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Highnam R.,Matakina Technology | Sauber N.,Matakina Technology | Destounis S.,Elizabeth Wende Breast Care LLC | Harvey J.,University of Virginia | McDonald D.,Sutter Health
Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics) | Year: 2012

It is well established that breast density is related to breast cancer risk; making that connection precise, and understanding how to use it in clinical practice, has been a major academic focus since the 1970's. However, it transpires that the first clinical uses of breast density have not been for risk prediction, rather they are for judging when to recommend further imaging. In this paper, we show how scientific research has had to be adapted in order to create the automated volumetric breast density assessment tool, Volpara®, to make it ready for actual clinical use and how it is impacting patient management. © 2012 Springer-Verlag Berlin Heidelberg.

Destounis S.,Elizabeth Wende Breast Care LLC
Topics in Magnetic Resonance Imaging | Year: 2014

The use of breast magnetic resonance imaging (MRI) has grown for the past decade and, along with the increase in use, there has been a progression in the indications for use. Breast MRI has been shown to be a valuable additional tool for breast imagers to use to provide optimal patient care. Because of the benefit that MRI can provide, the technology is now being used for a wide variety of indications, from evaluation of the extent of disease to evaluation of the high-risk patient, evaluation of tumor response to chemotherapy, and search for occult primary tumor. This review will cover the various indications for breast MRI, discuss research to date, as well as provide case examples. Copyright © 2014 Lippincott Williams & Wilkins.

Destounis S.,Elizabeth Wende Breast Care LLC | Gruttadauria J.L.,Elizabeth Wende Breast Care LLC
Journal of Radiology Nursing | Year: 2013

Ultrasound elasticity imaging (EI) was introduced in the early 1990s but is still a relatively new technique in the field of breast ultrasound as it is not used routinely in the clinical setting. Elastography offers many different features that may help radiologists to obtain more information regarding a detected lesion. By using elastography, the radiologist may be able to distinguish between benign and malignant lesions. Despite the advantages that elastography may be able to offer, there are also some disadvantages of the technology such as operator variability, difficulty of elastography image interpretation, and many different looks of elastography images depending on vendor and also different types of the elastography technique. This article will provide insight on ultrasound EI for the radiology nurse who may assist with procedures or educate patients. Copyright © 2013 by the Association for Radiologic & Imaging Nursing.

Barr R.G.,Radiology Consultants Inc | Barr R.G.,Northeastern Ohio Universities | Destounis S.,Elizabeth Wende Breast Care LLC | Lackey II L.B.,Northeastern Ohio Universities | And 3 more authors.
Journal of Ultrasound in Medicine | Year: 2012

Objectives: The purpose of this study was to determine the sensitivity and specificity of real-time compression elasticity imaging in characterizing breast lesions as benign or malignant. Methods: A cohort of 578 women scheduled for sonographically guided biopsy of breast lesions were recruited from 6 sites under an Institutional Review Board-approved protocol. All participants received an elastogram, which displayed both the B-mode and elasticity images in real time. The longest dimensions of the lesion on the B-mode and elasticity imaging were measured. An elasticity imaging/B-mode ratio of at least 1.0 was considered positive for malignant lesions. The reference standard was based on biopsy. Results: A total of 635 lesions were imaged and biopsied. There were 222 (35%) malignant or borderline lesions and 413 (65%) benign lesions. The benign lesions were either cystic (145 [35%]) or solid (268 [65%]). Of the 222 malignant lesions, 219 had an elasticity imaging/B-mode ratio of at least 1.0. Of the 413 benign lesions, 361 had an elasticity imaging/B-mode ratio less than 1.0. These results corresponded to overall sensitivity of 98.6% and overall specificity of 87.4%. Individual site sensitivities ranged from 96.7% to 100% whereas specificities ranged from 66.7% to 95.4%. Conclusions: Elasticity imaging has high sensitivity in characterizing malignant lesions of the breast. Variability in specificity between sites and sonographers is possibly due to individual technique differences in performing elastography and measuring lesions. Further work in standardizing the technique is required. © 2012 by the American Institute of Ultrasound in Medicine.

Destounis S.,Elizabeth Wende Breast Care LLC | Arieno A.,Elizabeth Wende Breast Care LLC | Morgan R.,Elizabeth Wende Breast Care LLC
Breast Cancer | Year: 2016

Background: To review the initial results of the implementation of a risk assessment program in our outpatient community-based breast-imaging practice. Methods: From May 1, 2011 through November 4, 2013 a total of 96,389 patients presented to our facility. Each patient was required to complete a health history form. 24,850 (25.7 %) were flagged through our radiology information system (RIS) as potentially being at increased risk for breast cancer per responses on the health history form. Patient flagging was based on a system we developed. Letters were generated informing flagged patients and her physician that the patient could be a candidate for further breast cancer risk assessment. Genetic testing performed was primarily for BRCA1/BRCA2; testing for other mutations was offered based on personal and family history of the patient. Results: 1,088 genetic counseling appointments occurred during the time frame from the 24,850 patients flagged, leading to 887 genetic tests performed. Forty-three mutations were detected: 21 BRCA1, 19 BRCA2, 1 MLH1, 1 MSH6 and 1 CHEK2. There were 717 negative tests, 20 variants of unknown significance; the remaining cases were cancelled. 464 high-risk MRIs were performed after the patient was referred from the program, from which 52 biopsies were performed due to a finding on MRI revealing 14 malignancies. Conclusions: In our experience after implementation of a risk assessment program, 24,850 potential at-risk patients have been flagged, revealing 40 BRCA 1 or 2 mutations. Screening with breast MRI provided to at-risk patients revealed 14 cancers diagnosed that may have otherwise been undetected. © 2014, The Japanese Breast Cancer Society.

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