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D D Adler

Publications and source records attributed to D D Adler.

At least 19 recordsLinked to original sources

Computer-aided classification of mammographic masses and normal tissue: linear discriminant analysis in texture feature space.

We studied the effectiveness of using texture features derived from spatial grey level dependence (SGLD) matrices for classification of masses and normal breast tissue on mammograms. One hundred and sixty-eight regions of interest (ROIS) containing biopsy-proven masses and 504 ROIS containing normal breast tissue were extracted from digitized mammograms for this study. Eight features were calculated for each ROI. The importance of each feature in distinguishing masses from normal tissue was determined by stepwise linear discriminant analysis. Receiver operating characteristic (ROC) methodology was used to evaluate the classification accuracy. We investigated the dependence of classification accuracy on the input features, and on the pixel distance and bit depth in the construction of the SGLD matrices. It was found that five of the texture features were important for the classification. The dependence of classification accuracy on distance and bit depth was weak for distances greater than 12 pixels and bit depths greater than seven bits. By randomly and equally dividing the data set into two groups, the classifier was trained and tested on independent data sets. The classifier achieved an average area under the ROC curve, Az, of 0.84 during training and 0.82 during testing. The results demonstrate the feasibility of using linear discriminant analysis in the texture feature space for classification of true and false detections of masses on mammograms in a computer-aided diagnosis scheme.

Biophysical Phenomena

Invasive lobular carcinoma: sonographic appearance and role of sonography in improving diagnostic sensitivity.

PURPOSE: To characterize the ultrasonographic (US) appearance of invasive lobular carcinoma (ILC) and to assess the potential role of US in the earlier detection of ILC. MATERIALS AND METHODS: US scans in 19 patients with ILC were retrospectively studied for the presence of a mass, characteristics of the margins, internal echogenicity, and attenuation effects. RESULTS: US showed masses in 13 of the 19 patients (68% sensitivity). Irregularly marginated masses with heterogeneous internal echoes and acoustic attenuation were present in seven patients. A variety of US findings, mimicking a benign lesion, were noted in the other six patients. US sensitivity in the detection of small cancers (< 1 cm) was 25% (one of four patients). Mammographic sensitivity in the detection of ILC in this series was 89% (17 of 19 patients). CONCLUSION: ILC has a variety of US appearances. US was insensitive and nonspecific in the diagnosis of ILC, especially for small cancers. A negative US result should not deter surgical biopsy if indicated by mammographic findings or clinical findings.

Breast

Dynamic three-dimensional imaging with partial k-space sampling: initial application for gadolinium-enhanced rate characterization of breast lesions.

PURPOSE: To evaluate a method to monitor gadolinium enhancement patterns at magnetic resonance (MR) imaging with high temporal resolution and full coverage through both breasts. MATERIALS AND METHODS: In 12 patients with 13 masses, including nine carcinoma, nonenhanced three-dimensional MR imaging was performed with full-matrix resolution. At dynamic imaging, 32 serial passes were made during bolus administration of contrast material, and temporal resolution was reduced to 12 seconds by collecting the central (low spatial frequency) 32 x 16 or 16 x 16 phase-encode views. Full-matrix dynamic images were reconstructed by complementing central phase-encode data with precontrast data from peripheral high-spatial-frequency views. RESULTS: Results at time-course analysis with a mono-exponential saturation model indicated malignant lesions tend to show rapid (< 60 seconds) contrast change relative to benign masses and normal tissues. One cancer displayed an exceptionally slow contrast change (260 seconds). CONCLUSION: The technical objectives of full tissue coverage, rapid temporal sampling, and quantification of enhancement curves are met with this method for certain lesions (> 5 mm in largest diameter).

Adult

New methods for imaging the breast: techniques, findings, and potential.

Mammography is currently the best imaging technique for the early detection and diagnosis of breast cancer. Although numerous advances and improvements in mammography in the past decades have greatly improved image quality, the technique is not without shortcomings that limit its sensitivity and specificity. Multiple areas of research have therefore been sought not only to improve film/screen mammography, but also to consider entirely new techniques in the study of breast cancer. Although this review is not intended to include all methods currently under investigation, those chosen for discussion represent areas where major efforts have provided data that suggest exciting future applications. These include MR imaging, digital mammography, computer-aided diagnosis (CAD), positron-emission tomography (PET), and single-photon emission planar CT imaging (SPECT).

Breast

Digitization requirements in mammography: effects on computer-aided detection of microcalcifications.

