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Publications (11)11.85 Total impact

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    ABSTRACT: To investigate the feasibility of noncontrast and contrast-enhanced cone beam breast Computed Tomography (CT) in demonstrating malignant breast lesions in the diagnostic setting. This Institutional Review Board approved, Health Information Portability and Accountability Act compliant, prospective study enrolled BI-RADS four and five patients from 2008 to 2010. Eighty-seven subjects had noncontrast breast CT, 42 had contrast-enhanced breast CT (CE-breast CT) with 70 pathologically confirmed cancer diagnoses. All 70 comprise the study cohort for noncontrast breast CT, and 23 who had CE-breast CT comprise the cohort for CE-breast CT. All had diagnostic work-up. Patient age, breast density, lesion size and characteristics, biopsy method, and core pathology were recorded. A Fisher's exact test was used to detect a difference in detectability. For agreement in size measurement between the imaging modalities, a paired t-test was employed. Reported p-values were based on 2-sided tests. Two one-sided tests were calculated to determine equivalence within ±0.3 cm at a 90% significance level. Noncontrast breast CT identified 67 of 70 malignant lesions, detected by diagnostic work-up. CE-breast CT identified 23 of 23 index malignant lesions and in addition, found three malignant lesions in three cases not previously detected. Noncontrast breast CT demonstrated the index lesion in 67 of 70 cases and CE-breast CT demonstrated the index lesion in all 23 cases. An additional three new malignant lesions not seen with conventional diagnostic work-up were detected. In this preliminary study, breast CT with or without contrast was shown to be accurate at identifying malignant breast lesions in the diagnostic setting.
    The Breast Journal 06/2014; · 1.83 Impact Factor
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    ABSTRACT: OBJECTIVE. The purpose of this study was to compare invasive breast cancer in patients in their 40s with and without a family history of breast cancer as well as the lymph node meta-static rate and mastectomy rate. MATERIALS AND METHODS. From 2000 to 2011, a total of 793,827 examinations were performed; 221,541 (28%) were women between 40 and 49 years old. A total of 6965 cancers were found in 6511 patients. Specifically, 1207 cancers (17.3%) were detected in 1162 patients in their 40s. Patients presenting for diagnostic evaluation and those with a personal history of breast cancer were excluded, leaving 388 cancers available for study; 238 (61%) cancers were in patients with no family history of breast cancer, and 150 (39%) were in patients with a family history of breast cancer. Pearson chi-square, Fisher exact, and Student t tests were used for between-group comparisons for qualitative data. A two-sided p value was reported for all tests. RESULTS. The difference in lesions detected by imaging was not statistically significant (p = 0.17); 65% (154/238) had invasive and 35% (84/238) noninvasive disease in the no family history of breast cancer group and 65% (98/150) and 35% (52/150), respectively, in the family history of breast cancer group (p = 0.90). The mastectomy rate was not statistically significantly different (p = 0.14). Fifteen percent (35/238) of the no family history of breast cancer patients and 12% (18/150) of the family history of breast cancer patients had positive lymph nodes (p = 0.45). CONCLUSION. In patients in their 40s with or without a family history of breast cancer, no differences were detected in the proportion of invasive versus noninvasive cancers diagnosed, lymph node metastases, or mastectomy rates. Screening mammography should be performed in this age group regardless of family history.
