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Biomedical subjects

V Velanovich

Publications and source records attributed to V Velanovich.

At least 19 recordsLinked to original sources
PubMed2000

Laparoscopic vs open surgery: a preliminary comparison of quality-of-life outcomes.

BACKGROUND: The purported advantages of laparoscopic surgery over conventional open techniques are less pain and faster return to normal functional status. Very few studies have included validated measures of quality of life as end points. This study prospectively assessed the health status outcomes of patients undergoing four types of laparoscopic and open operations. METHODS: Preoperatively, patients undergoing elective inguinal hernioplasty, esophageal surgery, cholecystectomy, and splenectomy completed the SF-36, a well-tested, validated health-status instrument. This instrument measures physical functioning (PF), role-physical (RP), role-emotional (RE), bodily pain (BP), vitality (VT), mental health (MH), social functioning (SF), and general health (GH) health status domains. Patients then underwent either laparoscopic or open surgery. Patients were reassessed with the instrument > or =6 weeks after surgery. A total of 100 patients underwent these procedures. RESULTS: Compared to preoperative values, median SF-36 scores for laparoscopic cholecystectomy patients were improved in the domains of PF (85 vs 95, p = 0.01), BP (42 vs 75, p = 0.002), and VT (47.5 vs 70, p = 0.04); open cholecystectomy patients did not show statistically significant improvements over preoperative values. In addition, laparoscopic cholecystectomy patients had a better score than open cholecystectomy patients in the BP domain (75 vs 41, p = 0.05). Laparoscopic esophageal surgery patients had better scores than open surgery patients in the domains of RP (100 vs 0, p = 0.02) and VT (65 vs 52.5, p = 0.05). Compared to preoperative values, laparoscopic splenectomy patients had an improved score in GH (52 vs 77, p = 0.02) and better scores than open splenectomy patients in PF (90 vs 45, p = 0.05) and BP (84 vs 55.5, p = 0.01). Compared to preoperative values, open mesh hernioplasty patients showed improved scores in PF (70 vs 92.5, p = 0.03) and MH (72 vs 84, p = 0.05). Laparoscopic hernioplasty did not produce improved scores compared to either preoperative values or open hernioplasty. CONCLUSIONS: Laparoscopic surgery has demonstrably better quality-of-life outcomes than open surgery for cholecystectomy, splenectomy, and esophageal surgery. However, open hernioplasty has at least as good, if not better, health status outcomes than laparoscopic repair.

Abdomen↗
PubMed1999

Quality of life of breast cancer patients with lymphedema.

BACKGROUND: Quality of life has increasingly become an important issue in breast cancer treatment. One of the impetuses for sentinel lymph node biopsy or selective axillary lymph node dissection (ALND) is the assumed decreased incidence of lymphedema compared with standard ALND. This is based on the assumption that ALND is associated with a clinically significant incidence of lymphedema and that this lymphedema decreases the quality of life of these patients. However, few data exist on this issue. This study attempts to define the incidence and effect on quality of life of postoperative lymphedema in breast cancer patients. METHODS: To determine the incidence of postoperative lymphedema, the Breast Cancer Registry at Henry Ford Hospital was accessed to obtain information on all patients who underwent ALND in the management of breast cancer over a 7-year period. The registry is a prospectively gathered data base to include the development of various complications, such as lymphedema. To determine the effects of lymphedema on quality of life, 101 consecutive, unselected patients who underwent breast surgery were asked to complete the SF-36, a generic quality of life instrument. The SF-36 measures eight domains of quality of life. Patients were then divided into three groups: (1) breast surgery without ALND (-ALND), (2) breast surgery with ALND but no lymphedema (-LE), and (3) breast surgery with ALND and lymphedema (+LE). RESULTS: In all, 827 patients with ALND were identified in the registry. Of these, 8.3% developed clinically apparent lymphedema. Patients in -ALND and -LE groups had similar scores in all domains of the SF-36. However, patients in the +LE group had significantly lower scores in the domains of role-emotional and bodily pain. A significantly higher percentage of patients in the +LE group had scores below one standard deviation compared with national norms in the domains of bodily pain (P = 0.005), mental health (P = 0.01), and general health (P = 0.04). CONCLUSIONS: Although postoperative lymphedema occurs in a minority of patients, when it does occur it can produce demonstrable diminutions in quality of life. Therefore, efforts to reduce the incidence of lymphedema, such as sentinel lymph node biopsy or selective ALND, would benefit breast cancer patients.

