Chaya S Moskowitz

Memorial Sloan-Kettering Cancer Center, New York, New York, United States

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Publications (124)553.25 Total impact

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    ABSTRACT: Introduction: Recurrent gene rearrangements are important drivers of oncogenesis in non-small cell lung cancers. RET and ROS1 rearrangements are each found in 1-2% of lung adenocarcinomas and represent distinct molecular subsets. This study assessed the computed tomography (CT) imaging features of patients with RET- and ROS1-rearranged lung cancers. Methods: Eligible patients included pathologically-confirmed lung adenocarcinomas of any stage with a RET or ROS1 rearrangement via fluorescence in-situ hybridization or next-generation sequencing, and available pre-treatment baseline imaging for review. A cohort of EGFR-mutant lung cancers was identified as a control group. CT features assessed included location, consistency, contour, presence of cavitation, and calcification of the primary tumor. Presence of an effusion, lung metastases, adenopathy and extrathoracic disease were recorded. The Wilcoxon rank-sum/Kruskal-Wallis and Fisher's exact tests were used to compare features between groups. Results: 73 patients with lung adenocarcinomas were identified: 17 (23%) with ROS1 fusions, 25 (34%) with RET fusions and 31 (43%) with EGFR mutations. ROS1-rearranged lung cancers were more likely to present as peripheral tumors in comparison to EGFR-mutant lung cancers (32% vs. 65%, p=0.04). RET-rearranged lung cancers did not significantly differ from EGFR-mutant lung cancers radiographically. The consistency of the primary lesion for RET and ROS fusions and EGFR mutations were most frequently solid and spiculated. Conclusions: Lung adenocarcinomas with RET and ROS1 fusions share many radiographic features and those with ROS1 fusions are more likely to present as peripheral lesions in comparison to EGFR-mutant lung cancers.
    Lung cancer (Amsterdam, Netherlands) 10/2015; DOI:10.1016/j.lungcan.2015.09.018 · 3.96 Impact Factor
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    ABSTRACT: Objective: The purpose of this study was to assess the prevalence of internal mammary node (IMN) adenopathy in patients with breast cancer and compare breast MRI and PET/CT for detection of IMN adenopathy. Materials and methods: This retrospective study included 90 women who underwent MRI and PET/CT before neoadjuvant chemotherapy for clinical stage IIA through IIIA disease. MRI and PET/CT examinations were read independently by two readers trained in breast imaging and nuclear medicine. All patients underwent follow-up MRI at the end of chemotherapy, and 10 with hypermetabolic IMNs underwent follow-up PET/CT. Histology was not obtained. Women were considered to have IMN adenopathy when nodes seen on MRI or having standardized uptake value (SUV) greater than mediastinal blood pool decreased in either size or SUV (or both) after treatment. Features including lymphovascular invasion, tumor quadrant(s), and axillary adenopathy were compared between presence and absence of IMN adenopathy using Fisher's exact test. Prevalence was determined on the basis of the percentage of patients with IMN adenopathy by either modality. The McNemar test compared the prevalence of IMN adenopathy on MRI to its prevalence on PET/CT. Results: Prevalence of IMN adenopathy was 16% (14/90) by MRI and 14% (13/90) by PET/CT (p = 0.317). After chemotherapy, IMN adenopathy resolved in 12 of 14 patients (86%). In two patients with poor responses in primary tumors, IMN adenopathy persisted, and both patients developed metastatic disease within 6 months. At 3 years, survival was significantly worse in patients with IMN adenopathy than in those without (85.7% vs 53.3%, respectively; p = 0.009). Conclusion: In women with advanced breast cancer receiving neoadjuvant chemo-therapy, prevalence of IMN adenopathy was 16%, equally detected by breast MRI and PET/CT. Identification of IMN adenopathy may affect treatment and provides prognostic information.
