Erin Cordeiro

Diagnostic Accuracy of Blood-Based Tests and Histopathology for Cytomegalovirus Reactivation in Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

Background: It is unclear if traditional histopathology and noninvasive blood-based tests are sufficiently accurate to detect cytomegalovirus (CMV) reactivation in inflammatory bowel disease. Therefore, we assessed the diagnostic accuracy of these tests compared with immunohistochemistry (IHC) and tissue polymerase chain reaction (PCR). Methods: A systematic search of electronic databases was performed from inception through January 2016 for observational studies comparing diagnostic tests for CMV reactivation in inflammatory bowel disease. IHC and tissue PCR were considered reference standards and were used to evaluate the accuracy of blood-based tests and hematoxylin and eosin histopathology. Weighted summary estimates with 95% confidence intervals (CIs) were calculated using bivariate analysis. Results: Nine studies examined the accuracy of blood-based tests for predicting colonic CMV reactivation: 5 studies by pp65 antigenemia and 4 studies by blood PCR. The overall sensitivity was 50.8% (95% CI, 19.9–81.6), the specificity was 99.9% (95% CI, 99–100), and the positive predictive value was 83.8% (95% CI, 58.6–95.0). The sensitivities of pp65 and blood PCR were 39.7% (95% CI, 27.4–52.1) and 60.0% (95% CI, 46.5–73.5), respectively. Nine studies examined the sensitivity of histopathology. The overall sensitivity was 12.5% (95% CI, 3.6–21.4), 34.6% by IHC (95% CI, 13.8–55.4), and 4.7% by tissue PCR (95% CI, 1.2–17.1). Conclusions: Although blood-based tests seem to predict colonic CMV reactivation, they are insensitive tests. Similarly, histopathology has poor sensitivity for detecting colonic CMV. In agreement with current guidelines, these tests should not replace IHC or tissue PCR for detecting CMV reactivation in inflammatory bowel disease.

The effect of neoadjuvant chemotherapy on short-term outcomes in breast surgery: A propensity score adjusted analysis of NSQIP data.

115 Background: Neoadjuvant chemotherapy (NAC) is increasingly used in the treatment of breast cancer. The primary objective of this study was to determine whether administration of NAC increased the proportion of overall 30-day post-operative complications among patients undergoing surgery for invasive breast cancer. METHODS An analysis of the American College of Surgeons, National Surgical Quality Improvement Program (ACS-NSQIP) participant user files from 2005-2012 was performed. Patients undergoing surgery for invasive breast cancer were included; those with high-risk comorbidities or concurrent surgery were excluded. The primary outcome was a composite of overall 30-day post-operative complications. A propensity score was calculated and a propensity score adjusted multivariable logistic regression model was used to determine the independent effect of NAC on overall 30-day complications. RESULTS In the study period67,685 patients having surgery for invasive breast cancer were identified; of those, 3,624 (5.5%) received NAC. The rate of NAC use within this cohort increased from 5.5% to 10.2%. Patients who received NAC were: younger and had fewer medical comorbidities, but, were more likely to receive neoadjuvant radiation and undergo bilateral surgery. On unadjusted analysis, patients receiving NAC had significantly more post-operative complications than those not receiving NAC (4.9% vs. 3.7%, p = 0.0003) mainly due to infection and bleeding. However, after adjusting for confounders by propensity score adjusted multivariable regression, there was no longer a significant difference in overall 30-day post-operative complications between those receiving NAC versus not (odds ratio 1.16 [95%CI: 0.98, 1.36]). CONCLUSIONS This is the largest study to examine the effect of NAC on post-operative complications in patients undergoing surgery for invasive breast cancer. The receipt of NAC does not impart a significantly increased risk of post-operative complications in this patient population.