Luz A. Venta

Prospective Comparison of Stereotactic Core Biopsy and Surgical Excision as Diagnostic Procedures for Breast Cancer Patients

ObjectiveTo determine whether stereotactic core biopsy (SCNB) is the diagnostic method of choice for all mammographic abnormalities requiring tissue sampling. Summary Background DataStereotactic core needle biopsy decreases the cost of diagnosis, but its impact on the number of surgical procedures needed to complete local therapy has not been studied in a large, unselected patient population. MethodsA total of 1,852 mammographic abnormalities in 1,550 consecutive patients were prospectively categorized for level of cancer risk and underwent SCNB or diagnostic needle localization and surgical excision. Diagnosis, type of cancer surgery, and number of surgical procedures to complete local therapy were obtained from surgical and pathology databases. ResultsThe malignancy rate was 24%. Surgical biopsy patients were older, more likely to have cancer, and more likely to be treated with breast-conserving therapy than those in the SCNB group. For all types of lesions, regardless of degree of suspicion, patients diagnosed by SCNB were almost three times more likely to have one surgical procedure. However, for patients treated with lumpectomy alone, the number of surgical procedures and the rate of negative margins did not differ between groups. ConclusionsStereotactic core needle biopsy is the diagnostic procedure of choice for most mammographic abnormalities. However, for patients undergoing lumpectomy without axillary surgery, it is an extra invasive procedure that does not facilitate obtaining negative margins.

Cost Minimization Study of Image-Guided Core Biopsy Versus Surgical Excisional Biopsy for Women With Abnormal Mammograms

PURPOSE To describe the clinical and economic consequences of image-guided core biopsy versus surgical excisional biopsy of mammographically identified breast lesions. PATIENTS AND METHODS Clinical and economic data were collected for 1121 patients undergoing core biopsies and 501 patients undergoing surgical biopsies between 1996 and 1998. Lesions were classified according to mammographic degree of suspicion and type of radiographic abnormality. Costs were measured from the societal perspective. A decision analytic model was constructed, with probabilistic sensitivity analysis. RESULTS Lesions diagnosed via core versus surgical biopsy were less likely to be masses (39% v 55%), less likely to be classified as high cancer suspicion (17% v 26%), and less likely to be treated with a single procedure (74% v 81%; P <.001 for each). Cancers diagnosed by a surgical biopsy were less likely to have had a single operative procedure (33% v 84%) and were associated with higher total costs whether mastectomy (US dollars 2775 v US dollars 1849) or lumpectomy (US dollars 2112 v US dollars 1365) was used. Sensitivity analysis showed core biopsy optimal in 95.4% of trials. Core biopsy was favored for low-suspicion lesions, calcifications, and masses, and overall for patients who underwent lumpectomy alone. CONCLUSION Image-guided core biopsy can be cost-saving compared with surgical biopsy, particularly when the mammographic abnormality is classified as low suspicion or consists of calcifications or masses. Moving to a policy in which core biopsy is the preferred approach in these settings has the potential to result in significant cost savings.

Measuring satisfaction with mammography results reporting

OBJECTIVE: To assess factors associated with patient satisfaction with communication of mammography results and their understanding and ability to recall these results.DESIGN: Cross-sectional telephone survey.SETTING: Academic breast imaging center.PATIENTS: Two hundred ninety-eight patients who had either a screening or diagnostic mammogram.MEASUREMENTS AND MAIN RESULTS: Survey items assessed waiting time for results, anxiety about results, satisfaction with several components of results reporting, and patients’ understanding of results and recommendations. Women undergoing screening exams were more likely to be dissatisfied with the way the results were communicated than those who underwent diagnostic exams and received immediate results (20% vs 11%, P=.05). For these screening patients, waiting for more than two weeks for notification of results, difficulty getting in touch with someone to answer questions, low ratings of how clearly results were explained, and considerable or extreme anxiety about the results were all independently associated with dissatisfaction with the way the results were reported, while age and actual exam result were not.CONCLUSIONS: Patients undergoing screening mammograms were more likely to be dissatisfied with the way the results were communicated than were those who underwent diagnostic mammograms. Interventions to reduce the wait time for results, reduce patients’ anxiety, and improve the clarity with which the results and recommendations are given may help improve overall satisfaction with mammography result reporting.

Using neural networks to aid the diagnosis of breast implant rupture

Abstract From a database consisting of 78 inplants that were surgically removed, ultrasound findings and surgical results were used to train and test backpropagation and radial basis function (RBF) neural networks using the round-robin or leave-one-out method. Receiver-operating-characteristic (ROC) curve analysis was applied to compare the performance of the different neural networks with that of the radiologists involved in the ultrasound evaluations. The neural networks outperformed the radiologists involved. RBF networks performed better in this classification problem than did backpropagation networks. The best performing network utilized, in addition to the findings, the (unaided) diagnosis of the radiologist. Thus, the ‘team’ approach appears to provide the best results. Also, the network performed particularly well in those cases in which the radiologist classified the implant as indeterminate. The results suggest that a neural network using findings extracted from sonograms by experienced sonographers can be of great assistance to physicians with the diagnosis of implant rupture.

Age and interval for screening mammography: Whom do you believe?

The purpose of this article is to help the clinician understand the benefits and limitations of screening mammography in the 40-49 age group. Since the benefit of screening mammography is well established in the literature for the 50-59 age group, comparison of the relevant issues is focused on similarities and differences between these two age groups. The incidence of breast cancer, the effectiveness of mammography, and the growth rates of tumors influence the benefit derived from screening. Available data suggest that mammography is equally effective in both age groups, with similar detection rates of minimal cancer (27 vs. 25%). The difference in estimated annual incidence between the 40-49 and the 50-59 age group is only 8%. Since tumor growth rate seems to be faster in the younger age group, screening should be performed annually, starting at 40 years of age, if it is to provide a benefit.

Computer-aided diagnosis of lesions on multimodality images of the breast

We have developed computerized methods for the analysis of lesions that combine results from different imaging modalities, in this case digitized mammograms and sonograms of the breast, for distinguishing between malignant and benign lesions. The computerized classification method -- applied here to mass lesions seen on both digitized mammograms and sonograms, includes: (1) automatic lesion extraction, (2) automated feature extraction, and (3) automatic classification. The results for both modalities are then merged into an estimate of the likelihood of malignancy. For the mammograms, computer-extracted lesion features include degree of spiculation, margin sharpness, lesion density, and lesion texture. For the ultrasound images, lesion features include margin definition, texture, shape, and posterior acoustic attenuation. Malignant and benign lesions are better distinguished when features from both mammograms and ultrasound images are combined.