PubMed Health⌕ Search

Biomedical subjects

S H Ominsky

Publications and source records attributed to S H Ominsky.

At least 19 recordsLinked to original sources
PubMed1998

Variability and accuracy in mammographic interpretation using the American College of Radiology Breast Imaging Reporting and Data System.

BACKGROUND: Several studies, which were limited by their small sample size and selection of difficult cases for review, have reported substantial variability among radiologists in interpretation of mammographic examinations. We have determined, in the largest study to date, intraobserver and interobserver agreement in interpreting screening mammography and accuracy of mammography by use of the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS). METHODS: The mammographic examinations were randomly selected on the basis of original mammographic interpretation and cancer outcome from 71,713 screening examinations performed by the Mobile Mammography Screening Program of the University of California, San Francisco, during the period from April 1985 through February 1995. The final sample included 786 abnormal examinations with no cancer detected, 267 abnormal examinations with cancer detected, and 1563 normal examinations. Films were read separately by two radiologists according to BI-RADS. Cancer status was determined by contacting women's physicians and by linkage to the regional Surveillance, Epidemiology, and End Results Program. RESULTS: There was moderate agreement between radiologists in reporting the presence of a finding when cancer was present (kappa = 0.54) and substantial agreement when cancer was not present (kappa = 0.62). Agreement was moderate in assigning one of the five assessment categories but was statistically significantly lower when cancer was present relative to when cancer was not present (kappa = 0.46 versus 0.56; two-sided P = .02). Agreement for reporting the presence of a finding and mammographic assessment was two-fold more likely for examinations with less dense breasts. Agreement was higher on repeat readings by the same radiologists than between radiologists. The sensitivity of mammography was lower with BI-RADS than with the original system for mammographic interpretation, but the positive predictive value of mammography was higher. CONCLUSION: Considerable variability in interpretation of mammographic examinations exists; this variability and the accuracy of mammography are neither improved nor diminished with use of BI-RADS.

Breast Neoplasms↗
PubMed1995

Clinical efficacy of mammographic screening in the elderly.

PURPOSE: To compare mammographic screening results for women aged 65 years and older (elderly group) with those for women aged 50-64 years (younger group). MATERIALS AND METHODS: Mammography was performed in 32,140 women aged 50 years and older (10,914 elderly, 21,226 younger). Parameters studied included demographic data, screening interpretations, disposition of abnormal interpretations, results of biopsies, and characteristics of breast cancers. RESULTS: The cancer detection rate is substantially higher in elderly women (9.2 per 1,000 women) than in younger women (5.7 per 1,000 women). The median size of cancers in elderly women is 11 mm (vs 12 mm in younger women). Axillary nodal status is 93% node negative in elderly women (vs 88% node negative in younger women). Cancer stage is earlier in elderly women than it is in younger women (84% stage 0 or 1 vs 75% stage 0 or 1). CONCLUSION: Mammographic screening is at least as effective in detecting cancers for which there is a favorable prognosis in women aged 65 years and older as it is in women aged 50-64 years. Because the efficacy of screening in younger-group women has already been proved, it may be inferred that screening also benefits elderly-group women.

Age Factors↗
PubMed1995

The comparative value of mammographic screening for women 40-49 years old versus women 50-64 years old.

OBJECTIVE: The purpose of our study was to compare the major prognostic factors (tumor size, axillary lymph node status, and tumor stage) of breast cancers detected at mammographic screening in women ages 40-49 years old with those in women ages 50-64 years old. MATERIALS AND METHODS: Study subjects were women ages 40-64 years old who participated in our mobile van mammographic screening program from April 1985 to June 1994. We retrospectively reviewed the clinical and pathology records of women in whom breast cancer was detected at mammographic screening. All examinations were performed with dedicated equipment using screen-film technique. RESULTS: A total of 44,301 screening examinations were done during the study period. Seventy-five cancers were detected in women ages 40-49 years old, and 128 cancers were detected in women ages 50-64 years old. The cancer detection rate was 3.0 per 1000 examinations in the younger age group compared with 5.5 per 1000 examinations in the older age group. The median size of breast cancers was 10 mm for women ages 40-49 versus 11 mm for women ages 50-64. Eighty-eight percent of the patients in both age groups had no evidence of metastasis to axillary lymph nodes. Nineteen percent of women in the younger age group had advanced breast cancer (stage II or higher) compared with 26% of women ages 50-64 (p = .25). No statistically significant differences were noted between the two age groups in the size, lymph node status, or stage of breast cancers detected at mammographic screening. However, the cancers found in younger women had slightly more favorable prognoses. CONCLUSION: The major prognostic factors of cancers detected with modern mammographic equipment appear to be at least as favorable for women ages 40-49 years old as for women ages 50-64 years old. As mammographic screening has already been shown to be beneficial for women ages 50-64 years old, screening should also be beneficial for women ages 40-49 years old.

Adult↗
PubMed1995

Initial versus subsequent screening mammography: comparison of findings and their prognostic significance.

