History Of Biopsy Research Articles

Simulation modeling as a tool to support clinical guidelines and care for breast cancer prevention and early detection in high-risk women.

10525 Background: To evaluate the incremental short- and long-term benefits and harms of primary prevention with risk reducing medication in high-risk women receiving screening mammography. Methods: We adapted an established, validated Cancer Intervention and Surveillance Modeling Network (CISNET) breast cancer discrete event microsimulation model developed to synthesize data the impact of using risk-reducing medication and annual mammography among women with a 3% or higher five-year risk of developing breast cancer. We also examined the effects of supplemental MRI. The model follows a simulated cohort of millions of US women from birth to death. We used large observational and clinical trial data to derive input parameters for cohort-specific birth rates, breast cancer risk, incidence and stage, screening performance, survival by age, stage, and subtype, treatment efficacy, and other cause mortality. Breast cancer risk was modeled based on family history, breast density, age and history of past breast biopsy. We compared two strategies, annual 3D mammography alone vs. annual 3D mammography and a 5-year course of risk reducing medication at various starting ages, and adding MRI to each approach. Outcomes included the benefits of risk-reducing drugs (avoiding breast cancer) and screening (stage, breast cancer death). Harms included drug side effects and screening false positives and overdiagnosis. Sensitivity analysis tested the impact of uncertainty in model inputs and assumptions on results. Results: Compared to mammography alone, adding risk reducing medication could decrease invasive breast cancer incidence by 30%, and breast cancer deaths by 30% (Table). However, due to reduction in breast cancer incidence, risk reducing medication could result in a 3% increase in false positive results; adding MRI increases benefits but also increases false-positive results. Benefits and harms of risk reducing medication and breast cancer screening strategies for women at high-risk of developing breast cancer. Conclusions: Risk-reducing mediation reduces the risk of hormone-receptor positive breast cancer, and combining this with mammography (and/or MRI) improves earlier detection. Additional work is ongoing to incorporate adverse effects of therapy. Simulation modeling can be used to provide individualized data to facilitate discussions about breast cancer prevention and early detection among high-risk women seen in clinical practice.[Table: see text]

Lymphedema therapy referral is associated with improved understanding of lymphedema prevention among breast cancer survivors.

12069 Background: Lymphedema is common among breast cancer survivors (BCS) and negatively affects quality of life. There are modifiable factors to reduce lymphedema risk and exacerbation; it is unknown how aware survivors are of these factors. We hypothesized referral to lymphedema therapy (LT) to be associated with improved lymphedema knowledge. Methods: BCS were approached during follow-up visits at an NCI-designated cancer center between 2014-2015 and asked to complete an anonymous survey. Eligibility criteria: age ≥18, English-speaking, > 6 months post-surgery, no cancer recurrence, no prior or subsequent second cancer. Surveys included 10 true/false questions to assess beliefs of common lymphedema misconceptions and questions about sociodemographics, cancer treatment, and prior LT referral. Charts were reviewed to determine history of axillary lymph node dissection (ALND) or sentinel node biopsy (SLNB). Multivariable logistic regression assessed the relationship between prior LT referral and correctly answering questions about lymphedema misconceptions. Results: Of 209 participants, 67% identified as non-Latinx white, 13% Black, 10% Latinx and 8% Asian. 53 (25%) had been referred to LT. Those who had SLNB were less frequently referred to LT [15 (14%)] than those who had ALND [38 (39%)]. There were 5 lymphedema knowledge questions with < 80% correct responses (Table). Those previously referred to LT more often correctly answered the questions about weight gain and using the arm on an airplane than those not referred (chi-2: p <0.01 and p < 0.01), but they were less likely to answer correctly about carrying > 10 lbs or strenuous activity at work (p < 0.01 and p = 0.02, respectively) (Table). These associations remained in multivariable analyses, other than strenuous work activity (Table). Conclusions: We identified several misconceptions regarding lymphedema among BCS. LT referral is a potential opportunity to debunk common misunderstandings regarding lymphedema risk reduction; providers should have a low threshold to refer patients. Lymphedema therapists teach progressive exercise strategies, which may have inadvertently caused participants to think they should avoid carrying objects > 10 lbs.[Table: see text]

