A recent study was conducted to evaluate the diagnostic characteristics of sonographic surveillance for detection of metachronous contralateral breast cancer in patients with a history of breast cancer surgery, in order to determine whether sonography in addition to mammography might be justified in terms of time and cost.

The results, published in the American Journal of Roentgenology indicate that while annual screening sonography in addition to mammograhy may be useful for the discovery of metachronous contralateral cancers, the time and cost involved may not be justified.

The Study
Over a 1-year retrospective period, patients who had undergone surgery for biopsy-proven breast malignancy were identified.

Those who had sonographic evaluation in addition to mammographic evaluation were included in the study. Patients had undergone bilateral whole breast sonography in addition to mammography every 6 months for the first 2 years and then annually thereafter. Exclusion criteria included a history of bilateral breast cancer surgery.

Methodology
1256 Asian women (mean age, 50 years) were included in the study. Over the follow-up period, the contralateral breast was classified as a BI-RADS 1 or 2 93.6% of the time. A BI-RADS 3 category was assigned to 3.8%, category 4 to 2.3%, and category 5 to 0.3%.

One radiologist reviewed the reports of the imaging studies and documented the BI-RADS category. The images were not reread.

Those classified as BI-RADS 1 or 2 were considered negative. BI-RADS categorization of 3, 4, or 5 were only included if they were referring to the breast contralateral to the surgical breast.

In other words, the originally reported BI-RADS was re-categorized to assess only the contralateral breast. The final diagnosis of each patient was determined based on tissue diagnosis at a follow-up time of ≥1 year.
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Results
Overall, 46 biopsies were performed. When tissue diagnosis was compared with BI-RADS category, the positive-predictive value (PPV) was 41.0%.

One cancer was missed, resulting in a false-negative rate of 0.06%.Of patients who continued sonographic adjuvant surveillance for >2 years, a 0.4% false-negative rate was revealed.

Two cases of biopsy-proven contralateral metachronous breast cancer were found on sonography and not detected on mammography.

Annual screening sonography may be useful for the discovery of metachronous contralateral cancers.

Reviewer’s Comments
The authors do not comment extensively on the finding that only 2 cancers discovered on sonography were also mammographically occult. For the remaining cases of metachronous cancer, the mammogram was judged to be positive as well.

Although a significant tool for those 2 cases, does it truly justify the time and cost of performing sonographic surveillance in addition to mammographic surveillance in a patient with otherwise no complaints?

On the other hand, those with a history of breast cancer, or any symptoms, might certainly consider having both sonography and mammography to rule out any chance of a false negative.

Author: Basil Hubbi, MD
Reference:
Kim MJ, Kim E-K, et al. Sonographic Surveillance for the Detection of Contralateral Metachronous Breast Cancer in an Asian Population. AJR; 2009; 192 (January): 221-228.

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Diagnosing Necrotizing Enterocolitis in Newborns and Infants

A recent study was conducted to evaluate intraobserver and interobserver agreement when using a 10-point scale of abnormal findings designed to standardize reporting of abdominal radiographs in neonates or infants with suspected necrotizing enterocolitis (NEC).

The study, published in AJR, demonstrates that substantial inter- and intraobserver agreement can be found when radiologists use a 10-point scale to report abnormal findings in children with suspected NEC.

The Study
All patients who underwent anteroposterior and cross-table lateral abdominal radiography for suspected necrotizing enterocolitis over a 1-year period were identified.

Inclusion criteria consisted of age <=2 months at the time of study, frontal and cross-table lateral views obtained, and clinically suspected NEC.

Subjects were selected as sample cases to exemplify the separate classifications of findings as determined on a 10-point scale (the Duke Abdominal Assessment Scale).

The scale was designed so that increasing numbers reflected increasing certainty that a patient had NEC and increasing concern regarding the severity of the patient’s disease, with 0 indicating a normal exam and 10 indicating pneumoperitoneum.

Eighty-eight cases from 49 patients were included in the study for review.

Methodology
The radiographs were reviewed as well as the most recent prior abdominal radiograph by 4 pediatric radiologists who were recruited as study participants. Each participant recorded a single score using the 10-point scale.

Each participant reviewed the cases in the same sequence. The studies were interpreted twice by all participants at least 4 weeks apart to evaluate for intraobserver agreement. Data analysis was performed by a statistician.

Results
The patient mean age in the total study population was 24.9 days. Overall, 47.3% were girls and 52.7% were boys. The 4-weighted kappa values for intraobserver agreement ranged from 0.635 to 0.946 corresponding to substantial intraobserver agreement.

