Biomedical subjects

D D Adler

Publications and source records attributed to D D Adler.

At least 37 records · Page 2Linked to original sources

PubMed1994

Digitization requirements in mammography: effects on computer-aided detection of microcalcifications.

We have developed a computerized method for detection of microcalcifications on digitized mammograms. The program has achieved an accuracy that can detect subtle microcalcifications which may potentially be missed by radiologists. In this study, we evaluated the dependence of the detection accuracy on the pixel size and pixel depth of the digitized mammograms. The mammograms were digitized with a laser film scanner at a pixel size of 0.035 mm x0.035 mm and 12-bit gray levels. Digitization with larger pixel sizes or fewer number of bits was simulated by averaging adjacent pixels or by eliminating the least significant bits, respectively. The SNR enhancement filter and the signal-extraction criteria in the computer program were adjusted to maximize the accuracy of signal detection for each pixel size. The overall detection accuracy was compared using the free response receiver operating characteristic curves. The results indicate that the detection accuracy decreases significantly as the pixel size increases from 0.035 mm x 0.035 mm to 0.07 mm x 0.07 mm (P < 0.007) and from 0.07 mm x 0.07 mm to 0.105 mm x 0.105 mm (P < 0.002). The detection accuracy is essentially independent of pixel depth from 12 to 9 bits and decreases significantly (P < 0.003) from 9 to 8 bits; a rapid decrease is observed as the pixel depth decreases further from 8 to 7 bits (P < 0.03) or from 7 to 6 bits (P < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Biophysical Phenomena↗

PubMed1994

Breast imaging.

Explore the source record for details and available documents.

Breast Neoplasms↗

PubMed1994

Breast thickness in routine mammograms: effect on image quality and radiation dose.

OBJECTIVE: The purpose of this study was to compare the thickness of the compressed breast between mediolateral oblique and craniocaudal mammograms and to relate these differences in thickness to image quality and radiation dose. These differences may partially explain why some subtle tumors are better visualized on the craniocaudal view. SUBJECTS AND METHODS: The study population consisted of 250 paired mediolateral oblique and craniocaudal mammograms obtained on one mammographic unit by seven certified mammography technologists during a 2-month period. Only women with breast implants, prior lumpectomy and radiotherapy, or chest wall deformity were excluded. The digital readout of compressed breast thickness and applied compression force was recorded. Mammographic positioning was assessed using standard criteria. Absorbed radiation dose at different thicknesses was measured with a BR-12 breast phantom. Image quality differences for geometric unsharpness and contrast were calculated for the observed breast thickness differences between mediolateral oblique and craniocaudal mammograms. RESULTS: The mean thickness of the compressed breast on the craniocaudal view was less than the mean thickness on the mediolateral oblique view (4.4 versus 4.8 cm, p < .0001) despite the greater force used to compress the breast for mediolateral oblique than for craniocaudal views (93 versus 86 newtons, p < .0001). The breast thickness on the mediolateral oblique view exceeded that on the craniocaudal view in 98 (84%) of 117 pairs that differed in thickness by 5 mm or more and 46 (94%) of 49 pairs that differed by 10 mm or more (p < .0001). Geometric unsharpness increased by 8% and 19% when a 4.4-cm-thick breast was compared to a 4.8- and 5.4-cm-thick breast, respectively. A 5% and 12% loss of contrast was noted when a 4.4-cm-thick breast was compared to a 4.8- and 5.4-cm-thick breast. Mean glandular radiation dose at 4.4, 4.8, and 5.4 cm was 1.40, 1.70, and 2.33 mGy, respectively. CONCLUSION: The compressed breast is 8% thicker on mediolateral oblique than on craniocaudal mammograms, a small but statistically significant difference. This difference results in a small loss of spatial and contrast resolution on the mediolateral oblique views and an increase in radiation dose. These image quality differences may partially explain why some subtle carcinomas are better visualized on the craniocaudal view.

Adult↗

PubMed1993

Benefits of a multidisciplinary approach to breast care.

The University of Michigan Breast Care Center (BCC) was established in 1985 to provide comprehensive, multidisciplinary diagnosis and treatment of benign and malignant breast disease. This work presents an overview of our experience in the BCC and assesses the clinical, academic, financial, and educational effectiveness of the program. A database was used to generate a list of all patients seen in the BCC between February 1, 1985 and December 31, 1991. Participating departments provided information regarding outpatient, inpatient, clinical and consultative activities, and referral patterns attributable to BCC endeavors. BCC educational and academic activities were reviewed and profiled. Clinical information was culled from the BCC database, hospital records, and the hospital tumor registry. The BCC has resulted in a fivefold increase in breast care related activity at the University of Michigan Medical Center. Over half of the patients treated in the BCC with primary operable breast cancer receive breast-conserving therapy. The BCC performs a unique educational function, providing the primary breast care experience for house staff as well as one third of the third year medical school class. The BCC supports over 20 clinical research protocols, and patient enrollment in clinical trials has increased dramatically since 1985. The BCC also provides support to basic science researchers receiving over 2.5 million dollars in peer reviewed direct cost support. These data suggest that a multidisciplinary approach to patient care as embodied by the BCC can be clinically, financially, and academically superior and productive. This model warrants further investigation not only in the field of breast care, but also in other clinical situations that require multidisciplinary input and therapy.