Axilla↗
PubMed1999

Comparison of mammographically guided breast biopsy techniques.

OBJECTIVE: To determine which mammographically guided breast biopsy technique is the most efficient in making a diagnosis in women with suspicious mammograms. SUMMARY BACKGROUND DATA: Mammographically guided biopsy techniques include stereotactic 14-gauge core-needle biopsy (SC bx), stereotactic 11-gauge suction-assisted core biopsy (Mammotome [Mbx]), stereotactic coring excisional biopsy (Advanced Breast Biopsy Instrument [ABBI]), and wire-localized biopsy (WL bx). Controversy exists over which technique is best. METHODS: All patients undergoing any one of these biopsy methods over a 15-month period were reviewed, totaling 245 SC bx, 107 Mbx, 104 ABBI, and 520 WL bx. Information obtained included technical success, pathology, discordant pathology, and need for open biopsy. RESULTS: Technical success was achieved in 94.3% of SC bx, 96.4% of Mbx, 92.5% of ABBI, and 98.7% of WL bx. The sensitivity and specificity were 87.5% and 98.6% for SC bx, 87.5% and 100% for Mbx, and 100% and 100% for ABBI. Discordant results or need for a repeat biopsy occurred in 25.7% of SC bx, 23.2% of Mbx, and 7.5% of ABBI biopsies. In 63.6% of ABBI and 50.9% of WL bx, positive margins required reexcision; of the cases with positive margins, 71.4% of ABBI and 70.4% of WL bx had residual tumor in the definitive treatment specimen. CONCLUSION: Although sensitivities and specificities of SC bx and Mbx are good, 20% to 25% of patients will require an open biopsy because a definitive diagnosis could not be reached. This does not occur with the ABBI excisional biopsy specimen. The positive margin rates and residual tumor rates are comparable between the ABBI and WL bx. The ABBI avoids operating room and reexcision costs; therefore, in appropriately selected patients, this appears to be the most efficient method of biopsy.

Biopsy↗
PubMed1999

Racial differences in the presentation and surgical management of breast cancer.

BACKGROUND: African American women are seen with more advanced breast cancers, are less likely to be treated with breast-conserving surgery, and generally have poorer prognoses than white women. There are a myriad of potential causes for these phenomena. The purpose of this study was to measure racial differences in the surgical treatment of breast cancer among women with comparable health care access and delivery. METHODS: The Breast Cancer Registry of the Department of Surgery at Henry Ford Hospital was accessed for all patients between January 1, 1990, and December 31, 1997 for whom data on race, tumor characteristics, stage, and treatment specifics were available. Socioeconomic information was collected with use of 1990 census block data. Proportions of women who received each treatment were compared for African Americans and whites with use of the relative risk (RR) and 95% confidence intervals (CI). We used multiple logistic regression to obtain estimates of the relative risk, controlling for potential confounding factors. RESULTS: Of the 1699 patients in the database, 1250 had sufficient information for analysis. A total of 8.7% of African American women were diagnosed with late-stage disease (i.e., stage III or IV) compared with 7.9% of whites. Nevertheless, African American women had a lower frequency of stage I disease (30.5% vs 36.2%) and a higher frequency of stage II disease (36.8% vs 31.4%). Overall and adjusted risk estimates for age, tumor stage, marital status, median income, and type of insurance revealed no substantive or statistically significant differences between African American and white patients. The adjusted RR for local excision was 1.39 (95% CI 0.78 to 2.49), for lumpectomy and axillary dissection RR 0.92 (95% CI 0.66 to 1.29), for simple mastectomy RR 0.84 (95% CI 0.41 to 1.72), and for modified radical mastectomy RR 1.00 (95% CI 0.73 to 1.36). CONCLUSIONS: In this setting of equal access to health care, African American women still have higher frequencies of stage II disease, although the frequencies for late-stage disease are similar. Nevertheless, no surgical differences were found in this population, even after the effects of socioeconomic indicators and stage at diagnosis were controlled for Survival differences between African American and white women are unlikely to be explained by differences in treatment.

