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P Skaane

Publications and source records attributed to P Skaane.

At least 19 recordsLinked to original sources
PubMed2005

Follow-up and final results of the Oslo I Study comparing screen-film mammography and full-field digital mammography with soft-copy reading.

PURPOSE: To compare cancer detection rates of screen-film (SFM) and full-field digital mammography (FFDM) with soft-copy reading in a screening program including the initial positive scores for interval cancers and cancers in the subsequent screening round, and to analyze the false-negative FFDM interpretations. MATERIAL AND METHODS: Using a paired study design, 3683 women underwent SFM and FFDM in a population-based screening program. Two standard views of each breast were acquired. The images were interpreted without previous films for comparison. Independent double reading using a 5-point rating scale for probability of cancer was used for each modality. An examination was defined as positive if at least one of the two independent readers scored 2 or higher on the 5-point rating scale. SFM-positive cases were discussed in a SFM consensus meeting and FFDM-positive cases in a separate FFDM consensus meeting before recall. The study population was followed for more than 2 years so that interval cancers and screen-detected cancers in the subsequent screening round could be included. Cancer detection rates were compared using the McNemar test for paired proportions. The kappa statistic and Wilcoxon signed-rank test for matched pairs were used for comparing rating scores. The reading time was recorded for all FFDM interpretations. RESULTS: A total of 31 cancers (detection rate 0.84%) were diagnosed initially, of which SFM detected 28 and FFDM 23 (McNemar test P=0.23, discordant pair 8 and 3). Two cancers with a positive score at initial SFM reading and three with a positive score at initial FFDM reading were dismissed at SFM and FFDM consensus meetings, respectively. The difference in cancer detection after recall (discordant pair 11 and 5) was not significant (McNemar test, P=0.21). Of the 10 interval cancers and 16 screen-detected cancers in the subsequent round, 3 had true-positive SFM scores while 4 had true-positive FFDM scores in the initial reading session. A total of 38 cancers therefore had a positive result at double reading at one or both modalities, 31 at SFM and 27 at FFDM (McNemar test, P=0.48). Comparison of SFM and FFDM interpretations using the mean score for each case revealed no statistically significant difference between the two modalities (Wilcoxon signed-rank test for matched pairs; P-value=0.228). Two initial round cancers (one tumor found incidentally at work-up for a mass proved to be a simple cyst with a positive score at FFDM but a negative score at SFM, and one tumor with positive score at SFM but negative score at FFDM due to positioning failure) were excluded from the further analysis. Excluding these two cancers from comparison, there were 31% (22 of 72) false-negative SFM and 47% (34 of 72) false-negative FFDM individual interpretations. The overall mean interpretation time for normal FFDM examinations was 45 s. For most false-negative FFDM results, the reading time was shorter or longer than for normal examinations. The recorded FFDM interpretation time was noticeably short for several overlooked cancers manifesting as microcalcifications (ductal carcinoma in situ). CONCLUSION: There is no statistically significant difference in cancer detection rate between SFM and FFDM with soft-copy reading in a mammography screening program. Analysis of cancers missed at FFDM with soft-copy reading indicates that close attention has to be paid to systematic use of image display protocols.

Aged↗
PubMed2002

Logistics of referral, diagnostic assessment and treatment of patients with breast symptoms and signs.

BACKGROUND AND AIMS: The logistics of diagnosis and treatment in a hospital with slightly above 400 new cases of breast cancer per year is analysed. MATERIALS AND METHODS: The patient flow from referral, through the diagnostic procedures and through surgical treatment is described. RESULTS AND CONCLUSIONS: The basic principle of the diagnostic assessment is the triple diagnostic procedure including mammography supplemented by ultrasonography, fine needle aspiration cytology and clinical examination. The radiologist and pathologist are working together in the breast diagnostic centre and are thus able to give a "single visit diagnosis" in most cases. The surgeon sees the patient either the same day or the next. A "consensus meeting" held each week with representatives for all specialities present has an important function in quality assurance and education. If one or more of the triple diagnostic components reach conclusion level "suspicious lesion", surgery is indicated. In hospital management is based on day surgery for all biopsies, wide excisions with or without sentinel node and some ablatio simplex mammae. For wide excision and ablation with complete axillary node clearance, the patients are transferred from the day surgery unit to a patient hotel after 3-4 hours of observation and stay till the drain can be removed. Only in rare case of high cardiopulmonary risk, beds in ordinary wards are used. This is a highly cost efficient logistic saving the hospital approximately 400,000 EUR a year compared to ordinary in hospital treatment.

