Carol A. Hulka

Breast cancer survival among women under age 50: is mammography detrimental?

Great uncertainty exists about the benefit of detecting breast cancer by mammography in women under 50 years of age. We have reviewed the survival of patients aged 49 years or less whose cancers were detected by mammography alone. 117 women under the age of 50 years were diagnosed with breast cancer between 1978 and 1991 based only on an abnormal mammogram. Ductal carcinoma in-situ (DCIS) was found in 47 (40%) of these women, whilst 70 (60%) had infiltrating ductal or infiltrating lobular carcinomas. During the same interval, 928 women in this age group presented with palpable breast cancer. DCIS was diagnosed in 82 (9%) of these women, whilst 846 (91%) had infiltrating carcinoma. Among the infiltrating cancers detected by mammography alone, 50% were stage I, whilst only 30% of the women with palpable cancers were stage I. Five-year survival for all mammographically detected cancer patients was 95%, whereas for women with palpable cancers the survival was 74% (p < 0.00005). If DCIS is not included, the corresponding survivals are 91% for mammographically detected infiltrating cancers and 72% for palpable infiltrating cancers. Only 1 woman who died among those with palpable cancer had had a mammogram before diagnosis. Our data contradict the suggestion that women under 50 are put at a survival disadvantage by undergoing mammography. We believe that investigators who have reported negative results in this age group must examine other causes for their results.

Technical factors influencing sonographic visualization of fetal echogenic intracardiac foci.

A fetal echogenic intracardiac focus (EIF) is most commonly a normal variant in a normal fetus, but owing to reports of an increased risk of aneuploidy with EIFs, the finding causes concern when noted on routine obstetric sonograms. This study was undertaken to determine which factors influence the sonographic visualization of fetal EIFs.

Digital synthesis of lung nodules.

Studies evaluating observer accuracy and visual perception of pulmonary nodules usually are based upon test films obtained from clinical practice in patients with proven pulmonary nodules. Unfortunately, such nodules do not always occur in the optimal size and location to facilitate testing. Such studies would be enhanced by the ability to place nodules of desired size and location on chest radiographs. This report describes a method of placing a computer-generated (synthesized) nodule on a digitized chest radiograph. To demonstrate the similarity of these synthesized nodules to real nodules, each digitized radiograph with a computer-generated nodule was paired with a digitized chest radiograph of a patient with a clinically proven pulmonary nodule. A total of 22 pairs of chest radiographs were then shown to 13 radiologists, who were asked to distinguish the synthesized nodule from the real nodule. With this two alternative forced-choice test, the radiologists were only able to distinguish the synthesized nodule in 51% of the cases, strongly suggesting that computer generated nodules may be used to simulate real pulmonary nodules in future tests of nodule detection.

Echo-planar chemical shift imaging of silicone gel prostheses

We have developed an echo-planar (EP) proton chemical shift imaging (CSI) MR technique that allow us to discriminate the polydimethylsiloxane (PDMS, silicone) proton MR signal from that of the fat and water protons found in tissues, in order to map the distribution of PDMA in humans who have silicone gel prostheses. Silicone gel-filled prosthetic implants induce histologic changes in the surrounding tissue which are attributed to the leakage of free PDMS from the prosthesis. The T2 relaxation measurements of three silicone gels show that there are two components in them, each with a different degree of molecular mobility. The presence of free silicone is confirmed by chloroform extraction, which removed 14-28% of the material. This free polymer present in the gel can pass through the intact or ruptured membrane of the implant into the surrounding tissue. Our preliminary imaging results indicate that EP-CSI MR might be useful as a diagnostic technique for implant malfunction.

Computed tomography-guided needle localization of nonpalpable breast lesions: review of 24 cases.

RATIONALE AND OBJECTIVES We examined the role of computed tomography (CT) in breast imaging, especially in guiding needle localization procedures. METHODS We reviewed our institutions breast imaging database, from 1978 to 1994, for procedures in which CT scanning was used. Twenty-four CT-guided needle localizations were identified. Medical records, mammograms, CT scans, and pathology reports were reviewed for all patients. RESULTS Twenty-four needle localizations were performed on 22 female patients. The average size of the lesions localized was 12 mm. The most common reason for CT scanning was the inability to image a suspicious density by conventional mammography on two orthogonal views. Nine malignant and 15 benign lesions were localized under CT guidance. One patient developed a postoperative hematoma. No other complications occurred. CONCLUSION CT-guided breast localization is a reliable technique that may be used to define selected breast lesions that are difficult to triangulate or localize by conventional two-view mammography.

Preoperative sonographic evaluation and laparoscopic management of persistent adnexal masses: A 1994 review

Carcinoma of the ovary is a frightening disease because it is a major cause of death due to cancer in women and is the leading cause of deaths from gynecologic malignancies. The disease is associated with a common clinical problem: persistent adnexal masses, most of which are benign. Operative laparoscopy has become an increasingly attractive way of diagnosing and removing adnexal masses. The practicing general gynecologist thus faces two new dilemmas: not to miss an early ovarian cancer or manage an unsuspected one to the patients detriment, and not to perform extensive major surgery for adnexal masses, most of which can be handled laparoscopically. Fortunately, pertinent data exist on which the resolution of these dilemmas may be based.

Evaluation of Fetal Central Nervous System Abnormalities with Ultrafast MRI

Central nervous system (CNS) abnormalities affect approximately 6000 neonates each year in the United States. The standard prenatal approach for evaluating these anomalies is ultrasonography (US). However, the sonographic evaluation of the fetal CNS is limited. 41 fetuses with suspected abnormal central nervous system (CNS) underwent prenatal MRI. In each case MR allowed for visualization of the region of suspected abnormality. MR added additional information to that provided by ultrasound in 28 cases. When a CNS anomaly is detected by US, then MR may demonstrate additional findings which alter patient counseling and management.