    American Journal of Roentgenology 09/2015; 205(4):899-904. DOI:10.2214/AJR.14.13804 · 2.73 Impact Factor
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    ABSTRACT: Objectives: To evaluate the recommendations for multiparametric prostate MRI (mp-MRI) interpretation introduced in the recently updated Prostate Imaging Reporting and Data System version 2 (PI-RADSv2), and investigate the impact of pathologic tumour volume on prostate cancer (PCa) detectability on mpMRI. Methods: This was an institutional review board (IRB)-approved, retrospective study of 150 PCa patients who underwent mp-MRI before prostatectomy; 169 tumours ≥0.5-mL (any Gleason Score [GS]) and 37 tumours <0.5-mL (GS ≥4+3) identified on whole-mount pathology maps were located on mp-MRI consisting of T2-weighted imaging (T2WI), diffusion-weighted (DW)-MRI, and dynamic contrast-enhanced (DCE)-MRI. Corresponding PI-RADSv2 scores were assigned on each sequence and combined as recommended by PI-RADSv2. We calculated the proportion of PCa foci on whole-mount pathology correctly identified with PI-RADSv2 (dichotomized scores 1-3 vs. 4-5), stratified by pathologic tumour volume. Results: PI-RADSv2 allowed correct identification of 118/125 (94 %; 95 %CI: 90-99 %) peripheral zone (PZ) and 42/44 (95 %; 95 %CI: 89-100 %) transition zone (TZ) tumours ≥0.5 mL, but only 7/27 (26 %; 95 %CI: 10-42 %) PZ and 2/10 (20 %; 95 %CI: 0-52 %) TZ tumours with a GS ≥4+3, but <0.5 mL. DCE-MRI aided detection of 4/125 PZ tumours ≥0.5 mL and 0/27 PZ tumours <0.5 mL. Conclusions: PI-RADSv2 correctly identified 94-95 % of PCa foci ≥0.5 mL, but was limited for the assessment of GS ≥4+3 tumours ≤0.5 mL. DCE-MRI offered limited added value to T2WI+DW-MRI. Key points: • PI-RADSv2 correctly identified 95 % of PCa foci ≥0.5 mL • PI-RADSv2 was limited for the assessment of GS ≥4+3 tumours ≤0.5 mL • DCE-MRI offered limited added value to T2WI+DW-MRI.
    European Radiology 09/2015; DOI:10.1007/s00330-015-4015-6 · 4.01 Impact Factor
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    ABSTRACT: It has been suggested that pediatric patients treated with spinal irradiation may have an elevated risk of breast cancer. Among a cohort of 363 long-term survivors of a pediatric central nervous system tumor or leukemia treated with spinal irradiation, there was little evidence of an increased breast cancer risk.
    Radiotherapy and Oncology 09/2015; DOI:10.1016/j.radonc.2015.09.016 · 4.36 Impact Factor
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    ABSTRACT: Women with a history of chest radiotherapy (RT) have an increased risk of breast cancer however many do not undergo annual recommended screening mammography. We sought to characterize the relationship between mammography and potentially modifiable factors, with the goal of identifying targets for intervention to improve utilization. Of 625 female participants sampled from the Childhood Cancer Survivor Study who were treated with chest RT, 551 responded to a survey about breast cancer screening practices. We used multivariate Poisson regression to assess several lifestyle and emotional factors, health care practices, and perceived breast cancer risk, in relation to reporting a screening mammogram within the last two years. Women who had a Papanicolaou test (Prevalence Ratio [PR]: 1.77, 95% confidence interval [CI]; 1.26-2.49), and who perceived their breast cancer risk as higher than the average woman were more likely to have had a mammogram (PR: 1.26, 95% CI: 1.09-1.46). We detected an attenuated effect of echocardiogram screening (PR: 0.70 (0.52-0.95) on having a mammogram among older women compared to younger women. Smoking, obesity, physical activity, coping, and symptoms of anxiety, depression and somatization were not associated with mammographic screening. Our findings suggest that compliance with routine and risk-based screening can be an important indicator of mammography in childhood cancer survivors. Additionally, there is a need to ensure women understand their increased breast cancer risk, as a means to encouraging them to follow breast surveillance guidelines. Screening encounters could be used to promote mammography compliance in this population. Copyright © 2015, American Association for Cancer Research.
