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L L Fajardo

Publications and source records attributed to L L Fajardo.

At least 37 records · Page 2Linked to original sources
PubMed1997

The role of stereotactic biopsy in abnormal mammograms.

Core needle biopsy using either stereotactic or ultrasonographic guidance is a reasonable and accurate alternative to surgical biopsy for diagnosis of most nonpalpable breast lesions. An important component of a stereotactic core breast biopsy procedure is the mammographic and pathologic correlation of findings to plan optimal patient management. The level of suspicion of a mammographic lesion, the accuracy of stereotactic targeting, and the confirmation of microcalcifications in specimen radiographs for calcified lesions must be considered carefully and correlated with the histopathologic findings. Meticulous operator technique is essential to provide representative samples of the mammographic abnormality. Properly performed, imaging-guided percutaneous core breast biopsy has reduced the morbidity of surgical breast biopsy and the overall cost of breast cancer diagnosis. Recent work has demonstrated that stereotactic core breast biopsy can reduce the cost of diagnosing mammographically detected breast lesions by more than 50%. At a time when health-care policy and reimbursement decisions are influenced by cost considerations, increased use of stereotactic core breast biopsy is anticipated. Meticulous attention to technique allows maximal realization of the benefits of this procedure.

Biopsy↗
PubMed1996

Comparison of contrast detail curves of full field digital with screen film breast phantom images.

In this investigation, we imaged a standard breast phantom and compared the contrast detail curves from a prototype full breast digital mammography system with the corresponding curves for a conventional, analog screen-film system. The full breast digital system exhibited superior contrast detail detectability. The results from this study will be used to plan future clinical evaluations comparing full breast digital and screen film mammography.

Breast Neoplasms↗
PubMed1996

Patient perceptions of stereotaxic large-core breast biopsy.

RATIONALE AND OBJECTIVES: The authors evaluated the perceptions of patients who underwent stereotaxic core breast biopsy before and after the procedure. METHODS: By using a standard questionnaire, 58 patients undergoing stereotaxic core breast biopsy with a 14-gauge needle were interviewed immediately before, immediately after, and 24 hours and 5 days after the procedure. RESULTS: Discomfort recorded by patients 24 hours after core biopsy correlated with the amount of time needed before normal activities were resumed (P = .001). Only five patients (9%) indicated severe discomfort during the procedure. Patient age, number of core biopsy samples taken, and lesion depth did not correlate with level of discomfort. Fifty-five patients (95%) resumed normal activities within 24 hours. However, 41 patients (71%) had some breast bruising as many as 5 days after the procedure. Overall, patient satisfaction with care was high; 56 patients (97%) stated they would return for another biopsy in the future. CONCLUSION: The morbidity associated with stereotaxic core breast biopsy is low, although the majority of patients in this series experienced bruising lasting as long as 5 days after the procedure. Despite this, almost all patients would return for a core breast biopsy in the future, if indicated.

Activities of Daily Living↗
PubMed1996

Estimating the cost-effectiveness of stereotaxic biopsy for nonpalpable breast abnormalities: a decision analysis model.

RATIONALE AND OBJECTIVES: We examined the clinical and economic trade-offs of shifting from surgical excisional biopsy to stereotaxic core breast biopsy for evaluating non-palpable, mammographically detected breast lesions. METHODS: A decision analysis model compared strategies beginning with excisional or stereotaxic core biopsy for hypothetical cohorts of 1,000 women. All women with negative initial biopsies had a 6-month follow-up mammogram. Sensitivities and specificities were based on the literature and expert estimates. Pretest probabilities of invasive cancer and in situ cancer were each 10% based on mammographic features. Adjusted costs were based on an audit of patients evaluated at the Medical College of Virginia and physician relative value units. RESULTS: Per 1,000 women, with an expected rate of 100 invasive and 100 in situ cancers, the stereotaxic core biopsy strategy would initially miss 6.7 invasive and 12.4 in situ cases. Most of these would be detected at 6-month follow-ups. Of the women having a stereotaxic core biopsy, 75.7% avoided a surgical procedure. Using stereotaxic core biopsy saved $804 per woman. Continuing to initially use surgical biopsy, total management costs were an additional $42,100 per each case of early detected invasive or in situ cancer. A speculative sensitivity analysis, in which the prognosis of invasive cancer was worse if diagnosis was delayed by 6 months, indicated that surgical biopsy had an incremental cost of $156,700 per additional life year gained. CONCLUSION: Using conservative estimates for the false-negative rate of stereotaxic core breast biopsy, widespread use of stereotaxic biopsy is projected to have substantial cost savings with a slight compromise in the rate of early detection. Whether the decremental cost-effectiveness is acceptable is dependent on the natural history of cancers whose diagnosis is delayed.

