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1.
Radiographics ; 43(10): e230027, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37708071

RESUMO

Triple-negative breast cancer (TNBC) refers to a heterogeneous group of carcinomas that have more aggressive biologic features, faster growth, and a propensity for early distant metastasis and recurrence compared with other breast cancer subtypes. Due to the aggressiveness and rapid growth of TNBCs, there are specific imaging challenges associated with their timely and accurate diagnosis. TNBCs commonly manifest initially as circumscribed masses and therefore lack the typical features of a primary breast malignancy, such as irregular shape, spiculated margins, and desmoplastic reaction. Given the potential for misinterpretation, review of the multimodality imaging appearances of TNBCs is important for guiding the radiologist in distinguishing TNBCs from benign conditions. Rather than manifesting as a screening-detected cancer, TNBC typically appears clinically as a palpable area of concern that most commonly corresponds to a discrete mass at mammography, US, and MRI. The combination of circumscribed margins and hypoechoic to anechoic echogenicity may lead to TNBC being misinterpreted as a benign fibroadenoma or cyst. Therefore, careful mammographic and sonographic evaluation with US image optimization can help avoid misinterpretation. Radiologists should recognize the characteristics of TNBCs that can mimic benign entities, as well as the subtle features of TNBCs that should raise concern for malignancy and aid in timely and accurate diagnosis. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.


Assuntos
Carcinoma , Neoplasias de Mama Triplo Negativas , Humanos , Neoplasias de Mama Triplo Negativas/diagnóstico por imagem , Mamografia , Mama , Imagem Multimodal
2.
Breast Cancer Res Treat ; 185(2): 479-494, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33010022

RESUMO

PURPOSE: To investigate the performance of an imaging and biopsy parameters-based multivariate model in decreasing unnecessary surgeries for high-risk breast lesions. METHODS: In an IRB-approved study, we retrospectively reviewed all high-risk lesions (HRL) identified at imaging-guided biopsy in our institution between July 1, 2014-July 1, 2017. Lesions were categorized high-risk-I (HR-I = atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ and atypical papillary lesion) and II (HR-II = Flat epithelial atypia, radial scar, benign papilloma). Patient risk factors, lesion features, detection and biopsy modality, excision and cancer upgrade rates were collected. Reference standard for upgrade was either excision or at least 2-year imaging follow-up. Multiple logistic regression analysis was performed to develop a multivariate model using HRL type, lesion and biopsy needle size for surgical cancer upgrade with performance assessed using ROC analysis. RESULTS: Of 699 HRL in 652 patients, 525(75%) had reference standard available, and 48/525(9.1%) showed cancer at surgical excision. Excision (84.5% vs 51.1%) and upgrade (17.6%vs1.8%) rates were higher in HR-I compared to HR-II (p < 0.01). In HR-I, small needle size < 12G vs ≥ 12G [32.1% vs 13.2%, p < 0.01] and less cores [< 6 vs ≥ 6, 28.6%vs13.7%, p = 0.01] were significantly associated with higher cancer upgrades. Our multivariate model had an AUC = 0.87, saving 28.1% of benign surgeries with 100% sensitivity, based on HRL subtype, lesion size(mm, continuous), needle size (< 12G vs ≥ 12G) and biopsy modality (US vs MRI vs stereotactic) CONCLUSION: Our multivariate model using lesion size, needle size and patient age had a high diagnostic performance in decreasing unnecessary surgeries and shows promise as a decision support tool.


Assuntos
Neoplasias da Mama , Carcinoma Intraductal não Infiltrante , Sistemas de Apoio a Decisões Clínicas , Biópsia com Agulha de Grande Calibre , Biópsia por Agulha , Mama/diagnóstico por imagem , Mama/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/cirurgia , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/cirurgia , Feminino , Humanos , Biópsia Guiada por Imagem , Estudos Retrospectivos
3.
AJR Am J Roentgenol ; 202(5): W496-502, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24758685

