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Featured researches published by Shishir Karthik.


Lung Cancer | 2015

Risk of malignancy in pulmonary nodules: A validation study of four prediction models

Ali Al-Ameri; Puneet Malhotra; Helene Thygesen; Paul K. Plant; Sri Vaidyanathan; Shishir Karthik; Andrew Scarsbrook; Matthew Callister

OBJECTIVES Clinical prediction models assess the likelihood of malignancy in pulmonary nodules detected by computed tomography (CT). This study aimed to validate four such models in a UK population of patients with pulmonary nodules. Three models used clinical and CT characteristics to predict risk (Mayo Clinic, Veterans Association, Brock University) with a fourth model (Herder et al. [4]) additionally incorporating (18)Fluorine-Fluorodeoxyglucose (FDG) avidity on positron emission tomography-computed tomography (PET-CT). MATERIALS AND METHODS The likelihood of malignancy was calculated for patients with pulmonary nodules (4-30mm diameter) and data used to calculate the area under the receiver operating characteristic curve (AUC) for each model. The models were used in a restricted cohort of patients based on each models exclusion criteria and in the total cohort of all patients. RESULTS Two hundred and forty-four patients were studied, of whom 139 underwent FDG PET-CT. Ninety-nine (40.6%) patients were subsequently confirmed to have malignant nodules (33.2% primary lung cancer, 7.4% metastatic disease). The Mayo and Brock models performed similarly (AUC 0.895 and 0.902 respectively) and both were significantly better than the Veterans Association model (AUC 0.735, p<0.001 and p=0.002 respectively). In patients undergoing FDG PET-CT, the Herder model had significantly higher accuracy than the other three models (AUC 0.924). When the models were tested on all patients in the cohort (i.e. including those outside the original model inclusion criteria) AUC values were reduced, yet remained high especially for the Herder model (AUC 0.916). For sub-centimetre nodules, AUC values for the Mayo and Brock models were 0.788 and 0.852 respectively. CONCLUSIONS The Mayo and Brock models showed good accuracy for determining likelihood of malignancy in nodules detected on CT scan. In patients undergoing FDG PET-CT for nodule evaluation, the highest accuracy was seen for the model described by Herder et al. incorporating FDG avidity.


Thorax | 2018

Lung cancer stage-shift following a symptom awareness campaign

M.P.T. Kennedy; Leanne Cheyne; Michael Darby; Paul Plant; R. Milton; J Robson; Alison Gill; Puneet Malhotra; Victoria Ashford-Turner; Kirsty Rodger; Elankumaran Paramasivam; Annette Johnstone; Bobby Bhartia; Shishir Karthik; Catherine Foster; Veronica Lovatt; Francesca Hewitt; Louise Cresswell; Victoria Coupland; Margreet Lüchtenborg; Ruth H Jack; Henrik Møller; Matthew Callister

Background Lung cancer outcomes in the UK are worse than in many other developed nations. Symptom awareness campaigns aim to diagnose patients at an earlier stage to improve cancer outcomes. Methods An early diagnosis campaign for lung cancer commenced in Leeds, UK in 2011 comprising public and primary-care facing components. Rates of community referral for chest X-ray and lung cancer stage (TNM seventh edition) at presentation were collected from 2008 to 2015. Linear trends were assessed by χ2 test for trend in proportions. Headline figures are presented for the 3 years pre-campaign (2008–2010) and the three most recent years for which data are available during the campaign (2013–2015). Findings Community-ordered chest X-ray rates per year increased from 18 909 in 2008–2010 to 34 194 in 2013–2015 (80.8% increase). A significant stage shift towards earlier stage lung cancer was seen (χ2(1)=32.2, p<0.0001). There was an 8.8 percentage point increase in the proportion of patients diagnosed with stage I/II lung cancer (26.5% pre-campaign vs 35.3% during campaign) and a 9.3% reduction in the absolute number of patients diagnosed with stage III/IV disease (1254 pre-campaign vs 1137 during campaign). Interpretation This is the largest described lung cancer stage-shift in association with a symptom awareness campaign. A causal link between the campaign and stage-shift cannot be proven but appears plausible. Limitations of the analysis include a lack of contemporary control population.


