Nevin Manimala

Photobiomodul Photomed Laser Surg. 2024 Feb 28. doi: 10.1089/photob.2023.0105. Online ahead of print.

ABSTRACT

Objective: To evaluate the therapeutic effect of a novel air-cooled Nd:YAG laser in the venous lakes of the lips (VLL). Background: The thermal injury is one of the most important issues during laser therapy for venous lakes. Methods: Six pieces of fresh pork livers were used to provide 30 regions with a diameter of 6 mm for experiment in vitro, among which 15 regions were treated by Nd:YAG laser with air cooling until the tissue turned gray-white, whereas the rest were treated without air cooling as control. The operation time of laser irradiation, the degree of temperature increase, and the depth of coagulation tissue were compared between two groups. Then, 60 VLL patients were selected for Nd:YAG laser treatment with or without air cooling. The operation time of laser irradiation, the degree of temperature increase, the postoperative pain visual analog scale (VAS) score, and the percentage of lesions removed within 1 month were compared. Results: In tissue studies, the treated group showed a longer operation time of laser irradiation (p < 0.01), a lower degree of temperature increase (p < 0.01), and there was no significant statistical difference in the depth of coagulation tissue (p = 0.624). In clinical studies, the treated group showed a longer operation time of laser irradiation (p < 0.01), a lower degree of temperature increase (p < 0.01), and a lower VAS score on the 1st and 2nd day, compared with the control group (p < 0.01). Conclusions: Air cooling during Nd:YAG laser for the treatment of VLL can prolong the surgical time, but lowered tissue temperature and reduced patient pain within 2 days under the premise of ensuring the treatment effect.

PMID:38417045 | DOI:10.1089/photob.2023.0105

J Womens Health (Larchmt). 2024 Feb 28. doi: 10.1089/jwh.2023.1021. Online ahead of print.

ABSTRACT

Background: Alcohol intake is associated with breast cancer (BC) risk, but estimates of greatest public health relevance have not been quantified in large studies with long duration. Materials and Methods: In this prospective cohort study of 39,811 women (median 25 years follow-up), we examined the association between alcohol consumption and BC incidence and mortality with adjusted hazard ratios (HRs), cubic splines, absolute risks, number needed to harm (NNH), and population-attributable fractions. Results: We documented 2,830 cases of BC, including 237 BC deaths. Each additional alcoholic drink/day was associated with a 10% higher rate (HR = 1.10, 95% confidence intervals [CIs]: 1.04-1.16) of total BC in a linear manner (p = 0.0004). The higher rate was apparent for estrogen receptor (ER)⁺ (HR = 1.12, 95% CI: 1.06-1.18) but not ER^– tumors (HR = 0.95, 95% CI: 0.82-1.10), with a statistically significant difference between these associations (p = 0.03). We constructed models comparing BC incidence among 100,000 women followed for 10 years. Compared to a scenario where all women rarely or never consumed alcohol, we expect 63.79 (95% CI: 58.35-69.24) more cases (NNH = 1,567) had all women consumed alcohol at least monthly and 278.66 (95% CI: 268.70-288.62) more cases (NNH = 358) had all women consumed >1 drink/day. Approximately 4.1% of BC cases were attributable to consumption exceeding one drink/month. Conclusion: Alcohol consumption is associated with a linear dose-response increase in BC incidence even within recommended limits of up to one alcoholic drink/day, at least for ER⁺ tumors. Our estimates of risk differences, attributable fraction, and NNH quantify the burden that alcohol consumption imposes on women in the general population. ClinicalTrials.gov Identifier: NCT00000479.

PMID:38417039 | DOI:10.1089/jwh.2023.1021

J Cardiovasc Pharmacol. 2024 Feb 27. doi: 10.1097/FJC.0000000000001547. Online ahead of print.

