Results of a multicenter patient registry to determine the clinical impact of breast-specific gamma imaging, a molecular breast imaging technique.

OBJECTIVE: Molecular breast imaging techniques, such as breast-specific gamma imaging, are increasingly being used as adjunctive diagnostic technologies to mammography and ultrasound. This multicenter clinical patient registry was designed to quantify the impact of this modality on the management of the breast patient population in clinical practice and to identify the subgroups of patients benefiting from its use. MATERIALS AND METHODS: There were 1042 patients included in this analysis, and breast-specific gamma imaging typically was recommended when the patient had at least two of the following indications: equivocal or negative mammogram or sonogram and an unresolved clinical concern; personal history of breast cancer or current cancer diagnosis; palpable masses negative on mammographic and sonographic examination; radiodense breast tissue; or high risk for breast cancer. Pathologic analysis or follow-up imaging, if biopsy was not conducted, was used as the reference standard, and lesions were classified as positive (i.e., malignant or high risk) in 250 cases and as negative (i.e., benign) in 792 cases. RESULTS: Breast-specific gamma imaging was positive in 408 patients (227 malignant or high-risk lesions requiring additional intervention), negative in 634 patients (23 with malignant or high-risk lesions), and indeterminate in 69 patients (all benign lesions). Breast-specific gamma imaging had an overall sensitivity of 91% and specificity of 77%. CONCLUSION: Breast-specific gamma imaging significantly contributed to the detection of malignant or high-risk lesions in patients with negative or indeterminate mammographic findings, and it provided improved management when compared with ultrasound.

Solid breast masses diagnosed as fibroadenoma at fine-needle aspiration biopsy: acceptable rates of growth at long-term follow-up.

PURPOSE: To determine what growth rate is acceptable before recommending histologic diagnosis of solid breast lesions diagnosed as fibroadenoma at fine-needle aspiration biopsy (FNAB). MATERIALS AND METHODS: For 1,070 consecutive patients with breast lesions diagnosed as fibroadenoma at FNAB, three measurements of each mass were performed at the initial visit when FNAB was performed and at each follow-up ultrasonographic examination. Changes in volumes were calculated. At one or more visits, 194 masses showed an increase in volume. Nonfibroadenomas were excluded, and the data were used for comparison. Percentiles (90th and 95th) for percentage change in volume per month were used to determine acceptable changes in dimensions (specifically, greatest anteroposterior, parallel-to-skin, and perpendicular-to-skin dimensions). RESULTS: There were 567 interval measurements of 179 masses in 173 patients younger than 50 years and 50 measurements of 15 masses in 14 patients 50 years or older at the time of FNAB. The 95th percentile for percentage change in volume per month was approximately 16% for patients younger than 50 years; the 90th percentile was approximately 13% for patients 50 years or older. The 95th percentile mean change in dimension in a 6-month interval for those younger than 50 years was 20%; the 90th percentile change for those 50 years or older was also 20%. All excised masses with slower growth proved benign at histologic examination. CONCLUSION: Solid breast masses diagnosed as fibroadenomas at FNAB may be safely followed up if volume growth rate is less than 16% per month in those younger than 50 years and less than 13% per month in those 50 years or older. Acceptable mean change in dimension for a 6-month interval is 20% for all ages.

The effect of estrogen-progestin treatment on bone mineral density in anorexia nervosa.

INTRODUCTION: Osteopenia is a serious complication of anorexia nervosa (AN). Although in other states of estrogen deficiency, estrogen replacement therapy increases bone mass, its role in AN remains unresolved. STUDY OBJECTIVE: To study the effect of estrogen-progestin administration on bone mass in AN. DESIGN, SETTING, AND PARTICIPANTS: A prospective observational study of 50 adolescents with AN (mean age 16.8 +/- 2.3 yrs) was conducted in a tertiary referral center. MAIN OUTCOME MEASURES: Bone mineral density (BMD) of the lumbar spine and left hip were prospectively measured using dual-energy x-ray absorptiometry at baseline and annually. INTERVENTIONS: Twenty-two subjects received estrogen-progestin and 28 standard treatment (Rx) alone. Estrogen-progestin was administered daily as an oral contraceptive containing 20-35 mcg ethinyl estradiol. All subjects received calcium supplementation and the same medical, psychological, and nutritional intervention (standard Rx). Mean length of follow-up was 23.1 +/- 11.4 months. RESULTS: At presentation, patients were malnourished (79.5% +/- 7.6% IBW), hypoestrogenemic (estradiol 24.7 +/- 10.7 pg/mL), and had reduced bone mass (lumbar spine BMD -2.01 +/- 0.69 SD below the young adult reference mean). Ninety-two percent of subjects were osteopenic and 26% met WHO criteria for osteoporosis. Body weight, and no treatment group, was the major determinant of BMD. At one-year follow-up, there were no significant differences in absolute values or in net change of lumbar spine or femoral neck BMD between those who received estrogen-progestin and those who received standard Rx (80% power of finding a 3% difference in BMD at 1 yr). In those followed for 2-3 yrs, osteopenia was persistent and in some cases progressive. CONCLUSION: In our study population, estrogen-progestin did not significantly increase BMD compared with standard Rx. These results question the common practice of prescribing hormone replacement therapy to increase bone mass in AN.