J. N. Cormier

BACKGROUND: Meta-analyses were performed to examine the utility of ultrasonography, computed tomography (CT), positron emission tomography (PET), and a combination of both (PET-CT) for the staging and surveillance of melanoma patients. METHOD: Patient-level data from 74 studies containing 10,528 patients (between January 1, 1990, and June, 30, 2009) were used to derive characteristics of the diagnostic tests used. Meta-analyses were conducted by use of Bayesian bivariate binomial models to estimate sensitivity and specificity. Diagnostic odds ratios [ie, true-positive results/false-negative results)/(false-positive results/true-negative results)] and their 95% credible intervals (CrIs) and positive predictive values were used as indicators of test performance. RESULTS: Among the four imaging methods examined for the staging of regional lymph nodes, ultrasonography had the highest sensitivity (60%, 95% CrI = 33% to 83%), specificity (97%, 95% CrI = 88% to 99%), and diagnostic odds ratio (42, 95% CrI = 8.08 to 249.8). For staging of distant metastases, PET-CT had the highest sensitivity (80%, 95% CrI = 53% to 93%), specificity (87%, 95% CrI = 54% to 97%), and diagnostic odds ratio (25, 95% CrI = 3.58 to 198.7). Similar trends were observed for melanoma surveillance of lymph node involvement, with ultrasonography having the highest sensitivity (96%, 95% CrI = 85% to 99%), specificity (99%, 95% CrI = 95% to 100%), and diagnostic odds ratio (1675, 95% CrI = 226.6 to 15,920). For distant metastases, PET-CT had the highest sensitivity (86%, 95% CrI = 76% to 93%), specificity (91%, 95% CrI = 79% to 97%), and diagnostic odds ratio (67, 95% CrI = 20.42 to 229.7). Positive predictive values were likewise highest for ultrasonography in lymph node staging and for PET-CT in detecting distant metastases. CONCLUSION: Among the compared modalities, ultrasonography was superior for detecting lymph node metastases, and PET-CT was superior for the detection of distant metastases in both the staging and surveillance of melanoma patients.

Currently, a limited number of studies have been conducted that examine sources of information and knowledge level in individuals with lymphedema. This study aimed (1) to examine self-reported information sources and perceived lymphedema knowledge among individuals with lymphedema; and (2) to examine differences in self-reported information sources and perceived lymphedema knowledge among individuals with primary or secondary lymphedema; and with upper or lower extremity lymphedema. The National Lymphedema Network (NLN) conducted a survey to collect self-report data from March 2006 to January 2010. Overall, participants preferred a variety of sources of information. Participants reported low levels of knowledge about the types of lymphedema, treatment approaches and methods, and self-administrated therapies. In comparison to participants with secondary or upper extremity lymphedema, participants with primary or lower extremity lymphedema reported lower knowledge level regarding causes of lymphedema, risks for and complications of lymphedema, treatment approaches and methods for lymphedema, and self-administered therapies. Opportunities exist to expand lymphedema information sources. Healthcare professionals should focus on delivering high quality information about treatment and self-care management to individuals with lymphedema.

3554 Background: The purpose of this study was to determine current practice trends and factors influencing adherence to the National Comprehensive Cancer Network (NCCN) guidelines for rectal adenocarcinoma. Methods: Retrospective cohort study of patients with rectal cancer identified from the National Cancer Database (2003-2007). Adherence to stage-specific NCCN guidelines was evaluated after individually determining AJCC/TNM stage for each patient (clinical (c) stage for patients receiving neoadjuvant therapy or pathologic (p) stage for those who received surgical resection as a first course of treatment). Stage-specific multivariate analyses were performed to determine factors associated with adherence to NCCN guidelines. Results: 45,876 patients with rectal cancer who met study criteria were analyzed. Overall, adherence to treatment guidelines was observed in 63% of patients; stage I (66%), stage II (57%), stage III (61%) and stage IV (73%). Nonadherence for stage I was largely due to overtreatment (20%) with neoadjuvant therapy. Stage I patients were least likely to be undertreated (14%) compared with stages II (43%), III (39%) and IV (27%), respectively (p<0.001). A primary reason for nonadherence was undertreatment of stage pII (44%) and pIII (40%) patients through lack of adjuvant therapy. Factors associated with adherence across all stages included age, race, comorbidity index, insurance status and type of facility. Conclusions: Young, healthy, clinical stage I rectal cancer patients with insurance are more likely to be overtreated. Conversely, pathologic stage II and III patients who are older, have greater comorbid disease, are underinsured or treated at community hospitals were likely to be undertreated. The impact of these departures from national practice guidelines on patient outcomes remain to be elucidated. Odds ratio for adherence. Stage I Stage II Stage III Stage IV Age <50 - - - - 50-64 1.22 0.84 0.86 0.56 65-74 1.25 0.60 0.70 0.42 >75 1.15 0.24 0.26 0.13 Charlson-Deyo ≥1 vs. 0 1.42 0.77 0.75 0.64 Insurance status Private - - - - Medicare 0.91 0.89 0.84 0.68 Medicaid 0.61 0.79 0.72 0.62 Uninsured 0.51 0.57 0.70 0.42 Facility Teaching - - - - Cancer center 1.01 0.93 1.07 0.92 Community 0.86 0.80 0.90 0.74