Diagnosis please. Case 8: solitary intraductal papilloma.
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Breast Neoplasms↗
Biomedical subjects
E D Pisano
Publications and source records attributed to E D Pisano.
Rate of insufficient samples for fine-needle aspiration for nonpalpable breast lesions in a multicenter clinical trial: The Radiologic Diagnostic Oncology Group 5 Study. The RDOG5 investigators.
BACKGROUND: Radiologic Diagnostic Oncology Group 5 is a multicenter clinical trial designed to evaluate fine-needle aspiration (FNA) of nonpalpable breast lesions performed by multiple operators using the same protocol. METHODS: Four hundred and nineteen women with mammographically detected nonpalpable breast lesions were enrolled on the trial at 18 institutions. Group A institutions randomized women to stereotactically guided FNA (SFNA) followed by stereotactically guided core needle biopsy (SCNB), or SCNB only. Group B institutions randomized women to SFNA and SCNB, SCNB, or ultrasonographically guided FNA followed by ultrasonographically guided core needle biopsy (USCNB), or USCNB only. A total of 377 women were eligible for analysis. RESULTS: FNA yielded 128 insufficient samples for the 377 patients (33.95%; 95% confidence interval, 29.2-38.7%). The rate of insufficient samples varied by type of lesion with calcified lesions associated with a significantly higher rate of insufficient sampling than masses (P < 0.001). The radiologist's level of suspicion of the lesion was not a statistically significant predictor of insufficient samples for mass lesions, but was a predictor for calcified lesions. For the 336 lesions for which histologic information was available, insufficient samples occurred in significantly more benign than malignant lesions. CONCLUSIONS: The high rate of insufficient samples for FNA of nonpalpable breast lesions in this multicenter trial makes its use impractical in this setting. Because of this factor, the study was terminated early.
Adult↗
Contrast limited adaptive histogram equalization image processing to improve the detection of simulated spiculations in dense mammograms.
The purpose of this project was to determine whether Contrast Limited Adaptive Histogram Equalization (CLAHE) improves detection of simulated spiculations in dense mammograms. Lines simulating the appearance of spiculations, a common marker of malignancy when visualized with masses, were embedded in dense mammograms digitized at 50 micron pixels, 12 bits deep. Film images with no CLAHE applied were compared to film images with nine different combinations of clip levels and region sizes applied. A simulated spiculation was embedded in a background of dense breast tissue, with the orientation of the spiculation varied. The key variables involved in each trial included the orientation of the spiculation, contrast level of the spiculation and the CLAHE settings applied to the image. Combining the 10 CLAHE conditions, 4 contrast levels and 4 orientations gave 160 combinations. The trials were constructed by pairing 160 combinations of key variables with 40 backgrounds. Twenty student observers were asked to detect the orientation of the spiculation in the image. There was a statistically significant improvement in detection performance for spiculations with CLAHE over unenhanced images when the region size was set at 32 with a clip level of 2, and when the region size was set at 32 with a clip level of 4. The selected CLAHE settings should be tested in the clinic with digital mammograms to determine whether detection of spiculations associated with masses detected at mammography can be improved.
Female↗
Educational outreach to mammography facility staff to assist with compliance with the Mammography Quality Standards Act in rural North Carolina.
RATIONALE AND OBJECTIVES: The purpose of this project was to develop and evaluate an educational program targeted at mammography facilities in rural areas of North Carolina that were having difficulty complying with the 1992 Mammography Quality Standards Act (MQSA). MATERIALS AND METHODS: Fourteen facilities deemed at risk for closure under MQSA were identified by state inspection personnel. Problems at the facilities were evaluated by a radiologist, a physicist-educator, and a radiation physicist through a written survey, review of phantom and clinical images, and a site visit. Individual advice and instruction were provided on-site by the physicist-educator, with written materials provided in follow-up. A repeat site visit was made 4-6 months after the initial visit. RESULTS: Of 51 problems identified at the 12 institutions that completed the program, 35 (69%) were corrected. All facilities that had failing phantom scores at the inspection prior to the intervention had passing scores at the inspection after the intervention. There was a statistically significant increase in the sum of the phantom scores for the facilities offered this intervention compared with those not offered it (P = .03). CONCLUSION: This educational program improved mammography quality at participating facilities.