    Cancer Epidemiology Biomarkers & Prevention 08/2015; DOI:10.1158/1055-9965.EPI-14-1377 · 4.13 Impact Factor
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    ABSTRACT: The purpose of this article is to investigate the added value of second-opinion evaluation of prostate MRI by subspecialized genitourinary oncologic radiologists for the assessment of extracapsular extension (ECE) of prostate cancer. We performed a retrospective evaluation of initial and second-opinion radiology reports of 76 patients who underwent MRI of the prostate before prostatectomy for histologically proven prostate cancer. Initial outside reports and second-opinion reports were unpaired and reviewed in random order by a urologist who was blinded to patients' clinical details and histopathologic data. Histopathologic analysis of the prostatectomy specimen served as the reference standard. Among cases with diagnostic-quality images available (71/76; 93%), disagreement between the initial report and the second-opinion report was observed in 30% of cases (21/71; κ = 0.35); in 18 of these 21 cases (86%), histopathologic analysis proved that the second-opinion report was correct. The second-opinion interpretations had statistically significantly higher sensitivity (66% vs 24%; p < 0.0001) than did the initial reports, whereas there was no statistically significant difference in specificity (87% vs 93%; p = 0.317). On ROC curve analysis, the second-opinion reports yielded a statistically significantly higher AUC for the detection of ECE (0.80 vs 0.65; p = 0.004). The reinterpretation of prostate MRI examinations by subspecialized genitourinary oncologic radiologists improved the detection of ECE of prostate cancer.
    American Journal of Roentgenology 07/2015; 205(1):W73-W78. DOI:10.2214/AJR.14.13600 · 2.73 Impact Factor
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    ABSTRACT: Purpose To assess the incidence of benign and malignant internal mammary lymph nodes (IMLNs) at magnetic resonance (MR) imaging among women with a history of treated breast cancer and silicone implant reconstruction. Materials and Methods The institutional review board approved this HIPAA-compliant retrospective study and waived informed consent. Women were identified who (a) had breast cancer, (b) underwent silicone implant oncoplastic surgery, and (c) underwent postoperative implant-protocol MR imaging with or without positron emission tomography (PET)/computed tomography (CT) between 2000 and 2013. The largest IMLNs were measured. A benign IMLN was pathologically proven or defined as showing 1 year of imaging stability and/or no clinical evidence of disease. Malignant IMLNs were pathologically proven. Incidence of IMLN and positive predictive value (PPV) were calculated on a per-patient level by using proportions and exact 95% confidence intervals (CIs). The Wilcoxon rank sum test was used to assess the difference in axis size. Results In total, 923 women with breast cancer and silicone implants were included (median age, 46 years; range, 22-89 years). The median time between reconstructive surgery and first MR imaging examination was 49 months (range, 5-513 months). Of the 923 women, 347 (37.6%) had IMLNs at MR imaging. Median short- and long-axis measurements were 0.40 cm (range, 0.20-1.70 cm) and 0.70 cm (range, 0.30-1.90 cm), respectively. Two hundred seven of 923 patients (22.4%) had adequate follow-up; only one of the 207 IMLNs was malignant, with a PPV of 0.005 (95% CI: 0.000, 0.027). Fifty-eight of 923 patients (6.3%) had undergone PET/CT; of these, 39 (67.2%) had IMLN at MR imaging. Twelve of the 58 patients (20.7%) with adequate follow-up had fluorine 18 fluorodeoxyglucose-avid IMLN, with a median standardized uptake value of 2.30 (range, 1.20-6.10). Only one of the 12 of the fluorodeoxyglucose-avid IMLNs was malignant, with a PPV of 0.083 (95% CI: 0.002, 0.385). Conclusion IMLNs identified at implant-protocol breast MR imaging after oncoplastic surgery for breast cancer are overwhelmingly more likely to be benign than malignant. Imaging follow-up instead of immediate metastatic work-up may be warranted. (©) RSNA, 2015.