The 24-weighted kappa values for interobserver agreement ranged from 0.574 to 0.898, also corresponding to substantial interobserver agreement. Reader agreement was greatest for a score of 9 and 10, indicating portal venous gas and pneumoperitoneum, respectively.

Agreement was poorest for scores of 4 and 6, indicating separation or focal thickening of bowel loops and possible pneumatosis with other abnormal findings, respectively.

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Conclusions
The investigation served to initiate validation of the Duke Abdominal Assessment Scale by demonstrating consistent substantial intraobserver and interobserver agreement when evaluating radiographs for suspected necrotizing enterocolitis.

Reviewer’s Comments
Although the authors allude to this also, this reviewer feels that this article lacks the correlation with the scoring system to clinical outcomes or change in management that may result depending on the scoring assigned.

They refer to the greatest inter- and intraobserver agreement with portal venous gas and pneumoperitoneum, both signs that often indicate impending surgical treatment.

However, this reviewer wonders how the scale can be helpful when the scoring falls somewhere between 2 and 6.

Thankfully for us, the authors recognize that this is only early data, and follow-up studies will be conducted

Author: Basil Hubbi, MD
Reference:
Coursey CA, Hollingsworth CL, et al. Radiologists’ Agreement When Using a 10-Point Scale to Report Abdominal Radiographic Findings of Necrotizing Enterocolitis in Neonates and Infants. AJR; 2008; 191 (July): 190-197

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A recent study was conducted to assess the mammographic appearance of breast cancer exhibiting a basal phenotype, and to determine whether these features facilitate earlier detection of these tumors, which tend to have a poor prognosis.

Methodology
Over a 12-year period, invasive breast cancers that were recorded in women <=70 years of age were identified.

Those cancers identified on pathology to be of the basal phenotype were noted.

Of those, mammographic features were recorded, including qualification of a mass as well-defined, ill-defined, or spiculated.

Also, architectural distortion, focal asymmetry, or microcalcifications were identified.

If >1 finding was present, the nondominant characteristics were also included in the descriptions.

Five experienced breast imagers, who were blinded to the pathology results, recorded the mammographic features.

The data sets were combined to identify cases where mammographic appearance at screening detection was recorded, and the breast tumor was classified as having basal or nonbasal phenotype.

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Results
356 screening-detected cases of invasive breast cancer with basal phenotype were identified, and 309 had the nonbasal phenotype.

For both types, the dominant mammographic feature was a mass with either ill-defined or spiculated margins.

Basal-phenotype tumors were significantly more likely to appear as ill-defined masses on mammograms.

Nonbasal-phenotype tumors were significantly more likely than basal tumors to exhibit marginal spiculation.

Comedo calcification was seen more frequently with basal tumors as well.

When tumor grade was taken into account, these findings persist, showing that differences in mammographic appearance are not simply due to tumor grade.

Conclusions
In the assessment of characteristics of basal-phenotype breast tumors, these tumors are less likely to have spiculation, more likely to manifest as an ill-defined mass, and more likely to be found in association with comedo calcification.

Breast tumors with basal phenotype have a different mammographic appearance than nonbasal tumors and may explain the good prognostic value of mammographic spiculation.

Reviewer’s Comments
This article is interesting in that it acts to correlate mammographic findings with actual histology, with the idea that basal-phenotype tumors are more aggressive. How will this affect everyday practice?

Regardless of mammographic findings suggesting more aggressive tumors, the lesions will still be subjected to the same algorithm of imaging workup, followed by biopsy, and ultimately surgery and/or neoadjuvant therapy as per true findings at pathology.

Author: Basil Hubbi, MD

Reference:
Luck AA, Evans AJ, et al. Breast Carcinoma With Basal Phenotype: Mammographic Findings. AJR; 2008; 191 (August): 346-351

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A recent study was conducted to evaluate intraobserver and interobserver agreement when using a 10-point scale of abnormal findings designed to standardize reporting of abdominal radiographs in neonates or infants with suspected necrotizing enterocolitis (NEC).

The study, published in AJR, demonstrates that substantial inter- and intraobserver agreement can be found when radiologists use a 10-point scale to report abnormal findings in children with suspected NEC.

The Study
All patients who underwent anteroposterior and cross-table lateral abdominal radiography for suspected necrotizing enterocolitis over a 1-year period were identified.

Inclusion criteria consisted of age <=2 months at the time of study, frontal and cross-table lateral views obtained, and clinically suspected NEC.

