National estimates project COVID-19 negatively influenced cancer screening, leading to an estimated deficit of 3.9 million breast cancer (BC) screenings among US adults. 1,2 In San Francisco, California, low-income neighborhoods disproportionately affected by COVID-19 bear the burden of higher BC stage at diagnosis. 3,4 We sought to evaluate the association of COVID-19 and BC screening in a safety-net hospital in San Francisco. MethodsThis cross-sectional study evaluated trends in BC screening at an urban integrated health system's safety-net hospital. We obtained the number of screening mammograms per month during 2019 from electronic health record (EHR) data, and aggregate numbers between September 1, 2019, and January 31, 2021, after the implementation of a new EHR. The number of screening mammograms per month was plotted against the 2019 baseline. Proportions of completed tests by phase of the pandemic (pre-COVID-19, first stay-at-home order, reopening, and second stay-at-home order) were compared by race/ethnicity and age with 2-sided, 2-sample proportion tests. Race/ethnicity was used as a proxy for the disproportionate burden of COVID-19 and experiences of individual and systemic racism experienced by minority communities. Analyses were conducted with Stata, version 16 (StataCorp LLC). P < .05 was used to determine significance. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cross-sectional studies. 5 Deidentified data collected for quality improvement activities does not require approval from The University of California, San Francisco institutional review board; this study was therefore exempted from review.
Aim. The aim of this investigation was to examine the alterations in the peritoneum after cold dry CO2, heated dry CO2, and humidified heated CO2 at pressures equivalent to intraperitoneal pressures used in human laparoscopy. Methods. Eighteen rats were divided into 4 treatment groups—group 1: untreated control; group 2: insufflation with cold dry CO2; group 3: insufflation with heated, dry CO2; group 4: insufflation with heated and humidified CO2. The abdomen was insufflated to 5 mm/Hg (flow rate 50 mL/min) for 2 h. Twelve hours later, tissue samples were collected for analysis by light microscopy (LM) and scanning electron microscopy (SEM). Results. Group 1: no abnormalities were detected. Group 2: specimens revealed an inflammatory response with loss of mesothelium and mesothelial cell nuclei showing lytic change. Cells were rounded with some areas of cell flattening and separation. Group 3: some animals showed little or no alteration, while others had a mild inflammatory response. Mesothelial cells were rounded and showed crenation on the exposed surface. Group 4: specimens showed little change from the control group. Conclusions. The LM results indicate that insufflations with heated, humidified CO2 are the least likely to induce mesothelial damage.
Background Magnetic resonance enterography (MRE) is increasingly used in children due to growing concerns of radiation. Objective To determine the performance of MRE, imaging findings were compared to wireless capsule endoscopy (WCE) and histology results in children with/or suspected inflammatory bowel disease (IBD). Materials and methods Pathology and WCE reports were retrospectively reviewed in 23 patients who had MRE. Results The sensitivity of MRE was 75.0% while the sensitivity of WCE was 77.8%. Conclusion MRE and WCE are complementary techniques in evaluation of the small bowel in IBD.
A general understanding of ultrasound physics relative to image optimization is essential when performing breast ultrasound examinations and in accurately interpreting images of the breast. Appropriate technique is crucial to achieve accurate lesion characterization and is emphasized in the second edition of the American College of Radiology Breast Imaging Reporting and Data System for ultrasound (2013). This pictorial essay reviews clinically relevant ultrasound physics to best characterize breast lesions for guiding the clinician to the proper diagnosis. Differences in chosen parameters on ultrasound imaging can create variability in the appearance of breast lesions.