    Radiology 06/2015; DOI:10.1148/radiol.2015142717 · 6.87 Impact Factor
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    ABSTRACT: To investigate Haralick texture analysis of prostate MRI for cancer detection and differentiating Gleason scores (GS). One hundred and forty-seven patients underwent T2- weighted (T2WI) and diffusion-weighted prostate MRI. Cancers ≥0.5 ml and non-cancerous peripheral (PZ) and transition (TZ) zone tissue were identified on T2WI and apparent diffusion coefficient (ADC) maps, using whole-mount pathology as reference. Texture features (Energy, Entropy, Correlation, Homogeneity, Inertia) were extracted and analysed using generalized estimating equations. PZ cancers (n = 143) showed higher Entropy and Inertia and lower Energy, Correlation and Homogeneity compared to non-cancerous tissue on T2WI and ADC maps (p-values: <.0001-0.008). In TZ cancers (n = 43) we observed significant differences for all five texture features on the ADC map (all p-values: <.0001) and for Correlation (p = 0.041) and Inertia (p = 0.001) on T2WI. On ADC maps, GS was associated with higher Entropy (GS 6 vs. 7: p = 0.0225; 6 vs. >7: p = 0.0069) and lower Energy (GS 6 vs. 7: p = 0.0116, 6 vs. >7: p = 0.0039). ADC map Energy (p = 0.0102) and Entropy (p = 0.0019) were significantly different in GS ≤3 + 4 versus ≥4 + 3 cancers; ADC map Entropy remained significant after controlling for the median ADC (p = 0.0291). Several Haralick-based texture features appear useful for prostate cancer detection and GS assessment. • Several Haralick texture features may differentiate non-cancerous and cancerous prostate tissue. • Tumour Energy and Entropy on ADC maps correlate with Gleason score. • T2w-image-derived texture features are not associated with the Gleason score.
    European Radiology 05/2015; 25(10). DOI:10.1007/s00330-015-3701-8 · 4.01 Impact Factor
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    Chaya S. Moskowitz · Mithat Gönen ·

    05/2015; 5(2). DOI:10.5430/jbgc.v5n2p1
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    ABSTRACT: The objective of our study was to characterize the MRI features of breast carcinomas detected in augmented breasts. A review of the MRI database identified 54 patients with biopsy-proven breast carcinoma in augmented breasts. The images were reviewed for the type and location of the implant and for the characteristics of the carcinoma. The cases included 46 (85%) invasive cancers (invasive ductal carcinoma, n = 35; invasive lobular carcinoma, n = 7; and mixed features, n = 4) and eight (15%) ductal carcinomas in situ. The median age of the patients at diagnosis was 49 years (range, 28-72 years). Thirty-eight of the 54 cancers (70%) were palpable. The mean tumor size was 2.8 cm (range, 0.6-9.6 cm). Of the 54 cancers, 34 (63%) presented as masses and 20 (37%) as nonmass enhancement on MRI. There was no detectable difference between implant position and lesion morphology (p = 0.55) or tumor size (p = 1.00). Twenty of 54 (37%) carcinomas abutted the implant, 13 (24%) abutted the pectoralis major muscle, and two (4%) invaded the pectoralis major muscle. Of the tumors abutting the implant, 18 of 20 (90%) spread along the implant capsule for more than 0.5 cm. This pattern of tumor spread was more common in breasts with retroglandular implants (9/16, 56%) than in those with retropectoral implants (9/38, 24%) (p = 0.03). MRI detected the index carcinoma in 16 of 54 (30%) cases, showed a greater extent of disease than was visible on mammography or ultrasound in 21 of 52 (40%) cases, and detected an unsuspected contralateral carcinoma in three of 54 (6%) cases. In augmented breasts, breast cancer often contacts either the implant or the pectoralis major muscle. Tumor spread along the implant contour is more often seen with retroglandular implants than with retropectoral implants. MRI should be considered to assess disease extent in women with augmented breasts before surgery.