ABSTRACT

The influence of IL-17 inhibition on blood pressure in autoimmune disease patients remains inconclusive. Our objective is to examine the risk of hypertension in patients with autoimmune diseases undergoing IL-17 inhibition therapies via meta-analysis of randomized, placebo-controlled trials (RCTs). We obtained integrated data from PubMed, Embase, and ClinicalTrials.gov. Incident hypertension rates were calculated, and hazard ratios (HRs) with 95% confidence intervals (CIs) were analyzed, along with Ι^2 statistics to assess heterogeneity. Sequential analysis ensured conclusion reliability. In 30 RCTs involving 9,909 patients with diverse autoimmune diseases treated with anti-IL-17 agents, our meta-analysis revealed a significant increase in hypertension risk (RR 1.69, CI 1.24-2.31, p=0.001), robustly supported by trial sequential analysis. Among the four agents (secukinumab, ixekizumab, bimekizumab, and brodalumab), only secukinumab exhibited a notable association with hypertension. Patients with various primary autoimmune diseases, particularly those with psoriatic arthritis, had a higher likelihood of developing hypertension; in rheumatic arthritis patient cohorts, anti-IL-17 agents did not elevate hypertension risk. Prolonged treatment duration correlated with an increased hypertension risk. Stratifying by gender, studies with a female predominance demonstrated a higher risk ratio for hypertension compared to male-predominant studies. This highlights that anti-IL-17 treatment escalates hypertension risk, emphasizing the need for extra caution when managing autoimmune disease patients. (Registered by PROSPERO, CRD42016053112).

PMID:38417026 | DOI:10.1097/FJC.0000000000001547

J Breast Imaging. 2022 Dec 11;4(6):582-589. doi: 10.1093/jbi/wbac063.

ABSTRACT

OBJECTIVE: Establish a radiologist-run consultation clinic to review breast density and supplemental screening exams (SSEs) directly with patients in response to breast density reporting laws.

METHODS: Breast radiologists opened and staffed a clinic for formal patient consultations regarding breast density and SSEs. An IRB-approved questionnaire assessed patient knowledge of breast density, SSEs, and encounter satisfaction. Comparative statistical analyses were performed on knowledge-based questions.

RESULTS: From February 2019 to February 2021, 294 reimbursable consultations were performed with 215 patients completing pre- and post-consultation questionnaires (survey response rate, 73%). Median patient age was 58 years (range, 34-86 years) and 9% (19/210) had a personal history of breast cancer. An increase in patient knowledge of breast density and SSEs was observed as follows: breast density categories (9% correct pre-consultation (20/215), 86% correct post-consultation (185/215), P < 0.001), dense breast effects on cancer risk (39% correct pre-consultation (83/215), 84% post-consultation (180/215)), mammogram sensitivity (90% correct pre-consultation (193/215), 94% post-consultation (201/215)), and increased cancer detection with SSEs (82% correct pre-consultation (177/215), 95% post-consultation (205/215)) (P < 0.001). Post-consultation, 96% (200/209) were satisfied with the usefulness of information, 89% (186/209) strongly agreed they had sufficient knowledge of SSEs, and 81% (167/205) agreed they would like future opportunities to meet with a breast radiologist.

CONCLUSION: A consultation clinic staffed by breast radiologists focused on breast density and supplemental breast cancer screening can provide personalized patient counseling, engage patients in shared decision making, assist referring clinicians, and support high quality patient-centered care.

PMID:38416998 | DOI:10.1093/jbi/wbac063

J Breast Imaging. 2022 Dec 11;4(6):612-617. doi: 10.1093/jbi/wbac064.

ABSTRACT

OBJECTIVE: To evaluate intervention of structured reporting after wrong-site surgery that occurred after localization of an incorrect breast biopsy marker.

METHODS: An IRB-exempt retrospective database review identified patients who underwent core-needle biopsy of a breast lesion from July 1, 2014 to July 1, 2020. They were divided into three cohorts: 2014 pre-intervention/pre-sentinel, 2017 pre-intervention/post-sentinel, and 2019 post-intervention of structured reports. One hundred reports per cohort were reviewed for documentation of marker and shape. Statistical analysis was performed with mixed-effects logistic regression model and chi-squared test with P < 0.05 considered significant.

RESULTS: The 2014 cohort consisted of 100 patients with 122 biopsies. Twenty-seven (22.1%) were excluded: 5/122 (4.1%) lesion resolution, 22/122 (18.0%) no documentation whether marker was/was not placed. Of the 95 biopsies remaining, 4/95 (4.2%) had no marker placed, 62/95 (65.3%) reported marker only, and 29/95 (30.5%) reported marker and shape. In the 2017 cohort, 100 patients underwent 108 biopsies. Four/108 (3.7%) were excluded: lesion resolution. Of the 104, 10/104 (9.6%) had no marker placed, 22/104 (21.2%) reported marker only, and 72/104 (69.2%) reported marker and shape. In the 2019 cohort, 100 patients underwent 114 biopsies. Two/114 (1.8%) were excluded: lesion resolution. Of the 112, 3/112 (2.7%) had no marker placed, 3/112 (2.7%) reported marker only, and 106/112 (94.6%) reported marker and shape. The predicted probability of both marker placement and shape described were statistically greater for 2019 compared to the other cohorts (P < 0.05).

