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W H Hindle

Publications and source records attributed to W H Hindle.

At least 19 recordsLinked to original sources
PubMed2000

Lack of utility in clinical practice of cytologic examination of nonbloody cyst fluid from palpable breast cysts.

OBJECTIVE: This study was undertaken to answer the following question: Does cytologic evaluation of nonbloody fluid aspirated from breast cysts contribute to appropriate clinical management? STUDY DESIGN: A retrospective review of palpable breast cyst fluid cytologic reports and associated medical records was undertaken to determine whether the cytologic findings affected patient management. Breast cyst size, fluid volume, fluid color, and patient age were abstracted from 689 medical records (1988-1999) of women whose palpable cysts had been aspirated at the Breast Diagnostic Center, Women's and Children's Hospital, Los Angeles. These observations were correlated with the fluid cytologic reports. RESULTS: Except for frankly bloody fluid, all breast fluid cytologic reports listed the results as acellular, inadequate for cytologic diagnosis, or no malignant cells identified. CONCLUSION: In clinical practice only frankly bloody fluid should be submitted for cytologic analysis. All other cyst fluid should be discarded.

Adolescent↗
PubMed1999

Clinical value of mammography for symptomatic women 35 years of age and younger.

OBJECTIVE: This retrospective observational study was designed to answer the following question: Is mammography clinically effective in the evaluation of women </=35 years old with breast symptoms or findings. STUDY DESIGN: A retrospective review was undertaken of 1908 consecutive initial mammogram reports of symptomatic women </=35 years old who came to a referral breast clinic. The clinic records were analyzed for the working diagnoses and management plans before and after the input of the initial mammogram reports. RESULTS: Of the 4160 initial mammograms of women who came (1992-1995) to the Breast Diagnostic Center at Women's and Children Hospital, Los Angeles, Calif, 1908 were of women </=35 years old. The mammogram reports were reviewed and tabulated by age group for mammography recommendations. The working diagnoses and management plans in the center's charts were retrospectively evaluated before and after the mammogram reports to ascertain whether the mammogram reports altered clinical management in this patient population and age group. No clinically unsuspected cancers were perceived by mammography performed at the center in women </=35 years old. (All of the 23 invasive cancers were palpable and had prior diagnoses after fine-needle aspiration biopsy.) The initial mammogram reports did not change the working diagnosis or clinical management of these cases in this patient population and clinic setting. Ultrasonography was recommended by the radiologists in 37% of the study cases. CONCLUSIONS: Routine initial mammography was not cost-effective or clinically beneficial in the evaluation of breast symptoms or findings and management of the cases of women </=35 years old who came to our center.

Adenocarcinoma↗
PubMed1999

A breast clinic in a department of obstetrics and gynecology.

In 1988, the Department of Obstetrics and Gynecology of the University of Southern California School of Medicine; created its own Breast Diagnostic Center for training resident physicians and providing breast care for outpatients and inpatients of Women's and Children's Hospital, Los Angeles, California. The structure and function of the Breast Diagnostic Center allow residents to be directly involved in and responsible for evaluation and care of benign breast problems and allow comprehensive breast-care education and integration of referral breast services for residents and patients. Direct faculty supervision, uniform history and physical records on printed forms, fine-needle aspirations and breast biopsies, and staff assistance with follow-up and patient tracking maximize resident physician education and experience. This departmental approach to resident physician training in breast care can be adapted to the resources and logistics of any department of obstetrics and gynecology.

Breast Diseases↗
PubMed1997

Accuracy of mammographic appearances after breast fine-needle aspiration.

