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Jiang, Xiaoyin

Overview:

I am a pathologist specializing in cytopathology and surgical pathology. I diagnose diseases through integrating clinical history and studying patient samples under the microscope. As a cytopathologist, I perform fine needle aspiration biopsies in our clinic.
My research interests focus on the pathology of the head and neck and endocrine systems, working with a multidisciplinary team to improve our understanding of disease. I also focus on novel applications of social media for physicians and medical education.

Positions:

Assistant Professor of Pathology

Pathology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2009

M.D. — Duke University School of Medicine

Resident, Pathology

Duke University School of Medicine

Fellow, Cytopathology

Duke University School of Medicine

Awards:

2016 Power List. The Pathologist Magazine.

Type
National
Awarded By
The Pathologist Magazine
Date
December 01, 2016

Publications:

Evaluation of the Afirma Gene Expression Classifier in Repeat Indeterminate Thyroid Nodules.

- Molecular testing in indeterminate thyroid nodules is a rapidly evolving field with variable reported outcomes.- To report our experience at a tertiary thyroid referral center with the Afirma Gene Expression Classifier (Veracyte, San Francisco, California) in repeat fine-needle aspirations of thyroid nodules with a previous indeterminate cytologic result.- Results of cytopathology and the Afirma test were collected from August 2013 to March 2015, as were diagnoses from surgical resection when performed.- One hundred and fifteen thyroid nodules were evaluated by Afirma. The fine-needle aspiration diagnostic categories for these nodules were 100 (87%) Bethesda III, 10 (9%) Bethesda IV, 3 (2%) Bethesda II, 1 (1%) Bethesda V, and 1 (1%) Bethesda I. Afirma results for 52 of the nodules (45%) were benign, 57 (50%) were suspicious, and 6 (5%) specimens yielded no result because of low messenger RNA content. Three of the benign nodules (6%) were treated surgically, and all were benign on final surgical pathology. Forty-six (81%) of the suspicious nodules were treated surgically; final surgical pathology revealed 30 (65%) were benign and 16 (35%) malignant, yielding a positive predictive value of 35%.- In our experience, 50% of the indeterminate nodules were classified as suspicious by Afirma, with a 35% rate of malignancy in these nodules at surgical resection, in comparison with a historical rate of malignancy at our institution of 11% for Bethesda III nodules and 23% for Bethesda IV. Our use of Afirma is consistent with prior reports in that it has a low positive predictive value in indeterminate thyroid nodules.

Authors
Harrison, G; Sosa, JA; Jiang, X
MLA Citation
Harrison, G, Sosa, JA, and Jiang, X. "Evaluation of the Afirma Gene Expression Classifier in Repeat Indeterminate Thyroid Nodules." Archives of pathology & laboratory medicine 141.7 (July 2017): 985-989.
PMID
28467214
Source
epmc
Published In
Archives of Pathology and Laboratory Medicine
Volume
141
Issue
7
Publish Date
2017
Start Page
985
End Page
989
DOI
10.5858/arpa.2016-0328-oa

Reply to Young Investigator Challenge: Molecular testing in noninvasive follicular thyroid neoplasm with papillary-like nuclear features.

Authors
Jiang, XS; Harrison, GP; Datto, MB
MLA Citation
Jiang, XS, Harrison, GP, and Datto, MB. "Reply to Young Investigator Challenge: Molecular testing in noninvasive follicular thyroid neoplasm with papillary-like nuclear features." Cancer 125.4 (April 2017): 293-294. (Letter)
PMID
28170161
Source
epmc
Published In
Cancer
Volume
125
Issue
4
Publish Date
2017
Start Page
293
End Page
294
DOI
10.1002/cncy.21829

#InSituPathologists: how the #USCAP2015 meeting went viral on Twitter and founded the social media movement for the United States and Canadian Academy of Pathology

Authors
Cohen, D; Allen, TC; Balci, S; Cagle, PT; Teruya-Feldstein, J; Fine, SW; Gondim, DD; Hunt, JL; Jacob, J; Jewett, K; Jiang, XS; Kaplan, KJ; Kulac, I; Meunier, R; Riddle, ND; Rush, PS; Stall, J; Stuart, LN; Terrano, D; Uthman, E; Wasco, MJ; Williamson, SR; Wu, RI; Gardner, JM
MLA Citation
Cohen, D, Allen, TC, Balci, S, Cagle, PT, Teruya-Feldstein, J, Fine, SW, Gondim, DD, Hunt, JL, Jacob, J, Jewett, K, Jiang, XS, Kaplan, KJ, Kulac, I, Meunier, R, Riddle, ND, Rush, PS, Stall, J, Stuart, LN, Terrano, D, Uthman, E, Wasco, MJ, Williamson, SR, Wu, RI, and Gardner, JM. "#InSituPathologists: how the #USCAP2015 meeting went viral on Twitter and founded the social media movement for the United States and Canadian Academy of Pathology." Modern Pathology 30.2 (February 2017): 160-168.
Source
crossref
Published In
Modern Pathology
Volume
30
Issue
2
Publish Date
2017
Start Page
160
End Page
168
DOI
10.1038/modpathol.2016.223

CV Polymerase: A Publication Primer for Young Pathology Faculty Members

Authors
Jiang, XS; Howell, D
MLA Citation
Jiang, XS, and Howell, D. "CV Polymerase: A Publication Primer for Young Pathology Faculty Members." Archives of Pathology & Laboratory Medicine 141.2 (February 2017): 189-190.
Source
crossref
Published In
Archives of Pathology and Laboratory Medicine
Volume
141
Issue
2
Publish Date
2017
Start Page
189
End Page
190
DOI
10.5858/arpa.2016-0304-ED

The utility of thyroglobulin washout studies in predicting cervical lymph node metastases: One academic medical center's experience.

