https://orcid.org/0000-0001-7300-1563All Publications
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Lung Cancer Risk for Patients Undergoing Cardiac Chest CT: Identification of a New High Risk Population for Lung Cancer Screening.
The Annals of thoracic surgery
2026
Abstract
Lung cancer screening (LCS) rates are low despite expanded eligibility criteria. Many patients receiving cardiac CT scans may also have risk factors for lung cancer. We aimed to identify an opportunity to increase LCS by quantifying this population.All patients in our healthcare system from January 2011 to December 2023 who received a CT heart or CT angiogram heart were included. Lung cancer rates in this population were assessed. LCS eligibility was determined by USPSTF guidelines.A total of 31,684 patients received cardiac CT scans and 17,232 patients met the study criteria (documented smoking history, age 50-80 years, no prior diagnosis of lung cancer). Based on 2021 USPSTF guidelines, 114 (0.7%) patients were eligible for LCS compared to 0.37% of all patients in our healthcare system. A total of 73 patients undergoing cardiac CT developed a diagnosis of lung cancer. Among those meeting LCS eligibility, 1 (0.8%) developed lung cancer, 7 (6.1%) received a low dose CT, and 21 (18.4%) received a diagnostic chest CT. An additional 72 (0.4%) patients of patients who received a cardiac CT were subsequently diagnosed with lung cancer at a median of 19.8 (5.7, 51.7) months, yet did not meet LCS eligibility.Risk of lung cancer diagnosis among patients receiving cardiac CT scan is significantly higher than that of the general population. However, most of these patients did not qualify for LCS. Advocacy for more complete chest imaging in this population may facilitate identification of lung cancer for early intervention.
View details for DOI 10.1016/j.athoracsur.2026.08.003
View details for PubMedID 42612958
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Evaluating Tumor Burden as a Predictive Biomarker for Epidermal Growth Factor Receptor Targeted Kinase Inhibitor Therapy in Advanced Non-Small Cell Lung Cancer.
JCO precision oncology
2026; 10 (4): e2500884
Abstract
As treatment options for advanced non-small cell lung cancer (NSCLC) evolve, biomarkers are needed to guide therapy selection while balancing efficacy and toxicity. Although tumor burden is a promising candidate, its prognostic role in guiding epidermal growth factor receptor (EGFR)-targeted kinase inhibitor (TKI) therapies remains understudied in real-world settings.We identified patients with de novo stage IV EGFR-mutant NSCLC treated with first-line EGFR-TKI at Stanford Health Care (2000-2021). Tumor burden metrics were manually annotated from 592 baseline radiology reports, encompassing size, number, and location (1,807 lesions). Multivariable Cox regression evaluated associations between tumor burden metric and overall survival (OS), adjusting for confounders, in the overall cohort and an osimertinib subgroup. A weighted composite tumor burden score was constructed using statistically significant metrics to stratify risk.Of 312 patients, bone metastasis (hazard ratio (HR)adjusted, 1.64 [95% CI, 1.23 to 2.19]) and the number of metastatic organs (HRadjusted, 1.21 [95% CI, 1.10 to 1.32]) were independently associated with worse OS and used to construct the composite score. Patients with low tumor burden (composite-score ≤ median 1.06) experienced better OS than those with high tumor burden, with a 3-year OS of 59.8% versus 41.5% (P = .001). Consistent findings were observed in the osimertinib subgroup, with a 3-year OS of 62.2% versus 44.6% (P = .03) for low versus high tumor burden.Tumor burden may serve as a prognostic biomarker in advanced NSCLC receiving EGFR-TKIs. These findings raise the hypothesis that durable survival in low-burden patients may be achievable with monotherapy, potentially sparing unnecessary toxicity from combination regimens. This warrants prospective validation comparing monotherapy versus combination strategies.
View details for DOI 10.1200/PO-25-00884
View details for PubMedID 41955549
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Blood IgE and Eosinophils are not Reliable Predictors of Nasal Tissue Eosinophils in Chronic Rhinosinusitis with Nasal Polyposis.
International archives of otorhinolaryngology
2025; 29 (2): 1-5
Abstract
Introduction Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a chronic inflammatory condition of the paranasal sinuses that is mainly associated with type-2 inflammation. Immunoglobulin E (IgE) and eosinophils in blood and nasal tissue have been suggested as biomarkers for the prognosis and severity of CRSwNP as well as indications for biological treatment. Objective The present study aims to assess the relationships between blood IgE concentration, blood eosinophil count, and nasal polyp eosinophil count in CRSwNP patients. Methods The present study is retrospective. Nasal polyps from CRSwNP patients (n = 73) were fixed and embedded in paraffin for hematoxylin and eosin stain. Blood was collected to measure IgE concentration and eosinophil count. Results Weak correlations were found between blood and tissue eosinophil counts ( p = 0.004, r = 0.367) as well as blood IgE concentration and blood eosinophil count ( p = 0.007, r = 0.372). There was no statistically significant correlation between blood IgE concentration and tissue eosinophil count. When dividing patients based on nasal polyp eosinophil count, blood eosinophil level was higher in the severely eosinophilic group than in the mildly eosinophilic group ( p = 0.002). Conclusion Blood IgE and eosinophils are not reliable biomarkers to predict the inflammatory condition in CRSwNP. Further research is needed on the clinical roles of these biomarkers.
