Chaya S Moskowitz

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

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Publications (106)415.56 Total impact

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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; · 1.73 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;
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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. · 2.74 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. · 2.74 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; · 2.16 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; · 0.60 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; · 2.35 Impact Factor
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    ABSTRACT: Introduction 5% of lung adenocarcinomas harbor rearrangements of the Anaplastic Lymphoma Kinase (ALK) gene. This study compared Computed Tomography (CT) imaging features in patients with ALK rearrangements and those with EGFR mutations. Material/Methods 30 patients with ALK rearrangements were studied. 97 patients with Epidermal Growth Factor Receptor (EGFR) mutations were used as controls. Features assessed included size and location of thoracic lymphadenopathy, and the size, contour, consistency and location of the primary tumor. Results 127 lung adenocarcinomas were examined. 30 (24%) tumors harbored ALK rearrangements, 97 (76%) tumors harbored EGFR mutations. ALK tumors had larger thoracic lymphadenopathy than the control group (p = 0.005). Both readers identified 17 (57%) patients in the ALK group with lymph nodes > 1.5 cm. Reader 1 identified 19 (20%) patients in the EGFR group with lymph nodes > 1.5 cm, and reader 2 identified 18 (19%) (kappa 0.969). Patients with ALK rearrangements were more likely to have multifocal lymphadenopathy. Reader 1 identified 22 (73%) ALK patients versus 35 (36%) EGFR patients with multifocal thoracic nodal enlargement, while reader 2 identified 20 (67%) ALK patients versus 30 (31%) EGFR patients (kappa 0.953). 92% of ALK positive lesions were solid. Conclusion ALK positive lung adenocarcinomas are more likely than EGFR mutant lung adenocarcinomas to be associated with larger volume, multifocal thoracic lymphadenopathy. While routine testing for ALK should be standard, the presence of such characteristics in a solid tumor should further prompt testing for ALK rearrangement.
    Lung Cancer 09/2014; · 3.74 Impact Factor
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    ABSTRACT: Our aim was to evaluate clinical management and outcomes in cancer patients who had an indeterminate Computed Tomographic Pulmonary Angiogram (CTPA) for the assessment of pulmonary embolus. We reviewed 1000 CTPA studies and identified 251 limited (indeterminate) CTPA. We examined follow-up imaging and reviewed clinical management decisions and any positive diagnosis of venous thromboembolic disease (VTE) within the subsequent 90 days. 60 patients (23.9%) had a follow-up imaging study within five days. 8 had a positive study for VTE disease within 5 days. 3 patients (1.2%) were placed on anticoagulation therapy based on the limited CT result.
    Clinical Imaging 09/2014; · 0.60 Impact Factor
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    ABSTRACT: The aim of this study was to assess the diagnostic performance of pre-treatment 3-Tesla (3T) multiparametric magnetic resonance imaging (mpMRI) for predicting Gleason score (GS) downgrading after radical prostatectomy (RP) in patients with GS 3 + 4 prostate cancer (PCa) on biopsy.
    European Radiology 08/2014; · 4.34 Impact Factor
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    ABSTRACT: Purpose Contrast enhanced digital mammography (CEDM) uses low energy and high energy exposures to produce a subtracted contrast image. It is currently performed with a standard full-field digital mammogram (FFDM). The purpose is to determine if the low energy image performed after intravenous iodine injection can replace the standard FFDM. Methods And Materials: In an IRB approved HIPAA compatible study, low-energy CEDM images of 170 breasts in 88 women (ages 26-75; mean 50.3;) undergoing evaluation for elevated risk or newly diagnosed breast cancer were compared to standard digital mammograms performed within 6 months. Technical parameters including posterior nipple line (PNL) distance, compression thickness, and compression force on the MLO projection were compared. Mammographic findings were compared qualitatively and quantitatively. Mixed linear regression using generalized estimating equation (GEE) method was performed. Intraclass correlation coefficients (ICC) with 95% confidence interval (95%CI) were estimated to assess agreement. Results No statistical difference was found in the technical parameters compression thickness, PNL distance, compression force (p-values: 0.767, 0.947 0.089). No difference was found in the measured size of mammographic findings (p-values 0.982-0.988). Grouped calcifications had a mean size/extent of 2.1 cm (SD 0.6) in the low-energy contrast images, and a mean size/extent of 2.2 cm (SD 0.6) in the standard digital mammogram images. Masses had a mean size of 1.8 cm (SD 0.2) in both groups. Calcifications were equally visible on both CEDM and FFDM. Conclusion Low energy CEDM images are equivalent to standard FFDM despite the presence of intravenous iodinated contrast. Low energy CEDM images may be used for interpretation in place of the FFDM, thereby reducing patient dose.
