The decrease in colorectal cancer (CRC) mortality over the past 2 decades is largely attributed to increased screening. This progress has not been evenly distributed across populations. Individuals who seek care at federally qualified health centers (FQHCs) have low CRC screening prevalence. This study aims to assess the effectiveness and cost of interventions to increase CRC screening at FQHCs, by using fecal immunochemical tests (FIT).

The authors evaluated changes in FIT screening uptake in eight FQHCs that participated in the Colorectal Cancer Control Program (CRCCP) before and after the multicomponent evidence-based interventions were implemented. Examples of interventions included patient reminders, provider assessment and feedback, and patient navigation. They collected the labor and nonlabor cost of implementing the interventions. Furthermore, they used a validated microsimulation model to assess the long-term cost-effectiveness of the interventions.

All eight FQHCs showed increases in CRC screening following the implementation of the multicomponent interventions, with an average increase of 14.4 percentage points (range, 4.9-26.7) and an average intervention cost of $14.40 per person (range, $5.76-$34.70). In five of the eight FQHCs, the interventions resulted in cost savings when public payer costs were considered. In the remaining three FQHCs, the cost per life years saved ranged from $14,898 to $54,111.

Multicomponent interventions to increase the use of FIT kits represent an effective and efficient strategy for increasing CRC screening uptake in FQHCs.

Standard economic models, which have been developed to reflect typical data availability for pharmaceutical products, often struggle with non-pharmaceutical interventions like diagnostics and medical devices, where clinical trial data is more likely to be short-term or non-comparative. This paper explores methodological challenges in evaluating Photodynamic Diagnosis (PDD) via blue light cystoscopy (BLC) versus Narrow Band Imaging (NBI) for non-muscle invasive bladder cancer (NMIBC).

A semi-Markov state-transition cost-utility model was developed for a health technology appraisal (HTA) by the Danish Treatment Council. The basis of the model was a differential effect of the two technologies on the risk of early local cancer recurrence. Due to a lack of direct comparative trials, an indirect hazard-function-based approach was used. Using TreeAge Pro software, baseline hazard curves were derived from ten-year survival data for conventional white light cystoscopy. Hazard ratios (HRs) from meta-analyses were then applied to these curves to derive simulated time-to-event curves for BLC and NBI.

The base-case analysis yielded an incremental cost-effectiveness ratio (ICER) of DKK 70,707/QALY for BLC-TURBT versus NBI-TURBT. Sensitivity analyses confirmed results remained robust and well below the DKK 500,000/QALY willingness-to-pay threshold. The model was most sensitive to HRs for time to first recurrence. Scenario analyses, including traditional parametric extrapolation, yielded consistent ICERs between DKK 36,775 and DKK 215,965/QALY.

The hazard-based workflow effectively integrated survival data from disparate sources, using a software-based method was quicker, simpler and more intuitive to use than conventional statistical methods. The approach used is equally applicable to a partitioned survival structure. The alignment between hazard-based and traditional parametric methods suggests this is a valid, efficient alternative for developing models in the face of evidence gaps.

A hazard-function approach provides a transparent, practical solution for building robust economic models when clinical data is limited or incompatible with standard approaches.

Human papillomavirus (HPV) assays vary regarding the minimum amount of virus they detect. We investigated analytical thresholds of HPV detection and cervical screening sensitivity and specificity. One hundred cervical intraepithelial neoplasia grade 2 or worse (CIN2+) cases and 200 matched population-based controls were obtained at the Swedish National HPV Reference Laboratory and analyzed by 10 laboratories across 10 countries. Cumulative sensitivity (weighted according to the global HPV type distribution in invasive cervical cancer (ICC)) and specificity were estimated at varying analytical detection thresholds. Consensus results found HPV in 99/100 CIN2+ cases and 52/200 controls. HPV16 prevalence declined in HPV-vaccinated birth cohorts, among both cases and controls. Line plots of 1-specificity and ICC-weighted sensitivity found optimal analytical detection thresholds as 3 International Units (IU)/µl for HPV16/18, 25 IU/µl for HPV31/33/35/45/52/58 and 100 genome equivalents (GE)/µl for HPV 39/51/56/59 resulting in 92.00% cumulative specificity and 90.08% ICC-weighted sensitivity. Thresholds defined using virus amounts per 10⁴ human cells gave similar results. Comparator assay testing using manufacturer-defined thresholds achieved high ICC-weighted sensitivity (96.61%) but low specificity (82.50%). This international collaborative study has identified HPV analytical detection thresholds optimizing the sensitivity and specificity of cervical screening.