Breast Neoplasms↗
PubMed2001

Interval cancers in the Norwegian breast cancer screening program: frequency, characteristics and use of HRT.

Breast cancers diagnosed between screening examinations among women who attend a breast cancer screening program are defined as interval cancers. The Norwegian Breast Cancer Screening Program started as a pilot project in 1996, and data from the first 2-year interval are available. Our study quantifies interval cancers in the pilot project and explores characteristics and factors that may be associated with interval cancer. Interval cancers in the screening population were identified through the Cancer Registry of Norway. The frequency of invasive interval cancer was calculated as cases per 10,000 screened and as observed/expected ratio. Characteristics of the interval cancers were compared to screening-detected and clinical cancers. Breast density was assessed in a blinded review of 3 categories of screening mammograms. Information on hormone replacement therapy (HRT) use was collected from a questionnaire. The frequency of invasive interval cancers was 18.2 (15.9-20.7) per 10,000 screened and the observed/expected ratio was 0.49 (0.43-0.56). The frequency in the second year of the interval was higher than reported from other programs. The median tumor size of the interval cancers was 19.5 mm and 44.0% of the patients had affected axillary lymph nodes. The interval cancer cases had higher proportions of dense breasts and reported use of HRT compared to screen normal and screening-detected cases. The reported frequency of interval cancers is similar to comparable programs. The interval cancers differed significantly from the cancers detected in the first screening round and were more similar to clinical cancers. Interval cancer was associated with dense breasts and use of HRT. Screening programs must keep these associations in focus.

Aged↗
PubMed2000

[Diagnostic and therapeutic localized breast biopsy].

Preoperative localized mammary biopsy has been used as a diagnostic tool since before 1983 in the Breast Clinic, Ullevål Hospital. The great majority of procedures have been performed in the outpatient clinic with use of local anesthesia. Since 1988 all activity has been registered prospectively in a database. We discuss the use of the procedure and the results obtained during the period 1983-95. In the later part of the observed period, the use of the procedure as a diagnostic tool has been less frequent, but it has been increasingly used as a tool to identify the pathologic process when performing breast-conserving surgery. Surveillance of the malign-benign ratio is an important parameter in the quality assurance of the procedure. The malign-benign ratio has been greater than 0.3 during the period of observation. Continuous registration of procedure-related parameters is necessary for documentation of the results.

Biopsy, Needle↗
PubMed1999

[A prospective registration of diagnosis and treatment of breast tumors at the Ulleval hospital 1988-1995].

During the years 1988 to 1995, all diagnostic and therapeutic activities in the Breast Clinic, Ullevål Hospital, Oslo, Norway were registered prospectively. This paper presents the results from the registration. Of 4,436 new referrals, 1,169 had infiltrating mammary carcinoma and 63 ductal carcinoma in situ. 13.6% of those with breast carcinoma and 12.3% of those with benign breast disease had a first degree relative with breast cancer. The use of diagnostic biopsies for palpable and nonpalpable lesions decreased significantly through the period, from 155/112 in 1988 to 65/78 in 1995. For palpable lesions, the malign/benign ratio decreased from 0.82 in 1988 to 0.54 in 1995 while it improved from 0.43 to 0.88 for marked biopsies for nonpalpable lesions. Excluding those with mammographically and/or cytologically suspicious lesions from those who had a biopsy for a palpable lesion, we found that only seven out of 101 had cancer (ratio 0.07). Radical surgery was done in 790 cases with cytology as the only pre- and peroperative cancer verification. Three of them had a false positive cytology, as cancer was not found in the breast. One patient had metastasis later confirming that a cancer had been present; thus we had two false positive cytologies (2.5 per thousand). More than six axillary lymph nodes have to be examined in order to avoid false negative axillary status. In 1988 we had 41% with less than six nodes examined. This improved to 15% in 1995. Breast preserving therapy increased throughout the period from 4.1% in 1988 to 29.4% in 1995. Tumor size (pTI around 40%) and node positivity (35%) was fairly constant. In our opinion, a continuous prospective registration of the activity in a breast diagnostic centre is essential in order to improve and maintain service quality. The decision made by the Norwegian parliament in 1998 to introduce nation-wide mammography screening may be used to institute such continuous prospective registrations in all centres involved in the screening.

