Should We Separate the Pulmonary Surveillance Protocol for Postsurgical T1a and T1b Renal Cell Carcinoma? A Multicenter Database Analysis.

OBJECTIVE: To investigate the incidence of pulmonary metastases (PM) and the utility of the surveillance chest radiography (CXR) in detecting PM after curative treatment to better define surveillance recommendations for T1a and T1b renal cell carcinoma. MATERIALS AND METHODS: A retrospective review of a multi-institutional database was performed to include patients with renal masses treated with partial nephrectomy or radical nephrectomy. Patients were excluded for ≥T2 disease, benign pathology, and metastases. The primary outcome was the incidence of asymptomatic pulmonary lesion concerning for PM detected by CXR within 3 years. RESULTS: Five hundred sixty-eight patients met criteria of which 384 had T1a and 184 had T1b at a mean follow-up of 45 and 43 months, respectively. Patients averaged 2.96 and 2.99 CXRs for T1a and T1b with 46.8% having surveillance beyond 3 years. Indeterminate lesions were found in 5.7% (22) of T1a and 5.4% (10) in T1b of which 0.01% (2) and 1.1% (2) were confirmed PM by chest computed tomography and biopsy. Three-year CXR surveillance period detected asymptomatic PM in zero and two patients for T1a and T1b, respectively. High risk pathological features were not present in patients with PM. There was no difference in the incidence PM for patients undergoing partial nephrectomy (3/290) or radical nephrectomy (1/278) (P = .62). CONCLUSION: Our review suggests that post-treatment pulmonary surveillance should be reserved for T1b and may not be required for T1a given the low yield and false positives of CXR leading to unnecessary radiation and potential biopsies.

Knowledge about Age-Related Decline in Fertility and Oocyte Cryopreservation: A National Survey.

CONTEXT: Women worldwide are delaying childbearing, but are they aware of the age-related decline in fertility? AIMS: The aim of this study is to investigate awareness of age-related decline in fertility and oocyte cryopreservation. SETTINGS AND DESIGN: A primary analysis of a cross-sectional electronic survey with a nationally representative sample of nulliparous women aged 25-45 years. SUBJECTS AND METHODS: A national online survey performed March 4-March 9, 2016. STATISTICAL ANALYSIS USED: A linear regression model and ANOVA tests were performed. RESULTS: A total of 1213 women completed the survey. A significant difference was discovered in fecundity knowledge between women who identified as in a partnership compared to those who did not. Partnered women were more likely to respond "know a lot" about the age-related decline in fertility, whereas unpartnered women were more likely to respond "never heard of it" (P < 0.01). Partnered women are also more likely to respond that they would have made different life choices had they been more knowledgeable about fertility at a younger age (P = 0.01). The majority of the survey population had heard of oocyte cryopreservation but did not know much about it. CONCLUSIONS: Slightly over half of participants had an understanding of the natural age-related decline in fertility. Having a partner significantly increased the likelihood that a woman reported more knowledge about fertility. More effort is necessary to educate all women on assisted reproductive technologies and the natural age-related decline in fertility, specifically single women of childbearing age.