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1.
Clin Imaging ; 49: 174-180, 2018.
Article in English | MEDLINE | ID: mdl-29571172

ABSTRACT

PURPOSE: To evaluate the performance of magnetic resonance imaging (MRI) to exclude malignancy in biopsy-proven high-risk breast lesions prior to surgical excision. MATERIAL AND METHODS: Breast MRIs performed after a core needle biopsy (CNB) yielding high-risk pathology were evaluated for the presence of suspicious enhancement. The diagnostic performance of MRI to exclude malignancy was calculated. RESULTS: The average reader sensitivity, specificity, negative predictive value, positive predictive value and accuracy of MRI were 92%, 51%, 98%, 22% and 56%, respectively. CONCLUSION: Lack of enhancement on MRI at the site of a high-risk lesion was useful for excluding malignancy.


Subject(s)
Breast Neoplasms/pathology , Breast/pathology , Contrast Media , Magnetic Resonance Imaging/methods , Adult , Aged , Biopsy , Biopsy, Large-Core Needle , Breast/surgery , Breast Neoplasms/diagnosis , Breast Neoplasms/surgery , Female , Humans , Mammography/methods , Middle Aged , Retrospective Studies , Sensitivity and Specificity , Ultrasonography/methods
2.
AJR Am J Roentgenol ; 207(1): 205-16, 2016 Jul.
Article in English | MEDLINE | ID: mdl-27077731

ABSTRACT

OBJECTIVE: The objective of our study was to evaluate the performance of DWI to detect mammographically occult breast cancer in elevated-risk women with dense breasts. MATERIALS AND METHODS: We retrospectively reviewed all women who underwent screening breast MRI at our institution from January 2007 through May 2013. We created a case-control cohort composed of 48 subjects with mammographically dense breasts: 24 with mammographically occult cancer detected on MRI and 24 healthy women with negative MRI findings who were matched to the subjects with breast cancer patients for age, breast density, and MRI protocol. The contrast-to-noise ratio (CNR), apparent diffusion coefficient (ADC), and conspicuity score (range, 1-5) were assessed on DWI for all malignancies. Lesions and normal tissue were compared using the Wilcoxon signed rank test; associations with clinical characteristics were evaluated using the Mann-Whitney U test. Three experienced breast imagers who were blinded to medical records and contrast-enhanced MRI findings independently evaluated the unenhanced MRI scans of the 48 women for the presence of cancer. RESULTS: Mammographically occult breast cancers (invasive carcinoma, n = 16; ductal carcinoma in situ, n = 8) in women with dense breasts typically exhibited higher signal intensity on DWI than normal parenchyma (median CNR of cancers, 1.4; median conspicuity score of cancers, 4) and a lower ADC (median, 1.31 vs 1.79 × 10(-3) mm(2)/s, respectively) (p < 0.0001). The conspicuity score, CNR, and ADC were not associated with patient age, menopausal status, lesion size, morphologic type, or histology (p > 0.05). Average reader performance using unenhanced MRI was 45% sensitivity, 91% specificity, 62% positive predictive value, and 83% negative predictive value. CONCLUSION: In elevated-risk women with dense breasts, DWI can reveal cancers in addition to those detected on mammography alone with a low false-positive rate; these results suggest that DWI may have potential as a rapid supplemental screening tool.


Subject(s)
Breast Neoplasms/diagnostic imaging , Diffusion Magnetic Resonance Imaging , Adult , Aged , Breast Density , Case-Control Studies , Clinical Competence , Contrast Media , Female , Humans , Mammography , Middle Aged , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity
3.
Retina ; 33(2): 387-91, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23064425

ABSTRACT

PURPOSE: To describe the effect of scleral buckle (SB) removal on preoperative symptoms and signs prompting removal and to assess the risk of recurrent retinal detachment (RD) after SB removal. METHODS: A retrospective study of 36 patients who underwent SB removal between August 1988 and December 2007 was performed. Indications for SB removal, presence or absence of pain or diplopia, and recurrence of RD were recorded. Composite RD rates were estimated from previously published studies and stratified into those occurring during the previtrectomy era versus later (1980 to present). RESULTS: Mean follow-up time was 75.5 months after SB removal. Thirty-two of 33 patients (97%) who had preoperative pain had symptom relief. Twelve of 12 patients who had clinical infection had resolution. Of the four patients with diplopia, two experienced complete resolution and two reported substantial improvement but required prisms to obtain single vision. Four of 34 patients (12%) whose retinas were attached at the time of SB removal developed recurrent RD but were successfully repaired without significant visual loss from the RD. CONCLUSION: Scleral buckle removal is effective in eliminating SB-related pain and infection. Symptomatic diplopia can sometimes improve after SB removal. The rates of RD after SB removal observed in this study (12%) and in others performed in the era of vitrectomy were notably lower than those of previous reports.


