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1.
Eur Radiol ; 33(9): 6213-6225, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37138190

RESUMEN

OBJECTIVES: To report mastectomy and reoperation rates in women who had breast MRI for screening (S-MRI subgroup) or diagnostic (D-MRI subgroup) purposes, using multivariable analysis for investigating the role of MRI referral/nonreferral and other covariates in driving surgical outcomes. METHODS: The MIPA observational study enrolled women aged 18-80 years with newly diagnosed breast cancer destined to have surgery as the primary treatment, in 27 centres worldwide. Mastectomy and reoperation rates were compared using non-parametric tests and multivariable analysis. RESULTS: A total of 5828 patients entered analysis, 2763 (47.4%) did not undergo MRI (noMRI subgroup) and 3065 underwent MRI (52.6%); of the latter, 2441/3065 (79.7%) underwent MRI with preoperative intent (P-MRI subgroup), 510/3065 (16.6%) D-MRI, and 114/3065 S-MRI (3.7%). The reoperation rate was 10.5% for S-MRI, 8.2% for D-MRI, and 8.5% for P-MRI, while it was 11.7% for noMRI (p ≤ 0.023 for comparisons with D-MRI and P-MRI). The overall mastectomy rate (first-line mastectomy plus conversions from conserving surgery to mastectomy) was 39.5% for S-MRI, 36.2% for P-MRI, 24.1% for D-MRI, and 18.0% for noMRI. At multivariable analysis, using noMRI as reference, the odds ratios for overall mastectomy were 2.4 (p < 0.001) for S-MRI, 1.0 (p = 0.957) for D-MRI, and 1.9 (p < 0.001) for P-MRI. CONCLUSIONS: Patients from the D-MRI subgroup had the lowest overall mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). This analysis offers an insight into how the initial indication for MRI affects the subsequent surgical treatment of breast cancer. KEY POINTS: • Of 3065 breast MRI examinations, 79.7% were performed with preoperative intent (P-MRI), 16.6% were diagnostic (D-MRI), and 3.7% were screening (S-MRI) examinations. • The D-MRI subgroup had the lowest mastectomy rate (24.1%) among MRI subgroups and the lowest reoperation rate (8.2%) together with P-MRI (8.5%). • The S-MRI subgroup had the highest mastectomy rate (39.5%) which aligns with higher-than-average risk in this subgroup, with a reoperation rate (10.5%) not significantly different to that of all other subgroups.


Asunto(s)
Neoplasias de la Mama , Femenino , Humanos , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/cirugía , Mastectomía , Mastectomía Segmentaria , Mama , Imagen por Resonancia Magnética , Cuidados Preoperatorios
2.
Eur Radiol ; 2023 Nov 24.
Artículo en Inglés | MEDLINE | ID: mdl-37999727

RESUMEN

OBJECTIVES: To investigate the influence of preoperative breast MRI on mastectomy and reoperation rates in patients with pure ductal carcinoma in situ (DCIS). METHODS: The MIPA observational study database (7245 patients) was searched for patients aged 18-80 years with pure unilateral DCIS diagnosed at core needle or vacuum-assisted biopsy (CNB/VAB) and planned for primary surgery. Patients who underwent preoperative MRI (MRI group) were matched (1:1) to those who did not receive MRI (noMRI group) according to 8 confounding covariates that drive referral to MRI (age; hormonal status; familial risk; posterior-to-nipple diameter; BI-RADS category; lesion diameter; lesion presentation; surgical planning at conventional imaging). Surgical outcomes were compared between the matched groups with nonparametric statistics after calculating odds ratios (ORs). RESULTS: Of 1005 women with pure unilateral DCIS at CNB/VAB (507 MRI group, 498 noMRI group), 309 remained in each group after matching. First-line mastectomy rate in the MRI group was 20.1% (62/309 patients, OR 2.03) compared to 11.0% in the noMRI group (34/309 patients, p = 0.003). The reoperation rate was 10.0% in the MRI group (31/309, OR for reoperation 0.40) and 22.0% in the noMRI group (68/309, p < 0.001), with a 2.53 OR of avoiding reoperation in the MRI group. The overall mastectomy rate was 23.3% in the MRI group (72/309, OR 1.40) and 17.8% in the noMRI group (55/309, p = 0.111). CONCLUSIONS: Compared to those going directly to surgery, patients with pure DCIS at CNB/VAB who underwent preoperative MRI had a higher OR for first-line mastectomy but a substantially lower OR for reoperation. CLINICAL RELEVANCE STATEMENT: When confounding factors behind MRI referral are accounted for in the comparison of patients with CNB/VAB-diagnosed pure unilateral DCIS, preoperative MRI yields a reduction of reoperations that is more than twice as high as the increase in overall mastectomies. KEY POINTS: • Confounding factors cause imbalance when investigating the influence of preoperative MRI on surgical outcomes of pure DCIS. • When patient matching is applied to women with pure unilateral DCIS, reoperation rates are significantly reduced in women who underwent preoperative MRI. • The reduction of reoperations brought about by preoperative MRI is more than double the increase in overall mastectomies.

