Info

37/457 (8.1)

17/37 (46)

7 (3)

2 (29)

17/22 (77)

19/22 (86)

8/22 (36)

Total

4,333

219/5,758 (3.8)

96/214 (45)

78 (1.8)

17/63 (27)

76/97 (78)

90/97 (93)

33/97 (34)

Numbers in parentheses represent percentages.

*Results of MRI and mammography were blinded to each other. Not stated in Leach et al.141 aBiopsies prompted by MRI per number of screenings.

bPPV, positive predictive value; number of malignancies of total number of biopsies. cOf cancers seen only on MRI, number (%) that were ductal carcinoma in situ (DCIS).

dMRI and mammographic sensitivity reported only when results of MRI and other imaging modalities and clinical follow-up are described. eNA, not applicable; all participants had negative mammography and clinical breast examination; NS, not stated.

fA total of 4,169 rounds of screening were performed. Of 6 DCIS lesions in this patient population, 5 were seen on mammography and only 1 on MRI.

g41 cancers were classified as BI-RADS category 3 or higher on either mammography or MRI, with 3 cancers classified as BI-RADS 3 on each, but overlap not specified. Sensitivity numbers for each of MRI and mammography do not include category 3 lesions.

Numbers in parentheses represent percentages.

*Results of MRI and mammography were blinded to each other. Not stated in Leach et al.141 aBiopsies prompted by MRI per number of screenings.

bPPV, positive predictive value; number of malignancies of total number of biopsies. cOf cancers seen only on MRI, number (%) that were ductal carcinoma in situ (DCIS).

dMRI and mammographic sensitivity reported only when results of MRI and other imaging modalities and clinical follow-up are described. eNA, not applicable; all participants had negative mammography and clinical breast examination; NS, not stated.

fA total of 4,169 rounds of screening were performed. Of 6 DCIS lesions in this patient population, 5 were seen on mammography and only 1 on MRI.

g41 cancers were classified as BI-RADS category 3 or higher on either mammography or MRI, with 3 cancers classified as BI-RADS 3 on each, but overlap not specified. Sensitivity numbers for each of MRI and mammography do not include category 3 lesions.

criteria,34 will help decrease variability in this technique, although there remains a shortage of highly qualified radiologists and technologists. To better assess the gen-eralizability of breast US, a 3-year multicenter trial of screening sonography in high-risk women, blinded to the results of mammography, opened in April 2004, funded by the Avon Foundation and National Cancer Institute through the American College of Radiology Imaging Network (ACRIN Protocol 6666; www.acrin.org).35 The ACRIN protocol provides training materials for investigators, and standardizes equipment and interpretive criteria, to better assess generalizability of screening US. Sonography is widely available and inexpensive, and it is easy to accurately biopsy lesions seen only on sonography with core biopsy technique.36

Importantly, DCIS is not well seen on US: it should be seen as complementary to mammography. When results of mammography were also reported,28,30,31 across 26,753 examinations another 56 cancers were seen only mammographi-cally, of which 42 (75%) were DCIS and 14 (25%) were invasive.

Across eight published series (Table 28.2), 4,293 very high risk women have been screened with MRI, with 77 (1.8%) of women having cancer depicted only on MRI. The median size of cancers was 7 to 20 mm, and in all but one series, more than 80% of MRI-only depicted cancers had negative nodes.37 Where detailed, 15 of 62 (24%) of the cancers seen only on MRI were DCIS (see Table 28.2). In the largest single series of MRI screening to date,38 mam-mographic and MRI interpretations were blinded to each other, and 51 cancers were detected in 1,909 women. Sensitivity to invasive cancer was 33% for mammography and 80% for MRI, with specificities of 95% and 90%, respectively;

sensitivity to DCIS was 83% for mammography and 17% for MRI.38

When both US and MRI have been performed in the same high-risk patients, MRI has shown superior sensitivity.39-41 Liberman42 summarized results across these series, which found 7 of 24 (29%) of cancers on mammography, 7 of 23 (30%) on US, and 23 of 24 (91%) on MRI. MRI is limited, however, by high cost, relative lack of availability, variable patient tolerance, the requirement for contrast injection, and relative lack of availability and expertise to biopsy lesions found only on MRI.

A Disquistion On The Evils Of Using Tobacco

A Disquistion On The Evils Of Using Tobacco

Among the evils which a vitiated appetite has fastened upon mankind, those that arise from the use of Tobacco hold a prominent place, and call loudly for reform. We pity the poor Chinese, who stupifies body and mind with opium, and the wretched Hindoo, who is under a similar slavery to his favorite plant, the Betel but we present the humiliating spectacle of an enlightened and christian nation, wasting annually more than twenty-five millions of dollars, and destroying the health and the lives of thousands, by a practice not at all less degrading than that of the Chinese or Hindoo.

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