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Biomedical subjects

J K Baum

Publications and source records attributed to J K Baum.

At least 19 recordsLinked to original sources
PubMed2001

Patient expectations and costs of immediate reporting of screening mammography: talk isn't cheap.

OBJECTIVE: Our purpose was to determine whether patients prefer immediate or delayed results of screening mammography and to determine the cost of immediate reporting at our institution. MATERIALS AND METHODS: A survey was anonymously and randomly distributed to 129 women who were 35-70 years old during a visit to their primary care physician, asking the women's preference for receiving mammography results by one of two systems: by letter with a return visit for any additional tests; or by speaking at once with the radiologist, with the option of additional tests being performed during the same visit. Patients' willingness to pay for the latter service was also determined. A cost identification model was constructed using commercially available software. We considered the impact on radiologists' and technologists' time and the need for additional equipment and space, and we analyzed the effect on the cost of immediate reporting. RESULTS: One hundred twenty (93%) surveys were completed. Eighty women (67%) preferred immediate reporting, and 62 (78%) of these 80 patients would wait 30-60 min. The additional cost of immediate reporting is $28.22 per patient. Only 11% of patients were willing to pay this additional cost. When new equipment and space were not required, the cost would increase by $4.38. This cost was most influenced by the time required to give patients normal results. CONCLUSION: Most surveyed patients preferred speaking with a radiologist immediately but were unwilling to pay additional fees. Radiologists, hospital administrators, and health care planners must be aware of the costs of immediate reporting and must factor these costs into any change in hospital or national policy.

Adult↗
PubMed2000

Use of Doppler ultrasound in the evaluation of breast carcinoma.

Ultrasound is an imaging modality commonly used to evaluate breast lesions in hopes to distinguish benign from malignant solid masses. Angiogenesis, defined as the emergence of new vessels to further the growth of tumor, has stimulated interest in the potential uses of Doppler ultrasound in patients with breast cancer. This article describes different forms of Doppler ultrasound, including color Doppler (CD), power Doppler (PD), and spectral Doppler (SD), as well as 3-dimensional (3D) ultrasound and ultrasound contrast media. We review the role of Doppler ultrasound in distinguishing benign from malignant solid breast masses. We also discuss the role of ultrasound in predicting tumor grade, histology, node status, and lymphatic vascular invasion, and in monitoring breast cancer treatment.

Breast↗
PubMed2000

Diagnostic accuracy of 99mTc-sestamibi breast imaging: multicenter trial results.

UNLABELLED: Although mammography is well established as a first-line tool for breast cancer screening and detection, efforts to develop complementary procedures continue. Observation of 99mTc-sestamibi tumor uptake provided the impetus for its evaluation as an adjunctive technique. This trial's objectives were to determine in a multicenter trial the diagnostic accuracy of 99mTc-sestamibi in women with suspected breast cancer and to investigate factors influencing diagnostic accuracy. METHODS: Our multicenter trial enrolled 673 women (387 with nonpalpable abnormalities; 286 with palpable abnormalities) scheduled for excisional biopsy or mastectomy. Blinded and unblinded interpretations of scintigraphic images were compared with core laboratory established histopathologic diagnoses to define the diagnostic accuracy of 99mTc-sestamibi breast imaging. RESULTS: Blinded readers' diagnostic accuracy was 78%-81%. Inter-reader agreement was excellent, ranging from 95% to 100% (kappa = 0.82-0.99). Overall institutional sensitivity and specificity for 99mTc-sestamibi breast imaging were 75.4% and 82.7%, respectively. In this population with a 40.1% disease prevalence, the positive predictive value was 74.5% and the negative predictive value was 83.4%. The negative predictive value was 94% in patients with a 40% or lower mammographic likelihood of breast cancer. Sensitivity was higher for palpable abnormalities; specificity was higher for nonpalpable abnormalities. Sensitivity was decreased for tumors <1 cm in largest dimension but appeared not to be affected by patient's age. CONCLUSION: As an adjunct to current procedures, 99mTc-sestamibi breast imaging may contribute to patient management decisions in selected populations, including women with dense breasts, mammographically indeterminate lesions >1 cm, and palpable abnormalities.

Biopsy↗
PubMed1999

Assessment of pathologic prognostic factors in breast core needle biopsies.