Fine-needle aspiration cytology (FNAC) is useful for evaluating cervical lymph nodes for metastases from thyroid carcinomas. Reports have illustrated that with application of standardized technique and appropriate cutoffs, thyroglobulin (TG) washout studies increase the sensitivity and specificity of FNAC in identifying lymph node metastases. This project describes our experience at an academic medical center utilizing needle wash thyroglobulin analyses as an ancillary to FNAC.We reviewed cases at our institution where thyroglobulin analysis was performed in conjunction with FNA of lymph nodes in patients with thyroid carcinoma. Thyroglobulin levels were measured on needle rinses from each FNA biopsy that appeared negative or equivocal at the time of immediate assessment. These results were compared with surgical pathology results from neck dissections, when performed.168 FNA biopsies were performed on suspicious lymph nodes from 97 patients with known or suspected thyroid malignancy between April 2013 and present. Using a cutoff of 1.0 ng TG/ml, thyroglobulin studies performed at our institution were found to have sensitivity and specificity results of 0.95. Surgical pathology results were used as the gold standard. When surgical pathology results are not available, FNAC is used as the mode of comparison. False positive Tg results occurred in two prethyroidectomy patients suggesting that sample contamination with blood may influence this method's specificity. A false-negative Tg result occurred in a lymph node with <1 mm focus of metastatic PTC, indicating that Tg results may not be sensitive in cases with few tumor cells.Our results suggest that thyroglobulin washout studies improve the quality of our biopsy diagnoses when used in conjunction with FNA in the assessment of metastatic disease in the context of established thyroid malignancy in post-thyroidectomy patients. Thyroglobulin values close to the cutoff of 1.0 ng/ml should be interpreted with caution, as these may represent a minute focus of metastatic tumor. Tg values in prethyroidectomy patients should also be interpreted with caution, as contamination with blood may cause its elevation. Diagn. Cytopathol. 2016;44:964-968. © 2016 Wiley Periodicals, Inc.

Authors
Tang, S; Buck, A; Jones, C; Sara Jiang, X
MLA Citation
Tang, S, Buck, A, Jones, C, and Sara Jiang, X. "The utility of thyroglobulin washout studies in predicting cervical lymph node metastases: One academic medical center's experience." Diagnostic cytopathology 44.12 (December 2016): 964-968.
PMID
27546053
Source
epmc
Published In
Diagnostic Cytopathology
Volume
44
Issue
12
Publish Date
2016
Start Page
964
End Page
968
DOI
10.1002/dc.23554

Young Investigator Challenge: Molecular testing in noninvasive follicular thyroid neoplasm with papillary-like nuclear features.

Molecular testing provides an important ancillary study for thyroid nodules with indeterminate cytology. The nomenclature shift to "noninvasive follicular thyroid neoplasm with papillary-like nuclear features" (NIFTP) will impact the performance of molecular tests. For the current study, the authors reviewed the performance of the Afirma gene-expression classifier (GEC) and the University of Pittsburgh Medical Center (UPMC) targeted mutation panel tests in thyroid nodules that were subsequently diagnosed as NIFTP on surgical resection.In total, 302 nodules were sent for molecular testing between June 2012 and June 2016. These cases were retrospectively reviewed to identify patients who underwent subsequent surgical resection and were diagnosed with follicular variant of papillary thyroid carcinoma (FVPTC). Twenty-five nodules that were diagnosed as FVPTC met the initial inclusion criteria. These cases were reviewed using strict criteria to identify NIFTP.Eight cases met criteria for NIFTP, and 4 NIFTPs underwent Afirma testing. Cytology diagnoses were all Bethesda category III, with 3 diagnosed as atypia of undetermined significance (AUS) and 1 diagnosed as follicular lesion of undetermined significance (FLUS). All of these nodules were identified as "suspicious" using GEC. Four NIFTPs underwent testing at UPMC, all using ThyroSeq V2. The cytology diagnoses for these nodules also were category III, with the exception of 1 nodule that was category IV, suspicious for follicular neoplasm. All NIFTPs were positive for mutations, all of which were RAS mutations (NRAS, KRAS). One patient who had a nodule classified as NIFTP had metastatic carcinoma identified in a lymph node. Another who had a 6-cm tumor had coexisting NRAS and TERT mutations.The current results indicate that NIFTP is a rare tumor if defined by strict criteria, that both the GEC and UPMC methods indicate abnormalities in NIFTP, and further independent study will be needed to better characterize the molecular and clinical characteristics of NIFTP. Cancer Cytopathol 2016;124:893-900. © 2016 American Cancer Society.

Authors
Jiang, XS; Harrison, GP; Datto, MB
MLA Citation
Jiang, XS, Harrison, GP, and Datto, MB. "Young Investigator Challenge: Molecular testing in noninvasive follicular thyroid neoplasm with papillary-like nuclear features." Cancer 124.12 (December 2016): 893-900.
PMID
27893191
Source
epmc
Published In
Cancer
Volume
124
Issue
12
Publish Date
2016
Start Page
893
End Page
900
DOI
10.1002/cncy.21802

Hürthle cell carcinoma: current perspectives.

Hürthle cell carcinoma (HCC) can present either as a minimally invasive or as a widely invasive tumor. HCC generally has a more aggressive clinical behavior compared with the other differentiated thyroid cancers, and it is associated with a higher rate of distant metastases. Minimally invasive HCC demonstrates much less aggressive behavior; lesions <4 cm can be treated with thyroid lobectomy alone, and without radioactive iodine (RAI). HCC has been observed to be less iodine-avid compared with other differentiated thyroid cancers; however, recent data have demonstrated improved survival with RAI use in patients with HCC >2 cm and those with nodal and distant metastases. Patients with localized iodine-resistant disease who are not candidates for a wait-and-watch approach can be treated with localized therapies. Systemic therapy is reserved for patients with progressive, widely metastatic HCC.