    American Journal of Roentgenology 05/2015; 204(5):W599-604. DOI:10.2214/AJR.14.13221 · 2.73 Impact Factor
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    ABSTRACT: To evaluate interreader and inter-test agreement in applying size- and necrosis-based response assessment criteria after transarterial embolization (TAE) for hepatocellular carcinoma (HCC), applying two different methods of European Association for the Study of the Liver (EASL) criteria. Seventy-four patients (median age, 67 years) from a prospectively accrued study population were included in this retrospective study. Four radiologists independently evaluated CT data at 2-3 (1st follow-up, FU) and 10-12 (2nd FU) weeks after TAE and assessed treatment response using size-based (WHO, RECIST) and necrosis-based (mRECIST, EASL) criteria. Enhancing tissue was bidimensionally measured (EASLmeas) and also visually estimated (EASLest). Interreader and inter-test agreements were assessed using intraclass correlation coefficient (ICC) and κ statistics. Interreader agreement for all response assessment methods ranged from moderate to substantial (κ = 0.578-0.700) at 1st FU and was substantial (κ = 0.716-0.780) at 2nd FU. Inter-test agreement was substantial between WHO and RECIST (κ = 0.610-0.799, 1st FU; κ = 0.655-0.782, 2nd FU) and excellent between EASLmeas and EASLest (κ = 0.899-0.918, 1st FU; κ = 0.843-0.877, 2nd FU). Size- and necrosis-based criteria both show moderate to excellent interreader agreement in evaluating treatment response after TAE for HCC. Inter-test agreement regarding EASLmeas and EASLest was excellent, suggesting that either may be used. • Applying EASL criteria, visual estimation and bidimensional measurements show comparable interreader agreement. • EASL meas and EASL est show substantial interreader agreement for treatment response in HCC. • Agreement was excellent for EASL meas and EASL est after TAE of HCC. • Visual estimation of enhancement is adequate to assess treatment response of HCC.
    European Radiology 04/2015; 25(9). DOI:10.1007/s00330-015-3677-4 · 4.01 Impact Factor
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    ABSTRACT: To investigate the effects of androgen-deprivation therapy (ADT) on MRI parameters and evaluate their associations with treatment response measures. The study included 30 men with histopathologically confirmed prostate cancer who underwent MRI before and after initiation of ADT. Thirty-four tumours were volumetrically assessed on DW-MRI (n = 32) and DCE-MRI (n = 18), along with regions of interest in benign prostatic tissue, to calculate apparent diffusion coefficient (ADC) and transfer constant (K(trans)) values. Changes in MRI parameters and correlations with clinical parameters (change in prostate-specific antigen [PSA], treatment duration, PSA nadir) were assessed. Prostate volume and PSA values decreased significantly with therapy (p < 0.001). ADC values increased significantly in tumours and decreased in benign prostatic tissue (p < 0.05). Relative changes in ADC and absolute post-therapeutic ADC values differed significantly between tumour and benign tissue (p < 0.001). K(trans) decreased significantly only in tumours (p < 0.001); relative K(trans) changes and post-therapeutic values were not significantly different between tumour and benign tissue. The relative change in tumour ADC correlated significantly with PSA decrease. No changes were associated with treatment duration or PSA nadir. Multi-parametric MRI shows significant measurable changes in tumour and benign prostate caused by ADT and may help in monitoring treatment response. • Androgen-deprivation therapy caused changes of ADC, K (trans) in tumour and benign prostate. • Prostate volume and PSA values decreased significantly with therapy. • ADC values may be helpful for monitoring treatment response.
