The introduction of computer-aided detection into this practice was not associated with statistically significant changes in recall and breast cancer detection rates, both for the entire group of radiologists and for the subset of radiologists who interpreted high volumes of mammograms.

In this small data set, FFDM appears to be slightly more sensitive than digital breast tomosynthesis for the detection of calcification. However, diagnostic performance as measured by area under the curve using BI-RADS was not significantly different. With improvements in processing algorithms and display, digital breast tomosynthesis could potentially be improved for this purpose.

Background Chylothorax is a rare but potentially lethal complication of esophagectomy. The study aims were to evaluate the rate of postesophagectomy chylothorax, identify associated risk factors and compare postoperative outcomes with patients who do not develop chylothorax. Methods We reviewed 892 consecutive patients undergoing esophagectomy (1997-2008). Preoperative, operative and postoperative details, including adverse outcomes and mortality, were analyzed. Results We identified postesophagectomy chylothorax in 34 patients (3.8%). Chylothorax was significantly associated with adverse outcomes, including 30-day major complications (85% vs. 46%; p<0.001) and mortality (17.7 vs. 3.9%, p<0.001). Patients with chylothorax were significantly more likely to develop sepsis (p=0.001), pneumonia (p=0.009), need reintubation (p=0.002) or require reoperation (p<0.001). Median length of stay was significantly longer (17 vs. 8 days; p=0.005). Median time to chylothorax diagnosis was 5 days. Thoracic duct ligation was performed in 62% (n=21; median 13 days after esophagectomy). Repeat duct ligation for persistent chylothorax was required in 2 patients. Squamous cell cancer histology (9/34; 26%) was an independent predictor of postoperative chylothorax (OR 4.18; 95% CI 1.39, 12.6). Odds of chylothorax were 36 times greater with average daily chest tube output >400 ml in the first 6 postoperative days (OR 35.9; 95% CI 8.2, 157.8). Conclusions Postoperative chylothorax is associated with significant postoperative morbidity and mortality. Patients with squamous cell cancer may be at increased risk. In addition, >400 ml average daily chest tube output in the early postoperative period should prompt fluid analysis for chylothorax to facilitate early diagnosis and consideration of thoracic duct ligation.

Purpose To compare radiologists’ performance during interpretation of screening mammograms in the clinic to their performance when reading the same examinations in a retrospective laboratory study. Materials and Methods This study was conducted under an Institutional Review Board approved HIPAA compliant protocol where informed consent was waived. Nine experienced radiologists rated an enriched set of examinations that they personally had read in the clinic (“reader-specific”) mixed with an enriched “common” set of examinations that none of the participants had read in the clinic, using a screening BI-RADS rating scale. The original clinical recommendations to recall the women for a diagnostic workup, or not, for both reader-specific and common sets were compared with their recommendations during the retrospective experiment. The results are presented in terms of reader-specific and group averaged “sensitivity” and “specificity” levels and the dispersion (spread) of reader-specific performance estimates. Results On average radiologists performed significantly better in the clinic as compared with their performance in the laboratory (p=0.035). Inter reader dispersion of the computed performance levels was significantly lower during the clinical interpretations (p<0.01). Conclusion Retrospective laboratory experiments may not represent well either expected performance levels or inter- reader variability during clinical interpretations of the same set of examinations in the clinical environment.