PAPs showed a strong predilection for the peripheral pulmonary arteries. Multiplicity of PAPs can be seen in the settings of endocarditis and pulmonary metastatic disease. Most PAPs were not associated with a ground-glass halo. PAPs can be lethal but were often not suspected clinically and were underreported by radiologists.
ObjectiveTo compare the interpretation times between conventional screening mammography and screening combined tomosynthesis and conventional 2D mammography in a large academic center with multiple participating radiologists with a wide range of experience for determining the effect of implementing a screening tomosynthesis program.
Materials and MethodsImages from 3665 examinations (1502 combined and 2163 digital mammography) from July 2012 to January 2013 were prospectively read by 10 radiologists from screening mammography or screening combined tomosynthesis conventional 2D mammography in at least five sessions per radiologist per modality (each session was 1-hour-long uninterrupted time). The number of cases reported for each reader during each session was recorded and the experience level for each radiologist was also correlated to the average number of cases reported per hour. Statistical analysis was used to assess the number of studies interpreted per hour and to evaluate correlation between breast imaging experience and time taken to interpret images from both modalities.
ResultsApproximately 24 studies were interpreted per hour for combined tomosynthesis and mammography and 34 for digital mammography alone. The mean interpretation time for combined tomosynthesis and mammography was 47% longer than that for digital mammography. The overall interpretation time for combined tomosynthesis and mammography examinations decreased with the increase in years of breast imaging experience.
ConclusionThe mean interpretation time for combined tomosynthesis and mammography was longer than that for digital mammography by 47% and the overall interpretation time decreased with increase in years of breast imaging experience. This increase in interpretation time may be within acceptable limits, given the technology has other associated benefits, such as increased cancer detection, reduced false-positive rates, and streamlined diagnostic workflow.
Methods of axillary evaluation in invasive breast cancer continue to evolve. The recent American College of Surgeons Oncology Group Z0011 Trial is a prospective, randomized, multicenter trial that compared the survival and locoregional recurrence rates after complete axillary lymph node dissection (ALND) versus sentinel node biopsy (SNB) alone in women with a positive sentinel node in an effort to avoid the complications associated with ALND. As the results of this trial are implemented clinically, affecting surgical management of axillary metastatic disease, radiologists may need to redefine their role in the preoperative assessment of the axilla. Before the Z0011 trial, breast imagers worked to identify axillary metastases preoperatively, allowing appropriate patients to proceed directly to ALND and avoiding the need for SNB. However, the Z0011 trial concluded that ALND may not be necessary in women with metastatic axillary disease who meet the trial criteria. In the Z0011 trial, after 6 years of median follow-up there was no difference in either locoregional recurrence or survival among the women who underwent SNB alone compared with those who underwent ALND, suggesting that ALND is unnecessary in a subset of women with a positive node at SNB. These results raise questions about how aggressively radiologists should pursue percutaneous sampling of axillary nodes, as some practitioners conclude that, in an otherwise eligible woman, positive results from imaging-guided percutaneous biopsy preclude a Z0011 trial-directed pathway. Debate about the best way to implement the results of the Z0011 trial into daily clinical practice exists. It is important for breast imagers to work closely with breast surgeons to provide the most appropriate treatment course for each patient.
women undergoing percutaneous breast biopsy in an academic medical center were recruited to participate in a mixed-mode survey 2-4 days after biopsy. Patients described their biopsy experience by using the Testing Morbidities Index (TMI), a validated instrument for assessing short-term quality of life related to diagnostic testing. The scale ranged from 0 (worst possible experience) to 100 (no adverse effects). Seven attributes were assessed: pain or discomfort before and during testing, fear or anxiety before and during testing, embarrassment during testing, and physical and mental function after testing. Demographic and clinical information were also collected. Univariate and multivariate linear regression analyses were performed to identify significant predictors of TMI score.
Results:In 188 women (mean age, 51.4 years; range, 22-80 years), the mean TMI score (6standard deviation) was 82 6 12. Univariate analysis revealed age and race as significant predictors of the TMI score (P , .05). In the multivariate model, only patient age remained a significant independent predictor (P = .001). TMI scores decreased by approximately three points for every decade decrease in patient age, which suggests that younger women were more adversely affected by the biopsy experience.
Conclusion:Younger patient age is a significant predictor of decreased short-term quality of life related to percutaneous breast biopsy procedures. Tailored prebiopsy counseling may better prepare women for percutaneous biopsy procedures and improve their experience.q RSNA, 2013
Follow-up imaging of radiographically suspected pneumonia leads to a small number of new diagnoses of malignancy and important nonmalignant diseases, which may alter patient management.
As clinical implementation of DBT becomes increasingly widespread, breast radiologists need an algorithm for addressing the small number of inconclusive findings that remain equivocal despite thorough DM/DBT and ultrasound examinations. Breast MRI is a useful adjunctive tool for these selected cases.
The majority of responding radiologists recommended follow-up on a case-by-case basis, influenced by multiple factors. Only a small minority reported a standardized practice at their institution. This lack of consistency demonstrates the need for a uniform, evidence-based approach.
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