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Background: Stereotactic breast biopsies have become the gold standard for tissue diagnosis in non-palpable, sonographically occult breast abnormalities seen on mammogram. Only limited data exist in South Africa on the correlation between imaging findings and stereotactic biopsy histology. Objectives: To describe the mammographic findings and histological diagnosis in patients who underwent stereotactic breast biopsy at a referral hospital. In addition, to evaluate the proportion of malignancy in each Breast Imaging Reporting and Data System (BI-RADS) category. Method: A retrospective review of stereotactic breast biopsies was performed. Imaging characteristics (including BI-RADS category) and histological diagnosis were recorded. Using histopathology, cases were classified as benign, high-risk or malignant. Results: A total of 131 biopsies, from 123 patients, were included in the study. Most biopsies were performed on asymptomatic patients (79.3%, 104/131). The majority were categorised as BI-RADS 4 and demonstrated calcifications. Histology revealed a malignant diagnosis in 40 (30.5%) patients, a high-risk lesion in 8 (6.1%) patients and a benign diagnosis in 83 (63.4%) patients. There was a stepwise increase in the proportion of malignancy from BI-RADS category 3 to 5. When compared with surgical histology, the stereotactic biopsies demonstrated an overall ductal carcinoma in situ (DCIS) underestimation rate of 10.3%. Conclusion: Despite resource restrictions, stereotactic breast biopsies performed in a South African context produce radiological-pathological concordance in keeping with BI-RADS guidelines, as well as with local and international studies.
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Introduction Computed tomography (CT) imaging forms an important component in the evaluation and management of patients with traumatic injuries. Many South African emergency departments (EDs) have a significant trauma-related workload, especially in the public sector, where there are limitations in resources relating to CT scanners. It is important to gauge the impact of traumatic injuries on CT utilization. The primary objectives were to quantify the number and type of CT imaging studies trauma patients received, as well as to determine the frequency of radiologically significant findings in a level one trauma center. The secondary objectives were to determine the CT utilization rate and describe the demographics of patients who received imaging. Methods This was a retrospective, quantitative, descriptive, cross-sectional study undertaken over two months at the level one trauma center of a tertiary, academic, public sector teaching hospital in Johannesburg, South Africa. The radiology department's picture archiving and communication system (PACS) was used to evaluate the reports of trauma patients who were referred for a CT scan. The trauma center register was used to calculate the CT utilization rate. Results There were 5,058 trauma patients seen in the two months. A total of 1,277 CT scans were performed on 843 patients. CT brain accounted for 52% of all scans performed. Radiologically significant findings were demonstrated in 407 scans (354 patients), i.e. 31.9% of scans and 42% of patients. CT chest and peripheral angiogram demonstrated radiologically significant findings in 60.5% and 50.9% of scans respectively. Assault accounted for 55.8% of the injuries sustained and road traffic accidents accounted for 33.2%. The overall CT utilization rate was 16.7% i.e. 843 out of the 5,058 trauma patients underwent a CT scan. Conclusions South Africa has a substantial trauma burden which commonly necessitates CT utilization. It is concerning that blunt and penetrating assault continues to dominate these traumatic presentations. Worldwide, there is a broad range of described CT utilization rates and the findings at this level one trauma center fall within that range. ED clinicians are encouraged to continue carefully using this scarce resource in the trauma setting.
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BACKGROUND: Breast cancer is a major cause of morbidity and mortality worldwide. From experience, we have found that the disease burden at Chris Hani Baragwanath Academic Hospital (CHBAH) is unique with an advanced stage at presentation. OBJECTIVE: To perform a breast-imaging audit at CHBAH, focused on interpretive performance and disease burden. METHOD: Demographic and imaging data were retrospectively collected over a 6-month period. Data collected and derived followed the audit-definitions and rules described within the American College of Radiology-breast-imaging reporting and data system (ACR-BI-RADS) atlas (5th edn.). A comparison was made to benchmark values published by the Radiological Society of North America (RSNA). RESULTS: A total of 1549 mammography examinations were analysed. The screening subgroup (n = 808) revealed 11 cancers with a cancer detection rate (CDR) of 13.6 per 1000 studies and a recall rate of 5.94. The diagnostic subgroup (n = 741) revealed 130 cancers with a CDR of 175.4 and an abnormal interpretation rate (AIR) of 39 per 100 studies. Along with the positive predictive values, these performance measures for diagnostic mammography were significantly larger than the RSNA-benchmarks (p < 0.0001). In addition, the cancer characteristics showed a greater histological mean tumour length, a lower percentage of minimal cancers (defined as ductal carcinoma in situ [DCIS] and invasive cancers ≤ 1 cm) and fewer nodal-negative cancers (p < 0.0001), in keeping with a more advanced loco-regional stage at presentation. CONCLUSION: The study illustrates the challenges faced by a South African breast-imaging unit confronted with advanced loco-regional disease. The cancer burden is highlighted within a community where there is a lack of national screening mammography. The process of performing a basic, clinically relevant audit is simple and should be a routine practice in breast-imaging units.