Thorax | 2015

S74 Assessing the diagnostic accuracy of the British Thoracic Society algorithm for investigation of solid pulmonary nodules

Ali Al-Ameri; Puneet Malhotra; Helene Thygesen; Sri Vaidyanathan; Shishir Karthik; Andrew Scarsbrook; Matthew Callister

Background The British Thoracic Society guidelines (2015) on the investigation and management of pulmonary nodules recommend the use of two risk prediction tools to assess the likelihood of malignancy in solid pulmonary nodules (Brock model following initial CT and the model described by Herder et al. following PET-CT). Management strategies are suggested on the basis of these risk assessments. The aim of this study was to assess the performance of this algorithm in patients with solid pulmonary nodules recruited from a UK teaching hospital. Method Patients with solid pulmonary nodules (4–30 mm) were retrospectively identified from the lung cancer MDT and a nodule follow-up clinic (n = 221). All patients had a final diagnosis confirmed by histology or radiological stability on 2-year follow up. Results The median age was 69 years. The prevalence of malignancy was 37.1% (29.9% primary lung cancer, 7.2% metastatic disease). 25 patients where PET-CT was recommended by the guideline but did not occur were excluded from subsequent analysis. Ten patients had nodules <5 mm and therefore would have been immediately discharged. All these nodules were benign. CT surveillance was recommended for 106 patients (37 with nodule <8 mm, 45 with malignant risk of <10% following initial CT, and 24 with malignant risk of <10% following PET-CT). 94% of these 106 patients had benign disease, 2% had primary lung cancer and 4% had metastatic disease. Surgical/non-surgical treatment was recommended for 58 patients where the malignant risk was >70% following PET-CT. 81% of these patients had primary lung cancer, 10% had metastatic disease and 9% were benign. For nodules with a malignant risk of between 10 and 70% following PET-CT, the guidelines recommend consideration of biopsy with alternatives of CT surveillance or surgical resection depending on patient preference and fitness. Of the 22 patients with nodules in this range, 36% were benign, 55% primary lung cancer and 9% metastatic disease. Conclusion The solid nodule algorithm from the BTS guidelines shows good accuracy in discriminating benign from malignant nodules, recommending appropriate management in a high proportion of cases. Further studies should evaluate this and the other management algorithms with prospectively collected data.


Clinical Radiology | 2014

Risks and rewards of CT-guided thoracic biopsy. Complications audit and patient experience survey

Annette Johnstone; Aung Win; Michael Darby; Bobby Bhartia; Shishir Karthik


Clinical Radiology | 2017

Additive value of PET-CT in detecting primary site of unknown primary in head and neck squamous cell cancer (CUP-HNSCC) with cervical nodal metastases

Seung-Jin Choi; Jenny Walsh; Helen Cliffe; Shishir Karthik; Sriram Vaidyanathan


Lung Cancer | 2015

37: The added value of positron emission tomography to a clinical prediction model for pulmonary nodules

Ali Al-Ameri; Puneet Malhotra; Helene Thygesen; Sri Vaidyanathan; Shishir Karthik; Andrew Scarsbrook; Paul Plant; Matthew Callister


Lung Cancer | 2015

Authors' response--Risk of malignancy in pulmonary nodules: a validation study of four prediction models.

Ali Al-Ameri; Puneet Malhotra; Helene Thygesen; Paul Plant; Sri Vaidyanathan; Shishir Karthik; Andrew Scarsbrook; Matthew Callister


Clinical Radiology | 2015

Safety checklist for image guided interventions in a teaching hospital computed tomography (CT) department

Andrew Snoddon; Shishir Karthik


Clinical Radiology | 2015

Efficiency and accuracy of consultant and specialist radiology review of acute and on-call neck sepsis imaging.

Swathi Selvam; Seung-Jin Choi; Sriram Vaidyanathan; Shishir Karthik


Clinical Radiology | 2014

Developing and evaluating an undergraduate radiology teaching programme

Collette L. Stadler; Shishir Karthik; Chirag N. Patel; Raneem Albazaz; Fahmid U. Chowdhury

Collaboration


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Matthew Callister

St James's University Hospital

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Puneet Malhotra

Leeds Teaching Hospitals NHS Trust

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Andrew Scarsbrook

Leeds Teaching Hospitals NHS Trust

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Paul Plant

Leeds Teaching Hospitals NHS Trust

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Ali Al-Ameri

St James's University Hospital

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Helene Thygesen

St James's University Hospital

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Sri Vaidyanathan

St James's University Hospital

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Annette Johnstone

Leeds Teaching Hospitals NHS Trust

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Bobby Bhartia

Leeds Teaching Hospitals NHS Trust

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Michael Darby

Leeds Teaching Hospitals NHS Trust

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