RESUMO

OBJECTIVE: The purpose of this study is to assess associations between patient characteristics and apparent diffusion coefficient (ADC) values of normal breast fibroglandular tissue on diffusion-weighted imaging (DWI) at 3 T. MATERIALS AND METHODS: The retrospective study included 103 women with negative bilateral findings on 3-T breast MRI examinations (BI-RADS category 1). DWI was acquired during clinical breast MRI scans using b = 0 and b = 800 s/mm(2). Mean ADC of normal breast fibroglandular tissue was calculated for each breast using a semiautomated software tool in which parenchyma pixels were selected by interactive thresholding of the b = 0 s/mm(2) image to exclude fat. Intrasubject right- and left-breast ADC values were compared and averaged together to evaluate the association of mean breast ADC with age, mammographic breast density, and background parenchymal enhancement. RESULTS: Overall mean ± SD breast ADC was 1.62 ± 0.30 × 10(-3) mm(2)/s. Intrasubject right- and left-breast ADC measurements were highly correlated (R(2) = 0.89; p < 0.0001). Increased breast density was strongly associated with increased ADC (p ≤ 0.0001). Age and background parenchymal enhancement were not associated with ADC. CONCLUSION: Normal breast parenchymal ADC values increase with mammographic density but are independent of age and background parenchymal enhancement. Because breast malignancies have been shown to have low ADC values, DWI may be particularly valuable in women with dense breasts owing to greater contrast between lesion and normal tissue.


Assuntos
Mama/anatomia & histologia , Imagem de Difusão por Ressonância Magnética , Adulto , Fatores Etários , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
Abdom Imaging ; 39(5): 1127-33, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25237003

RESUMO

PURPOSE: To determine the most common errors of epinephrine administration during severe allergic-like contrast reaction management using high-fidelity simulation surrogates. MATERIALS AND METHODS: IRB approval and informed consent were obtained for this HIPAA-compliant bi-institutional prospective study of 40 radiology residents, fellows, and faculty who were asked to manage a structured high-fidelity severe allergic-like contrast reaction scenario (i.e., mild hives progressing to mild bronchospasm, then bronchospasm unresponsive to bronchodilators, and finally anaphylactic shock) on an interactive manikin. Intravenous (IV) and intramuscular epinephrine ampules were available to all participants, and the manikin had a functioning intravenous catheter for all scenarios. Video recordings of their performance were reviewed by experts in contrast reaction management, and errors in epinephrine administration were recorded and characterized. RESULTS: No participant (0/40) failed to give indicated epinephrine, but more than half (58% [23/40]) committed an error while doing so. The most common mistake was to administer epinephrine as the first-line treatment for mild bronchospasm (33% [13/40]). Other common errors were to administer IV epinephrine without a subsequent IV saline flush or concomitant IV fluids (25% [10/40]), administer an overdose of epinephrine (8% [3/40]), and administer epinephrine 1:1000 intravenously (8% [3/40]). CONCLUSION: Epinephrine administration errors are common. Many radiologists fail to administer albuterol as the first-line treatment for mild bronchospasm and fail to flush the IV catheter when administering IV epinephrine. High-fidelity contrast reaction scenarios can be used to identify areas for training improvement.


Assuntos
Meios de Contraste/efeitos adversos , Epinefrina/uso terapêutico , Hipersensibilidade Imediata/tratamento farmacológico , Manequins , Erros de Medicação/estatística & dados numéricos , Radiologia/educação , Administração Intravenosa , Agonistas alfa-Adrenérgicos/uso terapêutico , Epinefrina/administração & dosagem , Humanos , Hipersensibilidade Imediata/induzido quimicamente , Estudos Prospectivos
5.
Emerg Radiol ; 20(4): 299-306, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23430296

RESUMO

The objectives of this article are to review allergy-type reactions to iodinated contrast media and the protocols utilized to prevent or reduce the occurrence of these adverse reactions in high-risk patients. We will begin by discussing the types or classifications of the adverse reactions to iodinated contrast media. We will then discuss reaction mechanisms, identify the patients at highest risk for adverse reactions, and clarify common misperceptions about the risk. Finally, we will discuss the actions of the medications used to help reduce or prevent allergy-type reactions to iodinated contrast media, the protocols used to help reduce or prevent contrast reactions in high-risk patients, and the potential side effects of these medications. We will also discuss the high-risk patient who has received premedication due to a prior index reaction and discuss the risk of having a subsequent reaction, termed "breakthrough reaction." Identifying patient at high risk for an "allergy-type" reaction to contrast media is an essential task of the radiologist. Prevention of or reduction of the risk of an adverse reaction is critical to patient safety. If an examination can be performed without contrast in a patient at high risk for an allergy-type reaction, it may be appropriate to avoid contrast. However, there are situations where contrast media is necessary, and the radiologist plays a vital role in preventing or mitigating an allergy-type reaction.


