Time-related changes in yield and harms of screening breast MRI.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 1508-1508
Author(s):  
Holly Jane Pederson ◽  
Colin O'Rourke ◽  
Lauren D Bolden ◽  
Sobia Khan ◽  
Manisha Yadav ◽  
...  
Keyword(s):  
High Risk ◽  
False Positive ◽  
Short Interval ◽  
Breast Mri ◽  
Patient Characteristics ◽  
Screening Mammography ◽  
Significance Level ◽  
High Risk Patients ◽  
Risk Patients ◽  
Over Time

1508 Background: MRI has been accepted as a useful adjunct to screening mammography in high-risk women. Concerns remain over false positive findings, however, and little is known about harms and yield over time. Such information will help women decide about enhanced surveillance. Methods: Of 350 high risk patients offered MRI screening, 320 underwent 757 screens with a 1.5 Tesla magnet from 2008 to 2012 alternating (q 6 mo.) with digital mammography. Data collected included patient characteristics, mammographic density, estimated lifetime risk, and need for additional imaging and/or biopsy. Harms were defined as second look ultrasounds, US or MRI guided core biopsies, surgical biopsies or recommendation for short interval follow up. Estimates of harms over time were modeled by logistic regression. A significance level of 0.05 was used for all testing. Results: Compliance with MRI screening as recommended was 91% with the first MRI, and was not associated with age, race or level of risk. Harms were highest with the first MRI and decreased significantly with subsequent MRIs. Of 59 biopsies, 7 were malignant. Two were found in MRI 1, 3 in MRI 3 and 2 in MRI 4. Women with biopsies resulting from false positive findings were significantly younger (median age 44.5 as compared with 48; p=0.049) and were more likely to have extremely dense breast tissue (36% vs 17%; p=0.028.) Conclusions: This study of highly compliant high risk patients supports the use of MRI as an adjunct to mammography for early detection. The rate of harmful events decreased over time, yet cancer detection did not. This information is critical in counseling women who are considering annual screening breast MRI, particularly younger women and those with dense tissue. [Table: see text]

scholarly journals The Kaiser score reliably excludes malignancy in benign contrast-enhancing lesions classified as BI-RADS 4 on breast MRI high-risk screening exams

2020 ◽  
Vol 30 (11) ◽  
pp. 6052-6061 ◽  
Author(s):  
Ruxandra Iulia Milos ◽  
Francesca Pipan ◽  
Anastasia Kalovidouri ◽  
Paola Clauser ◽  
Panagiotis Kapetas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Diagnostic Accuracy ◽  
Breast Mri ◽  
Histopathological Diagnosis ◽  
Risk Screening ◽  
High Risk Patients ◽  
Risk Patients ◽  
Malignant Lesions ◽  
High Risk Screening

Abstract Objectives MRI is an integral part of breast cancer screening in high-risk patients. We investigated whether the application of the Kaiser score, a clinical decision-support tool, may be used to exclude malignancy in contrast-enhancing lesions classified as BI-RADS 4 on breast MRI screening exams. Methods This retrospective study included 183 consecutive, histologically proven, suspicious (MR BI-RADS 4) lesions detected within our local high-risk screening program. All lesions were evaluated according to the Kaiser score for breast MRI by three readers blinded to the final histopathological diagnosis. The Kaiser score ranges from 1 (lowest, cancer very unlikely) to 11 (highest, cancer very likely) and reflects increasing probabilities of malignancy, with scores greater than 4 requiring biopsy. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy. Results There were 142 benign and 41 malignant lesions, diagnosed in 159 patients (mean age, 43.6 years). Median Kaiser scores ranged between 2 and 5 in benign and 7 and 8 in malignant lesions. For all lesions, the Kaiser score’s accuracy, represented by the area under the curve (AUC), ranged between 86.5 and 90.2. The sensitivity of the Kaiser score was high, between 95.1 and 97.6% for all lesions, and was best in mass lesions. Application of the Kaiser score threshold for malignancy (≤ 4) could have potentially avoided 64 (45.1%) to 103 (72.5%) unnecessary biopsies in 142 benign lesions previously classified as BI-RADS 4. Conclusions The use of Kaiser score in high-risk MRI screening reliably excludes malignancy in more than 45% of contrast-enhancing lesions classified as BI-RADS 4. Key Points • The Kaiser score shows high diagnostic accuracy in identifying malignancy in contrast-enhancing lesions in patients undergoing high-risk screening for breast cancer. • The application of the Kaiser score may avoid > 45% of unnecessary breast biopsies in high-risk patients. • The Kaiser score aids decision-making in high-risk breast cancer MRI screening programs.