Subjects were selected as sample cases to exemplify the separate classifications of findings as determined on a 10-point scale (the Duke Abdominal Assessment Scale).

The scale was designed so that increasing numbers reflected increasing certainty that a patient had NEC and increasing concern regarding the severity of the patient’s disease, with 0 indicating a normal exam and 10 indicating pneumoperitoneum.

Eighty-eight cases from 49 patients were included in the study for review.

Methodology
The radiographs were reviewed as well as the most recent prior abdominal radiograph by 4 pediatric radiologists who were recruited as study participants. Each participant recorded a single score using the 10-point scale.

Each participant reviewed the cases in the same sequence. The studies were interpreted twice by all participants at least 4 weeks apart to evaluate for intraobserver agreement. Data analysis was performed by a statistician.

Results
The patient mean age in the total study population was 24.9 days. Overall, 47.3% were girls and 52.7% were boys. The 4-weighted kappa values for intraobserver agreement ranged from 0.635 to 0.946 corresponding to substantial intraobserver agreement.

The 24-weighted kappa values for interobserver agreement ranged from 0.574 to 0.898, also corresponding to substantial interobserver agreement. Reader agreement was greatest for a score of 9 and 10, indicating portal venous gas and pneumoperitoneum, respectively.

Agreement was poorest for scores of 4 and 6, indicating separation or focal thickening of bowel loops and possible pneumatosis with other abnormal findings, respectively.

[text_ad]

Conclusions
The investigation served to initiate validation of the Duke Abdominal Assessment Scale by demonstrating consistent substantial intraobserver and interobserver agreement when evaluating radiographs for suspected necrotizing enterocolitis.

Reviewer’s Comments
Although the authors allude to this also, this reviewer feels that this article lacks the correlation with the scoring system to clinical outcomes or change in management that may result depending on the scoring assigned.

They refer to the greatest inter- and intraobserver agreement with portal venous gas and pneumoperitoneum, both signs that often indicate impending surgical treatment.

However, this reviewer wonders how the scale can be helpful when the scoring falls somewhere between 2 and 6.

Thankfully for us, the authors recognize that this is only early data, and follow-up studies will be conducted

Author: Basil Hubbi, MD
Reference:
Coursey CA, Hollingsworth CL, et al. Radiologists’ Agreement When Using a 10-Point Scale to Report Abdominal Radiographic Findings of Necrotizing Enterocolitis in Neonates and Infants. AJR; 2008; 191 (July): 190-197

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[headline_style_3r deck="Abdominal imaging CME just got a little easier..." headline="A Free Special Report From Radiology Daily is available for you to download now: Pancreatic Imaging: Current Techniques " subheadline="Claim your free copy from Oakstone Medical Publishing, the reliable source for continuing medical education, abdominal imaging courses and reports on the latest abdominal imaging research." headlinetext="" ]

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Every professional caregiver has dedicated themselves to a lifetime of learning.

You hunger for knowledge…for advanced skills…for tools that promote patient health…

Your goal is always the same:

You want to detect and diagnose diseases in the abdomen more quickly and efficiently, in its earliest stages, when treatment is likely to be less difficult and cure is more probable.

This invaluable Special Report, Pancreatic Imaging: Current Techniques tells you what you need to know about Magnetic resonance cholangiopancreatography (MRCP) and Endoscopic Retrograde Cholangiopancreatography (ERCP), and how they compare as diagnostic tools.

In this special report you will learn about:

• Magnetic resonance cholangiopancreatography (MRCP), what it is and how it works;
• The major applications of MRCP in reference to abdominal imaging;
• How MRCP compares with Endoscopic Retrograde Cholangiopancreatography (ERCP) in terms of procedure;
• The pros and cons of MRCP compared with ERCP;
• The barriers to using MRCP, and how they are currently being resolved;
• How MRCP compares with ERCP in terms of safety;
• How MRCP compares with ERCP in terms of imaging quality;
• How MRCP compared with ERCP in terms of visualization;
• How to use MRCP;
• How to deal with artifacts;
• MCRP terms of acquisition and display ;
• Recommended MRCP protocols;
• Major applications of MRCP;
• What patients are ideal candidates for MRCP;
• How does MRCP compare with ERCP and other Abdominal Imaging in terms of detection of:
  • Ductal anatomy
  • Gallstones
  • Tumors
  • Pancreatitis
  • Sclerosing cholangitis
  • Mucinous ductal ectasia
  • IPMT
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  • Biliary variants
  • Duct variants
  • The limitations of MRCP

And more….

