Debra A. Mangino

Sarcoidosis Presenting as Metastatic Bony Disease

Although asymptomatic lytic bony lesions of the phalanges of the hands and feet are not uncommon in patients with sarcoidosis, involvement of the vertebral bodies is rare. Because these lesions can mimic other diseases of the bones on radionuclide scans and magnetic resonance imaging (MRI), this case emphasizes the importance of obtaining tissue and excluding malignancy and infection before the diagnosis can be established with confidence

The lung in the immunocompromised host: diagnostic methods.

Accessible online at: www.karger.com/journals/res Previous articles in this series: 1. Nicod LP: Pulmonary defence mechanisms. Respiration 1999;66:2–11. 2. Baughman RP: The lung in the immunocompromised patient. Infectious complications, part I. Respiration 1999;66:95–109. 3. Tamm M: The lung in the immunocompromised patient. Infectious complications, part 2. Respiration 1999;66:199–207. 4. Cadranel J, Naccache JM, Wislez M, Mayaud C: Pulmonary malignancies in the immunocompromised patient. Respiration 1999;66:289–309. 5. Crawford S: Non-infectious lung diseases in the immunocompromised host. Respiration 1999;66:385–395. Over the past several decades, the number of immunosuppressed patients has become larger and the spectrum of illnesses has broadened and become more complex. Because the lung is a target organ for disease, the types of pulmonary disorders that affect the immunocompromised host (ICH) have also increased. Perhaps no other patient population presents with such a variety of infectious and noninfectious pathologic processes. Often these patients pose significant medical challenges because of difficulties associated with making a specific pulmonary diagnosis. Here we review the armamentarium of procedures available for making pulmonary diagnoses, with emphasis on the specific yield and risk associated with each procedure.

Comparison of screening CEDM and MRI for women at increased risk for breast cancer: A pilot study

OBJECTIVES Contrast enhanced digital mammography (CEDM) is a new breast imaging technology increasingly used in the diagnostic setting but its utility in the pure screening setting has not been reported. The goal of this pilot study is to prospectively compare screening CEDM to breast MRI in women with an increased risk for breast cancer. METHODS In this IRB-approved HIPAA-compliant study, 318 women at increased breast cancer risk were consented (December 2012-May 2015) to undergo CEDM in addition to their scheduled MRI. CEDM was performed within 30days of screening MRI. CEDM was interpreted blinded to MRI. The reference standard was defined as a combination of pathology and 2-year imaging follow-up. RESULTS Data from 307/318 patients were evaluable. Three cancers (two invasive cancers, one ductal carcinoma in situ) were detected at first round screening: MRI detected all three and CEDM detected the two invasive cancers. None of the three cancers was seen on the low energy mammograms which are comparable to conventional mammography. At 2year imaging follow up, there were 5 additional screen detected cancers and no palpable cancers. The positive predictive value 3 (PPV3) for CEDM was 15% (2/13, 95% CI: 2-45%) and 14% for MRI (3/21, 95% CI: 3-36%). The specificity of CEDM and MRI were 94.7% and 94.1% respectively. CONCLUSIONS Both CEDM and MRI detected additional cancers not seen on conventional mammography, primarily invasive cancers. Our pilot data suggest that CEDM could be valuable as a supplemental imaging exam for women at increased risk for breast cancer who do not meet the criteria for MRI or for whom access to MRI is limited. Validation in larger multi institutional trials is warranted.

Impact of self-reported data on the acquisition of multi-generational family history and lifestyle factors among women seen in a high-risk breast screening program: a focus on modifiable risk factors and genetic referral

BackgroundThe phrase “high-risk for breast cancer” is used to identify various groups at elevated cancer risk, and the appropriate surveillance and risk-reducing strategies differ based on the etiology of risk. Here, we review the utility of patient-reported data to capture women with modifiable lifestyle risk factors and those suitable for genetic counseling referral.MethodsPatient-reported data from a web-based survey were used to capture personal history, multi-generational family history, and lifestyle factors (body mass index, alcohol consumption, physical activity). Responses were tabulated, and percentage of patients who met criteria for possible intervention calculated.Results1277 women completed the survey from October 2014 to December 2015. Women were considered high risk for a combination of the following: family history of breast and/or ovarian cancer (77%), history of atypical hyperplasia or lobular carcinoma in situ (35%), known breast cancer-related gene mutation (11%). Based on self-reported data, 65% qualified for genetic evaluation but 40% reporting no prior testing. Only half of the population met national physical activity recommendations, nearly 40% were overweight/obese, and 18% reported consuming ≥1 alcoholic beverage per day.ConclusionsAmong women followed in a high-risk breast surveillance program, there is considerable opportunity for improved genetic referral and awareness of modifiable lifestyle factors based on self-reported data as 60% of respondents reported a possible area for intervention. While risk reduction associated with lifestyle changes is modest in comparison to chemoprevention or surgery, such changes are practically without risk, minimally expensive, and provide innumerable secondary health benefits.