Community-Institutional Relations↗
Advanced breast biopsy instrumentation: a critique.
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Biopsy, Needle↗
Screening mammography behavior after a false positive mammogram.
This pilot study describes women's interpretations of the experience of a false positive mammogram followed by a negative biopsy and the impact of this experience on subsequent participation in screening mammography. A 25-min, open-ended telephone interview was administered in 1992 to 30 women over age 39 who had negative biopsies in 1987 preceded by abnormal mammograms. Almost twice as many women reported getting regular mammograms after the biopsy (60%) as did before 1987 (33%). Most received their next mammogram after the biopsy within the recommended interval (73%), and those getting regular mammograms prior to the biopsy experience were more likely than those who did not have a prior habit of undergoing mammography to continue to get them afterwards. These preliminary findings suggest that a negative breast biopsy after a positive mammogram does not reduce a patient's likelihood of undergoing screening in the future. In fact, it may serve as an impetus for increased compliance with screening recommendations.
Adult↗
Future directions in imaging of breast diseases.
In the near future, investigation and refinement of emerging anatomic and functional breast imaging techniques will enable clinical trials that will evaluate their utility and potential for improving the survival and quality of life for patients with breast cancer. In the longer term, strategic research collaborations among investigators in the fields of functional imaging, molecular biology, and pathology are needed to merge existing science and advance the development of biomarker and genetic techniques focused on detecting and characterizing disease at the cellular and molecular levels. This research could create clinical tools for (a) detecting breast cancer earlier, (b) more accurately quantifying the extent of disease, (c) noninvasively evaluating lymph node involvement, (d) identifying micrometastases and residual microscopic disease, and (e) enhancing therapy by means of imaging-guided biomarker or tumor-specific delivery of pharmacologic, chemosensitizing, or radiosensitizing agents to tumors.
Breast↗
Screening behavior of women after a false-positive mammogram.
PURPOSE: To determine the effect of a false-positive mammogram that leads to open surgical biopsy on subsequent screening mammography behavior in women. MATERIALS AND METHODS: This study was performed with a retrospective cohort design, and data were collected by means of telephone interview. All participants were women aged at least 50 years, with no history of breast cancer. Study patients (n = 43) were women who had an abnormal mammogram followed within 6 months by benign excisional breast biopsy. Control subjects (n = 136) were randomly selected: They included women with a normal mammogram who had not undergone biopsy, as well as women with an abnormal mammogram and the recommendation to undergo 6-month follow-up mammography. RESULTS: Two differences between the study and control groups were statistically significant. Study patients were more likely than control patients to believe they had increased susceptibility to breast cancer (P = .039). Study patients were also more likely than control subjects to intend to undergo screening mammography annually in the future (P = .036). CONCLUSION: A false-positive mammogram that leads to open surgical biopsy does not inhibit most women from undergoing subsequent screening mammography. In fact, such an experience may increase their intentions to undergo regular screening.
Aged↗
A pilot study of eye movement during mammography interpretation: eyetracker results and workstation design implications.
Digital mammography can potentially improve mammography image and interpretation quality. On-line interpretation from a workstation may improve interpretation logistics and increase availability of comparison images. Interpretation of eight 4k- x 5k-pixel mammograms on two to four 2k- x 2.5k-pixel monitors is problematic because of the time spent in choosing which images display on which monitors, and zooming and roaming on individual images that are too large to display completely at full resolution. The authors used an eyetracker to measure radiologists viewing behavior during mammography interpretation with film on a viewbox. It was observed that a significant portion of the mammographers' time is spent viewing "comparison pairs" (typically two or more comparisons per case), such as the left mediolateral and craniocaudal images or old and new images. From the eyetracker measurements, we estimated that the number of image display, roam, and zoom operations decreases from an average of 64 for one monitor to 31 for four monitors, with the largest change going from one to two monitors. We also show that fewer monitors with a faster response time is superior to more monitors with a slower response time. Finally, the authors demonstrate the applicability of time-motion analysis to mammographic workstation design.