3.
Mem Cognit ; 51(2): 404-421, 2023 02.
Artículo en Inglés | MEDLINE | ID: mdl-36251160

RESUMEN

Given the complexities of episodic memory and necessarily social nature of in-person face-to-face interviews, theoretical and evidence-based techniques for collecting episodic information from witnesses, victims, and survivors champion rapport-building. Rapport is believed to reduce some of the social demands of recalling an experienced event in an interview context, potentially increasing cognitive capacity for remembering. Cognitive and social benefits have also emerged in remote interview contexts with reduced anxiety and social pressure contributing to improved performance. Here, we investigated episodic memory in mock-eyewitness interviews conducted in virtual environments (VE) and in-person face-to-face (FtF), where rapport-building behaviours were either present or absent. Main effects revealed when rapport was present and where interviews were conducted in a VE participants recalled more correct event information, made fewer errors and were more accurate. Moreover, participants in the VE plus rapport-building present condition outperformed participants in all other conditions. Feedback indicated both rapport and environment were important for reducing the social demands of a recall interview, towards supporting effortful remembering. Our results add to the emerging literature on the utility of virtual environments as interview spaces and lend further support to the importance of prosocial behaviours in applied contexts.


Asunto(s)
Memoria Episódica , Recuerdo Mental , Humanos , Relaciones Interpersonales , Ansiedad
4.
Eur Radiol ; 32(3): 1611-1623, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34643778

RESUMEN

OBJECTIVES: Preoperative breast magnetic resonance imaging (MRI) can inform surgical planning but might cause overtreatment by increasing the mastectomy rate. The Multicenter International Prospective Analysis (MIPA) study investigated this controversial issue. METHODS: This observational study enrolled women aged 18-80 years with biopsy-proven breast cancer, who underwent MRI in addition to conventional imaging (mammography and/or breast ultrasonography) or conventional imaging alone before surgery as routine practice at 27 centers. Exclusion criteria included planned neoadjuvant therapy, pregnancy, personal history of any cancer, and distant metastases. RESULTS: Of 5896 analyzed patients, 2763 (46.9%) had conventional imaging only (noMRI group), and 3133 (53.1%) underwent MRI that was performed for diagnosis, screening, or unknown purposes in 692/3133 women (22.1%), with preoperative intent in 2441/3133 women (77.9%, MRI group). Patients in the MRI group were younger, had denser breasts, more cancers ≥ 20 mm, and a higher rate of invasive lobular histology than patients who underwent conventional imaging alone (p < 0.001 for all comparisons). Mastectomy was planned based on conventional imaging in 22.4% (MRI group) versus 14.4% (noMRI group) (p < 0.001). The additional planned mastectomy rate in the MRI group was 11.3%. The overall performed first- plus second-line mastectomy rate was 36.3% (MRI group) versus 18.0% (noMRI group) (p < 0.001). In women receiving conserving surgery, MRI group had a significantly lower reoperation rate (8.5% versus 11.7%, p < 0.001). CONCLUSIONS: Clinicians requested breast MRI for women with a higher a priori probability of receiving mastectomy. MRI was associated with 11.3% more mastectomies, and with 3.2% fewer reoperations in the breast conservation subgroup. KEY POINTS: • In 19% of patients of the MIPA study, breast MRI was performed for screening or diagnostic purposes. • The current patient selection to preoperative breast MRI implies an 11% increase in mastectomies, counterbalanced by a 3% reduction of the reoperation rate. • Data from the MIPA study can support discussion in tumor boards when preoperative MRI is under consideration and should be shared with patients to achieve informed decision-making.


