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Biomedical subjects

Katherine E Dee

Publications and source records attributed to Katherine E Dee.

8 recordsLinked to original sources
PubMed2007

Performance parameters for screening and diagnostic mammography in a community practice: are there differences between specialists and general radiologists?

OBJECTIVE: The purpose of this study was to compare the performance of general radiologists in interpretation of mammograms with that of breast imaging specialists in a high-volume community hospital-based private practice. MATERIALS AND METHODS: A retrospective observational study was conducted with data prospectively collected over a 5-year period in a community hospital-based practice in which 106,405 screening and 52,149 diagnostic mammograms were performed. The performance of three radiologists specializing in breast imaging was compared with that of six general radiologists. The following data were extracted and analyzed: recall rate, biopsy recommendation rate, and cancer detection rate. Statistical analysis was performed with a chi-square test and two-tailed calculation of p values. RESULTS: The recall rates of the specialists and generalists were nearly the same at 6.5% and 6.7%, respectively. The biopsy recommendation rate at recall from screening examinations was nearly the same for generalists and specialists (1.2% and 1.1%, respectively; p = 0.4504). This rate also was similar for diagnostic examinations (8.5% for generalists; 8.4% for specialists; p = 0.4086). The cancer detection rate in the screening setting was slightly higher for specialists than for generalists: 2.5 and 2.0 cancers per 1,000 cases, respectively (p = 0.0614). The cancer detection rate in the diagnostic setting was 24.2% higher among specialists (20.0 cancers per 1,000 cases) compared with generalists (16.1 cancers per 1,000 cases) (p = 0.0177). CONCLUSION: The only statistically significant difference between generalists and specialists was in cancer detection rate among patients undergoing diagnostic mammography. No statistically significant difference was identified between the two groups in terms of recall rate, biopsy recommendation rate, or percentage of favorable-prognosis cases of cancer detected. There was a trend toward greater cancer detection by specialists in the screening setting.

Breast Neoplasms↗
PubMed2004

MRI-guided breast biopsy: clinical experience with 14-gauge stainless steel core biopsy needle.

OBJECTIVE: Core needle biopsy has proven advantages for wire localization and excision; however, MRI-guided core biopsy has been limited by less satisfactory sampling efficiency and less availability of MRI-compatible biopsy needles. We evaluated the feasibility and diagnostic yield of MRI-guided biopsy using 14-gauge stainless steel core biopsy needles and MRI-compatible coaxial sheaths in a closed 1.5-T scanner. MATERIALS AND METHODS: Thirty-five consecutive breast biopsies performed in 29 women between March 2001 and August 2002 were retrospectively reviewed. For each procedure, an MRI-compatible sheath was placed under MRI guidance using a dedicated breast coil and biopsy guidance system. With the patient out of the magnet, a 14-gauge steel core biopsy needle was used to obtain multiple samples. Lesion characteristics, including size, morphology, and enhancement, were recorded. Histology of all the lesions was obtained; and surgical, imaging, or clinical follow-up was performed. RESULTS: Targeted masses and enhancing foci ranged from 3 to 17 mm. Regional enhancement ranged from 14 to 70 mm. Thirty-four of the 35 biopsies were technically successful. Histology revealed malignancy in eight lesions (23%), atypical ductal hyperplasia in five lesions (14%), and benign entities in 21 lesions (60%). Surgery confirmed all eight core biopsies with malignant findings. Two of five lesions with atypical ductal hyperplasia were upgraded to malignancy after surgery. CONCLUSION: This new method of MRI-guided breast biopsy with a 14-gauge stainless steel core biopsy needle and a closed 1.5-T MRI scanner is feasible, safe, and effective and produces satisfactory diagnostic yield. This method offers an alternative to MRI-guided wire localization and to MRI-guided core biopsy with nonferrous needles.

Adult↗
PubMed2002

Performance parameters for screening and diagnostic mammography: specialist and general radiologists.