    American Journal of Roentgenology 04/2014; 202(4):928-32. · 2.90 Impact Factor
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    ABSTRACT: PURPOSE To review all benign MRI biopsies to determine lesion stability in follow-up. METHOD AND MATERIALS A total of 372 benign biopsies were performed from 2003 to December 2011. Further evaluation revealed 269 benign biopsies in 258 patients with follow-up available; these comprise the study cohort. One hundred and two were lost to follow-up and were not included in this analysis. Original MRI findings were recorded. Cases were reviewed to determine stability of the lesions in follow-up. Follow-up included mammographic imaging, MRI imaging, or a combination of both. Any new findings in follow-up were recorded, along with subsequent applicable biopsy information. Patient demographics, breast density and history of breast cancer were also recorded. RESULTS A total of 258 patients with 269 benign findings. Average patient age was 54, with a range of 30-79. Breast density consisted of 68 scattered, 105 heterogeneously dense and 85 dense. Menopausal status was reported in all cases; 162 post, 79 pre, 16 peri; 25 reported hormone use. Family history was reported for 111 patients, of which 21 also reported personal history. Forty one reported personal history only. Twelve patients reported positive BRCA status; 1 reported personal history only, 7 reported family history only, 1 reported both personal and family history, and 3 reported no history. In follow-up there were 11 findings within 24 months of the benign biopsy. Of these 11, 2 were diagnosed malignancies in the same area as the prior biopsy; 1 invasive lobular carcinoma and 1 ductal carcinoma in situ. One malignancy was diagnosed in the ipsilateral breast but different quadrant. There were five benign findings diagnosed in the ipsilateral breast; 2 malignancies diagnosed in the contralateral breast, and 1 atypia in the contralateral breast. CONCLUSION There were eleven findings discovered in follow up out of the 269 benign biopsies or 4.1%. Cancer was diagnosed within 24 months in five out of the eleven (1.9%); 3 in the ipsilateral breast and 2 in the contralateral. The number of cancers that are identified is small but present and interval monitoring is necessary. CLINICAL RELEVANCE/APPLICATION Follow up surveillance remains necessary to monitor patients after benign MRI biopsies to confirm stability of lesions.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: PURPOSE Review experience with patients undergoing screening mammography imaged with combination 2D/3D breast tomosynthesis or full field digital mammography (FFDM). METHOD AND MATERIALS From June 2011 to December 2011, all patients were offered the option to have 2D/3D tomosynthesis or FFDM; 527 patients opted for 2D/3D. A random sample group of 527 FFDM screening exams from this time period was also selected for analysis. These groups comprise the study cohort. The χ2 test was used to compare recall rates and personal history between FFDM and 2D/3D. A Wilcoxon rank sum test was used to compare breast densities. A comparison of family history between modalities was tested using a Fisher exact test. A P value of less than .05 was considered to indicate a statistically significant difference. RESULTS Of the 527 2D/3D patients, average age was 59 years. Personal history was reported in 31; personal and family history in 29, positive family history in 280. Breast density consisted of 62% heterogeneously or extremely dense. 4.6% (n=24) were recalled for diagnostic workup. Seven proceeded to biopsy revealing 4 benign findings and 3 malignancies; 2 ductal carcinoma in situ, 1 invasive ductal carcinoma. The biopsy rate for this group was 1.3% (n=7/527), with a cancer detection rate 0.6% (n=3/527) and PPV of 42.9% (n=3/7). Of the 527 FFDM patients, average age was 59. Personal history was reported in 19; personal and family in 6, positive family history in 196. Breast density consisted of 54% heterogeneously or extremely dense. 12.7% (n=67) were recalled for diagnostic workup. Three ultimately had biopsy, all benign. The recall rate for FFDM, 12.7%, was significantly higher (P < .0001) compared with 2D/3D (4.6%). Reported personal history in FFDM group (n=19) was significantly lower (P < .0001) than in the 2D/3D group (n=60). There was a significant difference in family history (P <.0001) amongst the groups, with a higher rate in the 2D/3D group. There was a significant difference in 2D/3D and FFDM when comparing breast density (P <.0001, 62% v. 54% respectively). CONCLUSION The 2D/3D breast tomosynthesis group showed significantly lower recall rates despite increased risk factors compared to the FFDM group, with additional cancers found. CLINICAL RELEVANCE/APPLICATION Combination 2D/3D tomosynthesis has the potential to lower recall rates despite increased risk factors such as dense tissue and personal and family history.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: The objective of our study was to show the importance of surgical excision after the diagnosis of lobular carcinoma in situ (LCIS) based on needle core biopsy. Retrospective evaluation of all cases of LCIS diagnosed at needle core biopsy from 2000 to 2011 was performed; 60 patients with 64 diagnoses of LCIS comprise the cohort. Data recorded included patient demographics, patient presentation, breast density, personal and family histories of breast cancer, lesion characteristics, biopsy method, and correlation of core results with surgical pathology or follow-up imaging. The pathology facility was recorded for all biopsies because the specimens from open surgical biopsy were frequently reviewed by a different laboratory. A total of 60 patients with 64 diagnoses of LCIS comprised the study cohort. The patients ranged in age from 36 to 93 years (average, 55 years). The lesions consisted of 39 calcifications, two masses with calcium, 10 masses, two asymmetries, two architectural distortions, two architectural distortions with calcifications, and seven MRI enhancements. Mammography detected lesions in 84% of the cases (n = 54) and 16% (n = 10) were not visualized. Sonography detected lesions in 30% of the cases (n = 19) and 70% (n = 45) were sonographically occult. Needle core biopsy was performed in all cases: 49 stereotactic biopsies (77%), 12 ultrasound-guided biopsies, and three MRI-guided biopsies. All but one case proceeded to surgery. Open surgical biopsy revealed 21 cancers (33%); of the remaining cases, 53% of the cases (n = 33) were atypical or high risk and 14% (n = 9) were benign. The diagnosis of LCIS at needle core biopsy, in this small study, revealed that 84% of lesions either were malignant or were atypical or high risk at surgery, of which 33% were found to be carcinoma. Our findings suggest that LCIS should be excised when noted at core biopsy.
