The primary objective is to examine patient self‐assessment of breast pain and cosmesis between t... more The primary objective is to examine patient self‐assessment of breast pain and cosmesis between three‐dimensional (3D‐CRT) versus intensity‐modulated radiotherapy (IMRT). The secondary objective is to evaluate any relationship of treatment planning conformality of both cohorts to patient‐assessed pain. Assessments were performed at interim 12, 24, 36, and 48 months with a final 5‐year assessment.
We assessed multiple readers' positive predictive values (PPVs) for ACR BI-RADS 3, 4a, 4b, 4c... more We assessed multiple readers' positive predictive values (PPVs) for ACR BI-RADS 3, 4a, 4b, 4c and 5 masses on ultrasound (US) pre- and post-proposed guidelines. This retrospective, IRB-approved study included four American and four non-American readers who assigned BI-RADS categories for US images of 374 biopsy-proved masses. Readers were offered guidelines and re-classified the masses. We assessed readers' abilities to achieve ACR benchmarks BI-RADS categories pre- and post-guidelines. PPVs increased with BI-RADS category. The PPVs pre- and post-guidelines were 6.0% and 4.4% for category 3, 27.3% and 30.5% for category 4a, 49.9% and 51.5% for category 4b, 69.0% and 67.4% for category 4c, and 79.3% and 80.1% for category 5. Readers achieved the PPV benchmark for category 4c, but not for categories 3, 4a, 4b and 5, with no significant improvement after guidelines. Regular BI-RADS 4 subcategory users missed benchmarks by less than non-regular users. Pre- and post-guidelines, r...
Sentinel node analysis represents a significant advance in the diagnosis and treatment of invasiv... more Sentinel node analysis represents a significant advance in the diagnosis and treatment of invasive breast cancer. The traditional crude method of full axillary dissection for assessing the status of the axillary nodes can now be discarded in favor of the much more elegant and modern approach of minimally invasive sentinel node analysis and its attendant elimination of the morbidity of traditional axillary node dissection. The many impediments to and pitfalls in the technique of sentinel node analysis, however, must be recognized and overcome for the procedure to be reliable and consistently successful. The use of ultrasound and a smaller particle size can help overcome many of these pitfalls. Because ultrasound identification of the axillary sentinel node in patients with invasive breast cancer is possible, it may allow for percutaneous excision of these nodes in the future (Fig. 8). Combining percutaneous excision and ablation of the primary breast carcinoma with percutaneous excision of the sentinel node allows for the nonsurgical treatment of small breast cancers in the future. The modern breast radiologist should be at the forefront of these advances.
To review the authors' experience with patients who presented with breast lumps and had norma... more To review the authors' experience with patients who presented with breast lumps and had normal mammograms and normal sonograms. The findings from 600 lumps in 486 women with no focal ultrasonographic (US) mass or mammographic finding in the area of clinical concern were retrospectively studied. Evaluated parameters included the individual reporting the lump, qualitative descriptors for the physical finding, mammographic density, US characteristics in the area of concern, whether there was a change in imaging and/or physical examination results, and whether there were diagnostic biopsy findings at follow-up. The study group included 540 lumps in 435 women who had a minimum mammographic and clinical follow-up of 2 years, as well as 60 additional lumps in 51 patients who underwent biopsy. No patient in the nonbiopsy group developed carcinoma at the initial site of concern during a mean mammographic and clinical follow-up period of 43 months, and all biopsy specimens were benign (ne...
To examine the outcome of breast cancer patients who have prior breast augmentation treated with ... more To examine the outcome of breast cancer patients who have prior breast augmentation treated with lumpectomy followed by accelerated partial breast external intensity-modulated radiotherapy (APBIMRT) with image-guided radiotherapy (IGRT). Four patients with previous elective subpectoral breast augmentation were enrolled on this APBIMRT trial. These four patients were treated with 10 equal twice daily 3.85 Gy fractions over 5 consecutive days (total dose of 38.5 Gy) using APBIMRT and IGRT. Patients were assessed for pain and cosmetic outcome (physician and a patient self-assessment). At last follow-up, two patients reported an excellent cosmetic results (at 2 years and at 8 months, respectively), one reported good cosmetic results (at 2 years), and one reported poor cosmetic results (at 20 months). Physicians rated the cosmetic outcomes as excellent in two (CEL; at 2 years and 8 months, respectively), good in one (CEL; at 20 months) and excellent in one (KTH; at 2 years). Three patien...
Abdominal hernias are a common clinical entity and can be a diagnostic challenge. Sonographic eva... more Abdominal hernias are a common clinical entity and can be a diagnostic challenge. Sonographic evaluation can provide not only realtime diagnosis of a potential hernia, but this modality also offers the added advantage of dynamic maneuvers. Consequently, hernia contents as well as reducibility, can be determined. Ultrasound should be the primary modality for evaluation of suspected abdominal wall hernias.
ABSTRACT Biometric measurements of the first trimester embryo are accurate in obtaining gestation... more ABSTRACT Biometric measurements of the first trimester embryo are accurate in obtaining gestational age information, providing the obstetrician with important data in pregnancy management. We evaluated 92 embryos conceived following in vitro fertilization and embryo replacement by measurement of fetal crown—rump length. Comparison to standard tables currently available showed that the actual age of these embryos were underestimated by the available information. Our table provides for adjustment of standard measured ages with 95% confidence, allowing an estimate of the youngest as well as the oldest an embryo might actually be. Until new information by endovaginal scanning is available on embryos with known gestational ages by in vitro fertilization, this may be the most practical way of assessing first trimester gestational age.