Aged↗
PubMed1999

Comparison of symptomatic and quality of life outcomes of laparoscopic versus open antireflux surgery.

BACKGROUND: Even though laparoscopic antireflux procedures have become the surgical treatment of choice for gastroesophageal reflux disease (GERD), little quantitative data exist comparing symptomatic and quality of life outcomes between laparoscopic and standard open procedures. This study was done to compare short-term outcomes. METHODS: All patients referred for surgical treatment of GERD are prospectively followed with a disease-specific reflux symptom score (the GERD-HRQL, best score 0, worst score 50) and a generic quality of life questionnaire (the SF-36, best score 100, worst score 0). Patients are evaluated preoperatively and at least 6 weeks postoperatively. Patients were treated with either laparoscopic or open Nissen (360-degree wrap) or Toupet (270-degree wrap) fundoplications. RESULTS: Sixty patients underwent laparoscopic surgery (LS) and 20 open surgery (OS). LS and OS had significant improvement in the median GERD-HRQL scores, 27 to 3 and 27 to 1, respectively, both P < .000001. LS had statistically significant improvements in the SF-36 domains of mental health (62 to 71.5, P = .05) and general health (57 to 67, P = .004). There was no worsening in any of the other 6 domains. OS produced a worsening score in the domain of physical functioning (75 to 67.5, P = .02). LS had better postoperative scores compared with OS in the domains of physical functioning (80 vs 67.5, P = .05) and trended to better scores in bodily pain (64 vs 51.5, P = .09). CONCLUSIONS: LS produces equivalent improvement in reflux symptoms compared with OS, with improved general quality of life outcomes.

Adult↗
PubMed1999

Adenocarcinoma of the head of the pancreas: effects of surgical and nonsurgical therapy on survival--a ten-year experience.

A retrospective analysis of all patients treated for adenocarcinoma of the head of the pancreas from 1989 to 1998 was performed. Excluded were cancers in the body and tail, cystic neoplasms, ampullary tumors, and cancers of the duodenum and bile ducts. One hundred forty-five patients were reviewed, and 43 patients underwent pancreaticoduodenectomy. Data collected included the stage, lymph node status, surgical margins, adjuvant therapies, and survival. Statistical analysis was performed with Cox's Proportional Hazards Analysis and Log-Rank Life Table Analysis. The surgical population had a 21 per cent 3-year survival rate and a 7 per cent operative mortality rate. Median survival was: 1) the resection group versus no resection was 13.5 versus 3.1 months; 2) adjuvant therapy versus no therapy after resection was 16.1 versus 5.1 months; and 3) chemoradiation therapy versus no therapy for unresectable disease was 5.3 versus 1.8 months. The presence of positive surgical margins was found in 33 per cent of the surgical specimens and carried an increased mortality hazard ratio of 3.1. Patients with negative lymph nodes had a 15 per cent 5-year survival, versus 0 per cent with positive nodes. Seventy-three per cent of those resected had a T2 lesion, and 46 per cent of patients presented with metastatic disease. Surgical resection and adjuvant therapy significantly improves survival in patients with adenocarcinoma of the head of the pancreas. All patients who underwent resection as part of their therapy showed extended survival compared with chemoradiation therapy alone. Adjuvant chemoradiation improved survival when compared with surgery alone. Multimodality treatment in carcinoma of the head of the pancreas provides the best treatment option. However, better adjuvant therapies are needed.