Adult↗
Does intensity windowing improve the detection of simulated calcifications in dense mammograms?
This study attempts to determine whether intensity windowing (IW) improves detection of simulated calcifications in dense mammograms. Clusters of five simulated calcifications were embedded in dense mammograms digitized at 50-microns pixels, 12 bits deep. Film images with no windowing applied were compared with film images with nine different window widths and levels applied. A simulated cluster was embedded in a realistic background of dense breast tissue, with the position of the cluster varied. The key variables involved in each trial included the position of the cluster, contrast level of the cluster, and the IW settings applied to the image. Combining the ten IW conditions, four contrast levels and four quadrant positions gave 160 combinations. The trials were constructed by pairing 160 combinations of key variables with 160 backgrounds. The entire experiment consisted of 800 trials. Twenty student observers were asked to detect the quadrant of the image in which the mass was located. There was a statistically significant improvement in detection performance for clusters of calcifications when the window width was set at 1024 with a level of 3328, and when the window width was set at 1024 with a level of 3456. The selected IW settings should be tested in the clinic with digital mammograms to determine whether calcification detection performance can be improved.
Breast Neoplasms↗
The effect of intensity windowing on the detection of simulated masses embedded in dense portions of digitized mammograms in a laboratory setting.
The purpose of this study was to determine whether intensity windowing (IW) improves detection of simulated masses in dense mammograms. Simulated masses were embedded in dense mammograms digitized at 50 microns/pixel, 12 bits deep. Images were printed with no windowing applied and with nine window width and level combinations applied. A simulated mass was embedded in a realistic background of dense breast tissue, with the position of the mass (against the background) varied. The key variables involved in each trial included the position of the mass, the contrast levels and the IW setting applied to the image. Combining the 10 image processing conditions, 4 contrast levels, and 4 quadrant positions gave 160 combinations. The trials were constructed by pairing 160 combinations of key variables with 160 backgrounds. The entire experiment consisted of 800 trials. Twenty observers were asked to detect the quadrant of the image into which the mass was located. There was a statistically significant improvement in detection performance for masses when the window width was set at 1024 with a level of 3328. IW should be tested in the clinic to determine whether mass detection performance in real mammograms is improved.
Analysis of Variance↗
New modalities in breast imaging: digital mammography and magnetic resonance imaging.
Mammography is currently the only screening method available with proven capability to diagnose nonpalpable breast cancer. However, mammography does not detect all cancers. Cancers are more difficult to detect in radiographically dense breasts because lesions are obscured by breast tissue. Digital mammography and magnetic resonance imaging of the breast may minimize the problems associated with screening dense breasts. If these methods prove to be useful, more cancers could be detected at an earlier stage.
Breast↗
Patient compliance in mobile screening mammography.
RATIONALE AND OBJECTIVES: We assessed the follow-up behavior of women who had abnormal results of screening mammograms taken on a mobile van. METHODS: A retrospective cohort study was conducted between 1988 and 1991 of all women served by a mobile mammography van in rural North Carolina. Compliance with radiologist recommendations for follow-up was assessed through review of patient records and mail surveys of patients with incomplete records. RESULTS: Compliance was 44% for negative or benign mammograms, 57% for indeterminate mammograms, and 62% for probably malignant or malignant mammograms. Women who had a previous mammogram or had a malignant finding were more likely to comply with follow-up recommendations (p < .0001) than women with normal or benign results and no history of mammography. Compliers and noncompliers did not differ with respect to family history of breast cancer or personal history of breast discomfort. CONCLUSION: Compliance with recommendations in this setting was lower than expected. This may be because rural women using mobile van mammography have limited access to the resources needed for appropriate follow-up. Further research is needed to examine explanations for poor compliance in this setting.
Adult↗
Computed tomography interpretations with a low-cost workstation: a timing study.