Authors
Ahmadi, S; Stang, M; Jiang, XS; Sosa, JA
MLA Citation
Ahmadi, S, Stang, M, Jiang, XS, and Sosa, JA. "Hürthle cell carcinoma: current perspectives." OncoTargets and therapy 9 (January 2016): 6873-6884. (Review)
Website
http://hdl.handle.net/10161/15141
PMID
27853381
Source
epmc
Published In
OncoTargets and Therapy
Volume
9
Publish Date
2016
Start Page
6873
End Page
6884

LGR5 is associated with tumor aggressiveness in papillary thyroid cancer.

Leucine-rich repeat-containing G-protein-coupled receptor 5 (LGR5) is a cancer stem cell marker and a down-stream target in Wnt/β-catenin signaling. In human papillary thyroid cancer (PTC), over activation of Wnt/β-catenin has been associated with tumor aggressiveness.Using established human cell lines (TPC-1, KTC-1, Nthy-ori-3-1), we report LGR5 and R-spondin (RSPO1-3) overexpression in PTC and manipulate LGR5 and Wnt/β-catenin signaling via both pharmacologic and genetic interventions. We test the association of LGR5 tumor expression with markers of PTC aggressiveness using a Discovery Cohort (n = 26 patients) and a Validation Cohort (n = 157 patients). Lastly, we explore the association between LGR5 and the BRAFV600E mutation (n = 33 patients).Our results reveal that LGR5 and its ligand, RSPO, are overexpressed in human PTC, whereby Wnt/β-catenin signaling regulates LGR5 expression and promotes cellular migration. In two separate cohorts of patients, LGR5 and RSPO2 were associated with markers of tumor aggressiveness including: lymph node metastases, vascular invasion, increased tumor size, aggressive histology, advanced AJCC TNM stage, microscopic extra thyroidal extension, capsular invasion, and macroscopic invasion. As a biomarker, LGR5 positivity predicts lymph node metastasis with 95.5% sensitivity (95% CI 88.8%-98.7%) and 61% specificity (95% CI: 48.4%-72.4%) and has a negative predictive value (NPV) of 91.3% (95% CI 79.2%-97.5%) for lymph node metastatic disease. In human PTC, LGR5 is also strongly associated with the BRAFV600E mutation (p = 0.005).We conclude that overexpression of LGR5 is associated with markers of tumor aggressiveness in human PTC. LGR5 may serve as a future potential biomarker for patient risk stratification and loco regional metastases in PTC.

Authors
Michelotti, G; Jiang, X; Sosa, JA; Diehl, AM; Henderson, BB
MLA Citation
Michelotti, G, Jiang, X, Sosa, JA, Diehl, AM, and Henderson, BB. "LGR5 is associated with tumor aggressiveness in papillary thyroid cancer." Oncotarget 6.33 (October 2015): 34549-34560.
PMID
26416247
Source
epmc
Published In
Oncotarget
Volume
6
Issue
33
Publish Date
2015
Start Page
34549
End Page
34560
DOI
10.18632/oncotarget.5330

Extramedullary plasmacytoma of the gallbladder diagnosed by endoscopic ultrasound fine needle aspiration (EUS-FNA).

Extramedullary plasmacytoma (EMP) is a rare entity that can exist independently or in conjunction with underlying plasma cell myeloma (PCM). When there is underlying multiple myeloma, the presence of EMP portends a poor prognosis. The most common locations for an EMP include the gastrointestinal tract, pleura, testis, skin, peritoneum, liver, endocrine glands and lymph nodes; involvement of the gallbladder is exceedingly rare with only five other cases reported and only one of which was associated with PCM. EMP of the gallbladder can manifest as acute cholecystitis, biliary obstruction, or may be asymptomatic. Treatment is traditionally surgical resection plus adjuvant chemotherapy or autologous stem cell transplant. We present a case of a 53-year-old man with PCM who was found to have a gallbladder mass on imaging and underwent endoscopic ultrasound (EUS) guided fine needle aspiration (FNA) of the mass, which was diagnostic of a plasma cell neoplasm.

Authors
St Romain, P; Desai, S; Bean, S; Jiang, X; Burbridge, RA
MLA Citation
St Romain, P, Desai, S, Bean, S, Jiang, X, and Burbridge, RA. "Extramedullary plasmacytoma of the gallbladder diagnosed by endoscopic ultrasound fine needle aspiration (EUS-FNA)." Journal of Gastrointestinal Oncology 6.2 (April 2015): E7-E9. (letter)
PMID
25830051
Source
epmc
Published In
Journal of Gastrointestinal Oncology
Volume
6
Issue
2
Publish Date
2015
Start Page
E7
End Page
E9
DOI
10.3978/j.issn.2078-6891.2014.092

Vaginal cuff thermal injury by mode of colpotomy at total laparoscopic hysterectomy: a randomized clinical trial.

STUDY OBJECTIVE: To evaluate if the use of Valleylab mode ("V mode") (Covidien, Mansfield, MA) electrothermal energy for colpotomy during total laparoscopic hysterectomy (LH) results in a smaller margin of thermal injury to the upper vagina compared with traditional cut/coagulate (cut/coag) electrothermal energy. DESIGN: Prospective randomized clinical trial (Canadian Task Force classification I). SETTING: University medical center. PATIENTS: A total of 101 subjects who underwent LH between June 2010 and August 2012. INTERVENTIONS: Subjects were randomized to colpotomy by V mode electrothermal energy or cut/coag electrothermal energy. MEASUREMENTS AND MAIN RESULTS: The primary end point was the median depth of thermal injury measured in millimeters. The secondary end points included the proportion of subjects who developed granulation tissue, induration, infection, or dehiscence at the vaginal cuff at 4 weeks, 3 months, or 6 months postoperatively. There was no significant difference in the median depth of thermal injury in the cut/coag and V mode arms (anterior margin: 0.68 mm vs 0.63 mm [p = .94], posterior margin: 0.66 mm vs 0.70 mm [p = .87], respectively). Twenty-seven percent of subjects in each arm developed at least 1 of the clinical end points at 4 weeks, 3 months, or 6 months postoperatively (granulation tissue: 6%-18% vs 8%-21%, induration: 0%-2% vs 4%-5%, infection: 0%-4% vs 0%-10%, dehiscence: 2% vs 0% in the cut/coag and V mode arms, respectively), with no difference between arms (p = 1.0). CONCLUSION: The V mode does not reduce the depth of thermal injury compared with cut/coag electrothermal energy when used for colpotomy incision during total laparoscopic hysterectomy (Clinical Trials.gov ID: NCT02080546).

