Rochester, NY, United States
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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.V.,Elizabeth Wende Breast Care LLC | Morgan R.,Elizabeth Wende Breast Care LLC | Arieno A.,Elizabeth Wende Breast Care LLC
American Journal of Roentgenology | Year: 2015

OBJECTIVE. Digital breast tomosynthesis (DBT) is a recent imaging technology that was developed to address the limitations of conventional 21) mammography. The limitations of Standard mammography are well known and include reduced sensitivity in dense breasts. Clinical research studies of DBT and the implementation of OUT have revealed that DBT has potential benefits for evaluating patients with dense breasts. This article will discuss the benefits and limitations of DBT as a screening alternative for women with dense breasts. CONCLUSION. Studies to date have revealed that the use of DBT reduces recall rates and increases cancer detection rates. This has been demonstrated with the use of DBT for both screening and diagnostic purposes, as well as with imaging dense breasts. DBT has the ability to reduce breast tissue overlap, thus potentially revealing lesions that would otherwise have been missed. The limitations of DBT include longer interpretation times, higher costs, and increased radiation dose. These limitations present challenges that radiologists must consider before DBT implementation. © American Roentgen Ray Society.


Destounis S.,Elizabeth Wende Breast Care LLC | Arieno A.,Elizabeth Wende Breast Care LLC | Morgan R.,Elizabeth Wende Breast Care LLC
Journal of Clinical Imaging Science | Year: 2014

Objective: To demonstrate the importance of presurgical bilateral breast Magnetic Resonance Imaging (MRI) in women 60 years of age and older.Materials and Methods: Institutional review board approval was obtained with waiver of informed consent for this retrospective review. From December 2003 to December 2011, all patients 60 years and older who had presurgical bilateral breast MRI were reviewed, revealing 1268 presurgical MRI examinations; 310 had a new lesion identified by MRI. Cases were excluded due to incomplete or missing data, resulting in 243 patients with 272 findings eligible for analysis. Data recorded included patient demographics, core biopsy method and pathology, type of surgery, and surgical pathology results.Results: Of 1268 exams performed in this population, 272 (21.5%) patients with suspicious MRI findings underwent needle biopsy. Malignancy was found in 114 (42%), benign findings in 127 (47%), and atypia in 31 (11%). Of the malignancies, 83 were in the ipsilateral breast and 31 in the contralateral breast to the original diagnosis. Of the ipsilateral findings, 47 were in the same quadrant as the primary diagnosis, 28 in a different quadrant, and 8 were metastatic lymph nodes. Of the 31 atypical findings, 14 were contralateral to the primary diagnosis and 17 were ipsilateral. Two hundred and thirty-three patients underwent surgical excision; 111 changed their surgical management as a lesion was seen on MRI and was diagnosed as cancer on needle biopsy.Conclusions: Among the patients aged 60 years and above who had presurgical bilateral breast MRI, we found additional cancers in 9.0% (n = 114/1268) and atypia in 2.4% (n = 31/1268). A change in management as a result of the MRI-detected lesion occurred in 8.8% (n = 111/1268). These results demonstrate that performing presurgical bilateral breast MRI is of value in women 60 years of age and above.


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.


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 | Murphy P.,Elizabeth Wende Breast Care LLC | And 3 more authors.
Journal of Ultrasound in Medicine | Year: 2013

Objectives-The aim of this study was to evaluate compression elasticity imaging in combination with standard B-mode imaging for assessment of benign versus malignant breast lesions and correlation with needle biopsy. Methods-Institutional Review Board approval was obtained, and patients were prospectively enrolled from 2007 to 2011. A total of 221 patients yielding 230 elastograms recommended for biopsy were the basis of this analysis. Information collected included patient demographics, lesion laterality and location, and needle biopsy method and results. The longest dimension of the lesion between B-mode and elasticity imaging was measured, and an elasticity imaging/B mode ratio of 1.0 or greater was considered to represent malignancy; a ratio of less than 1.0 was benign. Statistical analysis included calculation of descriptive statistics and generation of figures. Results-Of the 230 biopsies performed, cancer was revealed in 100 cases (43.5%). One hundred thirty (56.5%) benign findings were observed. Of the 100 malignant lesions, 99 had an elasticity imaging/B-mode ratio greater than or equal to 1.0 (99.0%). Of the 130 benign lesions, 119 had an elasticity imaging/B-mode ratio of less than 1.0 (91.5%). These results indicate 99.0% (99 of 100) sensitivity and 91.5% (119 of 130) specificity. Furthermore, we found a positive predictive value of 90.0% (99 of 110) and a negative predictive value of 99.2% (119 of 120). Conclusions-In this study, elasticity imaging had high sensitivity for malignant and benign lesions. Elasticity imaging in the clinical setting may prove to be an additional tool that is helpful to the breast clinician for characterization of lesions as benign or malignant. At this time, we are continuing our data collection because additional research is still necessary. Copyright © 2013 by the American Institute of Ultrasound in Medicine.