Breast Neoplasms↗
PubMed1999

The additional value of US to mammography in the diagnosis of breast cancer. A prospective study.

PURPOSE: To assess the additional value of ultrasonography (US) to mammography in the diagnosis of malignant breast tumors. MATERIAL AND METHODS: Prospectively recorded final assessment categories for mammography and US were compared for 327 (228 palpable and 99 nonpalpable) consecutive malignant tumors confirmed at histology. The additional value of US was assessed for a subpopulation of 71 of these 327 malignancies after excluding mammographically conclusive malignant findings, ductal carcinomas in situ (DCIS), and invasive carcinomas presenting with suspicious microcalcifications, since there is no indication for performing US in these patients. RESULTS: A total of 267 (82%) of the 327 malignant tumors were correctly diagnosed on both imaging modalities. Mammography correctly diagnosed 41 cancers with false-negative US findings as compared with 11 true-positive US diagnoses of malignant tumors with false-negative findings on mammography (McNemar test p<0.001). US correctly diagnosed ("upgraded") 31 (10%) of the 327 malignant tumors with benign or indeterminate mammographic diagnoses. In the subpopulation, US upgraded 20 (42%) of 48 palpable and 10 (44%) of 23 nonpalpable malignant tumors. CONCLUSION: The overall additional value of US to mammography in the diagnosis of breast cancer was rather limited in a population of mixed malignant tumors. Excluding cancers with mammographically conclusive diagnosis and suspicious microcalcifications as well as DCIS from analysis, US correctly upgraded more than 40% of palpable and nonpalpable malignant tumors.

Adult↗
PubMed1999

Diagnostic value of ultrasonography in patients with palpable mammographically noncalcified breast tumors.

PURPOSE: To analyze the diagnostic accuracy of mammography, ultrasonography (US), and both methods combined in evaluation of palpable noncalcified breast tumors. MATERIAL AND METHODS: Mammograms and sonograms of 200 patients with palpable noncalcified breast masses were retrospectively analyzed independently by four experienced radiologists in 3 sessions: Mammography or US interpretations in the first two and combined reading in the last session. Nonneoplastic abnormalities and mammographically obvious cancers were excluded. Receiver operating characteristic (ROC) analyses were performed for 115 (60 benign and 55 malignant) tumors and subgroups according to tissue density and tumor size. A single ROC curve for each diagnostic test was obtained by pooling the individual ratings. The area under the ROC curve was used as a measure of diagnostic performance. RESULTS: US revealed significantly higher diagnostic performance than mammography for tumors larger than 2 cm. Combined reading showed significantly higher performance than mammography except for tumors smaller than 2 cm. The performance of all three tests was reduced in dense parenchyma, and significantly so for mammographic and combined interpretation. CONCLUSION: The accuracy of US in patients with palpable mammographically noncalcified and not obviously malignant breast tumors is lower than reported for mixed sample populations. The accuracy of US may be influenced by breast parenchyma density. Combined reading offers the highest diagnostic accuracy.

Breast Neoplasms↗
PubMed1999

Variability in the interpretation of ultrasonography in patients with palpable noncalcified breast tumors.