Breast Diseases↗

PubMed1993

Invasive lobular carcinoma. Imaging features and clinical detection.

RATIONALE AND OBJECTIVES: Mammographic findings and method of detection of 52 cases of invasive lobular carcinoma (ILC), the second most common breast carcinoma, are reported. METHODS: Preoperative mammograms and clinical records of all patients with ILC not associated with a second mammary carcinoma (other than lobular carcinoma in situ) from 1979-1991 at the authors' institution were retrospectively reviewed. RESULTS: Abnormal mammographic findings were present in 48/52 (92%) and included irregular spiculated masses (33/52, 63%), asymmetric densities (7/52, 13%), architectural distortion (5/52, 10%), microcalcifications (2/52, 4%), and well circumscribed masses (1/52, 2%). The mean mammographic diameter was 2.1 cm. The tumor was most often best visualized in the craniocaudal projection. At the time of diagnosis, 54% of women had coexistent suggestive breast physical findings and 35% had metastatic carcinoma in axillary lymph nodes. CONCLUSIONS: The infrequency of microcalcifications in pure ILC may hinder mammographic detection and contrasts markedly with ductal carcinoma. Mammography and breast physical examination play complementary roles in the detection of ILC.

Adult↗

PubMed1993

Tubular carcinoma of the breast: mode of presentation, mammographic appearance, and frequency of nodal metastases.

OBJECTIVE: Tubular carcinoma of the breast is a distinct, well-differentiated histologic subtype of infiltrative adenocarcinoma. The purpose of this study was to determine the typical mode of presentation, mammographic appearance, and frequency of metastases to the axillary lymph nodes. MATERIALS AND METHODS: We retrospectively analyzed the clinical records, mammograms, and histologic slides of 20 cases of proved tubular carcinoma of the breast in 20 women. These patients were identified by computerized search of our pathology data base from 1984 to 1993. Histologic findings were reviewed in all cases and correlated with the mammographic findings. RESULTS: Thirteen (65%) of the 20 women had impalpable tubular cancers discovered on screening mammograms. Seven patients (35%) had mammography because of a palpable tumor. Abnormalities were seen on mammograms in 16 patients (80%). These consisted of a mass alone in 13 (65%), a mass with microcalcifications in two (10%), and calcifications associated with architectural distortion and asymmetric density in one (5%). Most masses (11/15, 73%) were irregular or spherical and had spiculated margins. The size of the masses ranged from 3 to 19 mm (median, 8 mm). Metastatic carcinoma was found in the axillary lymph nodes of four (29%) of 14 patients who had axillary lymph node dissections, three of whom had a primary tumor 1 cm or less in diameter. CONCLUSION: Tubular cancers were most frequently detected as impalpable abnormalities seen on mammograms, emphasizing the importance of screening mammography. However, tubular carcinomas did not have a unique appearance on mammograms that would allow differentiation from other carcinomas. Lymph node metastases were more common than has been previously reported for this type of tumor, indicating that axillary lymph node dissections should continue to be performed.

Adenocarcinoma↗

PubMed1992

The role of fine-needle aspiration and pneumocystography in the treatment of impalpable breast cysts.

Prior studies have suggested that the recurrence rate is lower in breast cysts treated by pneumocystography (injection of air into cyst cavities after cyst aspiration) than in cysts treated by fine-needle aspiration alone. To determine if this is the case for impalpable breast cysts, we reviewed the hospital records and mammograms of 38 women with 41 impalpable cysts. Mammograms obtained immediately after aspiration show that pneumocystography was successful in 18 and unsuccessful in 20 of the 41 cysts. Four cysts were excluded from the study: one cyst that recurred after aspiration and was sampled by biopsy and three cysts for which immediate post-aspiration mammograms were unavailable but which had recurred or persisted 3 years after aspiration. Review of follow-up mammograms made 4 months to 3 years after the aspiration showed that three (17%) of 18 cysts in the group with successful pneumocystography recurred and 11 (58%) of 19 cysts in the unsuccessful group recurred (p = .02). No difference was found in the number of recurrent cysts in relation to estrogen therapy or menopausal status. Our results indicate that impalpable breast cysts treated by pneumocystography are less likely to recur than are cysts treated by aspiration alone.