Prostate-Specific Antigen Variation as a Predictor of Prostate Cancer in Patients With Prostate-Specific Antigen ≤20 ng/mL Who Underwent Magnetic Resonance Imaging-Targeted Prostate Biopsy

Purpose: We investigated the role of prostate-specific antigen (PSA) variation as a predictor of prostate cancer in patients who underwent prebiopsy multiparametric magnetic resonance imaging (MRI).Materials and Methods: The clinicopathological data of 266 patients with PSA ≤20 ng/mL who underwent prebiopsy MRI and prostate biopsy between September 2019 and February 2021 were included. PSA variation was defined as the difference in PSA values taken when a prostate biopsy was recommended and performed (median 20 days). Receiver operating characteristic (ROC) curves and area under the ROC curves (AUCs) for predicting prostate cancer were analyzed through 4 models that considered conventional clinical variables and PSA variation.Results: Of the 258 patients, 166 (64.3%) were diagnosed with prostate cancer. The prostate cancer (+) group had a lower median PSA variation (-0.09 mg/mL vs. -0.27 ng/mL, p=0.006) and higher proportion of patients with PSA variation within -0.54 to 0.05 ng/mL (40 ng/mL [range, 24.1%] vs. 9 ng/mL [9.8%], p=0.002) than the prostate cancer (-) group. There was no significant difference in the duration between the 2 PSA measurements. When PSA variation and conventional variables, such as age, PSA density, prostate biopsy history, number of target lesions, were considered, the highest AUC value was 0.870. In a subgroup analysis of patients with PSA ≤10 ng/mL, the highest AUC value was 0.860 when PSA variation and conventional variables were considered.Conclusions: A large PSA variation within 1 month was a negative predictor of prostate cancer among patients who underwent prebiopsy MRI.

Factors for conversion risk of colorectal endoscopic submucosal dissection: a multicenter study.

Endoscopic submucosal dissection (ESD) has become a widely accepted treatment method for colorectal tumors; however, there are some persistent problems. This multi-center study aimed to characterize the risk factors for incomplete resection and perforation in standardized colorectal ESD procedures. This study included 2423 consecutive patients who underwent ESD for 2592 colorectal tumors between August 2013 and December 2018 at 11 institutions (1 academic hospital and 10 affiliated hospitals) from the Hiroshima GI Endoscopy Research Group. We evaluated the risk factors for interruption, piecemeal resection, and perforation of standardized colorectal ESD in relation to clinicopathologic and endoscopic characteristics. The incidences of interruption, piecemeal resection, and perforation were 0.7%, 2.9%, and 3.0%, respectively. Multivariate analysis identified the following risk factors for interruption: perforation during the procedure, deep submucosal invasion (> 1000μm), poor scope operability, and severe submucosal fibrosis. The risk factors for piecemeal resection included poor scope operability, severe submucosal fibrosis, and procedure time (≥ 85min). The risk factors for perforation during the procedure were severe submucosal fibrosis, poor scope operability, procedure time (≥ 85min), and tumor size (≥ 40mm). Independent risk factors for severe submucosal fibrosis included a history of biopsy and lesions located on the fold or flexure. Severe submucosal fibrosis and poor scope operability are the common risk factors for interruption, piecemeal resection, and perforation in standardized colorectal ESD.

MP51-08 DOES A POSITIVE MULTI-PARAMETRIC MRI ALWAYS WARRANT PROSTATE BIOPSY? THE IMPORTANCE OF INTEGRATING CLINICAL AND IMAGING DATA BASED ON A LARGE, MULTI-INSTITUTIONAL SERIES

MP51-08 DOES A POSITIVE MULTI-PARAMETRIC MRI ALWAYS WARRANT PROSTATE BIOPSY? THE IMPORTANCE OF INTEGRATING CLINICAL AND IMAGING DATA BASED ON A LARGE, MULTI-INSTITUTIONAL SERIES

MP016 - Compаrative study of transperineal MRI/US fusion biopsy and systematic transrectal ultrasound guided biopsy in patients with a history of prior negative prostate biopsy.