Destounis S.V.,Elizabeth Wende Breast Care LLC | Murphy P.F.,Elizabeth Wende Breast Care LLC | Seifert P.J.,Elizabeth Wende Breast Care LLC | Somerville P.A.,Elizabeth Wende Breast Care LLC | And 3 more authors.
American Journal of Roentgenology | Year: 2012

OBJECTIVE. The objective of our study was to show the importance of surgical excision after the diagnosis of lobular carcinoma in situ (LCIS) based on needle core biopsy. MATERIALS AND METHODS. Retrospective evaluation of all cases of LCIS diagnosed at needle core biopsy from 2000 to 2011 was performed; 60 patients with 64 diagnoses of LCIS comprise the cohort. Data recorded included patient demographics, patient presentation, breast density, personal and family histories of breast cancer, lesion characteristics, biopsy method, and correlation of core results with surgical pathology or follow-up imaging. The pathology facility was recorded for all biopsies because the specimens from open surgical biopsy were frequently reviewed by a different laboratory. RESULTS. A total of 60 patients with 64 diagnoses of LCIS comprised the study cohort. The patients ranged in age from 36 to 93 years (average, 55 years). The lesions consisted of 39 calcifications, two masses with calcium, 10 masses, two asymmetries, two architectural distortions, two architectural distortions with calcifications, and seven MRI enhancements. Mammography detected lesions in 84% of the cases (n = 54) and 16% (n = 10) were not visualized. Sonography detected lesions in 30% of the cases (n = 19) and 70% (n = 45) were sonographically occult. Needle core biopsy was performed in all cases: 49 stereotactic biopsies (77%), 12 ultrasound-guided biopsies, and three MRI-guided biopsies. All but one case proceeded to surgery. Open surgical biopsy revealed 21 cancers (33%); of the remaining cases, 53% of the cases (n = 33) were atypical or high risk and 14% (n = 9) were benign. CONCLUSION. The diagnosis of LCIS at needle core biopsy, in this small study, revealed that 84% of lesions either were malignant or were atypical or high risk at surgery, of which 33% were found to be carcinoma. Our findings suggest that LCIS should be excised when noted at core biopsy. © American Roentgen Ray Society.


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.


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

Rationale and Objectives: The purpose of this study was to examine whether patients with premenopausal breast cancer history only can benefit from screening breast magnetic resonance imaging (MRI) by comparing them to patients with both a personal and a family history of breast cancer. Materials and Methods: With Institutional Review Board approval and waiver of informed consent, a retrospective review was conducted to determine patients previously diagnosed with premenopausal breast cancer undergoing screening MRI. From December 2003 to October 31, 2014, a total of 4436 screening MRI examinations were performed; 381 examinations were performed in 131 patients with a personal history (PH) of premenopausal breast cancer. This cohort was evaluated further and revealed 146 examinations in 52 patients with PH only, and 235 examinations in 79 patients with personal history and family history (PHFH). Fisher's exact test was used to compare the distribution between the groups. Results: Total number of MRI examinations performed per patient ranged from 1 to 10, with an average of 2.9 in the PHFH group and 2.8 in the PH only group. Patient age at time of original diagnosis was significantly different between the groups (P = 0.0391). There were 74 (19.4%) suspicious MRI findings: 27 in the PH only group and 47 in the PHFH group. Fifty-two had needle biopsy tissue sampling performed; three additional lesions were sampled at excision. Malignancy was detected in 27.3%: 53.3% in the PHFH group and 46.7% in the PH only group (P = 0.7963). There was no significant difference when the pathology between the PH only group and the PHFH group was compared (P = 0.5692). Of those diagnosed with cancer, average time between diagnoses was 6.9 years for the PHFH group and 7.1 for the PH only group (range 2-16). Conclusions: Patients with a PH only are at a similar risk level as those with additional family history for the development of a subsequent breast cancer and therefore benefit from screening breast MRI, as a similar rate of cancer detection was found in both groups. © 2015.

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