Application of outpatient cardiac testing among emergency department patients with syncope

2018 ◽  
Vol 35 (8) ◽  
pp. 486-491
Author(s):  
Olivia G Cook ◽  
Muhammad A Mukarram ◽  
Soo-Min Kim ◽  
Kirtana Arcot ◽  
Marie-Joe Nemnom ◽  
...  
Keyword(s):  
High Risk ◽  
Improve Patient Safety ◽  
Structural Heart Disease ◽  
Patient Characteristics ◽  
Serious Adverse Events ◽  
High Risk Patients ◽  
Medium Risk ◽  
Risk Patients ◽  
Emergency Department Patients ◽  
Cardiac Testing

Objectives2.6% of ED syncope patients will suffer cardiac serious adverse events (SAEs) within 30 days of disposition, and outpatient cardiac testing can improve patient safety. The objective is to determine whether outpatient cardiac testing for ED syncope patients is being appropriately ordered after discharge. To this end, we describe the proportion of high-risk and non-high (low and medium)-risk ED syncope patients as per the Canadian Syncope Risk Score (CSRS) who have a SAE after ED discharge, and the proportion referred for outpatient cardiac testing.MethodsOur multicentre prospective cohort study enrolled adult syncope patients between 2010 and 2014 in five academic EDs. We collected patient characteristics, disposition, CSRS predictors, outpatient referrals and testing results (Holter, echocardiography), and 30-day adjudicated SAE (death due to unknown/cardiac cause, myocardial infarction, arrhythmia and structural heart disease). We used descriptive statistics (mean, SD) to report our results.ResultsOf 3584 enrolled patients (mean age 50.9 years, 57.7% women), 800 patients (22.3%) received an outpatient referral. Of these 800 patients, 40.3% of the non-high-risk patients (305/756) and 54.5% of the high-risk patients (24/44) received outpatient cardiac testing. Of all patients who received cardiac testing, five (1.5%; 95% CI 0.6% to 3.5%) suffered outpatient SAE (60.0% arrhythmias). Of all patients who did not receive cardiac testing, four patients (0.9%; 95% CI 0.3% to 2.2%) suffered SAE (all arrhythmias). Of the 20 (45.5%) high-risk patients who did not receive testing, two patients (10.0%; 95% CI 2.8% to 30.1%) suffered arrhythmias outside the hospital, while among the 451 (59.7%) non-high-risk patients, only two (0.4%; 95% CI 0.1% to 1.6%) suffered outpatient arrhythmias.ConclusionOutpatient cardiac testing is largely underused, especially among high-risk ED syncope patients. Better guidelines for outpatient cardiac testing are needed, as the practice is highly variable and mismatched with patient risk.

Trends in conditional survival and predictors of late death in neuroblastoma.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 10533-10533
Author(s):  
Hannah Olsen ◽  
Kevin M. Campbell ◽  
Rochelle Bagatell ◽  
Steven G. DuBois
Keyword(s):  
Overall Survival ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Primary Site ◽  
Conditional Survival ◽  
Late Death ◽  
High Risk Patients ◽  
Risk Patients ◽  
Over Time

10533 Background: Significant advances in the treatment of neuroblastoma have been made in the past several decades. There are scant data examining how these improvements have changed over time and differentially affected conditional survival among high- and non-high-risk patient groups. Methods: We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results Database. We analyzed clinical characteristics and survival outcomes for 4717 neuroblastoma patients. Kaplan-Meier methods were used to estimate overall survival (OS) and conditional overall survival (COS) conditioned on having survived 1, 2, or 5 years from diagnosis, with estimates compared between groups using log-rank tests. Results: Five-year OS was 41.46% (95% CI 38.77-44.13) for the high-risk group and 91.13% (95% CI 89.49-92.53) for the non-high-risk group. Both groups saw significant improvements in OS by decade (p<0.001). Five-year COS among 1-year survivors was 52.69% (95% CI 38.77-44.13) for the high-risk group and 96.75% (95% CI 95.57-97.62) for the non-high-risk group. One-year survivors in the high-risk group showed a statistically significant improvement in COS over time. No difference in COS was observed among 5-year high-risk survivors. There were no statistically significant changes in COS over time for 1- and 5-year survivors in the non-high-risk group. In the high-risk and non-high-risk groups, 82% and 32% of late deaths (>5 years from diagnosis) were attributable to cancer, respectively. Statistically significant adverse prognostic factors for late death were age >1 year at diagnosis, metastatic disease, and non-thoracic primary site (p=0.001). Conclusions: Improvements in COS over time have largely benefited high-risk patients, though they are still at higher risk for late death due to cancer when compared to non-high-risk patients. Age, stage, and primary site, but not treatment decade, influence outcomes among 5-year survivors. [Table: see text]