Adenocarcinoma↗
PubMed1998

Axillary lymph node dissection for breast cancer: a decision analysis of T1 lesions.

BACKGROUND: The value of routine axillary dissection for patients with breast cancer is still being debated. The argument centers around whether the information gained by knowing the lymph node status, which aids in making the decision about adjuvant chemotherapy, justifies the morbidity. This study quantitatively analyzes the potential outcomes of routine, selective, and no axillary dissection. METHODS: A decision analysis was performed of the strategies of lumpectomy and radiation versus simple mastectomy followed by no dissection, selective dissection, or routine dissection. Factors included biologic markers to identify high-risk lesions, the morbidity of axillary dissection, the effects of adjuvant chemotherapy on lymph node-negative and lymph node-positive disease, and the life expectancy of patients with high-risk and low-risk node-negative and node-positive lesions. Sensitivity analysis was done to determine threshold levels of these factors in choosing an option. RESULTS: We discovered an advantage in quality-adjusted life expectancy (QALE) for no axillary dissection until the probability of positive lymph nodes reaches >15%; after that, selective node dissection is superior. Selective dissection is superior for lower morbidity rates of axillary dissection. Routine dissection is never a superior strategy. The difference among these strategies is small, however, with no one strategy providing a QALE greater than 1 year longer than any other. CONCLUSIONS: Axillary dissection can be avoided in patients with high-risk lesions who would be candidates for adjuvant chemotherapy regardless of lymph node status, and possibly in patients with low-risk T1a lesions, but it should be recommended for low-risk T1b and T1c lesions for which lymph node status may determine the need for adjuvant chemotherapy.

Axilla↗
PubMed1998

Fractal analysis of mammographic lesions: a prospective, blinded trial.

Mammography has become the mainstay of breast cancer screening. However, widespread mammography has led to an increase of the number of breast biopsies done for benign disease. Therefore, a method to better discriminate benign from malignant lesions is needed. Fractal analysis is a mathematical method which can quantify complex shapes. It has been previously shown retrospectively that the composite fractal dimensions, D, of malignant mammographic masses is higher than for benign lesions. A prospective study of 75 patients who were recommended to undergo needle localized breast biopsy by independent radiologists had the composite D calculated. Fractal analysis was done without knowledge of the biopsy results. The mean composite D of malignant lesions was higher than benign lesions, 2.545+/-0.067 vs. 1.936+/-0.144 (p=0.00004). Calculation of a receiver-operating characteristic curve showed that a cutoff value of 2.067 had a 100% sensitivity and 63 % specificity (i.e., false positive rate of 37%). Mean D for fibroadenomas was 2.087+/-0.054, fibrocystic disease was 1.877+/-0.167, DCIS was 2.261+/-0.069, and invasive cancer was 2.634+/-0.039 (1-way ANOVA, p=0.00007). These data imply that fractal analysis may be beneficial in discriminating between benign and malignant lesions. However, further study in a larger number of patients with a variety of lesions is needed.

Analysis of Variance↗
PubMed1998

Staging laparoscopy in the management of intra-abdominal malignancies.

