PCa (pT ≥ 3a, pN0-1 or GG ≥ 4) between 2001 and 2022 at a single tertiary referral center (Henry Ford Hospital, Detroit). Patients without adequate information about PSA persistence were excluded from the analysis (n = 128). Kaplan-Meier curves estimated AT free-survival (ATFS) and all-cause mortality (ACM) free-survival, whereas the competing risk method was used to estimate cancer-specific mortality (CSM) free-survival, after stratification according to PSA persistence. Competing risk and Cox regression models tested the impact of PSA persistence on three endpoints: AT rates, CSM, and ACM.
RESULTS: Our final cohort consisted of 675 who underwent RALP for pathologically high-risk PCa, 187 (27.7%) of whom had PSA persistence. The median age at surgery was 64 years (IQR 59-68), and the median follow-up duration was 75 months (IQR 33-125). Patients with PSA persistence were more likely to have higher PSA values at surgery (8 vs. 7 ng/mL, p \u3c 0.001), pT3b-4 PCa (62.5% vs. 39.9%, p \u3c 0.001), pN1 PCa (55.6% vs. 35.7%, p \u3c 0.001), and positive surgical margins (PSMs) (65.2% vs. 43.4%, p \u3c 0.001). Moreover, patients in the PSA persistence group had higher proportion undergoing only hormone therapy (HT) (24.1% vs. 11.9%, p \u3c 0.001) and radiotherapy (RT) plus HT (50.8% vs. 31.1%, p \u3c 0.001), reporting higher median PSA values at RT (0.6 vs. 0.2 ng/mL, p \u3c 0.001), compared to patients with undetectable PSA. At 10 years after RALP, CSM-FS and ACM-FS were 79.7% versus 90.3% (Gray-test p-value = 0.001) and 72.1% versus 79.6% (log-rank p-value = 0.013), for persistent versus undetectable PSA, respectively. The 10-year rates of ATFS were 6.6% versus 33.2% (log-rank p-value \u3c 0.0001), for persistent versus undetectable PSA, respectively. At MVA, persistent PSA was associated with AT (HR: 3.05, p \u3c 0.001), but not with CSM (HR: 1.49, p = 0.2) or ACM (HR: 1.09, p = 0.9).
CONCLUSION: Patients with pathologically high-risk PCa and PSA persistence after RALP, despite being at greater hazard of AT (HT and/or RT), did not have less favorable cancer control outcomes at 10 years than their counterparts with undetectable PSA levels. Our report provides the longest follow-up after RALP for this subset of patients, making it a valuable resource for counseling patients on the long-term oncologic outcomes of this procedure and postoperative adjuvant/salvage therapies
Improved outcomes with robotic-assisted laparoscopic paraesophageal hernia repairs compared with laparoscopic and transthoracic approaches: A single high-volume institution experience
No full textOBJECTIVES: Laparoscopic (lap) paraesophageal hernia repair has excellent short-term outcomes but higher long-term recurrence rates compared with the transthoracic repair. We hypothesized that the robotic-assisted lap (robot) approach would have similarly good short-term outcomes as lap, but also lower recurrence rates.
METHODS: A retrospective study of prospectively collected data was performed for paraesophageal hernia repairs at a single high-volume quaternary hospital from July 2018 to September 2022. Outcomes analyzed included 2-year postoperative radiographic recurrence (Rad), Society of Thoracic Surgeons-defined radiographic recurrence (STS-rad), symptomatic recurrence (Sx), and perioperative outcomes. Lap, robot, and transthoracic groups were compared using univariate, multivariate, and propensity score analysis.
RESULTS: Among 207 cases (52 lap, 90 robot, and 65 transthoracic), robot was lower than lap (odds ratio [OR], 0.13-0.17; P \u3c .01) and similar to transthoracic (OR, 0.79-1.02; P \u3e .05) in univariate and multivariate analyses. STS-rad was similar between approaches across analyses, apart from robot being higher than transthoracic on propensity score analysis (OR, 1.83; P \u3c .01). Robotic Sx recurrence was lower in robot compared with lap across analyses (OR, 0.40-0.50; P \u3c .001). Median length of stay was 2 days for robot and lap, significantly shorter than transthoracic (median, 5 days; P \u3c .01). Fewer postoperative complications occurred in robot compared with transthoracic (OR, 0.19-0.21; P \u3c .01). Reoperation and endoscopic intervention were lower in robot compared with lap (OR, 0.09-0.12; P \u3c .01 and OR, 0.32-0.40; P \u3c .05).
CONCLUSIONS: Robotic paraesophageal hernia repairs had generally lower 2-year recurrence and reoperation than lap and shorter hospital stays and fewer immediate complications than transthoracic
Efficacy of a Collaborative Medication Record (MAR) During Charting Downtime
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1010/thumbnail.jp
Does Assigning Roles at the Beginning of the Shift Enhance Confidence and Team Organization in the Event of a Code Blue?
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1011/thumbnail.jp
ICU Made 4 U: Critical Care Education for Novice Nurses
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1014/thumbnail.jp
Ketamine as an Opiod-Sparing Strategy in Post Cardiac Surgery Patients: A Nursing Perspective in a Multidisciplinary Opiod Stewardship Initiative
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1021/thumbnail.jp