PURPOSE: To analyze interobserver variability of ultrasonography (US) as an adjunct to mammography in patients with palpable noncalcified breast tumors. MATERIAL AND METHODS: Mammographic, US, and combined reading of 200 patients with palpable noncalcified breast masses were performed independently by four experienced radiologists. Nonneoplastic abnormalities and mammographically obvious cancers were excluded. Receiver operating characteristic (ROC) analysis based on 115 tumors was carried out for mammography, US, and both combined for each radiologist. The US diagnoses of the 45 cancers excluded from ROC analysis and the 55 cancers included were compared. RESULTS: One radiologist revealed a significantly higher diagnostic performance with US than with mammography. Combined reading showed the highest performance for all observers, but the improvement as compared with mammography was significant for only two. Higher accuracy on combined reading was mainly caused by correct upgrading of tumors with benign or indeterminate mammographic findings. One radiologist had benefit of US for downgrading of tumors. All four radiologists made a malignant US diagnosis twice as often in mammographically obvious cancers than in mammographically nonconclusive tumors. CONCLUSION: Radiologists differ substantially in interpretation of breast imaging. Combined reading offers the highest diagnostic accuracy mainly by correct upgrading of tumors on US. The role of US for downgrading tumors is operator-dependent.

Breast Neoplasms↗
PubMed1999

Ultrasonographic evaluation of invasive lobular carcinoma.

PURPOSE: To compare ultrasonographic (US) and mammographic findings and tumor size measurements of invasive lobular carcinoma (ILC). MATERIAL AND METHODS: US diagnoses and mammographic findings were compared in 95 patients with pure ILC, including 46 palpable and 49 nonpalpable tumors. The diameters of tumors measured by mammography, US, and pathology were compared in 70 of the 95 patients using scatter plots and correlation analysis. RESULTS: Eighty-two (86.3%) of the ILCs were correctly diagnosed as malignant tumor, 5 (5.3%) were diagnosed as focal abnormality, and only 2 patients had normal findings on US. The most common mammographic findings were a spiculated mass (57%) and a focal asymmetric density (15%). US correctly diagnosed 8 of 12 patients with normal or equivocal mammographic findings. The correlation of tumor size assessment on imaging and pathology revealed that US measurements including the "halo" (r=0.69) was superior to that of mammography (r=0.59). ILCs larger than 30 mm were heavily underestimated by both methods. CONCLUSION: Malignant tumor was diagnosed on US in most of the patients with ILC. US tumor measurement including the "halo" predicted tumor size most accurately. The correlation between imaging measurements and tumor diameter on histology was lower for ILCs than reported for populations of mixed carcinomas.

Adult↗
PubMed1999

Ultrasonography of malignant breast neoplasms. Analysis of carcinomas missed as tumor.

PURPOSE: To analyze the malignant breast neoplasms missed as tumor on ultrasonography (US). MATERIAL AND METHODS: A total of 355 malignant tumors were confirmed at histology among 2,985 consecutive patients who underwent breast US. There were no prospectively recorded mammographic findings in 28 of the 355 tumors. The remaining 327 tumors included 16 ductal carcinomas in situ (DCIS) and 66 invasive carcinomas with suspicious microcalcifications on mammography. Excluding these 82 tumors because US would not have been indicated using strict criteria, a subpopulation of 245 noncalcified invasive malignant tumors remained for analysis. The neoplasms missed as tumor on US were analyzed for the whole tumor group (n=355) and the subpopulation (n=245). RESULTS: 42 (11.8%) of the 355 malignant neoplasms were missed as tumor on US, including 6 (2.5%) of the 243 palpable and 36 (32.1%) of the 1 12 nonpalpable malignancies. Most of the missed tumors were DCIS and microinvasive ductal carcinomas dominated by DCIS. In the subpopulation, 14 (5.7%) of the 245 malignancies were missed as tumor on US, including 4 (2.2%) of the 180 palpable and 10 (15.4%) of the 65 nonpalpable lesions. Of the 245 malignancies, 6 (2.4%) had a normal US finding, including 2 palpable retropapillary tumors and 4 incidental findings at histology. CONCLUSION: Using strict criteria for performing US as an adjunct to mammography, by far the most malignant breast neoplasms are diagnosed as a tumor on US.

Adolescent↗
PubMed1999

Ultrasonography as adjunct to mammography in the evaluation of breast tumors.

