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Screening mammography behavior in women with screening and interval breast cancers
ABSTRACTS 1-5
"Hands On" Experience in the Animal Lab for the Practicing Radiologist
Vol. 2, No. 12, December 1995
2-1
Daniel P. Link, M.D., J. Anderson, M.D., F.A. Osterman, Jr., M.D., A.C. Venbrux, M . D . U . C . Davis Medical Center; Johns Hopkins.
PURPOSE: lnterventional Radiology is a rapidly changing specialty where progress is dependent on learning new skills. The purpose of this study was to asses training of practicing radiologists utilizing the animal lab with prospective, structured curriculum. MATERIAL AND METHODS: Between 10 and 20 radiologists participating in a visiting fellowship program voluntarily came to the animal lab for the training session. Microcathetur techniques and embolizatioo stents, fillings, hollow viscous puncture and biliary access were performed utilizing the training protocol. Immediate and long term follow-up by phone was obtained to evaluate the skills acquked in the laboratory and what impact these skills made on their practice. R E S U L T S : All participating radiologists showed rapid skill acquisition. The structure of the experience allowed for maximum training per animal. An analysis of specific skills required for each task suggests that many of the tasks ean be emulated and evaluated with computerized simulation.
Mammoscintigraphy with Tc99m Sestamibi J. Villanueva-Meyer, M.H. Leonard, Jr., E. Briscoe, F. Cesani, S. Ali, M. Hove, D. Cowan. University of Texas Medical Branch.
The myocerdia[ imaging agent Tc-99m Seslamibi concentrates in breast cancer cells in vitro nine times more than in normal cells. We studied 52 patientswith abnormal mammograms. After obtaining informedconsent the patients received20 mCi of Tc99m-sestamibi IV. Planar images were gathered within 30 minutes of the ir~jection.The studies were interpreted as + or - for focal increased uptake. Ratios betweenthe abnormal increased uptake and adjacent normal tissues were calculated. Confirmatory pathologic diagnoses from open biopsy or mastectomy were obtained within two months. For focal increased uptake in the breast we report e sensitivity of 82%, specificity of 95%, positive predictivevalue of 96% and negativepredictivevalue of 76% The tumor to background ratio was 2.1 _+0.6, range 1.2 to 3.5 in 29 patients. Six patients with a malignancy had negative scans. Hypotheses for non-visualization include everexpression of the multidrug resistance gene, small size of the tumor and absence of stromal reaction. Only one of the 20 patients with benign lesions had an abnormal scan. Mammoscthtigraphy has a high 'sensitivity and specificity for the non-invasive diagnosis of breast cancer. In the proper context this study can be a valuable complement to mammography.
CONCLUSION: Skill, training and retraining are very important aspects of developing the specialty ofinterventional radiology. This represents the first attempt to stracture this process and assess this impact of such training.
2-2
Screening Mammography Behavior in Women with Screening and Interval Breast Cancers Cullen Ruff, M.D., Bonnie C. Yankaskas, Ph.D., Etta D. Pisano, M.D. University of North Carolina.
Objective: The objeetive of this study was to evaluate whether compliance with screening guidelines was more likely to be related to cancers identified at a regular screening exam when compared to nonscreen detected cancers. Methods: A case-control study was conducted. All breast cancers from 1988-1992, and additional hospital patients from 1993 were identified from a university hospital and a large private practice. Women were included if there was evidence of a screening mammogram any time previous to the detection of the cancer. Time from the screening mammogram to the cancer was calculated to dsterrrdne if the woman was in compliance with guidelines. The two groups were compared on percent compliance, tumor type and stage of disease. Results: Them were 347 women included, 243 cancers detected by screening mammogram and 104 non-screnn detected. Fourteen percent of the screen cancers occurred in women under 50 compared to 22% percent of the non-screen cancers (p=0.087). Among the women under 50, screening compllanee was identical in both cancer groups: 65% complying with screening guidelines, whether screen detected or non-screen detected. In the older women, compliance for having been screened within 12 months and within t5 months was 19% and 55% for women with screen detected, and 26% and 55% for women with non-screen detected cancers. No differences were found in cancer type, or stage. Conehadons: No difference was identified when comparing screening behavior or cancer type between women with cancers ~letected at regular screening exams compared to women appearing with a nonscreen detected cancer.
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Pitfalls in Ultrasound Evaluation of Patients with Breast Silicone Gel Implants Neela Lamki, M.D., Robert S. Malone, M.D., Alfred B. Watson, Jr., M.D., Larry A. Schwartz, M.D. Baylor College of Medicine.
l~'por¢: To identify pitfalls in ultrasound evaluation of patients with breast silicone gel implants and to find means of avoiding them. Methods: Thisstudy is based on our experiencein performingand interpretingultrasoundimaging in 1000 pafients who have had breast implant surgery performed. The scans were performed using an Acoustic Imaging 5200 (Phenaix, AZ.) with either a 5.0 Mhz or 7.5 lvIhz tmnsducex. The ultrasound findings w e ~ coffela~d with pathological findings following surgical ¢~plantafion in more than 200 of these patients. Results: Several conditions wexe encountered that mimic rupture and therefore represent potential pitfalls and we term these ~pseudo ruptures". These include: radial folds, double lumen implant, ribs and costal cartilage, implant with dacron patch, polyurethane coated implant, saline implant, sdmple breast cyst, o~Wal venous infusion port, volume adjustment valve and breast cancer. The paper will illustrate and contrast these with tree rupture or variations of normal. Conclusions: Idenfificalinn of true rupthre and diffemahafion from ~pseudo rupture~ is enl~mdy important consid~ing the Im~eat reputation of these implants in our society, lJ~ans of identifying thas¢pitfalls will be disphyed.
