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Biomedical subjects

A E Kirkpatrick

Publications and source records attributed to A E Kirkpatrick.

At least 19 recordsLinked to original sources
PubMed1992

Assessment of non-palpable mammographic abnormalities: comparison between screening and symptomatic clinics.

A retrospective study found that a breast screening clinic generated fewer localization biopsies for non-palpable mammographic abnormalities than a symptomatic clinic (3.36 versus 9.89 per 1000 mammograms, respectively) and that a greater proportion of such biopsies were malignant. This study determined the reason for this difference. There were 108 of 304 (35.5 per cent) and 17 of 130 (13.1 per cent) carcinomas in women attending the screening and breast clinics respectively (relative risk 2.72 (95 per cent confidence interval 1.70-4.34)). This difference was regardless of age. The characteristics of the mammographic abnormality, the Wolfe pattern, a family history of breast carcinoma, parity and age at first pregnancy were similar in both groups. Women attending the screening clinic were referred for localization biopsy after assessment by clinicians and radiologists at a joint clinic; there was no joint assessment for patients attending the breast clinic. The same staff attended both clinics, although the proportion of time spent at each varied. This study suggests that all women with a non-palpable mammographic abnormality should be reviewed at a joint assessment clinic before localization biopsy is recommended.

Biopsy↗
PubMed1991

Comparative pathology of breast cancer in a randomised trial of screening.

In the Edinburgh Randomised Breast Screening Project (EBSP) to December 1988 there were 500 cancers in the study population invited to screening and 340 cancers identified in the control population. The size and negative lymph node status characteristics of invasive cancers from the two populations were significantly different (P less than 0.05). The cancers detected by screening were predominantly 'early stage', with 16% noninvasive (PTIS) and 42% invasive stage I (pT1 node negative), whereas cancers were frequently 'late stage' (more than pT2) and inoperable in nonattenders (44%) and controls (36%). Grouped according to customary size ranges of invasive cancers, the proportion of cases lymph node positive differed in those screen detected compared with controls, but the benefit in favour of screen detection was not constant. In comparisons of cancers detected at prevalence and incidence screens, as a test of conformity with screening theory, no significant differences were apparent according to size and lymph node status, yet the characteristics of histological type of cancer discriminated significantly (P less than 0.05). When these same histological characteristics were used to compare survival, the capacity to separate invasive cancers into two groups having good and poor survival probabilities was evident, with a significant improvement for the screen detected poor survival group compared with controls (P less than 0.05).

Breast Neoplasms↗
PubMed1990

Edinburgh trial of screening for breast cancer: mortality at seven years.

Between 1979 and 1981, 45,130 women in Edinburgh aged 45-64 were entered into a randomised trial of breast cancer screening by mammography and clinical examination. The initial attendance rate was 61% but this varied according to age and socioeconomic status and decreased over succeeding years. The cancer detection rate was 6.2 per 1000 women attending at the first visit; the rate fell to around 3 per 1000 in the years when mammography was routinely repeated and to around 1 per 1000 at the intervening visits with clinical examination alone as the screening method. After 7 years of follow-up the mortality reduction achieved was 17% (relative risk = 0.83, 95% CI 0.58-1.18), which was not statistically significant, even when corrected for socioeconomic status. In women aged 50 years and over a mortality reduction of 20% was achieved.

Age Factors↗
PubMed1990

Outcome of surgery for non-palpable mammographic abnormalities.

Four hundred and ninety-three women underwent 515 localization biopsies for non-palpable mammographic abnormalities. The mammographic abnormality was located with a hooked wire in 509 cases. Specimen radiology was performed on all excised tissue. The mammographic abnormality was visualized in the first piece of tissue excised in 402 (78.1 per cent) cases and complete excision was achieved in 476 (92.4 per cent). A palpable nodule was removed in 38 (7.4 per cent) cases and in 17 (44.7 per cent) was shown to contain a carcinoma. The mammographic abnormality was missed in 14 (2.7 per cent) cases or only partly excised in 13 (2.5 per cent). Overall 144 (28.0 per cent) localization biopsies were malignant. The mammographic abnormality was not visualized on the specimen radiograph more frequently in women aged under 55 years, in women with dense breast (Wolfe grade DM or DY) or in those whose mammographic abnormality contained only microcalcification. The 27 women in whom the mammographic abnormality was not visible on the specimen radiograph underwent repeat mammography 2 months later. Only two women required a further localization biopsy and the mammographic abnormality was recovered in the first piece of tissue excised. Women with a carcinoma underwent mastectomy or wide local excision, and residual carcinoma at the localization biopsy site was found in 64 (44.4 per cent) cases. Oestrogen receptor analysis by ligand binding assay was possible in only 71 (49.3 per cent) carcinomas. If the specimen radiograph does not show the mammographic abnormality within pieces of tissue excised and there is no palpable nodule it may be best to conclude the biopsy. In this series these missed lesions were usually benign. Only rarely is a second localization biopsy required and this is performed without difficulty.

