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C B Stelling

Publications and source records attributed to C B Stelling.

At least 19 recordsLinked to original sources
PubMed1995

MR imaging of the breast for cancer evaluation. Current status and future directions.

This article discusses the current status of clinical feasibility testing and outlines some of the advantages and disadvantages of contrast-enhanced breast MR imaging. A review of imaging parameters includes the dose of paramagnetic contrast agents, two- versus three-dimensional scanning, and postprocessing data analysis with an emphasis on areas for further development. Principles of interpretation for normal tissue, benign lesions, and invasive cancers are summarized including causes of false-positive and false-negative MR imaging interpretations. Future clinical roles for breast MR imaging such as MR imaging-directed biopsies and therapies and MR as a complementary technique to film-screen mammography for selected clinical situations are suggested.

Breast↗
PubMed1994

Breast imaging.

Explore the source record for details and available documents.

Breast Neoplasms↗
PubMed1994

Ductal abnormalities detected with galactography: frequency of adequate excisional biopsy.

OBJECTIVE: Galactography (ductography) is a contrast examination of the mammary ducts performed to identify and localize intraductal growths that may be the cause of spontaneous discharge from the nipple. The objective of this study was to correlate the radiologic-pathologic findings in patients with abnormal findings on galactograms in order to determine how often the biopsy specimens included the lesions seen at galactography. MATERIALS AND METHODS: We retrospectively studied all galactograms with abnormal findings obtained in women who subsequently had biopsy at our institution between 1981 and 1991. Galactograms and tissue specimens from 29 women who had 30 biopsies were included. The standard technique was used to perform galactography. Biopsies were performed by using standard surgical technique for duct excision. The histopathologic findings were retrospectively reviewed by a pathologist to determine whether the biopsy specimens included the lesions seen at galactography. RESULTS: In six (20%) of the 30 biopsies, the lesion shown by galactography was not seen on histopathologic review. In the other 80%, the lesion was successfully identified on histopathologic examination. CONCLUSION: Our finding that the abnormality shown by galactography was not completely excised in one in five cases indicates that greater cooperation between the surgeon, radiologist, and pathologist is essential to ensure that all lesions are properly removed.

Biopsy↗
PubMed1993

Management of mammographic indeterminate lesions. First place winner of the Conrad Jobst Award in the Gold Medal paper competition.

The positive predictive value of mammography in nonpalpable malignancy, only 20 to 25 per cent, could be improved with better mammographic criteria for lesions not requiring biopsy. The outcomes of 89 patients with indeterminate lesions were reviewed to determine whether these lesions could be managed safely by observation rather than biopsy. Indeterminate lesions were defined as 1) tightly clustered, nonlinear calcifications (> 5 within 1 cm of tissue); 2) dominant, well-circumscribed soft-tissue masses (< or = 1 cm2); or 3) asymmetric density. Lesions not immediately undergoing biopsy were followed with frequent-interval mammography. Twenty-two lesions (26%) underwent immediate biopsy, and 2 of these demonstrated carcinoma in situ with microinvasion. Sixty-seven lesions (74%) were observed (median follow-up, 34 months), and 2 (2.5%) proved to be malignant, for an overall malignancy rate of 4.5 per cent. All malignancies were stage I, and the patients remain alive with no evidence of disease (average follow-up, 24 months). Sixty patients were spared unnecessary biopsy, decreasing potential wire-directed biopsies by 25 per cent. The positive predictive value of mammography increased from 21 to 32 per cent over the period. Indeterminate lesions can be safely followed with frequent ipsilateral mammography, reserving biopsy for lesions that progress. Management schemes such as this one can be used to decrease the number of negative wire-directed biopsies.

Awards and Prizes↗
PubMed1991

Abnormalities of the breast caused by biopsy: spectrum of mammographic findings.

