Set Of Consecutive Patients Research Articles

Perioperative Complications Following Spine Surgery in Adult Patients with Achondroplasia.

Retrospective cohort study. To describe the common types of complications and their risk factors during spine surgery in patients with achondroplasia. A retrospective review was performed of medical records of adult achondroplasia patients who underwent spine surgery at our institution between 2007 and 2021. Inclusion criteria were achondroplasia and age >16 years. Surgical encounters were evaluated for durotomy, postoperative neurologic deficit, wound compromise, medical complications, and return to the operating room. Statistical analysis included evaluation of relationships across complications and fisher exact test applied to bivariate/categorical variables and t-test/ANOVA for continuous variables. Multivariable analysis using logistic regression was performed to account for patient characteristics. Fifty-five patients with achondroplasia underwent 95 surgeries. Forty-nine percent of the surgeries involved a complication. These included durotomy (33.7%), neurologic deficit (11.6%), wound compromise (6.3%), and other medical complications (6.3%). Thirteen percent of surgeries required return to the operating room. The greatest number of complications occurred in thoracolumbar region (60.0%) compared to cervicothoracic (18.2%) and craniocervical junction (33.3%). Chronologically later surgical encounters had decreased complications and durotomies only occurred in thoracolumbar surgeries (45.7%). Adult patients with achondroplasia undergoing surgery chronologically later in this set of consecutive patients were at a decreased risk for complications. Thoracolumbar surgeries were at the greatest risk for durotomies. Male sex was a risk factor for durotomy, while age was a risk factor for neurologic deficit. The potential for adverse surgical events should be considered when evaluating patients with achondroplasia for spine surgery. .

P3. Significance of intracranial EEG parameters in prediction of seizure freedom

Introduction. In patients with focal drug-resistant epilepsy (DRE), intracranial electroencephalography (iEEG) with subdural electrodes (SDE) is used to delineate the seizure onset zone (SOZ) and to distinguish eloquent cortex areals, if non-invasive diagnostics did not yield conclusive results. Previous studies have shown ambiguous findings on the significance of iEEG parameters with respect to prediction of seizure freedom after resective epilepsy surgery. Most studies focused on subgroups of patients, such as those with frontal or temporal lobe epilepsy, or on some iEEG parameters, only. To that end, we comprehensively analyzed the significance of several iEEG parameters in one set of consecutive patients with DRE. Methods. All patients who had undergone invasive monitoring with SDE between 2005 and 2015 at our tertiary epilepsy center were included in this study 1 . We retrospectively analyzed iEEG parameters including seizure onset pattern (SOP), size of SOZ, latency to EEG seizure propagation and latency from clinical to EEG seizure onset. Furthermore, we assessed associations with post-operative seizure freedom, histopathology und brain region of SOZ. Results. Eighty-one patients (34 female) with 324 seizures were assessed. Low-voltage fast activity (LVFA, 37%) and sharp activity < 13 Hz (30%) were the most frequent SOPs. Focal SOZ (≤2 cm) was the only iEEG parameter independently associated with 1-year post-operative seizure freedom (OR 4.1, 95% CI 1.433–11.679). While no SOP was linked to specific histopathologies, LVFA was associated with temporal neocortical SOZ ( p < 0.01). Median latencies to EEG seizure propagation were significantly longer ( p < 0.001) in seizures originating from temporo-mesial SOZ (median 16.0 s) compared with temporo-neocortical (median 8.0 s) and frontal seizure onset (median 5.5 s). Also, latencies from clinical to EEG seizure onset were significantly longer ( p < 0.001) in seizures from temporo-mesial SOZ (median −20.0 s) compared with temporo-neocortical (median −12.0 s) and frontal seizure onset (median −6.0 s). Discussion. A focal EEG seizure onset but no specific SOP predicted seizure freedom after surgery. Also, different SOPs could be generated by the same histopathology and vice versa, putting clinical significance of SOPs into question. LVFA was associated with temporal neocortical seizure onset, possibly indicating a close-by seizure generator. Longer latencies until seizure spread and clinical signs or symptoms in seizures originating from temporo-mesial SOZ may be explained by inhibitory circuits in the hippocampus. Reference 1. Steinbart D, Steinbrenner M, Oltmanns F, Holtkamp M. Prediction of seizure freedom after epilepsy surgery – critical reappraisal of significance of intracranial EEG parameters. Clin Neurophysiol. 2020;131(11):2682-2690. doi:https://doi.org/10.1016/j.clinph.2020.08.018

