Trends for Stage and Grade Group of Prostate Cancer in the US (2010-2016).

OBJECTIVE: To quantify the yearly prostate cancer incidence per 100,000 men, comparing consecutive years from 2010 through 2016. In the years immediately following the 2011/2012 U.S. Preventive Services Task Force update to prostate specific antigen (PSA) screening guidelines, PSA screening, biopsy, and subsequent prostate cancer diagnosis and definitive local treatment have declined. We performed an analysis of stage and grade at diagnosis for prostate cancer in the US, in the years following the 2011/2012 update. METHODS/MATERIALS: This was a retrospective study performed using the Surveillance, Epidemiology, and End Results Program data. Inclusion criteria were men ≥ 40 years with prostate cancer diagnosed between the years 2010 and 2016. RESULTS: In total, 370,865 cases of prostate cancer were analyzed. Overall, the incidence of prostate cancer decreased from 522 to 327 cases per 100,000 persons from 2010 to 2016. Conversely, the rate of metastatic disease increased over this duration from 29 to 37 cases per 100,000 persons (P< .05). In patients ≥70 years, this increase was from 21 to 27 cases per 100,000 persons over the 7 years (P < .05). High-grade disease incidence did not change significantly over the study period, though low-grade disease incidence, (Grade Groups 1 and 2) decreased from 204 and 155 to 116 and 115 cases per 100,000 persons, respectively (P < .05). CONCLUSIONS: In the years following the 2011/2012 recommendation against PSA screening, fewer localized prostate cancers and more distantly metastatic prostate cancers were diagnosed. Most increases in metastatic disease was among men ≥70 years.

Resident Experience Associated with Lung Biopsy Outcomes: A Cross-Sectional Study of Diagnostic Radiology Residents. Does the Level of Training Matter?

INTRODUCTION: Efficient execution of image-guided percutaneous biopsy is a procedural competency milestone in radiology training. Despite the importance of achieving such mastery, literature on successful execution by residents is limited. The purpose of this study was to evaluate resident performance as measured by nondiagnostic biopsy and major complication percentages, on CT-guided transthoracic core needle biopsies (TTNB) of lung and mediastinal lesions. METHODS: A 12-year retrospective cohort study was conducted using charts from an academic hospital, 2006 - 2018, to evaluate TTNBs. Inclusion criteria were ≥ 18 years of age and ≥ 1 follow-up CT scan and chest x-ray. Bivariable associations by outcome(s) were evaluated. RESULTS: Of 1,191 biopsies conducted, case distribution was 41%, 26%, 18%, and 15% for postgraduate years (PGY) 2 - 5, respectively. Results from biopsies were 139 (11.7%) nondiagnostic, 218 (18.3%) benign, and 834 (70.0%) malignant cases. Resident year by nondiagnostic outcome was not significant; p = 0.430. There were 148 major complications. Complication rate by PGY 2 - 5 was 13.0%, 13.3%, 12.9%, and 9.2%, respectively; differences were not significant, p = 0.488. Of the 139 nondiagnostic cases, 42 were re-biopsied during the study period with 81% re-classified as malignant; no repeat biopsy was observed for the remaining 97 nondiagnostic cases. CONCLUSION: Of 1,191 lung/mediastinal biopsies analyzed, nearly 12% were nondiagnostic and over 12% had major complications; neither associated with resident level of experience. Outcomes were not affected significantly by level of training. Residency programs may benefit from affording opportunities for newer PGY classes to participate in procedures. Nondiagnostic cases may benefit from timely, repeat biopsies.

Urine Screening for Opioid and Illicit Drugs in the Total Joint Arthroplasty Population.

INTRODUCTION: Recent studies have shown an increase in post-operative orthopaedic complications associated with pre-operative opioid use. It is, therefore, important to know if patients use opioids before scheduled surgery. The purpose of this study was to determine if urine drug screening (UDS) is an effective screening tool for detecting opioid and illicit drug use prior to joint arthroplasty (JA) procedures. METHODS: This retrospective chart review was performed with IRB approval on 166 out of 172 consecutive patients in a community-based practice. All the patients had a pre-operative UDS prior to primary or revision JA by a fellowship trained orthopaedic surgeon between March 2016 and April 2017. Patient demographics documented opioid and illicit drug use, co-morbid diagnosis, and UDS results were collected from clinical charts. Statistical analysis was conducted using Pearson Chi-square, Fisher's exact, McNemar test, and t-tests with IBM SPSS Statistics, ver. 23. Significant differences were p < 0.05. RESULTS: Sixty-four of 166 patients (38.6%) tested positive for opioids. Among them, 55.0% (35/64) had no history of prescription opioid use. Significant differences were observed when comparing the test results of the UDS with the patient reported history of prescribed opioids (p = 0.001). CONCLUSION: With a significant number of patients testing positive for opioids without evidence of a previous prescription, UDS may be beneficial for initial risk assessment for patients undergoing JA procedures.