"Hands On" Experience in the Animal Lab for the Practicing Radiologist
Vol. 2, No. 12, December 1995
2-1
Daniel P. Link, M.D., J. Anderson, M.D., F.A. Osterman, Jr., M.D., A.C. Venbrux, M . D . U . C . Davis Medical Center; Johns Hopkins.
PURPOSE: lnterventional Radiology is a rapidly changing specialty where progress is dependent on learning new skills. The purpose of this study was to asses training of practicing radiologists utilizing the animal lab with prospective, structured curriculum. MATERIAL AND METHODS: Between 10 and 20 radiologists participating in a visiting fellowship program voluntarily came to the animal lab for the training session. Microcathetur techniques and embolizatioo stents, fillings, hollow viscous puncture and biliary access were performed utilizing the training protocol. Immediate and long term follow-up by phone was obtained to evaluate the skills acquked in the laboratory and what impact these skills made on their practice. R E S U L T S : All participating radiologists showed rapid skill acquisition. The structure of the experience allowed for maximum training per animal. An analysis of specific skills required for each task suggests that many of the tasks ean be emulated and evaluated with computerized simulation.
Mammoscintigraphy with Tc99m Sestamibi J. Villanueva-Meyer, M.H. Leonard, Jr., E. Briscoe, F. Cesani, S. Ali, M. Hove, D. Cowan. University of Texas Medical Branch.
The myocerdia[ imaging agent Tc-99m Seslamibi concentrates in breast cancer cells in vitro nine times more than in normal cells. We studied 52 patientswith abnormal mammograms. After obtaining informedconsent the patients received20 mCi of Tc99m-sestamibi IV. Planar images were gathered within 30 minutes of the ir~jection.The studies were interpreted as + or - for focal increased uptake. Ratios betweenthe abnormal increased uptake and adjacent normal tissues were calculated. Confirmatory pathologic diagnoses from open biopsy or mastectomy were obtained within two months. For focal increased uptake in the breast we report e sensitivity of 82%, specificity of 95%, positive predictivevalue of 96% and negativepredictivevalue of 76% The tumor to background ratio was 2.1 _+0.6, range 1.2 to 3.5 in 29 patients. Six patients with a malignancy had negative scans. Hypotheses for non-visualization include everexpression of the multidrug resistance gene, small size of the tumor and absence of stromal reaction. Only one of the 20 patients with benign lesions had an abnormal scan. Mammoscthtigraphy has a high 'sensitivity and specificity for the non-invasive diagnosis of breast cancer. In the proper context this study can be a valuable complement to mammography.
CONCLUSION: Skill, training and retraining are very important aspects of developing the specialty ofinterventional radiology. This represents the first attempt to stracture this process and assess this impact of such training.
2-2
Screening Mammography Behavior in Women with Screening and Interval Breast Cancers Cullen Ruff, M.D., Bonnie C. Yankaskas, Ph.D., Etta D. Pisano, M.D. University of North Carolina.
Objective: The objeetive of this study was to evaluate whether compliance with screening guidelines was more likely to be related to cancers identified at a regular screening exam when compared to nonscreen detected cancers. Methods: A case-control study was conducted. All breast cancers from 1988-1992, and additional hospital patients from 1993 were identified from a university hospital and a large private practice. Women were included if there was evidence of a screening mammogram any time previous to the detection of the cancer. Time from the screening mammogram to the cancer was calculated to dsterrrdne if the woman was in compliance with guidelines. The two groups were compared on percent compliance, tumor type and stage of disease. Results: Them were 347 women included, 243 cancers detected by screening mammogram and 104 non-screnn detected. Fourteen percent of the screen cancers occurred in women under 50 compared to 22% percent of the non-screen cancers (p=0.087). Among the women under 50, screening compllanee was identical in both cancer groups: 65% complying with screening guidelines, whether screen detected or non-screen detected. In the older women, compliance for having been screened within 12 months and within t5 months was 19% and 55% for women with screen detected, and 26% and 55% for women with non-screen detected cancers. No differences were found in cancer type, or stage. Conehadons: No difference was identified when comparing screening behavior or cancer type between women with cancers ~letected at regular screening exams compared to women appearing with a nonscreen detected cancer.
1 138
2-3
Pitfalls in Ultrasound Evaluation of Patients with Breast Silicone Gel Implants Neela Lamki, M.D., Robert S. Malone, M.D., Alfred B. Watson, Jr., M.D., Larry A. Schwartz, M.D. Baylor College of Medicine.
l~'por¢: To identify pitfalls in ultrasound evaluation of patients with breast silicone gel implants and to find means of avoiding them. Methods: Thisstudy is based on our experiencein performingand interpretingultrasoundimaging in 1000 pafients who have had breast implant surgery performed. The scans were performed using an Acoustic Imaging 5200 (Phenaix, AZ.) with either a 5.0 Mhz or 7.5 lvIhz tmnsducex. The ultrasound findings w e ~ coffela~d with pathological findings following surgical ¢~plantafion in more than 200 of these patients. Results: Several conditions wexe encountered that mimic rupture and therefore represent potential pitfalls and we term these ~pseudo ruptures". These include: radial folds, double lumen implant, ribs and costal cartilage, implant with dacron patch, polyurethane coated implant, saline implant, sdmple breast cyst, o~Wal venous infusion port, volume adjustment valve and breast cancer. The paper will illustrate and contrast these with tree rupture or variations of normal. Conclusions: Idenfificalinn of true rupthre and diffemahafion from ~pseudo rupture~ is enl~mdy important consid~ing the Im~eat reputation of these implants in our society, lJ~ans of identifying thas¢pitfalls will be disphyed.