Catheter ablation of atrial fibrillation using ablation index–guided high power (50 W) for pulmonary vein isolation with or without esophageal temperature probe (the AI-HP ESO II)

High-power, short-duration ablation for pulmonary vein isolation (PVI) in the treatment of atrial fibrillation (AF) facilitates the procedure and improve effectiveness; however, esophageal injury remains a safety concern. The purpose of this study was to investigate the role of luminal esophageal temperature (LET) monitoring during high-power ablation for PVI in terms of endoscopic esophageal lesion. Patients with symptomatic AF underwent ablation index-guided high-power (AI-HP) PVI (50 W; AI anterior wall/posterior wall: 550/400). In the first consecutive set of patients, an insulated esophageal temperature probe was used for LET monitoring (cutoff LET >39°C) (group A). In the second consecutive set of patients, the probe was not used (group B). All patients were scheduled to undergo esophageal endoscopy 1-3 days after ablation. A total of 120 patients (60 group A; 60 group B) were included in the study (mean age 67.8 years; 64% male). Baseline characteristics and procedural outcomes were similar between the 2 groups. Procedural PVI was achieved in all patients. First-pass PVI rate was 96.6%. Mean procedural radiofrequency (RF) time was 11.5 minutes, mean procedural time was 55.5 minutes, and fluoroscopic time was 5.6 minutes. Mean contact force at the LA posterior wall was 23 g, and mean RF ablation time at the LA posterior wall was 3.2 minutes. Two patients in group A and 1 patient in group B had endoscopic small esophageal lesions (P = .99). No serious procedural adverse events were observed. Among patients undergoing AI-HP (50 W) PVI, the incidences of ablation-related endoscopic esophageal lesion in patients with and those without use of a temperature probe for LET monitoring (cutoff 39°C) were comparably low.

MP19-13 THE ANTERIOR URETHROVESCIAL ANGLE MEASURED ON POSTOPERATIVE CYSTOGRAPHY CAN PREDICT URINARY INCONTINENCE AFTER ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I (MP19)1 Apr 2020MP19-13 THE ANTERIOR URETHROVESCIAL ANGLE MEASURED ON POSTOPERATIVE CYSTOGRAPHY CAN PREDICT URINARY INCONTINENCE AFTER ROBOT-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY Feifei Zhang*, Xuefeng Qiu, and Hongqian Guo Feifei Zhang*Feifei Zhang* More articles by this author , Xuefeng QiuXuefeng Qiu More articles by this author , and Hongqian GuoHongqian Guo More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000852.013AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robot-assisted laparoscopic radical prostatectomy (RALP) is associated with urinary incontinence. We evaluated early urinary continence in a set of consecutive patients who underwent conventional RALP (CON-RALP) and Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALP) to identify the useful predictors of postoperative urinary incontinence as determined by postoperative cystography. METHODS: The study consisted of 121 patients who underwent CON-RALP (n=61) and RS-RALP (n=60). Postoperative cystography was performed within7-10 days after RALP. The ratio between the horizontal and longitudinal length (H/L) of the bladder, the position of the urethrovesical junction (UVJ) quantitatively calculated by bladder neck to pubic symphysis(BNPS) ratio, the anterior urethrovesical angle (aUVA), posterior urethrovesical angle (pUVA) as seen on the cystogram were evaluated. Postoperative continence status was defined by no pad or a safety pad usage after catheter removal. The association between these vairables and urinary incontinence was then analyzed. All patients were followed for at least 3 months postoperatively. RESULTS: The demographic, intraoperative data and postoperative pathologic-related information showed no significant difference. The aUVA, pUVA and H/L ratio showed statistical significance. The continence recovery rates differed significantly at 2 weeks, 1 and 2 months. On univariate analysis, patients’ age was independent risk predictor of urinary incontinence. On multivariate analysis, urinary incontinence was significantly associated with H/L ratio, nerve-sparing technique at 2 weeks. At 1 month, the urinary continence was significantly correlated with age, nerve-sparing technique, aUVA. The independent risk factors at 2 month included age, nerve-sparing technique, aUVA, BNPS ratio. The multivariate logistic regression analysis just showed aUVA was related to the urinary incontinence at 3 months postoperatively. CONCLUSIONS: RS-RARP facilitate the recovery of early urinary continence after surgery. A larger aUVA measured on postoperative cystography is a useful and independent predictor for short-term urinary incontinence after RALP. Advanced age, nerve-sparing technique, larger aUVA, larger BNPS ratio, lesser H/L ratio will increase the risk of early urinary incontinence. Source of Funding: the National Natural Science Foundation of China (81772710, 81572519, 81602232) © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e303-e303 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Feifei Zhang* More articles by this author Xuefeng Qiu More articles by this author Hongqian Guo More articles by this author Expand All Advertisement PDF downloadLoading ...

