Search PubMed⌕ Search

Biomedical subjects

S G Orel

Publications and source records attributed to S G Orel.

At least 37 records · Page 2Linked to original sources
PubMed1999

Breast MR imaging in patients with axillary node metastases and unknown primary malignancy.

PURPOSE: To assess the usefulness of magnetic resonance (MR) imaging of the breast in patients with malignant axillary adenopathy and unknown primary malignancy. MATERIALS AND METHODS: Between October 1993 and December 1997, 38 women with malignant axillary adenopathy and negative mammographic and physical examination findings underwent contrast material-enhanced MR imaging. Sixteen patients were excluded due to axillary tail cancer (n = 7), lack of follow-up (n = 4), second primary malignancy (n = 3), or chemotherapy before MR imaging (n = 2). The study population comprised the remaining 22 patients. Histopathologic findings were available in 20 patients; follow-up MR imaging findings were available in two patients. RESULTS: MR imaging depicted a primary breast cancer in 19 patients (86%; identified at excisional biopsy or mastectomy in 17, resolved on follow-up MR images during treatment in two). MR imaging depicted 4-30-mm cancers (mean, 17 mm), which correlated closely with histopathologic size. Two patients (9%) had false-negative findings: (a) One had a 2-mm invasive ductal carcinoma, and (b) one had 17- and 20-mm invasive ductal carcinomas. Of the 19 patients, 11 underwent mastectomy, seven underwent breast-conservation therapy, and one did not undergo a surgical procedure. CONCLUSION: MR imaging is very sensitive for the detection of mammographically and clinically occult breast cancer in patients with malignant axillary adenopathy. In these patients, MR imaging offers potential not only for cancer detection but also for staging the cancer within the breast, which may be useful for treatment planning.

Axilla↗
PubMed1999

Cost-effectiveness of MR imaging and core-needle biopsy in the preoperative work-up of suspicious breast lesions.

PURPOSE: To assess the clinical and economic consequences of the use of preoperative breast magnetic resonance (MR) imaging and core-needle biopsy (CNB) to avert excisional biopsy (EXB). MATERIALS AND METHODS: A decision-analytic Markov model was constructed to compare MR imaging, CNB, and EXB without preoperative testing in a woman with a suspicious breast lesion. Stage-specific cancer prevalence, tumor recurrence, progression rates, and MR imaging and CNB sensitivity and specificity were obtained from the literature. Cost estimates were obtained from the literature and from the Medicare fee schedule. RESULTS: EXB without preoperative testing was associated with the greatest quality-adjusted life expectancy, followed by MR imaging and CNB; life expectancies were 17.409, 17.405, and 17.398 years, respectively. EXB resulted in the greatest lifetime treatment cost ($31,438), followed by MR imaging ($29,072) and CNB ($28,573). Results were robust over a wide range of cancer prevalence, stage distribution, tumor progression rates, and procedure and treatment costs. Incremental cost-effectiveness ratios showed that preoperative testing was cost-effective, but the choice between MR imaging and CNB was highly dependent on the accuracy of each test and to patient preferences. CONCLUSION: Preoperative testing of most suspicious breast lesions was cost-effective. More precise estimates of MR imaging and CNB test performance characteristics are needed. Until those are available, patient preferences should inform individual decisions regarding preoperative testing.

Biopsy, Needle↗
PubMed1999

Sentinel lymph node biopsy with metastasis: can axillary dissection be avoided in some patients with breast cancer?

PURPOSE: Recent studies have suggested that the sentinel lymph node (SLN) biopsy is an accurate alternative staging procedure for women with breast cancer. The goal of this study was to identify a subset of breast cancer patients in whom metastatic disease was confined only to the SLN. MATERIALS AND METHODS: From two institutions, we recruited 222 women with breast cancer for SLN biopsy. A SLN biopsy was performed in each patient, followed by an axillary dissection in 182 patients. Histologic and immunohistochemical cytokeratin stains were used on all SLNs. RESULTS: The SLN was identified in 220 (97. 8%) of the 225 biopsies. Evidence of metastatic breast cancer in the SLN was found in 60 (27.0%) of the 222 patients. Of these patients, 32 (53.3%) had evidence of tumor in the SLN only. By multivariate analysis, two factors were found to be significantly associated with a higher likelihood of tumor involvement in the non-SLNs: primary tumor size larger than 2.0 cm (P =.0004) and macrometastasis (> 2.0 mm) in the SLN (P =.002). Additional analysis revealed that none (0%; 95% confidence interval, 0% to 18.5%) of the 18 patients with primary tumors < or = 2.0 cm and micrometastasis to the SLN had remaining axillary lymph node involvement. CONCLUSION: The primary tumor size and metastasis size in the SLN are independent factors in predicting the incidence of tumor in the non-SLNs. Therefore, the SLN biopsy alone may be adequate for staging and/or therapy decision making in patients with primary breast tumors < or = 2.0 cm and micrometastasis in the SLN.