OBJECTIVE: The goal of this study was to compare findings on initial and subsequent screening mammograms to determine the prognostic significance of screening-detected abnormalities. MATERIALS AND METHODS: All 3386 abnormal examinations from a 9-year mammographic screening program were studied. An initial examination was defined as one for which there were no prior films available for comparison (even if one or more prior examinations had been performed); the remainder were called subsequent examinations. The principal mammographic feature of each abnormality was recorded, as well as whether a biopsy was performed. For all screening-detected cancers, we also determined several surrogate markers of prognosis (tumor size, presence of axillary lymph node metastasis, and tumor stage). These various parameters were analyzed as a function of initial versus subsequent screening. RESULTS: The frequency of abnormal examinations was more than 2 times greater for initial examinations (7%) than for subsequent examinations (3%). Only minor differences were noted between initial and subsequent screenings when comparing the principal mammographic features of the abnormalities. However, the number of cancers found per number of biopsies performed was significantly greater (p = .02) for subsequent screenings (41%) than for initial screenings (32%). Among the 333 cancers detected, tumor size was significantly smaller for subsequent screenings (p = .0076). Node-negative status and early tumor stage (stage 0 or 1) also were found more frequently for subsequently screened cancers, but these differences were not statistically significant. CONCLUSION: Substantially fewer abnormal screening interpretations are made when mammography has been performed previously and when the prior films are available for comparison. This results in cost savings and reduced morbidity at subsequent screening (no further work-up, less patient anxiety, fewer benign biopsies). Surrogate markers of prognosis also appear to be more favorable for cancers detected at subsequent screening.

Biopsy↗
PubMed1994

Plain film radiography of the chest: findings that simulate pulmonary disease.

Many pitfalls are encountered while interpreting routine radiographs of the chest. Intrathoracic disease can be mimicked by disease or anatomic variation of the superimposed bony thorax and soft tissues, by artifacts, and by iatrogenic intrathoracic changes. Although cross-sectional imaging may occasionally be necessary to solve a problem case, most often the simple use of an additional projection such as a lordotic, kyphotic, oblique, or skin marker view is sufficient to exclude pulmonary disease. We illustrate a series of cases in which serious intrathoracic disease was mimicked by extrapulmonary processes. The correct interpretation of these findings in a timely manner with relatively simple and inexpensive maneuvers can save the patient unnecessary worry and expense.

Diagnosis, Differential↗
PubMed1990

Medical audit of a rapid-throughput mammography screening practice: methodology and results of 27,114 examinations.

Medical audit results from the entire experience of a rapid-throughput mammography screening practice are presented, comprising 27,114 examinations conducted from April 1985 to September 1989. The authors screened a self-selected physician-referred population, almost 94% of whom were asymptomatic. Estimated sensitivity of initial mammography interpretation was 93.1% with a specificity of 94.2% and a positive predictive value of 10.0%. Biopsies prompted by screening yielded a diagnosis of malignancy in 32.1% of cases; 170 breast cancers were identified, 67.1% requiring mammographic needle localization. Median cancer size was 12 mm, the rate of axillary nodal metastasis was 11.0%, and the systemic metastasis rate was 1.2%. Of the cancers found, 76.5% were stage 0 or stage 1. Conducting a medical audit is the most convincing way to demonstrate the success of a mammography screening practice, thereby providing this important information for the benefit of screenees, referring physicians, third-party payers, and the personnel who perform the screening.

Adult↗
PubMed1986

Mammographic screening: how to operate successfully at low cost.

To offer mammographic screening to asymptomatic women at low cost requires a different approach than is appropriate for solving the more complex problems presented by symptomatic patients. Since the goal of screening is to detect unsuspected abnormalities, not to characterize them fully, operational procedures can be streamlined to maximize patient throughput and achieve substantial cost savings. Such procedures will be successful only if applied to large numbers of patients, thereby permitting cost reduction by economies of large-scale operation. Computerization of record-keeping and of image interpretation is ideally suited for screening examinations and permits further cost savings. Experience with a prototype low-cost screening program has shown that with only 15 patients per day, operation is feasible at a charge of $50 per patient. The income lost from asymptomatic patients, who will pay lower fees compared with the traditional mammography fees they now pay, is more than offset by the income generated by additional problem-solving mammograms needed to fully characterize screening-detected abnormalities and by the increased use of needle localization procedures to guide biopsy.

Breast Neoplasms↗
PubMed1986

Baseline screening mammography: one vs two views per breast.

To compare the advantages of one-view vs two-view mammography screening, films were reviewed for 2500 consecutive asymptomatic women undergoing baseline mammography. To provide screening at low cost, examinations were limited to two radiographs per breast, one each in the craniocaudal and mediolateral oblique projections, with the understanding that those few patients with detected abnormalities would require additional mammograms, taken with an individually directed, problem-solving approach, at considerably higher cost. Two separate interpretations were made of each case, one using only the oblique projection images, the other using both oblique and craniocaudal views. Two-view interpretations not only identified more cancers than one-view readings (27 vs 25), they also required fewer additional mammograms to evaluate potential abnormalities (179 vs 642, 7% vs 26%). These advantages outweigh the additional radiation risk and added cost. Baseline screening mammography should be done with two views per breast.