MP016 - Compаrative study of transperineal MRI/US fusion biopsy and systematic transrectal ultrasound guided biopsy in patients with a history of prior negative prostate biopsy.

Impact of Comorbidities on Lung Cancer Screening Evaluation

Objectives: We used data from the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial to examine the impact of self-reported chronic obstructive pulmonary disease, coronary artery disease, stroke, and diabetes mellitus on diagnostic complications in lung cancer screening evaluation. Methods: In our analysis, we included individuals from the usual care and intervention (annual chest x-ray) of the lung cancer screening trial with equal or greater than 55 years of age with a 20 pack-year smoking history who had undergone an invasive procedure. We performed multivariate logistic regression analysis to estimate the association of comorbidity on procedure complication. Our primary outcome was the incidence of major or moderate complications. Results: Features associated with high-risk complication included older age (OR = 1.03 per year, P = .001), history of coronary artery disease (OR = 1.40, P = .03), history of diabetes mellitus (OR = 0.41, P < .001, current smoking status (OR = 1.46, P ≤ .001), surgical biopsy (OR = 7.39, P < .001), needle biopsy (OR = 1.94, P < .001), and other invasive procedure (OR = 1.58, P < .001). We did not find an associated with complication and history of stroke (OR = 0.84, P = .53) or chronic obstructive pulmonary disease (OR = 1.27, P = .06). Conclusion: Patient and procedure-level factors may alter the benefits of lung cancer screening. Data concerning individual risk factors and high-risk complications should therefore be incorporated into diagnostic algorithms to optimize clinical benefit and minimize harm. Further study and validation of the risk factors identified herein are warranted.

Predictive value of PSA density in the diagnosis of prostate cancer in lebanese men.

Being the second most common cancer in men, prostate cancer detection relies on laboratory tests, imaging, and surgical procedures, although biopsy remains the mainstay in diagnosis of prostate cancer. No clear cut-off of prostate specific antigen density (PSAD) for suspecting prostate cancer has been established in the Lebanese population. Our primary objective was to evaluate the diagnostic strength of the PSAD value versus total prostate specific antigen (tPSA) level in the Lebanese men in correlation with biopsy outcome to avoid unnecessary prostate biopsy. A retrospective study of 347 patients with history of prostate biopsy done for cancer suspicion included tPSA, prostate volume, and prostate density values and results of prostate biopsy. Data was collected from Bahman hospital and statistical analysis of the mean values of tPSA, prostate volume and PSAD in different age groups was done. Significance of the results was tested using. On average, patients with negative biopsies were younger and they had lower tPSA levels, lower PSAD values and larger prostate volume compared to patients with positive biopsies. A PSAD cutoff of 0.185 ng/ml2 revealed the highest predictive strength for prostate cancer (6 times risk) compared with other parameters. These findings were mainly referred to patients with PSA > 10 ng/ml. A multifactorial approach must be conducted including all parameters in order to decide upon the need for prostate biopsy. PSAD proved to be a good marker in favor or against a prostate biopsy with a cut-off of 0.185 ng/ml2, especially in patients with tPSA level higher to 10 ng/ml. A multicenter study was recommended for better and more reliable results and more precise cut-offs.

Multimodality imaging of breast hematomas and their mimickers.

While breast hematomas are common, their imaging features are often underrecognized or mistaken for other conditions.Diagnosis of acute hematomas is generally easy when associated with a recent history of breast trauma, surgery, or percutaneous biopsy. However, minor trauma might not always be remembered, and breast hematoma might have longlasting imaging manifestations when associated with fat necrosis. Also, because of the increasing use of breast MRI and FDG-PET/CT, breast hematomas are increasingly detected as incidentalomas and may mimic malignancies.Conversely, breast hematomas may also be associated with authentic malignant processes.In this pictorial review, we present the natural history of breast hematomas, their various imaging features, as well as their differential diagnoses, highlighting the situations requiring histopathological correlation.