Breast MRI as an Adjunct to Mammography for Breast Cancer Screening in High-Risk Patients: Retrospective Review

2015 ◽  
Vol 204 (4) ◽  
pp. 889-897 ◽  
Author(s):  
Antony Raikhlin ◽  
Belinda Curpen ◽  
Ellen Warner ◽  
Carrie Betel ◽  
Barbara Wright ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Breast Cancer Screening ◽  
Retrospective Review ◽  
Breast Mri ◽  
High Risk Patients ◽  
Risk Patients

Breast MRI Key for High-Risk Patients

Ob Gyn News ◽  
2005 ◽  
Vol 40 (10) ◽  
pp. 1-4
Author(s):  
GINA SHAW
Keyword(s):  
High Risk ◽  
Breast Mri ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Performance, Correlation and Kinetic Profile of Circulating Serum Fungal Biomarkers of Invasive Aspergillosis in High-Risk Patients with Hematologic Malignancies

2021 ◽  
Vol 7 (3) ◽  
pp. 211
Author(s):  
Maria Siopi ◽  
Stamatis Karakatsanis ◽  
Christoforos Roumpakis ◽  
Konstantinos Korantanis ◽  
Elina Eldeik ◽  
...  
Keyword(s):  
High Risk ◽  
Invasive Aspergillosis ◽  
Patient Characteristics ◽  
Hematologic Malignancies ◽  
Diagnostic Tools ◽  
Predictive Values ◽  
High Risk Patients ◽  
Risk Patients ◽  
Fungal Biomarkers ◽  
Sensitivity Specificity

As conventional microbiological documentation of invasive aspergillosis (IA) is difficult to obtain, serum fungal biomarkers are important adjunctive diagnostic tools. Positivity rates and the kinetic profiles of galactomannan (GM), 1,3-β-D-glucan (BDG) and Aspergillus DNA (PCR) were studied in high-risk patients with hematologic malignancies. GM, BDG and PCR data from serial serum specimens (n = 240) from 93 adult hematology patients with probable (n = 8), possible (n = 25) and no (n = 60) IA were retrospectively analyzed. Positivity rates and sensitivity/specificity/positive/negative predictive values (NPV) of each fungal biomarker alone and in combination were estimated. The three markers were compared head-to-head and correlated with various biochemical, demographic and patient characteristics. The positivity rates for patients with probable/possible/no IA were 88%/8%/0 % for GM (X2 = 55, p < 0.001), 62%/46%/35% for BDG (X2 = 2.5, p = 0.29), 62%/33%/27% for PCR (X2 = 3.9, p = 0.15), 50%/4%/0% for GM + BDG and GM + PCR (X2 = 31, p < 0.001), 50%/8%/22% for BDG + PCR (X2 = 6.5, p = 0.038) and 38%/4%/0% for GM + BDG + PCR (X2 = 21, p < 0.001). Higher agreement (76%) and negative correlation (rs = -0.47, p = 0.0017) was found between GM index and PCR Ct values. The sensitivity and NPV was 45-55% and 90-92% when biomarkers assessed alone and increased to 75-90% and 93-97%, respectively when combined. Weak significant correlations were found between GM, PCR and BDG results with renal/liver function markers (r = 0.11–0.57) with most GM+ and PCR+ samples found in the first and second week of clinical assessment, respectively and BDG later on. Different positivity rates, time profiles and performances were found for the three biomarkers advocating the combination of GM with PCR for the early diagnosis of IA, whereas the high NPV of combined biomarkerscould help excluding IA.

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