Factors Associated with Recent HIV Testing among Men Who Have Sex with Men in Philadelphia: a Cross-Sectional Analysis of the National Behavioral Surveillance System Survey.

The main objective of this study was to determine the demographic, geographic and socioeconomic characteristics of men who have sex with men (MSM) in Philadelphia that were associated with having a recent HIV test. We used data from the National HIV Behavioral Surveillance System (NHBS) surveys from 2011 and 2014 among MSM in Philadelphia, with the outcome of interest of having received an HIV test in the past twelve months. Of 1043 HIV-negative MSM, 70.2% had an HIV test. Multivariable analysis showed that seeing a medical provider (aOR: 1.73; p = .0039) or having heard of PrEP (aOR: 2.24; p < .0001) was associated with recent HIV testing. Those participants forty-five years of age or older (aOR 0.40, p = .0001) and those with Medicaid had lower rates of HIV testing (aOR 0.48, p = .002). Although over 80% of participants had seen a medical provider in the past year, only 50% had been offered an HIV test by a provider. Optimizing HIV testing through the expansion and increased awareness of PrEP, especially among older MSM, is critical. Further research is needed to delineate barriers that prevent MSM from utilizing medical providers for HIV testing and for those with Medicaid from receiving HIV testing.

Is the upgrade rate of atypical ductal hyperplasia diagnosed by core needle biopsy of calcifications different for digital and film-screen mammography?

OBJECTIVE: The purpose of this study was to establish the upgrade rate of atypical ductal hyperplasia (ADH) diagnosed by stereotactic vacuum-assisted core needle biopsy for calcifications detected by digital mammography as compared with film-screen mammography. MATERIALS AND METHODS: A retrospective record search identified 101 cases of ADH. Criteria included women with calcifications biopsied using stereotactic vacuum-assisted core needle biopsy at our institution between January 2001 and December 2011. The center transitioned from film-screen mammography in 2001 to all digital mammography by 2010. Stereotactic vacuum-assisted core needle biopsies were performed using 11-gauge (59/101 [58%]) or 8-gauge (42/101 [42%]) needles. All pathology was interpreted by breast pathologists using standard criteria. RESULTS: Of 101 cases of ADH, 57 (56.4%) were detected using digital and 44 (43.6%) were detected using film-screen mammography. Seven of 57 (12.3%) cases of ADH detected by digital mammography were upgraded to ductal carcinoma in situ (DCIS) (n = 6) or invasive cancer (n = 1). Six of 44 (13.6%) cases of ADH detected by film-screen mammography were upgraded to DCIS (n = 5) or invasive cancer (n = 1) (p = 0.84). There was a trend toward low-grade DCIS in cases detected by digital mammography (3/7 [42.9%]) as compared with film-screen mammography (1/6 [16.7%]) (p = 0.68). A nonsignificant overall higher percentage of upgrades occurred when calcifications were not completely removed (10/52 [19.2%]) as compared with completely removed (3/47 [6.4%]). There was no difference in upgrade rate of stereotactic vacuum-assisted core needle biopsy performed using 11-gauge (7/59 [11.9%]) versus 8-gauge (6/42 [14.3%]) needles. CONCLUSION: The upgrade rate of ADH diagnosed by stereotactic vacuum-assisted core needle biopsy was not significantly different between digital and film-screen mammography. The current recommendation for excision of ADH diagnosed by stereotactic vacuum-assisted core needle biopsy should be applied to ADH detected by digital mammography.

A Narrative Review of Cervical Cancer Screening Utilization Among Haitian Immigrant Women in the U.S.: Health Beliefs, Perceptions, and Societal Barriers and Facilitators.

Haitian immigrant women living in the U.S. have a higher rate of cervical cancer mortality than any other ethnic group, primarily due to lower rates of screening test utilization. Therefore, it is important to understand the issues affecting their pap smear screening behaviors. We conducted a narrative review of articles from PubMed, SCOPUS, Embase, CINAHL/Nursing, and Psych Info. Inclusion criteria: U.S. Haitian immigrant, screening, cervical cancer, health beliefs/perceptions. Exclusion criteria: HPV-vaccine. Primary barriers: (1) lack of knowledge of cervical cancer, HPV, and pap smears; (2) lack of culturally appropriate dissemination of information; and (3) difficulty obtaining the test. Primary facilitators: (1) provider recommendations, (2) Haitian media to disseminate health information, and (3) having health insurance. This review highlights the points for intervention by health professionals and policy makers to address this group's low pap smear utilization.

Continuity of Radiologists Between Diagnostic Breast Imaging and Image-Guided Breast Biopsy: Impact on Patient-Reported Biopsy Morbidity Experiences.