It is important for radiologists to be familiar with the spectrum of mammographic abnormalities caused by postbiopsy changes in the breast. Although many breast biopsies leave no residual abnormality, occasionally an atypical manifestation of a biopsy scar may produce a radiologic finding suspicious enough to mandate a biopsy. Problem-solving maneuvers recommended to increase confidence that a change is related to a recent biopsy include (1) skin markers; (2) comparison with preoperative films; (3) correlation with physical examination; (4) tailored mammographic views, including focal spot compression, magnification, and tangential views; and (5) postoperative and follow-up mammograms.

Biopsy, Needle↗
PubMed1989

Sensitivity, specificity, predictive value and accuracy of film/screen mammography. A three-year experience.

Mammographic and pathologic findings of 312 breast lesions biopsied at the University of Kentucky Medical Center over a three-year period (Jan 1, 1984 through Dec 31, 1986) were correlated. Each of the 312 mammographic examinations was classified as a true positive, true negative, false positive, or false negative interpretation based on the final pathologic diagnosis. The data on 88 wire directed biopsies for clinically occult mammographic lesions and data on 224 biopsies of palpable lesions performed without wire localization were evaluated separately and in combination. From this data the sensitivity, specificity, predictive value, and accuracy of mammography for detecting breast cancer were calculated. Results of all breast biopsies 1984-1986 gave a sensitivity of 84%, specificity of 59%, positive predictive value of 40%, negative predictive value of 92%, and an accuracy of 65% for film-screen mammography. Wire directed biopsies increased the false positive diagnosis from 22 to 96 but also accounted for the detection of 14 clinically occult breast cancers, of which 84% had negative lymph nodes.

Biopsy↗
PubMed1988

Carcinoma of the breast: detection with MR imaging versus xeromammography.

Detectability of breast cancer with magnetic resonance (MR) imaging versus xeromammography was quantitatively compared. MR images were obtained of breasts of 120 women who underwent xeromammography. T1 values were determined for masses larger than 2 cm. Cancer was histologically confirmed in 39 breasts and was considered excluded from 81 due to results of biopsy, cyst aspiration, or sonography or absence of change in xeromammographic findings over time. Images were blindly interpreted by three observers, and results were expressed as receiver operating characteristic curves. Detectability of breast cancer was substantially better with xeromammography than with MR imaging for all observers (P less than .03, 10(-6), and .001). On MR images, spiculation of a mass, distorted architecture, skin thickening, and nipple or skin retraction were specific but relatively insensitive indicators of cancer. Masses with smooth, distinct margins and signal intensity greater than that of fat on T2-weighted images were always benign. Other findings and T1 values were not diagnostically useful. The authors conclude that xeromammography is superior to MR imaging in detection of breast cancer.

Breast Diseases↗
PubMed1988

Magnetic resonance imaging of the human female breast. Current status and pathologic correlations.

Over the past decade, research in MR of the female breast has focused on in vitro studies of excised breast tissue samples or mastectomy specimens and on in vivo clinical imaging of patients, usually with biopsy correlation. The results of in vitro measurement of T1 and T2 times of excised benign and malignant breast tissue do not conclusively demonstrate a clear separation based on these values alone. In particular, benign tumors (fibroadenomas) cannot be distinguished from carcinomas and there is considerable overlap in values for cancer and fibrocystic disease. MR images produced from mastectomy specimens allow detailed correlation with mammographic and histologic findings but are incompletely applicable to in vivo images because of numerous factors including tissue changes associated with disruption of blood supply. In vivo studies have shown that benign tumors (fibroadenomas), fibrocystic changes, and cancers can be imaged successfully by MR. To date the best images show a resolution of about 2 mm. Small cancers and cysts have been imaged successfully but proliferative patterns of fibrocystic disease cannot be differentiated at this time. Carcinomas occurring in dense fibroglandular breasts which are a problem to image mammographically have not been successfully imaged by MR in vivo and in only one instance in vitro in a mastectomy specimen. Since MR cannot image microcalcifications, it does not appear likely to replace mammography as the imaging modality of choice at the present time. Newer magnets of increased strength, specialized surface coils specifically for breast imaging, and the use of contrast enhancing agents all may increase the usefulness of MR as an imaging modality for the detection of breast disease. In particular, increased resolution and contrast enhancing agents which may aid in tissue differentiation should be studied for their ability to detect carcinomas in dense fibroglandular breast tissue and to identify lesions of carcinoma in situ and proliferative patterns of fibrocystic disease. The need for careful collaborative studies between radiologists and pathologists will be essential for the success of these research efforts.

