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R J Brenner

Publications and source records attributed to R J Brenner.

At least 37 records · Page 2Linked to original sources
PubMed1998

Metaplastic carcinoma of the breast: report of three cases.

BACKGROUND: Metaplastic carcinoma is a rare form of breast carcinoma that often is confused with other benign and malignant entities. The diagnosis can be difficult to establish on both a clinical and conventional histopathologic basis. One report recently described clinical and mammographic features dissimilar to the authors' experience but to the authors' knowledge no other reports have been published. Therefore a review of three cases was undertaken; all patients had undergone mammography to identify and report the mammographic features of this disease, suggesting that imaging may add to the proper diagnosis of this entity. METHODS: Three clinical cases in which the diagnosis of metaplastic carcinoma was confirmed and for which mammography was performed were reviewed retrospectively. Follow-up on all three patients was available. RESULTS: Metaplastic carcinoma may be manifest as a well circumscribed mass or an irregular or spiculated mass. The latter always is highly suspicious for malignancy and the former incurs suspicion if it grows, although in this series the smooth mass was biopsied immediately. The spiculated masses were associated with delayed diagnosis and poorer prognosis because immunohistochemical studies were not performed on the original excisional biopsy specimens. CONCLUSIONS: Although spiculated masses usually are associated with invasive ductal and lobular carcinoma, they also may represent metaplastic carcinoma and immunohistochemical studies often are required to establish this diagnosis and avoid delay in proper treatment. Well circumscribed masses representing this disease may suggest benign disease but metaplastic carcinoma should be included in the differential diagnosis, especially if the mass enlarges.

Breast Neoplasms↗
PubMed1997

Surveillance mammography and stereotactic core breast biopsy for probably benign lesions: a cost comparison analysis.

RATIONALE AND OBJECTIVES: The authors compared the economic effect of stereotactic core needle biopsy (CNB) with that of short-term unilateral surveillance mammography in the management of probably benign breast lesions detected during routine screening mammography. METHODS: Published data with regard to the cost of stereotactic CNB and unilateral mammography were applied to 3,184 patients who underwent surveillance mammography; including 161 patients who underwent biopsy. Costs of immediate tissue diagnosis were compared with costs of surveillance with use of ratios of published reimbursement scales to minimize geographic variations. Sensitivity analyses were applied to this ratio. RESULTS: The cost of managing probably benign breast lesions with surveillance mammography was $3,307,575 less than if all lesions had been managed with CNB. The ratio of the cost of CNB to the cost of surveillance mammography was 8:1. This ratio is more sensitive to the frequency of use of CNB than to reimbursement schedules. CONCLUSION: With similar false-negative rates, CNB is more costly than surveillance and has a negative effect in the management of probably benign breast lesions, unless interval change during surveillance prompts tissue diagnosis.

Biopsy, Needle↗
PubMed1997

Spetial and temporal distribution of house dust mite (Astigmata:Pyroglyphidae) allergens Der p 1 and Der f 1 in Barbadian homes.

House features contribute to house dust mite abundance and, therefore, exposure to mite allergens. Our study assessed the hypothesis that modernization of the domestic environment in a tropical setting may lead to a level of allergen from the house dust mites Dermatophagoides pteronyssinus (Trouessart) and D. farinae Hughes that previously has been defined clinically as at risk for people who suffer from allergic disease. Allergen (Der p 1 and Der f 1) levels were measured at 4 sites (mattress, bedroom floor, living room floor, and furniture) in 17 houses in Barbados during dry and rainy seasons. Der p 1(17 of 17 homes) at all 4 sites did not vary significantly from the dry to rainy season. Allergen levels varied according to site, and were highest in living room furniture in both seasons (geometric mean 40.37 and 64.17 micrograms/g, respectively). Concentration of Der p 1 allergens were higher in concrete than in wood or mixed concrete and wood houses. Der f 1(9 of 17 homes) levels were lower than Der p 1 by 1/1,000 (both seasons). Results indicate that season is less important in regard to levels of Der p 1 than house construction and confirm other studies that implicate D. pteronyssinus as a more abundant source of allergen than D. farinae in this tropical setting.

