ObjectiveOvarian needle aspiration and biopsy (ONAB) may be employed for pretreatment diagnosis of ovarian malignancies or intraoperatively to facilitate removal of ovarian masses. However, there is reluctance to utilize this procedure due to potential cyst rupture or seeding of malignant cells. The objective of this study was to examine the efficacy of ONAB over a 13-year period at our institution.MethodsBetween 2000 and 2013, all ONAB specimens were identified from the Queen's Medical Center Pathology Department database. All cytologic specimens were reviewed and correlated with histopathologic findings. A retrospective chart review was conducted to retrieve data on clinical course and treatment.ResultsThis study identified 144 cases of ovarian masses sampled by aspiration or needle biopsy between 2000 and 2013. Ninety-two (64%) cases had corresponding histopathology, 84 (91%) of which were obtained concomitantly. On histology, 12 (13%) cases were malignant and 80 (87%) benign. Three false negative cases were noted; 2 serous borderline tumors and 1 mucinous cystadenocarcinoma. These were sampling errors; no diagnostic tumor cells were present in the aspirates. Sensitivity and specificity of ONAB in the detection of malignancy were 75% and 100%, respectively. The positive and negative predictive values were 100% and 96%, respectively.ConclusionONAB represents a valuable tool in the diagnosis of malignancy and treatment of ovarian masses. In our study, it was highly specific, with excellent positive and negative predictive value.

Low-volume disease was present in one third of patients with nodal metastases, the largest metastatic deposit only in patients who had SLN dissection; these patients were significantly more likely to have grade 1 endometrioid carcinoma with less than 50% myometrial invasion, traditional "low-risk" features.

Table 1. Patient and procedural characteristics Age, Mean 6 SD 66.4 (12.0) Gender, Male N (%) 5 (35.7) Indication, N (%) Stone Removal/Decompression 13 (92.9) Stricture Diagnosis 1 (7.1) Altered anatomy. N (%) Roux-en-Y Gastric Bypass 10 (71.4) Billroth II 1 (7.1) Duodenal Switch 2 (14.2) Hepaticojejunostomy 1 (7.1) Prior ERCP Attempt, N (%) 3 (21.4) Prior EDGE Attempt, N (%) 1 (7.1) Preprocedural Labs, Mean 6 SD ALT (IU/L) 89.9 6 116.1 ALP (IU/L) 295.4 6 210.6 Total Bilirubin (mg/dL) 1.8 6 1.9 Findings N (%) Multiple Stones 10 (71.4) Single Stone 2 (14.2) Stricture 3 (21.3) No Stone 1 (7.1) Number of Sessions, Median (IQR) 1 (1-2) Therapeutic Device, N (%) EHL 8 (57.1) Balloon 5 (35.7) Basket 2 (14.3) Spybites, N (%) 3 (21.4) Success, N (%) 13 (92.9) Complication, N (%) 0 (0) Follow up Months, Median (IQR) 28.

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Background: Clinical management of orthostatic hypotension (OH) prioritizes the prevention of standing hypotension (HYP), sometimes at the expense of supine hypertension (HTN). It is unclear whether supine HTN is associated with adverse outcomes relative to standing HYP. Objectives: To compare supine HTN and standing HYP among middle-aged adults with and without OH. Methods: The Atherosclerosis Risk in Communities Study measured supine and standing blood pressure (BP) in adults aged 45-64 between 1987-1989. We defined OH as a positional drop in systolic BP ≥20 mmHg or diastolic BP ≥10 mmHg, supine HTN as a BP≥140/≥90 mmHg, and standing HYP as a BP≤105/≤65 mmHg. ARIC participants were followed >30 years. Coronary heart disease (CHD) and mortality were adjudicated; falls and syncope were based on hospital claims. We used adjusted Cox models that included both supine HTN and standing HYP. Results: Of 12,580 participants (55% female, 26% Black, mean age 54±6) 5% had OH. Among those without OH (N=11936), 19% had supine HTN and 21% had standing HYP, while among those with OH (N=644), 11% had supine HTN and 34% had standing HYP. Supine HTN was associated with CHD (HR 1.49; 1.36, 1.63), syncope (HR 1.26; 1.15, 1.39), and all-cause mortality (HR 1.47; 1.38, 1.57), while standing HYP was only associated with all-cause mortality (HR 1.08; 1.00, 1.16) and to a lesser extent than supine HTN (P comparing coefficients <0.001) (Table). Associations did not differ for those with OH (P-interactions>0.25). Conclusion: Supine HTN was associated with more adverse events than standing HYP, regardless of OH status, questioning conventional practices of prioritizing standing HYP among adults with OH.