Assessment of breast volume changes during human pregnancy using a three-dimensional surface assessment technique in the prospective CGATE study.

Pregnancies and breastfeeding are two important protective factors concerning breast cancer risk. Breast volume and breast volume changes might be a breast phenotype that could be monitored during pregnancy and breastfeeding without ionizing radiation or expensive equipment. The aim of the present study was to document changes in breast volume during pregnancy prospectively. In the prospective Clinical Gravidity Association Trial and Evaluation programme, pregnant women were followed up prospectively from gestational week 12 to birth. Three-dimensional breast surface imaging and subsequent volume assessments were performed. Factors influencing breast volume at the end of the pregnancy were assessed using linear regression models. Breast volumes averaged 420 ml at the start of pregnancy and 516 ml at the end of pregnancy. The first, second and third quartiles of the volume increase were 41, 95 and 135 ml, respectively. Breast size increased on average by 96 ml, regardless of the initial breast volume. Breast volume increases during pregnancy, but not all womens' breasts respond to pregnancy in the same way. Breast volume changes during pregnancy are an interesting phenotype that can be easily assessed in further studies to examine breast cancer risk.

Costs of in-patient treatment for endometriosis in Germany 2006: an analysis based on the G-DRG-Coding.

OBJECTIVE: The aim of this study was to estimate the financial burden of in-patients costs for endometriosis treatment in Germany in 2006. METHODS: Data from a national in-patient database for women of reproductive age who were admitted for surgical treatment for endometriosis were analysed retrospectively. The number and type of hospital admissions involving surgical interventions for endometriosis were identified, and the costs of these hospitalizations to funding bodies in Germany were estimated using the diagnosis-related group reimbursement rates. RESULTS: A total of 20,835 patients were admitted to hospital for endometriosis treatment in Germany in 2006 (1.27 per 1,000 women in reproductive age). The average cost per patient was estimated at 3,056.21 €. The total in-patient costs for endometriosis treatment in 2006 were estimated at 40,708,716.26 €. The surgical procedure most often performed in treating endometriosis was hysterectomy (in 24.70% of cases). CONCLUSION: The burden of admissions and the economic impact associated with the inpatients treatment of endometriosis in Germany is substantial. The results presented here may enable those responsible in the field of medicine and health-care policy to improve the allocation of resources and manage expenses on a more sustained basis.

Subjective assessment of ovarian masses using pattern recognition: the impact of experience on diagnostic performance and interobserver variability.

PURPOSE: To compare diagnostic performance and interobserver variability in a group of 36 examiners, with four different levels of experience. METHODS: Nine junior trainees, eight level I senior trainees, 11 level II senior gynecologists, and eight level III expert sonologists classified 105 ultrasound images of adnexal masses into three subgroups of ovarian lesions (malignancies, functional cysts, and dermoid cysts). RESULTS: The level III sonologists obtained the best diagnostic results together with the lowest interobserver variability (κ = 0.70, SD = 0.04). They achieved significantly better results in comparison with the junior trainees and also the senior trainees (κ = 0.51, SD = 0.12, p < 0.001; and κ = 0.51, SD = 0.09, p < 0.001). Differences between level III sonologists and the group of level II observers did not reach statistical significance (κ = 0.65, SD = 0.09, p = 0.70). There were no significant differences between senior and junior trainees (p = 1.0) and both groups achieved a significantly poorer diagnostic performance in comparison with the level II observers (p < 0.01 and p < 0.01). For all observers, the largest differences were seen for classifying malignancies, the best results for classifying functional cysts, and the poorest for evaluating dermoid cysts. CONCLUSIONS: Diagnostic performance of pattern recognition significantly improves with an increasing level of experience, emphasizing the importance of standardized ultrasound training programs with supervision by experts.