Allergens↗
PubMed1996

Isolation and characterization of a clone encoding a major allergen (Bla g Bd90K) involved in IgE-mediated cockroach hypersensitivity.

Previous studies have established that atopic individuals living in cockroach-infested housing become sensitized to cockroach aeroallergens and produce IgE antibodies to a variety of proteins. We describe the isolation of a complementary DNA clone from an expression library, constructed with messenger RNA from German (Blattella germanica) cockroaches, which encodes a major allergen involved in mediating cockroach hypersensitivity. Approximately 0.2% of the clones from a lambda ZAP XR cDNA library bound IgE from a patient with cockroach sensitivity. A randomly selected subset of these clones revealed that they were either different isolates of the same gene or members of a closely related gene family. One of the largest clones (a 4 kb insert) from this subset, Bla g Bd90K hybridized to a single mRNA of approximately the same size. DNA sequence analysis showed that this gene consisted of seven 576 bp tandem repeats with a short unique region at either end. No significant sequence homologies were found between the cockroach clone and any other gene reported in the GenBank database. Serum from 17 of 22 (77%) patients with cockroach hypersensitivity identified IgE-binding recombinant protein expressed from clone Bla g Bd90K in Escherichia coli XL-Blue cells as determined by sodium dodecylsulfate-polyacrylamide gel electrophoresis/immunoblot analysis. This recombinant protein migrates with a molecular weight (90 kd) apparently similar to one identified in whole body extracts. We have identified and isolated a cDNA that encodes a major cockroach allergen (Bla g Bd90K) present in German cockroaches.

Allergens↗
PubMed1996

Quality of housing and allergy to cockroaches in the Dominican Republic.

Fifty-one atopic asthmatic and/or allergic rhinitic children and 23 nonatopic control from Santo Domingo, the Dominican Republic, were skin tested with an extract mix of three cockroach species (Blattella germanica, Blatta orientalis, and Periplaneta americana). Sixteen percent of the atopics and none of the nonatopics demonstrated positive immediate skin reactions to the cockroach mix (chi 2 = 4.05, p = 0.04). Hypersensitivity was correlated with the quality of the homes; 22% (8/36) of the atopics who lived in a concrete home were skin test positive to the cockroach mix, while none (0/15) of the atopics who lived in a wood home were skin test positive (chi 2 = 4.86, p = 0.03). Although the incidence of cockroach allergy in this study is lower than that found elsewhere, these data support the notion that, in this tropical environment, sensitization to cockroaches is associated with housing quality.

Adolescent↗
PubMed1996

Percutaneous core biopsy of the breast: effect of operator experience and number of samples on diagnostic accuracy.

OBJECTIVE: The purpose of our study was to assess the degree of operator experience and the number of core biopsy samples required to achieve an accurate histologic diagnosis for each of five common mammographically defined lesions, using percutaneous core breast biopsy performed on a dedicated prone biopsy table. SUBJECTS AND METHODS: A prospective multisite study was performed that involved nine institutions (academic and private) with experienced breast radiologists and the use of dedicated prone biopsy table units with digital assistance and standardized protocol. Asymptomatic women evaluated during a 2-year study period were assigned a mammographic diagnosis reported in a manner prescribed by the American College of Radiology Breast Imaging Reporting and Data System lexicon. Mammographic lesions evaluated included masses, masses with calcifications, clustered calcifications, focal asymmetries, and architectural distortions. Where histologic diagnosis was indicated, core biopsy was performed with five individual samples obtained and sequentially analyzed. Two hundred thirty patients had immediate excisional biopsy, the results of which provided the basis for a statistical analysis to compare the accuracy of each sequential core biopsy sample with surgical results. Statistical analysis was also done to ascertain the accuracy of core biopsy diagnosis as a function of operator experience. RESULTS: Trends toward increasing accuracy were observed by increasing the number of core biopsies for each of five types of mammographically defined lesions, especially for clustered calcifications. Statistically significant increased accuracy was observed when the number of biopsies was increased beyond one (p = .003). Trends toward increased accuracy with more experience were observed for all lesions, especially for calcifications. Of the 230 lesions studied with immediate surgical validation, more than 80% of all lesions except clustered calcifications (75%) were diagnosed on the basis of two core biopsies; accuracy after five biopsies was 98% for masses, 91% for calcifications, 100% for masses with calcification, 100% for focal asymmetries, and 86% for architectural distortions. CONCLUSIONS: Accuracy of diagnosis based on the results of percutaneous core breast biopsy improved with an increase in the number of core biopsy samples obtained for any given lesion seen on mammograms and with increased experience in performing the procedure. Five samples yielded an overall diagnostic accuracy of 97%. Familiarity with expected accuracy from this procedure for different mammographic lesions and following increased experience may assist physicians in planning patient management.