Progression to acute myeloid leukemia (AML) is a rare complication of myeloproliferative neoplasms (MPNs) with limited treatment options and median overall survival (OS) of 3-6 months. The treatment of AML has been revolutionized in recent years with the introduction of novel targeted therapies including the BCL2 inhibitor venetoclax (VEN). However, evidence regarding outcomes in patients with post-MPN AML remains limited.

To evaluate the impact of novel therapies on the outcomes of patients with post-MPN AML, the authors conducted a retrospective analysis of 392 patients who were diagnosed with post-MPN AML during 2014-2024 in the United States and were included in the Flatiron Health Research Database.

Although the proportion of patients treated with lower-intensity therapies (LIT) including VEN in combination with hypomethylating agents increased over time, OS was very similar among patients diagnosed before and after VEN approval (median OS, 7.1 [95% confidence interval (CI), 5.7-9.5] months vs. 7.6 [95% CI, 5.8-10.1] months; p = .39). Only 15% of post-MPN AML patients underwent an allogeneic hematopoietic cell transplant (allo-HCT). Those who received allo-HCT experienced better OS than patients who did not receive allo-HCT (median OS, 20.5 [95% CI, 15.4-36.2] months vs. 5.8 [95% CI, 5.0-6.8] months; p < .01). Although patients treated with intensive chemotherapy (IC) had longer OS than those treated with LIT (hazard ratio, 1.95; 95% CI, 1.12-3.41; p = .02), patients receiving IC and LIT as a bridge to allo-HCT had comparable OS (p = .37).

This study highlights allo-HCT as the only potentially curative option with both IC and LIT serving as effective bridging therapies.

Studies that have gathered patient experiences of radiotherapy for gynaecological cancers have described anguish related to body image, lack of control, social isolation, lack of social support, mystification and self-criticism. Frequently, outward experiences of side effects are presented as 'necessary suffering' hampering opportunities to improve care and support.

This project aimed to address gaps in the understanding of how radiotherapy impacts patient bodies and social, personal and sexual lives and to identify priorities for more patient-centred support.

Qualitative narrative study informed by feminist health activism.

Narratives (written, audio-recorded or video recorded journal entries) were collected in the United Kingdom between August 2020 and September 2021. Thirty-four women who had received radiotherapy treatment for cervical, endometrial, vulval or ovarian cancer (up to 25 years previously) submitted written, audio-recorded or video-recorded accounts. Data were analysed thematically through collaborative, feminist-informed approaches.

The most prominent feature of the narratives related to patients not being listened to or not being heard. Seven principal areas for developing conversations for support were identified, which were grouped into four overarching and interlinking themes: Living Through Treatment and Its Physical Impacts; Shifts in Identity, Sexuality and Intimacy; Navigating Emotional and Psychological Wellbeing; and Communication, Dignity and the Practices that Support or Undermine Them. Physical effects were deeply intertwined with emotional, relational and identity challenges, and gaps in communication often compounded distress.

Radiotherapy for gynaecological cancer can have enduring and multi-dimensional impacts that are often poorly addressed in current care models. Improving services requires embedding patient voices in care planning, prioritising dignity and addressing long-term effects through open, ongoing conversations. The findings inform practical recommendations and highlight priorities for future research and policy to embed patient perspectives in radiotherapy services.

The aim of this study was to develop and validate an MRI radiomics-based predictive model to discriminate significant prostate cancer (sPCa), compare it with PI-RADS, and determine whether incorporating PI-RADS and other clinical variables improves clinical performance.

A retrospective observational study was conducted using a cohort of 1497 MRI cases from 1395 men to develop the models. For each case, the index-lesion PI-RADS score, systematic ± targeted biopsy results, and six additional clinical variables were collected. Prostate biopsy samples served as the reference standard, defining sPCa as Gleason Grade ≥ 7. Handcrafted radiomic features were extracted from automatically segmented prostate glands. Four machine learning models were developed: (1) Radiomics, (2) PI-RADS, (3) PI-RADS + Radiomics, and (4) PI-RADS + Radiomics + Clinical Variables. Model performance and comparisons were evaluated using the area under the curve (AUC), while clinical utility was assessed through the decision curve analysis plot, Clinical Utility plot, and the number of avoided biopsies.