Clinical presentation and surgical management of chronic Achilles tendon disorders — A retrospective observation on a set of consecutive patients being operated by the same orthopedic surgeon

BackgroundNon-invasive treatment is not always successful in patients with Achilles tendon disorders, and surgical treatment is instituted as the next step. There is sparse knowledge about the diagnoses, pain levels before surgery, surgically confirmed pathologies and postoperative complications in large patient groups. AimsTo study the diagnoses, pain scores before surgery, macroscopic surgical findings and postoperative complications in a series of patients treated for Achilles disorders. Material and methodsOne surgeon operated on 771 Achilles tendons of 481 men and 290 women during a 10-year period. The clinically and ultrasound confirmed diagnoses, pre-operative pain and functional scores (Visual Analogue Scale, VAS, range 0-100; Victorian Institute Sports Tendon Assessment — Achilles questionnaire, VISA-A), macroscopic findings during surgery and postoperative complications, were retrospectively collected from a database. ResultsClinically, by ultrasound and during surgery midportion Achilles tendinopathy was confirmed in 519 (67%) patients, 41% of them had a thickened plantaris tendon located close the Achilles tendon. Partial midportion rupture was found in 31 (4%) patients, chronic midportion rupture in 12 (2%) patients and insertional Achilles tendinopathy, including superficial and retro-calcaneal bursitis, Haglund deformity, distal Achilles tendinopathy, plantaris tendon pathology, and bone spurs, in 209 (27%) patients. The mean pre-operative pain scores for midportion Achilles tendinopathy were 73 (VAS) and 45 (VISA-A), and for insertional Achilles tendinopathy 77 (VAS) and 39 (VISA-A). For midportion Achilles tendinopathy there were 14 (3%), and for insertional Achilles tendinopathy 10 (5%), postoperative complications. ConclusionsPatients presenting high pain scores from midportion Achilles tendinopathy were the most common. Plantaris tendon involvement is a frequent observation. For insertional Achilles tendinopathy the combination of pathology in the subcutaneous and retrocalcaneal bursa, a Haglund deformity and distal Achilles tendinopathy/tendinosis was most frequent. Series study, Level of evidence: 4.

Osseointegrated Finger Prostheses Using a Tripod Titanium Mini-Plate.

BackgroundDigital amputation is a common upper extremity injury and can cause significant impairment in hand function, as well as psychosocial stigma. Currently, the gold standard for the reconstruction of such injuries involves autologous reconstruction. However, when this or other autologous options are not available, prosthetic reconstruction can provide a functionally and aesthetically viable alternative. This study describes a novel technique, known as a tripod titanium mini-plate, for osseointegrated digit prostheses, and reviews the outcomes in a set of consecutive patients.MethodsA retrospective review of patients who underwent 2-stage prosthetic reconstruction of digit amputations was performed. Demographic information, occupation, mechanism of injury, number of amputated fingers, and level of amputation were reviewed. Functional and aesthetic outcomes were assessed using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale and a visual analog scale (VAS) score, respectively. In addition, complications during the postoperative period were recorded.ResultsSeven patients were included in this study. Their average age was 29 years. Five patients had single-digit amputations and 2 patients had multiple-digit amputations. Functional and aesthetic outcomes were assessed using the Q-DASH score (average, 10.4) and VAS score (average, 9.1), respectively. One episode of mild cellulitis was seen at 24 months of follow-up. However, it was treated successfully with oral antibiotics. No other complications were reported.ConclusionsWhen autologous reconstruction is not suitable for digit reconstruction, prosthetic osseointegrated reconstruction can provide good aesthetic and functional results. However, larger series with longer-term follow-up are required in order to rule out the possibility of other complications.

