Prediction of Surgical Upstaging Risk of Ductal Carcinoma In Situ Using Machine Learning Models.

Objective: The purpose of this study was to build machine learning models to predict surgical upstaging risk of ductal carcinoma in situ (DCIS) to invasive cancer and to compare model performance to eligibility criteria used by the Comparison of Operative versus Monitoring and Endocrine Therapy (COMET) active surveillance trial. Methods: Medical records were retrospectively reviewed of all women with DCIS at core-needle biopsy who underwent surgery from 2007 to 2016 at an academic medical center. Multivariable regression and machine learning models were developed to evaluate upstaging-related features and their performance was compared with that achieved using the COMET trial eligibility criteria. Results: Of 1387 women (mean age, 57 years; range, 27-89 years), the upstaging rate of DCIS was 17% (235/1387). On multivariable analysis, upstaging-associated features were presentation of DCIS as a palpable area of concern, imaging finding of a mass, and nuclear grades 2 or 3 at biopsy (P < 0.05). If COMET trial eligibility criteria were applied to our study cohort, then 496 women (42%, 496/1175) would have been eligible for the trial, with an upstaging rate of 12% (61/496). Of the machine learning models, none had a significantly lower upstaging rate than 12%. However, if using the models to determine eligibility, then a significantly larger proportion of women (56%-87%) would have been eligible for active surveillance. Conclusion: Use of machine learning models to determine eligibility for the COMET trial identified a larger proportion of women eligible for surveillance compared with current eligibility criteria while maintaining similar upstaging rates.

Ipsilateral tumor recurrence risk in women with ductal carcinoma in situ: application of the Van Nuys Prognostic Index and the Memorial Sloan Kettering Cancer Center nomogram.

PURPOSE: To apply the Van Nuys Prognostic Index (VNPI) and the Memorial Sloan Kettering Cancer Center (MSKCC) ductal carcinoma in situ (DCIS) nomogram to DCIS patients with known long-term outcomes. METHODS: A retrospective review was performed of consecutive patients diagnosed with DCIS from 2007 to 2014. Included patients underwent breast-conserving surgery (BCS) and were followed with imaging for at least five years. For each patient, the VNPI and MSKCC nomogram risk estimates were determined. In addition, variables used in both models were compared between women with and without recurrences using the Wilcoxon signed-rank test and the Pearson's chi-squared test. RESULTS: Over the eight-year period, 456 women (average age 57 years, range 30-87) underwent BCS for DCIS. Thirty-one (6.8%) experienced an ipsilateral recurrence. The average VNPI scores were 7 (range 5-9) and 7 (range 4-10) for women with and without a recurrence (p = 0.14), respectively, with 4-6, 7-9, and 10-12 being the low, moderate, and high-risk groups, respectively. Per the MSKCC nomogram, the average five-year recurrence risks were 5% (range 1-12%) and 4% (range 1-38%) for women with and without a recurrence (p = 0.09), respectively. The recurrence risk-related variables were younger patient age, need for one or more re-excision surgeries, and use of endocrine therapy for 0 to less than five years after surgery. CONCLUSION: Ipsilateral tumor recurrence risk estimates based on the VNPI and MSKCC nomogram are similar between women with DCIS who did and did not have a recurrence, suggesting that more robust prognostic models are needed.

Taste of Clindamycin and Acetaminophen.

This study evaluated the taste palatability of liquid clindamycin and acetaminophen products on the market. Subjects rated the palatability of 3 clindamycin suspensions, 1 amoxicillin suspension (tasted twice), an acetaminophen elixir, and an acetaminophen suspension in a randomized blinded fashion on a 0 to 5 scale. Forty-six adults aged 20 to 82 years volunteered for this study. Means (and 95% confidence intervals) were as follows: amoxicillin-first taste 3.6 (3.3-3.9), amoxicillin-second taste 3.5 (3.2-3.7). Clindamycin Rising, Perrigo, Greenstone; 2.0 (1.6-2.5), 3.0 (2.7-3.3), and 2.2 (1.8-2.6), respectively. Acetaminophen elixir 0.6 (0.4-0.8) and acetaminophen suspension 3.4 (3.1-3.6). One clindamycin tasted significantly better than the others. Additionally, although 2 acetaminophen formulations are currently available over-the-counter, the suspension is more palatable and less costly. Medicaid drug programs that perpetuate the use of elixir should change their coverage to save money and provide patients access to better tasting acetaminophen.