Oakstone Medical Publishing is your reliable source for Abdominal Imaging CME.

Claim your copy of our free special report, Pancreatic Imaging: Current Techniques now, and download in minutes.

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Your time is very valuable.

Keeping current on new medical technology and procedures is time-consuming, but essential to your professional career.

So we’ve distilled the most important facts about Pancreatic Imaging: Current Techniques into a fast-reading report of only about 2,500 words.

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With kind regards,

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Medical Director
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P.S. As any diagnostician knows, experience is key in detecting disease. So is keeping up to date with the latest technologies, techniques, and procedures, in the hopes of gaining the best patient outcomes.

If you agree, I’m sure you’ll want to read Pancreatic Imaging: Current Techniques. Register now, download and start reading in minutes.

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Radiology Daily was launched to help you stay on top of your CME requirements, bringing you the latest news on Emergency Radiology. This is news you can use in your practice to stay on the cutting edge, or even ahead of the curve.

Radiology Daily, from Oakstone Medical Publishing, which produces the landmark Practical Reviews in Radiology, brings you the latest news in the world of radiology from over 40 journals around the globe. These peer-reviewed article abstracts are essential reading for anyone in the field of radiology who wants to keep current with the latest research and findings, and meet their CME requirements at the same time.

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In this invaluable Special Report, Imaging of Acute Stroke: Early Detection Is Key, you will learn about:

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• Why early detection is key for ischemic stroke;
• Key features to look for when imaging the brain;
• Key signs to look for when making your diagnosis;
• contrast versus noncontrast studies;
• signs of a hemorraghic infarct;
• key things to look for in the first 24 hours of symptom onset;
• which imaging studies show stroke within the first 24 hours to seven days;
• why FLARE is more sensitive than T2 weighted images;
• the most sensitive way to detect areas of acute stroke;
• contrast enhancement and what it means;
• other things to look for around the MCA sign;
• the significance of the gyriform pattern;
• CT versus MRI in an acute stroke setting;
• stroke imaging controveries to be aware of;
• dealing with artifacts;
• the advantages of fast-spin echo;
• other trauma to the brain;
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[headline_style_3r deck="Gastrointestinal Imaging CME just got a little easier..." headline="A Free Special Report From Radiology Daily is available for you to download now: Virtual Colonoscopy For Colon Cancer Screening Compared With Conventional Colonoscopy " subheadline="Claim your free copy from Oakstone Medical Publishing, the reliable source for continuing medical education, gastrointestinal imaging courses and reports on the latest gastrointestinal imaging research." headlinetext="" ]

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Dear concerned radiology professional,

If you’re a practising radiologist, radiology resident or internist, you know how crucial safe and accurate gastrointestinal imaging is.

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Radiology Daily was launched to help you stay on top of your CME requirements, bringing you the latest news on gastrointestinal imaging. This is news you can use in your practice to stay on the cutting edge, or even ahead of the curve professionally.

Radiology Daily, from Oakstone Medical Publishing, which produces the landmark Practical Reviews in Radiology, brings you the latest news in the world of radiology from over 40 journals around the globe.

The peer-reviewed article abstracts in Practical Reviews in Radiology are essential reading for anyone in the field of radiology who wants to keep current with the latest research and findings, and meet their CME requirements at the same time.

Now you can also get this invaluable free special report, Advantages and Efficacy of Virtual Colonoscopy for Colon Cancer Screening Compared With Conventional Colonoscopy, completely free.

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Every professional caregiver has dedicated themselves to a lifetime of learning.

You hunger for knowledge…for advanced skills…for tools that promote patient health…

Your goal is always the same:

You want to detect and diagnose disease more quickly and efficiently, in its earliest stages, when treatment is likely to be less difficult and cure is more probable.

This invaluable special report tells you what you need to know about virtual colonscopy, and how it compares with conventional colonoscopy as a diagnostic tool for detecting colon cancer and dealing with polyps before they can ever progress to the cancerous stage.

In this special report you will learn about:

• The statistics on colon cancer;
• Our progress in the fight against colon cancer;
• Our success in treating colon cancer;
• The current state of colon cancer screening;
  • Fecal occult blood test;

• Barium studies;
• Endoscopy;
• Sigmoidoscopy;
• Full colonoscopy;
• Virtual colonoscopy;

Radiology Daily is a free website and email newsletter service published by Oakstone Medical Publishing, for practicing radiologists and other medical professionals interested in the field of radiology and its various sub-specialties.

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