Determination of high-risk HPV status of head and neck squamous cell carcinoma using the Roche cobas HPV test on cytologic specimens and acellular supernatant fluid.

BACKGROUND: High-risk human papillomavirus-positive (hrHPV+) oropharyngeal squamous cell carcinomas comprise a subset of head and neck squamous cell carcinomas (HNSCCs) with a distinct biology and prognosis. Commonly, the diagnosis of HNSCC is rendered on fine-needle aspiration (FNA). Because cell blocks may be insufficient for determining HPV status using microscopy-based techniques, the ability of liquid-based assays was examined in the current study. METHODS: The performance of the Roche cobas 4800 platform was evaluated on the FNA material from the cell pellet and corresponding cell-free supernatant fluid specimens of primary and metastatic HNSCCs. These results were compared with the p16 immunostain result from the histologic material obtained from the same patient. Discrepant cases were adjudicated using hrHPV RNA in situ hybridization. RESULTS: A total of 41 samples (23 primary tumors and 18 lymph node metastases) were acquired from 34 patients with HNSCC. Primary tumors included the oropharynx (20 samples), oral cavity (13 samples), larynx (3 samples), and skin (3 samples). In 2 cases, a primary tumor could not be identified. Twenty-three samples (56%) were found to be p16 positive by immunohistochemistry. Twenty-two samples were found to be positive on cobas hrHPV testing from both cell pellet and cell-free supernatant fluid. Two cell-free supernatant fluid specimens yielded indeterminate cobas results. At the time additional hrHPV RNA in situ hybridization analysis was performed, one cobas-positive cell pellet was deemed to be a false-positive result. The sensitivity of the cobas assay was 100% for pellet material and cell-free supernatant fluid, with specificities of 94.7% and 100%, respectively. CONCLUSIONS: cobas hrHPV testing of HNSCC specimens demonstrated high concordance with p16 immunohistochemistry on the corresponding cell block and/or tissue specimen. Using the cell-free supernatant fluid in this platform could provide accurate HPV results while conserving material for cytomorphologic analyses.

Impact of Peritoneal Metastasis on Survival of Patients With Small Intestinal Neuroendocrine Tumor.

The liver and peritoneum are the 2 most common distant metastatic sites for small intestinal neuroendocrine tumors (SI-NET). In this study, we evaluated the differential impact of hepatic and/or peritoneal metastasis on prognosis of SI-NET patients. Surgical Pathology archives were searched for SI-NET resections performed between January 1, 1994 and August 31, 2017. Two hundred nineteen cases with clinical follow-up data were identified. Pathology reports and electronic medical records were reviewed. The 219 patients included 104 females and 115 males with a median age of 59 years (range, 19 to 85 y). There were 71 (33%) cases without hepatic or peritoneal metastasis, 80 (37%) with hepatic metastasis only, 14 (6%) with peritoneal metastasis only, and 53 (24%) with both hepatic and peritoneal metastasis at the time of surgery or during follow-up. The number of primary tumors, largest tumor size, lymph node metastasis, pT category, and sex were not significant independent prognostic factors in multivariate Cox proportional hazard regression. Age was the only variable other than presence of metastatic disease that was associated with worse prognosis (5% increase in risk/year of age; 95% confidence interval, 1.7%-8.2%; P=0.003). After controlling for patient age, pairwise comparisons of marginal linear predictions showed increased risk with peritoneal metastasis, with or without associated hepatic metastasis, compared to hepatic metastasis only. In conclusion, although limited by the number of patients with peritoneal metastasis only, these results support substratifying patients with metastatic SI-NET by anatomic site of metastasis.

Quality Improvement in Transfusion Practice of Orthotopic Liver Transplantation Reduces Blood Utilization, Length of Hospital Stay, and Cost.

OBJECTIVES: Orthotopic liver transplantation (OLT) can require substantial usage of blood products. Higher rates of transfusion have been associated with increased length of hospital stay, higher rates of infection, graft failure, and mortality. This study was a retrospective analysis to assess the impact of quality improvement interventions in OLT. METHODS: Data collection included demographics, preoperative and intraoperative data, blood utilization, and cost data. Statistical analysis was performed using R software. RESULTS: Total blood product utilization was reduced by approximately 50%. Statistically significant decreases were noted in blood product usage in the intraoperative and first 48-hour postoperative utilization, the number of OLTs using fewer than five RBC units, length of hospital stay, and cost. CONCLUSIONS: This study showed successful implementation of quality improvement team interventions to reduce blood utilization during OLT. Reduced transfusion significantly correlated with decreased length of hospital stay and cost.

How do research participants perceive "uncertainty" in genome sequencing?

PURPOSE: The scope of uncertainty in genome sequence information has no rival in health-care delivery. We present data from adults participating in a National Institutes of Health study using this technology, in which perceptions of uncertainty are hypothesized to be key in predicting decisions to learn and act on genome health information. METHODS: We conducted six professionally moderated focus groups with 39 randomly selected ClinSeq participants varying on whether they had coronary heart disease and had received prior sequence results. We elicited perceptions of the uncertainties associated with genome sequencing using written prompts. RESULTS: Participants perceived uncertainty as a quality of genome information. The majority of participants characterized uncertainty of sequencing information as "changing, fluid, developing, or ground breaking." These responses led to anticipation of more optimistic future outcomes. Fewer participants described uncertainty as "questionable, less accurate, limited, or poorly understood." These perceptions seemed to undermine participants' faith in genome information, leading to feelings of disillusionment. CONCLUSION: Our findings suggest that perceptions of uncertainty are related to epistemological beliefs that inform expectations for the information. Interventions that promote realistic expectations of genome sequencing may mitigate negative responses to uncertainty.