We have developed a computerized method for detection of microcalcifications on digitized mammograms. The program has achieved an accuracy that can detect subtle microcalcifications which may potentially be missed by radiologists. In this study, we evaluated the dependence of the detection accuracy on the pixel size and pixel depth of the digitized mammograms. The mammograms were digitized with a laser film scanner at a pixel size of 0.035 mm x0.035 mm and 12-bit gray levels. Digitization with larger pixel sizes or fewer number of bits was simulated by averaging adjacent pixels or by eliminating the least significant bits, respectively. The SNR enhancement filter and the signal-extraction criteria in the computer program were adjusted to maximize the accuracy of signal detection for each pixel size. The overall detection accuracy was compared using the free response receiver operating characteristic curves. The results indicate that the detection accuracy decreases significantly as the pixel size increases from 0.035 mm x 0.035 mm to 0.07 mm x 0.07 mm (P < 0.007) and from 0.07 mm x 0.07 mm to 0.105 mm x 0.105 mm (P < 0.002). The detection accuracy is essentially independent of pixel depth from 12 to 9 bits and decreases significantly (P < 0.003) from 9 to 8 bits; a rapid decrease is observed as the pixel depth decreases further from 8 to 7 bits (P < 0.03) or from 7 to 6 bits (P < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Biophysical Phenomena

Breast imaging.

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Breast Neoplasms

Breast thickness in routine mammograms: effect on image quality and radiation dose.

OBJECTIVE: The purpose of this study was to compare the thickness of the compressed breast between mediolateral oblique and craniocaudal mammograms and to relate these differences in thickness to image quality and radiation dose. These differences may partially explain why some subtle tumors are better visualized on the craniocaudal view. SUBJECTS AND METHODS: The study population consisted of 250 paired mediolateral oblique and craniocaudal mammograms obtained on one mammographic unit by seven certified mammography technologists during a 2-month period. Only women with breast implants, prior lumpectomy and radiotherapy, or chest wall deformity were excluded. The digital readout of compressed breast thickness and applied compression force was recorded. Mammographic positioning was assessed using standard criteria. Absorbed radiation dose at different thicknesses was measured with a BR-12 breast phantom. Image quality differences for geometric unsharpness and contrast were calculated for the observed breast thickness differences between mediolateral oblique and craniocaudal mammograms. RESULTS: The mean thickness of the compressed breast on the craniocaudal view was less than the mean thickness on the mediolateral oblique view (4.4 versus 4.8 cm, p < .0001) despite the greater force used to compress the breast for mediolateral oblique than for craniocaudal views (93 versus 86 newtons, p < .0001). The breast thickness on the mediolateral oblique view exceeded that on the craniocaudal view in 98 (84%) of 117 pairs that differed in thickness by 5 mm or more and 46 (94%) of 49 pairs that differed by 10 mm or more (p < .0001). Geometric unsharpness increased by 8% and 19% when a 4.4-cm-thick breast was compared to a 4.8- and 5.4-cm-thick breast, respectively. A 5% and 12% loss of contrast was noted when a 4.4-cm-thick breast was compared to a 4.8- and 5.4-cm-thick breast. Mean glandular radiation dose at 4.4, 4.8, and 5.4 cm was 1.40, 1.70, and 2.33 mGy, respectively. CONCLUSION: The compressed breast is 8% thicker on mediolateral oblique than on craniocaudal mammograms, a small but statistically significant difference. This difference results in a small loss of spatial and contrast resolution on the mediolateral oblique views and an increase in radiation dose. These image quality differences may partially explain why some subtle carcinomas are better visualized on the craniocaudal view.

Adult

Benefits of a multidisciplinary approach to breast care.

The University of Michigan Breast Care Center (BCC) was established in 1985 to provide comprehensive, multidisciplinary diagnosis and treatment of benign and malignant breast disease. This work presents an overview of our experience in the BCC and assesses the clinical, academic, financial, and educational effectiveness of the program. A database was used to generate a list of all patients seen in the BCC between February 1, 1985 and December 31, 1991. Participating departments provided information regarding outpatient, inpatient, clinical and consultative activities, and referral patterns attributable to BCC endeavors. BCC educational and academic activities were reviewed and profiled. Clinical information was culled from the BCC database, hospital records, and the hospital tumor registry. The BCC has resulted in a fivefold increase in breast care related activity at the University of Michigan Medical Center. Over half of the patients treated in the BCC with primary operable breast cancer receive breast-conserving therapy. The BCC performs a unique educational function, providing the primary breast care experience for house staff as well as one third of the third year medical school class. The BCC supports over 20 clinical research protocols, and patient enrollment in clinical trials has increased dramatically since 1985. The BCC also provides support to basic science researchers receiving over 2.5 million dollars in peer reviewed direct cost support. These data suggest that a multidisciplinary approach to patient care as embodied by the BCC can be clinically, financially, and academically superior and productive. This model warrants further investigation not only in the field of breast care, but also in other clinical situations that require multidisciplinary input and therapy.

Breast Diseases

Tubular carcinoma of the breast: mode of presentation, mammographic appearance, and frequency of nodal metastases.

