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Biomedical subjects

B Monsees

Publications and source records attributed to B Monsees.

At least 19 recordsLinked to original sources
PubMed1998

Rationale for annual screening mammography for women ages 40-49 years.

Proof of the benefit for mammographic screening of women ages 40-49 years is now available. Randomized controlled trials (RCTs) conducted in Gothenburg and Malmo, Sweden have shown statistically significant breast cancer mortality reductions of 36% and 45% respectively. A meta-analysis of all five Swedish trials has found a statistically significant mortality reduction of 29% for woman in this age group. Substantially greater reductions in mortality would likely have resulted if women in these trials had been screened annually. Because the benefits are substantial, and the risks from screening are relatively small and acceptable, screening mammography beginning at age 40 is now recommended by the American Cancer Society, as well as the National Cancer Institute.

Journal Article↗
PubMed1996

Mammographically detected breast cancer. Benefits of stereotactic core versus wire localization biopsy.

OBJECTIVE: The authors evaluated the differences between stereotactic core needle biopsy (SCNBx) and needle localization surgical biopsy (NLBx) in cost and treatment course for patients with mammographically detected breast cancer. SUMMARY BACKGROUND DATA: Stereotactic core needle breast biopsy is a reproducible and reliable alternative to surgical biopsy for histologic diagnosis of mammographic lesions. METHODS: Records from 52 consecutive patients with invasive breast cancer diagnosed by SCNBx (n = 21) or NLBx (n = 31) over 2 years were reviewed. Episode-of-care costs were extracted from the Barnes Hospital billing system database. RESULTS: At the time of excision, surgical margins were statistically more frequently positive in patients treated with NLBx (55%) than patients treated with SCNBx (0%, p < 0.0001). Furthermore, patients in the NLBx group undergoing breast conservation surgery required re-excision more frequently (74%) than those in the SCNBx group (0%, p = 0.001). There were no complications in either group after the diagnostic procedure. All SCNBx results were correct in the diagnosis of invasive breast cancer. The median cost of SCNBx was approximately $1000 less than the median cost of NLBx. This cost difference was carried through the definitive procedure, whether it was breast conservation or mastectomy. CONCLUSIONS: This study shows the advantage of SCNBx to diagnose breast cancer and definitive operative care at a single procedure. The preoperative diagnosis of breast cancer eliminated positive operative margins and procedures to re-excise breast tissue. The use of SCNBx also saved approximately $1000 per patient compared with the use of NLBx. Our data suggest that SCNBx is the diagnostic procedure of choice for mammographically detected cancers.

Adenocarcinoma↗
PubMed1995

Needle localization breast biopsy: a model for multidisciplinary quality assurance.

As part of the quality assurance role of the Cancer Committee at Barnes Hospital, an institutional audit of Needle Localization Breast Biopsy (NLBB) was performed. Mammographic, operative, and surgical pathology reports from 370 consecutive patients at our institution undergoing both mammography and needle localization biopsy over a 34-month interval were reviewed. Carcinoma was diagnosed pathologically in 103 patients (28%), and 27% of these proved to be noninvasive. Sixteen patients were found to have histologic or clinical involvement of the axillary nodes; no patients with Tis lesions were found to have axillary nodal involvement. Of the patients, 73% were found to have either Stage 0 or Stage I disease, and 61% with an established malignancy had mastectomy (67% of patients with invasive carcinoma, 44% of those with carcinoma-in-situ), whereas 39% had some form of conservation therapy (33% of patients with invasive lesions, 56% of those with carcinoma-in-situ). Our results have been compared with other published studies, and important clinical indicators for evaluating the results of individual centers performing NLBB are discussed. It is concluded that NLBB is a safe and effective method of biopsying nonpalpable breast lesions, which allows for the identification of early stage breast carcinomas. In the present environment of concerns about the quality of care and costs, it is the responsibility of each center performing NLBB periodically to evaluate their results with this multidisciplinary procedure and to bring about change in those areas found to be deficient.

Biopsy, Needle↗
PubMed1989

Calcification of breast implant capsule.

We have presented a case of bilateral capsular calcification, an extremely rare but clinically important complication of augmentation mammoplasty. Little is known about its pathogenesis, but it is believed to be related to the presence of molecular silicone and/or Dacron patches in the pericapsular environment. This condition may mask calcifications of the breast due to carcinoma, and it often exacerbates the symptoms of capsular contracture. We recommend removal of the calcified capsules and replacement of the implants in the submuscular position.