The primary objective is to examine patient self‐assessment of breast pain and cosmesis between t... more The primary objective is to examine patient self‐assessment of breast pain and cosmesis between three‐dimensional (3D‐CRT) versus intensity‐modulated radiotherapy (IMRT). The secondary objective is to evaluate any relationship of treatment planning conformality of both cohorts to patient‐assessed pain. Assessments were performed at interim 12, 24, 36, and 48 months with a final 5‐year assessment.
We assessed multiple readers' positive predictive values (PPVs) for ACR BI-RADS 3, 4a, 4b, 4c... more We assessed multiple readers' positive predictive values (PPVs) for ACR BI-RADS 3, 4a, 4b, 4c and 5 masses on ultrasound (US) pre- and post-proposed guidelines. This retrospective, IRB-approved study included four American and four non-American readers who assigned BI-RADS categories for US images of 374 biopsy-proved masses. Readers were offered guidelines and re-classified the masses. We assessed readers' abilities to achieve ACR benchmarks BI-RADS categories pre- and post-guidelines. PPVs increased with BI-RADS category. The PPVs pre- and post-guidelines were 6.0% and 4.4% for category 3, 27.3% and 30.5% for category 4a, 49.9% and 51.5% for category 4b, 69.0% and 67.4% for category 4c, and 79.3% and 80.1% for category 5. Readers achieved the PPV benchmark for category 4c, but not for categories 3, 4a, 4b and 5, with no significant improvement after guidelines. Regular BI-RADS 4 subcategory users missed benchmarks by less than non-regular users. Pre- and post-guidelines, r...
Sentinel node analysis represents a significant advance in the diagnosis and treatment of invasiv... more Sentinel node analysis represents a significant advance in the diagnosis and treatment of invasive breast cancer. The traditional crude method of full axillary dissection for assessing the status of the axillary nodes can now be discarded in favor of the much more elegant and modern approach of minimally invasive sentinel node analysis and its attendant elimination of the morbidity of traditional axillary node dissection. The many impediments to and pitfalls in the technique of sentinel node analysis, however, must be recognized and overcome for the procedure to be reliable and consistently successful. The use of ultrasound and a smaller particle size can help overcome many of these pitfalls. Because ultrasound identification of the axillary sentinel node in patients with invasive breast cancer is possible, it may allow for percutaneous excision of these nodes in the future (Fig. 8). Combining percutaneous excision and ablation of the primary breast carcinoma with percutaneous excision of the sentinel node allows for the nonsurgical treatment of small breast cancers in the future. The modern breast radiologist should be at the forefront of these advances.
To review the authors' experience with patients who presented with breast lumps and had norma... more To review the authors' experience with patients who presented with breast lumps and had normal mammograms and normal sonograms. The findings from 600 lumps in 486 women with no focal ultrasonographic (US) mass or mammographic finding in the area of clinical concern were retrospectively studied. Evaluated parameters included the individual reporting the lump, qualitative descriptors for the physical finding, mammographic density, US characteristics in the area of concern, whether there was a change in imaging and/or physical examination results, and whether there were diagnostic biopsy findings at follow-up. The study group included 540 lumps in 435 women who had a minimum mammographic and clinical follow-up of 2 years, as well as 60 additional lumps in 51 patients who underwent biopsy. No patient in the nonbiopsy group developed carcinoma at the initial site of concern during a mean mammographic and clinical follow-up period of 43 months, and all biopsy specimens were benign (ne...
To examine the outcome of breast cancer patients who have prior breast augmentation treated with ... more To examine the outcome of breast cancer patients who have prior breast augmentation treated with lumpectomy followed by accelerated partial breast external intensity-modulated radiotherapy (APBIMRT) with image-guided radiotherapy (IGRT). Four patients with previous elective subpectoral breast augmentation were enrolled on this APBIMRT trial. These four patients were treated with 10 equal twice daily 3.85 Gy fractions over 5 consecutive days (total dose of 38.5 Gy) using APBIMRT and IGRT. Patients were assessed for pain and cosmetic outcome (physician and a patient self-assessment). At last follow-up, two patients reported an excellent cosmetic results (at 2 years and at 8 months, respectively), one reported good cosmetic results (at 2 years), and one reported poor cosmetic results (at 20 months). Physicians rated the cosmetic outcomes as excellent in two (CEL; at 2 years and 8 months, respectively), good in one (CEL; at 20 months) and excellent in one (KTH; at 2 years). Three patien...
Abdominal hernias are a common clinical entity and can be a diagnostic challenge. Sonographic eva... more Abdominal hernias are a common clinical entity and can be a diagnostic challenge. Sonographic evaluation can provide not only realtime diagnosis of a potential hernia, but this modality also offers the added advantage of dynamic maneuvers. Consequently, hernia contents as well as reducibility, can be determined. Ultrasound should be the primary modality for evaluation of suspected abdominal wall hernias.
ABSTRACT Biometric measurements of the first trimester embryo are accurate in obtaining gestation... more ABSTRACT Biometric measurements of the first trimester embryo are accurate in obtaining gestational age information, providing the obstetrician with important data in pregnancy management. We evaluated 92 embryos conceived following in vitro fertilization and embryo replacement by measurement of fetal crown—rump length. Comparison to standard tables currently available showed that the actual age of these embryos were underestimated by the available information. Our table provides for adjustment of standard measured ages with 95% confidence, allowing an estimate of the youngest as well as the oldest an embryo might actually be. Until new information by endovaginal scanning is available on embryos with known gestational ages by in vitro fertilization, this may be the most practical way of assessing first trimester gestational age.
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