Megan E. McNally

Concomitant dysregulation of microRNAs miR‐151‐3p and miR‐126 correlates with improved survival in resected cholangiocarcinoma

BACKGROUND MicroRNAs (miRNAs) are small non-coding genes which become dysregulated in cancer and may predict survival. The role of miRNAs in outcomes in cholangiocarcinoma (CC) has not been reported. METHODS RNA was extracted from 32 resected CCs along with adjacent uninvolved bile duct epithelium. A total of 43 miRNAs were quantified using NanoString™. Clinicopathologic characteristics and outcomes were captured and compared. Overall survival curves were created using the Kaplan-Meier method; factors, including miRNA expression, were compared by log-rank, chi-squared or Cox regression analyses. RESULTS Absolute expression of each miRNA was compared with overall survival after excluding perioperative deaths (n= 3). One upregulated (miR-151-3p; P= 0.003) and one downregulated (miR-126; P= 0.023) miRNA in resected CC relative to adjacent normal bile duct epithelium correlated with survival on univariate analysis. Clinical factors and these miRNAs were compared. Dysregulated miR-151-3p and miR-126, respectively, were the only factors that correlated with improved overall survival [41.5 months vs. 12.3 months (P= 0.002) and 21.9 months vs. 15.1 months (P= 0.02), respectively]. In eight patients, both miRNAs were dysregulated. In the remainder, only one or neither showed dysregulation. Concomitant dysregulation correlated with the best overall survival (58.7 months vs. 15.1 months; P < 0.000; n= 8); clinicopathologic factors in these groups were otherwise similar. CONCLUSIONS In resected CC, the concomitant dysregulation of both miR-151-3p and miR-126 was the factor related to the greatest improvement in overall survival. Further analysis of the targets of these miRNAs may yield potential therapeutic targets or prognostic biomarkers.

An indeterminate nodule in the cirrhotic liver discovered by surveillance imaging is a prelude to malignancy.

Surveillance imaging often shows indeterminate lesions in the cirrhotic liver, which may represent early hepatocellular carcinoma (HCC), dysplastic or regenerative nodules, or vascular shunts. The risk of HCC after identification of an indeterminate nodule is not well described.

Perioperative mortality in patients with myelodysplastic syndrome

Myelodysplastic syndrome (MDS) is a conglomerate of diseases in which bone marrow‐derived cells die before or shortly after entering circulation. We sought to define the perioperative mortality in MDS patients.

The effects of race and age on axillary lymph node involvement in breast cancer patients at a Midwestern safety-net hospital

BACKGROUND Black and premenopausal patients have been shown to have poorer stage for stage survival than the overall population. The purpose of this study was to define the effects of age and race on axillary lymph node involvement at a Midwestern safety-net hospital. The hypothesis was that black patients under the age of 50 would be found to have increased rates of axillary involvement in breast cancer. METHODS A retrospective case review was performed of 184 breast cancer patients from 2000 to 2005. Statistical analysis was performed by race and age. Patients under 50 years of age were defined as premenopausal. RESULTS The overall rate of axillary involvement was 47.8%. Black patients had an overall rate of axillary involvement of 52.9%. However, premenopausal black patients had a 70.8% rate of axillary involvement (P < .05). Premenopausal white patients had a 46.3% rate of axillary involvement. Logistic regression analysis was performed, and premenopausal age and tumor size were found to be independent predictors of positive lymph node status in black patients. CONCLUSION In our study, premenopausal black patients had a much higher rate of axillary lymph node involvement than any other group. This finding was consistent even when tumor size was taken into account. More research needs to be done to better define this difference and to detect this disease at an earlier stage.

Surgical Oncology Coding

Just as there are increasing complexities to procedures performed for oncologic purposes, there also are increasing complexities to the coding. And as surgeons, beyond the medical record, we are in charge of the source document—the operative note. It is imperative to document thoroughly and completely and refrain from generalities in the operative note. It also is important to use certain terms in the ever more granular world of coding and documentation to ensure accuracy. Terms such as “through a separate site” or “bilateral” are necessary to define that more than one procedure was performed in that setting. Ensuring that not only the actions are described in the operative note but also the thought process behind straying from the typical scenario or planned operation should be included in the body of the document. These notations can justify why a part was or wasn’t performed for purposes of billing for that procedure.