OBJECTIVE: Tubular carcinoma of the breast is a distinct, well-differentiated histologic subtype of infiltrative adenocarcinoma. The purpose of this study was to determine the typical mode of presentation, mammographic appearance, and frequency of metastases to the axillary lymph nodes. MATERIALS AND METHODS: We retrospectively analyzed the clinical records, mammograms, and histologic slides of 20 cases of proved tubular carcinoma of the breast in 20 women. These patients were identified by computerized search of our pathology data base from 1984 to 1993. Histologic findings were reviewed in all cases and correlated with the mammographic findings. RESULTS: Thirteen (65%) of the 20 women had impalpable tubular cancers discovered on screening mammograms. Seven patients (35%) had mammography because of a palpable tumor. Abnormalities were seen on mammograms in 16 patients (80%). These consisted of a mass alone in 13 (65%), a mass with microcalcifications in two (10%), and calcifications associated with architectural distortion and asymmetric density in one (5%). Most masses (11/15, 73%) were irregular or spherical and had spiculated margins. The size of the masses ranged from 3 to 19 mm (median, 8 mm). Metastatic carcinoma was found in the axillary lymph nodes of four (29%) of 14 patients who had axillary lymph node dissections, three of whom had a primary tumor 1 cm or less in diameter. CONCLUSION: Tubular cancers were most frequently detected as impalpable abnormalities seen on mammograms, emphasizing the importance of screening mammography. However, tubular carcinomas did not have a unique appearance on mammograms that would allow differentiation from other carcinomas. Lymph node metastases were more common than has been previously reported for this type of tumor, indicating that axillary lymph node dissections should continue to be performed.

Adenocarcinoma

The role of fine-needle aspiration and pneumocystography in the treatment of impalpable breast cysts.

Prior studies have suggested that the recurrence rate is lower in breast cysts treated by pneumocystography (injection of air into cyst cavities after cyst aspiration) than in cysts treated by fine-needle aspiration alone. To determine if this is the case for impalpable breast cysts, we reviewed the hospital records and mammograms of 38 women with 41 impalpable cysts. Mammograms obtained immediately after aspiration show that pneumocystography was successful in 18 and unsuccessful in 20 of the 41 cysts. Four cysts were excluded from the study: one cyst that recurred after aspiration and was sampled by biopsy and three cysts for which immediate post-aspiration mammograms were unavailable but which had recurred or persisted 3 years after aspiration. Review of follow-up mammograms made 4 months to 3 years after the aspiration showed that three (17%) of 18 cysts in the group with successful pneumocystography recurred and 11 (58%) of 19 cysts in the unsuccessful group recurred (p = .02). No difference was found in the number of recurrent cysts in relation to estrogen therapy or menopausal status. Our results indicate that impalpable breast cysts treated by pneumocystography are less likely to recur than are cysts treated by aspiration alone.

Adult

Solitary breast papilloma: comparison of mammographic, galactographic, and pathologic findings.

OBJECTIVE: Our purpose was to determine the mammographic/galactographic features of solitary breast papillomas and to correlate these features with the pathologic findings. MATERIALS AND METHODS: Retrospective review of pathology files revealed 72 women in whom breast biopsy reports described a solitary papilloma. All patients with additional pathologic abnormalities were excluded from this study. Patients meeting the pathologic criteria and for whom mammograms, galactograms, or both were available and had been obtained within 6 months before biopsy were included. Twenty-four women met these criteria and form the basis of this study. Presenting clinical signs and symptoms were reviewed. Abnormal mammographic/galactographic findings were correlated with pathologic features. RESULTS: Nipple discharge was present in 21 (88%) of 24 patients, two (8%) of 24 patients had abnormal findings on screening mammography, and one patient had a palpable mass that was visible on mammograms. Eight (42%) of 19 mammograms had abnormal findings, including dilated duct(s) in five cases (26%), nodules in two cases (11%), and microcalcifications in one case (5%). All technically adequate galactograms (13/15) had abnormal findings, with 12 (92%) of 13 showing an intraluminal filling defect. The other technically adequate galactogram (8%) showed only a solitary obstructed duct. Ductal dilatation was greatest at or central to the papilloma on 12 (92%) of 13 galactograms. Imaging features correlated well with the histologic findings. CONCLUSION: Patients with solitary papillomas most commonly have nipple discharge, normal mammographic findings, and a galactographic filling defect. Galactography is useful for localizing papillomas.

Adult

Enhanced color flow imaging of breast cancer vasculature: continuous wave Doppler and three-dimensional display.

Two methods of potentially improving the detection and assessment of breast cancer vasculature by color flow Doppler ultrasonography were studied. Use of continuous wave (CW) Doppler imaging was one method evaluated by a comparison of system sensitivity to small vessel flow by continuous wave and pulsed Doppler methods. The second technique demonstrated color flow image acquisition and three-dimensional (3D) display. Six breast cancer patients were examined with both a color flow pulsed system and a CW Doppler system employing a hand-held transmitter-receiver pair with crossed-beam patterns. The CW unit consistently revealed more regions of tumor flow and multidirectional flow. Good 3D displays were achieved on larger pulsatile vessels, from images obtained during systole and selected for minimal noise.

