Short-Term Follow-Up Mammography in Breast Conservation Therapy Likely Leads to Unnecessary Downstream Workup: A Longitudinal Study.

PURPOSE: To analyze the effect of post-radiation therapy (XRT) mammographic timing and radiation technique in relation to additional downstream workup for 569 breast conservation therapy patients treated with adjuvant XRT after their initial surveillance mammogram (MMG). METHODS AND MATERIALS: From January 2011 to December 2014, 569 breast cancer patients treated with breast conservation surgery and adjuvant XRT with a follow-up MMG were reviewed. Patients were stratified by the time interval until their first post-XRT MMG, and by XRT technique-whole breast (472), accelerated partial breast (96), conventional fractionation (373), hypofractionation (94), surgical cavity boosts (407), or no boost (66). The primary endpoint was further imaging after the initial MMG. RESULTS: Additional workup for those receiving an MMG within 3 months of completing XRT was 51% (73 of 143), compared with 40% (84 of 210) with MMG between 3 and 6 months and 34.5% (75 of 216) with MMG after 6 months (P=.04). Radiation boost to the postoperative bed was associated with further downstream imaging, whereas accelerated partial-breast irradiation and hypofractionated treatment were not. CONCLUSIONS: Breast conservation therapy patients who underwent screening MMG before 6 months after completion of XRT were more likely to undergo downstream workup, including additional biopsies. Accelerated and hypofractionated radiation techniques were not associated with supplementary workup. Further study is needed to assess appropriate selection of high-risk patients and possible negative implications of earlier post-XRT screening MMG.

Surgical resident accuracy in predicting their ABSITE score.

BACKGROUND: The American Board of Surgery In-Training Examination (ABSITE) is given to all surgical residents as an assessment tool for residents and their programs in preparation for the American Board of Surgery qualifying and certifying examinations. Our objective was to ascertain how well surgical residents could predict their percentile score on the ABSITE using two predictor measures before and one immediately after the examination was completed. METHODS: A survey was given to surgical residents in postgraduate year(s) (PGY) 2 through 5 as well as to research residents in November and December 2011, and immediately after the examination in January 2012, to ascertain their predicted ABSITE scores. Thirty-one general surgery residents were measured consisting of PGY-2 (22%), PGY-3 (19.4%), PGY-4 (19.4%), and PGY-5 (12.9%), and research residents 25.8%. RESULTS: Mean prediction scores were consistently higher than actual examination scores for both junior and senior examination takers, with senior examination predictions exhibiting the highest proportion of variation on the actual examination score. Stratified linear regression analysis showed little predictive significance of all 3 examination predictions and actual score, except for the senior examination predictions in November 2011 (t test = 2.521, P = .027). We found no statistically significant difference in the proportion of residents overestimating or underestimating their predicted score. Secondary analysis using a linear regression model shows that 2011 scores were a statistically significant predictor of 2012 scores (overall F = 13.258, P = .001, R(2) = 0.31) for both junior and senior examinations. CONCLUSION: General surgery residents were not able to accurately predict their ABSITE score; however, the previous year's actual scores were found to have the most predictive value of the next year's actual scores.

Streptococcus viridans tubo-ovarian abscess in an adolescent virgin.

A tubo-ovarian abscess (TOA) is a common complication of pelvic inflammatory disease in premenopausal women; however, in virginal females, TOAs are an exceedingly rare occurrence. Within this rare subset of patients, there is almost always an underlying condition, such as vaginal voiding, or a concomitant disease process. A virginal adolescent female with no prior medical history presented with a large pelvic mass which proved to be a TOA. An exploratory laparotomy was eventually required to establish the diagnosis. Open drainage and antibiotic therapy successfully treated the patient. With only the organism, Streptococcus viridians, isolated in her cultures, an etiology of direct ascension from the lower genitourinary tract is implicated. We believe this to be the youngest case of a TOA occurring in a virginal adolescent female without a predisposing condition. A TOA should be considered in the differential diagnosis of pelvic masses in previously healthy pediatric patients regardless of their sexual activity.