Onset seasons and clinical outcomes in patients with Stanford type A acute aortic dissection: an observational retrospective study

ObjectivesTo evaluate the association of onset season with clinical outcome in type A acute aortic dissection (AAD).DesignA single-centre, observational retrospective study.SettingThe study was conducted in Fuwai Hospital, the National Centre...

Intranodal signal suppression in pelvic MR lymphography of prostate cancer patients: a quantitative comparison of ferumoxtran-10 and ferumoxytol.

ObjectivesThe key to MR lymphography is suppression of T2* MR signal in normal lymph nodes, while retaining high signal in metastatic nodes. Our objective is to quantitatively compare the ability of ferumoxtran-10 and ferumoxytol to suppress the MR signal in normal pelvic lymph nodes.MethodsIn 2010, a set of consecutive patients who underwent intravenous MR Lymphography (MRL) were included. Signal suppression in normal lymph nodes in T2*-weighted images due to uptake of USPIO (Ultra-Small Superparamagnetic Particles of Iron Oxide) was quantified. Signal suppression by two USPIO contrast agents, ferumoxtran-10 and ferumoxytol was compared using Wilcoxon’s signed rank test.ResultsForty-four patients were included, of which all 44 had a ferumoxtran-10 MRL and 4 had additionally a ferumoxytol MRL. A total of 684 lymph nodes were identified in the images, of which 174 had been diagnosed as metastatic. USPIO-induced signal suppression in normal lymph nodes was significantly stronger in ferumoxtran-10 MRL than in ferumoxytol MRL (p < 0.005).ConclusionsT2* signal suppression in normal pelvic lymph nodes is significantly stronger with ferumoxtran-10 than with ferumoxytol, which may affect diagnostic accuracy.

The impact of use of an intraoperative margin assessment device on re-excision rates.

Historically there has been a high rate of surgical interventions to obtain clear margins for breast cancer patients undergoing breast conserving local therapy. An intraoperative margin assessment tool (MarginProbe) has been approved for use in the US since 2013. This study is the first compilation of data from routine use of the device, to assess the impact of device utilization on re-excision rates. We present a retrospective, observational, review from groups of consecutive patients, before and after the implementation of intraoperative use of the device during lumpectomy procedures. Lesions were localized by standard methods. The intraoperative margin assessment device was used on all circumferential margins of the main specimen, but not on any additional shavings. A positive reading by the device led to an additional shaving of the corresponding cavity location. Specimens were also, when feasible, imaged intra-operatively by X-ray, and additional shavings were taken if needed based on clinical assessment. For each surgeon, historical re-excision rates were established based on a consecutive set of patients from a time period proximal to initiation of use of the device. From March 2013 to April 2014 the device was routinely used by 4 surgeons in 3 centers. In total, 165 cases lumpectomy cases were performed. Positive margins resulted in additional re-excision procedures in 9.7% (16/165) of the cases. The corresponding historical set from 2012 and 2013 consisted of 186 Lumpectomy cases, in which additional re-excision procedures were performed in 25.8% (48/186) of the cases. The reduction in the rate of re-excision procedures was significant 62% (P < 0.0001). Use of an intraoperative margin assessment device contributes to achieving clear margins and reducing re-excision procedures. As in some cases positive margins were found on shavings, future studies of interest may include an analysis of the effect of using the device on the shavings intra-operatively.

Combined experience at three breast centers with routine use of an intraoperative margin assessment device including comparison to historical re-excision rates.