Asunto(s)
Neoplasias de la Mama , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Mama , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Mastectomía , Mastectomía Segmentaria , Persona de Mediana Edad , Cuidados Preoperatorios , Adulto Joven
5.
Eur Radiol ; 30(10): 5427-5436, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32377813

RESUMEN

Despite its high diagnostic performance, the use of breast MRI in the preoperative setting is controversial. It has the potential for personalized surgical management in breast cancer patients, but two of three randomized controlled trials did not show results in favor of its introduction for assessing the disease extent before surgery. Meta-analyses showed a higher mastectomy rate in women undergoing preoperative MRI compared to those who do not. Nevertheless, preoperative breast MRI is increasingly used and a survey from the American Society of Breast Surgeons showed that 41% of respondents ask for it in daily practice. In this context, a large-scale observational multicenter international prospective analysis (MIPA study) was proposed under the guidance of the European Network for the Assessment of Imaging in Medicine (EuroAIM). The aims were (1) to prospectively and systematically collect data on consecutive women with a newly diagnosed breast cancer, not candidates for neoadjuvant therapy, who are offered or not offered breast MRI before surgery according to local practice; (2) to compare these two groups in terms of surgical and clinical endpoints, adjusting for covariates. The underlying hypotheses are that MRI does not cause additional mastectomies compared to conventional imaging, while reducing the reoperation rate in all or in subgroups of patients. Ninety-six centers applied to a web-based call; 36 were initially selected based on volume and quality standards; 27 were active for enrollment. On November 2018, the target of 7000 enrolled patients was reached. The MIPA study is presently at the analytic phase. Key Points • Breast MRI has a high diagnostic performance but its utility in the preoperative setting is controversial. • A large-scale observational multicenter prospective study was launched to compare women receiving with those not receiving preoperative MRI. • Twenty-seven centers enrolled more than 7000 patients. The study is presently at the analytic phase.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Protocolos de Ensayos Clínicos como Asunto , Imagen por Resonancia Magnética , Cuidados Preoperatorios , Anciano , Mama/diagnóstico por imagen , Neoplasias de la Mama/cirugía , Femenino , Humanos , Mastectomía , Persona de Mediana Edad , Estudios Prospectivos , Reoperación
6.
AJR Am J Roentgenol ; 208(4): 712-720, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28125269

RESUMEN

OBJECTIVE: The objective of this study was to investigate the incidence of plagiarism in a sample of manuscripts submitted to the AJR using CrossCheck, develop an algorithm to identify significant plagiarism, and formulate management pathways. MATERIALS AND METHODS: A sample of 110 of 1610 (6.8%) manuscripts submitted to AJR in 2014 in the categories of Original Research or Review were analyzed using CrossCheck and manual assessment. The overall similarity index (OSI), highest similarity score from a single source, whether duplication was from single or multiple origins, journal section, and presence or absence of referencing the source were recorded. The criteria outlined by the International Committee of Medical Journal Editors were the reference standard for identifying manuscripts containing plagiarism. Statistical analysis was used to develop a screening algorithm to maximize sensitivity and specificity for the detection of plagiarism. Criteria for defining the severity of plagiarism and management pathways based on the severity of the plagiarism were determined. RESULTS: Twelve manuscripts (10.9%) contained plagiarism. Nine had an OSI excluding quotations and references of less than 20%. In seven, the highest similarity score from a single source was less than 10%. The highest similarity score from a single source was the work of the same author or authors in nine. Common sections for duplication were the Materials and Methods, Discussion, and abstract. Referencing the original source was lacking in 11. Plagiarism was undetected at submission in five of these 12 articles; two had been accepted for publication. The most effective screening algorithm was to average the OSI including quotations and references and the highest similarity score from a single source and to submit manuscripts with an average value of more than 12% for further review. CONCLUSION: The current methods for detecting plagiarism are suboptimal. A new screening algorithm is proposed.