OBJECTIVE: The objective of this study was to document the observation that fine-needle aspiration of palpable breast masses by use of a modified technique performed shortly before mammography need not adversely interfere with mammographic interpretation nor produce falsely suspicious mammographic lesions that delay meaningful evaluation and management in this breast clinic. STUDY DESIGN: In a retrospective record review 1007 women who were seen in the Breast Diagnostic Center at Women's and Children's Hospital from January 1992 until April 1995 and who had fine-needle aspiration of a palpable solid breast mass within 2 weeks before mammography were analyzed overall and in 10-year age group subsets. The mammographic reports of "suspicious" lesions were correlated with having had a prior fine-needle aspiration (within 2 weeks). RESULTS: Of the 1007 women undergoing fine-needle aspirations, 91 had a cytologic or tissue biopsy specimen diagnosis of malignancy. Of these, 72 had "suspicious" mammograms and 19 had "nonsuspicious" mammograms. The calculated positive predictive value was 58%. The negative predictive value was 98%. Mammographic sensitivity was 79%. Specificity was 94%. Age stratification did not reveal any meaningful trends. Of the 916 patients with benign cytologic results of fine-needle aspiration specimens, 52 had "suspicious" mammograms and 864 had "nonsuspicious" mammograms. CONCLUSION: For patient convenience and expeditious diagnosis of a palpable breast mass, fine-needle aspiration can be performed on the initial visit and mammograms subsequently taken within 2 weeks without undue clinical confusion or misleading mammographic findings. Concordance of the diagnostic triad consisting of (1) clinical impression (by history and examination), (2) fine-needle aspiration, and (3) mammography gives a reliable conclusion and can appropriately be used as the basis for clinical management of a breast mass. However, when there is doubt or anxiety about the diagnosis either on the part of the patient or the physician, a definitive histologic tissue diagnosis should obtained.

Adolescent↗
PubMed1994

The diagnostic evaluation.

Breast symptoms are appropriately evaluated by a breast-oriented history and by the diagnostic triad of clinical breast examination, FNA, and mammography. In the case of a palpable dominant mass, concordance of the diagnostic triad yields a reliable clinical diagnosis. If there is not concordance, or if there is any doubt about the diagnosis either on the part of the physician or the patient, open surgical biopsy provides the definitive histologic diagnosis. The goal in clinical practice is to detect nonpalpable cancers by ordering screening mammography for all patients eligible by age, history, or both. The long-term cancer-free survival of women treated for nonpalpable breast cancer is excellent.

Biopsy, Needle↗
PubMed1993

The use of fine-needle aspiration in the evaluation of persistent palpable dominant breast masses.

OBJECTIVE: Our purpose was to determine if fine-needle aspiration can decrease the necessity for open surgical biopsy in the diagnosis of a persistent palpable dominant breast mass. STUDY DESIGN: In a university obstetrics-gynecology resident physician training program, persistent palpable dominant breast masses seen in the Breast Diagnostic Center at Women's Hospital, Los Angeles County-University of Southern California Medical Center, were evaluated by fine-needle aspiration. When a cytologic diagnosis was obtained, the patients were treated, followed, or referred for treatment. Open surgical biopsy was reserved for those lesions that were not cytologically diagnosed or for which there was no concordance of the diagnostic triad of palpation, fine-needle aspiration, and mammography. RESULTS: Resident physicians rotating through the Breast Diagnostic Center performed 568 fine-needle aspirations under staff supervision. The technique was readily learned by most of the resident physicians with equipment already available in most outpatient settings. Fine-needle aspiration was performed on the initial clinic visit, and the preliminary cytologic diagnosis was given to the patient on the same day. Forty-two cancers were cytologically diagnosed (7% of the fine-needle aspirations). Seventy-five (13%) other patients were referred for open surgical biopsy as the definitive diagnostic procedure. Twenty-four (4%) patients elected open surgical excision biopsy of fine-needle aspiration-diagnosed masses. CONCLUSION: Fine-needle aspiration of persistent palpable dominant breast masses allows expeditious and potentially cost-effective management of most cases and decreases the necessity of open surgical biopsy for definitive diagnosis.

Adenofibroma↗
PubMed1992

Mammography lexicon.

Explore the source record for details and available documents.

Dictionaries, Medical as Topic↗
PubMed1992

Breast evaluation and diagnosis by obstetrician-gynecologists. Survey of practice patterns.

Surveys of the obstetrician-gynecologists attending the breast disease postgraduate courses at the 1988 and 1990 American College of Obstetricians and Gynecologists annual clinical meetings report a high level of practice involvement in breast disease evaluation and cancer screening for their patients. A consistently high percentage stated they performed regular clinical breast examinations, documented the examinations with a diagram in the medical record, gave breast self-examination instruction, advised screening mammography following the American College of Obstetricians and Gynecologists guidelines, utilized a patient tracking system for follow-up and referred patients with undiagnosed dominant breast masses. Most stated that they did breast cyst aspiration; those who did not mostly referred their patients for cyst aspiration. The accurate and cost- and time-effective office technique of fine needle aspiration of palpable dominant solid breast mass continues to be underutilized even though the procedure has been proven effective and accurate in the cytologic diagnosis of benign and malignant breast neoplasms. Instruction in the technique of fine needle aspiration of palpable breast cysts and solid masses is available in many clinics, workshops and postgraduate courses.

