New publication by Ben Littenberg

AJR Am J Roentgenol. 2015 Aug;205(2):317-24. doi: 10.2214/AJR.14.13930.

DWI for Renal Mass Characterization: Systematic Review and Meta-Analysis of Diagnostic Test Performance.

Kang SK1,2, Zhang A3, Pandharipande PV4,5, Chandarana H1, Braithwaite RS2,6, Littenberg B7.

Abstract

OBJECTIVE:

The objective of our study was to perform a systematic review and meta-analysis of the test performance of DWI in the characterization of renal masses.

MATERIALS AND METHODS:

We performed searches of three electronic databases for studies on renal mass characterization using DWI. Methodologic quality was assessed for each study. We quantitatively analyzed test performance for three clinical problems: first, benign versus malignant lesions; second, clear cell renal cell carcinoma (RCC) versus other malignancies; and, third, high-versus low-grade clear cell RCCs. We summarized performance as a single pair of sensitivity and specificity values or a summary ROC curve.

RESULTS:

The studies in the literature were limited in both quantity and quality. For classification of benign versus malignant lesions, four studies with 279 lesions yielded a single summary estimate of 86% sensitivity and 78% specificity. For differentiation of clear cell RCC from other malignancies, five studies showed marked heterogeneity not conducive to meta-analysis. For differentiation of high-from low-grade clear cell RCCs, three studies with 110 lesions showed a threshold effect appropriate for summary ROC construction: The AUC was 0.83.

CONCLUSION:

Evidence suggests moderate accuracy of DWI for the prediction of malignancy and high-grade clear cell cancers, whereas DWI performance for ascertaining clear cell histologic grade remains unclear. To develop DWI as a noninvasive approach for the evaluation of solid renal masses, prospective studies with standardized test parameters are needed to better establish DWI performance and its impact on patient outcomes.

NIH Loan Repayment Programs

Here are some valuable funding opportunities for those of us with educational loans:

• Extramural Loan Repayment Program for Clinical Researchers (LRP-CR)
  (NOT-OD-15-121) National Institutes of Health
  
  
• Extramural Loan Repayment Program for Pediatric Research (LRP-PR)
  (NOT-OD-15-122) National Institutes of Health
  
  
• Extramural Loan Repayment Program for Health Disparities Research (LRP-HDR)
  (NOT-OD-15-123) National Institutes of Health
  
  
• Extramural Loan Repayment Program for Contraception and Infertility Research (LRP-CIR)
  (NOT-OD-15-124) National Institutes of Health
  
  
• Extramural Clinical Research Loan Repayment Program for Clinical Researchers from Disadvantaged Backgrounds (LRP-IDB)
  (NOT-OD-15-125) National Institutes of Health

Clinical Research Oriented Workshop (CROW) Meeting: July 2, 2015

Present:  Marianne Burke, Kairn Kelley (by phone), Rodger Kessler, Ayodelle LeBruin, Ben Littenberg, Connie van Eeghen

Start Up: Marianne has moved in!  Stay tuned for interior decorating changes… 

1.                  Discussion: Rodger is developing a project to automate a medical behavioral algorithm for treatment of out of control type 2 diabetes (probably moving to patients at high risk for diabetes), that has been the focus of his and Connie’s work as part of an R-03.  With colleagues in Bioinformatics at ASU (and anyone else interested in participating), we will be pursuing either NIH or AHRQ funding to develop and test, probably using Mayo clinic primary care site(s). Rodger is looking for feedback on the concept and the writing.

a.       The algorithm starts with data identified at-risk patients to receive an automated health risk assessment to generate a care-planning document (an annual CMS requirement).  The process was trialed with two sets of 10 patients.  Results identified two needs

                                                  i.      A full-time CHT support clinician to follow up on patients with self-identified need

                                                ii.      An internal PRISM build to automate the health risk appraisal and tailor it to the work flow

b.      FINER review

                                                  i.      Feasible: medium: not at UVM MC but possible at another location.  Not an EPIC problem but organizational leadership and cultural barriers exist

                                                ii.      Interest: clearly yes

                                              iii.      Novel: yes

                                              iv.      Ethical: no problem

                                                v.      Relevance: this doesn’t make the world a better place; people will not pay for this yet.  It is an interesting project for someone, but may not be the highest priority for CTS research now.

2.                  Next Workshop Meeting(s): Thursdays, 1:00 a.m. – 2:00 p.m., at Given Courtyard South Level 4.   Remember: the first 15 minutes are for checking in with each other.  The schedule for future meetings will be re-evaluated in May.

a.       July 9: Marianne: update (no Connie)

b.      July 17 (switch to Fridays): (no Connie or Ben)

c.       July 24: (no Ben or Marianne or Ayodelle) Kairn update

d.      July 31: (no Ben) Rodger’s List of Big Rocks

Recorder: Connie van Eeghen

Rodger Kessler promoted!

Many congratulations to Rodger Kessler, PhD who was promoted today to Associate Professor of Family Medicine!