An ergonomically simple prototype workstation with two 900 x 1,100-pixel monitors capable of displaying eight full-resolution computed tomography (CT) images in 0.2 seconds, was compared with film for interpretation of computed tomographic images of the chest and abdomen. The hardware platform for this workstation cost less than $11,500 in 1993. A repeated-measures experiment was used to generate average interpretation times of 6.17 minutes for the workstation and 6.03 minutes for the film, including loading and unloading films, with three of the four subjects averaging about a minute longer for each workstation interpretation. All dictated reports were of clinically acceptable accuracy. All radiologists stated that workstations based on this design would be an acceptable clinical tool. However, observation suggested human working-memory strain among infrequent CT readers that could indicate the need for additional training. These data suggest that low-cost workstations can have practical application in interpretation of digital medical images such as CT, with the possibility of small increases in interpretation time.
Adult↗
A method for determination of optimal image enhancement for the detection of mammographic abnormalities.
We present a paradigm for empirical evaluation of digital image enhancement algorithms for mammography that uses psychophysical methods for implementation and analysis of a clinically relevant detection task. In the experiment, the observer is asked to detect and assign to a quadrant, or indicate the absence of, a simulated mammographic structure characteristic of cancer embedded in a background image of normal breast tissue. Responses are indicated interactively on a computer workstation. The parameter values for the enhancement applied to the composite image may be varied on each trial, and structure detection performance is estimated for each enhancement condition. Preliminary investigations have provided insight into an appropriate viewing duration, and furthermore, suggest that nonradiologists may be used under this methodology for the tasks investigated thus far, for predicting parameter values for clinical investigation. We are presently using this method in evaluating several contrast enhancement algorithms of possible benefit in mammography. These methods enable an objective, clinically relevant evaluation, for the purpose of optimal parameter determination or performance assessment, of digital image-processing methods potentially used in mammography.
Algorithms↗
Eye movement during computed tomography interpretation: eyetracker results and image display-time implications.
Stacked displays hold the potential for accurate interpretation of multiple computed tomography (CT) studies on a low-cost workstation. But can such a display scroll as quickly as radiologists can move their eyes to the next image on a film? To address this question, eye-movement duration during CT chest interpretation was recorded using an electronic eye tracker. Adjacent eye movements (+/- 1 image in sequence) averaged 0.54 seconds. Time motion analysis indicates that a CT workstation using a stacked approach with a 0.2-second image display time and a simple interaction can display the next image in less than 0.4 seconds, so a stacked approach should allow a low-cost workstation to facilitate acceptable interpretation of multiple CT or magnetic resonance studies. However, nonadjacent eye movements is likely to take longer and radiologist behavior may be effected.
Data Display↗
Breast imaging fellowship programs. A survey of the fellows of the Society of Breast Imaging.
RATIONALE AND OBJECTIVES: Breast imaging, a subspecialty of diagnostic radiology, is becoming more important with the increased performance of screening mammography. Fellowships in breast imaging are being offered at many institutions. Information regarding the contents and structure of such fellowships is important for potential trainees and departments considering offering such programs. METHODS: All 79 fellows of the Society of Breast Imaging (SBI) were surveyed by mail. Those with breast imaging fellowships were asked questions about their program. All were asked their opinions about the appropriate features of a breast imaging fellowship. RESULTS: Forty-six (58%) surveys were returned. Nineteen respondents described breast imaging fellowships offered at 18 different institutions. CONCLUSIONS: This information may be useful as radiologists consider establishing fellowship standards within this subspecialty.
Breast Neoplasms↗
Real-time radiologist review of remote ultrasound using low-cost video and voice.
RATIONALE AND OBJECTIVES: A radiologist practicing remote ultrasound occasionally needs to review a case in real time before releasing the patient. The authors conducted a pilot study to evaluate one solution in which the radiologist views real-time images on a video monitor while conversing with the technologist via a headset telephone. METHODS: Two experienced ultrasonographers and five technologies participated in a 5-week pilot study in adjacent rooms. RESULTS: Subjective assessment indicated that the system could function well enough for use at a remote site. CONCLUSIONS: Although this technology appears effective, an ongoing training environment is recommended.
Attitude of Health Personnel↗