Search

To describe the rate and timeliness of diagnostic resolution after an abnormal screening mammogram in the ACR's National Mammography Database. Abnormal screening mammograms (BI-RADS 0 assessment) in the National Mammography Database from January 1, 2008, to December 31, 2021, were retrospectively identified. The rates and timeliness of follow-up with diagnostic evaluation and biopsy were assessed and compared across patient and facility demographics. Among the 2,874,310 screening mammograms reported as abnormal, follow-up was documented in 66.4% (n = 1,909,326). Lower follow-up rates were observed in younger women (59.4% in women < 30 years, 63.2% in women 30-39 years), Black (57.4%) and American Indian (59.5%) women, and women with no breast cancer family history (63.0%). The overall median time to diagnostic evaluation was 9 days. Longer median diagnostic evaluation time was noted in Black (14 days), other or mixed race (14 days), and Hispanic women (13 days). Of the 318,977 recalled screening mammograms recommended for biopsy, 238,556 (74.8%) biopsies were documented. Lower biopsy rates were noted in older women (71.5% in women aged ≥80) and Black (71.5%) and American Indian (52.2%) women. The overall median time from diagnostic evaluation to biopsy was 21 days. Longer median biopsy time was noted in older (23 days aged ≥80), Black (25 days), mixed or other race (26 days), and Hispanic women (23 days), and rural (24 days) or community hospital affiliated facilities (22 days). There is variability in the rates and timeliness of diagnostic evaluation and biopsy in women with abnormal screening mammogram. Subsets of women and facilities could benefit from targeted interventions to promote timely diagnostic resolution and biopsy after an abnormal screening mammogram. [Display omitted] [ABSTRACT FROM AUTHOR] more...

Hospitals are facing difficulties in predicting, evaluating, and managing cost-affecting parameters in patient treatments. Inaccurate cost prediction leads to a deficit in operational revenue. This study aims to determine the ability of Machine Learning (ML) algorithms to predict the cost of care in bariatric and metabolic surgery and develop a predictive tool for improved cost analysis. 602 patients who underwent bariatric and metabolic surgery at Wetzikon hospital from 2013 to 2019 were included in the study. Multiple variables including patient factors, surgical factors, and post-operative complications were tested using a number of predictive modeling strategies. The study was registered under Req 2022–00659 and approved by an institutional review board. The cost was defined as the sum of all costs incurred during the hospital stay, expressed in CHF (Swiss Francs). The data was preprocessed and split into a training set (80%) and a test set (20%) to build and validate models. The final model was selected based on the mean absolute percentage error (MAPE). The Random Forest model was found to be the most accurate in predicting the overall cost of bariatric surgery with a mean absolute percentage error of 12.7. The study provides evidence that the Random Forest model could be used by hospitals to help with financial calculations and cost-efficient operation. However, further research is needed to improve its accuracy. This study serves as a proof of principle for an efficient ML-based prediction tool to be tested on multi-center data in future phases of the study. [ABSTRACT FROM AUTHOR] more...

Purpose: The aim of this study was to quantify the initial decline and subsequent rebound in breast cancer screening metrics throughout the coronavirus disease 2019 (COVID-19) pandemic.Methods: Screening and diagnostic mammographic examinations, biopsies performed, and cancer diagnoses were extracted from the ACR National Mammography Database from March 1, 2019, through May 31, 2021. Patient (race and age) and facility (regional location, community type, and facility type) demographics were collected. Three time periods were used for analysis: pre-COVID-19 (March 1, 2019, to May 31, 2019), peak COVID-19 (March 1, 2020, to May 31, 2020), and COVID-19 recovery (March 1, 2021, to May 31, 2021). Analysis was performed at the facility level and overall between time periods.Results: In total, 5,633,783 screening mammographic studies, 1,282,374 diagnostic mammographic studies, 231,390 biopsies, and 69,657 cancer diagnoses were analyzed. All peak COVID-19 metrics were less than pre-COVID-19 volumes: 36.3% of pre-COVID-19 for screening mammography, 57.9% for diagnostic mammography, 47.3% for biopsies, and 48.7% for cancer diagnoses. There was some rebound during COVID-19 recovery as a percentage of pre-COVID-19 volumes: 85.3% of pre-COVID-19 for screening mammography, 97.8% for diagnostic mammography, 91.5% for biopsies, and 92.0% for cancer diagnoses. Across various metrics, there was a disproportionate negative impact on older women, Asian women, facilities in the Northeast, and facilities affiliated with academic medical centers.Conclusions: COVID-19 had the greatest impact on screening mammography volumes, which have not returned to pre-COVID-19 levels. Cancer diagnoses declined significantly in the acute phase and have not fully rebounded, emphasizing the need to increase outreach efforts directed at specific patient population and facility types. [ABSTRACT FROM AUTHOR] more...