Adult↗
PubMed1990

Comparison of temperature profiles (DeVeTherm) and conventional venography in suspected lower limb thrombosis.

In 124 patients admitted with suspected acute deep venous thrombosis, the screening value of a new thermographic scanner, DeVeTherm, was evaluated using conventional venography as a reference. The sensitivity of the scanner was calculated at 92% and the specificity at 25%. The predictive value of positive temperature profiles was 0.48, and that of negative temperature profiles, 0.82. On the basis of these results neither the accuracy nor the potential savings justify using temperature profiles alone as a screening test for this condition.

Adult↗
PubMed1990

Mammographic screening for breast cancer: recall rates using two views compared with the oblique view alone.

Six thousand and eighty women aged 40 to 64 years were screened for breast cancer by single oblique view mammography and 908 (14.9 per cent) were recalled for further examinations. It was estimated that the use of two-view mammography for initial screening would have resulted in a fall of the number of women recalled to 581 (9.5 per cent). More recently, with better equipment and the routine use of a moving grid, the recall rate at initial singleview screening in women over the age of 50 has fallen to the region of 10 per cent. The place of two-view screening is being evaluated in conjunction with grid films and, should a similar proportional fall in recall rates be gained by the addition of a second view, there may well be a place for two-view screening in this situation too.

Adult↗
PubMed1989

Stereotaxic localisation and aspiration cytology of impalpable breast lesions.

As part of a programme of assessment of the 'Sterotix' localisation device, aspiration cytology was carried out on 50 patients with 52 impalpable, mammographically detected breast lesions using the stereotaxic guidance device. This was followed by an open localisation biopsy of the area for confirmation. In 12 patients (23%) the aspirations failed to yield sufficient material for diagnosis. This was frequently due to the poorly cellular nature or very small size of the lesions. Of the remaining 40 patients, 15 were regarded as having both mammographically and cytologically benign changes which were confirmed histologically; they could thus have been spared diagnostic surgery. Ten patients had a diagnosis of malignancy with both investigations, and could have had planned investigation and subsequent definitive surgery. Of the remainder, 14 lesions had a report of malignancy or suspicion of it with either technique and these patients would have come to conventional localisation biopsy. Only one patient was found to have a malignancy, who had cytologically benign and mammographically 'probably benign' disease: this was an invasive lobular carcinoma with a dominant in-situ component and may well have been an incidental finding on biopsy.

Adult↗
PubMed1989

Films, screens and cassettes for mammography.

Various film-screen combinations intended for mammography have been compared for image quality and for dose. Image quality was assessed as in an earlier paper, using a test object having details which are both realistic and quantitative. Relative doses required to give film densities of 1.0 were measured. The Kodak MinR-MinR combination was taken as a standard against which others were compared, and in general a lower dose was accompanied by poorer image quality. The Fuji NH film with Fuji Hi-Mammo screen was the sole exception, giving slightly better image quality at about half the dose required by the MinR combination. A number of cassettes were also compared with each other and with evacuated envelopes. The Dupont Cronex cassette and three carbon-fibre fronted cassettes all performed well in image quality.

Equipment Design↗
PubMed1989

Effect of retrograde aminophylline administration on calcium and phosphate solubility in neonatal total parenteral nutrient solutions.