PURPOSE: To evaluate performance parameters for radiologists in a practice of breast imaging specialists and general diagnostic radiologists who interpret a large series of consecutive screening and diagnostic mammographic studies. MATERIALS AND METHODS: Data (ie, patient age; family history of breast cancer; availability of previous mammograms for comparison; and abnormal interpretation, cancer detection, and stage 0-I cancer detection rates) were derived from review of mammographic studies obtained from January 1997 through August 2001. The breast imaging specialists have substantially more initial training in mammography and at least six times more continuing education in mammography, and they interpret 10 times more mammographic studies per year than the general radiologists. Differences between specialist and general radiologist performances at both screening and diagnostic examinations were assessed for significance by using Student t and chi(2) tests. RESULTS: The study involved 47,798 screening and 13,286 diagnostic mammographic examinations. Abnormal interpretation rates for screening mammography (ie, recall rate) were 4.9% for specialists and 7.1% for generalists (P <.001); and for diagnostic mammography (ie, recommended biopsy rate), 15.8% and 9.9%, respectively (P <.001). Cancer detection rates at screening mammography were 6.0 cancer cases per 1,000 examinations for specialists and 3.4 per 1,000 for generalists (P =.007); and at diagnostic mammography, 59.0 per 1,000 and 36.6 per 1,000, respectively (P <.001). Stage 0-I cancer detection rates at screening mammography were 5.3 cancer cases per 1,000 examinations for specialists and 3.0 per 1,000 for generalists (P =.012); and at diagnostic mammography, 43.9 per 1,000 and 27.0 per 1,000, respectively (P <.001). CONCLUSION: Specialist radiologists detect more cancers and more early-stage cancers, recommend more biopsies, and have lower recall rates than general radiologists.

Biopsy↗
PubMed2002

Interpreting data from audits when screening and diagnostic mammography outcomes are combined.

OBJECTIVE: The objective of this study was to use mathematic models to aid mammography practices in interpreting outcomes data derived from a combination of screening and diagnostic examinations, and in interpreting diagnostic mammography outcomes data that are not segregated by indication for examination. MATERIALS AND METHODS: We analyzed outcomes from 51,805 consecutive mammography examinations. Screening and diagnostic examinations were audited separately. Diagnostic examinations were audited by indication for examination. Extrapolating from our known mix of screening (79%) and diagnostic (21%) examinations, we determined expected combined outcomes for various mixes that might be encountered in clinical practice. Similarly, we determined the expected overall diagnostic mammography outcomes for various clinically relevant mixes of indications for examination. RESULTS: Outcomes vary substantially depending on the mix of screening and diagnostic examinations performed. For example, expected outcomes for practices with screening-diagnostic mixes of 90-10% and 50-50% are, respectively: rate of abnormal findings, 6% versus 11%; rate of positive biopsy findings, 38% versus 42%; cancer detection rate, 10 per 1,000 versus 30 per 1,000; mean invasive cancer size, 14.4 mm versus 16.0 mm; nodal metastasis rate, 8% versus 11%; and rate of stage 0 and stage I cancers, 87% versus 82%. Diagnostic outcomes also vary substantially according to indication for examination, with a higher rate of abnormal findings, a higher rate of positive biopsy findings, and a larger mean invasive cancer size expected for mixes involving a high percentage of workups for palpable lesions. CONCLUSION: When screening and diagnostic mammography outcomes are not segregated during auditing, and when diagnostic outcomes are not segregated by indication for examination, analysis of combined audit data should be based on extrapolations from known outcomes.

Biopsy, Needle↗
PubMed2002

Differential value of comparison with previous examinations in diagnostic versus screening mammography.

OBJECTIVE: The purpose of our study was to analyze the differences in clinical outcomes of diagnostic and screening mammography depending on whether comparison is made with previous examinations. MATERIALS AND METHODS: We analyzed 48,281 consecutive mammography examinations for which previous mammography (9825 diagnostic, 38,456 screening) had been performed between 1997 and 2001, collecting data on demographics, whether comparison actually was made with previous examinations, abnormal findings (recall for screening mammography or biopsy recommendation for diagnostic mammography), biopsy yield of cancer, cancer detection rate, size of invasive cancers, axillary nodal status, and cancer stage. RESULTS: Comparison with previous examinations in the incidence screening setting decreases the recall rate from 4.9% to 3.8% (p < 0.0001) but does not significantly affect the biopsy yield (40-44%, p = 0.56) or the cancer detection rate (5.5-5.2/1000, p = 0.87). In the diagnostic setting, comparison with previous examinations increases the biopsy-recommended rate from 4.3% to 9.4% (p < 0.0001), the biopsy yield from 38% to 51% (p = 0.12), and the overall cancer detection rate from 11/1000 to 39/1000 (p < 0.0001). Comparison with previous examinations is not associated with a significant difference in mean tumor size. However, it is associated with a significant decrease in the frequency of axillary node metastasis and the cancer stage for screening mammography, but not for diagnostic mammography. CONCLUSION: For screening mammography, comparison with previous examinations significantly decreases false-positive but not true-positive findings and permits detection of cancers at an earlier stage. For diagnostic mammography, comparison with previous examinations increases true-positive findings.

Biopsy, Needle↗