Authors
Teoh, D; Lowery, WJ; Jiang, X; Ehrisman, J; Halvorson, P; Broadwater, G; Bentley, R; Secord, AA; Sobolewski, C; Berchuck, A; Havrilesky, LJ; Valea, FA; Lee, PS
MLA Citation
Teoh, D, Lowery, WJ, Jiang, X, Ehrisman, J, Halvorson, P, Broadwater, G, Bentley, R, Secord, AA, Sobolewski, C, Berchuck, A, Havrilesky, LJ, Valea, FA, and Lee, PS. "Vaginal cuff thermal injury by mode of colpotomy at total laparoscopic hysterectomy: a randomized clinical trial." February 2015.
PMID
25305572
Source
epmc
Published In
Journal of Minimally Invasive Gynecology
Volume
22
Issue
2
Publish Date
2015
Start Page
227
End Page
233
DOI
10.1016/j.jmig.2014.10.002

Pleomorphic liposarcoma: a cytologic study of five cases.

Pleomorphic liposarcoma represents one of the rarest variants of liposarcoma. It has a poor prognosis and unlike other variants of liposarcoma, lacks a molecular or genetic signature. Histologic studies of pleomorphic liposarcoma have defined this lesion as a high grade sarcoma, which contains a variable number of lipoblasts. We describe the cytologic features of five cases of pleomorphic liposarcoma, all of which had histologic confirmation. We consistently identified numerous lipoblasts as well as micro and macrovesicular fat vacuoles in the background of cellular, pleomorphic sarcomatoid neoplasms. The appearance of the aspirates differs substantially form other variants of liposarcoma.

Authors
Dodd, LG; Sara Jiang, X; Rao, K; Bui, MM
MLA Citation
Dodd, LG, Sara Jiang, X, Rao, K, and Bui, MM. "Pleomorphic liposarcoma: a cytologic study of five cases." Diagnostic cytopathology 43.2 (February 2015): 138-143.
PMID
24652822
Source
epmc
Published In
Diagnostic Cytopathology
Volume
43
Issue
2
Publish Date
2015
Start Page
138
End Page
143
DOI
10.1002/dc.23148

Rhabdomyosarcomatous Transformation of a Gastrointestinal Stromal Tumor following Treatment with Imatinib.

Rhabdomyosarcomatous dedifferentiation of GIST following tyrosine kinase inhibitor (TKI) therapy is rare, with only a handful of cases previously reported in the literature. Herein we present a case of metastatic GIST initially treated with imatinib that developed radiographic evidence of progression after 8 months of standard dose therapy with continued progression despite attempts at using dose-escalated imatinib 400 mg bid. Due to the patient's worsening clinical symptoms and radiographic concerns for colonic thickening, abscess, and extraluminal air, the patient underwent a palliative resection of a large heterogeneous mass arising from the posterior stomach and several metastatic foci. Pathology revealed a dedifferentiated GIST with rhabdomyosarcomatous features. This report will highlight the unique features of this case and review the existing literature.

Authors
Jiang, X; Anderson, HB; Guy, CD; Mosca, PJ; Riedel, RF; Cardona, DM
MLA Citation
Jiang, X, Anderson, HB, Guy, CD, Mosca, PJ, Riedel, RF, and Cardona, DM. "Rhabdomyosarcomatous Transformation of a Gastrointestinal Stromal Tumor following Treatment with Imatinib." Case reports in oncological medicine 2015 (January 28, 2015): 317493-.
PMID
25694839
Source
epmc
Published In
Case Reports in Oncological Medicine
Volume
2015
Publish Date
2015
Start Page
317493
DOI
10.1155/2015/317493

Pleomorphic liposarcoma: A cytologic study of five cases

© 2014 Wiley Periodicals, Inc. Pleomorphic liposarcoma represents one of the rarest variants of liposarcoma. It has a poor prognosis and unlike other variants of liposarcoma, lacks a molecular or genetic signature. Histologic studies of pleomorphic liposarcoma have defined this lesion as a high grade sarcoma, which contains a variable number of lipoblasts. We describe the cytologic features of five cases of pleomorphic liposarcoma, all of which had histologic confirmation. We consistently identified numerous lipoblasts as well as micro and macrovesicular fat vacuoles in the background of cellular, pleomorphic sarcomatoid neoplasms. The appearance of the aspirates differs substantially form other variants of liposarcoma.

Authors
Dodd, LG; Jiang, XS; Rao, K; Bui, MM
MLA Citation
Dodd, LG, Jiang, XS, Rao, K, and Bui, MM. "Pleomorphic liposarcoma: A cytologic study of five cases." Diagnostic Cytopathology 43.2 (January 1, 2015): 138-143.
Source
scopus
Published In
Diagnostic Cytopathology
Volume
43
Issue
2
Publish Date
2015
Start Page
138
End Page
143
DOI
10.1002/dc.23148

Clear cell chondrosarcoma: Cytologic findings in six cases.