Obturator hernias are rare, occur mainly in slender people and predominantly in females. Underlying pathology of the obturator hernia is a weakening of the obturator membrane. The obturator hernia is situated between the pubic and ischial bones and is therefore clinically occult. Patients predominantly present with symptoms of bowel obstruction, but can also present with sensory disturbance, leg pain and hip pain. Due to the usually delayed diagnosis, the obturator hernia is associated with increased morbidity and mortality. A 71-year-old female patient with hip pain underwent a protracted diagnostic work-up and was referred to the surgical department by the treating orthopedic surgeon. An incarcerated obturator hernia with a fistula in the adductor ligament was finally diagnosed via CT. The operation included laparoscopic reduction, hernia repair, open small bowel segment resection, local surgical exploration, lavage and antibiotic treatment. The primary hernia repair was performed by direct suture due to the contamination, and a post-primary mesh repair was indicated. However, after complete recovery and no remaining symptoms, the patient refused this despite the indication for definitive laparoscopic hernia repair. Hip pain can have multiple causes. Taking physical characteristics into account can lead to the correct diagnostic pathway. The CT scan revealed the fistula which led to the laparoscopic surgery. Due to the intestinal damage and contamination, the surgical steps were adapted. Obturator hernias should be considered as a reason for atypical symptoms in slender, older patients. Adequate surgical management can be chosen after correct diagnosis. • Obturator hernias predominantly occur in slender elderly individuals. • Obturator hernias often cause bowel obstruction but can also lead to hip or leg pain. • CT scans diagnose obturator hernias; early detection reduces complications. • Laparoscopic mesh repair is preferred for obturator hernias due to lower recurrence. [ABSTRACT FROM AUTHOR] more...

Purpose: The National Mammography Database (NMD) contains nearly 20 million examinations from 693 facilities; it is the largest information source for use and effectiveness of breast imaging in the United States. NMD collects demographic, imaging, interpretation, biopsy, and basic pathology results, enabling facility and physician comparison for quality improvement. However, NMD lacks treatment and clinical outcomes data. The network of state cancer registries (CRs) contains detailed pathologic, treatment, and clinical outcomes data. This pilot study assessed electronic linkage of NMD and CR data at a multicenter institution as proof of concept.Materials and Methods: We obtained Quality Oversight Committee approval for this retrospective study. Data of patients diagnosed with breast cancer in 2014 and 2015 were retrieved from our NMD-approved radiology information system (RIS) and matched with reportable patients in our CR using social security number (SSN), first name (fname), last name (lname), and date of birth (DOB). Matching was repeated without SSN. Percentage and reasons for mismatch were evaluated.Results: The RIS query identified 1,316 patients. CR linkage was 99.2% successful (n = 1,305 of 1,316) using SSN, fname, lname, and DOB. Eleven mismatches included four CR case-finding failures, one NMD fname error, five nonreportable in the CR, and one with correct identifiers in both databases. Without SSN, linkage was 97.3% successful (n = 1,281 of 1,316); name errors accounted for 19 and DOB accounted for 5 additional mismatches.Conclusion: Using common data elements, linkage between the NMD and state CRs may be feasible and could provide critical outcomes information to advance accurate assessment of breast imaging in the United States. [ABSTRACT FROM AUTHOR] more...

Rationale and Objectives: Evidence is inconsistent about whether radiologists' interpretive performance on a screening mammography test set reflects their performance in clinical practice. This study aimed to estimate the correlation between test set and clinical performance and determine if the correlation is influenced by cancer prevalence or lesion difficulty in the test set.Materials and Methods: This institutional review board-approved study randomized 83 radiologists from six Breast Cancer Surveillance Consortium registries to assess one of four test sets of 109 screening mammograms each; 48 radiologists completed a fifth test set of 110 mammograms 2 years later. Test sets differed in number of cancer cases and difficulty of lesion detection. Test set sensitivity and specificity were estimated using woman-level and breast-level recall with cancer status and expert opinion as gold standards. Clinical performance was estimated using women-level recall with cancer status as the gold standard. Spearman rank correlations between test set and clinical performance with 95% confidence intervals (CI) were estimated.Results: For test sets with fewer cancers (N = 15) that were more difficult to detect, correlations were weak to moderate for sensitivity (woman level = 0.46, 95% CI = 0.16, 0.69; breast level = 0.35, 95% CI = 0.03, 0.61) and weak for specificity (0.24, 95% CI = 0.01, 0.45) relative to expert recall. Correlations for test sets with more cancers (N = 30) were close to 0 and not statistically significant.Conclusions: Correlations between screening performance on a test set and performance in clinical practice are not strong. Test set performance more accurately reflects performance in clinical practice if cancer prevalence is low and lesions are challenging to detect. [ABSTRACT FROM AUTHOR] more...

Objective Preoperative testing for carotid endarterectomy (CEA) often includes blood typing and antibody screen (T&S). In our institutional experience, however, transfusion for CEA is rare. We assessed transfusion rate and risk factors in a national clinical database to identify a cohort of patients in whom T&S can safely be avoided with the potential for substantial cost savings. Methods With use of the National Surgical Quality Improvement Program database, transfusion events and timing were established for all elective CEAs in 2012-2013. Comorbidities and other characteristics were compared for patients receiving intraoperative or postoperative transfusion and those who did not. After random assignment of the total data to either a training or validation set, a prediction model for transfusion risk was created and subsequently validated. Results Of 16,043 patients undergoing CEA in 2012-2013, 276 received at least one transfusion before discharge (1.7%); 42% of transfusions occurred on the day of surgery. Preoperative hematocrit <30% (odds ratio [OR], 57.4; 95% confidence interval [CI], 29.6-111.1), history of congestive heart failure (OR, 2.8; 95% CI, 1.1-7.1), dependent functional status (OR, 2.7; 95% CI, 1.5-5.1), coagulopathy (OR, 2.5; 95% CI, 1.7-3.6), creatinine concentration ≥1.2 mg/dL (OR, 2.3; 95% CI, 1.6-3.3), preoperative dyspnea (OR, 2.0; 95% CI, 1.4-3.1), and female gender (OR, 1.6; 95% CI, 1.1-2.3) predicted transfusion. A risk prediction model based on these data produced a C statistic of 0.85; application of this model to the validation set demonstrated a C statistic of 0.81. In the validation set, 93% of patients received a score of 6 or less, corresponding to an individual predicted transfusion risk of 5% or less. Omitting a T&S in these patients would generate a substantial annual cost saving for National Surgical Quality Improvement Program hospitals. Conclusions Whereas T&S are commonly performed for patients undergoing CEA, transfusion after CEA is rare and well predicted by a transfusion risk score. Avoidance of T&S in this low-risk population provides a substantial cost-saving opportunity without compromise of patient care. [ABSTRACT FROM AUTHOR] more...

Introduction Giant peritoneal loose bodies (gPLB) occur rarely and therefore only few have been described. Often they are found incidentally and have no clinical relevance, whereas symptomatic forms may require surgical removal. Presentation of case We report the case of a male patient suffering from abdominal discomfort with alternating localizations for several years, actually presenting with a proctitis. With elevated inflammatory markers, a conspicuous resistance in the lower abdomen and in order to evaluate further affection of the colon, an abdominal CT-scan was performed. It revealed a spherical mass in the lesser pelvis. A colonoscopy confirmed the proctitis, showing no further pathologies. Due to the symptoms and the uncertain entity of the mass, a diagnostic laparoscopy was performed and a boiled egg-like structure (diameter 5.2 cm) was removed. The patient recovered well and was free of symptoms. Discussion The patient had two potential reasons for his symptoms, one of them being a suspected leftover foreign body years after an appendectomy. The proctitis was treated conservatively but without complete remission of the abdominal discomfort. Therefore, a diagnostic laparoscopy was performed and the mass turned out to be a gPLB. Conclusion To obtain a fast diagnosis and to perform an adequate conservative or surgical therapy, the knowledge about the rare entity of a gPLB is necessary. An exact anamnesis, clinical examination and the knowledge about the diagnostic values of radiological and endoscopic investigations are crucial. [ABSTRACT FROM AUTHOR] more...

Purpose: To describe recruitment, enrollment, and participation in a study of US radiologists invited to participate in a randomized controlled trial of two continuing medical education (CME) interventions designed to improve interpretation of screening mammography. Methods: We collected recruitment, consent, and intervention-completion information as part of a large study involving radiologists in California, Oregon, Washington, New Mexico, New Hampshire, North Carolina, and Vermont. Consenting radiologists were randomized to receive either a 1-day live, expert-led educational session; to receive a self-paced DVD with similar content; or to a control group (delayed intervention). The impact of the interventions was assessed using a preintervention–postintervention test set design. All activities were institutional review board approved and HIPAA compliant. Results: Of 403 eligible radiologists, 151 of 403 (37.5%) consented to participate in the trial and 119 of 151 (78.8%) completed the preintervention test set, leaving 119 available for randomization to one of the two intervention groups or to controls. Female radiologists were more likely than male radiologists to consent to and complete the study (P = .03). Consenting radiologists who completed all study activities were more likely to have been interpreting mammography for 10 years or less compared to radiologists who consented and did not complete all study activities or did not consent at all. The live intervention group was more likely to report their intent to change their clinical practice as a result of the intervention compared to those who received the DVD (50% versus 17.6%, P = .02). The majority of participants in both interventions groups felt the interventions were a useful way to receive CME mammography credits. Conclusions: Community radiologists found interactive interventions designed to improve interpretative mammography performance acceptable and useful for clinical practice. This suggests CME credits for radiologists should, in part, be for examining practice skills. [Copyright &y& Elsevier] more...

Purpose: The aim of this study was to assess agreement of mammographic interpretations by community radiologists with consensus interpretations of an expert radiology panel to inform approaches that improve mammographic performance. Methods: From 6 mammographic registries, 119 community-based radiologists were recruited to assess 1 of 4 randomly assigned test sets of 109 screening mammograms with comparison studies for no recall or recall, giving the most significant finding type (mass, calcifications, asymmetric density, or architectural distortion) and location. The mean proportion of agreement with an expert radiology panel was calculated by cancer status, finding type, and difficulty level of identifying the finding at the patient, breast, and lesion level. Concordance in finding type between study radiologists and the expert panel was also examined. For each finding type, the proportion of unnecessary recalls, defined as study radiologist recalls that were not expert panel recalls, was determined. Results: Recall agreement was 100% for masses and for examinations with obvious findings in both cancer and noncancer cases. Among cancer cases, recall agreement was lower for lesions that were subtle (50%) or asymmetric (60%). Subtle noncancer findings and benign calcifications showed 33% agreement for recall. Agreement for finding responsible for recall was low, especially for architectural distortions (43%) and asymmetric densities (40%). Most unnecessary recalls (51%) were asymmetric densities. Conclusions: Agreement in mammographic interpretation was low for asymmetric densities and architectural distortions. Training focused on these interpretations could improve the accuracy of mammography and reduce unnecessary recalls. [Copyright &y& Elsevier] more...

The article discusses Florida District Court of Appeals case Don King Productions, Inc. v. Walt Disney Co. which was regarding defamation suit filed by Don King plaintiff based on certain statements in a television program. It describes that the court upheld trial court's grant of summary judgment and held that the plaintiff had failed in establishing that the defendant Walt Disney acted with actual malice. It reflects that outcome of the case reiterated law regarding actual malice in Florida. more...

Rationale and Objectives: Mammography quality assurance programs have been in place for more than a decade. We studied radiologists' self-reported performance goals for accuracy in screening mammography and compared them to published recommendations.Materials and Methods: A mailed survey of radiologists at mammography registries in seven states within the Breast Cancer Surveillance Consortium (BCSC) assessed radiologists' performance goals for interpreting screening mammograms. Self-reported goals were compared to published American College of Radiology (ACR) recommended desirable ranges for recall rate, false-positive rate, positive predictive value of biopsy recommendation (PPV2), and cancer detection rate. Radiologists' goals for interpretive accuracy within desirable range were evaluated for associations with their demographic characteristics, clinical experience, and receipt of audit reports.Results: The survey response rate was 71% (257 of 364 radiologists). The percentage of radiologists reporting goals within desirable ranges was 79% for recall rate, 22% for false-positive rate, 39% for PPV2, and 61% for cancer detection rate. The range of reported goals was 0%-100% for false-positive rate and PPV2. Primary academic affiliation, receiving more hours of breast imaging continuing medical education, and receiving audit reports at least annually were associated with desirable PPV2 goals. Radiologists reporting desirable cancer detection rate goals were more likely to have interpreted mammograms for 10 or more years, and >1000 mammograms per year.Conclusion: Many radiologists report goals for their accuracy when interpreting screening mammograms that fall outside of published desirable benchmarks, particularly for false-positive rate and PPV2, indicating an opportunity for education. [ABSTRACT FROM AUTHOR] more...

Rationale and Objectives: Mammography quality assurance programs have been in place for more than a decade. We studied radiologists’ self-reported performance goals for accuracy in screening mammography and compared them to published recommendations. Materials and Methods: A mailed survey of radiologists at mammography registries in seven states within the Breast Cancer Surveillance Consortium (BCSC) assessed radiologists’ performance goals for interpreting screening mammograms. Self-reported goals were compared to published American College of Radiology (ACR) recommended desirable ranges for recall rate, false-positive rate, positive predictive value of biopsy recommendation (PPV2), and cancer detection rate. Radiologists’ goals for interpretive accuracy within desirable range were evaluated for associations with their demographic characteristics, clinical experience, and receipt of audit reports. Results: The survey response rate was 71% (257 of 364 radiologists). The percentage of radiologists reporting goals within desirable ranges was 79% for recall rate, 22% for false-positive rate, 39% for PPV2, and 61% for cancer detection rate. The range of reported goals was 0%–100% for false-positive rate and PPV2. Primary academic affiliation, receiving more hours of breast imaging continuing medical education, and receiving audit reports at least annually were associated with desirable PPV2 goals. Radiologists reporting desirable cancer detection rate goals were more likely to have interpreted mammograms for 10 or more years, and >1000 mammograms per year. Conclusion: Many radiologists report goals for their accuracy when interpreting screening mammograms that fall outside of published desirable benchmarks, particularly for false-positive rate and PPV2, indicating an opportunity for education. [ABSTRACT FROM AUTHOR] more...

Abstract: Background: This study investigated prescription spectacles ordered from online vendors and delivered directly to the public for compliance with the optical tolerance and impact resistance requirements for eyewear dispensed in the United States. Methods: Ten individuals ordered 2 pairs of spectacles from each of 10 of the most visited Internet vendors, totaling 200 eyewear orders. Spectacles ordered consisted of ranges of lens and frame materials, lens styles, and refractive corrections reflecting current distributions in the United States. Evaluations included measurement of sphere power, cylinder power and axis, add power (if indicated), horizontal prism imbalance, and impact testing. Results: We received and evaluated 154 pairs of spectacles, comprising 308 lenses. Several spectacles were provided incorrectly, such as single vision instead of multifocal and lens treatments added or omitted. In 28.6% of spectacles, at least 1 lens failed tolerance standards for at least 1 optical parameter, and in 22.7% of spectacles, at least 1 lens failed impact testing. Overall, 44.8% of spectacles failed at least 1 parameter of optical or impact testing. Conclusion: Nearly half of prescription spectacles delivered directly by online vendors did not meet either the optical requirements of the patient''s visual needs or the physical requirements for the patient''s safety. [Copyright &y& Elsevier] more...

To provide a comprehensive characterization of neural invasion (NI) in rectal adenocarcinoma (RC), to establish a novel NI-severity scoring system, and to assess the prognostic value of NI with emphasis on its localization and severity.The literature merely contains small-scale studies with limited histopathological characterization of NI in RC.Neural invasion was thoroughly characterized in 296 patients with locally advanced uT3-RC (139 with primary resection and 157 with neoadjuvant radiochemotherapy [nRCTx]). To identify the precise localization of NI, we investigated the main tumor, peritumoral area, adjacent normal tissue, and all lymph nodes. To classify the clinical impact of NI, an NI severity score was established and related to patient prognosis.Neural invasion was detected in 32% of patients with primary resection and in 19% (P = 0.010) receiving nRCTx. The major location of NI was found in the peritumoral area. The prevalence of NI in the main tumor within the primary resection group was 6%, whereas it was absent in the nRCTx group (P = 0.002). Increasing NI severity, but not NI localization, was associated with a significantly poorer survival and increased local recurrence rate in both groups. Multivariate analysis (including TNM-stage, grading, and Carcinoembryonic antigen (CEA)) revealed NI prevalence and severity as independent prognostic factors.Neural invasion in RC has a heterogeneous appearance in regard to its localization and its severity. nRCTx seems to have a suppressive effect on NI. Neural invasion severity might be applied as a novel tool to estimate accurately patient's prognosis and thus should be considered in pathology reports. [ABSTRACT FROM AUTHOR] more...

Purpose: MRI is increasingly used for the detection of breast carcinoma. Little is known about breast MRI techniques among community practice facilities. The aim of this study was to evaluate equipment and acquisition techniques used by community facilities across the United States, including compliance with minimum standards by the ACRIN® 6667 Trial and the European Society of Breast Imaging. Methods: Breast Cancer Surveillance Consortium facilities performing breast MRI were identified and queried by survey regarding breast MRI equipment and technical parameters. Variables included scanner field strength, coil type, acquisition coverage, slice thickness, and the timing of the initial postcontrast sequence. Results were tallied and percentages of facilities meeting ACRIN® and European Society of Breast Imaging standards were calculated. Results: From 23 facilities performing breast MRI, results were obtained from 14 (61%) facilities with 16 MRI scanners reporting 18 imaging parameters. Compliance with equipment recommendations of ≥1.5-T field strength was 94% and of a dedicated breast coil was 100%. Eighty-three percent of acquisitions used bilateral postcontrast techniques, and 78% used slice thickness ≤ 3 mm. The timing of initial postcontrast sequences ranged from 58 seconds to 8 minutes 30 seconds, with 63% meeting recommendations for completion within 4 minutes. Conclusions: Nearly all surveyed facilities met ACRIN and European Society of Breast Imaging standards for breast MRI equipment. The majority met standards for acquisition parameters, although techniques varied, in particular for the timing of initial postcontrast imaging. Further guidelines by the ACR Breast MRI Accreditation Program will be of importance in facilitating standardized and high-quality breast MRI. [ABSTRACT FROM AUTHOR] more...

The article discusses research on the survival differences between Hispanic and non-Hispanic women in New Mexico with breast cancer. Method of cancer detection was categorized from white women diagnosed with invasive breast cancer from 1995 through 2004. Results showed that difference in breast cancer-specific survival by race or ethnicity might be attributable to increased detection of tumors when asymptomatic and to biological factors that predispose to poor prognosis tumors. more...

Rationale and Objectives: The US Mammography Quality Standards Act mandates medical audits to track breast cancer outcomes data associated with interpretive performance. The objectives of our study were to assess the content and style of audits and examine use of, attitudes toward, and perceptions of the value that radiologists'' have regarding mandated medical audits. Materials and Methods: Radiologists (n = 364) at mammography registries in seven US states contributing data to the Breast Cancer Surveillance Consortium (BCSC) were invited to participate. We examined radiologists'' demographic characteristics, clinical experience, use, attitudes, and perceived value of audit reports from results of a self-administered survey. Information on the content and style of BCSC audits provided to radiologists and facilities was obtained from site investigators. Radiologists'' characteristics were analyzed according to whether or not they self-reported receiving regular mammography audit reports. Latent class analysis was used to classify radiologists'' individual perceptions of audit reports into overall probabilities of having “favorable,” “less favorable,” “neutral,” or “unfavorable” attitudes toward audit reports. Results: Seventy-one percent (257 of 364) of radiologists completed the survey; two radiologists did not complete the audit survey question, leaving 255 for the final study cohort. Most survey respondents received regular audits (91%), paid close attention to their audit numbers (83%), found the reports valuable (87%), and felt that audit reports prompted them to improve interpretative performance (75%). Variability was noted in the style, target audience, and frequency of reports provided by the BCSC registries. One in four radiologists reported that if Congress mandates more intensive auditing requirements, but does not provide funding to support this regulation they may stop interpreting mammograms. Conclusion: Radiologists working in breast imaging generally had favorable opinions of audit reports, which were mandated by Congress; however, almost 1 in 10 radiologists reported that they did not receive audits. [Copyright &y& Elsevier] more...

The US Preventive Services Task Force recently promulgated revised guidelines for screening mammography. Criticisms were related to the undervaluation of future lives saved and the overvaluation of negative impacts of mammography. Radiologists downplayed quality-of-life factors, potentially understating the value of all imaging procedures. The task force''s recommendations for core needle biopsy, based on similar conceptual frameworks, were not met with equivalent responses. Full appreciation of the costs and benefits of screening provides the basis for making the best decisions for individuals and populations. This is undermined by the mixed messages that patients and physicians receive during clinical encounters and through other means. Quantitative approaches to medical care are valid on their own terms and when evaluated in the individual context. Insights from behavioral economics and political science inform discussion of population-based medical interventions. Preventing harm from medical interventions satisfies both the “primum non nocere” dictum and the loss aversion heuristic concordantly. The most effective medical care is provided when benefits are maximized and complications are minimized, especially when the harms occur immediately and the benefits are delayed. The importance of both quality of life and longevity in health care decision making require minimizing negative impacts of mammography when screening low-risk populations. Current practice differs significantly from the successful randomized trials, front-loading costs of false-positive examinations, and overtreatment. By decreasing false-positive mammographic results through adherence to ACR BI-RADS® recommendations, radiologists can answer critics of early and frequent screening while still reducing cancer deaths. [Copyright &y& Elsevier] more...

Introduction Lateral lung hernias are rare, and a herniation of the lung is only reported in the context of high-energy trauma. The predilection site for lung hernias is the anterior thorax. Presentation of case We present the case of a 82-year-old male, who was admitted with dry cough, shortness of breath and breath-dependent left-sided chest pain after a fall. Chest X-ray suggested a pneumonia and subsequently the patient was treated with antibiotics. Due to persistent symptoms after 12 days a CT-scan was performed which showed an intercostal lung herniation without fractures. Surgeons were consulted and recommended an operative intervention. Intraoperatively the herniation could be confirmed and necrotic lung tissue was resected. The patient recovered well and was discharged after 10 days in good general condition. Discussion Herniation of lung tissue occurs as a result of injured intercostal muscles in a sudden increase of intrathoracic pressure. Especially lateral herniation is rare because of the additional lateral reinforcement of the thoracic wall by the Serratus muscle. While a conservative approach is possible in asymptomatic hernias and small defect size, surgical intervention is indicated for larger hernias, possible incarceration of lung tissue with resulting infarction and symptoms like chronic pain or respiratory failure. Conclusion For an adequate differential diagnosis of thoracic pain with a history and external signs of a trauma, a CT imaging should be evaluated at an early stage even after a low-energy trauma. An operation is indicated for large defect size and persistent symptoms. [ABSTRACT FROM AUTHOR] more...

Splenic cysts are rare. They are usually incidentally diagnosed and there is no harmonised treatment pathway. We report a case of a large splenic epidermoid type cyst without history of previous abdominal trauma. A 23-year old male patient presented with symptoms of upper abdominal pain, nausea and vomiting. Except for a tenderness in the upper and lower left quadrant of the abdomen, the initial examination showed no extraordinary findings. A contrast enhanced computed tomography revealed a large singular splenic cyst displacing neighbouring structures. Echinococcus serology was tested negative. A laparoscopic fenestration of the superficially located splenic cyst was performed. Perioperative course was free of complications. Histopathological analysis of the excisate showed a squamous lining indicating the cyst as epidermoid type. Non-parasitic cyst types include traumatic, neoplastic, degenerative and congenital cysts. Due to its considerable size, our patients splenic cyst was diagnosed after occurring symptoms lead to further examination (CT scan). Laparoscopic fenestration of the cyst was chosen as the optimal surgical approach because of the superficial location of the cyst and to preserve residual splenic parenchyma. In the present case, recurrence of the splenic cyst appeared, which left the patient with a total splenectomy as the final treatment choice. Due to the unspecific symptoms, the diagnosis of a splenic cyst can be prolonged. Choosing the adequate surgical technique to avoid complications is crucial. By deepening the understanding of the condition and surgical approaches, we can improve diagnostic and therapeutic management for affected patients. • Large splenic cysts present with unspecific and upper GI-symptoms. • Small splenic cysts are usually diagnosed incidentally. • Large splenic cysts > 5 cm are recommended to be treated with a surgical procedure. • Spleen-preserving procedures are preferred. [ABSTRACT FROM AUTHOR] more...

Background & Aims: Neoadjuvant chemoradiotherapy has become a standard treatment of locally advanced rectal carcinomas, even though the responsiveness varies from complete response to resistance. The aim of the study was to evaluate the capacity of gene expression signatures to identify responders and nonresponders pretherapeutically. Methods: By using microarray technology we generated gene expression profiles of 43 biopsy specimens of locally advanced rectal carcinomas. The transcription profile then was compared with histopathologic response and used to identify a set of genes discriminating responders from nonresponders. Results: We identified a gene expression signature of 42 genes, mostly encoding proteins that either play a role in the nucleus, such as the transcription factor ETS2, or are associated with transport function, such as the solute carrier SLC35E1, or the regulation of apoptosis, such as caspase-1. In leave-one-out cross-validation the correct classification of a responder was 71%, the specificity of the analysis for a correct classification of a nonresponder was 86%. By applying an additional statistical method of 200 successive splittings into training and test data sets we generated an individual prediction accuracy measure for each predicted response. Conclusions: Our study shows that pretherapeutic prediction of response of rectal carcinomas to neoadjuvant chemoradiotherapy is feasible, and may represent a new valuable and practical tool of therapeutic stratification. [Copyright &y& Elsevier] more...

The article offers information on a study which examined benign breast biopsy diagnosis and subsequent risk of breast cancer in New Mexico. The data used in the study was collected between 1992 and 2000. The study found that observed breast cancer occurrence is associated with benign biopsy. It added to the evidence concerning the link between breast density and the risk of breast cancer. more...

Background: Medicare data may be a useful source for determining the utilization of mammography among elderly women, but the accuracy of these data has not been established. Objective: We determined whether Medicare physician billing claims are an accurate reflection of mammography utilization among women ages 65 and older and whether they can be used to assess the use of screening as compared with diagnostic mammography. Data Sources: Mammography use was assessed using Medicare billing claims and radiology reports from 2 mammography registries; the San Francisco Mammography Registry and the New Mexico Mammography Registry. Methods: Completeness of the Medicare data was assessed by comparing mammography use based on Medicare, with radiology reports from the mammography registries, which served as the referent standard. Capture rates for Medicare claims for individual mammograms were examined, and women were characterized as having undergone at least 1 mammogram within each 2-year period based on the Medicare data, and these rates were compared with the referent standard. To determine whether Medicare data can distinguish between screening and diagnostic mammography, we performed a classification analysis using the mammography registries screening/diagnostic designation as the referent standard (dependent variable) and Medicare claim information as the independent/predictor variable. On the basis of the mammogram level classification analysis, women were categorized as having been frequently screened (at least 2 screening mammograms spaced by 12 to 36 months), screened (at least 1 screening mammogram), or not screened. Subjects: Women ages 65 and older, diagnosed with breast cancer between 1992-1999, who had at least 1 mammogram between 1992-1999 were examined. Results: A total of 3340 mammograms were obtained in 1371 women between 1992 and 1999. Overall, 83% of mammograms obtained by these women had a corresponding billing claim in Medicare. This increased from 65% in 1992 to 90% in 1999. Of women who underwent at least 1 mammogram during each 2-year period per the referent standard, 94% of women were accurately classified by Medicare claims as also having undergone mammography during the same 2-year period. In multivariable analysis, a mammogram was more likely to be associated with a billing claim over time, for women 80 years or older, and for white and Asian as compared with Hispanic women. Neither socioeconomic status nor screening/diagnostic designation affected the likelihood that a mammogram would be associated with a billing claim. The Medicare data accurately categorized a given mammogram as screening or diagnostic for 87.5% of mammograms. Lastly, there was moderate to substantial agreement in the categorization of women as frequently screened, screened or not screened between the 2 data sets (weighted kappa 0.74, 95% confidence interval 0.70-0.78). Conclusion: Medicare administrative claims are reliable for assessment of mammography utilization and have become more accurate over time. Medicare claims data also provide a mechanism for designating mammography as screening or diagnostic, which subsequently may allow accurate description of a woman's screening history. [ABSTRACT FROM AUTHOR] more...