    European Journal of Radiology 08/2014; · 2.16 Impact Factor
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    ABSTRACT: The aim of the study was to identify preoperative computed tomography (CT) imaging characteristics that correlated with surgical resectability.
    Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 07/2014; 9(7):1023-30. · 4.55 Impact Factor
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    ABSTRACT: Before developing a survivorship care plan (SCP) that colorectal cancer (CRC) survivors will value, understanding the informational needs of CRC survivors is critical.
    Journal of Oncology Practice 06/2014;
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    ABSTRACT: Purpose To investigate whether tumor volume derived from apparent diffusion coefficient (ADC) maps (VolumeADC) and tumor mean ADC value (ADCmean) are independent predictors of prostate tumor Gleason score (GS). Materials and Methods Tumor volume and GS were recorded from whole-mount histopathology for 131 men (median age, 60) who underwent endorectal diffusion-weighted magnetic resonance imaging for local staging of prostate cancer before prostatectomy. VolumeADC and ADCmean were derived from ADC maps and correlated with histopathologic tumor volume and GS. Uni- and multivariate analyses were performed to evaluate prediction of tumor aggressiveness. Areas under receiver-operating-characteristics curves (AUCs) were calculated to evaluate the performance of VolumeADC and ADCmean in discriminating tumors of GS 6 and GS ≥7. Results Histopathology identified 116 tumor foci >0.5 mL. VolumeADC correlated significantly with histopathologic tumor volume (ρ=0.683). The correlation increased with increasing GS (ρ=0.453 for GS 6 tumors; ρ=0.643 for GS 7 tumors; ρ=0.980 for GS≥8 tumors). Both VolumeADC (ρ=0.286) and ADCmean (ρ=-0.309) correlated with GS. At univariate analysis, both VolumeADC (p=0.0325) and ADCmean (p=0.0033) could differentiate GS=6 from GS≥7 tumor foci. However, at multivariate analysis, only ADCmean (p=0.0156) was a significant predictor of tumor aggressiveness (i.e., GS 6 vs. GS ≥7). For differentiating GS 6 from GS≤7 tumors, AUCs were 0.644 and 0.704 for VolumeADC and ADCmean, respectively, and 0.749 for both parameters combined. Conclusion In patients with prostate cancer, ADCmean is an independent predictor of tumor aggressiveness, but VolumeADC is not. The latter parameter adds little to the ADCmean in predicting tumor Gleason score.
    Clinical Cancer Research 05/2014; · 8.19 Impact Factor
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    ABSTRACT: The risk of breast cancer is high in women treated for a childhood cancer with chest irradiation. We sought to examine variations in risk resulting from irradiation field and radiation dose. We evaluated cumulative breast cancer risk in 1,230 female childhood cancer survivors treated with chest irradiation who were participants in the CCSS (Childhood Cancer Survivor Study). Childhood cancer survivors treated with lower delivered doses of radiation (median, 14 Gy; range, 2 to 20 Gy) to a large volume (whole-lung field) had a high risk of breast cancer (standardized incidence ratio [SIR], 43.6; 95% CI, 27.2 to 70.3), as did survivors treated with high doses of delivered radiation (median, 40 Gy) to the mantle field (SIR, 24.2; 95% CI, 20.7 to 28.3). The cumulative incidence of breast cancer by age 50 years was 30% (95% CI, 25 to 34), with a 35% incidence among Hodgkin lymphoma survivors (95% CI, 29 to 40). Breast cancer-specific mortality at 5 and 10 years was 12% (95% CI, 8 to 18) and 19% (95% CI, 13 to 25), respectively. Among women treated for childhood cancer with chest radiation therapy, those treated with whole-lung irradiation have a greater risk of breast cancer than previously recognized, demonstrating the importance of radiation volume. Importantly, mortality associated with breast cancer after childhood cancer is substantial.
