Walter Reed National Military Medical Center

Limited evidence is available comparing the cost-effectiveness of mesh augmented repairs with and without uterine preservation. Our model suggests that minimally invasive supracervical hysterectomy with sacrocolpopexy (SCH-SCP) is cost-effective compared with minimally invasive sacrohysteropexy (MISH) as it decreases the number of subsequent major surgical procedures, endometrial cancer diagnoses, and endometrial cancer deaths. This information is useful for decision making at the health system level and should be considered in the surgical counseling discussion. The objective of this study was to compare the cost-effectiveness of SCH-SCP versus MISH. A decision tree model using TreeAge® software was developed to evaluate the cost-effectiveness of SCH-SCP compared with uterine-sparing MISH. Effectiveness was expressed in quality-adjusted life years (QALYs), and the willingness-to-pay (WTP) threshold was set to $100,000 per QALY. The literature review provided probabilities, utilities, and cost data. We estimated the incremental cost-effectiveness ratio (ICER) between the 2 strategies, completed a probabilistic sensitivity analysis (PSA), and created a cost-effectiveness acceptability curve for WTP thresholds from $0 to $200,000. SCH-SCP was a cost-effective strategy, with an ICER of $59,820/QALY compared with MISH. For a cohort of 10,000, MISH is associated with an additional 648 major surgical procedures, 5 endometrial cancer cases, and 2 endometrial cancer deaths. PSA revealed the chance of SCH-SCP being cost-effective was 55.4% at a WTP of $100,000 and 57.9% at a WTP of $200,000. Our model suggests that SCH-SCP may be cost-effective compared with MISH. SCH-SCP decreases the number of additional major surgical procedures, endometrial cancer diagnoses, and endometrial cancer deaths in our analysis.

There is a gap in objective methods to review applications for advanced medical training. The objective of this study was to evaluate the accuracy of a new machine learning-based residency and fellowship applicant review program, Halsted (Medicratic) in urogynecology fellowship applicant selection compared with program director (PD) review. This Institutional Review Board-approved study compared PD's standard assessment of fellowship applicants to the Halsted-based assessment at 3 programs in the 2023-2024 application cycle. Each program provided a score for each candidate on a 100-point scale in several domains. After the conclusion of the match, each PD completed a profile within Halsted that identified their preferred qualities in applicants. Halsted scores were obtained, which were compared with PD scores. A total of 126 applications were reviewed, with 59 applicants reviewed by more than 1 program. Program 1 ( r =0.60; P =0.0019) and Program 2 ( r =0.58; P <0.001) exhibited a significantly strong positive correlation between PD-assigned overall application scores and Halsted scores, while Program 3 exhibited a weak positive correlation between scores ( r =0.33; P =0.0225). There were significant differences in the scoring of the same applicant between programs for PD-assigned mean overall scores ( P <0.001) and Halsted scores ( P <0.001). A significant positive correlation was found between Halsted rankings of applicants and rankings assigned by PDs. In addition, significant differences in interprogram rankings of applicants suggest that there is a range of qualities that each program values and that application review is individualized. Machine learning assistance in application review is a developing tool with the potential to reduce bias and decrease program administrative burden.

Leukemia cutis (LC) is a rare extramedullary manifestation of leukemia, most commonly associated with acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL). The classic clinical presentation of LC usually includes various cutaneous lesions such as papules, nodules, and plaques. There are limited case reports describing a primary presentation with hyperpigmented macules and patches. This case report describes a 29-year-old male, diagnosed with AML, who initially presented with extremity skin dyspigmentation, unexplained lymphadenopathy, and fatigue. A skin biopsy revealed a dense periadnexal and perivascular infiltrate of atypical blastoid cells. Special stains for melanin (Fontana Masson) and iron were negative for abnormal deposition. Immunohistochemical stains showed scattered immature leukocytes (myeloperoxidase-positive), CD4-positive cells consistent with flow cytometry, and weak CD56 staining of admixed cells within the dense infiltrates. The patient was diagnosed with AML with an 11q23 KMT2A::AFF1 gene rearrangement-a mutation increasingly associated with a poor prognosis. This case underscores the importance of recognizing hyperpigmentation as a rare but potential manifestation of LC, especially in younger patients, and highlights the need for prompt diagnosis and intervention to improve patient outcomes.

