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J Am Coll Radiol ; 17(5): 684-685, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31917247
Breast J ; 26(6): 1216-1220, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31925856


The purpose of this study is to review the clinical presentation, multi-modality appearance, and management of the most common benign and malignant fibroepithelial lesions of the breast. Fibroepithelial lesions of the breast may exhibit characteristic features on mammography, ultrasound, and MRI, although definitive diagnosis most often requires biopsy and at times, surgical excision. Knowledge of the imaging features can assist in refining the differential diagnosis and guiding appropriate management.

J Am Coll Radiol ; 17(2): 296-297, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31563521
J Am Coll Radiol ; 16(11S): S428-S439, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31685110


As the proportion of women diagnosed with early stage breast cancer increases, the role of imaging for staging and surveillance purposes is considered. National and international guidelines discourage the use of staging imaging for asymptomatic patients newly diagnosed with stage 0 to II breast cancer, even if there is nodal involvement, as unnecessary imaging can delay care and affect outcomes. In asymptomatic patients with a history of stage I breast cancer that received treatment for curative intent, there is no role for imaging to screen for distant recurrences. However, routine surveillance with an annual mammogram is the only imaging test that should be performed to detect an in-breast recurrence or a new primary breast cancer in women with a history of stage I breast cancer. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Breast J ; 25(4): 604-611, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31206889


The purpose is to determine whether an abbreviated MRI protocol (ABMR) is ready to be used for breast cancer screening in an academic practice setting. Two hundred and fifty nine breast MRIs from 1/1/2012 to 6/30/2012 were retrospectively reviewed using ABMR (MIP, Pre-contrastT1, single dynamic post-contrastT1, and subtraction). Five breast radiologists (4-28 year-expr) participated in this reader study performed in two phases: Phase1 - radiologist's privy to clinical history but not to comparison imaging. Phase2 - radiologists provided comparison imaging. For phase1, studies were reviewed using three steps: (a) MIP only (positive/negative/intermediate); (b) ABMR (recall/no recall) and (c) With T2 (for changes in recommendations). Radiologist also recorded total time for interpretation. In Phase2 the MRIs coded as "recall" were re-reviewed with available comparison studies, noting changes in final recommendation. The abnormal interpretation rates (AIRs) were calculated for phase1 and phase2 results with comparison to the original full protocol. Of the 259 patients (avg. age-52 years; range 26-78), there were seven cancers (three invasive, three DCIS and one breast lymphoma). Acquisition time for ABMR was 3 minutes, ABMR + T2-8 minutes, and original full protocol 16 minutes. Average MIP was positive or indeterminate in 86% (6/7) and negative in 14% (1/7) cancers. The average AIR for MIP only was 20.8% (sens-77.1%; spec-80.8%. The AIR w/o comparisons was 25.6% (sens-91.4%; spec- 76.2%); however the average AIR decreased in phase 2 with comparisons to 13.7% (sens-91.4%; spec-88.5%). The AIR of the original full protocol read was 16.2% (sens-100%; spec-85.7%). Addition of T2 changed assessment in only 3% (1.2%-6.5%). Avg. read time for ABMR including T2 was 2.5 minutes (1.6-4.0 minutes). ABMR is reliable for breast cancer screening, with acceptable interpretation time and acceptable AIR.

Neoplasias da Mama/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Centros Médicos Acadêmicos , Adulto , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/prevenção & controle , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/prevenção & controle , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Programas de Rastreamento , Pessoa de Meia-Idade , Radiologistas , Sensibilidade e Especificidade , Fatores de Tempo
Radiology ; 292(3): 550-551, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31211632

Mama , Leitura , Mamografia
Acad Radiol ; 26(12): 1707-1717, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31171464


RATIONALE AND OBJECTIVES: The Alliance of Directors and Vice Chairs in Education group identified the need to develop an education budget template as resource for our community. Having a framework and working knowledge of budgetary considerations is crucial to those with general oversight and executive managerial responsibility for departmental educational programs. METHODS: An online survey was sent to all the Alliance of Directors and Vice Chairs in Education members. Survey questions included education funding sources, presence of vice chair of finance, expectation of revenue generation, existing education budget, funding decision-makers, education budget formulation and approval, vice chair of education's role in budget, education budget line items, and income statement review. RESULTS: The survey response rate was 41/81 (51%). A majority 26/41 (63%) of respondents had an education budget that typically included funding for all medical students, residents, and fellows but only a minority of respondents report they developed 10/22 (45%), approved 6/22 (27%), or regularly reviewed 6/21 (29%) this budget. In sharp contrast was the role of department chairs and administrators, who presumably all participated in this process. To assist in education budget development and review, as well as meet the need to improve participants' financial accounting knowledge as a key tenet of faculty professional development, the authors developed sample budget templates and an income statement primer. CONCLUSION: Our survey results suggested the need for an educational budget framework and financial accounting resources for those in radiology education posts, and resources have been provided.