PURPOSE: The aims of the study was to analyze the features of cancers missed as tumor on ultrasonography (US), to determine the predictive power of US tumor descriptors in the differentiation of benign and malignant breast tumors, to evaluate US as adjunct to mammography, and to assess the validity and reliability of mammographic, US, and combined interpretation of breast tumors. MATERIAL AND METHODS: Prospectively recorded mammographic and US findings of 355 malignant breast tumors among 2,985 consecutive patients who underwent breast US were compared with clinical findings and pathologic subtypes of the tumors. In addition, a 10-year material of 95 invasive lobular carcinomas (ILCs) were investigated. Three retrospective studies assessed the validity and reliability of mammographic, US, and combined interpretation of 200 palpable mammographically noncalcified breast masses by four radiologists. RESULTS: A total of 97.5% of the palpable and 67.9% of the nonpalpable malignant neoplasms were detected as tumor on US. Most carcinomas missed as tumor on US were ductal carcinomas in situ (DCISs) and microinvasive ductal cancers dominated by DCIS manifesting with suspicious calcifications on mammography. Irregular shape, irregular contour, extensively hypoechogenicity, hyperechoic rim (halo), and distortion of the surrounding tissue were the US features with the highest odds of predicting carcinomas. A pseudocapsule is the strongest predictor of a benign tumor, the odds of cancer being 0.03 in nonpalpable and 0.08 in palpable breast tumors. A negative predictive value of 100% in palpable and 96% in nonpalpable tumors was achieved using strict US criteria. In patients with ILC, US measurements predicted tumor size more accurately than mammography. US as adjunct to mammography correctly diagnosed ("upgraded") 9.5% of tumors with benign or indeterminate mammographic diagnoses. Excluding mammographically conclusive malignant tumors and carcinomas presenting with microcalcifications. US correctly upgraded 42% of the palpable and 44% of the nonpalpable cancers. Combined mammographic-US interpretation offers the highest diagnostic performance in noncalcified breast tumors. The lowest interobserver agreement was found in US interpretation. CONCLUSION: The impact of US in mixed cancer populations is limited. US is, however, a valuable adjunct to mammography in patients with nonconclusive mammographic findings. Negative predictive values on US approaching 100% may be achieved using strict criteria for a benign diagnosis. A considerable interobserver variation in the US interpretation is a limiting factor for the potential of breast US in the differentiation of benign and malignant breast tumors.

Adolescent↗
PubMed1998

[Magnetic tomography of the breast].

Magnetic resonance imaging (MRI) is emerging as one of the most promising, but controversial areas in breast imaging. In recent years interest has been shown in the method because of improved MRI technology and the use of gadolinium-based contrast media for lesion enhancement. Dynamic contrast medium-enhanced MRI has a sensitivity of more than 96% for the detection of breast cancer, because the breast cancer image is enhanced after intravenous administration of gadolinium. MRI seems to be more accurate than other imaging modalities for measuring the size of the cancer, and for detecting multicentric disease and residual tumours. However, many benign lesions show an enhanced image where intravenous gadolinium is used, so that the specificity of MRI has been relatively poor in most studies. Careful assessment of lesion morphology and quantitative enhancement characteristics may help to differentiate benign tumours from malignant lesions, thus increasing specificity. The exact role that breast MR imaging will play in the diagnosis of breast abnormalities has yet to be defined. Mammography and ultrasonography remain the basic imaging modalities for evaluating breast cancer. MR examination is costly, and the appropriate use of MR imaging resources will require careful integration of this new technology with existing strategies for diagnosing breast conditions.

Adult↗
PubMed1998

Analysis of sonographic features in the differentiation of fibroadenoma and invasive ductal carcinoma.