33 Background: Historically, PSA DT can be prognostic for metastasis free survival in BCR (as defined on computed tomography (CT) and bone scan). PSA DT is also an important tool in risk stratification in BCR to identify which patients (pts) require therapy (e.g. pts with a PSA DT&gt;6 months). The emerging use of PSMA imaging creates another tool to assess BCR pts, but there is no data on the association of PSA DT and PSMA findings. Methods: NCT05588128 enrolls BCR pts after definitive +/- salvage therapies. Pts must have a PSA&gt;0.5 ng/ml, testosterone &gt;100 ng/dL, and negative CT/bone scans. Lymph nodes (LNs) up to 1.5 cm and prior therapies are permitted. All patients undergo a baseline PSMA PET scan, along with measurement of PSA and PSA DT. Here we describe the relationship between baseline PSA metrics and baseline PSMA imaging findings in patients with BCR. Results: 130 patients are currently evaluable with a median age= 71 years, baseline PSA of 1.95 ng/dL (range: 0.5 to 71) and PSA DT of 10.6 months (range 1.2 to 132) off therapy. Of all participants, 16.9% (n=22) had findings limited to the prostate bed and 34.6% (n=45) had PSMA+ avidity in the prostate bed with other findings. 42.3% (n=55) had PSMA + LNs, and 13.8% (n=18) had PSMA+ bone lesions. Four patients had serosal deposits with PSMA avidity, and one patient had a PSMA+ lung nodule. Conclusions: These data are the first to compare PSMA imaging results with corresponding PSA levels and PSA DT in a large cohort of patients with BCR. Results show that pts with historically favorable/long PSA DT may have high volume/bone+ findings on PSMA. There is no data to suggest treatment escalation is required in BCR pts with high volume PSMA findings, but long/favorable PSA DT. These results highlight the caveats of using PSMA imaging alone to drive treatment decisions in BCR without further data for how baseline PSMA imaging corresponds with long-term outcomes. Clinical trial information: NCT05588128 . PSMA PET+ lesion locations by PSA doubling time in patients with BCR prostate cancer (total n=130). PSA DT # Pts Median PSA PSMA Neg Prostate+ only Lymph Nodes+ ≥ 4 Lymph Nodes+ Bone+ ≥12 mo 52 3.55 9 (17.3%) 16 (30.8%) 24 (46.2%) 12 (23%) 6 (11.5%) 9 to &lt;12 mo 20 1.56 2 (10%) 4 (20%) 11 (55%) 3 (15%) 3 (15%) 6 to &lt;9 mo 17 0.9 5 (29.4%) 0 (0%) 12 (70%) 8 (47.1%) 2 (11.8*) &lt;6 mo 41 2.1 5 (12.2%) 2 (4.9%) 28 (68.3) 15 (36.6) 7 (17.1)

While the wide spectrum of soft tissue neoplasms found throughout the body may occur at the knee, this review focuses on the more commonly encountered intraarticular or juxtaarticular solid soft tissue lesions that may be encountered in this location. The benign intraarticular synovial-based tumors or tumor-like processes of tenosynovial giant cell tumor, synovial chondromatosis, and lipoma arborescens are reviewed, as are the solid juxtaarticular neoplasms of nerve sheath tumors, synovial sarcoma, and myxoid liposarcoma. Several uncommon lesions that occur at the knee while relatively rare elsewhere are also discussed and include synovial vascular malformations, the Hoffa fat pad chondroma, and popliteal arterial cystic adventitial disease. Finally, clear cell sarcoma, a rare malignancy which originates in ligaments and tendons, has the knee as the second most common site of occurrence and may be misinterpreted as a benign entity or sequelae of injury, is reviewed.