    Journal of Clinical Oncology 04/2014; · 17.88 Impact Factor
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    ABSTRACT: To determine the accuracy of 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET) in the detection of advanced colorectal adenomas. In this retrospective study, patient consent was waived by the institutional review board. Combined FDG whole-body PET and computed tomography (CT) images (2000-2009) were re-read and compared with reports of complete colonoscopy performed up to 1 year after the PET examination. One or more areas of focal colonic uptake greater than the background indicated a positive PET result, irrespective of standardized uptake value (SUV). Lesion and patient-level measures of PET accuracy with their 95% confidence intervals (CI) were calculated. One hundred and eighty patients undergoing colonoscopy with or without biopsy underwent PET within 1 year prior to colonoscopy. There were 92 women and 88 men (mean age 63.3 years). Indications for PET were extent of disease and treatment response in all cases. Patients had non-colorectal cancer (n = 160) or colon cancer (n = 20). One hundred and fourteen FDG-avid lesions were present. In 33, there was no colonoscopic correlate. Two hundred and fifty-eight biopsies revealed tubular adenomas (n = 91, one with intra-mucosal cancer), tubulovillous adenomas (n = 28), adenocarcinoma (n = 37), inflammation (n = 22), hyperplastic polyps (n = 54), serrated adenoma (n = 5), metastatic disease (n = 5), normal/benign mucosa or submucosal benign tumors (n = 13) or miscellaneous (n = 3). Per-lesion performance of PET showed a sensitivity of 38% (95% CI: 31-46; 64/167) for all adenomas and carcinomas and 58% (95% CI: 49-67; 57/98) for lesions ≥10 mm. At the patient level, for all adenomas and carcinomas the sensitivity was 54% (95% CI: 44-63; 61/113), specificity 100% (pre-defined), positive predictive value (PPV) 100% (pre-defined), and negative predictive value (NPV) 56% (95% CI: 47-65; 67/119). For patients with advanced adenoma, PET sensitivity was 49% (95% CI: 35-63; 26/53) specificity, 100%, PPV 100% and NPV 82% (95% CI: 76-88; 127/154). Five of 37 adenocarcinomas were not detected, one of which was mucinous at histology. FDG PET detected most cancers, but only identified one-half of patients harbouring advanced adenomas. Based on the data, PET cannot be relied upon to accurately identify patients with advanced adenoma.
    Clinical Radiology 02/2014; · 1.66 Impact Factor
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    ABSTRACT: Purpose To evaluate the relationship between prostate cancer aggressiveness and histogram-derived apparent diffusion coefficient (ADC) parameters obtained from whole-lesion assessment of diffusion-weighted magnetic resonance (MR) imaging of the prostate and to determine which ADC metric may help best differentiate low-grade from intermediate- or high-grade prostate cancer lesions. Materials and Methods The institutional review board approved this retrospective HIPAA-compliant study of 131 men (median age, 60 years) who underwent diffusion-weighted MR imaging before prostatectomy for prostate cancer. Clinically significant tumors (tumor volume > 0.5 mL) were identified at whole-mount step-section histopathologic examination, and Gleason scores of the tumors were recorded. A volume of interest was drawn around each significant tumor on ADC maps. The mean, median, and 10th and 25th percentile ADCs were determined from the whole-lesion histogram and correlated with the Gleason score by using the Spearman correlation coefficient (ρ). The ability of each parameter to help differentiate tumors with a Gleason score of 6 from those with a Gleason score of at least 7 was assessed by using the area under the receiver operating characteristic curve (Az). Results In total, 116 clinically significant lesions (89 in the peripheral zone, 27 in the transition zone) were identified in 85 of the 131 patients (65%). Forty-six patients did not have a clinically significant lesion. For mean ADC, median ADC, 10th percentile ADC, and 25th percentile ADC, the Spearman ρ values for correlation with Gleason score were -0.31, -0.30, -0.36, and -0.35, respectively, whereas the Az values for differentiating lesions with a Gleason score of 6 from those with a Gleason score of at least 7 were 0.704, 0.692, 0.758, and 0.723, respectively. The Az of 10th percentile ADC was significantly higher than that of the mean ADC for all lesions and peripheral zone lesions (P = .0001). Conclusion When whole-lesion histograms were used to derive ADC parameters, 10th percentile ADC correlated with Gleason score better than did other ADC parameters, suggesting that 10th percentile ADC may prove to be optimal for differentiating low-grade from intermediate- or high-grade prostate cancer with diffusion-weighted MR imaging. © RSNA, 2013.