Biopsy, Needle↗
PubMed1996

Signal-to-noise ratio and detective quantum efficiency analysis of optically coupled CCD mammography imaging systems.

RATIONALE AND OBJECTIVES: Design considerations for x-ray systems with optically coupled charge-coupled devices require an understanding of the characteristics of cascaded multistage imaging chains. Performance evaluations rely on accurate analyses of signal-to-noise ratio, noise power spectrum, and detective quantum efficiency. METHODS: Theoretic models of signal-to-noise ratio, noise power spectrum, and detective quantum efficiency were extended to analyze the optically coupled charge-coupled device and other electronic x-ray imaging systems. The descriptions of how to measure or compute these parameters are provided. RESULTS: The results of our quantitative analysis illustrate that x-ray quantum-noise limitation can be obtained without an image intensifier by using a low additive noise charge-coupled device. CONCLUSION: This theoretic model and experimental method provide a useful tool for developing optoelectronic x-ray imaging systems for digital mammography and other radiologic procedures.

Female↗
PubMed1996

Occurrence of fibroadenomas in postmenopausal women referred for breast biopsy.

OBJECTIVE: To examine the occurrence of breast fibroadenomas in postmenopausal patients referred for breast biopsy. DESIGN: A retrospective review of breast biopsy outcome and of patient demographics, including menstrual and hormonal status. SETTING: The Tucson Breast Center, a large outpatient breast cancer detection clinic affiliated with the University of Arizona Health Sciences Center in Tucson, Arizona. PARTICIPANTS: All women seen at the Tucson Breast Center between 1985 and 1990 who were referred for breast biopsy. RESULTS: A total of 100 fibroadenomas were found in 709 breast biopsies whose results were known. Fifty-two of these were in premenopausal women and 44 in postmenopausal women; the menopausal status of four women was unknown. In postmenopausal women, 11 of the 44 patients reported hormone use. Fibroadenomas constituted 20% (39 of 195) of the benign masses and 12% (39 of 339) of all breast masses in postmenopausal women. Fibroadenomas constituted 10% (44 of 447) of all biopsies in postmenopausal women, including those with breast masses, abnormal calcifications, or other lesions. CONCLUSION: Noncalcified fibroadenomas of the breast are not confined to young women and may constitute a small but noteworthy proportion of lesions coming to breast biopsy in postmenopausal women.

Adult↗
PubMed1995

Breast cancer diagnosis in women with subglandular silicone gel-filled augmentation implants.

PURPOSE: To determine whether breast augmentation implants interfere with detection of breast cancer and to characterize the projections that offer an improvement in the detection of disease. MATERIALS AND METHODS: The mammographic examinations, clinical presentation, and pathologic findings were retrospectively reviewed in 18 patients who underwent breast augmentation with silicone gel-filled implants. RESULTS: At diagnosis, 16 patients (89%) had palpable abnormalities. Standard mammographic views were negative in 17 patients (94%). Modified implant compression views (used with implant displacement) showed abnormalities in 12 patients (67%). Sixteen (89%) of the 18 patients had invasive carcinomas, and seven (39%) had positive axillary lymph nodes. CONCLUSION: Standard mammographic views are inadequate for breast cancer screening in patients with silicone gel-filled implants. Although additional modified compression views offer a moderate improvement in breast cancer detection, imaging with tangential mammographic views, sonography of palpable areas, and breast physical examination in conjunction with mammography will offer additional benefit in breast cancer detection.