Asunto(s)
Políticas Editoriales , Modelos Organizacionales , Revisión de la Investigación por Pares/métodos , Publicaciones Periódicas como Asunto , Plagio , Edición/organización & administración , Algoritmos , Manuscritos Médicos como Asunto , Estados Unidos
7.
Perfusion ; 32(3): 183-191, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27729502

RESUMEN

INTRODUCTION: The purpose of this study is to describe the sedative and analgesic requirements identifying factors associated with medication escalation in neonates and children supported on ECMO. METHOD: Observational retrospective cohort study in a tertiary pediatric intensive care unit from June 2009 to June 2013. RESULTS: One hundred and sixty patients were included in the study. Fentanyl and midazolam were the first line agents used while on ECMO. Higher opiate requirements were associated with younger age (p=0.01), thoracic cannulation (p=0.002), the use of dexmedetomidine (p=0.007) and prolonged use of muscle relaxants (p=0.03). Higher benzodiazepine requirements were associated with younger age (p=0.01), respiratory failure (p=0.02) and the use of second line agents (p=0.002). One third of the patients required second line agents as adjuvants for comfort without a decrease in opiate and/or benzodiazepine requirements. CONCLUSIONS: Providing comfort to subpopulations of pediatric ECMO patients seems to be more challenging. The use of second line agents did not improve comfort in our cohort. Prospective studies are required to optimize analgesia and sedation management in children on ECMO.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Oxigenación por Membrana Extracorpórea/métodos , Fentanilo/uso terapéutico , Hipnóticos y Sedantes/uso terapéutico , Midazolam/uso terapéutico , Adolescente , Benzodiazepinas/uso terapéutico , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos
8.
Pediatr Crit Care Med ; 15(9): 861-9, 2014 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-25251516

RESUMEN

OBJECTIVES: Describe aspects of one center's experience extubating infants and children during extracorporeal membrane oxygenation. DESIGN: Retrospective review of medical records. SETTING: Seventy-one-bed critical care service (PICU and cardiovascular ICU) in a large urban tertiary children's hospital. PATIENTS: Pediatric and neonatal patients supported on extracorporeal membrane oxygenation between 1996 and 2013 who were either not intubated or extubated greater than 24 hours during their extracorporeal membrane oxygenation course. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Sixteen of 511 patients on extracorporeal membrane oxygenation were extubated for at least 24 hours during their extracorporeal membrane oxygenation courses. Fourteen had respiratory failure and two had cardiac disease. Five patients died while on extracorporeal membrane oxygenation, but the cause of death was not related to complications associated with extubation. Extubated patients were supported a median of 19.7 days on extracorporeal membrane oxygenation, with a median extubation latency (time between cannulation and first extubation) of 6.2 days and a median extubation duration of 5.5 days. Mean time extubated was 43% of the total time on extracorporeal membrane oxygenation. Two patients were reintubated briefly or had a laryngeal mask airway placed for decannulation (n = 1). The remaining patients were extubated within 5 days of decannulation, weeks afterward (n = 2), transferred to outside facilities (n = 2), or died during extracorporeal membrane oxygenation support (n = 5). We also observed no complications directly attributable to extubation and spontaneous reaeration of consolidated lungs in acute respiratory distress syndrome in extubated patients on extracorporeal membrane oxygenation. CONCLUSION: Extubation and discontinuation of mechanical ventilation appear feasible in patients requiring long-term extracorporeal membrane oxygenation. Emergency procedure planning may need to be modified in extubated patients on extracorporeal membrane oxygenation.


Asunto(s)
Extubación Traqueal/métodos , Oxigenación por Membrana Extracorpórea/métodos , Unidades de Cuidado Intensivo Pediátrico , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos , Centros de Atención Terciaria
9.
J Med Imaging Radiat Oncol ; 68(4): 393-400, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38766916

RESUMEN

INTRODUCTION: Contrast-enhanced mammography (CEM) and MRI detect 'contrast-only' lesions (COLs) occult on standard breast imaging (ultrasound and conventional mammography). Until recently, MRI was the only reliable method of biopsy. This study presents the first Australian experience with CEM-guided biopsy (CEMBx) and the lessons learnt. METHODS: A prospective audit of the first 15 consecutive patients who underwent CEMBx for COLs was performed. Indications for contrast imaging, patient and lesion characteristics, procedural details, radiation dose and pathology data were collected. RESULTS: The 15 women were aged 37-81 years (mean 59 years). Indications for contrast imaging were problem solving (n = 3), moderate risk screening (n = 2), cancer staging (n = 9) and symptoms (n = 1). The COLs were non-mass (n = 14), mass (n = 1) and an enhancing asymmetry (n = 1). For one patient, two lesions were sampled during the same event. All lesions enhanced and were successfully sampled followed by marker clip insertion. Most biopsies (87.5%) were performed with the breast in cranio-caudal compression using a horizontal approach. Procedural duration ranged from 13 to 33 min (mean 22 min). Radiation dose was similar to standard stereotactic biopsy. Post-biopsy hematomas occurred in three patients, none required intervention. Clip displacement occurred in three cases. Core biopsy histopathology results were benign (n = 8), malignant (n = 7) and a borderline breast lesion (BBL) (n = 1). Patient satisfaction rates were high. Imaging follow-up is ongoing. CONCLUSIONS: CEMBx is a quick, safe and reliable alternative to MRIBx to sample COLs.