Abstract Background: Liquid biopsies using blood provide a less invasive method for cancer detection and treatment assessment compared to conventional tissue biopsies. The plasma proteome involves secreted proteins from various organs and tissues, making it a prime candidate for extensive biomarker discovery. However, the vast dynamic range of protein abundance in plasma presents a challenge. In this study, we employed a highly sensitive aptamer-based assay to explore plasma proteins associated with breast cancer (BC). Methods: The subjects were enrolled and specimens were collected through the Clinical Breast Care Project using IRB-approved protocols. We analyzed 260 heparinized plasma samples from breast cancer patients at primary diagnosis, prior to neoadjuvant chemotherapy and excisional surgery. Patients with stage IV, prior DCIS, synchronous breast cancer, or relapse within 6 months were excluded. SomaScan Assay 7k (Somalogic Inc, USA) using 7289 aptamers for human proteins was performed. The association of each clinicopathologic feature of the cohort with plasma protein expression was evaluated using linear regression. The clinical features with notable effect size were further subjected to differential expression analysis using Limma with matched samples followed by pathway analysis using Ingenuity Pathway Analysis (IPA) tool. Results: The protein expression levels were significantly (FDR &amp;lt; 0.05) associated with age, race and stage groups. Differential expression using matched subsets identified 359 significant (FDR &amp;lt; 0.05, |FC| &amp;gt; 1.2) differentially expressed proteins (DEPs) between old (&amp;gt;60 years, n = 44) and young (&amp;lt;40 years, n = 44), and 184 between Caucasian (n = 67) and African American (n = 67) sample groups. We utilized data from Peptide Atlas, and existing literature on normal aging and established cancer biomarkers to contextualize the significant proteins. Pathways significantly (p val &amp;lt; 0.05, |z score| &amp;gt; 2) upregulated in the old group included immune response (cytokine signaling, neutrophil degranulation etc.) and tumor related (PAK, SNARE signaling etc.) pathways. Pathways identified in young were PPAR, DHCR4 signaling, and LXR/RXR activation. For the race group, there were 11 significant pathways upregulated in Caucasians that included FAK and S100 family signaling. For the higher (n = 62) and lower (n = 62) stage comparison, there were 127 significant DEPs (p val &amp;lt; 0.01, |FC| &amp;gt; 1.2) with several cancer-related signaling pathways upregulated in higher stage group (VEGF, SCF-KIT etc.). To explore potential markers of relapse, we conducted a subgroup analysis within the higher-stage cohort, comparing patients who relapsed (n = 30) to those who did not (n = 30) that identified 24 significant DEPs (p &amp;lt; 0.05, |FC| &amp;gt; 1.2) LASSO regression with leave-one-out cross-validation (LOOCV) resulted in a predictive model comprising 18 proteins, achieving a classification accuracy of 0.92. Conclusion: This study identified plasma proteins associated with age group, race and tumor stage in breast cancer patients. These findings indicate that BC related plasma protein expression differs across age and racial groups, a factor to consider in drug target development. We also identified 18 proteins that are potential markers for BC relapse. The identified proteins need to be validated in samples of large cohort. Disclaimer: The contents of this publication are the sole responsibility of the author(s) and do not necessarily reflect the views, opinions, or policies of Uniformed Services University of the Health Sciences (USUHS), the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., the Department of Defense (DoD) or the Departments of the Army, Navy, or Air Force. Mention of trade names, commercial products, or organizations does not imply endorsement by the U.S. government. Citation Format: A. Praveen Kumar, P. Raj-Kumar, J. Liu, B. Deyarmin, B. Mostoller, C. Larson, H. Blackburn, D. Teeter, K. Miller, M. Johnson, M. Russo, L. Fantacone-Campbell, J. Hooke, C. Shriver, H. Hu, A. Kovatich, X. Lin. Association of clinicopathologic features with plasma protein expression in primary invasive breast cancer patients [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS2-10-05.