Adenofibroma↗
PubMed1987

Fibroadenomas: histopathologic and MR imaging features.

Twelve fibroadenomas were studied in vivo using magnetic resonance (MR) imaging with a cylindrical surface coil and at 0.15 T. On T1-weighted images, most fibroadenomas had an intensity similar to that of normal fibroglandular tissue; areas of inhomogeneity were seen in six. On five of the T2-weighted images, the fibroadenomas gave a signal equal to or slightly greater than that of normal fibroglandular tissue; five showed a marked increase in intensity, and two gave a low signal intensity. Four fibroadenomas were inhomogeneous on both T1- and T2-weighted images, and two additional lesions became inhomogeneous on T2-weighted images. No consistent correlations were found between MR appearances and histopathologic findings in the fibroadenomas. It is concluded that the appearance of fibroadenomas on MR images is sufficiently variable that it would be difficult to differentiate benign from malignant circumscribed tumors on the basis of MR imaging alone.

Adenofibroma↗
PubMed1986

Calcific tendinitis of the flexors of the forefoot.

We report a case of calcific tendinitis in the flexor tendons of the forefoot. A 33-year-old woman presented with a two-day history of foot pain but she recalled no direct trauma to the foot. Physical examination revealed redness, warmth, and tenderness on the plantar surface of the foot near the head of the first metatarsal. Radiographs showed a small focus of calcification in the flexor tendons of the great toe, diagnostic of calcific tendinitis. The patient was treated with supportive therapy and recovered.

Adult↗
PubMed1986

Nonpalpable breast lesions: wire localization and excisional biopsy.

From January, 1984, through July, 1984, 53 women with 56 nonpalpable suspicious mammographic breast lesions underwent breast biopsy directed by pre-operative needlewire localization. All of the suspicious lesions were removed at the first operation, and, although in 10 patients, the localization wire was greater than 2 cm from the lesion, this did not increase the number of attempts required to excise the lesion. Once the specimen and wire were removed, a radiograph was taken to assure removal of the suspicious area. Also, once the blocks were cut, they were x-rayed to pinpoint further which histopathologic sections would include the area in question. Six of the 56 suspicious mammographic lesions removed were intraductal breast carcinomas. All were Stage I tumors. The remainder of the lesions were benign including 24 with nonproliferative fibrocystic changes, 31 with proliferative fibrocystic changes and only one demonstrating proliferative changes with atypical hyperplasia. This procedure can be performed effectively on outpatients utilizing local anesthesia. Excellent communication among surgeon, radiologist, and surgical pathologist is imperative.

Adult↗
PubMed1985

Prototype coil for magnetic resonance imaging of the female breast. Work in progress.

Magnetic resonance imaging (MRI) of the breast was performed in 35 women using a prototype breast coil at 0.15 T. The distribution of fibroglandular and fatty tissues was demonstrated sufficiently well to permit correlation with the mammographic patterns of Wolfe, and it was possible to identify 1-cm cysts. The signal intensity of the cysts varied from low to high as repetition time (TR) and echo time (TE) using the spin echo technique (TR/TE) were prolonged from 250/30 to 1,000/120. In two women, fibroadenomas were seen as low-intensity, smoothly marginated lesions surrounded by fat. A range of in vivo observed T1 values is summarized for normal and pathologic tissues. It is concluded that MRI of the female breast, currently in the developmental phase, is feasible and further evaluation is indicated.

Adipose Tissue↗