Endoscopist-Level and Procedure-Level Factors Associated With Increased Adenoma Detection With the Use of a Computer-Aided Detection Device.

INTRODUCTION: To investigate the impact of procedure-related and endoscopist-related factors on the effectiveness of a computer-aided detection (CADe) device in adenomas per colonoscopy (APC) detection. METHODS: The SKOUT clinical trial was conducted at 5 US sites. We present prespecified analyses of procedure-related and endoscopist-related factors, and association with APC across treatment and control cohorts. RESULTS: There were numeric increases in APC between SKOUT vs standard colonoscopy in community-based endoscopists, withdrawal time of ≥8 minutes, for endoscopists with >20 years of experience, and endoscopists with baseline adenoma detection rate <45%. DISCUSSION: The application of CADe devices in clinical practice should be carefully evaluated. Larger studies should explore differences in endoscopist-related factors for CADe.

The Prognostic Value of Axillary Staging Following Neoadjuvant Chemotherapy in Inflammatory Breast Cancer.

BACKGROUND: Inflammatory breast cancer (IBC) has historically been characterized by high rates of recurrence and poor survival; however, there have been significant improvements in systemic therapy. We sought to investigate modern treatment of IBC and define the yield and prognostic significance of axillary lymph nodes after neoadjuvant chemotherapy (NAC). METHODS: Women with clinical stage T4d, N0-N3, M0 IBC from 2012 to 2016 in the National Cancer Database were included. Kaplan-Meier survival curves and Cox regression were used to assess mortality by receptor subtype and nodal status. RESULTS: We identified 5265 patients; 37% hormone receptor (HR) +/HER2 - , 19% HR +/HER2 + , 18% HR -/HER2 + , and 26% triple-negative, and 5-year overall survival was 51.6%. Only 34% were treated according to guidelines with NAC, modified radical mastectomy, and adjuvant radiation. Pathologically positive lymph nodes (ypN +) after NAC varied by subtype and clinical nodal status (cN) ranging from 82% in cN + HR +/HER2 - patients to 19% in cN0 HR -/HER2 + patients. ypN + strongly correlated with survival in all subtypes with the most pronounced impact in HR +/HER2 + patients, with 90% 5-year overall survival in ypN0 versus 66% for ypN + (HR 4.29, 95% CI 1.58-11.70, p = 0.03). CONCLUSIONS: Five-year survival in M0 IBC is 51.6%. Positive nodes after NAC varied by subtype and clinical N status but is sufficiently high and provided meaningful prognostication in all subtypes to support continued routine pathologic assessment. Future study is warranted to identify reliable, less morbid, methods of staging the axilla in IBC patients appropriate for deescalation of axillary surgery.

Clear differences in ovarian cancer incidence and trends by ethnicity among Asian Americans.

BACKGROUND: Across major races in the United States (U.S.), ovarian cancer incidence is low among Asian American women. However, this observation aggregates Asian Americans as a single group despite their heterogeneity. Disaggregating the ethnic Asian population will produce more useful information to better understand ovarian cancer incidence among Asian women in the U.S. METHODS: Data from the Surveillance, Epidemiology, and End Results Program from 1990 to 2014 were used to compare age-adjusted incidence rates (AAIRs, per 100,000 women) for ovarian cancer for the six largest U.S. Asian ethnicities (Asian Indian/Pakistani, Chinese, Filipino, Japanese, Korean, Vietnamese) to non-Hispanic whites (NHWs). The race/ethnicity-specific AAIRs were calculated by time period and histotype. We examined the magnitude and direction of AAIR trends using average annual percent change (AAPC) statistics. RESULTS: All Asian ethnicities had significantly lower ovarian cancer incidence rates than NHWs. However, among Asian ethnicities, Asian Indians/Pakistanis had the highest rate of ovarian cancer (AAIR = 10.51, 95% CI: 9.65-11.42) while Koreans had the lowest (AAIR = 7.23, 95% CI: 6.62-7.88). Clear cell ovarian cancer had significantly higher incidence rates among Chinese, Filipino, and Japanese women than NHW women (incidence rate ratio (IRR) = 1.49, 95% CI: 1.29-1.72, IRR = 1.30, 95% CI: 1.12-1.51, IRR = 1.64, 95% CI: 1.36-1.97, respectively). Incidence trends also differed by Asian ethnicity with significant decreases only observed for Chinese (AAPC = -1.49, 95% CI: -2.22 to -0.74) and Japanese (AAPC = -1.75, 95% CI: -2.57 to -0.92). CONCLUSIONS: Examining Asian Americans as a single group results in missed ethnic-specific disparities in ovarian cancer, hence disaggregating this heterogeneous population in future research is warranted.