Nola M Hylton

Publications (3)8.5 Total impact

• Article: Accuracy and Interpretation Time of Computer-Aided Detection Among Novice and Experienced Breast MRI Readers.

  Constance D Lehman, Jeffrey D Blume, Wendy B Demartini, Nola M Hylton, Benjamin Herman, Mitchell D Schnall
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  ABSTRACT: OBJECTIVE. The purpose of this study was to compare the diagnostic accuracy and interpretation times of breast MRI with and without use of a computer-aided detection (CAD) system by novice and experienced readers. SUBJECTS AND METHODS. A reader study was undertaken with 20 radiologists, nine experienced and 11 novice. Each radiologist participated in two reading sessions spaced 6 months apart that consisted of 70 cases (27 benign, 43 malignant), read with and without CAD assistance. Sensitivity, specificity, negative predictive value, positive predictive value, and overall accuracy as measured by the area under the receiver operating characteristic curve (AUC) were reported for each radiologist. Accuracy comparisons across use of CAD and experience level were examined. Time to interpret and report on each case was recorded. RESULTS. CAD improved sensitivity for both experienced (AUC, 0.91 vs 0.84; 95% CI on the difference, 0.04, 0.11) and novice readers (AUC, 0.83 vs 0.77; 95% CI on the difference, 0.01, 0.10). The increase in sensitivity was statistically higher for experienced readers (p = 0.01). Diagnostic accuracy, measured by AUC, for novices without CAD was 0.77, for novices with CAD was 0.79, for experienced readers without CAD was 0.80, and for experienced readers with CAD was 0.83. An upward trend was noticed, but the differences were not statistically significant. There were no significant differences in interpretation times. CONCLUSION. MRI sensitivity improved with CAD for both experienced readers and novices with no overall increase in time to evaluate cases. However, overall accuracy was not significantly improved. As the use of breast MRI with CAD increases, more attention to the potential contributions of CAD to the diagnostic accuracy of MRI is needed.
  American Journal of Roentgenology 06/2013; 200(6):W683-W689. · 2.78 Impact Factor
• Article: Locally advanced breast cancer: MR imaging for prediction of response to neoadjuvant chemotherapy--results from ACRIN 6657/I-SPY TRIAL.

  Nola M Hylton, Jeffrey D Blume, Wanda K Bernreuter, Etta D Pisano, Mark A Rosen, Elizabeth A Morris, Paul T Weatherall, Constance D Lehman, Gillian M Newstead, Sandra Polin, Helga S Marques, Laura J Esserman, Mitchell D Schnall
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  ABSTRACT: To compare magnetic resonance (MR) imaging findings and clinical assessment for prediction of pathologic response to neoadjuvant chemotherapy (NACT) in patients with stage II or III breast cancer. The HIPAA-compliant protocol and the informed consent process were approved by the American College of Radiology Institutional Review Board and local-site institutional review boards. Women with invasive breast cancer of 3 cm or greater undergoing NACT with an anthracycline-based regimen, with or without a taxane, were enrolled between May 2002 and March 2006. MR imaging was performed before NACT (first examination), after one cycle of anthracyline-based treatment (second examination), between the anthracycline-based regimen and taxane (third examination), and after all chemotherapy and prior to surgery (fourth examination). MR imaging assessment included measurements of tumor longest diameter and volume and peak signal enhancement ratio. Clinical size was also recorded at each time point. Change in clinical and MR imaging predictor variables were compared for the ability to predict pathologic complete response (pCR) and residual cancer burden (RCB). Univariate and multivariate random-effects logistic regression models were used to characterize the ability of tumor response measurements to predict pathologic outcome, with area under the receiver operating characteristic curve (AUC) used as a summary statistic. Data in 216 women (age range, 26-68 years) with two or more imaging time points were analyzed. For prediction of both pCR and RCB, MR imaging size measurements were superior to clinical examination at all time points, with tumor volume change showing the greatest relative benefit at the second MR imaging examination. AUC differences between MR imaging volume and clinical size predictors at the early, mid-, and posttreatment time points, respectively, were 0.14, 0.09, and 0.02 for prediction of pCR and 0.09, 0.07, and 0.05 for prediction of RCB. In multivariate analysis, the AUC for predicting pCR at the second imaging examination increased from 0.70 for volume alone to 0.73 when all four predictor variables were used. Additional predictive value was gained with adjustments for age and race. MR imaging findings are a stronger predictor of pathologic response to NACT than clinical assessment, with the greatest advantage observed with the use of volumetric measurement of tumor response early in treatment.
  Radiology 06/2012; 263(3):663-72. · 5.73 Impact Factor
• Chapter: Breast Magnetic Resonance Imaging Techniques

  Nola M. Hylton, Elizabeth A. Morris, Laura Liberman
  12/2004: pages 7-14;