Asunto(s)
Neoplasias de la Mama , Medios de Contraste , Mamografía , Humanos , Femenino , Persona de Mediana Edad , Anciano , Adulto , Mamografía/métodos , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Anciano de 80 o más Años , Australia , Estudios Prospectivos , Técnicas Estereotáxicas , Biopsia Guiada por Imagen
10.
J Med Imaging Radiat Oncol ; 67(1): 20-27, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-35754114

RESUMEN

INTRODUCTION: Breast Screen Australia and Breast Screen Aotearoa guidelines recommend breast biopsy marker (BBM) use in indicated patients. This study aims to evaluate breast biopsy practice and BBM utilisation by modality. METHODS: An online survey was disseminated to radiologists who identified 'breast imaging' as their area of practice in the Royal Australian and New Zealand College of Radiologists (RANZCR) customer relationship management system. Survey questions addressed participant demographics and factors relating to BBM use. RESULTS: Most respondents (72%) place between 1 and 4 BBMs per week. Almost all (99%) respondents perform ultrasound-guided biopsy of the breast or axillary nodes, with 85% performing stereotactic or tomosynthesis-guided breast biopsy and 27% performing MRI-guided breast biopsy. BBM utilisation differs by modality, with 97% respondents always placing a BBM post-MRI-guided breast biopsy, 50% always placing a BBM post-stereotactic-guided biopsy and 3% always placing a BBM post-ultrasound-guided breast biopsy. CONCLUSIONS: Almost all radiologists perform breast biopsy using ultrasound, stereotactic/tomosynthesis or MRI guidance. BBM utilisation varies by modality, with 72% of respondents placing between 1 and 4 clips per week. Reasons for placing or not placing BBM aligned with prior studies. This is the first study to evaluate the number of breast biopsies performed by radiologists on a weekly or monthly basis, providing a useful platform for comparison in the local setting.


Asunto(s)
Neoplasias de la Mama , Mama , Humanos , Femenino , Australia , Mama/patología , Tórax , Biopsia Guiada por Imagen , Radiólogos , Neoplasias de la Mama/patología , Biopsia
11.
J Med Imaging Radiat Oncol ; 67(4): 377-382, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-36659865

RESUMEN

INTRODUCTION: Breast Screen Australia and Breast Screen Aotearoa guidelines recommend breast biopsy marker (BBM) use in indicated patients. This study aims to evaluate whether BBM cost and availability impacts BBM utilisation. METHODS: An online survey was disseminated to radiologists who identified 'breast imaging' as their area of practice in the Royal Australian and New Zealand College of Radiologists (RANZCR) customer relationship management system. Survey questions addressed participant demographics and factors relating to BBM use. RESULTS: Most (92%, 245/266) participants report that BBMs are routinely available at their place of practice. Those employed in private practice were more likely to report that BBMs are not routinely available. 22% (58/266) of radiologists report that BBM cost influences choice of biopsy type (core biopsy vs fine needle aspirate), this finding was more frequent in those employed in private practice. 47% of respondents report that the cost of BBMs is passed on to the patient, with all these respondents employed in a private or mixed private/public setting. Half the respondents (133/266) reported that their decision to use BBMs would be influenced by the availability of insurance coverage to cover BBM costs. CONCLUSIONS: Results suggest that BBM cost and availability influences both choice of biopsy type (core biopsy vs FNA) and choice to use a BBM. Radiologists working in private practice or mixed private/public practice report that BBMs are less likely to be available for use, and that BBM cost is more likely passed to the patient; possibly disadvantaging patients who present to private radiology providers with imaging findings or conditions that would indicate BBM insertion under current national guidelines.