Analysis of Variance↗
PubMed1996

Mammographic features after conservation therapy for malignant breast disease: serial findings standardized by regression analysis.

OBJECTIVE: The purpose of this study was to determine the incidence and natural history of mammographic changes in patients within 5 years of conservation therapy for malignant breast disease. MATERIALS AND METHODS: We reviewed the records of 164 consecutive patients with a history of conservation therapy for malignant disease. We recorded mammographic changes related to treatment for each year after surgery. Linear regression analysis was applied to determine trends for progression, regression, or stability of findings. RESULTS: We evaluated 158 patients with 162 lesions for which initial mammographic evaluation had occurred within 5 years of surgery. Of these 158 patients, 121 (77%) underwent serial studies. A total of 152 patients (96%) showed changes on mammograms that represented scarring, usually in multiple locations. Findings at initial evaluation included architectural distortion (n = 110; 82%), increased regional density or scarring (n = 106; 79%), skin thickening (n = 73; 54%), masses (n = 16; 12%), and calcifications (n = 4; 3%). All findings except calcifications showed partial resolution over time, with architectural distortion showing the most significant resolution (p = .05). CONCLUSION: Mammographic features after conservation therapy for breast cancer are common at 1 year after treatment. With the exception of calcifications, we found that all changes showed decreased prominence during the next 5 years. Recognition of such trends during routine surveillance should facilitate the early identification of changes that represent recurrence or do novo malignancy.

Adult↗
PubMed1996

Mammographic changes after excisional breast biopsy for benign disease.

OBJECTIVE: The purpose of this study was to establish the incidence and natural history of mammographic changes in patients within 5 years of an excisional breast biopsy. MATERIALS AND METHODS: We reviewed the records of 428 consecutive patients who had undergone excisional biopsy for benign breast disease. We recorded year by year the mammographic changes seen after surgery. Because the site of surgery was known in each patient and because follow-up imaging continued for at least 2 years after biopsy, our analysis was able to exclude interval malignancy in the area of surgery. We then applied linear regression analysis to determine trends regarding progression, stability, or regression of changes after surgery. RESULTS: We evaluated 293 patients with 296 biopsies for which the initial mammographic study occurred within 5 years of surgery. Of those 293 patients, 237 (81%) underwent serial mammographic studies. Of the 293 patients studied, 146 patients (50%) showed no changes related to surgery. Of the remaining 147 patients (50%) who showed mammographic changes, the most common changes at initial mammographic follow-up were architectural distortion (98/205, 48%), skin thickening (35/205, 17%), and increased focal density (parenchymal scar) (30/205, 15%). Regression analysis showed no significant change of mammographic features in all patients during 5 years of follow-up (p > .2). CONCLUSION: Mammographic changes after excisional breast biopsy were seen in 50% of patients. When mammographic changes were seen, they remained stable during 5 years of follow-up. Recognition of such trends during routine surveillance should facilitate the identification of changes that represent developing malignancy.

Adult↗
PubMed1996

Wire fragments after needle localization.

OBJECTIVE: Scant information exists on the natural history of a retained wire fragment after needle localization for breast biopsy. We review 10 cases in which wire fragments were present 1.5-11 years after surgery. CONCLUSION: Only one patient had symptoms attributed to the retained wire. Position of the wire fragment in the breast remained stable over time. Our management recommendations include early mammographic follow-up at 3 and 6 months to reveal stability in asymptomatic patients and excision of fragments in symptomatic patients.