The radiomics model did not perform significantly better than PI-RADS in the validation cohort (AUC 0.838 vs. 0.833, p = 0.874). The combination of radiomics, PI-RADS, and clinical variables achieved the highest performance, with an AUC of 0.891 (95% CI: 0.853-0.930), significantly outperforming the other models (p < 0.05). It also showed the highest specificity (29.41%) and biopsy avoidance rate (18.15%), although the differences were not statistically significant (p = 0.313).

Incorporating radiomics and clinical variables into PI-RADS enhances its ability to discriminate sPCa, potentially decreasing false positives and unnecessary biopsies.

The incorporation of clinical variables and radiomics into PI-RADS enhances its ability to predict significant prostate cancer, helping mitigate some of PI-RADS's current limitations, such as a significant false-positive rate, and might help reduce unnecessary biopsies.

PI-RADS limitations result in overdiagnosis of indolent prostatic lesions and unnecessary biopsies. Radiomics and clinical variables enhance PI-RADS ability to detect significant prostate cancer. Combined clinical-radiological models reduce false positives and help avoid unnecessary biopsies.

Intracranial sarcomas can arise secondarily from primary brain tumors, including gliomas and meningiomas, either spontaneously or following radiotherapy. The current WHO classification recognizes sarcomatous transformation in several tumor entities; however, sarcomas arising from meningiomas remain poorly characterized and are regarded as a possible histological manifestation within the spectrum of anaplastic meningiomas. We analyzed nine matched meningioma-sarcoma pairs using integrated histopathological assessment and molecular profiling, including DNA methylation analysis, next-generation sequencing, copy number profiling, and proteomics. Although recurrent sarcomatous tumors were clonally related to their meningioma precursors-sharing identical NF2 alterations and overlapping chromosomal aberrations-they demonstrated pronounced divergence at the histological, immunophenotypic, and epigenetic levels. Importantly, sarcomatous transformation occurred in four cases without prior radiotherapy. Sarcomatous recurrences exhibited loss of meningothelial markers and acquired expression of cytokeratin and myogenic markers. DNA methylation profiling revealed a shift away from canonical meningioma signatures toward profiles resembling non-meningothelial mesenchymal tumors. Proteomic analysis showed consistent upregulation of SOX2 in sarcomatous tumors compared with their primary counterparts, suggesting acquisition of stem-like features during lineage divergence. Clinically, these tumors were associated with aggressive growth, early recurrence, and extracranial metastases, resembling malignant sarcomas more closely than anaplastic meningiomas. In addition, analysis of an institutional cohort of NF2-mutant intracranial tumors (n = 316) suggests that sarcomas with inactivating NF2 mutations may originate from meningiomas even in the absence of a clinically recognized precursor. Together, these findings suggest that sarcomatous transformation represents a rare evolutionary endpoint in NF2-mutant meningiomas, marked by clonal continuity but pronounced biological divergence. These results highlight limitations of morphology-based classification and emphasize the value of integrated molecular diagnostics in distinguishing these tumors from conventional high-grade meningiomas. Given their sarcoma-like behavior despite a meningioma ancestry, these tumors may not be adequately captured by current meningioma grading schemes.

Adult gastric inflammatory myofibroblastic tumors (IMT) are rare mesenchymal neoplasms that often mimic gastrointestinal stromal tumors (GIST). This systematic review with pooled individual patient data aimed to define their clinical presentation, diagnostic work-up, and surgical management. Electronic databases (PubMed/MEDLINE, Embase, Scopus, Cochrane Library) were searched for adult (≥18 years) cases of histologically confirmed gastric IMT. Individual patient data on demographics, tumor characteristics, treatment, and outcomes were extracted from eligible case reports and series. Continuous variables were summarized as means with standard deviations and categorical variables as proportions with 95% confidence intervals, with prespecified comparisons by tumor location and surgical approach. Thirty-one patients were identified, with a female predominance and a mean age of 47.7 years. Most were symptomatic, presenting with abdominal pain or upper gastrointestinal bleeding/anemia. Tumors most frequently involved the middle third of the stomach and showed wide size variability. Distal tumors were larger and predominantly associated with pain, whereas proximal tumors more often presented with hemorrhage and less pain, suggesting distinct location-dependent clinical phenotypes. Surgical resection was the mainstay of treatment. Stomach-preserving resections were feasible in most cases, and minimally invasive surgery (MIS) was increasingly used for smaller, well-circumscribed lesions, while larger or locally invasive tumors more often required open major gastrectomy. Preoperative EUS-guided biopsy with immunohistochemistry, including ALK-1, is critical to avoid misdiagnosis. Complete surgical resection offers excellent short-to mid-term outcomes, and MIS stomach-preserving techniques appear safe for tumors under 5 cm when negative margins can be achieved.

