Effects of nonparticipation at previous screening rounds on the characteristics of screen-detected breast cancers.

PURPOSE: We determined the incidence and effects of different screening intervals prior to a true positive recall on the tumour characteristics of screen-detected cancers (SDC) and interval cancers (ICs) at biennial screening mammography. METHODS: A consecutive series of 553020 subsequent screens was included, obtained in a Dutch screening region between January 2009 and July 2019. During 2-year follow-up, we obtained data on radiological procedures, pathology and surgical interventions of all recalled women. RESULTS: A total of 13,221 women were recalled (2.4% recall rate), yielding 3662 women with a SDC (6.6 SDCs per 1000 screen). Of these, 3477 (94.9%) had attended their two most recent screens as scheduled (i.e., 2-year screening interval), whereas the interval between the two most recent screens was four years or at least six years in respectively 132 (3.6%) and 53 (1.4%) women. There was a trend of higher cancer detection rates in case of longer screening intervals. The proportions of DCIS versus invasive cancer, as well as tumour histology, tumour size, axillary lymph node status, B&R grading, hormone receptor status and type of surgical treatment (breast conserving surgery or mastectomy) were comparable for women with a 2-year or 4-year interval between their two latest screens. SDCs in women with at least six years between their two latest screens were more frequently estrogen receptor negative or triple negative and were more frequently treated by mastectomy. All tumour characteristics mentioned above were less favourable for ICs than SDCs. CONCLUSIONS: A vast majority of women with a SDC had a 2-year screening interval between their two latest screens. A screening interval of at least six years had a slight negative influence on the tumour characteristics and treatment of SDCs.

Volume measurement of intracranial aneurysms from 3D rotational angiography: improvement of accuracy by gradient edge detection.

Manual volume measurement of intracranial aneurysms from 3D rotational angiography varies on different threshold settings and, therefore, is operator-dependent. We developed and validated a method based on automatic gradient edge detection that is independent on threshold settings and provides an accurate and reproducible volume measurement. This method was compared with manual volume calculation in 13 aneurysm phantoms, and the results were significantly more accurate.

Influence of coil thickness on packing, re-opening and retreatment of intracranial aneurysms: a comparative study between two types of coils.

OBJECTIVES: To compare packing, re-opening and retreatment of intracranial aneurysms treated with two types of coils with different wire thickness and different shapes. MATERIALS AND METHODS: Packing, defined as the ratio between volume of inserted coils and volume of aneurysm, was calculated for 235 aneurysms-120 treated with predominantly helical-shaped coils of 0.010-inch diameter wire (GDC 10) and 115 treated with predominantly complex shaped coils of 0.012-inch diameter wire (Cordis TruFill). Aneurysm packing, re-opening and retreatment during follow-up were compared for aneurysms treated with either type of coils. RESULTS: Mean packing was significantly higher (absolute value 6.8%, relative value 23.0%, p<0.0001) in aneurysms treated with Cordis TruFill coils compared with aneurysms coiled with GDC 10 coils. Six month follow-up angiography was available in 194 of 235 aneurysms. Re-opening occurred in 22 of 99 aneurysms (22.2%) treated with GDC 10 coils and in 15 of 95 aneurysms (15.8%) treated with Cordis TruFill coils. Retreatment was performed in 16 of 120 aneurysms (13.3%) treated with GDC 10 coils and in nine of 115 aneurysms (7.8%) treated with Cordis TruFill coils. CONCLUSION: Coiling of intracranial aneurysms using complex shaped Cordis TruFill coils with a wire diameter of 0.012 inch results in significantly better packing compared with helical GDC 10 coils of 0.010-inch diameter wire. The retreatment rate was lower for aneurysms treated with Cordis TruFill coils compared with aneurysms treated with GDC 10 coils.

The relation between packing and reopening in coiled intracranial aneurysms: a prospective study.

We evaluated prospectively the relation between packing and reopening in coiled intracranial aneurysms. Packing, defined as the ratio between the volume of inserted coils and volume of the aneurysm expressed as percentage, was calculated for 82 intracranial aneurysms treated with detachable coils. Aneurysm volume was assessed from 3D angiography. Reopening of the aneurysmal lumen at the 6-month follow-up angiography was dichotomized into present or absent. We assessed whether packing above 24% protected against reopening. Twenty-three of 82 aneurysms (28%) showed reopening. Reopening was caused by compaction in 20 aneurysms and by partial thrombosis, undetected at the time of initial treatment in three aneurysms. Three of 29 aneurysms (10%) with a packing of more than 24% showed reopening. These three aneurysms contained partially intraluminal thrombosis undetected at the time of treatment. We conclude that in coiled intracranial aneurysms packing above 24% protects against reopening by compaction in non-thrombosed aneurysms. Since intraluminal thrombosis may go undetected at the time of treatment, follow-up angiography is still warranted in aneurysms with packing densities greater than 24%.

Coil thickness and packing of cerebral aneurysms: a comparative study of two types of coils.