Breast Diseases↗
PubMed1989

Nipple simulating a breast mass on a mammogram.

On a mediolateral mammogram obtained during routine screening, a mass was noted deep within the breast. However, no mass could be palpated, and additional views showed no mass. Observation of the patient during imaging demonstrated the nipple of the opposite breast was inadvertently projected onto the image. Radiologists should be aware of this cause of pseudotumor of the breast.

Adult↗
PubMed1989

Ascending lower limb phlebography: comparison of ioversol and iothalamate meglumine.

Fifty patients undergoing ascending phlebography of a lower limb were evaluated, in a randomized double-blind fashion, to compare the efficacy, patient tolerance, and safety of two different contrast agents. Ioversol-240 (MP-238), a new nonionic agent, and iothalamate-202 (Conray 43), an established ionic agent, were the contrast agents used. Twenty-five patients were injected with iothalamate and 25 with ioversol. The phlebograms were evaluated for diagnostic quality and the patients for symptoms, with special reference to complaints of heat and pain. No significant difference was demonstrated between the two agents in either examination quality or patient tolerance. No major contrast-related reactions were recorded. We conclude that ioversol-240 appears to be a safe and acceptable alternative to iothalamate-202.

Adult↗
PubMed1989

The effect of breast implants on the radiographic detection of microcalcification and soft-tissue masses.

Current implants for breast augmentation containing silicone gel, saline, or both can totally obscure mammographic detection of microcalcifications and soft-tissue masses. To investigate the possibility of developing a more radiolucent implant, radiographs were obtained of silicone shells that contained silicone gel, saline, silicone gel and saline, polyurethane-covered silicone gel, gelatin, sunflower oil, and peanut oil. All radiographs were obtained using a Siemens Mammomat by placing the implant over an American College of Radiology mammography phantom. Results were measured by the ability to visualize or resolve the artifacts in the mammography phantom. The silicone shell alone minimally altered artifact resolution. Silicone shells filled with silicone gel, silicone gel and saline, saline alone, polyurethane-covered silicone gel, and gelatin were equal in radiodensity and completely obscured all phantom artifacts. Silicone shells filled with peanut oil and sunflower oil had equal radiodensity and allowed visualization of large microcalcifications and some soft-tissue masses. Current implants used for augmentation mammaplasty can totally obscure mammographic detection of microcalcifications and soft-tissue masses. A more radiolucent breast implant is possible, and further research is needed to define the best filler material and test its biocompatibility.

Breast↗
PubMed1988

The self-referred mammography patient: a new responsibility for radiologists.

A mammography screening program was initiated in which self-referred women were accepted for examination. Two views of each breast were obtained, and no physical examination was performed. Reports were sent to each patient and to the patient's primary care physician, if she had one. The program was successful in that the number of examinations performed per day increased from 36 to 80 within 6 months. Approximately 50% of the women who came for screening did so at their own request. Self-referred women with abnormal findings on mammograms who did not have a primary care physician were contacted by phone and told of the results. Advice was given for further evaluation, and the patient was referred to a local physician if she still did not know of one. Further workup in patients with abnormal findings was verified with the use of computer tracking and follow-up phone calls. Self-referral is an important component of screening mammography, but it places added responsibility on the radiologist in cases in which there is no referring physician.

Breast Neoplasms↗
PubMed1987

Light scan evaluation of nonpalpable breast lesions.

Transillumination light scanning of the breast was performed immediately before needle localization of 112 nonpalpable mammographic abnormalities detected in 103 patients. Twenty-four cancers were diagnosed in 23 patients. The positive predictive value for mammography was 21%. Ten (42%) of these nonpalpable cancers were not visible on transillumination light scanning. Eleven of 16 invasive ductal cancers and three of seven intraductal cancers were evident on transillumination light scans, but a single case of lobular carcinoma in situ was not evident. There were 12 false-positive light scan examinations. Transillumination light scanning had a 58% sensitivity, an 86% specificity, a 54% positive predictive value, and an 88% negative predictive value for small breast lesions. Therefore, the authors are unable to recommend delaying biopsy in patients with mammographic abnormalities on the basis of a negative light scan study.

Biopsy↗