Nomogram Predicting Adverse Pathology Outcome on Radical Prostatectomy in Low-Risk Prostate Cancer Men

ObjectiveTo develop and validate a prediction model to predict the risk of adverse pathology outcome on final pathology in low-risk prostate cancer (PCa) men. Materials and MethodsThis study was a monocentric retrospective analysis of 426 men who underwent radical prostatectomy (RP) for low-risk PCa. The validation cohort included 103 men from another hospital. Adverse pathology outcome was defined either by upgrading on RP Gleason Score (GS) (from GS 3+3 to GS ≥ 3+4 with Gleason pattern 4 ≥ 10%) or a non-organ confined disease (pathologic stage ≥ pT3a). Multivariable logistic regression analysis was performed to build nomogram for predicting adverse pathology outcome. Nomogram validation was performed by calculating the area under receiver operating characteristic curves (AUC) and comparing nomogram-predicted probabilities with actual rates of adverse pathology outcome in the external cohort. The Kaplan-Meier method was used to estimate and compare the biochemical recurrence-free survival rates between the two groups. ResultsOf 426 men in the development cohort, 45.7% showed adverse pathology outcome on RP. Age, body mass index, prostate specific antigen density, history of prior negative biopsy, magnetic resonance imaging prostate imaging reporting and data system score 4-5 and percentage of positive biopsies were significant predictors in multivariate analysis. A nomogram was constructed with an area under curve of 87%. There was agreement between predicted and actual rates of adverse pathology outcome in the validation cohort. The 5-year biochemical recurrence-free survival rates in patients with and without adverse pathology outcome was 70% and 98%, respectively. ConclusionThis novel nomogram would help identify low-risk PCa men at risk of adverse pathology outcome and can be relevant for treatment decision-making.

Ultrasound diagnosis of renal arteriovenous malformation in a young adult: An underrecognized cause of recurrent haematuria

AbstractRenal arteriovenous malformations (AVMs) although uncommon are the most underrecognized cause of recurrent haematuria especially in young patients. Although renal AVMs are commonly incidentally detected, life threatening complications such as gross haematuria and AVM rupture have been implicated. Ultrasound is the first line imaging investigation which has a crucial role in treatment planning, post‐procedural, long‐term follow‐up, and assessment of complications associated with renal AVMs. This is a report of a rare case of spontaneous renal AVM in a patient without prior history of renal biopsy or previous trauma. A 26‐year‐old male presented for an ultrasound with recurrent haematuria. This case report highlights the role of ultrasound in the diagnosis, follow‐up and assessment of treatment related complications of renal AVMs.

Hypokalemic paralysis due to distal renal tubular acidosis type 1 in patient of mucormycosis on amphotericin B: a case report

A 42-year-old male patient who is a known case of DM and mucormycosis on treatment presented with sudden onset difficulty in moving all 4 limbs followed by decreased depth of respiration for 4 hours. The patient was known case of DM for 10 years and was on OHA for the same, he had history of biopsy diagnosed rhino mucormycosis 4 months ago and was on treatment for the same. On initial examination the tone was hypotonic in all4 limbs along with power of 3+, respiration was shallow and patient was bedridden unable to stand on his own, he was ambulatory 6 days before presenting to hospital. Potassium-1.7 mEq/l, ABGA pH-7.18, HCO3-10 Meq/l, urine osmolality 220 mOsm/l, urine pH-7.0, potassium-to-creatinine rstio (K/Cr)-3.9 mEq/ml, urine K-22 mEq/ml. Distal RTA (dRTA) is the classical form of RTA, being the first described. Distal RTA is characterized by a failure of H+ secretion into lumen of nephron by the alpha intercalated cells of the medullary collecting duct of the distal nephron. This failure of acid secretion may be due to a number of causes, and it leads to an inability to acidify the urine to a pH of less than 5.3. This case study enumerates the potentially dangerous side effects of amphotericin B in patients which can precipitate RTA type 1 leading to severe hypokalaemia and acidosis, thus all patients receiving amphotericin B should be cautiously warned regarding side effect of hypokalaemia and prophylactic potassium syrup supplementation may be given in predisposed patients.

