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D B Kopans

Publications and source records attributed to D B Kopans.

At least 19 recordsLinked to original sources
PubMed1996

Computed tomography-guided needle localization of nonpalpable breast lesions: review of 24 cases.

RATIONALE AND OBJECTIVES: We examined the role of computed tomography (CT) in breast imaging, especially in guiding needle localization procedures. METHODS: We reviewed our institution's breast imaging database, from 1978 to 1994, for procedures in which CT scanning was used. Twenty-four CT-guided needle localizations were identified. Medical records, mammograms, CT scans, and pathology reports were reviewed for all patients. RESULTS: Twenty-four needle localizations were performed on 22 female patients. The average size of the lesions localized was 12 mm. The most common reason for CT scanning was the inability to image a suspicious density by conventional mammography on two orthogonal views. Nine malignant and 15 benign lesions were localized under CT guidance. One patient developed a postoperative hematoma. No other complications occurred. CONCLUSION: CT-guided breast localization is a reliable technique that may be used to define selected breast lesions that are difficult to triangulate or localize by conventional two-view mammography.

Aged↗
PubMed1996

Positive predictive value of breast biopsy performed as a result of mammography: there is no abrupt change at age 50 years.

PURPOSE: To determine if the positive predictive value (PPV) of a biopsy initiated because of an abnormal mammogram changes abruptly at age 50 years. MATERIALS AND METHODS: The PPV and its variation with age was analyzed for 4,778 women who underwent biopsy for a clinically occult abnormality detected at mammography. The relationship of the results to the patient's age was analyzed with age represented as a continuous and two-categorized (< 50, > 50) measure. The latter measure represented an abrupt change, which distinguished those aged 49 years and younger from those aged 50 years and over. With this measure, the patients in each of the two age groups were statistically indistinguishable. RESULTS: The results were consistent with a steady increase in PPV and the yield of cancers with age, and there was no abrupt change at age 50 years. The modeled PPV for all cancers for these 4,778 patients was approximately 12% for women aged 40 years and increased to 46% by age 79 years. CONCLUSION: The PPV did not change abruptly at any age for women aged 40-79 years but increased steadily, which reflects the prior probability of breast cancer at each age. Inappropriate grouping of data can lead to misinterpretation of results. Screening guidelines should not be predicated on the false assumption that this variable changes at age 50 years.

Adult↗
PubMed1996

The sternalis muscle: an unusual normal finding seen on mammography.

OBJECTIVE: We studied the appearance of the sternalis muscle on mammography and on CT and MR imaging. To our knowledge, this is the first description of this normal anatomic variant. An approach is provided that permits differentiation of the sternalis from significant pathology. SUBJECTS AND METHODS: Between January 1992 and December 1994, four women of an estimated 32,000 who had mammograms at the Massachusetts General Hospital had an unusual, irregular structure visible medially on the craniocaudal projection that posed a diagnostic dilemma. The records and imaging studies of these women and two others from the Deaconess Hospital breast imaging program were reviewed to determine the etiology of the findings seen by mammography and to establish a diagnostic approach. RESULTS: Surgery in one patient and cross-sectional imaging in the other five established that the structure was the sternalis muscle. Although it may be bilateral, the sternalis muscle was visible only unilaterally on the mammograms of these six women. The appearance of the muscle ranged from an irregularly rounded density at the sternal edge of the film to flame-shaped and almost completely surrounded by fat. CT and MR imaging are diagnostic when they show the longitudinal extent of the muscle, which lies anterior to the medial margin of the pectoralis major muscle. CONCLUSION: The sternalis muscle is an unusual variant of the chest wall musculature. It may be visible as a rounded or irregular density on the craniocaudal mammogram along the sternal edge of the film. With improved mammographic positioning it will be seen more frequently. The muscle has a variety of appearances that should be familiar to the radiologist to avoid confusion with a malignant lesion. The etiology can be confirmed and cancer excluded by CT or MR imaging.

Adult↗
PubMed1996

Physicians' opinions on the delivery of mammographic screening services: immediate interpretation versus double reading.

