Biomedical subjects
W H Hindle
Publications and source records attributed to W H Hindle.
The diagnostic evaluation.
Breast symptoms are appropriately evaluated by a breast-oriented history and by the diagnostic triad of clinical breast examination, FNA, and mammography. In the case of a palpable dominant mass, concordance of the diagnostic triad yields a reliable clinical diagnosis. If there is not concordance, or if there is any doubt about the diagnosis either on the part of the physician or the patient, open surgical biopsy provides the definitive histologic diagnosis. The goal in clinical practice is to detect nonpalpable cancers by ordering screening mammography for all patients eligible by age, history, or both. The long-term cancer-free survival of women treated for nonpalpable breast cancer is excellent.
The use of fine-needle aspiration in the evaluation of persistent palpable dominant breast masses.
OBJECTIVE: Our purpose was to determine if fine-needle aspiration can decrease the necessity for open surgical biopsy in the diagnosis of a persistent palpable dominant breast mass. STUDY DESIGN: In a university obstetrics-gynecology resident physician training program, persistent palpable dominant breast masses seen in the Breast Diagnostic Center at Women's Hospital, Los Angeles County-University of Southern California Medical Center, were evaluated by fine-needle aspiration. When a cytologic diagnosis was obtained, the patients were treated, followed, or referred for treatment. Open surgical biopsy was reserved for those lesions that were not cytologically diagnosed or for which there was no concordance of the diagnostic triad of palpation, fine-needle aspiration, and mammography. RESULTS: Resident physicians rotating through the Breast Diagnostic Center performed 568 fine-needle aspirations under staff supervision. The technique was readily learned by most of the resident physicians with equipment already available in most outpatient settings. Fine-needle aspiration was performed on the initial clinic visit, and the preliminary cytologic diagnosis was given to the patient on the same day. Forty-two cancers were cytologically diagnosed (7% of the fine-needle aspirations). Seventy-five (13%) other patients were referred for open surgical biopsy as the definitive diagnostic procedure. Twenty-four (4%) patients elected open surgical excision biopsy of fine-needle aspiration-diagnosed masses. CONCLUSION: Fine-needle aspiration of persistent palpable dominant breast masses allows expeditious and potentially cost-effective management of most cases and decreases the necessity of open surgical biopsy for definitive diagnosis.
Mammography lexicon.
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Screening mammography reports. Toward clear, concise clinical descriptions.
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Breast evaluation and diagnosis by obstetrician-gynecologists. Survey of practice patterns.
Surveys of the obstetrician-gynecologists attending the breast disease postgraduate courses at the 1988 and 1990 American College of Obstetricians and Gynecologists annual clinical meetings report a high level of practice involvement in breast disease evaluation and cancer screening for their patients. A consistently high percentage stated they performed regular clinical breast examinations, documented the examinations with a diagram in the medical record, gave breast self-examination instruction, advised screening mammography following the American College of Obstetricians and Gynecologists guidelines, utilized a patient tracking system for follow-up and referred patients with undiagnosed dominant breast masses. Most stated that they did breast cyst aspiration; those who did not mostly referred their patients for cyst aspiration. The accurate and cost- and time-effective office technique of fine needle aspiration of palpable dominant solid breast mass continues to be underutilized even though the procedure has been proven effective and accurate in the cytologic diagnosis of benign and malignant breast neoplasms. Instruction in the technique of fine needle aspiration of palpable breast cysts and solid masses is available in many clinics, workshops and postgraduate courses.
Conservative management of breast fibroadenomas.
Is it conservative or radical management to excise all fibroadenomas of the breast, especially in women less than 30 years old? Once a definite diagnosis is established by physical examination, fine-needle aspiration cytologic testing, and mammography, is it prudent to monitor women with small fibroadenomas (less than 4 cm in diameter)? We reviewed 498 cases of biopsy-proved fibroadenomas and 17 cases of phyllodes tumors (by biopsy) seen at Los Angeles County/University of Southern California Medical Center from 1986 to 1989. Analysis of patient age and measured tumor size in 203 fibroadenomas and 10 phyllodes tumor specimens revealed similar ranges for both tumors. The mean values were 28.5 years and 2.3 cm for fibroadenomas and 44 years and 3.8 cm for phyllodes tumors. No cases of coincident carcinoma within a fibroadenoma or of metastatic malignant phyllodes tumors were present in this review. As an alternative to excising all breast tumors, cytologically diagnosed fibroadenomas can be monitored, because they have no intrinsic premalignant potential and tend to regress with time. All breast tumors that rapidly increase in size should probably be excised at any age.
Concise, clinically pertinent mammography requests and reports as an aid to increasing the utilization of screening and diagnostic mammography.
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Breast masses. In-office evaluation with diagnostic triad.
Using the diagnostic triad of clinical breast examination, fine-needle aspiration, and mammography, primary care physicians can make an in-office definitive diagnosis in 90% of women presenting with a dominant breast mass. The remaining 10% should undergo open surgical biopsy. This diagnostic-triad approach is accurate, efficient, and cost-effective, and it does not require additional lengthy training, expensive equipment, or complex technology. In the case of breast cancer, the woman and her family can be immediately counseled and quickly prepared for consulting appointments and appropriate treatment options.
Breast aspiration cytology: a neglected gynecologic procedure.
Presented is a retrospective review of 1,196 breast aspiration cytologic procedures done during 1973 through 1981, at the Straub Clinic and Hospital, Inc., Honolulu, Hawaii. Aspirations which yielded clear fluid are not included. Of all the patients who had breast aspirations, 204 subsequently underwent open biopsy, and a definitive histologic diagnosis was made. Of the 204 open biopsies, 23% proved the existence of malignancy. Thus, 4% of the 1,196 breast aspirations proved the presence of carcinoma. Office aspiration cytologic examination of breast lesions is an efficient and cost-effective technique which is available to every gynecologist, and for which there are no medical contraindications. Complications are rare and usually not significant. If clear fluid is obtained, a clinical diagnosis of benign cystic disease can be made with a high degree of reliability. If the findings of breast aspiration cytologic examination are reported to be suspicious or to disclose malignancy, the patient should be referred as soon as possible for a definitive open biopsy and appropriate surgical treatment.
Clinical evaluation and follow-up on 3,829 IUD procedures.
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The conservative surgical treatment of arrhenoblastoma. Report of a case.
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Leiomyosarcoma of the uterus. Current case reports. Review of all cases in Honolulu, 1955-1965. Review of the literature.
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The Ryukyu Islands: medical problems and programs.
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