Adult↗
PubMed1999

Solitary intraductal papilloma: findings at MR imaging and MR galactography.

OBJECTIVE: The purpose of this article is to describe MR findings in surgically proven solitary intraductal papillomas of the breast, including findings on MR galactography. CONCLUSION: Women with spontaneous nipple discharge and solitary intraductal papilloma show, on MR imaging, dilated ducts with an associated enhancing, well-circumscribed mass.

Adult↗
PubMed1998

Breast MRI.

Explore the source record for details and available documents.

Journal Article↗
PubMed1997

Multicoil array for high resolution imaging of the breast.

An RF multicoil array for high resolution imaging of the breast is presented. The RF multicoil is incorporated into a dedicated breast imaging apparatus that holds either breast in gentle compression during imaging. Simulations and imaging experiments demonstrate the high sensitivity and RF homogeneity of the multicoil array. Direct comparisons are made between the multicoil and a surface coil. In vivo images are presented to demonstrate the homogeneity of the RF field of the multicoil over the entire breast. An in vivo image of both high temporal and spatial resolution is shown, which demonstrates the sensitivity of the RF multicoil array that may be achieved in a practical imaging experiment.

Adult↗
PubMed1997

MR imaging of ductal carcinoma in situ.

PURPOSE: To investigate the ability of magnetic resonance (MR) imaging to depict ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: Between January 1992 and April 1996, 330 women underwent MR imaging before excisional biopsy. Of these, 101 women had carcinoma, 19 of whom had DCIS. The MR imaging findings in the 19 women were reviewed. RESULTS: Thirteen of 19 patients had pure DCIS. The mean lesion diameter was 10 mm (range, 2-22 mm). MR imaging enabled identification of DCIS in 10 (77%) of the 13 cases as ductal enhancement (n = 6), regional enhancement (n = 3), or a peripherally enhancing mass (n = 1). The three lesions not identified had a mean diameter of 3.7 mm. Six of 19 patients had both DCIS and an invasive cancer. In four of these patients, DCIS was identified only at MR imaging (mean diameter, 3 mm). In two of six patients, DCIS was not identified at MR imaging. CONCLUSION: MR imaging can depict mammographically visible and occult foci of DCIS. Some small foci of DCIS detected at mammography and histologic examination, however, may be occult at MR imaging.

Adult↗
PubMed1997

Breast MR imaging: interpretation model.

PURPOSE: To develop an interpretation model based on architectural features of suspicious breast findings on magnetic resonance (MR) images. MATERIALS AND METHODS: One hundred ninety-two patients with mammographically visible or palpable findings underwent T1- and fat-saturated T2-weighted spin-echo and contrast agent-enhanced fat-saturated gradient-echo MR imaging. Patients underwent subsequent excisional biopsy for histopathologic confirmation. An interpretation model was constructed by using 98 cases and was tested prospectively and expanded by using 94 different cases. Sensitivity, specificity, predictive values, and receiver operating characteristic curves were computed for all models. RESULTS: Individual features with high predictive values were MR visibility, enhancement degree and pattern, focal mass border characteristics, and focal mass internal septations. Feature combinations with high negative predictive values for malignancy were absence of an MR-visible abnormality, focal masses with smooth borders, lobulated or irregular masses with nonenhancing internal septations, and focal masses with no (or minimal) enhancement. The validated- and revised-model performance characteristics were, respectively, as follows: sensitivity, 100% and 96%; specificity, 69% and 79%; positive predictive value, 75% and 76%; negative predictive value, 100% and 97%; and overall accuracy, 83% and 86%. CONCLUSION: An interpretation model that incorporates breast MR architectural features can achieve high sensitivity and improve specificity for diagnosing breast cancer.

Adult↗
PubMed1997

Fibroadenomas: MR imaging appearances with radiologic-histopathologic correlation.