Breast Neoplasms↗
PubMed1983

The role of single and double-contrast radiography in the diagnosis of reflux esophagitis.

Sixty-seven patients with endoscopically proved esophagitis and 25 patients who had no esophageal disease were examined by double-contrast esophagography, followed by a single-contrast examination. The radiographs were evaluated separately and as a combined examination technique by three independent radiologists in a blind analysis. The respective sensitivities were 77% for the single-contrast examination, 80% for the double-contrast examination, and 88% for the combined examination method with no significant statistical difference (P = 0.05). The sensitivity increased for all methods with an increased severity of esophagitis. False positives more frequently occurred with double-contrast radiography, leading to similar accuracy rates for all methods (74% to 77%). The double-contrast examination technique showed an advantage over single-contrast radiography only if a granular pattern and erosions were the only radiographically detectible features of esophagitis. The use of the combined examination technique is recommended.

Adult↗
PubMed1981

Radiographic examination of the upper gastrointestinal tract: a survey of current techniques.

A multiple-choice questionnaire was sent to 156 radiologists, surveying techniques used to evaluate the upper gastrointestinal tract. Of the 123 who responded, all but 5 used the double-contrast examination. Pharmacological agents were frequently employed. Preferences regarding filming formats, indications for use of water-soluble contrast material, and indications for use of the double-contrast examination are discussed.

Contrast Media↗
PubMed1981

Mountain view of the patella.

Radiographic evaluation of the patellofemoral joint is usually attempted with the "sunrise" view originally described by Settegast in 1921. Unfortunately this view both fails to demonstrate the articular surfaces of the patellofemoral joint and can be painful for the acutely traumatized patient. A tangential view of the patellofemoral joint, the "mountain" view, has been known to orthopedic surgeons for several years but has never been mentioned in the radiology literature. The mountain view is well tolerated by the patient, requires no special equipment, and it gives a better view of the articulating surfaces of the patellofemoral compartment than the sunrise view. Selected cases demonstrating the usefulness of this view are illustrated and include examples of subluxation, fracture, and degenerative joint disease not apparent on sunrise views.

Adolescent↗
PubMed1980

The radiographic appearance of erosive duodenitis: a radiographic-endoscopic correlative study.

We studied 12 patients who had had endoscopically proved erosive duodenitis and a radiographic examination of the upper gastrointestinal (UGI) tract, which had been performed within 2 weeks of endoscopy. Radiographic criteria for erosive duodenitis were established by two radiologists and consisted of spasm, thickening of duodenal folds, erosions, and ulcers. Using these criteria, two other radiologists interpreted the radiographs of the 12 patients with duodenitis 15 others with normal duodenums, and five with pancreatic disease. They made correct diagnoses for eight of the patients with erosive duodenitis, nine with normal duodenums, and three with pancreatic disease. A third radiologist interpreted only the 12 misdiagnosed radiographs; he was correct only for three cases of duodenitis. Analysis of these results show that radiographic diagnosis of erosive duodenitis can be made only in advanced disease.

Adult↗
PubMed1980

Esophagitis caused by oral medication.

Three cases of esophagitis caused by oral medication are reported: 2 were the result of prolonged use of quinidine tablets (producing focal subacute inflammation mimicking carcinoma in one and stricture in the other) and one occurred soon after ingestion of liquid KCl. Previous reports have implicated KCl tablets ("slow KCl"), tetracycline and doxycycline capsules, and ferrous sulfate tablets. The factors predisposing to this uncommon complication of oral medication are discussed. In all reported cases caused by KCl tablets, left atrial enlargement was present as the result of mitral stenosis.

Administration, Oral↗
PubMed1979

The postoperative stomach: a comparative study of double-contrast barium examinations and endoscopy.

The results of double-contrast examinations of Billroth I and Billroth II anastomoses were compared to endoscopic results in 37 patients. Radiographic and endoscopic correlation was present in 32 of the 37 patients (86%). All 22 cases with enlarged perianastomotic folds on the double-contrast examination had endoscopic confirmation. The double-contrast examination provides excellent visualization of the Billroth I and Billroth II anastomosis and adjacent mucosal detail. We advocate its use as the routine examination of the postoperative stomach.

Barium Sulfate↗
PubMed1979

The thorax as the initial site for systemic relapse in malignant melanoma: a prospective survey of 324 patients.

Thirteen of 324 patients with malignant melanoma followed during a 24 month period experienced dissemination. The thorax was the initial site for relapse in 12, all of whom were asymptomatic. Ten gave no evidence of extrathoracic disease. Retrospective analysis of previous x-rays originally interpreted as negative revealed metastases in 33%. Life table analysis demonstrated a significantly longer survival for the subset with isolated intrathoracic metastases treated surgically than for their counterparts with metastases no longer amenable to surgery and treated by other modalities. We conclude that the thorax is the site of predilection for initial systemic relapse in malignant melanoma, that detection of early, surgically resectable metastases correlates with longer patient survival, and that routine chest roentgenography is inadequate in reliably uncovering such early disease. These data suggest the potential value of more vigorous radiographic surveillance (with either computed tomography or conventional full lung tomography) in patients at high risk for relapse.

Adult↗