    European Radiology 03/2015; 25(9). DOI:10.1007/s00330-015-3688-1 · 4.01 Impact Factor
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    ABSTRACT: After completing treatment for cancer, survivors may experience late effects: consequences of treatment that persist or arise after a latent period. To identify and describe all models that predict the risk of late effects and could be used in clinical practice. We searched Medline through April 2014. Studies describing models that (1) predicted the absolute risk of a late effect present at least 1year post-treatment, and (2) could be used in a clinical setting. Three authors independently extracted data pertaining to patient characteristics, late effects, the prediction model and model evaluation. Across 14 studies identified for review, nine late effects were predicted: erectile dysfunction and urinary incontinence after prostate cancer; arm lymphoedema, psychological morbidity, cardiomyopathy or heart failure and cardiac event after breast cancer; swallowing dysfunction after head and neck cancer; breast cancer after Hodgkin lymphoma and thyroid cancer after childhood cancer. Of these, four late effects are persistent effects of treatment and five appear after a latent period. Two studies were externally validated. Six studies were designed to inform decisions about treatment rather than survivorship care. Nomograms were the most common clinical output. Despite the call among survivorship experts for risk stratification, few published models are useful for risk-stratifying prevention, early detection or management of late effects. Few models address serious, modifiable late effects, limiting their utility. Cancer survivors would benefit from models focused on long-term, modifiable and serious late effects to inform the management of survivorship care. Copyright © 2015. Published by Elsevier Ltd.
    European journal of cancer (Oxford, England: 1990) 02/2015; 51(6). DOI:10.1016/j.ejca.2015.02.002 · 5.42 Impact Factor
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    ABSTRACT: To develop a preoperative CT-based nomogram for predicting overall survival (OS) in patients with non-endometrioid carcinomas of the uterine corpus. Waiving informed consent, the institutional review board approved this HIPAA-compliant, retrospective study of 193 women with histopathologically proven uterine papillary serous carcinomas (UPSC), uterine clear cell carcinomas (UCCC), and uterine carcinosarcomas (UCS) who underwent primary surgical resection between May 1998 and December 2011, and had a preoperative CT ≤ 6 weeks before surgery. All CT scans were reviewed for local or/and regional tumor extent, presence of pelvic or/and para-aortic adenopathy, and presence of distant metastases. Univariate survival analysis was performed using log-rank test and Cox regression. Variables shown significant by the univariate analysis were evaluated with the multivariable Cox regression analysis and the results were used to create a nomogram for predicting OS. The predictive accuracy of the nomogram was assessed with the concordance probability index (c-index) and a 3-year calibration plot. Mean patient age was 67.2 years (range 49.0-85.9); histologies included UPSC (n = 116), UCCC (n = 27), and UCS (n = 50). Median follow-up was 38.1 months (0.9-168.5 months). At multivariate analysis, patient age, ascites, and omental implants on CT were significant adverse predictors of OS and were used to build the nomogram. Concordance index for the nomogram was 0.640 ± 0.028. We developed a nomogram with a good concordance probability at predicting OS based on readily available pretreatment clinical and imaging characteristics. This preoperative nomogram has the potential to improve initial treatment planning and patient counseling.
    Abdominal Imaging 12/2014; 40(6). DOI:10.1007/s00261-014-0337-0 · 1.63 Impact Factor
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    ABSTRACT: The objective of this study is to identify computed tomography (CT) features of local recurrence (LR) after stereotactic body radiation therapy (SBRT) for lung cancer. Two hundred eighteen patients underwent SBRT for lung cancer from January 1st, 2006 to March 1st, 2011. Signs of LR recorded: opacity with new bulging margin, opacification of air bronchograms, enlarging pleural effusion, new or enlarging mass, and increased lung density at the treatment site. A new bulging margin at the treatment site was the only feature significantly associated with LR (P<.005). Most CT features classically associated with LR following conventional radiation therapy are unreliable for predicting LR following SBRT. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinical Imaging 12/2014; 39(2). DOI:10.1016/j.clinimag.2014.12.005 · 0.81 Impact Factor
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    ABSTRACT: Objective: The purpose of this study was to evaluate the usefulness and diagnostic performance of a 5-point standardized diagnostic certainty lexicon for reporting the likelihood of extracapsular extension (ECE) of prostate cancer on routine staging prostate MRI. Materials and methods: This study was a retrospective analysis of routine clinical prostate MRI reports before (254 patients) and after (211 patients) the implementation of a 5-point diagnostic certainty lexicon. Whole-mount step-section pathology of the radical prostatectomy specimens served as the reference standard. The terms used to express diagnostic certainty regarding ECE on standard-of-care MRI and the presence of ECE on pathology were compared between the two periods. ROC analysis was used to evaluate the diagnostic accuracy of the 5-point certainty lexicon for detecting ECE. Results: Before the implementation of the certainty lexicon, radiologists used 38 different terms to express the levels of certainty regarding the presence of ECE on MRI. Afterward, they adhered to the lexicon's predefined 5-point terminology in 85.3% of cases. The 5-point certainty lexicon used on MRI reports had an AUC of 0.852 for diagnosing ECE. Conclusion: The implementation of a lexicon of diagnostic certainty dramatically reduced the number of expressions used by radiologists to indicate their levels of diagnostic certainty. The accuracy of the certainty lexicon for diagnosing ECE on standard-of-care prostate MRI is similar to previously reported accuracy values for the diagnosis of ECE by MRI. Thus, the use of such a lexicon might prevent miscommunication and help referring clinicians reliably incorporate radiologists' assessments into clinical decision making.
