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Biomedical subjects

D L Monticciolo

Publications and source records attributed to D L Monticciolo.

13 recordsLinked to original sources
PubMed1999

Coding mammograms using the classification "probably benign finding--short interval follow-up suggested".

OBJECTIVE: Many benign breast lesions revealed by mammography show features indicating that the lesions have a high, but not complete, likelihood of being benign. The Breast Imaging Reporting and Data System (BI-RADS) allows radiologists to classify these mammograms as "probably benign finding-short interval follow-up suggested" (category 3). We explored whether certain factors are associated with the use of category 3 in a national cancer detection program. MATERIALS AND METHODS: We analyzed data from the National Breast and Cervical Cancer Early Detection Program, a comprehensive nationwide program that provides cancer screening for low-income and medically underserved women. The study population included all women at least 40 years old who had undergone mammography on or before September 30, 1996 (n = 372,760). RESULTS: Of the 372,760 mammograms, 7.7% were classified as category 3. The probability of receiving a category 3 classification decreased as patients' ages increased. Women who were symptomatic were nearly twice as likely as women who were asymptomatic to receive a category 3 classification, and women whose clinical breast examinations had abnormal findings were more than twice as likely as women with examinations having normal findings to receive a category 3 classification. The percentage of mammograms classified as category 3 by state or tribal organization ranged from 1.4% to 14.0%. CONCLUSION: Several patient variables, including patient symptomatology, were associated with the probability of having a mammogram classified as category 3. One of the most important determinants was where the patient underwent mammography, which suggests that variability exists among radiologists themselves in using this BI-RADS code for "probably benign" mammographic lesions.

Adult↗
PubMed1998

Fine needle aspiration biopsy of the breast: importance of benign, nonspecific results.

RATIONALE AND OBJECTIVES: The authors attempted to determine the importance of benign but nonspecific findings from an adequate sample obtained with image-guided, fine-needle aspiration biopsy (FNAB) of the breast. MATERIALS AND METHODS: Four hundred thirty-seven image-guided FNAB specimens obtained over a 4-year period were reviewed. Pathologic results, mammograms, sonograms, and radiology reports were correlated for all cases described as benign but nonspecific on the basis of cytologic results. Lesion characterization, type of imaging, and targeting accuracy were assessed. Follow-up method (imaging and/or clinical follow-up, core biopsy, open biopsy) was determined. RESULTS: Of the 427 lesions, 99 (23%) were designated benign but nonspecific. In 75 of the cases, biopsy (core or open) had been performed or there had been at least 2 years of follow-up at the time of this study. Of these, 32 lesions were benign on the basis of follow-up, 27 (36%) were benign at secondary biopsy, seven (9%) were malignant at final biopsy, and nine (12%) were lost to follow-up. Five of the seven cancers occurred in the 1st year of the study; these lesions were sampled for biopsy based on their mammographic appearance. The lesions in an additional 24 patients were benign after at least 1 year of follow-up. CONCLUSIONS: Benign, nonspecific imaged-guided FNAB results are reliable if targeting is accurate and if the mammographic findings support a benign process.

Adult↗
PubMed1996

Optimization of radiation dose and image quality in mammography: a clinical evaluation of rhodium versus molybdenum.

Mammography was done with a conventional molybdenum anode/filter combination and either a molybdenum/rhodium (Mo/Rh) or rhodium/rhodium (Rh/Rh) combination to compare the contrast characteristics and penetrating ability of the different techniques. Each pair was rated as being equal, one slightly better than the other, or one much better than the other. The "preferred" image was also selected. The entrance surface exposure and the mean glandular dose were determined for each exposure. Mo/Mo was compared with Mo/Rh in 26 patients and to Rh/Rh in 23. Mo/Mo was judged to produce better or equal contrast and penetration in all cases except one using the Mo/Rh combination. Mo/Rh was the preferred image only once and Rh/Rh not at all. In comparison to the conventional Mo/Mo technique, the average dose was reduced by approximately 25% with Mo/Rh and by 50% with Rh/Rh.