Acad Radiol ; 26(5): 591-596, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31047102


RATIONAL AND OBJECTIVES: To develop subspecialty-specific entrustable professional activities for breast imaging radiology (EPA-BRs) through the use of a double consensus-driven, validity-enhancing methodology that may be relevant to other subspecialties in radiology and medicine in general. MATERIALS AND METHODS: A six-step methodology was used to develop EPA-BRs via a double Delphi process followed by educational theorist's refinement. Two groups of experts completed each Delphi process: the core group of breast imaging educators and an expert panel of national experts in breast imaging standards and appropriateness. RESULTS: Five EPA-BRs were developed, with eight nested EPA-BRs, one of which is elective. This comprehensive list of EPA-BRs covers the role of a breast imaging radiologist in the care of a patient from detection of breast cancer to post-treatment follow-up. CONCLUSION: A combined modified and classic double Delphi approach can be utilized by other graduate medical education (GME) specialties and subspecialties as a method by which GME education can be transformed into a clinical framework that more closely bridges individual competencies and real-world clinical practice.

Mama/diagnóstico por imagem , Competência Clínica/normas , Educação de Pós-Graduação em Medicina/normas , Radiologia/educação , Educação Baseada em Competências/métodos , Técnica Delfos , Educação de Pós-Graduação em Medicina/métodos , Humanos , Relações Interprofissionais , Mamografia/normas , Mastodinia/diagnóstico por imagem , Exame Físico/normas , Radiologia/normas
Clin Imaging ; 57: 35-39, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31103907


PURPOSE: Core biopsy-proven fibroadenomas that enlarge on clinical or imaging follow-up are often surgically excised to exclude an associated malignancy. The purpose of this study was to assess how often malignancy is detected upon excision, and to determine whether excision of enlarging, biopsy-proven, uncomplicated fibroadenomas is still warranted. MATERIALS AND METHODS: Review of our institutional pathology database from 2000 to 2010 identified 1117 cases of fibroadenoma, and retrospective chart review, including review of pathology and imaging findings of all these records, was performed. RESULTS: 1117 cases of fibroadenoma were identified in a population of women ranging from ages 17 to 78. Of these, 378 (33.8%) were diagnosed by ultrasound core needle biopsy and formed the study population. Of the 378 cases, 24 (6.3%) had co-existent atypia and were immediately excised; these cases were excluded. An additional 107 (28%) were lost to follow-up. Of the remaining 247 cases, 201 (81%) showed stability on follow-up imaging (mean 31.5 months), and 46 (18.6%) enlarged on follow-up. Of the 46 biopsy proven fibroadenomas that enlarged, 19 had a biopsy at initial presentation and 27 underwent biopsy after they enlarged. Seventeen of the 19 were excised after enlargement, and pathology confirmed fibroadenoma in all cases (100%); two enlarged on initial follow-up imaging but remained stable for at least three years on continued follow-up. Of the 27 cases which were biopsied after enlargement, 23 revealed fibroadenoma on core biopsy, 3 had fibroadenoma with associated atypia with subsequent surgery revealing fibroadenoma and no associated malignancy, and one showed fibroadenoma with smooth muscle with subsequent surgery showing phyllodes tumor. CONCLUSION: Based on this study, enlarging biopsy proven fibroadenomas are not associated with malignancy; therefore, surgical excision does not seem warranted. For presumed enlarging fibroadenomas on imaging, core biopsy should be performed to exclude associated atypia or phyllodes tumor. Finally, surgical excision is indicated for lesions with associated atypia or suspected phyllodes and for symptomatic lesions or cosmetic reasons.

Neoplasias da Mama/cirurgia , Fibroadenoma/cirurgia , Adolescente , Adulto , Idoso , Biópsia com Agulha de Grande Calibre , Neoplasias da Mama/patologia , Feminino , Fibroadenoma/patologia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
J Am Coll Radiol ; 16(11): 1595-1597, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31072777