Clear cell chondrosarcoma (CCCS) is a rare variant of chondrosarcoma characterized, in most instances, by indolent behavior and a long interval to progression of disease. CCCS commonly occurs in adult individuals and has a proclivity for the epiphysis of long bones, although it has been reported in other sites. This lesion is difficult to diagnose preoperatively. Factors contributing to difficulty in recognizing this lesion include its relative scarcity as well as its tendency to be confused with other lesions on imaging studies. In the following, we report six cases of CCCS initially diagnosed by fine needle aspiration and/or touch preparations of needle biopsy samples. The cytologic features identified include large, plasmacytoid cells with foamy cytoplasm as well as extracellular chondroid type matrix material. Definitive diagnosis was made in each case by recognizing the "clear cell" nature of the tumor on cell block material.

Authors
Jiang, XS; Pantanowitz, L; Bui, MM; Esther, R; Budwit, D; Dodd, LG
MLA Citation
Jiang, XS, Pantanowitz, L, Bui, MM, Esther, R, Budwit, D, and Dodd, LG. "Clear cell chondrosarcoma: Cytologic findings in six cases." Diagnostic cytopathology 42.9 (September 2014): 784-791.
PMID
24167115
Source
epmc
Published In
Diagnostic Cytopathology
Volume
42
Issue
9
Publish Date
2014
Start Page
784
End Page
791
DOI
10.1002/dc.23043

Gastroesophageal heterotopia and HER2/neu overexpression in an adenocarcinoma arising from a small bowel duplication.

Small bowel duplications are congenital structures commonly lined by heterotopic gastric or pancreatic mucosa. Though benign in children, small bowel duplications have the potential for malignant degeneration in adulthood. Here, we present the first reported case of metastatic adenocarcinoma arising from a small bowel duplication lined by gastroesophageal mucosa. The cancer demonstrated overexpression of the HER2/neu oncoprotein and amplification of the HER2/neu gene. This represents the only report of HER2 overexpression in this type of lesion. The patient is being treated with traditional chemotherapeutic agents in addition to monoclonal antibody therapy directed at the HER2 protein, and has demonstrated a clinical benefit from treatment. This case demonstrates that the anatomic location of a mass may be distinct from its biological origin, and this difference may have important practical implications for diagnostic testing and treatment.

Authors
Nussbaum, DP; Bhattacharya, SD; Jiang, X; Cardona, DM; Strickler, JH; Blazer, DG
MLA Citation
Nussbaum, DP, Bhattacharya, SD, Jiang, X, Cardona, DM, Strickler, JH, and Blazer, DG. "Gastroesophageal heterotopia and HER2/neu overexpression in an adenocarcinoma arising from a small bowel duplication." Archives of pathology & laboratory medicine 138.3 (March 2014): 428-431.
PMID
24576036
Source
epmc
Published In
Archives of Pathology and Laboratory Medicine
Volume
138
Issue
3
Publish Date
2014
Start Page
428
End Page
431
DOI
10.5858/arpa.2012-0523-cr

O6-methylguanine-DNA methyltransferase (MGMT) immunohistochemistry as a predictor of resistance to temozolomide in primary CNS lymphoma.

Temozolomide, an alkylating agent, has shown promise in treating primary central nervous system lymphoma (PCNSL). The enzyme O(6)-methylguanine-DNA methyltransferase (MGMT) repairs alkylating damage, such as that induced by temozolomide. We hypothesized that MGMT immunohistochemistry would predict resistance to temozolomide in PCNSL. A retrospective study of newly-diagnosed and recurrent PCNSL patients treated at our institution was conducted to study the predictive value of MGMT immunohistochemistry for response to temozolomide. 20 patients who were treated with temozolomide as a single agent were identified during the study time period. 6/20 patients demonstrated a response, corresponding to an objective response rate of 30 % (95 % CI 8-52). Five patients with low MGMT level (<30 %) showed a response to temozolomide. Only one of 10 patients (10 %) with high MGMT level (≥30 %) exhibited a response to temozolomide. Small sample numbers precluded formal statistical comparisons. Two patients with complete response remain alive without progressive disease 6.7 and 7.2 years after temozolomide initiation. Immunohistochemistry can be performed on small biopsies to selectively assess MGMT status in tumor versus surrounding inflammation. MGMT analysis by immunohistochemistry may predict response to temozolomide in PCNSL and should be prospectively investigated.

Authors
Jiang, X; Reardon, DA; Desjardins, A; Vredenburgh, JJ; Quinn, JA; Austin, AD; Herndon, JE; McLendon, RE; Friedman, HS
MLA Citation
Jiang, X, Reardon, DA, Desjardins, A, Vredenburgh, JJ, Quinn, JA, Austin, AD, Herndon, JE, McLendon, RE, and Friedman, HS. "O6-methylguanine-DNA methyltransferase (MGMT) immunohistochemistry as a predictor of resistance to temozolomide in primary CNS lymphoma." United States. August 2013.
PMID
23686298
Source
pubmed
Published In
Journal of Neuro-Oncology
Volume
114
Issue
1
Publish Date
2013
Start Page
135
End Page
140
DOI
10.1007/s11060-013-1162-y

O6-methylguanine-DNA methyltransferase (MGMT) immunohistochemistry as a predictor of resistance to temozolomide in primary CNS lymphoma.