OBJECTIVE: Mammographic services are delivered in many ways. Emphasis has been placed on providing women with immediate reports of their screening mammograms. We believe that double reading of mammograms is more important than an immediate report. We sought to determine physicians' attitudes toward this issue and if education affects their opinions. MATERIALS AND METHODS: Questionnaires were mailed to 1000 physicians in Massachusetts who were randomly selected from 16,000 members of the state medical society. The questionnaire had four sections, of which two were pertinent to this subject. The first section collected general information on the physician's practice and experience. The second section described two common delivery systems for mammographic screening services and asked physicians to choose the delivery system that would most benefit their patients. RESULTS: Of the 1000 physicians, 294 returned the questionnaire, giving a response rate of 29%. Of these, 16 physicians returned blank surveys, leaving 278 for analysis. Two hundred forty-nine (90%) valued off-site, delayed interpretation of mammographic screening for their patients over on-site reading by a single radiologist if an off-site, delayed reading made double reading possible. CONCLUSION: An off-site, double-reading delivery system for mammographic screening services is preferred by many physicians for their patients once they are educated as to the benefits of double reading.

Adult↗
PubMed1995

Mammographic screening for women aged 40 to 49 years: the primary care practitioner's dilemma.

The data from population-based, randomized trials of the mammographic screening of women aged 40 to 49 years are limited by retrospective subgroup analysis, low statistical power, and the use of older mammographic techniques. Nonetheless, meta-analysis involving the most recently reported data from all similarly designed trials shows a 21% mortality reduction in women who have had mammographic screening compared with those in control groups, a statistically significant difference (upper bound of 95% Cl, 0.98). Evidence from modern mammography demonstration projects (which are limited by a lack of control groups and the unavailability of mortality results) also shows that the tumor size, axillary lymph node status, and stage of screening-detected breast cancers in women aged 40 to 49 years indicate that screening is at least as beneficial for these women as it is for those aged 50 to 64 years, for whom mammographic screening is widely accepted. Overall, the evidence suggests that screening will benefit women aged 40 to 49 years, but some argue that the level of proof provided is not rigorous enough to establish the efficacy of screening. In the United States, more than 10,000 deaths per year occur among women who develop breast cancer between the ages of 40 and 49. Thousands of lives are probably lost each year because women are not being screened. We believe that it is much more prudent to endorse mammographic screening now, risking the unlikely subsequent determination that the effort was ineffective, than to withhold screening until it is determined whether "proof" of efficacy will be obtained, risking the loss of so many lives. We urge primary care practitioners to recommend routine mammography for women aged 40 to 49 years.

Adult↗
PubMed1995

Benign and malignant breast lesions: differentiation with echo-planar MR imaging.

PURPOSE: To quantify dynamic enhancement of breast lesions with echo-planar and conventional magnetic resonance (MR) imaging, to correlate these data with histologic findings and vessel density, and to evaluate MATERIALS AND METHODS: Twenty female patients with 22 breast lesions underwent conventional and MR echo-planar imaging T1 values, change in gadopentetate dimeglumine concentration, and extraction-flow products were calculated with echo-planar imaging data and were correlated with histologic findings and microvessel density. RESULTS: T1 values of cancers were not statistically significantly shorter. Cancers had more rapid uptake and higher extraction-flow products (P < .02). Sensitivity was 86% and specificity was 93% for diagnosis of malignancy. Microvessel density was higher for malignant lesions (P < .02) with an overall positive (not statistically significant) correlation between extraction-flow product and microvessel density. CONCLUSION: Echo-planar imaging appears promising for quantification of breast lesion enhancement. Microvessel data indicate that tumor angiogenesis affects enhancement.

Adolescent↗
PubMed1995

Problems with the American College of Radiology Standard for Diagnostic Mammography.

In an effort to help assure quality, the American College of Radiology (ACR) has developed standards for many imaging procedures. One of the most recent standards adopted is the ACR Standard for Diagnostic Mammography and Problem-Solving Breast Evaluation. Despite the fact that this Standard apparently went through a lengthy review process (although this author, a member of the Breast Cancer Task Force of the ACR, never gave his approval), it contains many unsupportable recommendations.

Breast Implants↗
PubMed1995

Mammography screening and the controversy concerning women aged 40 to 49.

The screening controversy arose from inappropriate and scientifically insupportable data analysis of the early results from the randomized, controlled trials of screening. Data were used that were inadequate for making medical recommendations by using subgroup analyses from trials that were not designed to permit subgroup analysis by age. Contrary to suggestions made by some opposed to screening women younger than the age of 50, there are no parameters such as breast density, cancer detection rate, or positive predictive value that change abruptly at age 50 or any other age. The most recent meta-analysis provides statistically significant "proof" that screening can reduce the death rate from breast cancer by at least 24% for women aged 40 to 49.

Adult↗