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

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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.

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Your time is very valuable.

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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.

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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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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 AJR, indicate that while annual screening sonography in addition to mammography 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.
[text_ad]

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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The peer-reviewed article abstracts in each issue of 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, Advances in Spine Imaging, completely free.

When you download your copy of your free special report, Advances in Spine Imaging, you’ll also be registered for free Radiology Daily email newsletters.

Each time we publish a new article on Neuroradiology, it will be sent direct to your inbox, to help keep you up to date on the news you need to know in the world of radiology. It couldn’t be easier and more convenient.

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The invaluable Special Report Advances in Spine Imaging, tells you what you need to know about better spine imaging using the latest technology.

In this special report you will learn about:

• The main difficulties with spine imaging;
• Areas of spine imaging which require improvement;
• The limitations of fast-spin echo sequences;
• The importance of the myelographic effect in MR imaging of the spine;
• The issue of long acquisition time;
• How attempts to solve the problem of long acquisition time have led to other imaging problems;
• The new solutions to some of these new problems:
• Driven equilibrium;
• SPACE readout;
• Parallel imaging;
• How Driven equilibrium works;
• What the SPACE readout does;
• The 4 main benefits of the SPACE readout;
• How parallel imaging works;
• How it affects the different planes you need to view;
• The other advantages of parallel imaging;
• How Driven equilibrium, SPACE readout, and parallel imaging can be used in combination to obtain better spine images;
• How to get better bone images of the spine;
  And much more.

Oakstone Medical Publishing is your reliable source for Neuroradiology CME.

Claim your copy of our free special report, Advances in Spine Imaging now, and download in minutes.

Simply click on the button below. We will send you a download link to your copy of this free report, and notify you by email whenever we post new information about Neuroradiology and Neuroradiology CME courses to the Radiology Daily website.

[rclp_ofie title="Claim your copy of our free special report, Advances in Spine Imaging right now!" titlestyle="color:#003399;font-size:3em;" subtitle="" subtitlestyle="color:#000000;" instructions="Simply click on the button below. We will send you a download link to your copy of this free report, and notify you by email whenever we post new information about Neuroradiology research and Neuroradiology courses to the Radiology Daily website. Save time, money, and potentially lives with this invaluable special report." button="http://radiologydaily.com/wp-content/themes/oakstone/images/buttons/click_to_get_your_special_report.gif"]

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 Advances in Spine Imaging into a fast-reading report of only about 3,000 words. Authored by Elias R. Melhem, MD, Wallace T. Miller, Sr. Professor of Radiology, and recognized by Best Doctors in America 2007-2008, this is news you can use in your quest for better spine imaging.

Why not invest the next 10 minutes in gaining a deeper understanding of the latest techniques for imaging of the spine?

With kind regards,

Don Deye, M.D.
Medical Director