Asunto(s)
Mama , Radiología , Humanos , Australia , Mama/patología , Radiografía , Biopsia con Aguja Fina
12.
Radiol Case Rep ; 18(12): 4558-4563, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37886731

RESUMEN

Vacuum-assisted excision biopsy (VAEB) provides a safe alternative to surgical excision for selected (low-risk) B3 breast lesions. We report a case of imaging findings that mimicked malignancy in a patient one year post-VAEB. Awareness of this entity is important to prevent misdiagnosis and unnecessary surgical excision.

13.
J Med Imaging Radiat Oncol ; 67(5): 514-518, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-37401164

RESUMEN

With modern technological advances in imaging, radial scars are more frequently encountered in clinical practice. The management of radial scars remains challenging due to associated upgrade to malignancy at excision. Contrast-enhanced mammography (CEM) has a similar sensitivity compared to MRI in addition to lower cost, better availability and fewer contra-indications. CEM is reported to have an overall excellent negative predictive value for malignancy. In this study, imaging of 55 patients with a core biopsy diagnosis of radial scar since the introduction of CEM into local practice was reviewed. Nine patients underwent CEM as part of their diagnostic work-up and these appearances are presented as a pictorial essay to demonstrate enhancement patterns of radial scars on CEM in this cohort and consider how this knowledge may influence management.


Asunto(s)
Neoplasias de la Mama , Enfermedad Fibroquística de la Mama , Femenino , Humanos , Cicatriz/diagnóstico por imagen , Cicatriz/patología , Mamografía , Biopsia con Aguja Gruesa , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Mama/diagnóstico por imagen , Mama/patología
14.
ANZ J Surg ; 93(4): 876-880, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-36797222

RESUMEN

BACKGROUND: Radio-guided occult lesion localisation using iodine 125 seeds (ROLLIS) is used to localize impalpable breast cancers for breast conserving surgery (BCS). Previous studies have suggested improved efficiency and patient outcomes with ROLLIS compared with hook-wire localisation (HWL). The aim of this report is to compare the post-operative complication rates and safety profiles of ROLLIS versus hook-wire guided surgery. METHODS: Between September 2013 and March 2018, 690 women with non-palpable breast cancer eligible for breast-conserving surgery were randomly assigned to either pre-operative localisation with 125 I seed or hook-wire as part of the ROLLIS clinical trial. Medical record review of 170 women (30% of the total participants) from three tertiary hospitals in Western Australia was performed. Post-operative complications were classified using the Common Terminology Criteria for Adverse Events(CTCAE) grade I to V. RESULTS: Total of 170 surgeries were performed: 82 by ROLLIS and 88 by hook-wire. The overall complication rate in the ROLLIS group was 19.5%, with 15.9% being grade II and 3.66% grade III. In the HWL group, the complication rate was 22.7% with 20.5% being grade II and 2.27% grade III. There was no statistically significant difference in complication grades between the 2 groups. No grade IV or grade V complications were reported. Complications observed included drainable seroma, drainable haematoma and surgical site infection. CONCLUSION: ROLLIS is a safe method of localisation for surgical resection with similar complication rates as hookwires. We encourage its use as an alternative localisation technique as it has demonstrable superiority and efficacy.


Asunto(s)
Neoplasias de la Mama , Mastectomía Segmentaria , Femenino , Humanos , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/patología , Radioisótopos de Yodo/uso terapéutico , Australia Occidental
15.
Br J Radiol ; 96(1144): 20211172, 2023 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-36753450

RESUMEN

OBJECTIVE: To evaluate and compare the accuracy and precision of contrast-enhanced mammography (CEM) vs MRI to predict the size of biopsy-proven invasive breast cancer. METHODS: Prospective study, 59 women with invasive breast cancer on needle biopsy underwent CEM and breast MRI. Two breast radiologists read each patient's study, with access limited to one modality. CEM lesion size was measured using low-energy and recombined images and on MRI, the first post-contrast series. Extent of abnormality per quadrant was measured for multifocal lesions. Reference standards were size of largest invasive malignant lesion, invasive (PathInvasive) and whole (PathTotal). Pre-defined clinical concordance ±10 mm. RESULTS: Mean patient age 56 years, 42 (71%) asymptomatic. Lesions were invasive ductal carcinoma 40 (68%) with ductal carcinoma in situ (31/40) in 78%, multifocal in 12 (20%). Median lesion size was 17 mm (invasive) and 27 mm (total), range (5-125 mm). Lin's concordance correlation coefficients for PathTotal 0.75 (95% CI 0.6, 0.84) and 0.71 (95% CI 0.56, 0.82) for MRI and contrast-enhanced spectral mammography (CESM) respectively. Mean difference for total size, 3% underestimated and 4% overestimated, and for invasive 41% and 50% overestimate on MRI and CESM respectively. LOAs for PathTotal varied from 60% under to a 2.4 or almost threefold over estimation. MRI was concordant with PathTotal in 36 (64%) cases compared with 32 (57%) for CESM. Both modalities concordant in 26 (46%) cases respectively. CONCLUSION: Neither CEM nor MRI have sufficient accuracy to direct changes in planned treatment without needle biopsy confirmation. ADVANCES IN KNOWLEDGE: Despite small mean differences in lesion size estimates using CEM or MRI, the 95% limits of agreement do not meet clinically acceptable levels.