79 Background: Historically there has been a high rate of surgical interventions to obtain clear margins for breast cancer patients undergoing breast conserving local therapy. This study is the first compellation of data among three breast centers to assess the impact of an intraoperative margin assessment tool (MarginProbe) on re-excision rates. This device has been approved for clinical use in the United States since 2013. We present groups of consecutive patients in each of these breast centers – before and after the implementation of routine intraoperative use of the margin assessment device during lumpectomy procedures. Methods: Lesions were localized by standard methods. The intraoperative margin assessment device was used on all circumferential margins of the main specimen, but not on any additional shavings. A positive reading by the device led to an additional shaving of the corresponding cavity location. Specimens were also imaged intra-operatively by X-ray, and additional shavings were taken if needed based on clinical assessment. We established the historical re-excision rates of each surgeon on a consecutive set of patients in a corresponding period just before we began using the device. Results: In total, 165 patients were treated in three institutions up until April 2014. Sixteen patients (9.7%, 16/165) required re-excision. Historical re-excision rates corresponding to periods of use before the intraoperative margin assessment device was put into use were 25.8% (48/186). The re-excision rate was reduced by 62% (P&lt;0.0001). Six re-excisions were due to a positive shaving which was not measured by the device. Conclusions: Use of an intraoperative margin assessment device contributes to achieving clear margins and reducing re-excision procedures. As in some cases positive margins were found on shavings, future studies of interest may include an analysis of the effect of using the device on the shavings intra-operatively.

Predicting haemorrhage in pre‐hospital traumatic patients: evaluation of the novel heart‐to‐arm time index

Early recognition of hypovolaemia in trauma patients is very important. However, the most often used clinical signs, such as hypotension and tachycardia, lack specificity and sensitivity. We propose a non-invasive index of hypovolaemia, the heart to arm time (iHAT), based on a modified pulse transit time indexed to heart rate. Pulse transit time is the sum of pre-ejection period and vascular transit time. Following pre-load reductions due to hypovolaemia, ventricular diastolic filling time increases causing an increase in pre-ejection-period, pulse transit time, and hence iHAT. One hundred and four consecutive patients with suspected major trauma were enrolled. The primary aim was to evaluate the use of the iHAT for detecting haemorrhage in major trauma. The secondary end point was to compare the specificity and sensitivity of iHAT compared to commonly used indexes. iHAT was calculated in 84 subjects, 11 of whom were haemorrhagic. iHAT discriminated haemorrhagic from non-haemorrhagic group (46.8% vs. 66.9%, P < 0.0001). The cut-off for iHAT with the best compromise between sensitivity (90.9%) and specificity (100%) was reached at the 58.78% level. Comparing haemorrhagic and non-haemorrhagic patients, the area under the ROC curve was 0.952 for iHAT, 0.835 for heart rate, and 0.911 for systolic blood pressure, showing no significant differences. iHAT is a non-invasive index that can identify haemorrhage in trauma patients with high sensitivity and specificity. These data should be considered as an exploration, but any conclusion should be validated in a new set of consecutive patients.

A Novel Percutaneous Coronary Intervention Risk Score to Predict One-Year Mortality

Clinical and angiographic risk factors associated with adverse outcomes after percutaneous coronary intervention (PCI) have been included in previous validated risk scores. Complications after PCI are known to increase mortality and morbidity but have not been included in any model. Records of 6,932 consecutive patients who underwent PCI from 2000 to 2005 were reviewed. Patients presenting with cardiogenic shock were excluded. Logistic regression and bootstrap methods were used to build an integer risk score for estimating risk of death at 1 year after PCI using baseline, angiographic, and procedural characteristics and postprocedural complications. This risk score was validated in a set of consecutive patients who underwent PCI from 2006 to 2007. The following 8 variables were significantly correlated with outcome: older age, history of diabetes mellitus, chronic renal failure, heart failure, left main coronary artery disease, lower baseline hematocrit, greater hematocrit decrease after PCI, and Thrombolysis In Myocardial Infarction grade <3 flow after PCI. In the validation population (n = 973), average receiver operating characteristic curve area was 0.836. In conclusion, we developed and validated a simple integer risk score, including postprocedural variables that closely predict long-term mortality after PCI. This model emphasizes the significant impact of complications occurring after PCI on long-term outcomes.

131 ADULT SPORADIC MULTIFOCAL RENAL CELL CARCINOMA: HELICAL CT AND PATHOLOGY CORRELATIONS IN A RECENT AND CONSECUTIVE SET OF PATIENTS ASSESSED ACCORDING TO A MULTIDISCIPLINARY APPROACH