Adenocarcinoma

Mammographic biopsy recommendations.

Breast biopsy recommendations are commonly made on the basis of mammographic findings. Benign breast biopsies secondary to false positive mammographic interpretation remain a major source of discussion. A review of recent series of biopsy results is presented and the factors influencing positive predictive value are discussed. Methods to improve mammographic specificity, including validity of certain mammographic signs such as mass density are summarized. Issues relating to lesions followed on mammography--including number of views, compliance, and patient anxiety--are also addressed.

Biopsy, Needle

Mammographic follow-up of low-suspicion lesions: compliance rate and diagnostic yield.

All recommendations for mammographic follow-up of low-suspicion lesions seen at mammography during a 6-month period were reviewed to establish compliance rate and eventual outcome. One hundred forty-four of 2,650 mammograms (5%) showed minimal abnormalities that warranted short-term and periodic mammographic follow-up. Rates of compliance at 4 months and at 1, 2, and 3 years were 88%, 71%, 60%, and 47%, respectively. Progressive mammographic change was found in 10 patients, only one of whom had a carcinoma. It was concluded that mammographic follow-up of low-suspicion lesions is a reasonable alternative to surgical biopsy, although patient compliance remains a significant problem.

Biopsy

Localization and needle aspiration of breast lesions: complications in 370 cases.

A prospective study of the immediate complications of 370 consecutive breast-imaging procedures (203 wire localizations and 167 radiographically or sonographically guided fine-needle aspirations) is reported. Vasovagal reactions occurred in 27 (7%) of 370 cases, ranging in severity from syncope (four of 370, 1%) to mild light-headedness. These vasovagal reactions were independent of procedure type or use of local anesthesia, but were more common in younger patients. Other complications included prolonged (5 min or longer) bleeding (three of 370, 1%) and extreme pain (two of 370, 1%). One patient was found to have malignant hypertension. We conclude that wire localizations and imaging-guided aspirations are generally well tolerated procedures. However, vasovagal reactions are frequent enough to warrant close observation of patients. Radiologists and breast-imaging personnel should be able to recognize and treat vasovagal reactions.

Adult

Quantitative sonographic parameters as a means of distinguishing breast cancers from benign solid breast masses.

Ultrasound examinations of solid breast masses were reviewed retrospectively to determine whether quantitative data of their dimensions could distinguish benign from malignant tumors. Forty-nine fibroadenomas and 30 carcinomas with cytologic or histologic proof were identified. No significant difference was found between carcinomas and fibroadenomas when comparing the average ratio of length to anteroposterior (L/AP) diameter or the mean ratio of anteroposterior diameter to transverse diameter (AP/T). In this limited series, quantification of the degree of mass elongation along the natural breast tissue planes had low sensitivity in distinguishing malignant from benign tumors.

Adenofibroma

Doppler ultrasound color flow imaging in the study of breast cancer: preliminary findings.

A prospective study of the Doppler color flow features of 55 proved breast cancers was performed. On a three-level scale of low to marked vascularity, visual assessment of the color flow images classified 82% of the cancers as moderately or markedly vascular (minimal: 14%, moderate: 29%, marked: 53%). Four percent of the cancers had no detectable flow. In 29 women, a volume of tissue comparable to the cancer was scanned in the contralateral normal breast. Sixty-nine percent of the normal breasts had moderate or marked vascularity (minimal: 28%, moderate: 41%, marked: 28%), and 3% were avascular. There was poor distinction between normal tissues and cancer which suggests that more sensitive Doppler methods than were employed in this study may be needed in order to detect the small vessel flow reported to be rather specific for malignancy. The high, 82%, detection rate of tumor vessels in this study suggests the potential use of color flow Doppler for directing more specific but lengthy Doppler procedures.

Adult

Mammographic detection of breast cancer in women under the age of 35.

There have been few studies of the radiographic findings of breast cancer in young women. We report our series of 42 cancers in 39 women under the age of 35 who had a mammogram prior to biopsy. Abnormal findings were present on 86% of the mammograms with 94% of the abnormalities classified as high or intermediate suspicion. Mammographic findings were: mass in 50%, calcifications in 31%, diffuse inflammatory changes in 11%, and an asymmetric density in 8%. Six of the mammograms were normal. While young women are usually expected to have dense breasts, 23 mammograms showed either entirely fatty or mixed fatty/glandular tissue. Dense parenchyma infrequently obscured a palpable malignancy. We conclude that mammography can provide important diagnostic information in young women with breast cancer.

Adult