BACKGROUND: Laparoscopy in the evaluation of intra-abdominal malignancies has become a debated issue. Proponents have claimed that it increases resectability rates, whereas opponents suggest that many patients require laparotomy regardless of the laparoscopic findings. The purpose of this study was to compare outcomes in patients undergoing staging laparoscopy versus those who were managed by initial exploratory laparotomy. METHODS: The medical records of all patients during an 18-month period who underwent surgical evaluation for upper gastrointestinal or hepatobiliary malignancies were reviewed. Forty-eight patients underwent staging laparoscopy (SL) initially; 80 patients underwent initial exploratory laparotomy (EL). Data obtained included type of cancer, laparoscopic findings, laparoscopic determination of resectability, laparoscopic procedures, open determination of resectability, open procedures, and length of stay (LOS). Statistical analysis was done by using Fisher exact test or the Mann-Whitney U test. RESULTS: The malignancies of 75% of patients were deemed resectable by SL. Of these, 77.8% were resected. This compares to 56.3% resectability rate in the EL group (P = .025). SL findings in patients with unresectable malignancies were carcinomatosis (75%), liver metastasis (33.3%), and direct invasion (16.7%). In the 8 false-negative SLs, 75% were unresectable as a result of vascular invasion and 25% for other reasons. Findings in the EL group whose malignancies were unresectable were carcinomatosis (34.3%), direct invasion (22.6%), liver metastasis (42.9%), and vascular invasion only (17.1%). Therefore 82.9% of patients in the EL group could have been determined to have unresectable malignancy by SL. In the EL group 22.5% of the laparotomies were nontherapeutic, whereas 4.2% of patients in the SL group underwent nontherapeutic laparotomy. Average LOS for unresectable patients in the SL group was 0.5 days, with 75% discharged the same day of operation. This compares to 10.9 days in the EL group (P < .00001) and 7.6 days in the nontherapeutic EL group (P < .00001). CONCLUSIONS: SL increases the resectability rate, decreases the nontherapeutic laparotomy rate, and decreases LOS in patients with unresectable disease. SL is poor at detecting unresectability as a result of vascular invasion only, but this accounts for less than one-fifth of patients. Laparoscopic sonography and palliation may further decrease the need for EL.

Abdominal Neoplasms↗
PubMed1998

When it's not appendicitis.

Other pathology besides appendicitis may be found in patients with right lower quadrant pain. This has led some to advocate diagnostic laparoscopy/laparoscopic appendectomy for all such cases. This policy would substantially raise the costs of care without a priori proof of its efficacy. However, a selective approach on when to proceed with diagnostic laparoscopy will depend on the frequency of finding unexpected, nonappendiceal pathology. To determine this, we reviewed our experience with 202 appendectomies. For females < 50 years old, 33 per cent had normal appendices, 12 per cent had periappendicitis, 47 per cent had acute appendicitis, 12 per cent had perforated appendicitis, and 26 per cent had other nonappendiceal pathology. For males < 50 years old, 13 per cent had normal appendices, 8 per cent had periappendicitis, 67 per cent had acute appendicitis, 15 per cent had perforated appendicitis, and 5 per cent had other pathology. For patients > 50 years old, 7 per cent had normal appendices, 13 per cent had periappendicitis, 33 per cent had acute appendicitis, 60 per cent had perforated appendicitis, and 20 per cent other pathology. Other nonappendiceal pathology was found in 42 per cent of females < 50 with normal appendices, 57 per cent with periappendicitis, and 14 per cent with acute/perforated appendicitis. In males < 50 years, 50 per cent of those with normal appendices, 10 per cent of those with periappendicitis, and 0.7 per cent of those with acute appendicitis had nonappendiceal pathology. In conclusion, women of childbearing age and patients > 50 years old have a significant incidence of nonappendiceal pathology. In this group of patients, a diagnostic laparoscopy appears justifiable to identify the cause of the abdominal pain.

Abdominal Pain↗
PubMed1998

Measuring gastroesophageal reflux disease: relationship between the Health-Related Quality of Life score and physiologic parameters.

The Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) scale is a reliable, valid, responsive, and practical measure of symptom severity in patients with GERD. This type of scale is needed to determine effects of treatments and their comparison. This study defines the relationship between the GERD-HRQL score and the physiologic parameters of esophagogastroduodenoscopy, esophageal manometry, and 24-hour esophageal pH monitoring. Fifty-five patients referred for surgical evaluation of GERD answered the GERD-HRQL, a nine-item ordinal-scaled questionnaire. They were evaluated with esophagogastroduodenoscopy, esophageal manometry, and 24-hour pH monitoring. The relationships among these results were determined by linear regression analysis. There were no correlations between lower esophageal sphincter (LES) and any of the pH monitoring parameters (all r < 0.25, P > 0.2), esophagitis grade (r = -0.21, P = 0.2), nor any individual GERD-HRQL item score nor total score (all r < 0.2, P > 0.11). There were correlations between all the pH monitoring parameters and esophagitis grade (all r > 0.6, P < 0.001), but not with any of the GERD-HRQL item scores or total score (r < 0.3, P > 0.15). Six of the nine items scores and the total GERD-HRQL score correlated with esophagitis grade (all r > 0.4, P < 0.01). LES pressure is a poor indicator of symptom severity, the amount of reflux, and esophageal mucosal damage. pH monitoring-measured reflux and GERD-HRQL-measured symptom severity correlate well with mucosal damage. If the goals of GERD treatment are to relieve symptoms and reverse mucosal damage, the GERD-HRQL score and 24-hour pH monitoring are better outcome measures than the LES pressure. In an era of cost containment, the GERD-HRQL may be an adequate outcome measure.

Attitude to Health↗
PubMed1997

Biliary dyskinesia and biliary crystals: a prospective study.

The management of patients with biliary colic without gallstones has remained controversial in part because a mechanism for "biliary dyskinesia" has not been elucidated. A prospective study was done on patients presenting with biliary colic symptoms but without demonstrable gallstones. Thirty-six patients were evaluated with ultrasound and hepatobiliary/cholecystokinin scintigraphic scanning. Patients with gallbladder ejection fractions of less than 35 per cent and/or symptoms reproducible with cholecystokinin were offered cholecystectomy. At cholecystectomy, bile was aspirated from the gallbladder for crystal analysis. A random sample of 36 patients with gallstones undergoing cholecystectomy were analyzed as a control group. Pathologic evaluation was done; the gallbladder wall was examined using polarized microscopy to determine the presence of crystals within the gallbladder wall. The mean gallbladder ejection fraction in patients without stones was 24.1 per cent and in patients with stones, 34.6 per cent (P = 0.14). 89.7 per cent of patients without stones had crystals in their gallbladder bile. 61.8 per cent of patients without stones and 81.3 per cent of patients with stones (P = 0.22) had crystals within their gallbladder walls. 94.1 per cent of patients without stones and 100 per cent of patients with stones (P = 0.49) had pathologic evidence of chronic cholecystitis. These data suggest that a spectrum of biliary disease exists in which bile saturation and gallbladder dysmotility lead to crystal growth and subsequent gallstone formation and chronic inflammation. Biliary pain may be generated at any point in this spectrum.

Bile Acids and Salts↗
PubMed1997

Biologic tumor markers, lymph node status, and decision about adjuvant chemotherapy for breast cancer.

The reasons to perform axillary dissection for breast cancer are to determine lymph node status for prognosis and adjuvant chemotherapy treatment decisions. Some have questioned whether this knowledge actually affects such decisions in some patients. A retrospective review was done on 30 patients with invasive breast cancer whose tumors were further evaluated by tumor size, estrogen and progesterone receptor status, ploidy, S-phase fraction, DNA index, and lymph node status. All patients were treated either with lumpectomy/axillary dissection and postoperative radiation therapy or with modified radical mastectomy. A stepwise logistic regression was done to determine which factors were statistically significant in the decision to offer adjuvant cytotoxic chemotherapy by independent medical oncologists (endocrine therapy was not an end point in this study). Only high S-phase fraction (above 5 per cent) was an independent predictor of subsequent administration of cytotoxic chemotherapy (P < 0.0001). The sensitivity and specificity of high S-phase fraction leading to chemotherapy was 100 per cent. There was a high concordance between S-phase fraction and lymph node status, with high S-phase being predictive of positive lymph nodes (P = 0.008), and positive lymph nodes (P = 0.008) and estrogen receptor-negative status (P = 0.034) predictive of high S-phase fraction. When S phase was excluded from analysis, the lymph node status (P < 0.0001) and DNA index (P = 0.03) were independent predictors of subsequent chemotherapy. In the subset of patients with high S-phase fraction, knowledge of lymph node status did not affect decisions about adjuvant cytotoxic chemotherapy. Axillary dissections may be avoided in these patients, decreasing morbidity and costs. However, in the absence of knowledge of S-phase fraction, knowledge of lymph node status becomes important in determining need for chemotherapy.