Asunto(s)
Neoplasias de la Mama , Femenino , Humanos , Persona de Mediana Edad , Neoplasias de la Mama/patología , Estudios Prospectivos , Medios de Contraste , Mamografía/métodos , Imagen por Resonancia Magnética/métodos
16.
Eur Radiol Exp ; 7(1): 8, 2023 02 13.
Artículo en Inglés | MEDLINE | ID: mdl-36781808

RESUMEN

BACKGROUND: Contrast-enhanced mammography (CEM) is more available than MRI for breast cancer staging but may not be as sensitive in assessing disease extent. We compared CEM and MRI in this setting. METHODS: Fifty-nine women with invasive breast cancer underwent preoperative CEM and MRI. Independent pairs of radiologists read CEM studies (after reviewing a 9-case set prior to study commencement) and MRI studies (with between 5 and 25 years of experience in breast imaging). Additional lesions were assigned National Breast Cancer Centre (NBCC) scores. Positive lesions (graded NBCC ≥ 3) likely to influence surgical management underwent ultrasound and/or needle biopsy. True-positive lesions were positive on imaging and pathology (invasive or in situ). False-positive lesions were positive on imaging but negative on pathology (high-risk or benign) or follow-up. False-negative lesions were negative on imaging (NBCC < 3 or not identified) but positive on pathology. RESULTS: The 59 women had 68 biopsy-proven malignant lesions detected on mammography/ultrasound, of which MRI demonstrated 66 (97%) and CEM 67 (99%) (p = 1.000). Forty-one additional lesions were detected in 29 patients: six of 41 (15%) on CEM only, 23/41 (56%) on MRI only, 12/41 (29%) on both; CEM detected 1/6 and MRI 6/6 malignant additional lesions (p = 0.063), with a positive predictive value (PPV) of 1/13 (8%) and 6/26 (23%) (p = 0.276). CONCLUSIONS: While MRI and CEM were both highly sensitive for lesions detected at mammography/ultrasound, CEM may not be as sensitive as MRI in detecting additional otherwise occult foci of malignancy. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry: ACTRN 12613000684729.


Asunto(s)
Neoplasias de la Mama , Femenino , Humanos , Australia , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Imagen por Resonancia Magnética/métodos , Mamografía , Estadificación de Neoplasias
17.
J Med Radiat Sci ; 70(3): 218-228, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37194479

RESUMEN

INTRODUCTION: Impalpable breast lesions generally require image-guided localisation for breast-conserving surgery. A standard technique is to place a hook wire (HW) within the lesion. Radioguided occult lesion localisation using iodine seeds (ROLLIS) involves inserting a 4.5 mm iodine-125 seed (seed) into the lesion. We hypothesised that a seed could be more precisely positioned in relation to the lesion than a HW and that this may be associated with a lower re-excision rate. METHODS: Retrospective review of consecutive participant data from three ROLLIS RCT (ACTRN12613000655741) sites. Participants underwent preoperative lesion localisation (PLL) with seed or HW between September 2013 and December 2017. Lesion and procedural characteristics were recorded. Distances between (1) any part of the seed or thickened segment of the HW ('TSHW') and the lesion/clip ('distance to device' DTD) and (2) centre of the TSHW/seed and centre of the lesion/clip (device centre to target centre 'DCTC') were measured on immediate postinsertion mammograms. Pathological margin involvement and re-excision rates were compared. RESULTS: A total of 390 lesions (190 ROLLIS and 200 HWL) were analysed. Lesion characteristics and guidance modality used were similar between groups. Ultrasound-guided DTD and DCTC for seed were smaller than for HW (77.1% and 60.6%, respectively, P-value < 0.001). Stereotactic-guided DCTC for seeds was 41.6% smaller than for HW (P-value = 0.001). No statistically significant difference in the re-excision rates was found. CONCLUSION: Iodine-125 seeds can be more precisely positioned for preoperative lesion localisation than HW, however, no statistically significant difference in re-excision rates was detected.


