A 24-year-old male presented to the institute in GI Oncosurgery Department as a diagnosed case of metastatic adenocarcinoma of rectum. The cross sectional imaging done in the radiology department also showed evidence of polypoidal infiltrative rectal mass with perirectal, bilateral iliac and paraaortic lymphadenopathy and bony lesions [Table/ Fig-1]. Patient underwent abdominoperineal resection with abdominal lymph node dissection after receiving neoadjuvant chemotherapy and radiotherapy. Thereafter, patient received multiple cycles of FOLFOX-4 based chemotherapy and was on regular follow up for one and a half years, when he presented with complain of painless right scrotal swelling. USG examination revealed multicystic septated lesion involving head and body of right epididymis measuring 3.0 x 1.6 x 3.6 cm. On colour Doppler imaging there was no internal vascularity b]. Mild ipsilateral hydrocele was also present. Bilateral testis were unremarkable. Imaging differentials of cystic lymphangioma, loculated hydrocele, epididymal cysts and spermatocele were considered and patient
Background
Abbreviated breast MRI (A-MRI) substantially reduces the image acquisition and reading times and has been reported to have similar diagnostic accuracy as a full diagnostic protocol but has not been evaluated prospectively with respect to impact on psychological distress in women with a prior history of breast cancer (PHBC). This study aimed to determine if surveillance mammography (MG) plus A-MRI reduced psychological distress and if A-MRI improved cancer detection rates (CDR) as compared to MG alone.
Methods
This prospective controlled trial of parallel design was performed at a tertiary cancer center on asymptomatic women with PHBC who were randomized into two groups: routine surveillance with MG or intervention of MG plus A-MRI in a 1:1 ratio. Primary outcome was anxiety measured by four validated questionnaires at three different time-points during the study. Other parameters including CDR and positive predictive value for biopsy (PPV3) were compared between imaging modalities of MG and A-MRI. Tissue diagnoses or 1 year of follow-up were used to establish the reference standard. Linear mixed models were used to analyze anxiety measures and Fisher’s exact test to compare imaging outcomes.
Results
One hundred ninety-eight patients were allocated to either MG alone (94) or MG plus A-MRI (104). No significant group difference emerged for improvement in trait anxiety, worry and perceived health status (all Time-by-surveillance group interaction ps > .05). There was some advantage of A-MRI in reducing state anxiety at Time 2 (p < .05). Anxiety scores in all questionnaires were similarly elevated in both groups (50.99 ± 4.6 with MG alone vs 51.73 ± 2.56 with MG plus A-MRI, p > 0.05) and did not change over time. A-MRI detected 5 invasive cancers and 1 ductal carcinoma in situ (DCIS), and MG detected 1 DCIS. A-MRI had higher incremental CDR (48/1000(5/104) vs MG 5/1000(1/198, p = 0.01)) and higher biopsy rates (19.2% (20/104) vs MG 2.1% (2/94), p < 0.00001) with no difference in PPV3 (A-MRI 28.6% (6/21) vs MG 16.7% (1/6, p > .05).
Conclusion
There was no significant impact of A-MRI to patient anxiety or perceived health status. Compared to MG alone, A-MRI had significantly higher incremental cancer detection in PHBC. Despite a higher rate of biopsies, A-MRI had no demonstrable impact on anxiety, worry, and perceived health status.
Trial registration
ClinicalTrials.gov (NCT02244593). Prospectively registered on Sept. 14, 2014.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.