OBJECTIVE: To determine whether continuity of care between diagnostic breast imaging and subsequent image-guided breast biopsy could reduce patient-reported biopsy-related morbidity. METHODS: This was a prospective, pragmatically randomized, 2-arm health utilities analysis of 200 women undergoing diagnostic breast imaging followed by US- or stereotactic-guided breast biopsy at a single quaternary care center from September 3, 2019, to April 10, 2023. Breast biopsy-naive women with a BI-RADS 4 or 5 finding at diagnostic imaging were randomly scheduled for the typically first available biopsy appointment. One day after biopsy, enrolled patients were administered the Testing Morbidities Index (TMI). The primary outcome was the difference in TMI summary utility scores in patients who did vs did not have the same radiologist perform diagnostic imaging and biopsy. RESULTS: Response rates were 63% (100/159) for the different radiologist cohort and 71% (100/140) for the same radiologist cohort; all respondents answered all questions in both arms. Mean time to biopsy was 7 ± 6 days and 10 ± 9 days, and the number of participating radiologists was 11 and 18, respectively. There was no difference in individual measured domains (pain, fear, or anxiety before procedure; pain, embarrassment, fear, or anxiety during procedure; mental or physical impact after procedure; all P >.00625) or in overall patient morbidity (0.83 [95% CI, 0.81-0.85] vs 0.82 [95% CI: 0.80-0.84], P = .66). CONCLUSION: Continuity of care between diagnostic breast imaging and image-guided breast biopsy did not affect morbidity associated with breast biopsy, suggesting that patients should be scheduled for the soonest available biopsy appointment rather than waiting for the same radiologist.

Outcomes of High-Risk Breast MRI Screening in Women Without Prior History of Breast Cancer: Effectiveness Data from a Tertiary Care Center.

OBJECTIVE: To evaluate the diagnostic performance outcomes of a breast MRI screening program in high-risk women without prior history of breast cancer. METHODS: Retrospective cohort study of 1 405 consecutive screening breast MRI examinations in 681 asymptomatic women with high risk of breast cancer without prior history of breast cancer from January 1, 2015, to December 31, 2019. Outcomes (sensitivity, specificity, positive predictive value, negative predictive value, false-negative rate [FNR], cancer detection rate [CDR]) and characteristics of cancers were determined based on histopathology or 12-month follow-up. MRI examinations performed, BI-RADS assessments, pathology outcomes, and CDRs were analyzed overall and by age decade. Results in incidence screening round (MRI in last 18 months) and nonincidence round were compared. RESULTS: Breast MRI achieved CDR 20/1000, sensitivity 93.3% (28/30), and specificity 83.4% (1 147/1375). Twenty-eight (28/1 405, CDR 20/1000) screen-detected cancers were identified: 18 (64.3%, 18/28) invasive and 10 (35.7%, 10/28) ductal carcinoma in situ. Overall, 92.9% (26/28) of all cancers were stage 0 or 1 and 89.3% (25/28) were node negative. All 14 incidence screening round malignancies were stage 0 or 1 with N0 disease. Median size for invasive carcinoma was 8.0 mm and for ductal carcinoma in situ was 9.0 mm. There were two false-negative exams for an FNR 0.1% (2/1 405). CONCLUSION: High-risk screening breast MRI was effective at detecting early breast cancer and associated with favorable outcomes.

Breast Imaging Fellowship Consortium: Developing a Comprehensive Virtual Educational Platform for Breast Imaging Fellows.

Creating a comprehensive didactic curriculum for breast imaging fellows can be a demanding undertaking, especially considering that most breast practices are understaffed because of the COVID-19 pandemic and amid rising clinical volumes. This leaves little time for didactic education. In this article, we present our approach to creating a collaborative weekly multidisciplinary didactic lecture series involving multiple institutions, using the Society of Breast Imaging's suggested fellowship curriculum as the foundation. We discuss the advantages for both trainees and faculty, including fostering camaraderie, networking, and engagement among breast imaging fellows. Faculty have the opportunity for professional development by leveraging their clinical expertise through selecting didactic topics in their niche. This creates a pathway for speaking faculty to be recognized as regional and national experts.

Deep learning denoising of digital breast tomosynthesis: Observer performance study of the effect on detection of microcalcifications in breast phantom images.