Temozolomide, an alkylating agent, has shown promise in treating primary central nervous system lymphoma (PCNSL). The enzyme O(6)-methylguanine-DNA methyltransferase (MGMT) repairs alkylating damage, such as that induced by temozolomide. We hypothesized that MGMT immunohistochemistry would predict resistance to temozolomide in PCNSL. A retrospective study of newly-diagnosed and recurrent PCNSL patients treated at our institution was conducted to study the predictive value of MGMT immunohistochemistry for response to temozolomide. 20 patients who were treated with temozolomide as a single agent were identified during the study time period. 6/20 patients demonstrated a response, corresponding to an objective response rate of 30 % (95 % CI 8-52). Five patients with low MGMT level (<30 %) showed a response to temozolomide. Only one of 10 patients (10 %) with high MGMT level (≥30 %) exhibited a response to temozolomide. Small sample numbers precluded formal statistical comparisons. Two patients with complete response remain alive without progressive disease 6.7 and 7.2 years after temozolomide initiation. Immunohistochemistry can be performed on small biopsies to selectively assess MGMT status in tumor versus surrounding inflammation. MGMT analysis by immunohistochemistry may predict response to temozolomide in PCNSL and should be prospectively investigated.

Authors
Jiang, X; Reardon, DA; Desjardins, A; Vredenburgh, JJ; Quinn, JA; Austin, AD; Herndon, JE; McLendon, RE; Friedman, HS
MLA Citation
Jiang, X, Reardon, DA, Desjardins, A, Vredenburgh, JJ, Quinn, JA, Austin, AD, Herndon, JE, McLendon, RE, and Friedman, HS. "O6-methylguanine-DNA methyltransferase (MGMT) immunohistochemistry as a predictor of resistance to temozolomide in primary CNS lymphoma." Journal of neuro-oncology 114.1 (August 2013): 135-140.
Source
epmc
Published In
Journal of Neuro-Oncology
Volume
114
Issue
1
Publish Date
2013
Start Page
135
End Page
140
DOI
10.1007/s11060-013-1162-y

Lymph node infarction: role of underlying malignancy, tumour proliferation fraction and vascular compromise--a study of 35 cases and a comprehensive review of the literature.

AIMS:   To determine the roles of the presence of malignancy, tumour proliferation fraction, vascular compromise and therapeutic and diagnostic manipulations in lymph node infarction (LNI). METHODS AND RESULTS:   Thirty-five cases of LNI were identified over a 20-year period. Of the 35 patients, 31 (89%) had an underlying malignancy: 27 of the 31 (87%) were haematologic malignancies, the rest being metastatic carcinoma (two), melanoma, and seminoma. Of the four patients without evidence of malignancy, two were diagnosed with viral infection, one had LNI adjacent to a thrombosed pancreas graft, and one was lost to follow-up. Ki67 immunostaining in viable tumour demonstrated a range (5-60%) of proliferation fractions. A history of fine needle aspiration alone was present in seven of the 35 patients (20%), a history of chemotherapy alone in 11 (31%), and a history of both in two (5.7%). Factor VIII immunostaining highlighted thrombosed and recanalized vessels next to the infarction. CONCLUSIONS:   Infarction of lymph nodes is associated with previous, concurrent or subsequent diagnosis of malignancy in the vast majority of cases. Chemotherapy or previous fine needle aspiration can precipitate infarction in some cases, but infarction may occur without such intervention, possibly because of an underlying subacute or chronic vascular compromise produced by vascular thrombosis.

Authors
Jiang, XS; West, DS; Lagoo, AS
MLA Citation
Jiang, XS, West, DS, and Lagoo, AS. "Lymph node infarction: role of underlying malignancy, tumour proliferation fraction and vascular compromise--a study of 35 cases and a comprehensive review of the literature." Histopathology 62.2 (January 2013): 315-325. (Review)
PMID
23020754
Source
pubmed
Published In
Histopathology
Volume
62
Issue
2
Publish Date
2013
Start Page
315
End Page
325
DOI
10.1111/j.1365-2559.2012.04361.x

Handoffs in the era of duty hours reform: a focused review and strategy to address changes in the Accreditation Council for Graduate Medical Education Common Program Requirements.

With changes in the Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements related to transitions in care effective July 1, 2011, sponsoring institutions and training programs must develop a common structure for transitions in care as well as comprehensive curricula to teach and evaluate patient handoffs. In response to these changes, within the Duke University Health System, the resident-led Graduate Medical Education Patient Safety and Quality Council performed a focused review of the handoffs literature and developed a plan for comprehensive handoff education and evaluation for residents and fellows at Duke. The authors present the results of their focused review, concentrating on the three areas of new ACGME expectations--structure, education, and evaluation--and describe how their findings informed the broader initiative to comprehensively address transitions in care managed by residents and fellows. The process of developing both institution-level and program-level initiatives is reviewed, including the development of an interdisciplinary minimal data set for handoff core content, training and education programs, and an evaluation strategy. The authors believe the final plan fully addresses both Duke's internal goals and the revised ACGME Common Program Requirements and may serve as a model for other institutions to comprehensively address transitions in care and to incorporate resident and fellow leadership into a broad, health-system-level quality improvement initiative.

Authors
DeRienzo, CM; Frush, K; Barfield, ME; Gopwani, PR; Griffith, BC; Jiang, X; Mehta, AI; Papavassiliou, P; Rialon, KL; Stephany, AM; Zhang, T; Andolsek, KM; Duke University Health System Graduate Medical Education Patient Safety and Quality Council,
MLA Citation
DeRienzo, CM, Frush, K, Barfield, ME, Gopwani, PR, Griffith, BC, Jiang, X, Mehta, AI, Papavassiliou, P, Rialon, KL, Stephany, AM, Zhang, T, Andolsek, KM, and Duke University Health System Graduate Medical Education Patient Safety and Quality Council, . "Handoffs in the era of duty hours reform: a focused review and strategy to address changes in the Accreditation Council for Graduate Medical Education Common Program Requirements." Acad Med 87.4 (April 2012): 403-410. (Review)
PMID
22361790
Source
pubmed
Published In
Academic Medicine
Volume
87
Issue
4
Publish Date
2012
Start Page
403
End Page
410
DOI
10.1097/ACM.0b013e318248e5c2

Phase II trial of temozolomide (TMZ) plus irinotecan (CPT-11) in adults with newly diagnosed glioblastoma multiforme before radiotherapy.

