Image-Guided Core Needle Biopsy of Adipocytic Tumors: Diagnostic Accuracy and Concordance With Final Surgical Pathology.

OBJECTIVE. Diagnostic accuracy of core needle biopsy (CNB) for adipocytic tumors can be low because of sampling error from these often large, heterogeneous lesions. The purpose of this study was to evaluate the diagnostic accuracy of image-guided CNB for various adipocytic tumors in comparison with excisional pathology. MATERIALS AND METHODS. Adipocytic tumors (n = 77) of all adult patients undergoing image-guided CNB and subsequent surgical excision of an adipocytic tumor at a tertiary referral center between 2005 and 2019 were studied. To determine concordance, we compared pathologic diagnoses based on CNB to the reference standard of pathologic diagnoses after surgical excision. Tumors were divided into three categories (benign lipomatous tumors [lipoma, lipoma variants, hibernomas], atypical lipomatous tumors [ALTs] or well-differentiated liposarcomas [WDLs], and higher grade liposarcomas [myxoid, dedifferentiated, pleomorphic]), and diagnostic accuracy was calculated for each category. RESULTS. In 73 of 77 adipocytic tumors (95%), diagnosis at CNB and diagnosis after excision were concordant. Accuracy of diagnosis was poorer for ALTs and WDLs than for the other two categories, and the difference was statistically significant (p < .002). For the 29 benign lipomatous tumors and the 27 higher-grade liposarcomas, diagnoses at CNB and after excision were concordant in all cases (100%). Seventeen of the 21 tumors (81%) diagnosed as ALTs or WDLs at CNB had a concordant diagnosis after excision; four of the 21 were upgraded (dedifferentiated liposarcoma, n = 3; myxoid liposarcoma, n = 1). CONCLUSION. CNB provides high diagnostic accuracy for adipocytic tumors, particularly for benign lipomatous tumors and higher grade liposarcomas. However, though still high at 81%, diagnostic accuracy of CNB is not as high for tumors diagnosed as ALTs or WDLs. Awareness of this limitation is important when determining management, particularly of cases of ALT or WDL for which surgery is not planned.

Appropriate Implantable Defibrillator Therapy in Adults With Hypertrophic Cardiomyopathy.

INTRODUCTION: Implantable cardioverter-defibrillators (ICDs) are effective at terminating the ventricular arrhythmias that cause sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). However, identifying patients at risk for SCD remains an ongoing challenge. METHODS AND RESULTS: We retrospectively studied all adult patients with HCM treated with ICDs at our referral center from 2000 to 2013 to determine the risk factor profile, rates of appropriate ICD therapy, and complications associated with ICD implantation and discharge. Over a mean follow-up period of 5.2 ± 4.5 years, ICDs provided appropriate therapy to 25 of 135 patients (2.6%/year for primary prevention, 9.8%/year for secondary prevention). Established risk factors for SCD were equally prevalent among patients who received appropriate therapy and those who did not. There were similar rates of appropriate therapy for primary prevention patients with each risk factor. Patients with multiple risk factors had similar rates of appropriate therapy to patients with a single risk factor. Patients who underwent implantation at a younger age were more likely to experience appropriate therapy. Inappropriate therapy occurred in 27 of 135 patients (20%). CONCLUSIONS: These data indicate that the rate of appropriate ICD therapy for primary prevention in a contemporary adult HCM population is lower than previously reported. The frequency of appropriate therapy was equally modest regardless of the nature and number of risk factors that led to ICD implantation, and patients with multiple risk factors for SCD did not have an increased rate of appropriate therapy.

State dependent valuation: the effect of deprivation on risk preferences.

The internal state of an organism affects its choices. Previous studies in various non-human animals have demonstrated a complex, and in some cases non-monotonic, interaction between internal state and risk preferences. Our aim was to examine the systematic effects of deprivation on human decision-making across various reward types. Using both a non-parametric approach and a classical economic analysis, we asked whether the risk attitudes of human subjects towards money, food and water rewards would change as a function of their internal metabolic state. Our findings replicate some previous work suggesting that, on average, humans become more risk tolerant in their monetary decisions, as they get hungry. However, our specific approach allowed us to make two novel observations about the complex interaction between internal state and risk preferences. First, we found that the change in risk attitude induced by food deprivation is a general phenomenon, affecting attitudes towards both monetary and consumable rewards. But much more importantly, our data indicate that rather than each subject becoming more risk tolerant as previously hypothesized based on averaging across subjects, we found that as a population of human subjects becomes food deprived the heterogeneity of their risk attitudes collapses towards a fixed point. Thus subjects who show high-risk aversion while satiated shift towards moderate risk aversion when deprived but subjects who are risk tolerant become more risk averse. These findings demonstrate a more complicated interaction between internal state and risk preferences and raise some interesting implications for both day-to-day decisions and financial market structures.