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Background Controversy exists regarding the optimal sequence of chemotherapy among women with operable node‐negative breast cancers with high‐risk tumor biology. We evaluated national patterns of neoadjuvant chemotherapy (NACT) use among women with early‐stage HER2+, triple‐negative (TNBC), and high‐risk hormone receptor‐positive (HR+) invasive breast cancers. Methods Women ≥18 years with cT1‐2/cN0 HER2+, TNBC, or high recurrence risk score (≥31) HR+ invasive breast cancers who received chemotherapy were identified in the National Cancer Database (2010–2016). Cochran‐Armitage and logistic regression examined temporal trends and likelihood of undergoing NACT versus adjuvant chemotherapy based on patient age and molecular subtype. Results Overall, 96,622 patients met study criteria; 25% received NACT and 75% underwent surgery first, with comparable 5‐year estimates of overall survival (0.90, 95% CI 0.892–0.905 vs 0.91, 95% CI 0.907–0.913). During the study period, utilization of NACT increased from 14% to 36% and varied according to molecular subtype (year*molecular subtype p

Transbronchial lung cryobiopsy (TBLC) has emerged as a less invasive method to obtain a tissue diagnosis in patients with interstitial lung disease (ILD). The diagnostic yield of TBLC compared to surgical lung biopsy (SLB) remains uncertain.The aim of this study was to determine the diagnostic accuracy of forceps transbronchial lung biopsy (TBLB) and TBLC compared to SLB when making the final diagnosis based on multidisciplinary discussion (MDD).Patients enrolled in the study underwent sequential TBLB and TBLC followed immediately by SLB. De-identified cases, with blinding of the biopsy method, were reviewed by a blinded pathologist and then discussed at a multidisciplinary conference.Between August 2013 and October 2017, we enrolled 16 patients. The raw agreement between TBLC and SLB for the MDD final diagnosis was 68.75% with a Cohen's kappa of 0.6 (95% CI 0.39, 0.81). Raw agreement and Cohen's kappa of TBLB versus TBLC and TBLB versus SLB for the MDD final diagnosis were much lower (50%, 0.21 [95% CI 0, 0.42] and 18.75%, 0.08 [95% CI -0.03, 0.19], respectively). TBLC was associated with mild bleeding (grade 1 bleeding requiring suction to clear) in 56.2% of patients.In patients with ILD who have an uncertain type based on clinical and radiographic data and require tissue sampling to obtain a specific diagnosis, TBLC showed moderate correlation with SLB when making the diagnosis with MDD guidance. TBLB showed poor concordance with both TBLC and SLB MDD diagnoses.

To assess the diagnostic performance and reader confidence in determining the resectability of pancreatic cancer at computed tomography (CT) using a new deep learning image reconstruction (DLIR) algorithm.A retrospective review was conduct of on forty-seven patients with pathologically confirmed pancreatic cancers who underwent baseline multiphasic contrast-enhanced CT scan. Image data sets were reconstructed using filtered back projection (FBP), hybrid model-based adaptive statistical iterative reconstruction (ASiR-V) 60 %, and DLIR "TrueFidelity" at low(L), medium(M), and high strength levels(H). Four board-certified abdominal radiologists reviewed the CT images and classified cancers as resectable, borderline resectable, or unresectable. Diagnostic performance and reader confidence for categorizing the resectability of pancreatic cancer were evaluated based on the reference standards, and the interreader agreement was assessed using Fleiss k statistics.For prediction of margin-negative resections(ie, R0), the average area under the receiver operating characteristic curve was significantly higher with DLIR-H (0.91; 95 % confidence interval [CI]: 0.79, 0.98) than FBP (0.75; 95 % CI:0.60, 0.86) and ASiR-V (0.81; 95 % CI:0.67, 0.91) (p = 0.030 and 0.023 respectively). Reader confidence scores were significantly better using DLIR compared to FBP and ASiR-V 60 % and increased linearly with the increase of DLIR strength level (all p0.001). Among the image reconstructions, DLIR-H showed the highest interreader agreement in the resectability classification and lowest subject variability in the reader confidence.The DLIR-H algorithm may improve the diagnostic performance and reader confidence in the CT assignment of the local resectability of pancreatic cancer while reducing the interreader variability.

To improve the efficiency of clinical research, there is interest in using electronic health record (EHR) data for outcome ascertainment [(1)][1]. However, EHR data are designed for clinical care and billing and their utility for event capture is largely untested [(2,3)][2]. We investigated 4

Exercise training is recommended for chronic heart failure (HF) patients to improve functional status and reduce risk of adverse outcomes. Elevated plasma levels of amino-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), and cardiac troponin T (cTnT) are associated with increased risk of adverse outcomes in this patient population. Whether exercise training leads to improvements in biomarkers and how such improvements relate to clinical outcomes are unclear.Amino-terminal pro-brain natriuretic peptide, hs-CRP, and cTnT levels were assessed at baseline and 3 months in a cohort of 928 subjects from the HF-ACTION study, a randomized clinical trial of exercise training versus usual care in chronic HF patients with reduced left ventricular ejection fraction (35%). Linear and logistic regressions were used to assess 3-month biomarker levels as a function of baseline value, treatment assignment (exercise training vs usual care), and volume of exercise. Linear regression and Cox proportional hazard modeling were used to evaluate the relations between changes in biomarker levels and clinical outcomes of interest that included change in peak oxygen consumption (peak VO2), hospitalizations, and mortality. Exercise training was not associated with significant changes in levels of NT-proBNP (P = .10), hs-CRP (P = .80), or detectable cTnT levels (P = .83) at 3 months. Controlling for baseline biomarker levels or volume of exercise did not alter these findings. Decreases in plasma concentrations of NT-proBNP, but not hs-CRP or cTnT, were associated with increases in peak VO2 (P.001) at 3 months and decreased risk of hospitalizations or mortality (P ≤ .04), even after adjustment for a comprehensive set of known predictors.Exercise training did not lead to meaningful changes in biomarkers of myocardial stress, inflammation, or necrosis in patients with chronic HF. Only improvements in NT-proBNP translated to reductions in peak VO2 and reduced risk of clinical events.