Background and Aims: To assess helical CT sensitivity in detecting preoperatively Multifocal Renal Cell carcinoma (MFRCC) and clinical occult multifocality in a contemporary and consecutive set of patients according to a multidisciplinary approach. Methods: The renal masses were assessed preoperatively by volumetric multislice helical CT with the objective to detect multifocality. Renal cells carcinoma (RCCs) were classified as unifocal (UF) or multifocal (MF). MFRCCs were selected in 2 groups including CT detected (CT+) and CT undetected (CT-). RCCs were classified in UF and MF. MFRCCs were selected in 2 groups including CT+ and CT-. CT and pathologic findings of MFRCCs were correlated and CT sensitivity was assessed. Statistical methods were performed in order to compare the CT sensitivity with the overall mean sensitivity calculated from the reported literature, to assess statistical inference between UF and MF – RCCs; and to detect statistical significance between CT(+) and CT(-) MFRCCs . Results: Over a period of 24 months, 116 kidney units (KU) of 111 patients were surgically treated for RCC. Multifocality was assessed in 13/116 KU of 12 patients (10.8%). Helical CT detected preoperative multifocality in 8/111 patients (7.2%) and preoperative occult multifocality was assessed in 4 (3.6%), as well. Helical CT sensitivity difference between our (66.7%) and the reported literature experience (22.9%) was significant (p <0.0001). Significant predictors for multifocality were tumor size (p = 0.007), laterality (p = 0.002), pT (p = 0.008) and surgery (p = 0.0002). Primary tumor size (p = 0.05) and satellite tumor size (p = 0.01) were significantly correlated to CT-undetected (CT-) multifocal tumors. Conclusions: In our experience, helical CT was effective in improving preoperative detection of sporadic primary MRCC as well as in lowering clinical occult multifocality. Clinical predictors of multifocality including bilaterality and primary tumor size as well as technical and methodological improvements in performing Helical CT will improve its sensibility in detecting renal masses less than 0.5 cm. CT preoperative detection of clinical multifocality may help in planning effective preoperative surgical treatment as well as lowering local recurrence after nephron sparing surgery.

Expression of selected markers in patients treated for breast cancer – based on our own data

Summary Background Breast cancer patients’ long-term survival rate depends on many factors, such as the biological features of the tumour, stage of disease and mode of treatment. In most cases, in management of breast cancer combination therapy is used, according to indications. Qualification for adjuvant therapy is based on the assessment of several factors of established prognostic and predictive values. As a standard the patient's age, primary tumour size, axillary lymph node involvement, cancer histological type, its malignancy grade and steroid receptor expression are considered. Aim Analysis of status of selected immunohistochemical markers in a set of consecutive patients undergoing surgery for breast cancer. Materials/Methods Samples from 623 patients were examined. Colour reaction was used for oestrogen (ER) and progesterone (PgR) receptors, P53 protein, cathepsin D and c-erbB-2. Overexpression of HER-2 protein was examined in 150 patients. Results The presence of oestrogen receptors in cell nuclei was detected in 431 (69.2%) patients, of progesterone receptors in 504 (80.2%), and ER+, PgR+ phenotype in 382 (61%) patients. Cathepsin D expression was observed in 438 (70.3%) subjects. In 176 (27.3%) patients P53 protein accumulation was observed. Oncoprotein c-erbB-2 overexpression was observed in 99 (15.9%) and overexpression of HER-2 receptor in 29 (19.8%) patients. Conclusions Nowadays oestrogen receptors are detected more frequently than in patients treated in the years 1980–1986. Detection rates of cathepsin D and P53 protein expression remain at comparable levels. The difference observed in detection rate of c-erbB-2 expression requires further analysis. Assessment of the correlation between expression of studied immunohistochemical markers and survival rate is necessary.

Diagnostic value of radiological breast imaging in a non-screening population.

The aim of this study was to assess the diagnostic performance of breast imaging in the diagnosis of breast cancer in a non-screening population. In a consecutive set of patients referred for mammography in one year, the results of palpation and radiological breast imaging were scored on a 5-point grading scale and linked to pathology as gold standard after a follow up period of one year. The diagnostic performance was studied by logistic regression analysis and ROC-curves. There were 1,944 breast examinations in 1,890 patients and 3,816 breasts. Pathology results reported 118 malignancies in 115 women. With a cut-off point between benign and uncertain benign a sensitivity of 89% and a specificity of 98% was found for radiological imaging. ROC-curves showed a significant increase in diagnostic performance when radiology was added to results of palpation and age (p = 0.007). Radiological imaging tests have a large diagnostic value in the detection of breast cancer in addition to palpation and age. A sensitivity close to 100% could be reached.