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“The Society for Women’s Health Research (SWHR) is a national, nonprofit organization based in Washington DC that is dedicated to transforming women’s health through science, advocacy, and education. For more than 10 years,
women and the physicians who treat them have been concerned about the safety of menopausal hormone therapy, largely since the early termination of two large federally funded studies. Considerable confusion remains despite decades of accumulated evidence from observational studies, clinical trials, and meta-analyses. In November 2012, SWHR convened 18 of the foremost experts within the field for a roundtable event to discuss the collective evidence related to the risks and benefits of hormone therapy. This report includes a synopsis of those discussions, the clinical statements that were generated and agreed upon, and the selleck chemicals research recommendations suggested by the assembled experts.”
“Background and Purpose: Accurate assessment of upper-tract
urothelial carcinoma (UTUC) pathology may guide use of endoscopic vs extirpative therapy. We present a multi-institutional cohort of patients with UTUC who underwent surgical resection to characterize the association of ureteroscopic (URS) biopsy features with final pathology results.
Patients and Methods: URS biopsy data were available in 238 patients who underwent surgical resection of UTUC. IWR-1-endo datasheet Biopsies were performed using a brush biopsy kit, mechanical biopsy device, or basket. Stage was classified as a positive brush, nonmuscle-invasive (<pT(2)), or muscle invasive (MI; >= pT(2)). Grade was classified as low or high.
Results: On URS biopsy, 88/238 (37%) patients had a positive brush, 140 (59%) had a diagnosis of non-MI, and 10 (4%) had MI disease. Biopsy results showed low-grade cancer in 140 (59%) and high-grade Cl-amidine concentration cancer
in 98 (41%). Pathologic evaluation at surgical resection demonstrated non-MI tumors in 140 (59%) patients, MI in 98 (41%), and high-grade disease in 150 (63%). On univariate analysis, high URS biopsy grade was associated with high-grade (positive predictive value [PPV] 92%, P < 0.0001) and MI (PPV 60%, P < 0.0001) UTUC at surgery. URS biopsy stage, however, was associated with surgical pathology grade (P = 0.005), but not MI (P = 0.16) disease. On multivariate analysis, high URS grade, but not biopsy stage, was associated with high final pathology grade (hazard ratio [HR] 16.6, 95% confidence interval [CI] 7.0-39.5, P < 0.0001) and MI UTUC (HR 3.6, 95% CI 2.1-6.8, P < 0.0001).
Conclusion: High URS biopsy grade, but not stage, is associated with adverse tumor pathology. This information may play a valuable role for risk stratification and in the appropriate selection of endoscopic management vs surgical extirpation for UTUC.