44 research outputs found
ESUR guidelines for MR imaging of the sonographically indeterminate adnexal mass: an algorithmic approach
A significant proportion of
adnexal masses detected by sonography
are indeterminate. Either their
organ of origin is uncertain or it is
unclear whether their nature is benign
or malignant. MR imaging of the
sonographically indeterminate adnexal
mass can resolve most of these
uncertainties. Most indeterminate
masses result from common benign
conditions and women with such
masses can avoid unnecessary or inappropriate surgery. For the minority
of women whose masses are malignant,
use of MR imaging rather than
a ‘wait and watch’ strategy of repeat
ultrasound (US) results in a more
timely diagnosis. There are simple
diagnostic steps in the MR imaging
assessment which direct an algorithmic
and problem-solving approach
based on signal characteristics and
morphology. MR imaging should
provide a more timely diagnosis and,
thereby, guide the management of the
patient with reduced costs of investigation
and treatment
The impact of the National HIV Health Care Worker Hotline on patient care in South Africa
<p>Abstract</p> <p>Background</p> <p>South Africa has a huge burden of illness due to HIV infection. Many health care workers managing HIV infected patients, particularly those in rural areas and primary care health facilities, have minimal access to information resources and to advice and support from experienced clinicians. The Medicines Information Centre, based in the Division of Clinical Pharmacology at the University of Cape Town, has been running the National HIV Health Care Worker (HCW) Hotline since 2008, providing free information for HIV treatment-related queries via telephone, fax and e-mail.</p> <p>Results</p> <p>A questionnaire-based study showed that 224 (44%) of the 511 calls that were received by the hotline during the 2-month study period were patient-specific. Ninety-four completed questionnaires were included in the analysis. Of these, 72 (77%) were from doctors, 13 (14%) from pharmacists and 9 (10%) from nurses. 96% of the callers surveyed took an action based on the advice received from the National HIV HCW Hotline. The majority of actions concerned the start, dose adaption, change, or discontinuation of medicines. Less frequent actions taken were adherence and lifestyle counselling, further investigations, referring or admission of patients.</p> <p>Conclusions</p> <p>The information provided by the National HIV HCW Hotline on patient-specific requests has a direct impact on the management of patients.</p
ESUR recommendations for MR imaging of the sonographically indeterminate adnexal mass: an update
An update of the 2010 published ESUR recommendations of
MRI of the sonographically indeterminate adnexal mass integrating
functional techniques is provided. An algorithmic approach
using sagittal T2 and a set of transaxial T1 and T2WI
allows categorization of adnexal masses in one of the following
three types according to its predominant signal characteristics.
T1 'bright' masses due to fat or blood content can be
simply and effectively determined using a combination of
T1W, T2W and FST1W imaging. When there is concern for a solid component within such a mass, it requires additional
assessment as for a complex cystic or cystic-solid mass. For
low T2 solid adnexal masses, DWI is now recommended.
Such masses with low DWI signal on high b value image
(e.g. > b 1000 s/mm2
) can be regarded as benign. Any other
solid adnexal mass, displaying intermediate or high DWI signal,
requires further assessment by contrast-enhanced
(CE)T1W imaging, ideally with DCE MR, where a type 3
curve is highly predictive of malignancy. For complex cystic
or cystic-solid masses, both DWI and CET1W—preferably DCE MRI—is recommended. Characteristic enhancement
curves of solid components can discriminate between lesions
that are highly likely malignant and highly likely benign
Breast ultrasound: recommendations for information to women and referring physicians by the European Society of Breast Imaging
Abstract
This article summarises the information that should be provided to women and referring physicians about breast ultrasound (US). After explaining the physical principles, technical procedure and safety of US, information is given about its ability to make a correct diagnosis, depending on the setting in which it is applied. The following definite indications for breast US in female subjects are proposed: palpable lump; axillary adenopathy; first diagnostic approach for clinical abnormalities under 40 and in pregnant or lactating women; suspicious abnormalities at mammography or magnetic resonance imaging (MRI); suspicious nipple discharge; recent nipple inversion; skin retraction; breast inflammation; abnormalities in the area of the surgical scar after breast conserving surgery or mastectomy; abnormalities in the presence of breast implants; screening high-risk women, especially when MRI is not performed; loco-regional staging of a known breast cancer, when MRI is not performed; guidance for percutaneous interventions (needle biopsy, pre-surgical localisation, fluid collection drainage); monitoring patients with breast cancer receiving neo-adjuvant therapy, when MRI is not performed. Possible indications such as supplemental screening after mammography for women aged 40–74 with dense breasts are also listed. Moreover, inappropriate indications include screening for breast cancer as a stand-alone alternative to mammography. The structure and organisation of the breast US report and of classification systems such as the BI-RADS and consequent management recommendations are illustrated. Information about additional or new US technologies (colour-Doppler, elastography, and automated whole breast US) is also provided. Finally, five frequently asked questions are answered.
Teaching Points
• US is an established tool for suspected cancers at all ages and also the method of choice under 40.
• For US-visible suspicious lesions, US-guided biopsy is preferred, even for palpable findings.
• High-risk women can be screened with US, especially when MRI cannot be performed.
• Supplemental US increases cancer detection but also false positives, biopsy rate and follow-up exams.
• Breast US is inappropriate as a stand-alone screening method
Image-guided breast biopsy and localisation: recommendations for information to women and referring physicians by the European Society of Breast Imaging
Abstract: We summarise here the information to be provided to women and referring physicians about percutaneous breast biopsy and lesion localisation under imaging guidance. After explaining why a preoperative diagnosis with a percutaneous biopsy is preferred to surgical biopsy, we illustrate the criteria used by radiologists for choosing the most appropriate combination of device type for sampling and imaging technique for guidance. Then, we describe the commonly used devices, from fine-needle sampling to tissue biopsy with larger needles, namely core needle biopsy and vacuum-assisted biopsy, and how mammography, digital breast tomosynthesis, ultrasound, or magnetic resonance imaging work for targeting the lesion for sampling or localisation. The differences among the techniques available for localisation (carbon marking, metallic wire, radiotracer injection, radioactive seed, and magnetic seed localisation) are illustrated. Type and rate of possible complications are described and the issue of concomitant antiplatelet or anticoagulant therapy is also addressed. The importance of pathological-radiological correlation is highlighted: when evaluating the results of any needle sampling, the radiologist must check the concordance between the cytology/pathology report of the sample and the radiological appearance of the biopsied lesion. We recommend that special attention is paid to a proper and tactful approach when communicating to the woman the need for tissue sampling as well as the possibility of cancer diagnosis, repeat tissue sampling, and or even surgery when tissue sampling shows a lesion with uncertain malignant potential (also referred to as “high-risk” or B3 lesions). Finally, seven frequently asked questions are answered