Ultrasound guided pO2 measurement of breast cancer reoxygenation after neoadjuvant chemotherapy and hyperthermia treatment.

The objective of this study was to determine whether neoadjuvant chemotherapy in combination with hyperthermia (HT) would improve oxygenation in locally advanced breast tumours. The study describes a new optimized ultrasound guided technique of pO2 measurement using Eppendorf polarographic oxygen probes in 18 stage IIB-III breast cancer patients. Prior to treatment, tumour hypoxia (median pO2<10 mmHg) was present in 11/18 patients (average median pO2=3.2 mmHg). Seven patients had well oxygenated tumours (median pO2 of 48.3 mmHg). Eight patients with hypoxic tumours prior to treatment had a significant improvement (p=0.0008) in tumour pO2 after treatment (pO2 increased to 19.2 mmHg). In three patients, tumours remained hypoxic (average median pO2=4.5 mmHg). The advantages of the ultrasound guided pO2 probe are in the accuracy of the Eppendorf electrode placement in tumour tissue, the ability to monitor electrode movement through the tumour tissue during the measurement and the ability to avoid electrode placement near or in large blood vessels by using colour Doppler imaging. The results of this preliminary study suggest that the combination of neoadjuvant chemotherapy and hyperthermia improves oxygenation in locally advanced breast tumours that are initially hypoxic.

Tissue harmonic imaging sonography of breast lesions: improved margin analysis, conspicuity, and image quality compared to conventional ultrasound.

The purpose of this preference study is to determine if tissue harmonic imaging (THI) is preferred over conventional sonography for imaging breast masses. A prospective evaluation of 73 identical image pairs (one obtained with conventional sonography, one with THI sonography) was performed, examining 25 cysts, 36 solid masses, and 12 indeterminate lesions. Each image was evaluated for lesion contrast, margins, and overall image quality using a graduated score. Statistical analysis was performed using a modified t test. For cystic and solid lesions, THI was preferred for lesion conspicuity, margin, and overall quality (P<.001). For indeterminate lesions, THI was significantly preferred for lesion conspicuity and overall quality (P<.05), but the preference for margins was not significant. Overall, THI of breast lesions was significantly preferred for lesion contrast and margin evaluation compared to conventional sonography. This modality deserves further evaluation and may improve detection and evaluation of breast lesions.

Negative predictive value of sonography with mammography in patients with palpable breast lesions.

OBJECTIVE: This study was performed to determine the negative predictive value of sonography with mammography in evaluating palpable breast lesions. MATERIALS AND METHODS: Four hundred twenty patients with 455 palpable breast lesions were retrospectively identified from our mammography database as having negative mammographic and sonographic results. For patients diagnosed with breast cancer, images and medical records were reviewed to determine whether the palpable lesion evaluated on sonography and mammography corresponded to the patient's breast cancer. On the basis of the number of breast cancers that correlated to the palpable areas imaged, the negative predictive value of sonography with mammography was determined. RESULTS: Sixty-two of the 420 patients in the study group were already diagnosed with breast carcinoma, and eight new carcinomas were diagnosed during the study period. Only one of six ipsilateral cancers corresponded to a palpable lesion that had a negative imaging evaluation. This lesion was diagnosed as an invasive lobular cancer, hard and fixed at physical examination. Imaging and clinical follow-up of the remaining patients showed no abnormality at the sites of previously investigated palpable abnormalities. The mean imaging follow-up was 25 months. The negative predictive value of sonography and mammography in the setting of a palpable lesion was 99.8%. CONCLUSION: The negative predictive value of sonography with mammography is high, and together these imaging modalities can be reassuring if follow-up is planned when the physical examination is not highly suspicious. However, if the physical examination is suspicious, biopsy should not be delayed.

Metallic clip deployment during stereotactic breast biopsy: retrospective analysis.

PURPOSE: To determine the visibility of presumably excised lesions on screen-film mammograms obtained after biopsy and to determine the accuracy of clip deployment on the basis of measurements obtained on routine pre- and postbiopsy mammograms. MATERIALS AND METHODS: One hundred eleven cases of core-needle biopsy with clip deployment were reviewed. In each, the type of lesion, lesion location, and biopsy approach were recorded. Pre- and postbiopsy images were reviewed, and the distance between the clip and biopsy site was measured. Postbiopsy images were reviewed to determine whether the targeted lesion remained visible. RESULTS: In 62 (56%) cases, the clip was located within 5 mm of the target on postbiopsy images (craniocaudal and mediolateral), while in 18 (16%), the clip was within 6-10 mm on one projection. However, 31 (28%) clips were more than 1 cm from the target on at least one postbiopsy image. Of the 111 cases, 39 (35%) were malignant or atypical and required excision. Of these, 18 (46%) had clips at least 1 cm from the targeted lesion on at least one projection. CONCLUSION: Metallic clips placed during core-needle breast biopsy are intended to mark the biopsy site when the visible lesion is excised, in case additional biopsy is required. The data suggest that the position of metallic clips placed during stereotactic core-needle biopsy may differ substantially from the location of the biopsy site. Postbiopsy mammography should be performed in two orthogonal planes to document clip position relative to the biopsy site.