This phase II trial evaluated efficacy and safety of temozolomide (TMZ) in combination with irinotecan (CPT-11) before radiotherapy in patients with newly diagnosed glioblastoma multiforme (GBM). Prior to radiotherapy, patients were treated with a maximum of three 6-week cycles of TMZ and CPT-11. Patients received TMZ at a dose of 200 mg/m(2)/day on days 1-5 and CPT-11 on days 1, 8, 22, and 29, with a dose adjustment for enzyme-inducing antiepileptic drug use. The primary end point was objective response rate (ORR). Secondary end points included progression-free survival (PFS), overall survival (OS), safety, and tumor O(6)-methylguanine-DNA methyltransferase (MGMT) expression. Of the 42 patients treated, 8 (19%) patients achieved a partial response. Median PFS and median OS were 3.1 and 13.8 months, respectively. Grade 3 or 4 AEs were documented in 36% of patients, most of which were hematologic (29%). Twenty-four percent of patients had grade 3 or 4 non-hematologic AEs, with gastrointestinal AEs being the most common (12%) Two patients died, one of intracranial hemorrhage and one of treatment-related renal failure. Low MGMT expression, compared with high MGMT expression, showed no significant difference in ORR (25 vs. 8%), median PFS (14 vs. 5 months) or OS (21 vs. 15 months). Although TMZ plus CPT-11 is at least comparable in efficacy to TMZ alone, this combination appears more toxic and poorly tolerated. The lack of correlation of activity with MGMT expression is intriguing, but needs further evaluation in subsequent trials.

Authors
Quinn, JA; Jiang, SX; Reardon, DA; Desjardins, A; Vredenburgh, JJ; Friedman, AH; Sampson, JH; McLendon, RE; Herndon, JE; Friedman, HS
MLA Citation
Quinn, JA, Jiang, SX, Reardon, DA, Desjardins, A, Vredenburgh, JJ, Friedman, AH, Sampson, JH, McLendon, RE, Herndon, JE, and Friedman, HS. "Phase II trial of temozolomide (TMZ) plus irinotecan (CPT-11) in adults with newly diagnosed glioblastoma multiforme before radiotherapy." J Neurooncol 95.3 (December 2009): 393-400.
PMID
19533023
Source
pubmed
Published In
Journal of Neuro-Oncology
Volume
95
Issue
3
Publish Date
2009
Start Page
393
End Page
400
DOI
10.1007/s11060-009-9937-x

Phase 1 trial of temozolomide plus irinotecan plus O6-benzylguanine in adults with recurrent malignant glioma.

BACKGROUND: The current study was a phase 1 clinical trial conducted with patients who had recurrent or progressive malignant glioma (MG). The trial was designed to determine the maximum tolerated dose (MTD) and toxicity of irinotecan (CPT-11) when administered with temozolomide (TMZ) and O(6)-benzylguanine (O(6)-BG). METHODS: All 3 drugs, CPT-11, TMZ, and O(6)-BG, were administered on Day 1 of a 21-day treatment. First, patients were treated with a 1-hour bolus infusion of O(6)-BG at a dose of 120 mg/m(2) followed immediately by a 48-hour continuous infusion of O(6)-BG at a dose of 30 mg/m(2)/d. Second, within 60 minutes of the end of the 1-hour bolus infusion of O(6)-BG, TMZ was administered orally at a dose of 355 mg/m(2). Third, 1 hour after administration of TMZ, CPT-11 was infused over 90 minutes. Patients were accrued to 1 of 2 strata based on CYP3A1- and CYP3A4-inducing antiepileptic drug (EIAED) use; dose escalation was conducted independently within these strata. RESULTS: Fifty-five patients were enrolled. In both strata, the dose-limiting toxicities were hematologic and included grade 4 neutropenia, febrile neutropenia, leukopenia, and/or thrombocytopenia. For Stratum 1 (EIAEDs), when TMZ was administered at a dose of 355 mg/m(2), the MTD of CPT-11 was determined to be 120 mg/m(2). In contrast, for Stratum 2 (no EIAEDs), when TMZ was administered at a dose of 200 mg/m(2), the MTD of CPT-11 was determined to be 80 mg/m(2). CONCLUSIONS: The authors believe that the results of the current study provide the foundation for a phase 2 trial of O(6)-BG in combination with CPT-11 and TMZ in patients with MG.

Authors
Quinn, JA; Jiang, SX; Reardon, DA; Desjardins, A; Vredenburgh, JJ; Gururangan, S; Sampson, JH; McLendon, RE; Herndon, JE; Friedman, HS
MLA Citation
Quinn, JA, Jiang, SX, Reardon, DA, Desjardins, A, Vredenburgh, JJ, Gururangan, S, Sampson, JH, McLendon, RE, Herndon, JE, and Friedman, HS. "Phase 1 trial of temozolomide plus irinotecan plus O6-benzylguanine in adults with recurrent malignant glioma." Cancer 115.13 (July 1, 2009): 2964-2970.
PMID
19402172
Source
pubmed
Published In
Cancer
Volume
115
Issue
13
Publish Date
2009
Start Page
2964
End Page
2970
DOI
10.1002/cncr.24336

Phase II trial of temozolomide plus o6-benzylguanine in adults with recurrent, temozolomide-resistant malignant glioma.