Subject(s)
Device Removal , Diplopia/therapy , Eye Infections/therapy , Eye Pain/therapy , Retinal Detachment/surgery , Scleral Buckling/adverse effects , Vitrectomy , Diplopia/etiology , Eye Infections/etiology , Eye Pain/etiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Recurrence , Retinal Detachment/etiology , Retrospective Studies , Time Factors
4.
Am J Ophthalmol ; 146(3): 434-439, 2008 Sep.
Article in English | MEDLINE | ID: mdl-18614132

ABSTRACT

PURPOSE: To identify preoperative, perioperative, and postoperative risk factors for scleral buckle (SB) removal. DESIGN: Retrospective, consecutive, matched, case-control study. METHODS: Cases included all patients undergoing SB removal between August 1988 and December 2007 at a single academic center. Cases were matched against four randomly selected control patients who underwent SB implantation during the same year as the case. Odds ratios (OR) were calculated for each factor investigated. RESULTS: Forty cases of SB removal and 148 matched control cases were identified. Three cases of SB removal were omitted from analysis because of incomplete records. Factors associated with SB removal for any reason, using univariate analysis, included concurrent globe-penetrating injury at time of SB placement (OR, 24; 95% confidence interval [CI], 2.9 to 200), concurrent pars plana vitrectomy (PPV) (OR, 17.3; 95% CI, 4.9 to 61), diabetes mellitus (DM) (OR, 7.3; 95% CI, 1.8 to 30), prior chronic topical ocular therapy (OR, 4.3; 95% CI, 1.7 to 11), and subsequent ocular procedures (OR, 3.4; 95% CI, 1.5 to 7.5). Factors independently associated with SB removal using multivariate analysis included concurrent globe-penetrating injury (OR, 27.3; 95% CI, 1.7 to 426), concurrent PPV (OR, 11.3; 95% CI, 2.9 to 45), DM (OR, 8.9; 95% CI, 1.3 to 58), and subsequent ocular procedures (OR, 3.9; 95% CI, 1.4 to 11). Factors that did not alter SB removal risk included patient age; gender; and type, size, or location of buckling elements used. CONCLUSIONS: Awareness of these risk factors may be valuable for the surgical planning of retinal detachment repair in patients at higher risk for subsequent SB removal and for risk stratification subsequent to SB implantation.


Subject(s)
Device Removal , Retinal Detachment/surgery , Scleral Buckling/instrumentation , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Child , Child, Preschool , Diabetes Complications , Female , Humans , Infant , Intraoperative Complications , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Rheumatic Diseases/complications , Risk Factors
5.
Trans Am Ophthalmol Soc ; 106: 171-7; discussion 177-8, 2008.
Article in English | MEDLINE | ID: mdl-19277232

ABSTRACT

PURPOSE: To identify preoperative, perioperative, and postoperative risk factors for scleral buckle (SB) removal. METHODS: A retrospective, consecutive, matched, case-control study. Cases included all patients undergoing SB removal between 1988 and 2007 at a single academic center. Case patients were matched against 4 randomly selected control patients who underwent SB implantation during the same year as the case patients. Odds ratios (ORs) were calculated for each factor investigated. RESULTS: Forty cases of SB removal and 148 matched control cases were identified. Three cases of SB removal were omitted from analysis because of incomplete records. Factors associated with SB removal for any reason, according to univariate analysis, included concurrent globe-penetrating injury at the time of SB placement (OR, 24; 95% confidence interval [CI], 2.9-200), concurrent pars plana vitrectomy (PPV) (OR, 17.3; CI, 4.9-61), diabetes mellitus (DM) (OR, 7.3; CI, 1.8-30), prior long-term topical ocular therapy (OR, 4.3; CI, 1.7-11), and subsequent ocular procedures (OR, 3.4; CI, 1.5-7.5). Factors independently associated with SB removal according to multivariate analysis included concurrent globe-penetrating injury (OR, 27.3; CI, 1.7-426), concurrent PPV (OR, 11.3; CI, 2.9-45), DM (OR, 8.9; CI, 1.3-58), and subsequent ocular procedures (OR, 3.9; CI, 1.4-11). Factors that did not alter SB removal risk included patient age; sex; and type, size, or location of buckling elements used. CONCLUSIONS: Awareness of these risk factors may be valuable for the surgical planning of retinal detachment repair in patients at higher risk for subsequent SB removal and for risk stratification subsequent to SB implantation.


Subject(s)
Device Removal , Retinal Detachment/surgery , Scleral Buckling/instrumentation , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Child , Child, Preschool , Diabetes Complications , Female , Humans , Infant , Intraoperative Complications , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Rheumatic Diseases/complications , Risk Factors , Young Adult
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