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Biomedical subjects

Y T Adler

Publications and source records attributed to Y T Adler.

6 recordsLinked to original sources
PubMed2001

Rates and causes of disagreement in interpretation of full-field digital mammography and film-screen mammography in a diagnostic setting.

OBJECTIVE: This study was performed to determine the rates and causes of disagreements in interpretation between full-field digital mammography and film-screen mammography in a diagnostic setting. SUBJECTS AND METHODS: Patients undergoing diagnostic mammography were invited to participate in the digital mammography study. Three views, selected by the radiologist interpreting the film-screen mammography, were obtained in both film-screen mammography and digital mammography. Radiologists independently assigned a Breast Imaging Reporting and Data System (BI-RADS) category to the film-screen mammography and the digital mammography images. The BI-RADS categories were grouped into the general categories of agreement, partial agreement, or disagreement. A third and different radiologist reviewed all cases of disagreement, reached a decision as to management, and determined the primary cause of disagreement. RESULTS: Six radiologists reviewed digital mammography and film-screen mammography diagnostic images in a total of 1147 breasts in 692 patients. Agreement between digital mammography and final film-screen mammography assessment was present in 937 breasts (82%), partial agreement in 159 (14%), and disagreement in 51 (4%), for a kappa value of 0.29. The primary causes of disagreement were differences in management approach of the radiologists (52%), information derived from sonography or additional film-screen mammograms (34%), and technical differences between the two mammographic techniques (10%). CONCLUSION: Significant disagreement between film-screen mammography and digital mammography affecting follow-up management was present in only 4% of breasts. The most frequent cause of disagreement in interpretation was a difference in management approach between radiologists (interobserver variability). This source of variability was larger than that due to differences in lesion visibility between film-screen mammography and digital mammography.

Adult↗
PubMed1999

Imaging features of focal breast fibrosis: mammographic-pathologic correlation of noncalcified breast lesions.

OBJECTIVE: Our objective was to describe the spectrum of imaging and histologic findings of focal breast fibrosis with an emphasis on noncalcified lesions, thereby offering a means of confirming mammographic-pathologic concordance on core biopsy of this increasingly encountered diagnosis. MATERIALS AND METHODS: Retrospective review of 610 core needle biopsies revealed the histologic diagnosis of focal fibrosis in 89 (15%). Thirty-nine cases were excluded: 17 in which focal fibrosis was not the primary diagnosis and 22 in which calcifications were the main imaging findings. The 50 remaining patients with noncalcified lesions that proved on histology to be focal fibrosis constituted the basis of the study. RESULTS: Mammographically, focal fibrosis presented as a mass in 68% of patients (n = 34), architectural distortion in 12% (n = 6), and asymmetric density in 10% (n = 5); focal fibrosis was mammographically occult in 10% (n = 5). Sonographically, 72% (n = 36) of cases of focal fibrosis presented as masses with three echo texture patterns: hypoechoic, isoechoic, and centrally echogenic with a peripheral hypoechoic rim. The sonographic margins were well circumscribed (n = 21), lobulated (n = 10), or ill defined (n = 5). Histologic review revealed three morphologic patterns of collagen deposition: perilobular, septal, and haphazard fibrosis. Correlation with the imaging findings showed that septal and perilobular fibrosis most often presented as hypoechoic or centrally echogenic masses, whereas the haphazard form was more often seen with architectural distortion. CONCLUSION: Focal fibrosis often presents as a noncalcified mass on mammography or sonography. The diagnosis of focal fibrosis on core needle biopsy can be considered concordant for a mass exhibiting well-circumscribed or partially obscured margins. Imaging findings discordant with focal fibrosis, such as marginal spiculation, require excisional biopsy.

Adult↗
PubMed1992

Breast ultrasonography.

Ultrasound of the breast has a role both as the primary and as an ancillary modality in the work-up of breast abnormalities. Its main role is to differentiate cystic from solid abnormalities and to thereby guide further work-up and intervention. Only the diagnosis of a simple cyst will obviate the need for further evaluation or therapy. Doppler ultrasonography of breast lesions may give further information in the future, although this is currently not employed in clinical practice. Various types of ultrasound examinations may yield useful information in the patient with breast cancer or in women with breast prostheses.

Adenofibroma↗
PubMed1988

Nuclear magnetic resonance in the diagnosis of breast cancer.

We believe that the preponderance of evidence suggests that MRI is less accurate than conventional mammography in the diagnosis of primary cancer of the breast. Thus, it currently has no established place in algorithms for the evaluation of patients suspected of having breast cancer. MRI could be used to evaluate masses with mammographically smooth, well-defined margins, since high signal intensity (greater than fat) in a T2-weighted image is a highly specific indicator of benignancy in such lesions. However, most of these masses are cysts and can be reliably and less expensively identified as such by sonography. Nonetheless, MRI might be used to re-evaluate a smooth, well-defined mass if sonography has failed to identify the lesion as a cyst. MRI might be particularly useful in this regard if a lesion is difficult to evaluate by other modalities because it is located adjacent to the chest wall, is deep within a very large breast, or is obscured by a breast prosthesis. MRI with Gd-DTPA may be useful in evaluating radiographically dense breasts or in differentiating breast malignancies from irregular dysplastic or scar tissue. However, further investigation of this technique is needed. It has been hoped that in vivo measurement of T1 and T2 or in vivo NMR spectroscopy might improve the accuracy of noninvasive diagnosis of cancer of the breast. However, there is currently no credible evidence that in vivo measurements of relaxation times provide useful indexes for the diagnosis of breast cancer. In vivo NMR spectroscopy of nuclei other than P may ultimately provide reliable criteria for noninvasive diagnosis of breast cancer in humans, but the technique is currently in its infancy.

Breast Neoplasms↗
PubMed1986

Pseudoobstruction in the geriatric population.

In this time of sophisticated technology, the diagnosis of intestinal obstruction and pseudoobstruction still depends on plain radiographs and barium studies. Old myths and rigid routines interfere with the interpretation of plain radiographic examinations, however. Air-fluid levels can be present in the colon owing to fluid accumulation from prolonged stasis, and they do not necessarily indicate obstruction. Positioning of the patient for diagnostic studies should be directed so that the shifting of gas within the colon gives maximal information about intestinal patency and diameter. Barium studies are only necessary and desirable when the gas pattern suggests a mechanical obstruction. Pseudoobstruction, which tends to be amenable to conservative treatment, is a frequent occurrence in the elderly population. If properly managed, the risk of perforation is low, and invasive procedures can usually be avoided. In the elderly population with poor intestinal tone, colonic caliber is often large; yet some textbooks still quote specific cecal diameters as indicators of impending perforation. Mobilizing the gas with positional maneuvers can help to decrease cecal size, facilitate evacuation, and allay fear. This is one more situation in which the radiologist can play an active role in patient management. Close cooperation with the clinician is necessary to insure optimal care of these difficult and challenging patients.

Age Factors↗