Adult↗

PubMed1992

Solitary breast papilloma: comparison of mammographic, galactographic, and pathologic findings.

OBJECTIVE: Our purpose was to determine the mammographic/galactographic features of solitary breast papillomas and to correlate these features with the pathologic findings. MATERIALS AND METHODS: Retrospective review of pathology files revealed 72 women in whom breast biopsy reports described a solitary papilloma. All patients with additional pathologic abnormalities were excluded from this study. Patients meeting the pathologic criteria and for whom mammograms, galactograms, or both were available and had been obtained within 6 months before biopsy were included. Twenty-four women met these criteria and form the basis of this study. Presenting clinical signs and symptoms were reviewed. Abnormal mammographic/galactographic findings were correlated with pathologic features. RESULTS: Nipple discharge was present in 21 (88%) of 24 patients, two (8%) of 24 patients had abnormal findings on screening mammography, and one patient had a palpable mass that was visible on mammograms. Eight (42%) of 19 mammograms had abnormal findings, including dilated duct(s) in five cases (26%), nodules in two cases (11%), and microcalcifications in one case (5%). All technically adequate galactograms (13/15) had abnormal findings, with 12 (92%) of 13 showing an intraluminal filling defect. The other technically adequate galactogram (8%) showed only a solitary obstructed duct. Ductal dilatation was greatest at or central to the papilloma on 12 (92%) of 13 galactograms. Imaging features correlated well with the histologic findings. CONCLUSION: Patients with solitary papillomas most commonly have nipple discharge, normal mammographic findings, and a galactographic filling defect. Galactography is useful for localizing papillomas.

Adult↗

PubMed1992

Enhanced color flow imaging of breast cancer vasculature: continuous wave Doppler and three-dimensional display.

Two methods of potentially improving the detection and assessment of breast cancer vasculature by color flow Doppler ultrasonography were studied. Use of continuous wave (CW) Doppler imaging was one method evaluated by a comparison of system sensitivity to small vessel flow by continuous wave and pulsed Doppler methods. The second technique demonstrated color flow image acquisition and three-dimensional (3D) display. Six breast cancer patients were examined with both a color flow pulsed system and a CW Doppler system employing a hand-held transmitter-receiver pair with crossed-beam patterns. The CW unit consistently revealed more regions of tumor flow and multidirectional flow. Good 3D displays were achieved on larger pulsatile vessels, from images obtained during systole and selected for minimal noise.

Adenocarcinoma↗

PubMed1992

Mammographic biopsy recommendations.

Breast biopsy recommendations are commonly made on the basis of mammographic findings. Benign breast biopsies secondary to false positive mammographic interpretation remain a major source of discussion. A review of recent series of biopsy results is presented and the factors influencing positive predictive value are discussed. Methods to improve mammographic specificity, including validity of certain mammographic signs such as mass density are summarized. Issues relating to lesions followed on mammography--including number of views, compliance, and patient anxiety--are also addressed.

Biopsy, Needle↗

PubMed1991

Mammographic follow-up of low-suspicion lesions: compliance rate and diagnostic yield.

All recommendations for mammographic follow-up of low-suspicion lesions seen at mammography during a 6-month period were reviewed to establish compliance rate and eventual outcome. One hundred forty-four of 2,650 mammograms (5%) showed minimal abnormalities that warranted short-term and periodic mammographic follow-up. Rates of compliance at 4 months and at 1, 2, and 3 years were 88%, 71%, 60%, and 47%, respectively. Progressive mammographic change was found in 10 patients, only one of whom had a carcinoma. It was concluded that mammographic follow-up of low-suspicion lesions is a reasonable alternative to surgical biopsy, although patient compliance remains a significant problem.

Biopsy↗

PubMed1991

Localization and needle aspiration of breast lesions: complications in 370 cases.

A prospective study of the immediate complications of 370 consecutive breast-imaging procedures (203 wire localizations and 167 radiographically or sonographically guided fine-needle aspirations) is reported. Vasovagal reactions occurred in 27 (7%) of 370 cases, ranging in severity from syncope (four of 370, 1%) to mild light-headedness. These vasovagal reactions were independent of procedure type or use of local anesthesia, but were more common in younger patients. Other complications included prolonged (5 min or longer) bleeding (three of 370, 1%) and extreme pain (two of 370, 1%). One patient was found to have malignant hypertension. We conclude that wire localizations and imaging-guided aspirations are generally well tolerated procedures. However, vasovagal reactions are frequent enough to warrant close observation of patients. Radiologists and breast-imaging personnel should be able to recognize and treat vasovagal reactions.

Adult↗

PubMed1991

Quantitative sonographic parameters as a means of distinguishing breast cancers from benign solid breast masses.