View details for DOI 10.1055/s-0044-1801316
View details for PubMedID 40291367
View details for PubMedCentralID PMC12020605
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SinoNasal Microbiota Transfer to treat recalcitrant chronic rhinosinusitis: A case series.
International forum of allergy & rhinology
2024
Abstract
SinoNasal Microbiota Transfer (SNMT) was safe with immediate benefit in all recipients, with sustained improvement in two of three recipients for up to 180 days. The addition of antimicrobial photodynamic therapy worsened chronic rhinosinusitis. These promising SNMT results warrant further study of safety and efficacy.
View details for DOI 10.1002/alr.23352
View details for PubMedID 38616557
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Development and validation of the Sinonasal Endoscopic Score (SiNES) for chronic rhinosinusitis.
Rhinology
2024
Abstract
Although there are several endoscopic grading systems for chronic rhinosinusitis (CRS), they are limited in their range and applicability. We developed a SiNonasal Endoscopic Score (SiNES) that builds upon the strengths of previous systems while addressing their limitations.The SiNES system was developed by consensus after multiple rounds of guided discussions. Face, content, and convergent validity were investigated. It was validated using an independent sample of 79 CRS individuals from two referral centres from September 2021 to February 2022. Each patient underwent a sinonasal endoscopy and filled PROM questionnaires. Three independent rhinologists graded endoscopic videos using the SiNES and modified Lund-Kennedy (MLK) scores. Inter-rater and test-retest reliability were assessed via the intraclass correlation coefficient (ICC). SiNES and MLK scores were correlated with PROMs using a Spearman correlation and canonical correlation analysis (CCA).The SiNES system evaluates five anatomical spaces regarding edema, discharge, and scarring. Face, content, and convergent validity were deemed satisfactory by the study authors and an independent panel of Otolaryngologists. Inter-rater reliability was excellent for the SiNES and good for the MLK score. Test-retest reliability was excellent for both systems. Total SiNES was correlated with self-reported smell loss.The SiNES system is an accurate and reliable grading framework applicable to all CRS subtypes. It can be utilized in clinical and research settings and improves upon previously published systems.
View details for DOI 10.4193/Rhin23.434
View details for PubMedID 38598348
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Comparison between upper and lower airway microbiome profiles in chronic rhinosinusitis patients.
International forum of allergy & rhinology
2024
Abstract
Dysregulation of the airway microbiota is thought to contribute to airway inflammation in both chronic rhinosinusitis (CRS) and asthma. However, the relationship between the upper and lower airway microbiome remains unclear.Sinus and lung brushes were collected from 29 CRS participants undergoing sinus surgery. DNA was extracted and submitted for 16s rRNA microbiome sequencing. Alpha and beta diversity metrics, taxonomic composition, and differences between individual taxa were compared for paired sinus and bronchial samples.Twenty-three out of 29 participants had sufficient samples for analysis. The mean (standard deviation) age was 51.59 (14.57) years, and 10 (44%) patients were female. Twelve (52%) patients had comorbid asthma. Sinus brushes had significantly higher alpha diversity indexes (Shannon and Faith) compared to bronchial brushes (p < 0.001). Beta diversity metrics were significantly different between the sinus and bronchial samples. Principal coordinate analysis showed no clustering of paired nasal and bronchial samples. Sinus brushes had significantly more Lawsonella, Corynebacterium, and Staphylococcus compared to bronchia brushes, while the latter were enriched in Tropheryma and Sphingomonas, among others (false discovery rate [FDR]-adjusted p < 0.01). Finally, CRS patients with comorbid asthma had significantly higher Pseudomonas and Peptoniphilus in sinus brushes and lower Prevotella in bronchial brushes when compared to non-asthmatics (FDR-adjusted p < 0.01).The sinus and bronchial bacterial microbiomes differ in important ways. Our study suggests that migration of bacteria from the sinus into the lower airways is unlikely in patients with CRS.
View details for DOI 10.1002/alr.23335
View details for PubMedID 38343306
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The efficacy of silastic sheet nasal splints in endoscopic nasal septal repair surgery: a prospective, randomized, single-blinded controlled trial
INTERNATIONAL FORUM OF ALLERGY & RHINOLOGY
2021; 11 (9): 1381-1383
View details for DOI 10.1002/alr.22791
View details for Web of Science ID 000630773700001
View details for PubMedID 33742768
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Anatomic Sphenoid Cell Variants: Introduction of the Retrosphenoid Cell and Relevance in the Presentation and Management of Sinus Disease
AMERICAN JOURNAL OF RHINOLOGY & ALLERGY
2020; 34 (2): 170-175
View details for DOI 10.1177/1945892419881837
View details for Web of Science ID 000491430500001
View details for PubMedID 31623450