    American Journal of Roentgenology 02/2012; 198(2):281-7. · 2.90 Impact Factor
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    ABSTRACT: PURPOSE To compare the rate of invasive disease in patients with and without family history aged 40-49. METHOD AND MATERIALS A retrospective review was conducted of all patients’ records to identify cancers diagnosed from 2000-2010. Pearson’s chi-square t-test was used for between-group comparisons for qualitative data. A 2-sided p-value was reported for all tests. Statistical analysis was performed in SAS-PC 9.2. RESULTS 6,154 cancers were found in 5,813 patients during the study period; 1,071 were aged 40-49 (average 45) with 1,116 cancers (18.1%) detected. 373 patients presented for screening; 144 (39%) had family history of breast cancer (FHBC), 228 (61%) did not (NFHBC); 1 unknown. There were 16 (7.02%) NFHBC patients with personal history of breast cancer, compared to 7 (4.86%) in the FHBC group (p=0.4003). Lesions detected in NFHBC patients consisted of 86 mass, 97 calcification, 18 mass with calcium, 18 architectural distortion and 9 asymmetry. For FHBC patients; 42 mass, 69 calcification, 21 mass with calcium, 11 architectural distortion and 1 asymmetry, which was statistically significantly different from the NFHBC group (p=0.0459). 64.0% (n=146) invasive disease and 36.0% (n=82) non-invasive disease was found in the NFHBC group, and 63.2% (n=91) and 36.8% (n=53), respectively, in the FHBC group (p=0.8695). 227 of the 228 NFHBC patients and all the FHBC patients proceeded to surgery; 1 NFHBC patient did not due to metastatic disease. 67 (29.4%) NFHBC patients and 45 (31.3%) FHBC patients had positive lymph nodes (p=0.7026). 156 NFHBC patients had lumpectomy; 21 proceeded to mastectomy after initial surgery revealed residual disease/close margins. 90 lumpectomies were performed in FHBC patients; 13 had residual disease/close margins and proceeded to mastectomy. 71 (31.1%) NFHBC patients and 54 (37.5%) FHBC patients had mastectomy (p=0.2059). CONCLUSION In the 40-49 group, 373 presented for screening and were diagnosed with breast cancer. Invasive cancer was diagnosed in 64% of cases presenting without family history and 63% with family history. The lymph node metastatic rate was similar at 29% without and 31% with family history. Family history does not seem to impact the rate of invasive disease in this patient cohort. CLINICAL RELEVANCE/APPLICATION We found women with and without family history had a significant number of cancers diagnosed, with similar rates of invasive disease and of lymph node metastases.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 12/2011
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    ABSTRACT: PURPOSE To determine the incidence of breast cancer in patients presenting for high risk breast MRI screening due to a personal history. METHOD AND MATERIALS Retrospective review of patients presenting for high risk breast MRI screening from 2003 to 2010. A total of 1,502 high risk MRI patients were reviewed; revealing 796 having a personal history of breast cancer. Thirteen of these patients had abnormal MRI enhancements, which were mammographically occult, with a subsequent cancer diagnosis; these comprise the study cohort. For these 13 patients data recorded included patient demographics, risk assessment (including personal and family history), BI-RADS® breast density, lesion characteristics (type, size), biopsy method and correlation with surgical pathology. RESULTS A total of 13 patients comprise the study cohort. Average patient age was 56 years (range 43 to 78). Breast density consisted of 5 scattered, 2 heterogeneously dense and 6 extremely dense. 