Faculty Bibliography
Searched for:
ACR Appropriateness Criteria
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Total Results:
249
Is Digital Breast Tomosynthesis the Better Mammogram for Local Breast Cancer Staging? [Comment]
PMID: 30964742
ISSN: 1527-1315
CID: 3809212
Journal of the American College of Radiology : JACR. 2019:16(4 Pt A):409-410.DOI: 10.1016/j.jacr.2019.01.009
Response to Letter: "Is Breast MRI Without Contrast Feasible and Appropriate During Pregnancy?" [Comment]
PMID: 30947953
ISSN: 1558-349x
CID: 3859642
Utility of Diffusion-weighted Imaging to Decrease Unnecessary Biopsies Prompted by Breast MRI: A Trial of the ECOG-ACRIN Cancer Research Group (A6702)
PURPOSE/OBJECTIVE:A total of 107 women with MRI-detected BI-RADS 3, 4, or 5 lesions were enrolled from March 2014 to April 2015. ADCs were measured both centrally and at participating sites. ROC analysis was employed to assess diagnostic performance of centrally measured ADCs and identify optimal ADC thresholds to reduce unnecessary biopsies. Lesion reference standard was based on either definitive biopsy result or at least 337 days of follow-up after the initial MRI procedure. RESULTS:/s) to site-measured ADCs reduced the biopsy rate by 26.2% (16/61) but missed three cancers. CONCLUSIONS:DWI can reclassify a substantial fraction of suspicious breast MRI findings as benign and thereby decrease unnecessary biopsies. ADC thresholds identified in this trial should be validated in future phase III studies.
PMCID:6420847
PMID: 30647080
ISSN: 1078-0432
CID: 3789522
Overstated Harms of Breast Cancer Screening? A Large Outcomes Analysis of Complications Associated With 9-Gauge Stereotactic Vacuum-Assisted Breast Biopsy
OBJECTIVE:The purpose of this study was to assess the rate, type, and severity of complications related to 9-gauge stereotactic vacuum-assisted breast biopsy (SVAB) and to delineate associated factors that may contribute to a higher rate of complications. MATERIALS AND METHODS/METHODS:This retrospective study included 4776 patients who underwent SVAB between 2003 and 2016. A total of 319 patients with documented postbiopsy complications were identified. Complications were subcategorized as bleeding, pain, lightheadedness, bruising, and other complications, and their severity was classified as minor, moderate, or severe. Hematoma volumes were correlated with biopsy location and complication severity. A group of control subjects who underwent SVAB but had no complications was compared with the group of study patients with regard to age, biopsy location, lesion type, and pathologic findings. Postbiopsy screening adherence was assessed. Statistical analyses were performed using the Fisher exact, Mann-Whitney, Kruskal-Wallis, and Spearman rank correlation tests. RESULTS:) did not correspond to the severity of complications. Larger hematoma volumes were associated with a posterior biopsy location (p = 0.008). The rate of return to annual screening after biopsy was not adversely affected by the presence of biopsy complications. CONCLUSION/CONCLUSIONS:Clinically significant complications associated with SVAB were exceedingly rare (0.3%) in this large study spanning 13 years.
PMID: 30741561
ISSN: 1546-3141
CID: 3656012
Risk Stratification for Screening Mammography: Benefits and Harms
OBJECTIVE:The purpose of this article is to compare commonly used breast cancer risk assessment models, describe the machine learning approach and big data in risk prediction, and summarize the potential benefits and harms of restrictive risk-based screening. CONCLUSION/CONCLUSIONS:The commonly used risk assessment models for breast cancer can be complex and cumbersome to use. Each model incorporates different sets of risk factors, which are weighted differently and can produce different results for the same patient. No model is appropriate for all subgroups of the general population and only one model incorporates mammographic breast density. Future development of risk prediction tools that are generalizable and simpler to use are needed in guiding clinical decisions.
PMID: 30557052
ISSN: 1546-3141
CID: 3556912
New Frontiers: An Update on Computer-Aided Diagnosis for Breast Imaging in the Age of Artificial Intelligence
OBJECTIVE:The purpose of this article is to compare traditional versus machine learning-based computer-aided detection (CAD) platforms in breast imaging with a focus on mammography, to underscore limitations of traditional CAD, and to highlight potential solutions in new CAD systems under development for the future. CONCLUSION/CONCLUSIONS:CAD development for breast imaging is undergoing a paradigm shift based on vast improvement of computing power and rapid emergence of advanced deep learning algorithms, heralding new systems that may hold real potential to improve clinical care.
PMID: 30667309
ISSN: 1546-3141
CID: 3609912
Large-scale classification of breast MRI exams using deep convolutional networks [Meeting Abstract]
ORIGINAL:0014731
ISSN: 1049-5258
CID: 4668952
Journal of the American College of Radiology : JACR. 2018:15(11S):S313-S320.DOI: 10.1016/j.jacr.2018.09.017
ACR Appropriateness Criteria Evaluation of the Symptomatic Male Breast
Although the majority of male breast problems are benign with gynecomastia as the most common etiology, men with breast symptoms and their referring providers are typically concerned about whether or not it is due to breast cancer. If the differentiation between benign disease and breast cancer cannot be made on the basis of clinical findings, or if the clinical presentation is suspicious, imaging is indicated. The panel recommends the following approach to breast imaging in symptomatic men. In men with clinical findings consistent with gynecomastia or pseudogynecomastia, no imaging is routinely recommended. If an indeterminate breast mass is identified, the initial recommended imaging study is ultrasound in men younger than age 25, and mammography or digital breast tomosynthesis in men age 25 and older. If physical examination is suspicious for a male breast cancer, mammography or digital breast tomosynthesis is recommended irrespective of patient age. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
PMID: 30392600
ISSN: 1558-349x
CID: 3429252
Journal of the American College of Radiology : JACR. 2018:15(11S):S276-S282.DOI: 10.1016/j.jacr.2018.09.014
ACR Appropriateness Criteria Breast Pain
Breast pain is a common complaint. However, in the absence any accompanying suspicious clinical finding (eg, lump or nipple discharge), the association with malignancy is very low (0%-3.0%). When malignancy-related, breast pain tends to be focal (less than one quadrant) and persistent. Pain that is clinically insignificant (nonfocal [greater than one quadrant], diffuse, or cyclical) requires no imaging beyond what is recommended for screening. In cases of pain that is clinically significant (focal and noncyclical), imaging with mammography, digital breast tomosynthesis (DBT), and ultrasound are appropriate, depending on the patient's age. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
PMID: 30392596
ISSN: 1558-349x
CID: 3429242
Journal of the American College of Radiology : JACR. 2018:15(11S):S263-S275.DOI: 10.1016/j.jacr.2018.09.013