PURPOSE: To identify histopathologic correlates for the varied magnetic resonance (MR) imaging appearances of fibroadenomas. MATERIALS AND METHODS: Twenty-three fibroadenomas in 21 patients (aged 23-66 years) examined with gadolinium-enhanced MR imaging were graded for signal intensity on T2-weighted images, contrast material enhancement, shape, and internal septations and were correlated with histopathologic findings. RESULTS: Fibroadenomas demonstrated high T2 signal intensity with enhancement (n = 11), low T2 signal intensity with enhancement (n = 3), or low T2 signal intensity without enhancement (n = 9). Low T2 signal intensity and lack of enhancement were associated with more sclerotic stroma and older patient age. Lesion shape was lobular, oval, or round in 19 of 23 fibroadenomas (83%). Internal septations were identified within nine of 14 enhancing fibroadenomas (64%) and appeared to correlate with collagenous bands at histopathologic analysis. CONCLUSION: Fibroadenomas demonstrate marked histopathologic variability. The resultant variability in the MR appearance limits the ability to distinguish between benign and malignant masses on the basis of signal intensity and enhancement alone. Lobulation and internal septation, which appear to reflect intrinsic growth patterns of fibroadenomas, may provide a more reliable basis for distinction.

Adult↗
PubMed1997

Breast carcinoma: MR imaging before re-excisional biopsy.

PURPOSE: To investigate the role of magnetic resonance (MR) imaging in the examination of patients after excisional biopsy of breast carcinoma before re-excision. MATERIALS AND METHODS: Forty-seven patients underwent contrast material-enhanced MR imaging after initial excisional biopsy of breast carcinoma before further surgery. RESULTS: The positive predictive value of MR imaging for predicting residual disease was 82%; the negative predictive value was 61%. Fourteen patients had multifocal (n = 6) or diffuse (n = 8) carcinoma. The extent of tumor was correctly identified with MR imaging alone in nine of the 14 patients, with both mammography and MR imaging in three patients, with mammography alone in one patient, and with no imaging modality in one patient. In four of the 14 patients, management was altered from re-excision to mastectomy (n = 3) or from breast-conservation therapy to mastectomy (n = 1). CONCLUSION: MR imaging has a high positive predictive value for predicting residual tumor after excisional biopsy. The identification of mammographically and clinically unsuspected multifocal or extensive residual tumor may lend support for mastectomy rather than re-excision. However, false-negative findings due to postsurgical changes and false-positive findings due to enhancement of granulation tissue and benign breast tissue remain limitations.

Adult↗
PubMed1997

Diagnostic performance characteristics of architectural features revealed by high spatial-resolution MR imaging of the breast.

OBJECTIVE: Our objective was twofold: to determine which architectural features revealed by high spatial-resolution MR imaging of the breast contribute to diagnostic accuracy and to evaluate the diagnostic performance characteristics of those architectural features. MATERIALS AND METHODS: Eligible patients with suspicious mammographic or palpable findings or both underwent MR imaging. Ninety-three patients whose MR images revealed lesions that corresponded to the mammographically visible or palpable findings were included in the study. Patients were examined with sagittal T1-weighted spin-echo MR imaging, fat-saturated T2-weighted fast spin-echo MR imaging, and dynamically enhanced fat-saturated fast gradient-echo MR imaging. All patients underwent subsequent excisional biopsy or cyst aspiration. Lesions were identified initially by an experienced radiologist who was aware of the patient's clinical or mammographic information. Two radiologists who were unaware of the patients' histories and who had less experience in MR imaging of the breast then independently evaluated each lesion for the architectural-features and predicted each lesion's potential for malignancy. RESULTS: Architectural features that were highly predictive of benign disease included smooth or lobulated borders (97-100%), the absence of mass enhancement (100%), and enhancement that was less than the enhancement of surrounding breast fibroglandular tissue (93-100%). Nonenhancing internal septations were specific for the diagnosis of fibroadenoma. Architectural features that were highly predictive of malignant disease included spiculated borders (76-88%) and peripheral rim enhancement in the presence of central lesion enhancement (79-92%). CONCLUSION: Architectural features revealed by high spatial-resolution MR imaging of the breast can help distinguish benign from malignant disease.

Adult↗
PubMed1996

High-resolution MR imaging of the breast.

Investigation into the use of MRI as a breast imaging tool is ongoing. Several studies have shown that MRI is a very accurate imaging method for the identification of implant failure in the symptomatic patient with augmented breasts. In this clinical setting. MRI may be the study of choice. Imaging techniques, and the MRI appearance of normal and abnormal implants, are described. The use of MRI for the detection of breast cancer is not as straightforward. Preliminary results suggest that this technique can be used as an adjunct to mammography for the detection and diagnosis of breast cancer. However, it is premature to draw firm conclusions regarding the role that MRI should play in the management of women with breast disease because of the wide variability of imaging techniques, protocols, and patient populations in the studies reported to date. In this overview, the current state of MR imaging of the breast is discussed. Technical requirements are described, and potential clinical applications- including the differentiation of benign from malignant lesions, breast cancer staging, detection of recurrence after breast conservation therapy, and detection of cancer in patients presenting with positive axillary lymph nodes with an unknown primary-are reviewed. Many of these potential clinical applications will require an accurate MR-guided biopsy system, and the implementation of such a system as well as its inherent limitations are discussed.