69% of patients reported post-menopausal status, and 85% of patients reported no hormone usage. Ethnic background consisted of 85% Caucasian, 8% Asian and 8% Hispanic. The new MRI enhancements ranged in size from 3mm to 50mm. Of the abnormalities on MRI, 38% (n=5) were in the contralateral breast, 54% (n=7) in the ipsilateral breast; one patient had findings in both the contralateral and ipsilateral breast. All of the ipsilateral findings were in patients who had prior lumpectomy; 4 of whom did not receive radiation therapy. All new findings underwent biopsy; 5 MRI-guided biopsy, 6 second look ultrasound-guided biopsy. One patient had fine needle aspiration biopsy and 1 patient underwent open surgical biopsy. All biopsies revealed carcinoma; 85% (n=11) invasive and 15% (n=2) DCIS. CONCLUSION MRI is a useful screening tool in women with a personal history of breast cancer. This small cohort shows that MRI is significant as it revealed invasive cancer in 85% of enhancing lesions. This is significant as one of the main criticisms against breast MRI in women with a personal history of the disease is that it is thought to lead to unnecessary tests and overtreatment for mostly negligible disease. CLINICAL RELEVANCE/APPLICATION Breast MRI is beneficial in women with a personal history of breast cancer as it can identify new mammographically occult disease.
    Radiological Society of North America 2011 Scientific Assembly and Annual Meeting; 11/2011
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    ABSTRACT: PURPOSE Assess the value of CBBCT in the evaluation of breast lesions as compared to MR. METHOD AND MATERIALS Following IRB approval, BIRADS 4 & 5 patients were consented to have a non-contrast CBBCT or Contrast Enhanced CBBCT prior to undergoing breast needle biopsy. All patients had complete diagnostic work-up and underwent a unilateral CBBCT scan. Patients consented for CECBBCT were given an intravenous contrast injection. Pertinent patient, imaging and pathology information was recorded. RESULTS Enrollment consisted of 133 BIRADS 4 &5 patients; 119 patients underwent CBBCT imaging. 52 patients proceeded to MR imaging following a positive biopsy to evaluate the extent of their disease. 2 were excluded: 1 due to artifacts on the CT image, and another was unable to be imaged with MR due to size limitations. Therefore, the study cohort consisted of 50 patients. In 74% (37/50) of lesions, CBBCT and MR imaging were concordant; there were discordant results in 26% (13/50) of lesions. Of the discordant results, the original lesion was seen on 92% (12/13) of both MR and CBBCT exams. However, in 15.39% (2/13) of the discordant lesions, CT revealed cancerous lesions not seen on MR; both of these patients were imaged with contrast enhanced CBBCT. In 38.47% (5/13) of these lesions, MR revealed additional lesions not seen on CT; all of these cases were non-contrast CBBCT exams. MR was able to image lymph node involvement in 30.77% (4/13) of these discordant cases, whereas CBBCT was unable to image this posterior tissue. Both CT and MR were able to image lesions which were not seen on mammography (2/13). CONCLUSION In this small study, CECBBCT shows promise in the diagnostic evaluation of patients, particularly in identifying extent of disease. This may prove to be an alternative to breast MR in patients who are claustrophobic, have contraindications due to implantable devices or are limited secondary to size. Limitations in imaging posterior axillary tissue on CBBCT is well documented in this study; further work on table ergonomics is needed. Continued investigation of CBBCT is necessary for statistical significance and evaluation. CLINICAL RELEVANCE/APPLICATION Clinical experience of CBBCT in the diagnostic setting.
