Richard P. Jacobs

Performance Parameters for Screening and Diagnostic Mammography in a Community Practice: Are There Differences Between Specialists and General Radiologists?

OBJECTIVE The purpose of this study was to compare the performance of general radiologists in interpretation of mammograms with that of breast imaging specialists in a high-volume community hospital-based private practice. MATERIALS AND METHODS A retrospective observational study was conducted with data prospectively collected over a 5-year period in a community hospital-based practice in which 106,405 screening and 52,149 diagnostic mammograms were performed. The performance of three radiologists specializing in breast imaging was compared with that of six general radiologists. The following data were extracted and analyzed: recall rate, biopsy recommendation rate, and cancer detection rate. Statistical analysis was performed with a chi-square test and two-tailed calculation of p values. RESULTS The recall rates of the specialists and generalists were nearly the same at 6.5% and 6.7%, respectively. The biopsy recommendation rate at recall from screening examinations was nearly the same for generalists and specialists (1.2% and 1.1%, respectively; p = 0.4504). This rate also was similar for diagnostic examinations (8.5% for generalists; 8.4% for specialists; p = 0.4086). The cancer detection rate in the screening setting was slightly higher for specialists than for generalists: 2.5 and 2.0 cancers per 1,000 cases, respectively (p = 0.0614). The cancer detection rate in the diagnostic setting was 24.2% higher among specialists (20.0 cancers per 1,000 cases) compared with generalists (16.1 cancers per 1,000 cases) (p = 0.0177). CONCLUSION The only statistically significant difference between generalists and specialists was in cancer detection rate among patients undergoing diagnostic mammography. No statistically significant difference was identified between the two groups in terms of recall rate, biopsy recommendation rate, or percentage of favorable-prognosis cases of cancer detected. There was a trend toward greater cancer detection by specialists in the screening setting.

Clip Placement After Sonographically Guided Percutaneous Breast Biopsy

Abstract: A simple and inexpensive technique for deployment of a metallic marker at the site of an ultrasound guided core breast biopsy is described. An illustrative case in which this technique was employed to mark the location of three biopsied lesions is presented.

Angiographic findings of choledochal cyst

Congenital cystic dilatation of the common bile-duct (choledochal cyst) is an uncommon anomaly (Ravitch and Snyder, 1958). Its pathogenesis is not precisely known. Episodic enlargement of the cyst coincides with fluctuating obstruction of the common bile-duct and the clinical triad of abdominal pain, jaundice and a mass in the right upper quadrant. Progressive biliary cirrhosis develops if the obstructing cyst is not surgically decompressed (Alonso-Lej, Rever and Pessagno, 1959; Ravitch and Snyder, 1958). The pre-operative diagnosis of choledochal cyst depends primarily upon a high index of suspicion in the appropriate clinical setting. Radiographic studies can then be directed toward definitive diagnosis. This case report presents the angiographic findings that led to pre-operative diagnosis of choledochal cyst.

Neoplastic Pseudoaneurysm of the Superior Mesenteric Artery

The authors describe a case of pseudoaneurysm of the superior mesenteric artery caused by arterial invasion by a liposarcoma. Neoplastic pseudoaneurysms are rare; most are due to sarcomas and usually involve veins.

Microcystic Calcifications at Stereotactic Breast Biopsy

▪Abstract: Calcifications in breast microcysts frequently exhibit characteristic layering in 90‐degree horizontal beam mammographic images. This observation is sufficiently predictive of a benign process that biopsy can be avoided. We report our experience with nine patients in whom stereotactic biopsy was attempted for clustered calcifications which failed to convincingly layer in true lateral magnification views. Two cases are described and illustrated. In all nine patients, layering of calcifications was more convincingly suggested on preliminary digital images prior to stereotactic biopsy. The effect of compression and dependent breast position may explain this observation. Calcification was sparse or absent in extracted cores yet diminished or disappeared in postbiopsy mammograms. Radiologists are alerted to these possible results when stereotactic biopsy of microcystic calcification is attempted. ▪