The effect of retrograde administration of aminophylline injection on calcium and phosphate solubility in neonatal total parenteral nutrient (TPN) solutions was studied. Neonatal TPN solutions containing two amino acids solutions in three concentrations (Travasol 1% and 2% and TrophAmine 2%) were formulated. Calcium and phosphate salts were added to achieve calcium concentrations of 10, 15, 20, 25, 30, or 40 meq/L and phosphorus concentrations of 10, 15, 20, 25, 30, or 40 mmol/L. Samples were inspected visually after 18-24 hours; solutions free of precipitation were then infused through two parallel syringe-pump systems designed to simulate clinical conditions for TPN solution administration to a 1-kg neonate. To one system, a 7.5-mg aminophylline dose was added as a manual retrograde injection; sterile water for injection was added as a manual retrograde injection to the other system. The solutions were inspected throughout a one-hour infusion period for precipitate formation in the i.v. apparatus, and the pH of the effluents was determined. Concurrent aminophylline administration resulted in visible precipitate in all but a few of the solutions tested. The solution containing Travasol 2%, calcium 10 meq/L, and phosphorus 10 mmol/L remained clear, as did the solutions containing TrophAmine 2% and the following concentrations of calcium and phosphorus: calcium 10 meq/L and phosphorus 10, 15, or 20 mmol/L; calcium 15 meq/L and phosphorus 10 or 15 mmol/L; and calcium 20 meq/L and phosphorus 10 or 15 mmol/L. An average increase in pH of 0.63 unit was noted in all solutions.(ABSTRACT TRUNCATED AT 250 WORDS)

Aminophylline↗
PubMed1988

Film processing for mammography.

The effect of processing time and temperature on image quality in mammograms was investigated over the ranges 2.5-4 min and 30-36 degrees C. Image quality results from seven processors of different manufacture and different processing methods, operated at a range of times and temperatures, showed the same image quality except for one which received little use. Effects of these parameters on the patient dose required were also considered, longer times up to 4 min and higher temperatures up to 36 degrees C being advantageous. No variation was found with processor design or mechanism of action. Implications for screening programmes are briefly discussed and an optimum regime of 3.5 min and 36 degrees C is suggested.

Mammography↗
PubMed1987

Computed tomogram myelography in cervical spondylosis.

Nine patients with severe and prolonged signs and symptoms due to cervical spondylosis had myelography followed by a CT Scan using the same injection of intrathecal contrast. All patients had radiographic changes of cervical spine degeneration and were being considered for exploration and fusion of the anterior cervical spine. All patients had a full clinical evaluation, EMG studies and plain radiographs taken prior to their CT Scan. EMG readings showed several levels of compression in three patients but did not indicate a single level in any. Plain radiography showed multiple level involvement in every patient. Myelography indicated significant indentation in three of five patients with clinical signs but did not demonstrate root cut off in any case. CT Myelography indicated the degree of Lushka and facet joint involvement, indentation, exit foramen encroachment, and the degree of spinal stenosis at the involved segment. In three patients, the findings at operation correlated closely with the CT Scans. Myelography failed to indicate the presence of significant osteophytes in these two cases.

Adult↗
PubMed1987

A comparative study of films and screens for mammography.

Ten films and six screens suitable for mammography have been compared for image quality using a realistic quantitative phantom under controlled conditions. The best screen was Min R (Kodak), but three black and white films, Min R (Kodak), Fuji II NC (Fuji) and MR3 (Agfa-Gevaert), scored highly. Patient dose was also considered and, with these three films, small gains in image quality were balanced by small increases in dose. Medichrome Blue film, however, gave the highest score of all, and did so for a dose that was less than the highest. These results were confirmed on a second phantom of entirely different design.

Female↗
PubMed1986

Specimen radiology of excised breast lesions.

The value of specimen radiology in the surgical management of palpable breast lesions was assessed in 100 consecutive patients undergoing excision of a palpable breast lump. Only 41 per cent of palpable breast lesions were demonstrable as a radiological abnormality on the excised specimen. The greatest sensitivity was found for lesions which proved to be malignant. Only 27 of 88 benign palpable breast lesions were radiologically visible in the specimen. Surprisingly, only 8 of 13 fibroadenomas were identified as discrete opacities. No residual breast lump was detected on clinical examination in patients reviewed postoperatively, including those patients who had a demonstrable preoperative mammographic abnormality and a negative specimen radiograph. We conclude that specimen radiology does not contribute to the surgical management of palpable breast lesions.

Biopsy↗