Electrodes↗
PubMed1996

Autologous breast reconstruction with endoscopic latissimus dorsi musculosubcutaneous flaps in patients choosing breast-conserving therapy: mammographic appearance.

OBJECTIVE: The objective of this study was to define and evaluate mammographic changes in patients treated with breast-conserving therapy and a new reconstructive technique that uses autologous tissue from a latissimus dorsi musculosubcutaneous flap. MATERIALS AND METHODS: Of 20 patients who underwent either immediate or delayed endoscopic latissimus dorsi muscle flap reconstruction after lumpectomy, 13 also had postsurgery mammograms available for review. Radiographic findings assessed included skin thickening, density or radiolucency at the reconstruction site, density around the flap, fat necrosis, calcifications, and the presence of surgical clips. RESULTS: Mammograms for three patients (23%) revealed thickening that we believed was attributable to radiation therapy. No patient had increased density in the flap itself; all flaps were relatively radiolucent centrally (13/13; 100%). Mammograms revealed density around the rim of the flap in four patients (31%). This density was most likely secondary to latissimus dorsi muscle fibers and did not limit radiographic evaluation. One patient had calcifications, probably secondary to fat necrosis. No oil cysts were seen. In the majority of patients (11/13; 85%), surgical clips were visible. CONCLUSION: Endoscopic latissimus dorsi muscle flap reconstruction, previously used only for mastectomy patients, is now being used for improved esthetic outcome in selected patients who desire breast conservation. Our results indicate that the mammographic findings are predictable. The most common findings are relative radiolucency centrally, with or without density from muscle fibers around the edges of the area of tissue transfer. The transplanted musculosubcutaneous flap does not interfere with mammographic evaluation.

Adult↗
PubMed1995

Discovery method and stage of breast cancer in two different patient populations.

Our purpose was to determine the discovery method and stage of newly discovered breast cancers at two different medical centers. To do this, we conducted a retrospective chart review at our urban and suburban teaching hospitals during 1991 through 1992 and 1992, respectively. Only 29 (26%) of 112 cancers at our urban hospital were discovered mammographically; 38 (38%) of 100 neoplasms were discovered using mammography at our suburban hospital. At both institutions, the mammographically discovered cancers had a lower stage than those detected clinically. Despite proven benefits and the efforts of organizations such as the American College of Radiology and the American Cancer Society, screening mammography remains underused in the patient populations that we studied.

Adult↗
PubMed1994

MR detection of leakage from silicone breast implants: value of a silicone-selective pulse sequence.

OBJECTIVE: The purpose of this study was to determine the value of MR imaging with a silicone-selective pulse sequence for detecting leakage from silicone breast implants. SUBJECTS AND METHODS: Women with silicone breast implants were referred for this study on the basis of clinical or imaging findings suggestive of implant rupture. Twenty-eight patients with 38 implants were examined with silicone-selective MR imaging and also underwent surgical removal of the studied implant. All but four also had mammography before MR imaging. Results of silicone-selective MR imaging for the detection of silicone leakage were compared with mammographic and surgical findings. Surgical proof was considered the gold standard. RESULTS: Silicone-selective MR imaging showed an apparently intact implant in 21 cases; 20 of these were found to be intact at surgery. Silicone-selective MR imaging showed evidence of leakage in 17 implants, all of which showed leakage at surgery. The sensitivity for detection of leakage was 94%; the specificity was 100%. The findings of silicone-selective MR imaging and mammography were in agreement in 30 of 34 cases in which both studies were performed. In the four cases of disagreement, surgical findings agreed with MR findings in three and with mammographic findings in one. When the findings of mammography and silicone-selective MR imaging were combined, the correct status (leakage or no leakage) of all implants examined was determinable. CONCLUSION: Silicone-selective MR imaging is highly effective for detecting leakage from silicone breast implants. Accuracy is improved when mammographic and MR findings are considered together.

