Objectives
To meta-analyze complication rate in computed tomography (CT)-guided transthoracic lung biopsy and associated risk factors.
Methods
Four databases were searched from 1/2000 to 8/2015 for ...studies reporting complications in CT-guided lung biopsy. Overall and major complication rates were pooled and compared between core biopsy and fine needle aspiration (FNA) using the random-effects model. Risk factors for complications in core biopsy and FNA were identified in meta-regression analysis.
Results
For core biopsy, 32 articles (8,133 procedures) were included and for FNA, 17 (4,620 procedures). Pooled overall complication rates for core biopsy and FNA were 38.8 % (95 % CI: 34.3–43.5 %) and 24.0 % (95 % CI: 18.2–30.8 %), respectively. Major complication rates were 5.7 % (95 % CI: 4.4–7.4 %) and 4.4 % (95 % CI: 2.7–7.0 %), respectively. Overall complication rate was higher for core biopsy compared to FNA (
p
< 0.001). For FNA, larger needle diameter was a risk factor for overall complications, and increased traversed lung parenchyma and smaller lesion size were risk factors for major complications. For core biopsy, no significant risk factors were identified.
Conclusions
In CT-guided lung biopsy, minor complications were common and occurred more often in core biopsy than FNA. Major complication rate was low. For FNA, smaller nodule diameter, larger needle diameter and increased traversed lung parenchyma were risk factors for complications.
Key Points
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Minor complications are common in CT-guided lung biopsy
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Major complication rate is low in CT-guided lung biopsy
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CT-guided lung biopsy complications occur more often in core biopsy than FNA
•
Major complication rate is similar in core biopsy and FNA
•
Risk factors for FNA are larger needle diameter, smaller lesion size
A search for mixing between active neutrinos and light sterile neutrinos has been performed by looking for muon neutrino disappearance in two detectors at baselines of 1.04 and 735 km, using a ...combined MINOS and MINOS+ exposure of 16.36×10^{20} protons on target. A simultaneous fit to the charged-current muon neutrino and neutral-current neutrino energy spectra in the two detectors yields no evidence for sterile neutrino mixing using a 3+1 model. The most stringent limit to date is set on the mixing parameter sin^{2}θ_{24} for most values of the sterile neutrino mass splitting Δm_{41}^{2}>10^{-4} eV^{2}.
Abstract Objective In 2008 GROINSS-V-I, the largest validation trial on the sentinel node (SN) procedure in vulvar cancer, showed that application of the SN-procedure in patients with early-stage ...vulvar cancer is safe. The current study aimed to evaluate long-term follow-up of these patients regarding recurrences and survival. Methods From 2000 until 2006 GROINSS-V-I included 377 patients with unifocal squamous cell carcinoma of the vulva (T1,<4 cm), who underwent the SN-procedure. Only in case of SN metastases an inguinofemoral lymphadenectomy was performed. For the present study follow-up was completed until March 2015. Results The median follow-up was 105 months (range 0–179). The overall local recurrence rate was 27.2% at 5 years and 39.5% at 10 years after primary treatment, while for SN-negative patients 24.6% and 36.4%, and for SN-positive patients 33.2% and 46.4% respectively (p = 0.03). In 39/253 SN-negative patients (15.4%) an inguinofemoral lymphadenectomy was performed, because of a local recurrence. Isolated groin recurrence rate was 2.5% for SN-negative patients and 8.0% for SN-positive patients at 5 years. Disease-specific 10-year survival was 91% for SN-negative patients compared to 65% for SN-positive patients (p < .0001). For all patients, 10-year disease-specific survival decreased from 90% for patients without to 69% for patients with a local recurrence (p < .0001). Conclusions Survival is very good for patients with a negative SN, but still 36% of these patients, as well as 46% of the patients with a positive SN, will have a local recurrence. Although a local recurrence is treated with curative intent, the disease-specific survival of these patients decreases significantly.
We describe the procedure used to flux calibrate the three-band submillimetre photometer in the Spectral and Photometric Imaging Receiver instrument on the Herschel Space Observatory. This includes ...the equations describing the calibration scheme, a justification for using Neptune as the primary calibration source, a description of the observations and data processing procedures used to derive flux calibration parameters (for converting from voltage to flux density) for every bolometer in each array, an analysis of the error budget in the flux calibration for the individual bolometers and tests of the flux calibration on observations of primary and secondary calibrators. The procedure for deriving the flux calibration parameters is divided into two parts. In the first part, we use observations of astronomical sources in conjunction with the operation of the photometer internal calibration source to derive the unscaled derivatives of the flux calibration curves. To scale the calibration curves in Jy beam−1 V−1, we then use observations of Neptune in which the beam of each bolometer is mapped using a very fine scan pattern. The total instrumental uncertainties in the flux calibration for most individual bolometers is ∼0.5 per cent, although a few bolometers have uncertainties of ∼1-5 per cent because of issues with the Neptune observations. Based on application of the flux calibration parameters to Neptune observations performed using typical scan map observing modes, we determined that measurements from each array as a whole have instrumental uncertainties of 1.5 per cent. This is considerably less than the absolute calibration uncertainty associated with the model of Neptune, which is estimated at 4 per cent.