Breast Implants↗
PubMed1994

Stereotactic fine-needle aspiration cytology of nonpalpable breast lesions: an analysis of 258 consecutive aspirates.

BACKGROUND: The role of stereotactic fine-needle aspiration cytology (SFNAC) in the diagnosis of nonpalpable breast lesions is poorly defined. PATIENTS AND METHODS: Data were prospectively collected from 225 consecutive patients with nonpalpable breast lesions who had aspiration cytology followed by immediate surgical excision. RESULTS: Between 1988 and 1993, 258 such procedures were performed. The results of 84 (33%) were interpreted as benign, 84 (33%) as atypical, 28 (11%) as suspicious for malignancy, and 49 (19%) as malignant. In all, 88 (34%) surgical specimens were malignant. SFNAC had an 80% sensitivity, a 96% specificity, a 91% positive predictive value, and an 89% negative predictive value. There were 18 false-negative and 7 false-positive aspirates. CONCLUSIONS: SFNAC for diagnosing nonpalpable breast lesions is moderately sensitive and highly specific, and has a high positive and negative predictive value. In conjunction with mammography and clinical assessment, the procedure is useful for determining which patients with nonpalpable breast lesions may require surgical biopsy.

Adult↗
PubMed1993

Sonographic image degradation after barium enema.

RATIONALE AND OBJECTIVES: The authors previously showed that barium does not interfere with abdominal sonography performed after a biphasic upper gastrointestinal tract examination. This study was designed to assess the impact of a barium enema (BE) examination on the quality of abdominal sonography performed immediately after the barium enema. METHODS: Forty patients scheduled for routine barium enemas (22 air contrast and 18 solid column) were prospectively examined with abdominal sonography before and after their BEs. The resulting 80 sonograms were randomized; three radiologists blindly assessed the quality of images of each of six anatomic areas (aorta, pancreas, porta hepatis, gallbladder, and the right and left lobes of the liver). RESULTS: There was no statistically significant degradation of the images for the right and left lobes of the liver and the pancreas. However, the images for the gallbladder, porta hepatis, and aorta had a statistically significant (P < .05) degradation of their ultrasound quality following barium enema. CONCLUSIONS: Unlike upper gastrointestinal tract examination, BE examination does interfere with the quality of a subsequent abdominal ultrasonography. Thus, when both studies are required, sonography should be performed first.

Abdomen↗
PubMed1993

Evaluation of medical students in radiology. Written testing using uncued multiple-choice questions.

RATIONALE AND OBJECTIVES: Evaluation of uncued multiple-choice questions (UMCQ) was compared with traditional multiple-choice questions (MCQ) for assessing medical student performance during radiology electives. Methods for analyzing and improving the quality of UMCQ examinations are described. METHODS: The authors compared the performance of radiology medical students on similarly constructed MCQ and UMCQ tests. For the UMCQ examination, the reliability (coefficient alpha), standard error of measurement, item difficulty index, and corrected item-to-total test coefficient (point biserial correlation) were analyzed. RESULTS: Students' level of performance was lower on UMCQs (mean percent correct score = 68.9 +/- 10.2 standard deviation [SD]) than on MCQs (mean percent correct score = 75.6 +/- 12.4 SD). Coefficient alpha for the UMCQ format was .7690 (standard error of measurement mean = 4.89%). Analysis of the item difficulty index and point biserial correlation for each test item provided information for improving the quality of the UMCQ examination. CONCLUSIONS: Because the UMCQ measures students' abilities to recall critical information without providing cues, this format can be used to overcome some of the limitations of conventional MCQs. With simple computerization, analysis of UMCQ testing instruments provides important feedback to both the examinees and the examiner.