Adult↗
PubMed1992

Breast ultrasonography.

Ultrasound of the breast has a role both as the primary and as an ancillary modality in the work-up of breast abnormalities. Its main role is to differentiate cystic from solid abnormalities and to thereby guide further work-up and intervention. Only the diagnosis of a simple cyst will obviate the need for further evaluation or therapy. Doppler ultrasonography of breast lesions may give further information in the future, although this is currently not employed in clinical practice. Various types of ultrasound examinations may yield useful information in the patient with breast cancer or in women with breast prostheses.

Adenofibroma↗
PubMed1990

Medical audit of a rapid-throughput mammography screening practice: methodology and results of 27,114 examinations.

Medical audit results from the entire experience of a rapid-throughput mammography screening practice are presented, comprising 27,114 examinations conducted from April 1985 to September 1989. The authors screened a self-selected physician-referred population, almost 94% of whom were asymptomatic. Estimated sensitivity of initial mammography interpretation was 93.1% with a specificity of 94.2% and a positive predictive value of 10.0%. Biopsies prompted by screening yielded a diagnosis of malignancy in 32.1% of cases; 170 breast cancers were identified, 67.1% requiring mammographic needle localization. Median cancer size was 12 mm, the rate of axillary nodal metastasis was 11.0%, and the systemic metastasis rate was 1.2%. Of the cancers found, 76.5% were stage 0 or stage 1. Conducting a medical audit is the most convincing way to demonstrate the success of a mammography screening practice, thereby providing this important information for the benefit of screenees, referring physicians, third-party payers, and the personnel who perform the screening.

Adult↗
PubMed1990

Computerized follow-up of abnormalities detected at mammography screening.

Obtaining follow-up information after abnormal interpretations is an important aspect of a mammography practice, but it can be tedious, time-consuming, and produce suboptimal results. This study demonstrates the effect of computer-generated reminders on the collection of follow-up data for patients in whom abnormalities were detected at mammography screening. From April 1985 until December 1987, follow-up data for 1009 abnormal examinations were collected by using standard procedures, supplemented by occasional searches of pathology records and sporadic letters and telephone calls to referring physicians. Results showed that follow-up was limited to a normal physical examination in 104 women (10.3%); eight other women (0.8%) were lost to follow-up. For over 90% of these inadequately followed cases, referring physicians were first contacted more than 3 months after screening. Since December 1987, follow-up data for 777 abnormal examinations were collected, supplemented by computer-generated reminders sent to referring physicians for cases apparently unresolved 3 months after screening. Only four (0.5%) of these women have had inadequate follow-up (normal physical examination alone). We conclude that use of a computer-generated reminder system prompts more timely and more appropriate patient management. It also makes follow-up data collection much less onerous.

Appointments and Schedules↗
PubMed1987

Radiologic case study. Chondroblastoma.

Chondroblastoma is a benign cartilaginous tumor nearly always found in the epiphysis of long bones. It is usually a well-defined, radiolucent lesion with a thin, sclerotic margin that varies in size from 1 cm to 4 cm; it may contain small calcifications. Most patients are 5 to 25 years of age and males predominate 2:1. The treatment of choice is curettage; a favorable prognosis is expected.

Adult↗
PubMedDate not supplied

MR imaging of silicone gel-filled breast implants in vivo with a method that visualizes silicone selectively.

The lack of an adequately sensitive method for detecting silicone leakage and reported serious complications due to silicone leakage were cited as justification by the U.S. Food and Drug Administration for imposing the current restrictions on silicone gel-filled breast prostheses. The authors report a new magnetic resonance imaging method for visualizing silicone leakage: the silicone-only sequence (SOS). The method uses the conventional STIR (short-inversion-time inversion-recovery) technique combined with a 1331 radio-frequency pulse train widely used for water suppression in spectroscopy. With the SOS, silicone can be imaged while signals from fat and water are suppressed. The authors used the SOS to image phantoms and normal and ruptured silicone gel-filled breast prostheses.

Breast↗