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Biomedical subjects

William H Goodson

Publications and source records attributed to William H Goodson.

9 recordsLinked to original sources
PubMed2006

Closure of partial mastectomy.

A longstanding controversy surrounds whether to close breast parenchyma at the completion of a partial mastectomy for breast cancer. Modification of a technique described 80 years ago finds the middle ground between various opinions and simultaneously addresses 2 issues: (1) approximation of the deep and superficial surfaces of the parenchyma, without sutures within the parenchyma, minimizes "dents;" and (2) a radial suture line preserves the distance from the nipple to the periphery of the breast which minimizes traction on the nipple.

Breast Neoplasms↗
PubMed2002

Causes of physician delay in the diagnosis of breast cancer.

BACKGROUND: Understanding sources of physician delay in diagnosis of breast cancer will assist efforts to expedite diagnosis. OBJECTIVE: To test whether increased reliance on screening mammography has affected causes of physician delay in diagnosis of breast cancer. DESIGN: Survey of delays in a case series. SETTING: Practice specializing in breast diseases in a region with high use of screening mammography. PATIENTS: Four hundred thirty-five consecutive patients treated for 454 breast cancers of any stage. INTERVENTION: Customary patient care. MAIN OUTCOME MEASURES: Whether delay was related to how cancer was identified, patient age, individual cancer characteristics (such as tumor type), mammography reports, or physician expertise. RESULTS: Twenty-one women (5%) were inappropriately reassured that a malignant lump was benign without biopsy, 14 women (3%) had a misread mammogram, 4 women (1%) had a misread pathologic finding, and 5 women (1%) had cancer missed by a poorly performed fine-needle aspiration biopsy. Delay was associated with a benign mammography report (relative risk, 10.8; 95% confidence interval, 5.1-22.8), a woman finding her own mass (relative risk, 3.3; 95% confidence interval, 1.8-6.2), and current hormone replacement therapy (relative risk, 3.1; 95% confidence interval, 1.2-8.5). CONCLUSIONS: The leading cause of physician delay in diagnosis of breast cancer continues to be inappropriate reassurance that a mass is benign without biopsy. Reducing delay in diagnosis will require less willingness to rely on clinical examination to decide that a mass is benign, less reliance on benign mammography reports to decide not to biopsy a mass, and a requirement that fine-needle aspiration biopsy be done by persons with demonstrated competence for the procedure.

Adult↗
PubMed2002

Overall clinical breast examination as a factor in delayed diagnosis of breast cancer.

HYPOTHESIS: A standardized description of clinical breast examination (CBE) can predict the risk of delayed diagnosis of breast cancer. DESIGN: Survey of case series. SETTING: Breast surgery referral practice. PATIENTS: Consecutive sample of 371 women with 386 breast cancers of any stage for whom overall characteristics of CBE were recorded at the initial consultation. INTERVENTION: None. MAIN OUTCOME MEASURES: Overall breast "durity" (from Latin duritia, meaning "hardness") was recorded as the inverse of whether rib edges could be felt through breast tissue in the most "dur" (firm or hard) part of the breast, usually the upper outer quadrant adjacent to the areola. "Nodularity" was recorded in this same area by means of an ordinal scale ranging from "surface is smooth" to "coarse nodularity." Delayed diagnosis was tabulated if the patient was told that cancer was not present when there was a sign of cancer on CBE, mammogram, and/or pathology slides. Relative risk of delayed diagnosis was determined within categories of nodularity or durity and within nodularity and durity categories combined. RESULTS: Diagnosis was delayed for 35 (9.1%) of cancers. Delay was least common (2 [2.2%] of 92) for less dur and less nodular breasts (relative risk, 1.0), most common (18 [13.5%] of 133) for less dur and more nodular breasts (relative risk, 6.23; 95% confidence interval, 3.58-10.22), and intermediate for other descriptions (chi(2) = 9.08; P =.03). Neither nodularity alone nor durity alone correlated with delay. CONCLUSIONS: A standardized system to describe CBE will alert physicians to an increased risk of delayed diagnosis of breast cancer (especially for women with less dur and more nodular breasts), help improve interpretation of CBE, and reduce delayed diagnosis of breast cancer.

Biopsy↗