CONCLUSION: Using structured reports facilitates and improves documentation of breast biopsy markers and may potentially reduce the risk of medical errors.

PMID:38416997 | DOI:10.1093/jbi/wbac064

J Breast Imaging. 2022 Jul 29;4(4):392-399. doi: 10.1093/jbi/wbac036.

ABSTRACT

OBJECTIVE: To assess the frequency, management, and early outcomes of COVID-19 vaccine-related adenopathy on breast MRI.

METHODS: This IRB-exempt retrospective study reviewed patients who underwent breast MRI following COVID-19 vaccine approval in the U.S. from December 14, 2020, to April 11, 2021 (N = 1912) and compared patients who underwent breast MRI the year prior to the pandemic, March 13, 2019, to March 12, 2020 (N = 5342). Study indication, patient age, date of study, date and type of vaccination(s), time difference between study and vaccinations, lymph node-specific and overall management recommendations, and outcomes of additional examinations were recorded. Differences in the final assessment categories between the subjects scanned pre-pandemic and post-vaccine were compared using the Fisher exact test.

RESULTS: Vaccine-related adenopathy was mentioned in 67 breast MRI reports; only 1 in the pre-pandemic group. There were no clinically relevant differences in patient demographics between groups. There was a statistically significant increase in BI-RADS 0 assessments between the pre-pandemic and post-vaccine approval groups-0.8% (45/5342) versus 1.8% (34/1912) (P = 0.001) and BI-RADS 3 assessments-6.5% (348/5342) versus 9.2% (176/1912) (P < 0.0001). Of the 29 patients who underwent additional imaging (range, 2-94 days following MRI) and the 2 patients who underwent biopsy, 47% (31/66), none were found to have malignant adenopathy.

CONCLUSION: COVID-19 vaccination is associated with transient axillary adenopathy of variable duration. This leads to additional imaging in women undergoing breast MRI, so far with benign outcomes, and this may affect audits of outcomes of MRI.

PMID:38416988 | DOI:10.1093/jbi/wbac036

J Breast Imaging. 2022 Jul 29;4(4):371-377. doi: 10.1093/jbi/wbac034.

ABSTRACT

OBJECTIVE: To evaluate breast density notification legislation (BDNL) on breast imaging practice patterns, risk assessment, and supplemental screening.

METHODS: A 20-question anonymous web-based survey was administered to practicing Society of Breast Imaging radiologists in the U.S. between February and April 2021 regarding breast cancer risk assessment, supplemental screening, and density measurements. Results were compared between facilities with and without BDNL using the two-sided Fisher’s exact test.

RESULTS: One hundred and ninety-seven radiologists from 41 U.S. states, with (187/197, 95%) or without (10/197, 5%) BDNL, responded. Fifty-seven percent (113/197) performed breast cancer risk assessment, and 93% (183/197) offered supplemental screening for women with dense breasts. Between facilities with or without BDNL, there was no significant difference in whether risk assessment was (P = 0.19) or was not performed (P = 0.20). There was no significant difference in supplemental screening types (P > 0.05) between BDNL and non-BDNL facilities. Thirty-five percent (69/197) of facilities offered no supplemental screening studies, and 25% (49/197) had no future plans to offer supplemental screening. A statistically significant greater proportion of non-BDNL facilities offered no supplemental screening (P < 0.03) and had no plans to offer supplemental screening compared to BDNL facilities (P < 0.02).

CONCLUSION: Facilities in BDNL states often offer supplemental screening compared to facilities in non-BDNL states. Compared to BDNL facilities, a statistically significant proportion of non-BDNL facilities had no supplemental screening nor plans for implementation. Our data suggest that upcoming federal BDNL will impact how supplemental screening is addressed in currently non-BDNL states.

PMID:38416983 | DOI:10.1093/jbi/wbac034

J Breast Imaging. 2022 Jun 7;4(3):285-290. doi: 10.1093/jbi/wbac016.

ABSTRACT

OBJECTIVE: To determine whether providing a biopsy marker informational handout to patients improves patient knowledge and comfort with receiving a marker.

METHODS: In this IRB-exempt prospective study, a patient educational handout on breast biopsy markers was developed. A questionnaire was created with four questions asking patients to self-evaluate their knowledge of biopsy markers and their comfort level with marker placement before and after reading the handout. Technologists distributed the educational handouts to patients presenting for a percutaneous breast biopsy under any modality from December 11, 2020, to April 23, 2021. Data from the completed questionnaires were entered into a database. Statistical analyses included paired t-test and Wilcoxon analyses.