    Radiological Society of North America 2010 Scientific Assembly and Annual Meeting; 11/2010
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    ABSTRACT: The clinical implementation of needle core biopsies has given radiologists an invaluable tool for the diagnostic evaluation of suspicious breast lesions. Despite improvements made to the technology of breast biopsy, the underestimation of disease in tissue samples retrieved continues. This can be attributed to many factors, including variability between different needle gauges. This study was undertaken to assess the pathological underestimation for 9 and 12 gauge breast needle core biopsies at surgical excision. A retrospective review of image-guided consecutive core needle biopsies performed from 2003 to 2006 yielded a total of 1,201 needle core biopsies: 837 twelve gauge and 364 nine gauge. Further analysis was completed to distinguish needle biopsies whose pathological outcome was underestimated at core needle biopsy when compared to their subsequent surgical excision. Ninety-seven lesions in 88 patients were reviewed and comprise the study cohort. Underestimation was found in 97 needle core procedures in 88 patients. Of the 97, 67 were performed with 12 gauge vacuum-assisted biopsy devices and 30 with 9 gauge vacuum-assisted biopsy devices, resulting in an underestimation rate of 8.00 and 8.24% for 12 gauge and 9 gauge, respectively. The difference in underestimation rate was not statistically significant per Pearson's chi squared test (P = 0.8898). In this analysis, the underestimation of needle biopsy results with surgical pathology was found to be 8.00% for the 12 gauge group and 8.24% for the 9 gauge group. These results support our current clinical practice of utilizing either needle gauge.
    Breast Cancer 03/2010; 18(1):42-50. · 1.33 Impact Factor
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    ABSTRACT: The objective of our study was to compare the bleeding complication rates after core needle biopsy in patients receiving anticoagulation therapy and those who had not to assess the safety of performing core needle breast biopsy in anticoagulated patients. Core needle biopsy was performed at 1,144 sites in 1,055 women from August 2004 to May 2007. A retrospective study of these cases was performed. The patient group was composed of 200 women (220 biopsy sites) who were taking anticoagulant therapy daily (180 patients, aspirin; 16 patients, warfarin; and four patients, Excedrin), and the control group was composed of 855 women (924 biopsy sites) who were not receiving daily anticoagulant therapy. Any adverse reactions after core needle biopsy, including the presence and size of bruises or lumps (hematomas), were recorded. There was a statistically significant difference (p = 0.035) in the percentage of bruises between patients receiving anticoagulation therapy and those who were not. Bruising occurred in 68 of the 200 (34%) women in the patient group (anticoagulated), whereas bruising occurred in 227 of the 855 (26.5%) women in the control group (nonanticoagulated). The differences were not statistically significant for hematoma formation (p = 0.274) or bruising with hematoma formation (p = 0.413). Hematoma occurred in 12 of the 200 (6%) anticoagulated patients versus 36 of the 855 (4.2%) patients in the control group. Patients reporting a bruise and lump (hematoma) numbered 10 of 200 (5%) for the anticoagulated group and 32 of 855 (3.7%) for the control group. No patients undergoing core needle biopsy reported any clinically important complications. The results of this study confirm that performing core needle biopsy in patients on anticoagulation therapy is safe.
    American Journal of Roentgenology 11/2008; 191(4):1194-7. · 2.90 Impact Factor
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    ABSTRACT: PURPOSE/AIM To review initial results of a risk assessment program implementation in an outpatient community-based breast imaging practice. CONTENT ORGANIZATION From May 2011 to December 2011, 50,047 patients filled out health history forms; 8,407 (17%) were flagged through Radiology Information System (RIS) as having potential risk for breast cancer if their responses met criteria outlined by National Comprehensive Cancer Network (NCCN) guidelines. Letters were then generated informing patients and physicians of risk factors identified suggesting further breast cancer risk assessment, which may include breast MRI and/or genetic testing. Physicians aware of our program referred additional patients for risk assessment. Data collected included family history of breast or ovarian cancer, personal history of breast cancer with age at diagnosis and Ashkenazi-Jewish ancestry. Results and outcomes from additional imaging and genetic testing were collected. SUMMARY Early experience of risk assessment program implementation has flagged 8,407 potential at risk patients resulting in 413 phone assessments performed. 219 patients were flagged from RIS or physician referred to have genetic counseling; 186 (2%) chose genetic testing, revealing 12 (6.5%) BRCA 1 or 2 mutations. Additional screening with MRI provided to at risk women revealed 3 (3/62, 5%) cancers.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting;