Optimizing the Patient Experience for Women With Disabilities in the Breast Imaging Clinic.

While there are varying opinions on what age to begin and at what interval to perform breast cancer screening, screening mammography is recommended for all women irrespective of disability. Unfortunately, women with disabilities are more likely to present with later-stage disease and higher mortality owing to the barriers for more widespread screening in this population. Women with disabilities may experience challenges accessing breast imaging services, and imaging centers may have suboptimal facilities and staff who are inexperienced in caring for this population. Efforts to increase accessibility by employing universal design to increase ease of access and provide training to improve the patient experience will go far to improve outcomes for patients with disabilities. To date, there exists no comprehensive guidance on how to improve breast cancer screening programs for women with disabilities. The purpose of this paper is to review barriers to screening faced by patients with disabilities, describe strategies to overcome these barriers, and provide guidance for radiologists and referring providers in selecting the best exam for the individual patient.

Axillary lymph node "bubbly" calcifications and body tattoo: A case series and proposed algorithm to minimize lymph node biopsies.

The presence of mammographically evident hyperdense foci within axillary lymph nodes elicits concern for calcium deposits, which in turn have a wide differential diagnosis including both benign and malignant entities. Tissue sampling, most commonly by way of image-guided core needle biopsy, is needed in many cases when a definite etiology cannot be clinically established. In this case series we present history, imaging findings, and pathology results (or long term follow-up stability as biopsy surrogate) of several women with body tattoos who at mammography were noted to have a characteristic pattern of "bubbly" pseudo-calcifications within axillary lymph nodes, and absence of other mammographic, sonographic and clinical abnormalities.

Ductal and lobular carcinoma in situ arising within an enlarging biopsy proven fibroadenoma.

The diagnosis via core needle biopsy of concurrent ductal carcinoma in situ and lobular carcinoma in situ within an enlarging previously biopsied benign fibroadenoma in women in their 40s is rare. Several case reports have described the occurrence of malignant changes within fibroadenomas, usually as an incidental finding following excision, and few reports have documented the transition of a fibroadenoma to malignancy. The current case report emphasises the importance of re-biopsying enlarging fibroadenomas, even with otherwise maintained benign appearing features on imaging, in women in their 40s, in order to exclude the possibility of malignancy.

Do Calcifications Seen on Mammography After Neoadjuvant Chemotherapy for Breast Cancer Always Need to Be Excised?

BACKGROUND: This study aimed to determine the relationship between mammographic calcifications and magnetic resonance imaging (MRI) tumoral enhancement before and after neoadjuvant chemotherapy (NAC) and to assess the impact of these findings on surgical management. METHODS: This Institutional Review Board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study involved breast cancer patients who underwent NAC between 2009 and 2015. The study cohort comprised 90 patients with pre- and posttreatment MRI and mammograms demonstrating calcifications within the tumor bed either at presentation or after treatment. The data gathered included pre- and post-NAC imaging findings and post-NAC histopathology, particularly findings associated with calcifications. Comparisons were made using Fisher's exact test, with p values lower than 0.05 considered significant. RESULTS: Complete resolution of MRI enhancement occurred for 44% of the patients, and a pathologic complete response (pCR) was achieved for 32% of the patients. No statistically significant correlation between changes in mammographic calcifications and MRI enhancement was found (p = 0.12). Resolution of enhancement was strongly correlated with pCR (p < 0.0001). The majority of the patients with pCR demonstrated complete resolution of enhancement (79%, 23/29). No statistically significant relationship was found between changes in calcifications and rates of pCR (p = 0.06). A pCR was achieved most frequently for patients with resolution of enhancement and new, increasing, or unchanged calcifications (p < 0.0001). CONCLUSIONS: Although calcifications seen on post-NAC mammography may be associated with benign disease, loss of MRI enhancement does not predict the absence of residual tumor with sufficient accuracy to leave calcifications in place. Complete excision of tumor bed calcifications remains standard practice and a substantial limitation to NAC use for downstaging patients to be eligible for breast conservation treatment.

Temporal bone trauma and the role of multidetector CT in the emergency department.

The temporal bone anatomy is complex, with many critical structures in close association with one another. The temporal bone region comprises cranial nerves V, VI, VII, and VIII; vascular structures such as the internal carotid and middle meningeal arteries; sigmoid sinus; jugular bulb; and sensorineural and membranous structures of the inner ear. Most temporal bone fractures are a result of high-energy blunt head trauma. Multidetector computed tomography (CT) plays a fundamental role in the initial evaluation of patients with polytrauma in the emergency department. Multidetector CT may help identify important structural injuries that may have devastating complications such as sensorineural hearing loss, conductive hearing loss, dizziness and balance dysfunction, perilymphatic fistulas, cerebrospinal fluid leaks, facial nerve paralysis, and vascular injury. Although classifying temporal bone fractures helps physicians understand and predict trauma-associated complications and guide treatment, identifying injury to critical structures is more important for guiding management and determining prognosis than is simply classifying temporal bone fractures into a general category. Many temporal bone fractures and complications may be readily identified and characterized at routine cervical, maxillofacial, and head multidetector CT performed in patients with polytrauma, without the need for dedicated temporal bone multidetector CT. Dedicated temporal bone multidetector CT should be considered when there is a high degree of suspicion for temporal bone fractures and no fractures are identified at head, cervical, or maxillofacial CT.

Computerized analysis of speech and language to identify psycholinguistic correlates of frontotemporal lobar degeneration.

OBJECTIVE: To evaluate the use of a semiautomated computerized system for measuring speech and language characteristics in patients with frontotemporal lobar degeneration (FTLD). BACKGROUND: FTLD is a heterogeneous disorder comprising at least 3 variants. Computerized assessment of spontaneous verbal descriptions by patients with FTLD offers a detailed and reproducible view of the underlying cognitive deficits. METHODS: Audiorecorded speech samples of 38 patients from 3 participating medical centers were elicited using the Cookie Theft stimulus. Each patient underwent a battery of neuropsychologic tests. The audio was analyzed by the computerized system to measure 15 speech and language variables. Analysis of variance was used to identify characteristics with significant differences in means between FTLD variants. Factor analysis was used to examine the implicit relations between subsets of the variables. RESULTS: Semiautomated measurements of pause-to-word ratio and pronoun-to-noun ratio were able to discriminate between some of the FTLD variants. Principal component analysis of all 14 variables suggested 4 subjectively defined components (length, hesitancy, empty content, grammaticality) corresponding to the phenomenology of FTLD variants. CONCLUSION: Semiautomated language and speech analysis is a promising novel approach to neuropsychologic assessment that offers a valuable contribution to the toolbox of researchers in dementia and other neurodegenerative disorders.