The Clinical Assessment Scoring System for Tracheostomy (CASST) was developed to predict the need for elective tracheostomy in head and neck cancer surgery, but evidence on its external performance remains limited. This prospective study evaluated the predictive accuracy of CASST and its concordance with clinical decision-making in patients undergoing major oral cancer surgery. A secondary objective was to describe short-term postoperative airway complications stratified by CASST category. All patients undergoing major oral cancer resections at a tertiary care centre between September 2021 and January 2024 were enrolled and followed prospectively. CASST scores were computed preoperatively but did not guide airway management decisions. Among 258 patients, 126 (48.8%) underwent elective tracheostomy. Only 31.7% of these procedures aligned with CASST score recommendations (score ≥7). The CASST score demonstrated a sensitivity of 31.7%, specificity of 91.7%, positive predictive value of 78.4%, and negative predictive value of 58.5%. The area under the receiver operating characteristic curve was 0.617, demonstrating poor overall discrimination. Short-term postoperative complications did not differ significantly between CASST risk groups. While CASST demonstrates high specificity, its low sensitivity and frequent misalignment with clinical practice limit its standalone utility. Further refinement and integration with intraoperative findings may improve its applicability in airway management planning.

Tumor angiogenesis is a hallmark of malignant transformation. Abnormal vascular structure and blood flow characteristics provide crucial information for differentiating benign from malignant lesions. Conventional ultrasound relies primarily on morphological features, lesion boundaries, and blood flow patterns. However, some tumors exhibit overlapping grayscale characteristics between benign and malignant types. Moreover, color Doppler flow imaging (CDFI) has limitations in detecting microvascular flow. Superb microvascular imaging (SMI) utilizes adaptive algorithms to display intratumoral microvascular morphology and distribution with high resolution, potentially improving early differentiation. This research therefore conducted a diagnostic test accuracy meta-analysis to systematically assess and compare the diagnostic performance of SMI against conventional CDFI for distinguishing benign from malignant tumors.

An extensive literature retrieval was performed across the Web of Science, PubMed, Cochrane Library, and Embase up to February 26, 2025. The retrieval focused on studies using SMI and CDFI for diagnosing tumors across various organ systems. The Quality Assessment of Diagnostic Accuracy Studies-2 tool was employed to evaluate methodological quality. Review Manager 5.4 was used to generate quality assessment figures. Meta-DiSc 1.4 was used for threshold effect testing (Spearman correlation between sensitivity and 1-specificity). STATA software was then utilized for heterogeneity testing and to compute pooled sensitivity, negative likelihood ratio (LR-), specificity, diagnostic odds ratio (DOR), and positive likelihood ratio (LR+). Summary receiver operating characteristic (SROC) curves were constructed.

Twenty-eight studies were included: 22 focused on superficial organ tumors (17 breast, 5 other) and 6 on abdominal organ tumors (Five kidney, One liver). Pooled analysis showed that SMI yielded an overall sensitivity of 0.84 (95% CI: 0.80-0.87), a specificity of 0.79 (0.74-0.84), and an area under the curve (AUC) of 0.88. In the superficial organ group, SMI yielded a sensitivity of 0.84 (0.79-0.88), a specificity of 0.79 (0.73-0.84), and an AUC of 0.89. In the abdominal organ group, it yielded a sensitivity of 0.83 (0.77-0.88), a specificity of 0.81 (0.71-0.88), and an AUC of 0.89.

SMI demonstrates high specificity and sensitivity for differentiating benign from malignant tumors compared to conventional CDFI. It thus represents a promising novel imaging technique for clinical adoption. Future research should expand sample sizes for abdominal organs and investigate the specific performance of SMI across different lesion types.