BI-RADS 3 (short-interval follow-up) assessment rate at diagnostic mammography: Correlation with recall rates and utilization as a performance benchmark.

The purpose of this study was to identify a correlation between the screening BI-RADS 0 (recall) rates and diagnostic BI-RADS 3 (short-interval follow-up) rates of individual interpreting radiologists, with the goal of utilizing the BI-RADS 3 rate as an acceptable performance metric in the diagnostic population. A multicenter retrospective analysis of medical audit statistics was conducted on annual radiologist performance data collected over a 14-year period in a community hospital-based practice. Mixed regression models were used to estimate the association between screening BI-RADS 0 and diagnostic BI-RADS 3 examinations while adjusting for calendar year, annual radiologist screening volume, annual radiologist diagnostic volume, and diagnostic examination indication. A moderate statistically significant positive correlation was established between the screening BI-RADS 0 rates and Diagnostic BI-RADS 3 rates (Pearson correlation coefficient + 0.349, P ≤ .001). Furthermore, when utilizing a national benchmark range of 8%-12% as an acceptable BI-RADS 0 rate within a screening population, the correlative BI-RADS 3 assessment rate was demonstrated to be approximately 16%. We propose that this BI-RADS category 3 rate may represent an additional acceptable performance metric in the diagnostic population. Routine inclusion of an interpreting mammographer's diagnostic BI-RADS 3 rate in the annual medical audit may help reduce inappropriate and/or excess use of the BI-RADS 3 category, which may lead to significant potential reductions in follow-up examinations with their associated healthcare-related costs, resource expenditure, and induced patient anxiety.

Cutaneous malignancies of the perineum.

This review discusses multiple cutaneous malignancies that can present on the perineum. Although all of these neoplasms are uncommon, a focus will be on the more common neoplasms including extramammary Paget disease, basal cell carcinoma, squamous cell carcinoma, and melanoma. Other more rare entities discussed are superficial leiomyosarcoma, giant solitary trichoepithelioma, and cutaneous endometriosis.

Precervical myositis ossificans in an infant secondary to child abuse.

We present a 10-week-old girl with myositis ossificans circumscripta (MO) of the neck secondary to nonaccidental trauma. This condition is rarely seen in infants; furthermore, the majority of MO lesions develop in the extremities rather than the head and neck region. We will detail the US-guided biopsy technique used in our case, in addition to discussing the characteristic imaging and pathological findings of MO to assist in the diagnosis and successful treatment of this condition.

Uterine position in adnexal torsion: specificity and sensitivity of ipsilateral deviation of the uterus.

BACKGROUND: Ipsilateral deviation of the uterus (IDU) has been suggested to be specific for torsion. OBJECTIVE: To investigate the sensitivity and specificity of IDU in diagnosing torsion. MATERIALS AND METHODS: We retrospectively reviewed the pelvic US examinations in girls performed at Nationwide Children's Hospital in 2007 and compared the uterine position in girls with a normal US scan (group 1) or with adnexal masses (group 2) with the uterine position in girls with torsion (group 3). RESULTS: Uterine deviation was found in 7 of 297 girls (2%) in group 1 and in 6 of 47 (13%) in group 2, and was attributed to stool in the colon splaying the adnexa and uterus. In group 3, 18 of 44 girls (41%) had moderate or marked uterine deviation and none was associated with stool displacing the uterus. Uterine deviation was more common and severe in girls in group 3 than in girls in group 1 (P<0.001) and group 2 (P=0.010). The sensitivity and specificity of IDU for torsion were 41% and 98%, respectively. CONCLUSION: IDU is more common in adnexal torsion than in other causes of adnexal masses. With supporting clinical and imaging findings, IDU appears to be a specific marker for torsion.

Isolated fallopian tube torsion: sonographic and CT features.

BACKGROUND: Isolated fallopian tube torsion (IFTT) rarely occurs in pediatric patients and is difficult to diagnose preoperatively. OBJECTIVE: To determine the common sonographic and CT findings in girls with IFTT. MATERIALS AND METHODS: We retrospectively reviewed the hospital charts and imaging studies of the eight girls diagnosed with and treated for IFTT at Columbus Children's Hospital between January 1995 and June 2006 whose final diagnosis was IFTT. RESULTS: The mean age was 13 years with a range of 12 to 15 years. Two girls were premenarcheal. The most common presenting symptom was acute pelvic pain (n = 5). All patients were imaged. Six girls were imaged first with US, and the most common finding was a complex cystic pelvic mass in the midline (n = 5) and normal uterus and ovaries. Three of the eight girls had imaging with CT. In two girls, the torsed tube could be identified. In 63% of the girls, the uterus was deviated toward the side of torsion. The correct preoperative diagnosis was made in only one girl. None of the torsed fallopian tubes was salvaged at surgery. Pathological findings included ipsilateral adnexal cysts associated with the torsed tube (n = 7). CONCLUSION: IFTT should be considered in the differential diagnosis for perimenarcheal girls who present with acute pelvic pain and who demonstrate a cystic mass in a midline position (either in the cul-de-sac or superior to the uterus) associated with a normal ipsilateral ovary.