The diagnosis of salivary gland neoplasms is a complex and difficult area of surgical pathology. Most of the salivary gland tumours present a varieted and pleomorphic morphology that make difficult the histopathological categorisation. In addition, there are no clinical and/or radiological features specific for each neoplasm. According to the latest WHO classification of the salivary gland tumours, there are more than 30 benign and malignant neoplastic entities, 1 15%-26% are malignant [2][3][4] and approximately 85% originate from the parotid gland. 5 Fine-needle aspiration (FNA) has been used for more than 50 years for the diagnosis of salivary gland tumours. 6 FNA is a safe, quick, less invasive, cost effective and relatively reliable diagnostic tool, especially when performed under the ultrasound guidance 7 and in experienced and skilful hands, 8 can be easily performed in the outpatient setting. In addition, it helps to plan the management and extent of parotid surgery. 8 However, FNA presents a high false positive rate, 9,10 and the data of its sensitivity, specificity and accuracy are controversial. FNA sensitivity presents a huge variability between 41.7% and 92.8%, and its specificity is 93.9%-98.5%. The overall diagnostic accuracy rates vary from 79% to 97%. 11,12 For malignant neoplasms, the FNA diagnosis is nondiagnostic in 26% of the cases. 11,13 In a series of 151 cases, FNA results were non-diagnostic/inconclusive in 18% of cases 14 and its sensitivity was 76%-92% for benign tumours and 53%-79% for malignant neoplasm. [15][16][17][18] FNA specimens are inadequate for diagnosis in 9%-12% of all cases and in 14% of malignant tumours. 18,19 It is worth mentioning that FNA is operator dependent technique and the results are strongly related to the experience of the clinicians and cytopathologists.
We define cancer equity as all people having as the same opportunity for cancer prevention, treatment, and survivorship care. However, marginalized populations continue to experience avoidable and unjust disparities in cancer care, access to clinical trials, and cancer survival. Racial and ethnic minorities, and individuals with low socioeconomic status, Medicaid insurance, limited health literacy, disabilities, and mental health disorders are more likely to experience delays to cancer diagnosis and less likely to receive guideline-concordant cancer care. These disparities are impacted by the social determinants of health including structural discrimination, racism, poverty, and inequities in access to healthcare and clinical trials. There is an urgent need to develop and adapt evidence-based interventions in collaboration with community partners that have potential to address the social determinants of health and build capacity for cancer care for underserved populations. We established the Virtual Equity Hub by developing a collaborative network connecting a comprehensive cancer center, academic safety net hospital, and community health centers and affiliates. The Virtual Equity Hub utilizes a virtual tumor board, an evidence-based approach that increases access to multi-specialty cancer care and oncology subspecialty expertise. We adapted the tumor board model by engaging person-centered teams of multi-disciplinary specialists across health systems, addressing the social determinants of health, and applying community-based research principles with a focus on populations with poor cancer survival. The virtual tumor board included monthly videoconferences, case discussion, sharing of expertise, and a focus on addressing barriers to care and trial participation. Specifically, we piloted virtual tumor boards for breast oncology, neuro-oncology, and individuals with cancer and serious mental illness. The Virtual Equity Hub demonstrated promise at building capacity for clinicians to care for patients with complex needs and addressing barriers to care. Research is needed to measure the impact, reach, and sustainability of virtual equity models for patients with cancer.
Background Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are the leading causes of hepatocellular carcinoma (HCC) worldwide. Limited data exist on surgical outcomes for NAFLD/NASH-related HCC compared with other HCC etiologies. We evaluated differences in clinicopathological characteristics and outcomes of patients undergoing surgical resection for NAFLD/NASH-associated HCC compared with other HCC etiologies. Methods Demographic, clinicopathological features, and survival outcomes of patients with surgically resected HCC were collected. NAFLD activity score (NAS) and fibrosis score were assessed by focused pathologic review in a subset of patients. Results Among 492 patients screened, 260 met eligibility (NAFLD/NASH [n = 110], and other etiologies [n = 150]). Median age at diagnosis was higher in the NAFLD/NASH HCC cohort compared with the other etiologies cohort (66.7 vs. 63.4 years, respectively, P = .005), with an increased percentage of female patients (36% vs. 18%, P = .001). NAFLD/NASH-related tumors were more commonly >5 cm (66.0% vs. 45%, P = .001). There were no significant differences in rates of lymphovascular or perineural invasion, histologic grade, or serum AFP levels. The NAFLD/NASH cohort had lower rates of background liver fibrosis, lower AST and ALT levels, and higher platelet counts (P < .01 for all). Median overall survival (OS) was numerically shorter in NAFLD/NASH vs other etiology groups, however, not statistically significant. Conclusions Patients with NAFLD/NASH-related HCC more commonly lacked liver fibrosis and presented with larger HCCs compared with patients with HCC from other etiologies. No differences were seen in rates of other high-risk features or survival. With the caveat of sample size and retrospective analysis, this supports a similar decision-making approach regarding surgical resection for NAFLD/NASH and other etiology-related HCCs.
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