BACKGROUND: Core needle biopsies (CNB) are being used increasingly as the initial diagnostic procedure in women with breast cancer. Many clinicians are interested in obtaining as much prognostic information as possible from these limited specimens. However, the accuracy of assessing pathologic prognostic factors in core biopsy material has not been studied in detail. DESIGN: We studied CNB and subsequent excision specimens from 79 women with invasive breast cancer. Slides from CNB and excision specimens were reviewed in a blinded fashion and each was assessed for histologic type, tumor size, histologic grade, lymphatic vessel invasion (LVI), and the presence of an extensive intraductal component (EIC). RESULTS: Among the 79 cancers, there were 58 invasive ductal carcinomas, six invasive lobular carcinomas, 13 invasive carcinomas with ductal and lobular features and two tubular carcinomas, based on examination of the excision specimens. Histologic type on CNB correlated with that on excision in 64 cases (81%). Although there was a significant correlation between tumor size on CNB and excision specimens (r2 = 0.30, P = 0.01), the pathologic T stage was underestimated on CNB in 79% of cases. Furthermore, T substage was underestimated on CNB in 71% of T1 lesions. There was concordance in histologic grade between CNB and excisions in 75% of cases. Among the 20 discordant cases, the grade was higher in the excision than in the CNB in 13 cases and lower in seven. However, all discrepancies were within one grade. None of the 17 cancers with LVI in the excision specimen showed LVI on the CNB. Among 14 cases with an EIC on the excision specimen, only four (29%) were scored as having an EIC on CNB. CONCLUSION: Histologic type can be accurately determined on CNB in most cases. While there was concordance in histologic grade between CNB and excision in the majority of cases, grade was discordant in a substantial minority (25%). The ability to accurately determine tumor size (pathologic T-stage), LVI, and EIC on CNB is severely limited.

Adenocarcinoma↗
PubMed1998

Do prognostic marker studies on core needle biopsy specimens of breast carcinoma accurately reflect the marker status of the tumor?

Core needle biopsies (CNB) are often used for the diagnosis of breast lesions. In some breast cancer patients, e.g., those treated with preoperative chemotherapy, the CNB specimen might be the only pretreatment tissue sample available for studies of prognostic and predictive markers. Our purpose was to evaluate whether marker studies performed on CNB specimens accurately reflect the marker status of the tumor. Immunostaining for five commonly used prognostic and predictive markers was performed on both CNB and subsequent excision specimens from 56 consecutive patients who had a CNB with carcinoma followed by excision of the tumor. None of the patients received radiotherapy or chemotherapy between the CNB and the excision. Paraffin sections of the CNB and excision specimens were immunostained for bcl-2, estrogen receptor (ER), c-erbB-2, and p53. These markers were scored as positive or negative. Microvessel density (MVD) was scored as a continuous variable on sections immunostained for Factor VIII-related antigen by calculating the average number of microvessels in three 224x fields of highest tumor vascularity ("hot spots"). Immunostaining results for bcl-2, ER, c-erbB-2, and p53 on the CNB and the corresponding excision specimens were 100% concordant. Although there was significant correlation between MVD on the CNB specimens and the corresponding excisions (r = 0.507, P = 0.0002), the mean MVD on the CNB and corresponding excision specimens differed by more than 10% in 85.7% of cases, with differences ranging from 4.3 to 233.3%. MVD was higher in the CNB than in the excision specimens in 30 (61.2%) of 49 cases. In conclusion, in all of the cases studied, accurate results for the dichotomously scored markers bcl-2, ER, c-erbB-2, and p53 were obtained on CNB specimens. In contrast, in most cases, MVD, which was scored as a continuous variable, could not be reliably assessed on the CNB specimen.

Biomarkers, Tumor↗
PubMed1997

Solid breast lesions: evaluation with power Doppler US.

PURPOSE: To evaluate power Doppler ultrasound (US) in detection of vascularity of solid breast lesions and to correlate patterns of vascular distribution with histopathologic findings. MATERIALS AND METHODS: Eighty-six solid breast masses, which were subsequently sampled for biopsy, were studied with gray-scale and power Doppler US. Patterns of vascular distribution were assigned before biopsy. RESULTS: There were 25 cancers, 38 fibroadenomas, and 23 other benign lesions. Seventeen (68%) cancers had penetrating vessels, four had peripheral vessels, and four had no vessels. Power Doppler US depicted no vessels in 21 fibroadenomas, peripheral vessels in 15, and penetrating vessels in two. Other benign lesions included 11 with no detectable vessels, nine with peripheral vessels, two with central vessels, and one with penetrating vessels. By using penetrating vessels to indicate malignancy, sensitivity for power Doppler US was 68%, specificity was 95%, positive predictive value was 85%, and negative predictive value was 88%. Two cancers were found to be malignant with power Doppler US only. CONCLUSION: The pattern of distribution and morphology of blood vessels in solid breast masses seen at power Doppler US is a potentially important feature to be considered along with other sonographic criteria to predict the likelihood of malignancy.

