A comparative ID migraine™ screener study in ophthalmology, ENT and neurology out-patient clinics

Migraine is more likely to be misdiagnosed in patients with comorbid diseases. Not only primary care physicians, but also specialists might misdiagnose it due to the lack of diagnostic criteria awareness. The ID migraine test is a reliable screening instrument that may facilitate and accelerate migraine recognition. This study aimed to compare the prevalence and characteristics of migraine in a large sample of patients admitted to clinics of ophthalmology (OC), ear, nose and throat diseases (ENTC) and neurology (NC), as well as to validate the use of the ID migraine test in OC and ENTC settings. This was a multicentre (11 cites) study of out-patients admitting either to NC, ENTC or OC of the study sites during five consecutive working days within 1 week. From each of the clinics, 100 patients were planned to be recruited. All recruited patients were interviewed and those having a headache complaint received an ID migraine test and were examined for headache diagnosis by a neurologist, blinded to the ID migraine test result. A total of 2625 subjects were recruited. Only 1.3% of OC patients and 5.4% of ENTC patients have been admitted with a primary complaint of headache, whereas the percentage of NC patients suffering from headache was 37.6%. Whereas 138 patients (19.3%) in OC, 154 (17.3%) in ENTC and 347 (34%) in NC were found to be ID migraine test positive, 149 patients (20.8%) in OC, 142 (16%) in ENTC and 338 (33.1%) in NC were diagnosed with migraine. The sensitivity, specificity, and positive and negative predictive ratios of the ID migraine test were found to be similar in all clinics. An important fraction of the patients admitted to NC, as well as to OC and ENTC, for headache and/or other complaints were found out to have migraine by means of a simple screening test. This study validated the ID migraine test as a sensitive and specific tool in OC and ENTC, encouraging its use as a screening instrument. © Blackwell Publishing Ltd.This study was supported by an unrestricted research grant made by Pfizer-Turkey. The authors wish to thank the researchers the names of whom are listed below: MIRA-3 study group Name of the study centre Investigators 1. Sutcu Imam University Medical Faculty, Department of Neurology 1 , Department of Eye Diseases 2 , Department of ENT Diseases 3 Deniz Tuncel 1 , Mustafa Gokce 1 Gokhan Ozdemir 2 , Mehmet Akif Kilic 3 2. Ege University Medical Faculty, Department of Neurology 1 Department of Eye Diseases 2 , Department of ENT Diseases 3 Bilge Cetin 1 , Figen Gokcay 1 , Hadiye Sirin 1 3. Ataturk University Medical Faculty, Department of Neurology 1 , Department of Eye Diseases 2 , Department of ENT Diseases 3 Orhan Deniz 1 , Recep Demir 1 , Ibrahim Kocer 2 , Bulent Aktan 3 4. Dokuz Eylül University Medical Faculty, Department of Neurology 1 , Department of Eye Diseases 2 , Department of ENT Diseases 3 Vesile Ozturk 1 , Fethi Idiman 1 , Gokhan Gurel 1 , Fusun Boyacioglu 1 5. Uludag University Medical Faculty, Department of Neurology 1 , Department of Eye Diseases 2 , Department of ENT Diseases 3 Necdet Karli 1 , Cigdem Cavdar 1 , Mehmet Zarifoglu 1 6. Abant Izzet Baysal University Medical Faculty, Department of Neurology 1 , Department of Eye Diseases 2 , Department of ENT Diseases 3 Nebil Yildiz 1 , Sule Aydin 1 , Nazire Dogan 1 , Tolga Beyazit 1 7. Istanbul University Cerrahpasa Medical Faculty, Department of Neurology 1 , Department of Eye Diseases 2 , Department of ENT Diseases 3 Aksel Siva 1 , Sabahattin Saip 1 , Baki Göksan 1 , Selim Gokdemir 1 , Idris Sayilir 1 8. Ankara Numune Education and Research Hospital, Department of Neurology 1 , Department of ENT Diseases 3 Fikri Ak 1 , Gurdal Orhan 1 , Aysegul Akagunduz 1 , Mustafa Kaymakçi 3 9. Dicle University Medical Faculty, Department of Neurology 1 , Department of ENT Diseases 3 Mediha Yalman 1 , Ufuk Aluçlu 1 10. Mustafa Kemal University Medical Faculty Department of Neurology 1 , Department of Eye Diseases 2 , Department of ENT Diseases 3 Taskin Duman 1 , Ismet Murat Melek 1 , Cengaver Tamer 2 , Huseyin Oksuz 2 , Ali Safak Dagli 3 , Ertap Akoglu 3 11. Firat University Medical Faculty, Department of Neurology 1 , Department of Eye Diseases 2 , Department of ENT Diseases 3 Serpil Bulut 1 , Sait Berilgen 1 , Caner Demir 1 , Meliha Aydin Ulger 1 -

The Tumor Profiler Study: integrated, multi-omic, functional tumor profiling for clinical decision support

The application and integration of molecular profiling technologies create novel opportunities for personalized medicine. Here, we introduce the Tumor Profiler Study, an observational trial combining a prospective diagnostic approach to assess the relevance of in-depth tumor profiling to support clinical decision-making with an exploratory approach to improve the biological understanding of the disease

Establishing standardized immune phenotyping of metastatic melanoma by digital pathology

CD8+ tumor-infiltrating T cells can be regarded as one of the most relevant predictive biomarkers in immune-oncology. Highly infiltrated tumors, referred to as inflamed (clinically “hot”), show the most favorable response to immune checkpoint inhibitors in contrast to tumors with a scarce immune infiltrate called immune desert or excluded (clinically “cold”). Nevertheless, quantitative and reproducible methods examining their prevalence within tumors are lacking. We therefore established a computational diagnostic algorithm to quantitatively measure spatial densities of tumor-infiltrating CD8+ T cells by digital pathology within the three known tumor compartments as recommended by the International Immuno-Oncology Biomarker Working Group in 116 prospective metastatic melanomas of the Swiss Tumor Profiler cohort. Workflow robustness was confirmed in 33 samples of an independent retrospective validation cohort. The introduction of the intratumoral tumor center compartment proved to be most relevant for establishing an immune diagnosis in metastatic disease, independent of metastatic site. Cut-off values for reproducible classification were defined and successfully assigned densities into the respective immune diagnostic category in the validation cohort with high sensitivity, specificity, and precision. We provide a robust diagnostic algorithm based on intratumoral and stromal CD8+ T-cell densities in the tumor center compartment that translates spatial densities of tumor-infiltrating CD8+ T cells into the clinically relevant immune diagnostic categories “inflamed”, “excluded”, and “desert”. The consideration of the intratumoral tumor center compartment allows immune phenotyping in the clinically highly relevant setting of metastatic lesions, even if the invasive margin compartment is not captured in biopsy material