    American Journal of Roentgenology 12/2014; 203(6):W651-7. DOI:10.2214/AJR.14.12654 · 2.73 Impact Factor
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    ABSTRACT: Objective: The purpose of this retrospective study was to measure interobserver agreement in the assessment of malignant imaging features of intraductal papillary mucinous neoplasms (IPMNs) on MDCT. Materials and methods: Pancreatic protocol CT studies were reviewed for 84 patients with resected IPMNs. Maximal diameter of the dominant cyst, presence of a mural nodule, presence of a solid component, and diameters of the main pancreatic duct (MPD) and common bile duct (CBD) were measured by four radiologists independently. In each patient, the IPMN was classified into one of three types: main duct, branch duct, or mixed IPMN. Interobserver agreement of lesion features was examined using the intraclass correlation coefficient (ICC) for continuous features and Fleiss kappa for categorical features. Results: The final dataset included 55 branch duct IPMNs, nine main duct IPMNs, and 20 mixed IPMNs. Moderate agreement (ĸ = 0.458; 95% CI, 0.345-0.564) was observed in assigning branch duct, main duct, or mixed IPMN subtypes. Measurement agreement was substantial to excellent for dominant cyst (ICC = 0.852; 95% CI, 0.777-0.907), MPD (0.753, 0.655-0.837), and CBD (0.608, 0.463-0.724) but only fair to moderate for the detection of the presence of mural nodule (ĸ = 0.284, 0.125-0.432) or solid component (ĸ = 0.405, 0211-0.577). Conclusion: Substantial to excellent interobserver agreement in the measurement of cyst diameter, MPD, and CBD support their use for characterizing malignant features of IPMN on MDCT. However, the subjective interpretation of the presence of solid components and mural nodules by individual radiologists was more variable.
    American Journal of Roentgenology 11/2014; 203(5):973-9. DOI:10.2214/AJR.13.11490 · 2.73 Impact Factor
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    ABSTRACT: To evaluate if computed tomographic (CT) features of intradiverticular bladder cancer can predict clinical outcome. Retrospective study of 34 patients with intradiverticular bladder cancer. Two radiologists independently evaluated all CT exams. CT tumor length and width were significantly associated with survival for both readers [hazard ratios (HRs) 1.31-1.62, P<.001-.043]. No other tumor features were significantly associated with survival. The interreader agreement for the assessment of CT features was fair to substantial (k=0.34-0.78, concordance correlation coefficient=0.56-0.66). There was no association between transurethral resection pathology stage and survival (HR 2.10, P=.21). In patients with intradiverticular bladder cancer, the tumor length and width measured on the pretreatment CT predicted survival. Copyright © 2014 Elsevier Inc. All rights reserved.