Cervical neoplasia‐specific biomarkers, e.g. DNA methylation markers, with high sensitivity and specificity are urgently needed to improve current population‐based screening on (pre)malignant ...cervical neoplasia. We aimed to identify new cervical neoplasia‐specific DNA methylation markers and to design and validate a methylation marker panel for triage of high‐risk human papillomavirus (hr‐HPV) positive patients. First, high‐throughput quantitative methylation‐specific PCRs (QMSP) on a novel OpenArray™ platform, representing 424 primers of 213 cancer specific methylated genes, were performed on frozen tissue samples from 84 cervical cancer patients and 106 normal cervices. Second, the top 20 discriminating methylation markers were validated by LightCycler® MSP on frozen tissue from 27 cervical cancer patients and 20 normal cervices and ROCs and test characteristics were assessed. Three new methylation markers were identified (JAM3, EPB41L3 and TERT), which were subsequently combined with C13ORF18 in our four‐gene methylation panel. In a third step, our methylation panel detected in cervical scrapings 94% (70/74) of cervical cancers, while in a fourth step 82% (32/39) cervical intraepithelial neoplasia grade 3 or higher (CIN3+) and 65% (44/68) CIN2+ were detected, with 21% positive cases for ≤CIN1 (16/75). Finally, hypothetical scenario analysis showed that primary hr‐HPV testing combined with our four‐gene methylation panel as a triage test resulted in a higher identification of CIN3 and cervical cancers and a higher percentage of correct referrals compared to hr‐HPV testing in combination with conventional cytology. In conclusion, our four‐gene methylation panel might provide an alternative triage test after primary hr‐HPV testing.
The primary aim of this study was to assess the association between human papilloma virus (HPV) and p53 expression and local recurrence (LR), disease specific survival (DSS), and overall survival ...(OS) in patients with vulvar squamous cell carcinoma (VSCC). Secondary, the accuracy of p16 immunohistochemistry for HPV status was assessed. The tumor tissue of 255 patients, surgically treated for primary unifocal VSCC between 2000 and 2010, was analyzed. HPV-PCR and P16 and p53 immunohistochemical stainings were performed. All histologic slides were independently reviewed by two expert gyneco-pathologists. Time to first LR, DSS, and OS for the variables p16, p53, and HPV-PCR were compared using univariable and multivariable Cox-regression analyses. In 211/255 (83.5%) patients, HPV-PCR was negative. The local recurrence rate was significantly lower in patients positive with HPV-PCR (10-year LR rate 24.6%) versus negative tumors (47.5%),
p
= 0.004. After multivariable analyses, this difference remained significant (HR 0.23 (95% CI 0.08–0.62)
p
= 0.004). There was no difference in LR rate correlated to the p53 expression. DSS and OS did not significantly differ after multivariable analyses for all different subgroups. Sensitivity and specificity of p16 staining for presence of HPV detected by HPV-PCR were 86.4% and 93.8%, respectively. In conclusion, patients with HPV-negative VSCCs have significantly more LR compared to patients with HPV-positive VSCCs, and p16 immunohistochemistry is a reliable surrogate marker for HPV status. No relevant subgroup for LR or survival based on HPV/p53 status could be identified. We advise to perform an HPV-PCR or p16 IHC staining in all patients with VSCC.
We report measurements of oscillation parameters from ν(μ) and ν(μ) disappearance using beam and atmospheric data from MINOS. The data comprise exposures of 10.71×10(20) protons on target in the ...ν(μ)-dominated beam, 3.36×10(20) protons on target in the ν(μ)-enhanced beam, and 37.88 kton yr of atmospheric neutrinos. Assuming identical ν and ν oscillation parameters, we measure |Δm2| = (2.41(-0.10)(+0.09))×10(-3) eV2 and sin2(2θ) = 0.950(-0.036)(+0.035). Allowing independent ν and ν oscillations, we measure antineutrino parameters of |Δm2| = (2.50(-0.25)(+0.23))×10(-3) eV2 and sin2(2θ) = 0.97(-0.08)(+0.03), with minimal change to the neutrino parameters.
We report results of a search for oscillations involving a light sterile neutrino over distances of 1.04 and 735 km in a ν_{μ}-dominated beam with a peak energy of 3 GeV. The data, from an exposure ...of 10.56×10^{20} protons on target, are analyzed using a phenomenological model with one sterile neutrino. We constrain the mixing parameters θ_{24} and Δm_{41}^{2} and set limits on parameters of the four-dimensional Pontecorvo-Maki-Nakagawa-Sakata matrix, |U_{μ4}|^{2} and |U_{τ4}|^{2}, under the assumption that mixing between ν_{e} and ν_{s} is negligible (|U_{e4}|^{2}=0). No evidence for ν_{μ}→ν_{s} transitions is found and we set a world-leading limit on θ_{24} for values of Δm_{41}^{2}≲1 eV^{2}.
We report the results of a search for ν(e) appearance in a ν(μ) beam in the MINOS long-baseline neutrino experiment. With an improved analysis and an increased exposure of 8.2 × 10(20) protons on the ...NuMI target at Fermilab, we find that 2 sin(2) (θ(23))sin(2)(2θ(13))<0.12(0.20) at 90% confidence level for δ = 0 and the normal (inverted) neutrino mass hierarchy, with a best-fit of 2sin(2) (θ(23))sin(2)(2θ(13)) = 0.041(-0.031)(+0.047) (0.079(-0.053) (+0.071)). The θ(13) = 0 hypothesis is disfavored by the MINOS data at the 89% confidence level.
We report on a new analysis of neutrino oscillations in MINOS using the complete set of accelerator and atmospheric data. The analysis combines the ν(μ) disappearance and ν(e) appearance data using ...the three-flavor formalism. We measure |Δm(32)(2)| = 2.28-2.46 × 10(-3) eV(2) (68% C.L.) and sin(2)θ(23) = 0.35-0.65 (90% C.L.) in the normal hierarchy, and |Δm(32)(2)| = 2.32-2.53 × 10(-3) eV(2) (68% C.L.) and sin(2)θ(23) = 0.34-0.67 (90% C.L.) in the inverted hierarchy. The data also constrain δ(CP), the θ(23} octant degeneracy and the mass hierarchy; we disfavor 36% (11%) of this three-parameter space at 68% (90%) C.L.
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