Asunto(s)
Neoplasias de la Mama , Humanos , Femenino , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Mama , Radioisótopos de Yodo/uso terapéutico , Mamografía
18.
ANZ J Surg ; 93(9): 2197-2202, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-37438677

RESUMEN

BACKGROUND: Contrast enhanced mammography (CEM) and magnetic resonance imaging (MRI) are more accurate than conventional imaging (CI) for breast cancer staging. How adding CEM and MRI to CI might change the surgical plan is understudied. METHODS: Surgical plans (breast conserving surgery (BCS), wider BCS, BCS with diagnostic excision (>1BCS), mastectomy) were devised by mock-MDT (radiologist, surgeon and pathology reports) according to disease extent on CI, CI + CEM and CI + MRI. Differences in the mock-MDT's surgical plans following the addition of CEM or MRI were investigated. Using pre-defined criteria, the appropriateness of the modified plans was assessed by comparing estimated disease extent on imaging with final pathology. Surgery performed was recorded from patient records. RESULTS: Contrast imaging modified mock-MDT plans for 20 of 61(32.8%) breasts. The addition of CEM changed the plan in 16/20 (80%) and MRI in 17/20 breasts (85%). Identical changes were proposed by both CEM and MRI in 13/20 (65%) breasts. The modified surgical plan based on CI + CEM was possibly appropriate for 6/16 (37.5%), and CI + MRI in 9/17, (52.9%) breasts. The surgery performed was concordant with the mock-MDT plan for all 10 patients where the plans could be compared (BCS 1, >1 BCS 2 and mastectomy 7). CONCLUSION: Adding CEM or MRI to CI changed mock-MDT plans in up to one third of women, but not all were appropriate. Changing surgical plans following addition of contrast imaging to CI without biopsy confirmation could lead to over or under-treatment.


Asunto(s)
Neoplasias de la Mama , Mastectomía , Femenino , Humanos , Mastectomía/métodos , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/cirugía , Mamografía/métodos , Mastectomía Segmentaria/métodos , Imagen por Resonancia Magnética/métodos , Mama/diagnóstico por imagen , Mama/cirugía , Mama/patología
19.
J Med Imaging Radiat Oncol ; 67(4): 365-376, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-36596982

RESUMEN

INTRODUCTION: In Australia, the usual approach to breast lesions where core biopsy returns an uncertain result ("B3" breast lesion) is to perform surgical diagnostic open biopsy (DOB). This is associated with patient time off work, costs of hospital admission, risks of general anaesthesia and surgical complications. The majority of B3 lesions return benign results following surgery. Vacuum assisted excision biopsy (VAEB) is a less invasive, lower cost alternative, and is standard of care for selected B3 lesions in the United Kingdom. Similar use of VAEB in Australia, could save many women unnecessary surgery. The aim of this study was to document our experience during the introduction of VAEB as an alternative to DOB for diagnosis of selected B3 lesions. METHODS: The multidisciplinary team developed an agreed VAEB pathway for selected B3 lesions. Technically accessible papillary lesions, mucocele-like lesions and radial scars without atypia measuring ≤ 15mm were selected. RESULTS: Over a 7 month period, 18 women with 20 B3 lesions were offered VAEB. 16 women (18 lesions) chose VAEB over DOB. Papillomas were the commonest lesion type. All lesions were successfully sampled: 17/18 were benign. One lesion (6%) was upgraded to malignancy (ductal carcinoma in situ on VAEB, invasive ductal carcinoma at surgery). No major complications occurred. Patient satisfaction was high: 15/16 respondents would again choose VAEB over surgery. CONCLUSION: VAEB is a patient-preferred, safe, well-tolerated, lower-cost alternative to DOB for definitive diagnosis of selected B3 breast lesions.


Asunto(s)
Neoplasias de la Mama , Mamografía , Femenino , Humanos , Australia , Mama/diagnóstico por imagen , Mama/patología , Biopsia con Aguja , Biopsia , Biopsia Guiada por Imagen , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología
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