Focal fibrosis: a common breast lesion diagnosed at imaging-guided core biopsy.

OBJECTIVE: Focal fibrosis is a benign breast lesion commonly diagnosed by imaging-guided core biopsy. The goal of this study is to determine the frequency of focal fibrosis diagnosed at core biopsy and to describe its imaging features. MATERIALS AND METHODS: A consecutive series of 894 imaging-guided breast core biopsies were reviewed, and all cases of focal fibrosis were selected. The imaging features of each lesion were characterized. All lesions had been reviewed during radiologic-histologic review sessions to assess for accurate needle positioning and concordant results. Follow-up imaging and histologic data were reviewed to document lesion stability. RESULTS: Focal fibrosis was diagnosed in 80 (8.9%) of 894 imaging-guided core biopsies: 20 (8.7%) of 229 sonographically guided biopsies and 60 (9.0%) of 665 mammographically guided biopsies. Of 75 mammographically visible lesions, 39 (52%) were masses, 29 (39%) were densities, and seven (9.3%) were clusters of calcifications. Thirty-five hypoechoic lesions were visualized on sonography: 29 (80%) were oval, and six (17%) were irregularly shaped. Six (21%) of the 28 oval masses showed posterior enhancement, four (14%) posterior shadowing, and 19 (68%) neither feature. Fifty-two (65%) of 80 patients with focal fibrosis had routine imaging follow-up; all had stable findings (mean follow-up period, 27 months). No false-negative cases were identified. CONCLUSION: Focal fibrosis most commonly appears as an enlarging solid mass or developing density on mammography or as an oval mass on sonography. Our data suggest that focal fibrosis accounts for 9% of lesions that undergo imaging-guided core biopsy and that the diagnosis can be accurately reached using imaging-guided biopsy.

Outcome analysis for women undergoing annual versus biennial screening mammography: a review of 24,211 examinations.

OBJECTIVE: Our goal was to determine differences in outcome measures between women undergoing annual versus biennial screening mammography. MATERIALS AND METHODS: A retrospective review of prospectively collected data on 24,211 consecutive screening mammography examinations was performed in women aged 40-79 years, all of whom had undergone previous normal screening mammography. Annual screening and biennial screening were defined as examinations performed 10-14 months and 22-26 months, respectively, after previous normal screening mammography. The rates of recall, biopsy, cancer detection, and interval cancer for annual and biennial screening cohorts were calculated, as were tumor size, lymph node status, and stage of invasive cancer. Interval cancer cases were identified by linkage with a regional tumor registry. RESULTS: Of the 4306 biennially screened women, 160 were recalled (3.7%), 45 were biopsied (1.0%), and cancer was detected in 19 (0.44%). Of the 19,905 annually screened women, 518 were recalled (2.6%), 150 were biopsied (0.75%), and cancer was detected in 71 (0.36%). Of the 3278 registry-linked biennially screened women, five had interval cancer (0.15%); of the 15,031 registry-linked annually screened women, 10 had interval cancer (0.07%). For biennial screening-detected cancer and interval invasive cancer combined, the median tumor size was 15 mm, 24% had lymph node metastasis, and 29% were stage 2 or higher. For annual screening-detected cancer, these measures were 11 mm, 14% positive nodes, and 17% stage 2+ cancer, respectively. CONCLUSION: Annual screening mammography results in lower recall rates than does biennial screening (p < .0001). Moreover, annual screening results in the detection of smaller tumors that have a more favorable prognosis (p = .04).

Ability of mammography to reveal nonpalpable breast cancer in women with palpable breast masses.

OBJECTIVE: Our goal was to determine the frequency with which mammography reveals nonpalpable malignancies in women with benign palpable masses and to compare these nonpalpable malignancies with the palpable malignancies and nonpalpable malignancies detected in asymptomatic women. SUBJECTS AND METHODS: This study of nominally asymptomatic women involved 85,399 consecutive mammographic examinations, of which 3459 (4.1%) examinations were performed on women who had palpable masses identified before or at the time of mammography. A medical outcomes audit identified mammographic examinations after which breast cancer was diagnosed and determined selected surrogate measures for mortality reduction for the mammographically detected malignancies. RESULTS: Of the 3459 examinations in women with palpable masses, 64 cases of cancer were revealed by mammography. Of these, 54 cases involved palpable malignancies (15.6/1000 examinations) and 10 involved nonpalpable malignancies (2.6/1000 examinations). Of the 81,940 examinations in asymptomatic women, 346 cases of nonpalpable cancer were detected (4.2/1000 examinations). Of the 10 cases of nonpalpable cancer detected in women with benign palpable masses, median tumor size was 13.8 mm, 10% had axillary node metastasis, and 10% were stage 2 or higher. The corresponding surrogate measures for cases of nonpalpable cancer detected in asymptomatic women were median tumor size, 13.6 mm; node metastasis, 7%; stage 2 or higher, 14%. The surrogate measures for the 54 palpable malignancies were median tumor size, 23.7 mm; node metastasis, 31%; stage 2 or higher, 63%. CONCLUSION: The surrogate measures for the nonpalpable malignancies in women with benign palpable lesions resemble those in asymptomatic women and are much more favorable than those of palpable malignancies. Therefore, in women with a palpable breast mass, it is important to use mammography to screen the remainder of both breasts for nonpalpable cancer.