OBJECTIVE: The purpose of this study was to determine the predictive power of sonographic tumor descriptors in the differentiation of fibroadenoma from invasive ductal carcinoma of the breast. SUBJECTS AND METHODS: Three hundred thirty-six tumors (142 fibroadenomas and 194 invasive ductal carcinomas) of the breast diagnosed using sonography were prospectively recorded with respect to the shape, contour, echo texture, echogenicity, sound transmission, and surrounding tissue of the tumors. Evaluation included odds and odds ratios of single sonographic features as well as sensitivity, specificity, and positive and negative predictive values of combinations of features. Tumor descriptors were also evaluated using multiple logistic regression analysis after adjustment for age and clinical examination. RESULTS: Irregular shape and contour, extensive hypoechogenicity, shadowing, echogenic halo, and distortion of surrounding tissue were the findings with the highest predictive value of malignancy. A thin echogenic pseudocapsule was the most important sonographic finding predictive of the benign nature of a solid mass. Echo texture was of little value in the differentiation of breast tumors. Age and clinical examination remained important predictors in a clinically referred patient population because a palpable mass in an elderly patient is most likely a carcinoma. We saw considerable overlap of most sonographic features in both benign and malignant tumors. However, using strict sonographic criteria and a combination of descriptors, we found a negative predictive value of 100% in palpable and 96% in impalpable tumors. CONCLUSION: A combination of tumor descriptors gave negative predictive values approaching 100%, allowing downgrading of solid breast masses with a high degree of confidence. Extensive sonographic features analysis in patients with indeterminate clinical and mammographic findings has the potential for downgrading a tumor and possibly obviating the need for excision in a subgroup of patients. Further investigations may provide standardization of sonographic descriptor analysis and establishment of the combination of the most predictive features that would be useful in daily practice.

Adult↗
PubMed1997

Interobserver variation in the interpretation of breast imaging. Comparison of mammography, ultrasonography, and both combined in the interpretation of palpable noncalcified breast masses.

PURPOSE: To analyze interobserver agreement in the interpretation of palpable noncalcified breast masses by means of mammography, ultrasonography, and a combination of both methods. MATERIAL AND METHODS: Mammograms and ultrasonograms of 100 benign breast masses and 100 malignant ones in 200 patients were retrospectively analyzed by 4 radiologists with experience in both imaging modalities. The images were analyzed independently and without knowledge of the final diagnosis. The analysis was performed in 3 sessions and used a 5-point rating scale for probability of malignancy. The interobserver variation was analyzed by means of observed agreement, kappa, and weighted kappa statistics based on the 5-point rating scale and a 3-level scale of the collapsed 5-point scale. The chi-square statistic was used for testing the equality of the kappa values. RESULTS: The overall kappa value on the 3-level scale was 0.48 (range 0.37-0.61) for ultrasonography, 0.58 (range 0.52-0.66) for mammography, and 0.71 (range 0.63-0.79) for the combined reading. The kappa values were statistically different for ultrasonography but did not differ significantly for the mammographic and combined readings. The combined reading showed higher kappa values than mammography alone, and the improvement was statistically significant for 3 of the 6 pairs of comparison. CONCLUSION: Radiologists differ substantially in their interpretations of mammograms and breast ultrasonograms. Agreement was highest in the combined reading, intermediate in mammography, and lowest in ultrasonography.

Breast Neoplasms↗
PubMed1997

Routine ultrasonography in the diagnosis of acute appendicitis: a valuable tool in daily practice?

Initial clinical examination, laboratory inflammation parameters, and routine ultrasonography (US) were evaluated prospectively in 205 patients admitted for suspected acute appendicitis. The purpose of the study was to compare initial clinical examination and laboratory tests with the accuracy of US obtained in daily practice. All ultrasonographic examinations were performed by residents in radiology and radiologists qualified for routine abdominal US but not specifically trained in the diagnostics of appendicitis. Initial clinical examination had the highest sensitivity, but the specificity was poor. The single laboratory tests were of limited value in predicting appendicitis. The accuracy of US was disappointing, and the reported promising results of previous studies were not confirmed. Sonographers with less experience had a higher sensitivity but a poorer specificity compared with more experienced sonographers, who had a high specificity at the cost of extremely poor sensitivity. Biases, dichotomization problems, and factors influencing the accuracy of US in patients with suspected acute appendicitis are discussed.

Acute Disease↗