    Clinical Imaging 10/2014; 39(1). DOI:10.1016/j.clinimag.2014.10.004 · 0.81 Impact Factor
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    ABSTRACT: Objective To evaluate the ability of an abbreviated breast magnetic resonance imaging (MRI) protocol, consisting of a precontrast T1 weighted (T1 W) image and single early post-contrast T1 W image, to detect breast carcinoma. Materials and Methods A HIPAA compliant Institutional Review Board approved review of 100 consecutive breast MRI examinations in patients with biopsy proven unicentric breast carcinoma. 79% were invasive carcinomas and 21% were ductal carcinoma in situ. Four experienced breast radiologists, blinded to carcinoma location, history and prior examinations, assessed the abbreviated protocol evaluating only the first post-contrast T1 W image, post-processed subtracted first post-contrast and subtraction maximum intensity projection images. Detection and localization of tumor were compared to the standard full diagnostic examination consisting of 13 pre-contrast, post-contrast and post-processed sequences. Results All 100 cancers were visualized on initial reading of the abbreviated protocol by at least one reader. The mean sensitivity for each sequence was 96% for the first post-contrast sequence, 96% for the first post-contrast subtraction sequence and 93% for the subtraction MIP sequence. Within each sequence, there was no significant difference between the sensitivities among the 4 readers (p = 0.471, p = 0.656, p = 0.139). Mean interpretation time was 44 seconds (range 11 to 167 seconds). The abbreviated imaging protocol could be performed in approximately 10-15 minutes, compared to 30-40 minutes for the standard protocol. Conclusion An abbreviated breast MRI protocol allows detection of breast carcinoma. One pre and post-contrast T1 W sequence may be adequate for detecting breast carcinoma. These results support the possibility of refining breast MRI screening protocols.
    European Journal of Radiology 10/2014; 84(1). DOI:10.1016/j.ejrad.2014.10.004 · 2.37 Impact Factor
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    ABSTRACT: Background Treatment with radiotherapy (RT) is associated with an increased risk of second malignant neoplasms (SMNs) in childhood cancer survivors; it is unclear how treatment with intensity-modulated radiation therapy (IMRT) impacts this risk. We provide the first report of SMN risk in a cohort of childhood cancer survivors treated with IMRT.ProcedureRetrospective review of patients ≤21 years of age treated with IMRT at Memorial Sloan Kettering Cancer Center between December 1998 and February 2009. Eligible patients survived at least 5 years from IMRT initiation. The risk of SMN was assessed via standardized incidence ratios (SIRs) and excess absolute risk (EAR). The cumulative incidence was estimated using methods for competing risks.ResultsAmong 242 patients, six developed SMNs: four developed second solid cancers (all within the radiation field), and two developed myelodysplastic syndrome. Median time from IMRT initiation to a second solid cancer was 7.2 years (range, 6.8–9.5), with a 10-year cumulative incidence of 3.3% (95% confidence interval [CI], 1.0–7.8%), SIR of 11.4 (95% CI, 3.1–29.2) and EAR of 1.8 per 1,000 person-years (95% CI, −0.1 to 3.8).Conclusions Longer follow-up is required to determine how the risk of SMN after IMRT compares to other modalities of radiation treatment, such as proton therapy. This study provides a preliminary report, which will serve as a baseline for future longitudinal analyses of SMN risk after IMRT. Pediatr Blood Cancer © 2014 Wiley Periodicals, Inc.
    Pediatric Blood & Cancer 10/2014; 62(2). DOI:10.1002/pbc.25285 · 2.39 Impact Factor

Publication Stats

3k Citations
553.25 Total Impact Points


  • 2004-2015
    • Memorial Sloan-Kettering Cancer Center
      • Epidemiology & Biostatistics Group
      New York, New York, United States
    • Harvard University
      • Department of Biostatistics
      Cambridge, MA, United States
  • 2011
    • Cornell University
      Итак, New York, United States
  • 2010
    • Brown University
      Providence, Rhode Island, United States
  • 2009
    • Columbia University
      New York, New York, United States
  • 2002
    • University of Washington Seattle
      • Department of Biostatistics
      Seattle, Washington, United States