Assuntos
Meios de Contraste/efeitos adversos , Hipersensibilidade a Drogas/prevenção & controle , Glucocorticoides/administração & dosagem , Antagonistas dos Receptores Histamínicos/administração & dosagem , Compostos de Iodo/efeitos adversos , Pré-Medicação , Tomografia Computadorizada por Raios X , Tratamento de Emergência , Humanos , Fatores de Risco
6.
Can Assoc Radiol J ; 64(3): 193-9, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22560565

RESUMO

The objectives of this article are to review the diagnosis and management of acute nonrenal reactions to iodinated contrast media. We will begin by discussing the types of contrast media and their correlative rates of reaction. The mechanism of contrast reactions, predisposing risk factors, and preventative measures will then be discussed. The remainder of the article will review the assessment of potential reactions, initial management, and treatment algorithms for specific reactions.


Assuntos
Meios de Contraste/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Compostos de Iodo/efeitos adversos , Segurança , Doença Aguda , Adulto , Criança , Hipersensibilidade a Drogas/tratamento farmacológico , Hipersensibilidade a Drogas/prevenção & controle , Humanos , Injeções Intravenosas , Fatores de Risco
7.
AJR Am J Roentgenol ; 196(6): 1288-95, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21606291

RESUMO

OBJECTIVE: The objective of our study was to assess whether high-fidelity simulation-based training is more effective than traditional didactic lecture to train radiology residents in the management of contrast reactions. SUBJECTS AND METHODS: This was a prospective study of 44 radiology residents randomized into a simulation group versus a lecture group. All residents attended a contrast reaction didactic lecture. Four months later, baseline knowledge was assessed with a written test, which we refer to as the "pretest." After the pretest, the 21 residents in the lecture group attended a repeat didactic lecture and the 23 residents in the simulation group underwent high-fidelity simulation-based training with five contrast reaction scenarios. Next, all residents took a second written test, which we refer to as the "posttest." Two months after the posttest, both groups took a third written test, which we refer to as the "delayed posttest," and underwent performance testing with a high-fidelity severe contrast reaction scenario graded on predefined critical actions. RESULTS: There was no statistically significant difference between the simulation and lecture group pretest, immediate posttest, or delayed posttest scores. The simulation group performed better than the lecture group on the severe contrast reaction simulation scenario (p = 0.001). The simulation group reported improved comfort in identifying and managing contrast reactions and administering medications after the simulation training (p ≤ 0.04) and was more comfortable than the control group (p = 0.03), which reported no change in comfort level after the repeat didactic lecture. CONCLUSION: When compared with didactic lecture, high-fidelity simulation-based training of contrast reaction management shows equal results on written test scores but improved performance during a high-fidelity severe contrast reaction simulation scenario.


Assuntos
Meios de Contraste/efeitos adversos , Avaliação Educacional , Radiologia/educação , Ensino/métodos , Competência Clínica , Currículo , Humanos , Internato e Residência , Manequins , Estudos Prospectivos
8.
Cutis ; 83(1): 24-7, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19271567

RESUMO

Glomus tumors are benign localized tumors of the skin accounting for 1% to 2% of all soft tissue tumors. They may present as a solitary tumor or multiple tumors, termed glomangioma. We describe a 69-year-old man with a medical history of psoriasis and hypertension who presented with an incidental finding of multiple asymptomatic, noncompressible, blue lesions over his arms, chest, and back. The lesions, present since childhood, had never been subject to a workup. The patient had no history of gastrointestinal bleeding and no known family history of similar lesions. Physical examination revealed multiple nontender, blue, subcutaneous nodules that were 1 to 2 cm in diameter and located on the bilateral arms, chest, and back. The diagnosis of glomangioma was made and no further treatment was indicated.