American Nursing Informatics Association role survey.

A descriptive study, using a survey approach, was conducted among 48 American Nursing Informatics Association (ANIA) member respondents to determine the nursing informatics role among professional nurses working in the specialty. Members were asked to complete a survey regarding their current position, educational and work experience, continuing education, and work challenges. Although the ages of the informatics nurses parallel the national, range, most have been in the field of nursing informatics for 2.5 to 5 years and in their current position only 1.5 to 2 years. Job responsibilities and challenges indicate common issues and concerns that have implications for the specialty of nursing informatics and nursing in general.

Nonenzymatic glycosylation of proteins and protease activities in granulation tissues in experimental diabetes.

Serum proteins and hemoglobins show increased nonenzymatic glycosylation in diabetes mellitus. The measure of glycosylated proteins, particularly hemoglobin, is considered to be a preferred indicator in the control of diabetes. In a study of diabetes and inflammation, we assessed the extent of nonenzymatic glycosylation of proteins of granulation tissue from diabetic rats. Five, seven, and ten days after carrageenan injection, the granuloma proteins were extracted. Nonenzymatic glycosylation was measured in soluble and insoluble granuloma proteins by thiobarbituric acid assay. Protease activities and free amino groups were assayed in soluble extracts. Nonenzymatic glycosylation in soluble proteins of both groups reached a maximum on the seventh day. However, nonenzymatic glycosylation in soluble proteins of the diabetic granulomas was significantly greater than the controls on days five and seven. During the days after granuloma induction, nonenzymatic glycosylation in the insoluble granuloma tissue proteins gradually decreased without any significant differences between controls and diabetics. Significant decreases in the free amino groups in soluble proteins of the diabetic tissues were noted. Greater activities of cathepsins B and D were noted in diabetic tissues over controls. These observations suggest that, in addition to increased proteolysis, increased nonenzymatic glycosylation of tissue proteins could be associated with the impaired process of wound healing in diabetics.

Glycoprotein biosynthesis during inflammation in normal and streptozotocin-induced diabetic rats.

Extracellular glycoproteins play an important role in wound healing; yet little is known about glycoprotein biosynthesis and its regulation by insulin in inflammation. Using [1-14C] fucose as a marker, glycoprotein biosynthesis was studied in carrageenan-induced granuloma from diabetic and control rats. Fucose incorporation into glycoproteins was followed for 24 h after an intraperitoneal injection of the label. Radioactivity in trichloroacetic acid precipitable serum glycoproteins and saline-soluble and insoluble glycoproteins was assessed in five-, seven-, and ten-day-old granuloma tissues. Fucose incorporation was higher in soluble glycoproteins (P less than 0.01) at all points in controls than in diabetic granulomas, and peak incorporation was reached in both groups on the seventh day. Incorporation of fucose into insoluble glycoproteins was higher in normals on the seventh day than in diabetics. Liver-, kidney-, and intestine-soluble glycoproteins showed a maximum incorporation on the seventh day, but no difference was noted between diabetic and normal rats. Incorporation of fucose in insoluble glycoproteins showed a gradual decline with the age of granuloma in all tissues from both groups, with the exception of the kidney. In the kidney, fucosylation of insoluble glycoproteins was decreased (P less than 0.01) in diabetics compared to controls. These results indicate an active phase of biosynthesis, with an increase in glycosylation during inflammation that is probably insulin dependent.

Factors influencing referral decisions in physiatry.

As the population ages and more emphasis is placed on patient management than on curative exercise, physical medicine gains an important place in medical specialties. This study investigates the referral behavior in physiatry and compares it with referrals to other specialties. From a sample of 159 primary care physicians in the St. Louis metropolitan area who have a high probability of using physical medicine and rehabilitation, a referral model in physiatry was constructed. The results indicate that while the traditional determinants of referral decision play a significant role in influencing the referral behavior in physiatry, there also is a group of variables in physiatry that are significantly different from those of other subspecialties in determining referral process.