BACKGROUND: The noise in digital breast tomosynthesis (DBT) includes x-ray quantum noise and detector readout noise. The total radiation dose of a DBT scan is kept at about the level of a digital mammogram but the detector noise is increased due to acquisition of multiple projections. The high noise can degrade the detectability of subtle lesions, specifically microcalcifications (MCs). PURPOSE: We previously developed a deep-learning-based denoiser to improve the image quality of DBT. In the current study, we conducted an observer performance study with breast radiologists to investigate the feasibility of using deep-learning-based denoising to improve the detection of MCs in DBT. METHODS: We have a modular breast phantom set containing seven 1-cm-thick heterogeneous 50% adipose/50% fibroglandular slabs custom-made by CIRS, Inc. (Norfolk, VA). We made six 5-cm-thick breast phantoms embedded with 144 simulated MC clusters of four nominal speck sizes (0.125-0.150, 0.150-0.180, 0.180-0.212, 0.212-0.250 mm) at random locations. The phantoms were imaged with a GE Pristina DBT system using the automatic standard (STD) mode. The phantoms were also imaged with the STD+ mode that increased the average glandular dose by 54% to be used as a reference condition for comparison of radiologists' reading. Our previously trained and validated denoiser was deployed to the STD images to obtain a denoised DBT set (dnSTD). Seven breast radiologists participated as readers to detect the MCs in the DBT volumes of the six phantoms under the three conditions (STD, STD+, dnSTD), totaling 18 DBT volumes. Each radiologist read all the 18 DBT volumes sequentially, which were arranged in a different order for each reader in a counter-balanced manner to minimize any potential reading order effects. They marked the location of each detected MC cluster and provided a conspicuity rating and their confidence level for the perceived cluster. The visual grading characteristics (VGC) analysis was used to compare the conspicuity ratings and the confidence levels of the radiologists for the detection of MCs. RESULTS: The average sensitivities over all MC speck sizes were 65.3%, 73.2%, and 72.3%, respectively, for the radiologists reading the STD, dnSTD, and STD+ volumes. The sensitivity for dnSTD was significantly higher than that for STD (p < 0.005, two-tailed Wilcoxon signed rank test) and comparable to that for STD+. The average false positive rates were 3.9 ± 4.6, 2.8 ± 3.7, and 2.7 ± 3.9 marks per DBT volume, respectively, for reading the STD, dnSTD, and STD+ images but the difference between dnSTD and STD or STD+ did not reach statistical significance. The overall conspicuity ratings and confidence levels by VGC analysis for dnSTD were significantly higher than those for both STD and STD+ (p ≤ 0.001). The critical alpha value for significance was adjusted to be 0.025 with Bonferroni correction. CONCLUSIONS: This observer study using breast phantom images showed that deep-learning-based denoising has the potential to improve the detection of MCs in noisy DBT images and increase radiologists' confidence in differentiating noise from MCs without increasing radiation dose. Further studies are needed to evaluate the generalizability of these results to the wide range of DBTs from human subjects and patient populations in clinical settings.

Effect of Dose Level on Radiologists' Detection of Microcalcifications in Digital Breast Tomosynthesis: An Observer Study with Breast Phantoms.

OBJECTIVES: To compare radiologists' sensitivity, confidence level, and reading efficiency of detecting microcalcifications in digital breast tomosynthesis (DBT) at two clinically relevant dose levels. MATERIALS AND METHODS: Six 5-cm-thick heterogeneous breast phantoms embedded with a total of 144 simulated microcalcification clusters of four speck sizes were imaged at two dose modes by a clinical DBT system. The DBT volumes at the two dose levels were read independently by six MQSA radiologists and one fellow with 1-33 years (median 12 years) of experience in a fully-crossed counter-balanced manner. The radiologist located each potential cluster and rated its conspicuity and his/her confidence that the marked location contained a cluster. The differences in the results between the two dose modes were analyzed by two-tailed paired t-test. RESULTS: Compared to the lower-dose mode, the average glandular dose in the higher-dose mode for the 5-cm phantoms increased from 1.34 to 2.07 mGy. The detection sensitivity increased for all speck sizes and significantly for the two smaller sizes (p <0.05). An average of 13.8% fewer false positive clusters was marked. The average conspicuity rating and the radiologists' confidence level were higher for all speck sizes and reached significance (p <0.05) for the three larger sizes. The average reading time per detected cluster reduced significantly (p <0.05) by an average of 13.2%. CONCLUSION: For a 5-cm-thick breast, an increase in average glandular dose from 1.34 to 2.07 mGy for DBT imaging increased the conspicuity of microcalcifications, improved the detection sensitivity by radiologists, increased their confidence levels, reduced false positive detections, and increased the reading efficiency.

MR imaging of heat stroke: external capsule and thalamic T1 shortening and cerebellar injury.

We present a case of increased signal intensity of the cerebrum (symmetric involvement of the paraventricular thalamus and external capsule) and cerebellum on both T1- and T2-weighted images in a patient with documented heat stroke. An ischemic and hemorrhagic mechanism is proposed, and the contributions of the direct effects of hyperthermia are discussed.