PURPOSE: This phase II trial was designed to define the role of O(6)-benzylguanine (O(6)-BG) in restoring temozolomide sensitivity in patients with recurrent or progressive, temozolomide-resistant malignant glioma and to evaluate the safety of administering O(6)-BG in combination with temozolomide. PATIENTS AND METHODS: Patients were accrued into two independent strata on the basis of histology: glioblastoma multiforme (GBM) and anaplastic glioma. Both temozolomide and O(6)-BG were administered on day 1 of a 28-day treatment cycle. Patients were administered a 1-hour O(6)-BG infusion at a dose of 120 mg/m(2) followed immediately by a 48-hour infusion at a dose of 30 mg/m(2)/d. Temozolomide was administered orally within 60 minutes of the end of the 1-hour O(6)-BG infusion at a dose of 472 mg/m(2). The primary end point was objective response rate. Secondary end points included progression-free survival, overall survival, and safety. RESULTS: Sixty-six of 67 patients who enrolled were treated with temozolomide and O(6)-BG. One of 34 patients (3%) with GBM (95% CI, 0.1% to 15%) and five of 32 assessable patients (16%) with anaplastic glioma (95% CI, 5% to 33%) were responders. The most commonly reported adverse events were grade 4 hematologic events experienced in 48% of the patients. CONCLUSION: O(6)-BG when added to a 1-day dosing regimen of temozolomide was able to restore temozolomide sensitivity in patients with temozolomide-resistant anaplastic glioma, but there seemed to be no significant restoration of temozolomide sensitivity in patients with temozolomide-resistant GBM.

Authors
Quinn, JA; Jiang, SX; Reardon, DA; Desjardins, A; Vredenburgh, JJ; Rich, JN; Gururangan, S; Friedman, AH; Bigner, DD; Sampson, JH; McLendon, RE; Herndon, JE; Walker, A; Friedman, HS
MLA Citation
Quinn, JA, Jiang, SX, Reardon, DA, Desjardins, A, Vredenburgh, JJ, Rich, JN, Gururangan, S, Friedman, AH, Bigner, DD, Sampson, JH, McLendon, RE, Herndon, JE, Walker, A, and Friedman, HS. "Phase II trial of temozolomide plus o6-benzylguanine in adults with recurrent, temozolomide-resistant malignant glioma." J Clin Oncol 27.8 (March 10, 2009): 1262-1267.
PMID
19204199
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
27
Issue
8
Publish Date
2009
Start Page
1262
End Page
1267
DOI
10.1200/JCO.2008.18.8417

Phase II trial of Gliadel plus O6-benzylguanine in adults with recurrent glioblastoma multiforme.

PURPOSE: This phase II trial was designed to define the efficacy of Gliadel wafers in combination with an infusion of O6-benzylguanine (O6-BG) that suppresses tumor O6-alkylguanine-DNA alkyltransferase (AGT) levels in patients with recurrent glioblastoma multiforme for 5 days and to evaluate the safety of this combination therapy. EXPERIMENTAL DESIGN: This was a phase II, open-label, single center trial. On gross total resection of the tumor, up to eight Gliadel wafers were implanted. Bolus infusion of O6-BG was administered at 120 mg/m2 over 1 hour on days 1, 3, and 5, along with a continuous infusion at 30 mg/m2/d. The primary end points were 6-month overall survival (OS) and safety, and the secondary end points were 1-year, 2-year, and median OS. RESULTS: Fifty-two patients were accrued. The 6-month OS was 82% [95% confidence interval (95% CI), 72-93%]. The 1- and 2-year OS rates were 47% (95% CI, 35-63%) and 10% (95% CI, 3-32%), respectively. The median OS was 50.3 weeks (95% CI, 36.1-69.4 weeks). Treatment-related toxicity with this drug combination included grade 3 hydrocephalus (9.6%), grade 3 cerebrospinal fluid (CSF) leak (19.2%), and grade 3 CSF/brain infection (13.4%). CONCLUSION: The efficacy of implanted Gliadel wafers may be improved with the addition of O6-BG. Although systemically administered O6-BG can be coadministered with Gliadel wafers safely, it may increase the risk of hydrocephalus, CSF leak, and CSF/brain infection. Future trials are required to verify that inhibition of tumor AGT levels by O6-BG results in increased efficacy of Gliadel wafers without added toxicity.

Authors
Quinn, JA; Jiang, SX; Carter, J; Reardon, DA; Desjardins, A; Vredenburgh, JJ; Rich, JN; Gururangan, S; Friedman, AH; Bigner, DD; Sampson, JH; McLendon, RE; Herndon, JE; Threatt, S; Friedman, HS
MLA Citation
Quinn, JA, Jiang, SX, Carter, J, Reardon, DA, Desjardins, A, Vredenburgh, JJ, Rich, JN, Gururangan, S, Friedman, AH, Bigner, DD, Sampson, JH, McLendon, RE, Herndon, JE, Threatt, S, and Friedman, HS. "Phase II trial of Gliadel plus O6-benzylguanine in adults with recurrent glioblastoma multiforme." Clin Cancer Res 15.3 (February 1, 2009): 1064-1068.
PMID
19188181
Source
pubmed
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
15
Issue
3
Publish Date
2009
Start Page
1064
End Page
1068
DOI
10.1158/1078-0432.CCR-08-2130

Phase I trial of temozolomide plus O-6-benzylguanine on three different 5-day temozolomide regimens for patients with progressive glioblastoma multiforme

Authors
Quinn, JA; Jiang, XS; Rich, JN; Desjardins, A; Vredenburgh, JJ; Reardon, DA; Gururangan, S; Walker, AR; Birch, R; Friedman, AH; Friedman, HS
MLA Citation
Quinn, JA, Jiang, XS, Rich, JN, Desjardins, A, Vredenburgh, JJ, Reardon, DA, Gururangan, S, Walker, AR, Birch, R, Friedman, AH, and Friedman, HS. "Phase I trial of temozolomide plus O-6-benzylguanine on three different 5-day temozolomide regimens for patients with progressive glioblastoma multiforme." JOURNAL OF CLINICAL ONCOLOGY 26.15 (May 20, 2008).
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
26
Issue
15
Publish Date
2008
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