Assuntos
Tumor Glômico/patologia , Neoplasias Cutâneas/patologia , Idoso , Humanos , Masculino
9.
Eur J Radiol ; 82(12): 2247-52, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24041436

RESUMO

PURPOSE: We developed a computer-based interactive simulation program for teaching contrast reaction management to radiology trainees and compared its effectiveness to high-fidelity hands-on simulation training. MATERIALS AND METHODS: IRB approved HIPAA compliant prospective study of 44 radiology residents, fellows and faculty who were randomized into either the high-fidelity hands-on simulation group or computer-based simulation group. All participants took separate written tests prior to and immediately after their intervention. Four months later participants took a delayed written test and a hands-on high-fidelity severe contrast reaction scenario performance test graded on predefined critical actions. RESULTS: There was no statistically significant difference between the computer and hands-on groups' written pretest, immediate post-test, or delayed post-test scores (p>0.6 for all). Both groups' scores improved immediately following the intervention (p<0.001). The delayed test scores 4 months later were still significantly higher than the pre-test scores (p ≤ 0.02). The computer group's performance was similar to the hands-on group on the severe contrast reaction simulation scenario test (p = 0.7). There were also no significant differences between the computer and hands-on groups in performance on the individual core competencies of contrast reaction management during the contrast reaction scenario. CONCLUSION: It is feasible to develop a computer-based interactive simulation program to teach contrast reaction management. Trainees that underwent computer-based simulation training scored similarly on written tests and on a hands-on high-fidelity severe contrast reaction scenario performance test as those trained with hands-on high-fidelity simulation.


Assuntos
Instrução por Computador/estatística & dados numéricos , Meios de Contraste/efeitos adversos , Currículo , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/prevenção & controle , Radiologia/educação , Interface Usuário-Computador , Adulto , Hipersensibilidade a Drogas/diagnóstico , Avaliação Educacional/estatística & dados numéricos , Feminino , Humanos , Internato e Residência/organização & administração , Masculino , Washington , Adulto Jovem
10.
Acad Radiol ; 18(1): 107-12, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20920859

RESUMO

RATIONALE AND OBJECTIVES: Radiology residents have variable training in managing acute nonrenal adverse reactions to iodinated contrast media because of their rarity. Preliminary results show positive feedback and knowledge gain with high-fidelity simulation-based training. Financial costs and the time required to implement a high-fidelity simulation curriculum are higher than for a lecture series. The objective of this study was to provide a financial and time cost-benefit analysis for high-fidelity simulation training of acute adverse reactions to iodinated contrast media. MATERIALS AND METHODS: Forty-four radiology residents were divided into lecture and simulation groups. Five simulation scenarios were created, with core education content mirrored in the lecture. Lengths of faculty time commitment and resident training were recorded. Financial costs, including manikin and simulation facility rates, were recorded and divided by the number of residents to obtain per resident simulation and lecture costs. A written evaluation of the experience, with Likert-type items and unstructured response items, was conducted. RESULTS: Cost per resident for simulation training setup was $259.76, and $203.46 for subsequent years, compared to <$5 for lecture. Faculty time was 7 academic days for simulation versus 2 days for lecture format. Resident simulation commitment was 3 hours 30 minutes. Time to train technologists to run the simulation was 3 hours. All residents provided positive feedback regarding the simulation curriculum, with mean feedback scores statistically higher than lecture group (P < .05). CONCLUSIONS: This study illustrates that financial costs of implementation are low compared to the potential cost of morbidity associated with the life-threatening event of an acute adverse reaction to iodinated contrast media.


Assuntos
Simulação por Computador/economia , Meios de Contraste , Currículo , Radiologia/educação , Custos e Análise de Custo , Avaliação Educacional/métodos , Estudos de Viabilidade , Humanos , Internato e Residência/economia , Internato e Residência/métodos , Manequins , Competência Profissional/economia , Estados Unidos
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