Adult↗
PubMed1996

Film management and custody: current and future medicolegal issues.

Filmless, seamless, interactive imaging departments at health centers and freestanding image centers will prompt development of legal and administrative regulations that may be universally applicable and enforced. However, until such time, issues related to custodianship and transferral of imaging studies will remain a local issue, governed by laws and advisories that have far-reaching legal implications. Familiarity with the rationale and particular rules governing a specific locale should facilitate the adoption of risk-management strategies that satisfy the interests of all parties involved in patient care.

Confidentiality↗
PubMed1996

Nonpalpable versus palpable invasive breast tumors treated with breast-conserving surgical management.

Most mammographically detected breast cancers are small, nonpalpable malignancies that should be amenable to cure by definitive breast-conserving therapy (BCT) consisting of tumor excision and postoperative radiation. We examined this hypothesis by retrospectively comparing the incidence of local recurrence and the rate of survival in breast cancer patients undergoing BCT for nonpalpable versus palpable lesions. Between 1982 and 1991, 345 patients at the John Wayne Cancer Institute, a large referral center for breast diseases, underwent BCT for invasive ductal and/or invasive lobular breast carcinomas: 120 (35%) had nonpalpable lesions detected by mammography (MG group), and 225 (65%) had palpable lesions detected by physical exam (PE group). The clinical and pathologic tumor status and the clinical outcome were recorded in each case. Median tumor size was significantly larger in PE than MG patients (2 cm versus 1 cm, P < 0.001). Only 29 percent of MG patients were premenopausal, compared with 51 percent of PE patients (P < 0.05). Axillary node involvement was more frequent in PE than MG patients (46% versus 19%, P < 0.01). Over a median follow-up of 58 months, local recurrence rates were 8 per cent for both MG and PE patients. In both groups, the incidence of local recurrence increased significantly when tumor was found in the margins of the resected breast specimen. In the MG group, the risk of local recurrence was significantly higher in premenopausal patients (P < 0.05). Survival was similar in both groups. The rate of local recurrence after BCT is the same for nonpalpable and palpable breast tumors. However, nonpalpable lesions have a lower rate of regional node metastases, which may improve survival. Both local recurrence and metastases seem to be related to tumor size. Tumor-free operative margins are the best predictor of local control.

Adult↗
PubMed1995

[Ductal carcinoma in situ of the breast].

With the advent of screening mammography, ductal carcinoma in situ (DCIS) is detected with increasing frequency and now accounts for 10-15% of all diagnosed breast cancers. Before 1980, DCIS was usually diagnosed by clinical findings of a breast mass or nipple discharge; today most cases are detected mammographically and nonpalpable. The most common mammographic findings associated with DCIS are a cluster of microcalcifications. The concept that DCIS invariably progresses to invasive breast cancer and requires mastectomy has been challenged. Knowledge of DCIS is limited and primarily based on retrospective data. Further insight will emerge from ongoing randomized prospective studies that are near completion. Currently available data indicate that breast-conserving modalities may offer a valid alternative to mastectomy in selected patients with DCIS.

Breast Neoplasms↗
PubMed1995

Interventional procedures of the breast: medicolegal considerations.

Interventional procedures of the breast are increasing in frequency both because of screening programs designed to detect large numbers of nonpalpable lesions and the advent of new technologies. These procedures afford the radiologist new opportunities to participate in patient care. Those radiologists involved in interventional programs need to be familiar with the legal ramifications of such procedures, many of which have not been historically important outside of the treating clinical community. The high frequency of legal exposure associated with breast cancer evaluation should prompt the development of risk management guidelines for the performance of interventional procedures of the breast.

Biopsy, Needle↗
PubMed1995

Technical note: magnetic resonance imaging-guided pre-operative breast localization using "freehand technique".

A 1.5 cm focus in the breast with intense gadolinium uptake was incidentally detected during magnetic resonance (MR) imaging evaluation of a cluster of microcalcifications. Because the apparent mass was both mammographically and sonographically occult, MR imaging was used to guide a needle by "freehand technique" to the lesion, permitting successful pre-operative localization and subsequent surgical excision of the area.

Breast↗