    Radiology 12/2013; · 6.21 Impact Factor
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    ABSTRACT: PURPOSE To determine if suspicious breast MRI lesions proven to represent invasive ductal carcinoma with an ultrasound correlate are of different histological grade compared with ultrasound occult lesions. METHOD AND MATERIALS Institutional review board approved retrospective study of 310 MRI examinations performed between 2008 and 2011 yielded 350 suspicious lesions for which biopsy was recommended. Subsequent high resolution targeted ultrasound was performed and histopathological grade of carcinomas was recorded as I (low), II (intermediate) or III (high). Statistical analysis was performed applying the Fisher's exact test ,Kruskal-Wallis test and exact Wilcoxon rank sum test. RESULTS Targeted ultrasound demonstrated a correlate in 181/350 (52%) suspicious MRI lesions yielding 63/181 (35%) malignant lesions. The remaining 169 (48%) lesions which were sonographically occult, yielded 25/169 (15%) malignant lesions. Sonographic correlates were seen for 72% (63/88) of malignant lesions. Of these, 87% (55/63) were invasive carcinomas and 13% (8/63) were ductal carcinomas in situ. Histological grade was available for 46 invasive ductal carcinomas with ultrasound correlate (3(6.5%),13(28.3%) and 30(65.2%) were histological grade I,II and III, respectively)and 8 without correlate (4(50%),3(37.5%) and 1(12.5%) were histological grade I,II and III, respectively). There was no statistically significant difference in the size of tumors with or without an ultrasound correlate (p=0.163). In the group with an ultrasound correlate, no significant difference was observed in tumor size between the recorded histological grades (p=0.052). A grade III tumor was more likely to be present in the group with an ultrasound correlate (p <0.001). CONCLUSION When a suspicious breast MRI lesion has an ultrasound correlate, it is more likely to represent invasive carcinoma of higher histological grade. CLINICAL RELEVANCE/APPLICATION The presence of an ultrasound correlate for a suspicious breast MRI lesion may indicate a more aggressive cancer.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: PURPOSE To compare the low energy contrast-enhanced digital mammography (CEDM) image done after intravenous iodine injection to standard mammography. METHOD AND MATERIALS This was an IRB approved HIPAA compatible study. Low-energy CEDM images of 170 breasts in 88 patients (6 unilateral mastectomies) were compared to standard digital mammograms performed within 6 months. Images were qualitatively assessed side-by-side by a non-blinded reader. The following parameters were tabulated: posterior nipple line to pectoral muscle (PNL) distance; compression force on the MLO projection; compression thickness on the MLO projection. Wherever possible, the following additional parameters were tabulated: the number or extent of dominant calcifications; the size of masses, asymmetries, or distortions. Parameters were summarized using median, range, mean and standard deviation (SD). A mixed linear regression using a generalized estimating equation (GEE) method was performed to examine whether each parameter was different between two imaging techniques. Fisher’s exact test was used to compare the count of calcifications. To assess agreement between two image techniques, intra class correlation coefficient (ICC) along with the 95% confidence interval (95%CI) were estimated for continuous measurements, and kappa statistics were estimated for the count of calcifications. RESULTS No qualitative difference or statistical difference was found in any of the image parameters between the two imaging techniques. The two techniques had excellent agreement on compression thickness; PNL distance; calcification size or extent; and mass, asymmetry or distortion size (ICC range from 0.817-0.997). The count of calcifications perfectly agreed between two image techniques (kappa = 1.000). There was slight agreement on compression force (ICC = 0.287). CONCLUSION The same equipment and technical settings are used in both studies, and the Kedge of iodine is above the kV of the low energy CEDM. As expected, low energy CEDM images demonstrate excellent agreement with standard digital mammography despite the prior administration of intravenous contrast, and could be used for routine breast imaging. CLINICAL RELEVANCE/APPLICATION Since there is no substantial difference between the images, low energy CEDM could replace the standard mammogram.
    Radiological Society of North America 2013 Scientific Assembly and Annual Meeting; 12/2013
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    ABSTRACT: Eighteen percent of incident malignancies in the United States are a second (or subsequent) cancer. Second primary neoplasms (SPNs), particularly solid tumors, are a major cause of mortality and serious morbidity among cancer survivors successfully cured of their first cancer. Multiple etiologies may lead to a cancer survivor subsequently being diagnosed with an SPN, including radiotherapy for the first cancer, unhealthy lifestyle behaviors, genetic factors, aging, or an interaction between any of these factors. In this article, we discuss these factors and synthesize this information for use in clinical practice, including preventive strategies and screening recommendations for SPNs.
    Seminars in Oncology 12/2013; 40(6):676-689. · 3.94 Impact Factor

Publication Stats

2k Citations
415.56 Total Impact Points


  • 2004–2014
    • Memorial Sloan-Kettering Cancer Center
      • • Epidemiology & Biostatistics Group
      • • Department of Radiology
      • • Department of Medical Physics
      • • Department of Medicine
      New York City, New York, United States
    • Children's Oncology Group
      Monrovia, California, United States
    • Harvard University
      • Department of Biostatistics
      Cambridge, MA, United States
  • 2013
    • The Washington Hospital
      Washington, Pennsylvania, United States
  • 2012
    • Mount Sinai Medical Center
      New York City, New York, United States
  • 2010
    • University of Cambridge
      • Department of Radiology
      Cambridge, ENG, United Kingdom
    • Brown University
      Providence, Rhode Island, United States
  • 2009
    • Columbia University
      • Division of Oral Epidemiology and Biostatistic
      New York City, New York, United States
  • 2002
    • University of Southern California
      • Department of Preventive Medicine
      Los Angeles, CA, United States
    • University of Washington Seattle
      • Department of Biostatistics
      Seattle, Washington, United States