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991.
Background
Diagnosis of breast cancer recurrence can be difficult as a result of the presence of scar tissue in the breast. Magnetic resonance imaging (MRI) may be superior to traditional imaging in diagnosis of recurrence because of its ability to differentiate malignancy from scarring. Current guidelines on investigation of suspected breast cancer recurrence recommend MRI when other investigations have equivocal findings. We performed the first systematic review on this topic.Methods
Literature search revealed 35 potentially relevant studies; 10 were included in final analysis. Included were clinical studies comparing MRI with another diagnostic modality for diagnosis of breast cancer recurrence, with at least 10 patients, in the English language. Data extraction focused on sensitivity and specificity of standard diagnostic modalities and MRI for diagnosis of local disease recurrence.Results
In total 494 patients were assessed across 10 studies; all were case series. Sensitivity of MRI for detection of recurrence ranged 75?C100?%, while specificity ranged 66.6?C100?%. Both sensitivity and specificity increased when MRI was performed after a longer time interval from the original surgery, although the longest follow-up reported was only 36?months. A negative MRI can avoid the need for further biopsy.Conclusions
Available data are based on clinically heterogeneous case series and superiority over standard triple assessment for breast cancer recurrence has not been proven. At present, MRI cannot be recommended in the routine diagnostic assessment for breast cancer recurrence but has a potentially useful role as a second-line investigation. A negative MRI is more useful than a positive MRI as positive MRIs require further investigation. 相似文献992.
MG Shah-Khan XJ Geiger C Reynolds JW Jakub ER Deperi KN Glazebrook 《Annals of surgical oncology》2012,19(10):3131-3138
Background
Lobular neoplasia (LN) includes atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS). LN often is an incidental finding on breast core needle biopsy (CNBx) and management remains controversial. Our objective was to define the incidence of malignancy in women diagnosed with pure LN on CNBx, and identify a subset of patients that may be observed.Methods
Patients diagnosed with LN on CNB between January 1993 and December 2010 were identified. Patients with an associated high-risk lesion or ipsilateral malignancy at time of diagnosis were excluded. All cases were reviewed by dedicated breast pathologists and breast imagers for pathologic classification and radiologic concordance, respectively.Results
The study cohort was comprised of 184 (1.3?%) cases of pure LN (147 ALH, 37 LCIS) from 180 patients. Pathologic?Cradiologic concordance was achieved in 171 (93?%) cases. Excision was performed in 101 (55?%) cases and 83 (45?%) were observed. Mean follow-up was 50.3 (range, 6?C212) months. Of cases excised, 1 of 81 (1.2?%) ALH and 1 of 20 (5?%) LCIS cases were upstaged to ductal carcinoma in situ (DCIS) and invasive lobular carcinoma (ILC), respectively. Only 1 of 101 (1?%) concordant lesions was upstaged on excision. Of the cases observed, 4 of 65 (6.2?%) developed ipsilateral cancer during follow-up: 1 of 51 (2?%) case of ALH and 3 of 14 (21.4?%) cases with LCIS (2 ILC, 2 DCIS). During follow-up, 2.9?% (4/138) patients with excised or observed LN developed a contralateral cancer.Conclusions
These data support that not all patients with LN diagnosed on CNB require surgical excision. Patients with pure ALH, demonstrating radiologic?Cpathologic concordance, may be safely observed. 相似文献993.
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Kristin M. Poole Devin R. McCormack Chetan A. Patil Craig L. Duvall Melissa C. Skala 《Biomedical optics express》2014,5(12):4118-4130
Longitudinal monitoring techniques for preclinical models of vascular remodeling are critical to the development of new therapies for pathological conditions such as ischemia and cancer. In models of skeletal muscle ischemia in particular, there is a lack of quantitative, non-invasive and long term assessment of vessel morphology. Here, we have applied speckle variance optical coherence tomography (OCT) methods to quantitatively assess vascular remodeling and growth in a mouse model of peripheral arterial disease. This approach was validated on two different mouse strains known to have disparate rates and abilities of recovering following induction of hind limb ischemia. These results establish the potential for speckle variance OCT as a tool for quantitative, preclinical screening of pro- and anti-angiogenic therapies.OCIS codes: (170.4500) Optical coherence tomography, (170.3880) Medical and biological imaging, (170.2655) Functional monitoring and imaging, (100.2960) Image analysis, (110.6150) Speckle imaging 相似文献
996.
Taber DR Stevens J Poole C Maciejewski ML Evenson KR Ward DS 《Journal of community health》2012,37(1):242-252
Evidence is conflicting as to whether youth obesity prevalence has reached a plateau in the United States overall. Trends vary by state, and experts recommend exploring whether trends in weight-related behaviors are associated with changes in weight status trends. Thus, our objective was to estimate between-state variation in time trends of adolescent body mass index (BMI) percentile and weight-related behaviors from 2001 to 2007. A time series design combined cross-sectional Youth Risk Behavior Survey data from 272,044 adolescents in 29 states from 2001 to 2007. Self-reported height, weight, sports participation, physical education, television viewing, and daily consumption of 100% fruit juice, milk, and fruits and vegetables were collected. Linear mixed models estimated state variance in time trends of behaviors and BMI percentile. Across states, BMI percentile trends were consistent despite differences in behavioral trends. Boys experienced a modest linear increase in BMI percentile (ß = 0.18, 95% CI: 0.07, 0.30); girls experienced a non-linear increase, as the rate of increase declined over time from 1.02 units in 2001–2002 (95% CI: 0.68, 1.36) to 0.23 units in 2006–2007 (95% CI: ?0.09, 0.56). States in which BMI percentile decreased experienced a greater decrease in TV viewing than states where BMI percentile increased. Otherwise, states with disparate BMI percentile trends did not differ with respect to behaviors. Future research should explore the role of other behaviors (e.g., soda consumption), measurement units (e.g., portion size), and societal trends (e.g., urban sprawl) on state and national adiposity trends. 相似文献
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Physicians' opinions about medications to treat alcoholism 总被引:4,自引:1,他引:4
Mark TL Kranzler HR Song X Bransberger P Poole VH Crosse S 《Addiction (Abingdon, England)》2003,98(5):617-626
Aims Medications play a limited role in the treatment of alcoholism. This paper examines physicians’ opinions about and use of two alcoholism medications currently approved in the US—disulfiram and naltrexone—and one alcoholism medication—acamprosate—that might be approved. Design A total of 1388 substance abuse specialist physicians who were members of the American Academy of Addiction Psychiatry or the American Society of Addiction Medicine completed a questionnaire in 2001 (65% response rate). Findings The average percentages of physicians’ patients with alcoholism who were prescribed the following medications were: 13% (naltrexone), 9% (disulfiram), 46% (antidepressants) and 11% (benzodiazepines). Almost all physicians had heard of naltrexone and disulfiram, but their self‐reported level of knowledge about these medications was lower than for antidepressants. Physicians estimated that naltrexone had a small‐to‐medium effect size, which was similar in magnitude to the effect size reported in recent meta‐analyses of randomized clinical trials. Physicians identified the following three courses of action as the most likely to result in greater use of medications to treat alcohol dependence: more research to develop new medications (33%), more education of physicians about existing medications (17%), and increased involvement of physicians in alcoholism treatment (17%). Conclusions Physicians’ low rate of use of naltrexone may reflect its small‐to‐medium effect size. 相似文献
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