Biopsy↗
PubMed1991

Conservative management of breast fibroadenomas.

Is it conservative or radical management to excise all fibroadenomas of the breast, especially in women less than 30 years old? Once a definite diagnosis is established by physical examination, fine-needle aspiration cytologic testing, and mammography, is it prudent to monitor women with small fibroadenomas (less than 4 cm in diameter)? We reviewed 498 cases of biopsy-proved fibroadenomas and 17 cases of phyllodes tumors (by biopsy) seen at Los Angeles County/University of Southern California Medical Center from 1986 to 1989. Analysis of patient age and measured tumor size in 203 fibroadenomas and 10 phyllodes tumor specimens revealed similar ranges for both tumors. The mean values were 28.5 years and 2.3 cm for fibroadenomas and 44 years and 3.8 cm for phyllodes tumors. No cases of coincident carcinoma within a fibroadenoma or of metastatic malignant phyllodes tumors were present in this review. As an alternative to excising all breast tumors, cytologically diagnosed fibroadenomas can be monitored, because they have no intrinsic premalignant potential and tend to regress with time. All breast tumors that rapidly increase in size should probably be excised at any age.

Adenofibroma↗
PubMed1990

Breast masses. In-office evaluation with diagnostic triad.

Using the diagnostic triad of clinical breast examination, fine-needle aspiration, and mammography, primary care physicians can make an in-office definitive diagnosis in 90% of women presenting with a dominant breast mass. The remaining 10% should undergo open surgical biopsy. This diagnostic-triad approach is accurate, efficient, and cost-effective, and it does not require additional lengthy training, expensive equipment, or complex technology. In the case of breast cancer, the woman and her family can be immediately counseled and quickly prepared for consulting appointments and appropriate treatment options.

Adult↗
PubMed1983

Breast aspiration cytology: a neglected gynecologic procedure.

Presented is a retrospective review of 1,196 breast aspiration cytologic procedures done during 1973 through 1981, at the Straub Clinic and Hospital, Inc., Honolulu, Hawaii. Aspirations which yielded clear fluid are not included. Of all the patients who had breast aspirations, 204 subsequently underwent open biopsy, and a definitive histologic diagnosis was made. Of the 204 open biopsies, 23% proved the existence of malignancy. Thus, 4% of the 1,196 breast aspirations proved the presence of carcinoma. Office aspiration cytologic examination of breast lesions is an efficient and cost-effective technique which is available to every gynecologist, and for which there are no medical contraindications. Complications are rare and usually not significant. If clear fluid is obtained, a clinical diagnosis of benign cystic disease can be made with a high degree of reliability. If the findings of breast aspiration cytologic examination are reported to be suspicious or to disclose malignancy, the patient should be referred as soon as possible for a definitive open biopsy and appropriate surgical treatment.

Adolescent↗
PubMedDate not supplied

Hormone alterations in breast cancer: examining the hypotheses.

Many of the epidemiologic risk factors for breast cancer offer clinicians little help in anticipating who is likely to be struck with the disease or how to prevent it. There are only a handful of clinically significant risk factors for breast cancer. These include being a woman, growing older, already having breast cancer in 1 breast, and having a first-degree relative (mother, sister, or daughter) who has been diagnosed with breast cancer. Most risk factors have a weak association with breast cancer, occur too infrequently, or are physiologic events not amenable to intervention. In recent years, the search for breast cancer causes has led to the identification of genetic markers that seem to predispose some women to breast cancer. For decades, however, researchers have been assessing and analyzing hormonal changes in the hope of finding a predictable breast cancer marker or cause that can easily be manipulated to prevent or more effectively treat the disease. Nearly a dozen hormonal hypotheses of breast cancer causes have been proposed -- among them estrogen excess, low luteal-phase progestational activity, adrenal androgen deficiency, ovarian androgen excess, melatonin deficiency, prolactin excess, and thyroid insufficiency. For most, the data are equivocal and inconclusive. The androgen deficiency hypotheses, however, may have some bearing on premenopausal breast cancer, and the ovarian dysfunction hypothesis may have some bearing on postmenopausal breast cancer.

Breast Neoplasms↗