Breast Neoplasms↗
PubMed1990

Angiosarcoma of the breast with report of unusual site of first metastasis.

Angiosarcoma of the breast accounts for less than 1% of all primary breast lesions. It occurs at all ages, but more frequently in younger women than does primary breast carcinoma. It often has a rapidly progressive clinical course and, as in one of the reported cases, can present with unusual sites of metastases even after a long disease-free interval.

Adult↗
PubMed1990

Optical spectroscopy (INVOS) is unreliable in detecting breast cancer.

Recently a new nonionizing, nonimaging technique for evaluating risk of breast cancer, in vivo optical spectroscopy (INVOS), became available. The procedure evaluates the biochemical composition of the breast with spectrophotometry to provide a risk number related to the development of breast cancer. INVOS was evaluated in a prospective study of 180 women who were referred to our institution for needle localization and excisional biopsy of 181 breast lesions. All women had mammography and INVOS before surgical biopsy. The INVOS risk numbers and mammographic findings were compared with the pathologic diagnoses. Of 39 breast cancers, 19 (49%) had high-risk INVOS numbers, as did 52% of women with benign disease. INVOS had a sensitivity of 95%, specificity of 4%, and a positive predictive value of 21% for the detection of breast cancer. Mammography predicted malignancy with a sensitivity of 97%, specificity of 48%, and a positive predictive value of 34%. Receiver-operating-characteristic (ROC) curve analysis also was performed. The ROC area for mammography was 0.85 compared with 0.43 for INVOS, indicating a significantly greater (p less than .0000001) ability for mammography to detect breast cancer. We conclude that because INVOS cannot accurately predict the presence of breast cancer, it is unlikely that INVOS can be used to predict which patients are at risk for the development of breast cancer.

Adenofibroma↗
PubMed1985

Breast cancer screening: the underuse of mammography.

The early detection of breast cancer is promoted by the American Cancer Society (ACS) and the American College of Radiology (ACR) by encouraging the regular use of three types of screening: breast self-examination (BSE), the clinical breast examination, and mammography. In August 1983, the ACS publicized seven recommendations pertaining to screening, including a revised statement about the routine use of mammography for women between the ages of 40 and 49 years. In response to the ACS statement, the present study assessed compliance with the updated recommendations for all three types of screening. The results show reasonable rates of compliance for the BSE (53%-69%) and clinical examination (70%-78%). In contrast, only 19% of the women between the ages of 35 and 49 and 25% of the women older than 50 reported complying with the recommendation to undergo one baseline screening mammogram. In addition, only 9% of the mammograms were obtained for the early detection of disease, which is the rationale for the recommendation. In fact, it appears that mammography is being performed mainly for the diagnosis of symptomatic women instead of the screening of asymptomatic women. Some implications for health education by physicians and the professional education by physicians and the professional education of physicians in the use of mammography are discussed.

Adult↗
PubMed1980

Intramammary arterial calcifications associated with diabetes.

Arterial calcification was seen on the mammograms of 37 of 319 patients. Twenty-eight patients were known diabetics, while 7 had an abnormal fasting blood sugar level or glucosuria but were not being treated for diabetes. Eighteen (51%) of the 35 diabetic and borderline diabetic patients had breast arterial calcification, compared to only 19 (6.7%) of the 284 nondiabetics (p greater than 0.01). These findings suggest that arterial calcification on mammograms may be a sign of co-existing diabetes.

Aged↗
PubMed1975

Mid-sagittal dimensions of cervical vertebral bodies.

A series of lateral radiographs of the cervical spinal column was evaluated in order to determine vertebral body dimensions. The sample included males (N=30) and females (N=31) 18 to 24 years old, comprising three stature percentile ranges (1-20; 40-60; 80-99) of the U.S. adult population. A two-dimensional analysis of vertebral body height (average distance between superior-inferior surgaces), depth (average distance between anteriorposterior surfaces), and area (average height X average depth) revealed minimal effects due to stature. In all subjects, average depth exceeded average height for vertebral bodies C3 through C7. Upon combining stature groups, both sexes revealed maximum average values for these dimensions at the seventh cervical vertebral body. Minimum average height occurred at C5 whereas minimum average depth was found at C3. Significant correlation (alpha greater than 0.05) was found for males between ponderal index and height and depth of the C7 vertebra. Male head weight correlated significantly with C3, C4, C5 and C6 vertebral body height and with C3, C5 and C6 vertebral body depth. For females, C7 height and C6 depth correlated significantly with ponderal index and head weight respectively. Probable biomechanical relationships of specific cervical vertebral bodies are noted

Adolescent↗