John Barclay

Utility of Magnetic Resonance Imaging in the Management of Breast Cancer: Evidence for Improved Preoperative Staging

PURPOSE The staging and treatment for breast cancer are changing; there is an increase in the incidence of ductal carcinoma-in-situ, the use of fine-needle aspiration and stereotactic biopsy for diagnosis, and the use of neoadjuvant chemotherapy. Thus, there is a need for a tool to assess more precisely the extent of cancer in the breast before surgery. To better plan surgical and chemotherapeutic interventions, we evaluated high-resolution magnetic resonance imaging (MRI) as such a tool. PATIENTS AND METHODS Fifty-seven patients with 58 cases of breast cancer were evaluated preoperatively with MRI using a technique called the triple-acquisition rapid gradient echo technique to maximize anatomic detail. Imaging results were compared with mammography and subsequent pathology results. RESULTS Magnetic resonance imaging correctly identified residual or primary cancer in 55 of 58 cases and accurately predicted the extent of the cancer in 54 of 58 cases. The anatomic extent was more accurately defined with MRI compared with mammography (98% v 55%). Magnetic resonance imaging added the greatest value in cases of multifocal disease. CONCLUSION By applying MRI selectively to patients with a known diagnosis of cancer and focusing on defining the extent of malignant lesions, we were able to obtain clear and accurate anatomic information. Our results suggest that MRI could provide very valuable information for preoperative planning and single-stage resection in breast cancer. Based on preliminary data from our series, MRI would be valuable as a staging tool in the preoperative setting even if the cost is in the range of

Development, standardization, and testing of a lexicon for reporting contrast-enhanced breast magnetic resonance imaging studies

1,300 to

Predictors of visits to commercial sex workers by male attendees at sexually transmitted disease clinics in southern Vietnam

2,000. It is already significantly less than the target cost, so it is reasonable to refine this technique for clinical use to help plan the most appropriate surgical intervention and possibly reduce costs as well. A careful prospective study is warranted to validate our findings.

Sexual Risk Behavior of Women in Entertainment Services, Vietnam

The purpose of this study was to develop, standardize, and test reproducibility of a lexicon for reporting contrast‐enhanced breast magnetic resonance imaging (MRI) examinations. To standardize breast MRI lesion description and reporting, seven radiologists with extensive breast MRI experience developed consensus on technical detail, clinical history, and terminology reporting to describe kinetic and architectural features of lesions detected on contrast‐enhanced breast MR images. This lexicon adapted American College of Radiology Breast Imaging and Data Reporting System terminology for breast MRI reporting, including recommendations for reporting clinical history, technical parameters for breast MRI, descriptions for general breast composition, morphologic and kinetic characteristics of mass lesions or regions of abnormal enhancement, and overall impression and management recommendations. To test morphology reproducibility, seven radiologists assessed morphology characteristics of 85 contrast‐enhanced breast MRI studies. Data from each independent reader were used to compute weighted and unweighted kappa (κ) statistics for interobserver agreement among readers. The MR lexicon differentiates two lesion types, mass and non‐mass‐like enhancement based on morphology and geographical distribution, with descriptors of shape, margin, and internal enhancement. Lexicon testing showed substantial agreement for breast density (κ = 0.63) and moderate agreement for lesion type (κ = 0.57), mass margins (κ = 0.55), and mass shape (κ = 0.42). Agreement was fair for internal enhancement characteristics. Unweighted kappa statistics showed highest agreement for the terms dense in the breast composition category, mass in lesion type, spiculated and smooth in mass margins, irregular in mass shape, and both dark septations and rim enhancement for internal enhancement characteristics within a mass. The newly developed breast MR lexicon demonstrated moderate interobserver agreement. While breast density and lesion type appear reproducible, other terms require further refinement and testing to lead to a uniform standard language and reporting system for breast MRI. J. Magn. Reson. Imaging 2001;13:889–895.

High HIV Seropositivity at an Anonymous Testing Site in Chennai, India: Client Profile and Trends over Time

OBJECTIVES To determine the HIV/sexually transmitted disease (STD) status of male patients at STD clinics and factors associated with frequent visits to commercial sex workers (CSW) in southern Vietnam. DESIGN Cross-sectional survey. METHODS Confidential interviews and physical and laboratory evaluation of 804 male patients at STD clinics in two semi-rural provinces in the Mekong delta. RESULTS HIV seroprevalence was 0.5%. The prevalence of urethritis syndrome was 19.3%, gonorrhea 10.2% (Gram-stain positive) and syphilis 2% (reactive rapid plasma reagin test). All the men had visited CSW in the past and 58% had their first sexual experience with a CSW; 73% had visited a CSW in the last 3 years. Married men were equally as likely as single men to have casual partners or to have visited a CSW. The men recruited CSW more from the streets (45%) than from brothels (38%). Factors independently associated with visiting a CSW in the last 3 years included being single [odds ratio (OR), 2.2], age under 20 years (OR, 1.9), having first sexual intercourse with a CSW (OR, 2.1), not having a current girlfriend (OR, 2.1), using alcohol before sex (OR, 2.7) and drug use (OR, 1.8). Only 7% of men used condoms consistently; 70% had never used them. Only 37% had used a condom last time they had intercourse with a CSW. CONCLUSIONS Prevention programs for men in Vietnam, particularly those who are young or single, need to focus on reducing drug and alcohol consumption and improving condom use with CSWs.

Incidence of and Treatment for Ductal Carcinoma In Situ of the Breast

An increase in heterosexual HIV transmission is occurring in Vietnam, where women working in entertainment establishments as well as women in brothels may practice commercial sex. This study surveyed a cross-sectional sample of 500 women in entertainment services in the tourist city of Vung Tau in southern Vietnam in 1996. The mean age of the women was 24 years, 23% were married, and 266 (53%) reported sex during the last 12 months, of whom 70% were having multiple or casual partners (nonregular sex). Twenty-nine percent of married women were having extramarital relations; the mean number of partners during the last year was 22.5 among married women and 18.8 among unmarried women (range 2–360). The HIV prevalence among sexually active women was 0.5%. Factors associated with having more than 5 partners or nonregular sex included working in bars or coffee shops and having a high declared income (>100 USD/month), even though many received no official salary. It is likely that many of these women are practicing commercial sex. Despite the difficulty of access, these women must be targeted for condom promotion and HIV prevention services.

Effect of Age, Breast Density, and Family History on the Sensitivity of First Screening Mammography

Despite the magnitude of the HIV epidemic in India, few centers exist that provide anonymous HIV testing that is also accompanied by adequate counseling and referral. This study describes the trends in demographic profiles, HIV serostatus, and risk factors among 1,745 male and female clients who accessed an anonymous counseling and testing center in Chennai, India from 1994 to 1998. The prevalence of HIV in this sample was 51%, indicating that the clinic is successful in its outreach to at-risk individuals. The increasing number of clients over time suggests that this clinic has been well-received by the community. Correlates of being HIV-positive included occasional condom use, being married, being referred by an HIV-positive sex partner, working as a truck driver or migrant, or having a spouse in these professions. The success of this clinic serves as a model for similar centers in India, and points to the widespread need for anonymous testing and counseling.