RESULTS: In total, 141 completed surveys were included in the analysis. The mean scores prior to reading the handout for knowledge and comfort were 2.59 and 3.40, respectively. After reading the handout, there was a significant increase in mean scores for knowledge and comfort (4.26 and 4.20, respectively) (P < 0.001). There was a 64% increase vs 23% increase for knowledge and comfort, respectively.

CONCLUSION: Patient-assessed knowledge of biopsy markers increased significantly after reading our educational handout. Patient-assessed comfort with biopsy marker placement also increased significantly after reading the educational handout, though to a lesser degree than knowledge. Although not included in our study, use of an educational handout may impact patient acceptance of marker placement. Future directions may include quantitatively assessing the effect of the handout on time to consent for a biopsy or influence on acceptance of marker placement.

PMID:38416970 | DOI:10.1093/jbi/wbac016

J Breast Imaging. 2022 Jun 7;4(3):263-272. doi: 10.1093/jbi/wbac002.

ABSTRACT

OBJECTIVE: To compare readers’ performances when detecting architectural distortion (AD) on digital breast tomosynthesis (DBT). To determine the risk of malignancy of DBT with synthetic mammogram (SM)-detected AD and evaluate imaging features that are associated with malignancy risk.

METHODS: This IRB-approved retrospective review included all cases of DBT-detected AD that were recommended for biopsy from October 2013 to July 2019. Cases were reviewed by three breast radiologists and the overall agreement between radiologists was calculated. Medical records were reviewed for pathological outcomes and imaging findings. Statistical analyses used were Cohen’s kappa and its 95% confidence interval, and one-way analysis of variance.

RESULTS: A total of 172 lesions were included. The overall agreement for the presence of AD in our study was fair (0.253). The majority (20/36, 55.5%) of the malignant ADs were associated with asymmetries (13/36, 36.1%), calcifications (4/36, 11.1%), or both (3/36, 8.3%), compared to nonmalignant ADs (40/136, 31.0%; P = 0.038). The positive predictive value (PPV) of DBT with SM-detected AD for malignancy was 21.8% (36/165), 18.8% (18/96) for DBT-detected AD, and 26.0% (18/69) for SM-detected AD, although the difference was not statistically significant (P = 0.258). A breast MRI correlate was identified for all malignant AD lesions (17/17, 100.0%; P = 0.004).

CONCLUSION: The detection of AD remains a challenging task for radiologists, with moderate-to-fair interobserver agreement. With a PPV for malignancy of 21.8%, percutaneous biopsy and subsequent pathology-imaging correlation are necessary for AD to exclude the possibility of malignancy.

PMID:38416967 | DOI:10.1093/jbi/wbac002

J Breast Imaging. 2023 Feb 6;5(1):56-66. doi: 10.1093/jbi/wbac070.

ABSTRACT

OBJECTIVE: To assess and understand the inclusion, diversity, and equity (IDE) needs of the Society of Breast Imaging (SBI) membership to guide development of a strategic plan and goals for the Inclusion, Diversity, Equity Alliance (IDEA) of SBI.

METHODS: A 23-question survey developed by IDEA was distributed electronically to all SBI members in November 2020 to assess and understand the society’s IDE needs. Descriptive statistics were used to summarize the responses. Open-ended responses were reviewed by the authors and sorted into three categories: supportive, nonsupportive, or neutral suggestions.

RESULTS: The response rate was 12% (453/3686). Only 55% (238/429) of respondents agreed that the diversity of SBI leadership reflected the diversity of the society, with stronger agreement that actions of SBI aligned with their core values of collaboration and collegiality (327/249,75%), and of respect for diversity and inclusiveness (303/429, 70%). Overall, 65% (172/264) of respondents were satisfied with the quality and diversity of speakers at the annual symposium; however, White respondents agreed more compared to non-White respondents (P = 0.035), and those practicing greater than 20 years agreed more compared to those practicing 6 to 10 years (P = 0.023). Of 88 total suggestions, three common themes were: more resources for recruitment, retention, and education for a diverse staff; further increase in diversity among leadership and membership; and more patient care resources.

CONCLUSION: In addition to showing areas of agreement by SBI members, this survey also identified opportunities for SBI and IDEA to further incorporate IDE into our initiatives and organization.

PMID:38416964 | DOI:10.1093/jbi/wbac070