Education, Medical, Undergraduate↗
PubMed1993

Epidermal inclusion cyst after reduction mammoplasty.

Reduction mammoplasty has become an increasingly common surgical procedure in the United States. Because the technique generally involves repositioning of the nipple-areolar unit with infolding of a vascularized tissue pedicle, epidermal inclusion cysts may develop after the procedure. The authors encountered three cases of epidermal inclusion cysts after reduction mammoplasty and describe the associated mammographic and sonographic characteristics. The authors found that stereotaxic needle biopsy is useful for the diagnosis of these lesions.

Adult↗
PubMed1993

Mammographic surveillance of breast cancer patients: should the mastectomy site be imaged?

OBJECTIVE: This study evaluated the usefulness of routine mammography of the mastectomy site in women who have been treated for breast carcinoma. MATERIALS AND METHODS: From a retrospective review of medical records and mammographic examinations of 827 patients who had mastectomies, the following information was obtained: demographic data, type of breast reconstruction (if any), length of follow-up after mastectomy, evidence of local recurrence, and results of physical examination of the breast and mammography immediately before diagnosis of local recurrence. RESULTS: Local recurrences of breast cancer were seen in 39 (4.5%) of the 859 breasts in the study group. All patients had a physical examination of the breast and mammography within 3 months of the diagnosis of recurrent breast carcinoma. Mammography of the mastectomy site did not show any recurrences that were not suspected on the basis of physical examination. For two of 20 patients, spot-compression views of palpable abnormalities showed thickening of the surgical scar. In four patients with pain in the chest wall, no abnormalities were found on physical examination or mammograms, but bone scintigrams showed metastasis to the ribs. CONCLUSION: Our results indicate that mammographic imaging of the mastectomy site does not increase the detection of locally recurrent breast cancer.

Adult↗
PubMed1993

Previous mammograms in patients with impalpable breast carcinoma: retrospective vs blinded interpretation. 1993 ARRS President's Award.

OBJECTIVE: We examined differences between blinded and retrospective reviews of screening mammograms obtained before a mammogram that resulted in the diagnosis of an impalpable breast carcinoma. MATERIALS AND METHODS: We reviewed 152 previous mammograms in 73 patients in whom impalpable breast carcinomas were subsequently detected on later mammograms. The earlier studies were interpreted in two ways: (1) blindly (without knowledge that carcinoma was subsequently detected) and (2) retrospectively (with the mammogram showing the carcinoma for comparison). The two interpretations were then compared with regard to the presence of carcinoma, recommendations for biopsy, parenchymal density, histologic characteristics of the tumor, lymph node status, and film quality. RESULTS: When we did a blinded review of the mammograms obtained before the diagnostic mammograms, the previous study was interpreted as showing evidence of carcinoma in 30 patients (41%). For the remaining 43 patients (59%), the findings of the most-recent previous mammogram were interpreted as normal or benign by the blinded reviewers; however, the retrospective reviewers thought evidence of cancer was visible in 25 of these patients (34%). Differences between blinded and retrospective interpretations were statistically significant. In patients in whom evidence of tumor was thought to be present on retrospective review but not on blinded review, the majority of mammographic abnormalities were asymmetric densities on the most-recent previous examination. This was true whether or not the retrospective reviewers thought that the mammographic finding warranted earlier biopsy. The histologic characteristics and lymph node status among patients in whom mammograms were interpreted retrospectively as showing evidence of tumor were no different from those among patients with no evidence of tumor. CONCLUSION: Our results show that impalpable breast carcinomas are frequently evident in retrospect on previous mammograms. However, because many are manifested only as an asymmetric density, these may not necessarily be true radiologic errors. Failure to detect a retrospectively visible abnormality on a screening mammogram is not necessarily negligent, and retrospective reviews do not reflect the everyday practice of screening mammography.

Awards and Prizes↗