Ultrasound examinations of solid breast masses were reviewed retrospectively to determine whether quantitative data of their dimensions could distinguish benign from malignant tumors. Forty-nine fibroadenomas and 30 carcinomas with cytologic or histologic proof were identified. No significant difference was found between carcinomas and fibroadenomas when comparing the average ratio of length to anteroposterior (L/AP) diameter or the mean ratio of anteroposterior diameter to transverse diameter (AP/T). In this limited series, quantification of the degree of mass elongation along the natural breast tissue planes had low sensitivity in distinguishing malignant from benign tumors.

Adenofibroma↗

PubMed1990

Doppler ultrasound color flow imaging in the study of breast cancer: preliminary findings.

A prospective study of the Doppler color flow features of 55 proved breast cancers was performed. On a three-level scale of low to marked vascularity, visual assessment of the color flow images classified 82% of the cancers as moderately or markedly vascular (minimal: 14%, moderate: 29%, marked: 53%). Four percent of the cancers had no detectable flow. In 29 women, a volume of tissue comparable to the cancer was scanned in the contralateral normal breast. Sixty-nine percent of the normal breasts had moderate or marked vascularity (minimal: 28%, moderate: 41%, marked: 28%), and 3% were avascular. There was poor distinction between normal tissues and cancer which suggests that more sensitive Doppler methods than were employed in this study may be needed in order to detect the small vessel flow reported to be rather specific for malignancy. The high, 82%, detection rate of tumor vessels in this study suggests the potential use of color flow Doppler for directing more specific but lengthy Doppler procedures.

Adult↗

PubMed1990

Mammographic detection of breast cancer in women under the age of 35.

There have been few studies of the radiographic findings of breast cancer in young women. We report our series of 42 cancers in 39 women under the age of 35 who had a mammogram prior to biopsy. Abnormal findings were present on 86% of the mammograms with 94% of the abnormalities classified as high or intermediate suspicion. Mammographic findings were: mass in 50%, calcifications in 31%, diffuse inflammatory changes in 11%, and an asymmetric density in 8%. Six of the mammograms were normal. While young women are usually expected to have dense breasts, 23 mammograms showed either entirely fatty or mixed fatty/glandular tissue. Dense parenchyma infrequently obscured a palpable malignancy. We conclude that mammography can provide important diagnostic information in young women with breast cancer.

Adult↗

PubMed1990

Radiographically guided fine-needle aspiration of nonpalpable breast lesions.

Radiographically guided fine-needle aspiration (X-FNA) in 215 nonpalpable, mammographically detected breast lesions was performed by means of a coordinate-grid localization system. Aspirates were categorized either into four cytologic groups or as simple cysts. Based on the most stringent cytologic criteria, the maximum sensitivity for detection of carcinoma was 97% and the specificity was 94%. However, according to these strict cytologic criteria, only 46% of aspirates contained representative material. Based on less stringent cytologic criteria, the maximum sensitivity was 68% and the specificity was 97%. Forty-one of 74 lesions proved to be malignant at biopsy. Thirty-four patients did not complete adequate mammographic follow-up. High sensitivity and specificity can be achieved with X-FNA. However, management decisions ultimately require integration of mammographic findings with cytologic results. Close cooperation among mammographer, surgeon, cytopathologist, and patient is mandatory for successful results.

Biopsy, Needle↗

PubMed1990

Radial sclerosing lesion of the breast: mammographic features.

The authors present the clinical, mammographic, and pathologic findings in seven patients with radial sclerosing lesions (RSLs) who had a nonpalpable stellate lesion at mammography. Although the radiographic findings were suggestive of RSL in six of seven patients, diagnostic excisional biopsy was recommended for all. One RSL had associated microcalcifications localized in contiguous adenosis. The authors did not find this a useful criterion to differentiate RSL from carcinoma. Similarly, the presence of either a lucent or dense central core was not radiographically diagnostic. Surgical excision of these stellate lesions is therefore required.

Breast↗

PubMed1990

Breast carcinoma in young women previously treated for Hodgkin disease.

The increased risk of a second malignant neoplasm developing after treatment for Hodgkin disease is well documented. Subsequent development of breast cancer in women who have been treated for Hodgkin disease is a relatively rare association. To date, no reports of the mammographic detection of breast cancer in this group of women have been published. We report six patients who developed seven breast cancers after treatment for Hodgkin disease. The average age of the women at the time of diagnosis of breast cancer was 33.5 years; diagnosis was made 10-23 years after treatment. There appears to be an increased prevalence of breast carcinoma in women who have been treated for Hodgkin disease. This association should receive further study to evaluate appropriate modifications in routine breast cancer screening for these women.

Adult↗