BACKGROUND AND PURPOSE: In coiling cerebral aneurysms, high packing prevents reopening over time. The purpose of this study was to compare packing of cerebral aneurysms treated with two types of coils with different wire thickness and different shapes. METHODS: Packing, defined as the ratio between the volume of inserted coils and the volume of an aneurysm, was calculated for 144 cerebral aneurysms treated in 130 patients. Seventy-two aneurysms were treated with predominantly helical-shaped coils of 0.010-inch-diameter wire, and 72 aneurysms were treated with predominantly complex-shaped coils of 0.012-inch-diameter wire. Aneurysm volume was assessed from three-dimensional angiography. Aneurysm packing, inserted coil lengths, and numbers of coils were compared for both types of coils. RESULTS: Mean packing was significantly higher (absolute value, 6.4%; relative value, 26.6%; P < .0001) in aneurysms coiled with 0.012-inch-diameter coils than aneurysms coiled with 0.010-inch-diameter coils. Inserted coil length per cubic millimeter of aneurysmal volume was equal for both types of coils. CONCLUSION: Use of complex-shaped coils with a wire diameter of 0.012 inch to coil cerebral aneurysms results in significantly better packing than is achieved with helical coils of 0.010-inch-diameter wire.

Predictive value of angiographic testing for tolerance to therapeutic occlusion of the carotid artery.

BACKGROUND AND PURPOSE: Controversy exists on how to assess a patient's tolerance before permanent carotid artery occlusion. We sought to determine the positive predictive value of synchronous opacification of hemispheric cortical veins at angiography of the contralateral carotid or vertebral artery as a predictor of tolerance to permanent carotid artery occlusion without development of ischemic injury. METHODS: Seventy-six angiographic test occlusions were performed in 74 consecutive patients considered for therapeutic occlusion. Angiography of collateral cerebral vessels was performed during test occlusion. Synchronous filling (a < 0.5-second delay of opacification between the cortical veins of the occluded and collateral vascular territories) was considered a predictor for tolerance to permanent occlusion. To detect clinically silent ischemic defects, MR imaging was performed before and 6-12 weeks after permanent occlusion. Positive predictive value (95% confidence interval [CI]) of synchronous venous filling for absence of ischemic deficits after permanent occlusion was calculated. RESULTS: No procedural complications of the test occlusion occurred. In 51 of 54 patients who passed the test, permanent occlusion was performed. Two patients, both in poor clinical condition after subarachnoid hemorrhage, died of diffuse vasospasm after permanent occlusion. Of the 49 surviving patients, one developed a transient discrete hemiparesis with small new hypoperfusion infarctions on MR images. All other patients remained neurologically unchanged with no new ischemic lesions on follow-up MR images. Positive predictive value of tolerance to carotid artery occlusion after passing the angiographic test was 98% (95% CI: 89-100%). CONCLUSION: The angiographic test occlusion protocol reliably predicts tolerance to therapeutic carotid artery occlusion. It is safe and easy to perform.

Additional coiling of previously coiled cerebral aneurysms: clinical and angiographic results.

BACKGROUND AND PURPOSE: Some cerebral aneurysms that have been coiled reopen over time and additional treatment should be considered to reduce the risk of recurrent hemorrhage. Our purpose was to assess procedural complications and angiographic results of additional coiling in patients with previously coiled but reopened aneurysms and to evaluate protection against (re)bleeding. METHODS: We compared procedural complications of initial coiling of 488 aneurysms in 439 patients with those of 53 additional coiling procedures in 41 reopened aneurysms in 40 patients. Angiographic results of additional coiling were assessed. We compared episodes of (re)bleeding in patients with complete or near-complete aneurysm occlusion after additional coiling with those of patients with incomplete aneurysm occlusion at 6-month follow-up angiography who were not additionally treated or who still had incomplete occlusion after additional coiling. RESULTS: Thirty-five procedural complications occurred in 488 initial coiling procedures, and no complications occurred in 53 additional procedures. Complete or near-complete angiographic occlusion after additional coiling was obtained in 31 (76%) of 41 aneurysms. Rebleeding occurred in two of 29 patients with incomplete aneurysm occlusion but in none of the 31 patients with complete or near-complete occlusion after additional coiling. CONCLUSION: Additional coiling of previously coiled aneurysms has a low procedural complication rate and leads to sufficient occlusion in most aneurysms. The data indicate that successful additional coiling decreases the risk of rebleeding.

Use of a clinical decision rule in combination with D-dimer concentration in diagnostic workup of patients with suspected pulmonary embolism: a prospective management study.

BACKGROUND: We designed a diagnostic strategy, based on clinical probability and D-dimer concentration, to select patients who were unlikely to have pulmonary embolism (PE), before further diagnostic workup was performed. The utility and safety of this strategy were evaluated in a prospective management study. METHODS: Consecutive patients with suspected PE had D-dimer testing and clinical probability assessment with a clinical decision rule. Patients with a low probability and a normal D-dimer concentration (<500 ng/mL) were considered not to have PE, and further diagnostic testing and anticoagulant therapy were withheld. In patients with a low probability and elevated D-dimer level or with a moderate or high probability, bilateral compression ultrasonography of the legs was performed. If deep venous thrombosis was detected, venous thromboembolism was diagnosed. If compression ultrasonography was normal, pulmonary angiography was performed. All patients were followed up for 3 months. RESULTS: Of the 234 consecutive patients, 26% had the combination of a low probability and normal D-dimer level. During the follow-up period, none of these patients died and 3 patients had recurrent complaints of PE. In these 3 patients, PE was excluded by objective testing. The 3-month thromboembolic risk was therefore 0% (95% confidence interval, 0%-6%). The prevalence of PE in the entire population was 22%. CONCLUSIONS: The combination of a low clinical probability and a normal D-dimer concentration appears to be a safe method to exclude PE, with a high clinical utility, and is readily accepted by clinicians.