Adult↗
PubMed1997

Long-term quality of life outcome after treatment for Helicobacter pylori gastric infection.

Helicobacter pylori has been associated with a number of upper gastrointestinal diseases. Treatment directed toward H. pylori promotes ulcer healing and decreases ulcer recurrence. This study reports a longer-term quality of life follow-up in a group of patients treated for H. pylori. Thirty patients who were treated for upper gastrointestinal symptoms at least 2 years (median 32 months) prior to the initiation of this study had the Gastrointestinal Symptom Rating Scale questionnaire mailed to them. 19 patients responded. This scale measures abdominal pain, heartburn, acid regurgitation, sucking sensations in the upper abdomen, nausea and vomiting, borborygmus, abdominal distention, and belching. Three groups of patients were studied: symptomatic patients without H. pylori infection, symptomatic patients with H. pylori infection and successful eradication, and symptomatic patients with H. pylori infections without eradication. The median symptom scores for each group were no more than 1.5. However, there were no statistically significant differences among these three groups in any of the eight items measured by the Gastrointestinal Symptom Rating Scale. The sample size of this study was sufficient to detect a difference between groups of 1.6. Patients treated for H. pylori have no to occasional upper gastrointestinal symptoms in more than 2 years' follow-up. There appears to be no difference in patients treated for the infection and those without the infection.

Drug Therapy, Combination↗
PubMed1997

Massive hemorrhage from proximal gastric vascular ectasias.

Gastric vascular ectasias are rare lesions of the gastric antrum that may be the cause of iron deficiency anemia in the elderly. We report a case of proximal gastric vascular ectasias in a young man which caused rapidly fatal hemorrhage. This case is instructive because of the patient's youth, the location of the lesions, and the rapidly fatal hemorrhage.

Adult↗
PubMed1996

Fractal analysis of mammographic lesions: a feasibility study quantifying the difference between benign and malignant masses.

The increased use of screening mammography has led to increased pressure to differentiate between benign and malignant lesions. Even those lesions considered "suspicious" by qualitative radiologists' interpretations may prove malignant in less than 30% of cases. Fractal analysis is a mathematical technique that quantifies complex shapes. The hypothesis tested is that fractal analysis can quantify the difference between the shapes of benign and malignant lesions as imaged by mammography. Ten mammograms from patients with biopsy-proven invasive ductal carcinoma and 10 mammograms from patients with biopsy-proven benign disease were compared using the box-counting technique of fractal analysis. The fractal dimension of the mediolateral and craniocaudal views were added together to derive the composite fractal dimension. Statistical analysis was done using the Mann-Whitney U test. The median composite fractal dimension for benign lesions was 1.831 (range 1.359-2.009) and for malignant lesions 2.477 (range 2.084-3.158) (P < 0.0001). In addition, all benign lesions had fractal dimensions < or = 2.009, and all malignant lesions had fractal dimensions > or = 2.084. In this sample of 10 mammograms of malignant lesions versus 10 mammograms of benign masses, the composite fractal dimension was perfectly discriminatory. Fractal analysis may be useful to evaluate mammographically discovered breast masses. A blinded, prospective trial will be needed to determine its ultimate usefulness.

Breast Neoplasms↗