Breast↗
PubMed1996

High-resolution MR imaging of the breast: clinical context.

Preliminary investigation into magnetic resonance (MR) imaging as a breast imaging technique has demonstrated several promising roles for this modality when used as an adjunct to mammography for the detection and diagnosis of breast cancer. There are many technical factors that must be considered, including high resolution, rapid imaging, fat suppression, and localization and biopsy capability. Potential clinical applications include differentiating benign from malignant lesions, detecting cancer when results of clinical examination or conventional imaging are equivocal, detecting cancer recurrence after breast conservation treatment, staging newly diagnosed breast cancer, and detecting occult cancer in patients presenting with axillary node metastasis. Pitfalls include false-positive and false-negative results. Awareness of the strengths and limitations of MR imaging of the breast will facilitate integration of this technique into the work-up of patients with suspicious breast lesions.

Adult↗
PubMed1995

Staging of suspected breast cancer: effect of MR imaging and MR-guided biopsy.

PURPOSE: To investigate the effect of contrast material-enhanced magnetic resonance (MR) imaging on staging of breast cancer in patients with mammographically or clinically suspected tumor. MATERIALS AND METHODS: One hundred seventy-six patients underwent breast MR imaging at 1.5 T before excisional biopsy of a suspicious mammographic or palpable abnormality. Diagnostic imaging studies in patients with biopsy-proved or presumed breast carcinoma were reviewed. RESULTS: Sixty-four patients met the study criteria. MR imaging enabled detection of all 57 invasive breast cancers and nine of 15 in situ cancers. In 22 patients (34%), MR imaging depicted one or more cancers not visible at mammography, 13 (20%) of which were unsuspected multifocal or diffuse disease. As a result of the increased sensitivity of MR imaging compared with that of mammography, clinical staging and subsequent treatment were altered in seven patients (11%). CONCLUSION: MR imaging allows detection of mammographically and clinically occult foci of carcinoma in patients with suspected breast cancer.

Adult↗
PubMed1994

Suspicious breast lesions: MR imaging with radiologic-pathologic correlation.

PURPOSE: To study the architecture and enhancement characteristics of breast lesions with magnetic resonance imaging. MATERIALS AND METHODS: Forty-one patients with mammographic and/or palpable lesions were imaged. T1-weighted, fat-saturated T2-weighted fast spin-echo, and gadolinium-enhanced and -unenhanced fat-saturated spoiled gradient-echo images were obtained. All patients underwent excisional biopsy or cyst aspiration. RESULTS: Fifteen of 16 carcinomas were identified and exhibited at least partially irregular borders. T2-weighted signal intensity and contrast enhancement varied. Rim enhancement was seen in five lesions. Nine of 10 fibroadenomas were visualized and showed well-defined borders. T2-weighted signal intensity and contrast enhancement varied and correlated with histologic features. Internal septations were seen in five lesions. Time-intensity curves showed no statistically significant difference between fibroadenomas and cancers. CONCLUSION: There is an overlap in the signal intensity characteristics and enhancement profiles of benign and malignant lesions. However, border characteristics, internal architecture, enhancement characteristics, and the presence of multiple tiny associated cysts may be important clues to lesion identification.

Adult↗
PubMed1994

MR imaging-guided localization and biopsy of breast lesions: initial experience.

PURPOSE: To evaluate the usefulness of a magnetic resonance (MR) imaging-guided system for localization and biopsy of mammographically and clinically occult breast lesions. MATERIALS AND METHODS: The 11 needle localizations and one cyst aspiration were performed with MR imaging guidance in 11 patients with breast lesions. Two MR systems were tested; both required the patient to lie prone with the breast compressed between medial and lateral plates. One system used a grid with 18-gauge holes placed at 5-mm intervals and two reference markers to position the needle; the other, a stereotaxic external needle guide and a software system to calculate coordinates. RESULTS: Fibroadenoma, ductal carcinoma in situ, invasive ductal carcinoma, atypical ductal hyperplasia, fat necrosis, and sclerosing adenosis were found at histologic examination. In two cases, biopsies revealed multi-focal breast cancer where mammographic and clinical findings had indicated a single lesion. CONCLUSION: MR imaging-guided needle localizations may be performed in a clinical setting with the systems described. Accurate localization of mammographically and clinically occult lesions will allow MR imaging to achieve a clinically significant role.

Biopsy, Needle↗