Acceptability of periodic follow-up as an alternative to biopsy for mammographically detected lesions interpreted as probably benign
Article Abstract:
Most breast lesions (areas of abnormal tissue growth) detected with mammography are benign (non-cancerous). These breast lesions display features on mammograms that strongly suggest they are benign (referred to as 'probably benign' lesions). Asymmetric lesions that are probably benign are interspersed by fatty tissue and often demonstrate concave margins. Radiologists cannot make a definitive diagnosis of probably benign lesions, and it is known that a small percentage of these will ultimately prove to be malignant (cancerous). Some radiologists choose to recommend excisional biopsy (removal of a tissue sample for examination) while others choose periodic follow-up and office-based examination. The choice between biopsy and follow-up examination may be influenced by the likelihood of legal action in the event of an incorrect diagnosis. The penalty for recommending a biopsy for a lesion that proves to be benign will, generally, not be as severe as the penalty for recommending office follow-up examination for a lesion that proves, eventually, to be malignant (seen as a case of 'delayed diagnosis of cancer'). An incorrect decision due to a follow-up exam is more likely to result in malpractice action, on the basis of 'negligence' than the recommendation of a biopsy for a lesion than proves to be benign (which may be legally interpreted as unnecessary surgery). The authors state there is justification for radiologists who recommend follow-up rather than biopsy in cases where a strong statistical likelihood exists that the lesion is probably benign. For instance, a noncalcified mass that has a well-defined shape is likely to be benign. Very small masses that are easily detected with state-of-the-art mammographic technology have an even smaller likelihood of proving to be malignant. The authors recommend follow-up examination as the procedure of choice in cases of probably benign breast lesion. They believe that a rational, prudent, and well-documented medical practice history of recommending follow-up in cases of probably benign lesion is one of the best defenses against a claim of delayed diagnosis of breast cancer. In the absence of overriding legislative or legal precedents, the establishment of periodic follow-up in cases of probably benign lesion may be seen as a 'standard of care' in mammography practice.
Publication Name: Radiology
Subject: Health
ISSN: 0033-8419
Year: 1989
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Mammography in a mobile setting: remaining barriers
Article Abstract:
Mammograms are X-rays of the breast tissue, mainly used to detect breast cancer. It is estimated that the death rate from breast cancer could be greatly reduced if all women over the age of 40 had regular breast examinations that included the use of mammography. Mammography has become widely available for most women, but it is not used as much as would be desirable. Access is readily available to most women and costs have been reduced significantly. This study examined other barriers that prevent women from regularly undergoing screening for breast cancer. A survey was conducted of women working in a large corporation. Screening mammography was available to them at a low cost at their place of employment. The survey involved women who made appointments for the screening. Results indicated that 2,550 women made appointments and that 347 women missed their appointments. Of these 347 women, 213 (61.4 percent) completed the survey. Results were compared with those of 275 randomly selected women who kept their appointments. No differences in age, race, or educational level were found between the two groups. The women who kept their appointments (the compliant group) were more likely to have a professional position and a higher income. They were also more likely to have had a previous mammogram, which had been recommended by a physician. The women who did not make their appointments (the noncompliant group) were less likely to fear they had breast cancer and less likely to have had previous breast problems. The results of the survey suggest some of the factors involved in why some women fail to undergo mammography outside of accessibility and cost. They may be useful in helping to find ways to increase the number of women who undergo regular screening mammography. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Radiology
Subject: Health
ISSN: 0033-8419
Year: 1991
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Focal pulmonary lesions in patients with AIDS: Percutaneous transthoracic needle biopsy
Article Abstract:
AIDS patients are subject to a number of infections and other abnormal conditions in the lungs. X-ray results and clinical symptoms are similar for many of these diseases, making diagnosis difficult. Quick and accurate diagnosis is imperative for proper treatment. Percutaneous transthoracic needle biopsy (PTNB) is a technique for obtaining lung tissue samples that can be examined to obtain a definitive diagnosis. With this technique, a needle is inserted through the chest wall to obtain tissue from the lungs. It has not been used often on AIDS patients for fear of complications. This study examined if PTNB performed on selected AIDS patients with undiagnosed lung abnormalities was both safe and effective. The procedure was performed on 13 AIDS patients. In 11 patients, a final diagnosis was obtained after PTNB was performed. Only three fairly minor complications occurred. One patient spit up blood (hemoptysis) and two patients developed a small pneumothorax (air pockets in the pleural cavity.) These results indicate that PTNB may be both safe and effective for use in diagnosing lung abnormalities in AIDS patients when less invasive diagnostic techniques are not adequate. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Radiology
Subject: Health
ISSN: 0033-8419
Year: 1991
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