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Bielefeld, Germany

Sadigh G.,University of Michigan | Carlos R.C.,University of Michigan | Neal C.H.,VA Ann Arbor Healthcare System | Neal C.H.,University of Michigan | And 3 more authors.
European Radiology | Year: 2013

Objectives: To conduct an individual patient data meta-analysis comparing the diagnostic performance of ultrasound elastography (USE) versus B-mode ultrasound (USB) across size ranges of breast masses. Methods: An extensive literature search of PubMed and other medical/general purpose databases from inception through August 2011 was conducted. Corresponding authors of published studies that reported a direct comparison of the diagnostic performance of USE using the elasticity score versus USB for characterisation of focal breast masses were contacted for their original patient-level data set. Summary diagnostic performance measures were compared for each test within and across three mass size groups (<10 mm, 10-19 mm, and >19 mm). Results: The patient-level data sets were received from five studies, providing information on 1,412 breast masses. For breast masses <10 mm (n = 543; 121 malignant), the sensitivity/specificity of USE and USB were 76 %/93 % and 95 %/68 %, respectively. For masses 10-19 mm of size (n = 528; 247 malignant), sensitivity/specificity of USE and USB were 82 %/90 % and 95 %/67 %, respectively. For masses >19 mm of size (n = 325; 162 malignant), sensitivity/specificity of USE and USB were 74 %/94 % and 97 %/55 %, respectively. Conclusion: Regardless of the mass size, USE has higher specificity and lower sensitivity compared to USB in characterising breast masses. The performance of each of these two tests does not vary significantly by mass size. Key Points: • Ultrasound elastography is increasingly used for breast lesions. • Its diagnostic performance is not dependent on the size of the mass. • Ultrasound elastography has higher specificity/lower sensitivity than B-mode ultrasound. • Elastography is advised when B-mode results are equivocal. © 2012 European Society of Radiology.

Huebner J.,Goethe University Frankfurt | Micke O.,Franziskus Hospital | Muecke R.,Lippe Hospital GmbH | Buentzel J.,Nordhausen Clinic | And 4 more authors.
Anticancer Research | Year: 2014

Background: In Europe about 40% to 50% of patients with cancer use complementary or alternative medicine (CAM). Only scarce data regarding the use of CAM have been reported from comprehensive cancer Centers. Patients and Methods: We carried out a survey on patients attending the counseling Unit for CAM of a German comprehensive cancer Center using a standardized questionnaire. Results: A total of 165 patients participated in the survey; 60% had already used CAM. Trace elements and vitamins were most often used. Strengthening oneself and one's immune system were the two main reasons (73% and 69% respectively for CAM use). The most important sources of information are print media and physicians (41% and 35% respectively). The two main reasons for using CAM were practitioners spending more time with patients and patients having experienced positive effects from CAM. Conclusion: For patients with cancer becoming active is an important goal, while disappointment in conventional medicine is not. Accepting patients' motivation for autonomy may help oncologists to increase adherence to conventional therapy. © 2014, International Institute of Anticancer Research. All rights reserved.

Heyd R.,Offenbach Hospital | Micke O.,Franziskus Hospital | Berger B.,University of Tubingen | Eich H.T.,University of Cologne | And 2 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2010

Purpose: The German Cooperative Group on Radiotherapy in Benign Diseases (GCG-BD) conducted a pattern-of-care study (PCS) to analyze the radiation therapy (RT) practice for pigmented villonodular synovitis (PVNS). Methods and Materials: In 2007, a structured questionnaire to assess the number of patients, the pretreatments, the RT indication, technique, target volume concepts, outcome data, and possible early or late toxicity was circulated to 227 institutions. Results: Until August 2008, a response was available from 189 institutions (83.2 %), of whom 19 (10.0 %) experienced RT for PVNS. Complete clinical information was available for 41 patients from 14 RT departments. Thirty patients (73.2 %) received postsurgical RT because of primary incomplete resection, 11 patients (26.8 %) as an adjunct after complete resections of recurrences or unclear resection status. The total doses ranged from 30 to 50 Gy (median, 36 Gy), the median single dose was 2.0 Gy. Local control was achieved 95.1%, and 82.9% had no or only slight functional impairment. The early and late toxicity was mild (≤RTOG Grade II). Conclusions: Radiation therapy is a safe and effective treatment for PVNS in the postoperative setting after incomplete resection, and also as a salvage option for treatment of recurrences it provides a high rate of local control. © 2010 Elsevier Inc.

Huebner J.,Goethe University Frankfurt | Prott F.J.,RNS Praxisgemeinschaft GbR | Micke O.,Franziskus Hospital | Muecke R.,Ruhr University Bochum | And 3 more authors.
Oncology Research and Treatment | Year: 2014

Introduction: Complementary and alternative medicine (CAM) is often used by cancer patients, yet, communication with the oncologist is poor. The objective of our study was to gather information on patients' usage of CAM, source of information, and aims, in order to derive strategies to improve the communication between physicians and patients on this topic. Materials and Methods: An online survey was conducted by linking a standardized questionnaire to the largest internet portal for cancer patients in Germany. The questionnaire addresses CAM usage, disclosure to physicians, source of information, objectives for using CAM, and perceived reasons for cancer. Results: Of 170 participants, 77% were currently using CAM. Disclosure to a physician was rather high with 63% having informed their oncologist. Asked whether the oncologist took time to discuss CAM, 74% answered 'no'. Most frequently used are biologically based therapies, relaxation techniques, prayer, and meditation. Most patients want to reduce side effects, boost their immune system, and get active. Almost half the participants had positive experiences with some type of CAM before they fell ill. Conclusion: Understanding patients' concepts of the etiology of cancer and accepting their goals for using CAM may help oncologists communicate with their patients and guide them to a safe use of CAM. © 2014 S. Karger GmbH, Freiburg.

Heyd R.,Offenbach Hospital | Micke O.,Franziskus Hospital | Surholt C.,Ansbach Hospital | Berger B.,University of Tubingen | And 4 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2011

Purpose: The German Cooperative Group on Radiotherapy for Benign Diseases conducted a national patterns-of-care study to investigate the value of radiation therapy (RT) in the management of Gorham-Stout syndrome. Methods and Materials: In 2009 a structured questionnaire was circulated to 230 German RT institutions to assess information about the number of patients, the RT indication and technique, and the target volume definition, as well as accompanying treatments, outcome data, and early or late radiation toxicity. Results: In November 2009 responses were available from 197 departments (85.6%): 29 university hospitals (14.7%), 89 community hospitals (45.2%), and 79 private RT offices (40.1%). Of these institutions, 8 (4.0%) had experience using RT, for a total of 10 cases in various anatomic sites. Four patients underwent irradiation postoperatively, and six patients received primary RT. The total doses applied after computed tomography-based treatment planning ranged from 30 to 45 Gy. After a median follow-up period of 42 months, local disease progression was avoided in 8 cases (80.0%). In 2 of these cases a progression occurred beyond the target volume. Acute and late toxicity was mild; in 4 patients RT was associated with Grade I side effects according to Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer criteria. The literature analysis of 38 previously published articles providing results after the use of RT in 44 patients showed stable or regressive disease in 77.3%. Conclusions: RT may prevent disease progression effectively in Gorham-Stout syndrome in 77% to 80% of cases. Total doses ranging from 30 to 45 Gy applied after computed tomography-based treatment planning are recommended. © 2011 Elsevier Inc.

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