Objective To evaluate the impact of comparison with multiple prior examinations on screening mammography outcomes relative to comparison with a single prior. Materials and Methods Following institutional review board approval, we retrospectively analyzed 46,288 consecutive screening mammograms in 22,792 women at our institution. We subdivided these examinations into three groups: those interpreted without priors, with one prior, and with two or more priors. For each group we determined the recall rate. We also calculated the positive predictive value of recall (PPV1) and cancer detection rate (CDR) for the single and multiple prior groups. Generalized estimating equations with logistic link function were used to determine the relative odds of recall as a function of the number of comparisons with adjustment for age as a confounding variable. Fisher’s exact test was performed to compare the PPV1 and CDR in the different cohorts. Results Recall rates for mammograms interpreted with no priors, one prior and two or more priors were 16.6%, 7.8%, and 6.3%, respectively. After adjusting for age, the odds ratio of recall for the multiple prior relative to the single prior group was 0.864 (95% CI: 0.776, 0.962; p=0.0074). There were also statistically significant increases in PPV1 of 0.05 (p=0.0009) and CDR of 2.3/1000 (p=0.0481) for mammograms compared with multiple priors relative to a single prior. Conclusions Comparison with two or more prior mammograms resulted in a statistically significant reduction in the screening mammography recall rate and increases in the CDR and PPV1 relative to comparison with a single prior.
Radiology 2018; 289:630-638 • https://doi.org/10.1148/radiol.2018181180 • Content code:Purpose: To compare the performance of two-dimensional synthetic mammography (SM) plus digital breast tomosynthesis (DBT) versus conventional full-field digital mammography (FFDM) in the detection of microcalcifications on screening mammograms. Materials and Methods:In this retrospective multireader observer study, 72 consecutive screening mammograms recalled for microcalcifications from June 2015 through August 2016 were evaluated with both FFDM and DBT. The data set included 54 mammograms with benign microcalcifications and 18 mammograms with malignant microcalcifications, and 20 additional screening mammograms without microcalcifications used as controls. FFDM alone was compared to synthetic mammography plus DBT. Four readers independently reviewed each data set and microcalcification recalls were tabulated. Sensitivity and specificity for microcalcification detection were calculated for SM plus DBT and for FFDM alone. Interreader agreement was calculated with Fleiss kappa values. Results:Reader agreement was kappa value of 0.66 (P , .001) for FFDM and 0.63 (P , .001) for SM plus DBT. For FFDM, the combined reader sensitivity for all microcalcifications was 80% (229 of 288; 95% confidence interval [CI]: 74%, 84%) and for malignant microcalcifications was 92% (66 of 72; 95% CI: 83%, 97%). For SM plus DBT, the combined reader sensitivity for all microcalcifications was 75% (215 of 288; 95% CI: 69%, 80%) and for malignant microcalcifications was 94% (68 of 72; 95% CI: 86%, 98%). For FFDM, the combined reader specificity for all microcalcifications was 98% (78 of 80; 95% CI: 91%, 100%) and for malignant microcalcifications was 98% (78 of 80; 95% CI: 91%, 100%). For SM plus DBT, combined reader specificity for all microcalcifications was 95% (76 of 80; 95% CI: 88%, 99%) and for malignant microcalcifications was 95% (76 of 80; 95% CI: 88%, 99%). Mixed-effects model concluded no differences between modalities (20.03; 95% CI: 20.08, 0.01; P = .13). Conclusion:Relative to full-field digital mammography, synthetic mammography plus digital breast tomosynthesis had similar sensitivity and specificity for the detection of microcalcifications previously identified for recall at screening mammography.
As the proportion of women diagnosed with early stage breast cancer increases, the role of imaging for staging and surveillance purposes is considered. National and international guidelines discourage the use of staging imaging for asymptomatic patients newly diagnosed with stage 0 to II breast cancer, even if there is nodal involvement, as unnecessary imaging can delay care and affect outcomes. In asymptomatic patients with a history of stage I breast cancer that received treatment for curative intent, there is no role for imaging to screen for distant recurrences. However, routine surveillance with an annual mammogram is the only imaging test that should be performed to detect an in-breast recurrence or a new primary breast cancer in women with a history of stage I breast cancer.
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