Xanthogranulomatous Inflammation of Myometrium Causing Pelvic Extension: Report of Two Cases

Background: Xanthogranulomatous inflammation of the female reproductive organs is a rare chronic inflammation. In most reported cases, the lesion was limited to the endometrium and fallopian tubes. Here, we report two cases of xanthogranulomatous inflammation of the myometrium with a history of endometrial biopsy. Case Reports: In two cases, myometrial xanthogranulomatous inflammation destroyed the myometrium. This inflammation developed into surrounding pelvic organs, resulting in uterine perforation. Conclusion: When inflammatory lesions are found after intrauterine manipulation, the possibility of developing xanthogranulomatous inflammation should be considered. If antibiotics are ineffective, prompt surgical treatment is necessary.

Presentation of Low-grade Fibro Myxoid Sarcoma in Male Breast: Rare and Challenging Entity for Diagnosis - A Case Report with Review of Literature

Primary breast sarcomas are very rare tumors accounting &lt;1% of primary malignant breast tumors and &lt;5% of soft tissue sarcomas. They are seen in young adults with tendency for multiple recurrences. They can metastasize if incompletely excised, so the prognosis is poor. There is rarity because of lack of consensus and a few case reports have been reported till date. We report a case of 31-year-old male with history of left areolar swelling. He had history of excision biopsy one year back from same site which on histopathology was diagnosed as low-grade fibro myxoid sarcoma. The patient was asymptomatic for one year and now presented with history of swelling at scar site. The lumpectomy was done. There was no systemic dissemination. The tumor was histologically diagnosed as recurrence of low-grade fibro myxoid sarcoma. We review the literature about breast sarcomas and low-grade fibro myxoid sarcoma of the breast.

Oral cancer analysis in a Brazilian city: interval between diagnosis and treatment.

In Brazil, there are 15,500 incident cases of oral cancer (OC) yearly, and early diagnosis is the main factor for a better prognosis. The objective of this study was to analyze the interval between the first symptoms, diagnosis, and treatment commencement in patients with malignant neoplasms in the oral cavity, lips, and oropharynx diagnosed between 2012-2018. Epidemiological data, duration, history of lesion, biopsy, and diagnosis were obtained from the medical records of these patients, who were then contacted via phone and interviewed about their oncological treatment. The results were analyzed and expressed as mean, median, and SD. Of 184 patients, most were men, white, 50-69 years old, smokers, and alcoholics. The longest interval was between the first symptoms and first evaluation (a mean of 275 days). The interval between the first appointment and the result of the biopsy was shorter (13 days). Among the 85 patients interviewed, the interval between the diagnosis, the first appointment at the oncological clinic and treatment commencement was 55 days (mean) for patients using private-sector health care, and 96 days (mean) for patients using public health care. The interval was twice as long in the public health system compared with the private sector, which highlights the inequality of access to health care in Brazil. Delay in seeking health care after the appearance of the first symptoms remains a major problem.

Small Scale Study on Awareness of Breast Cancer Among Women Aged &gt;35years, the Risk Factors for Breast Cancer and Utilization of Mammogram

Introduction: Breast cancer has become an increasing concern and is a major global public health burden. Over100, 000 new breast cancer patients are estimated to be diagnosed annually in India. The health care facilitypattern is diverse, where the benefits of the awareness, early diagnosis and treatment programs is still notavailable in many regions of the country. However, the study aimed to assess the awareness of the small scalecommunity women on breast cancer, its risk factors and utilization of manmmogram as a screening test. Thiswill give an insight for the large scale community study.Methods: The researcher adopted a descriptive research design using a simple random sampling technique tocollect data among 20 unmarried and married women from the village of Badagabettu, Udupi district, Karnataka.Tools were developed and sent for validation. Reliability of tools were done before the data collection. Data wascollected after getting ethical clearance and written consent from the participants. Collected data were analyzedusing the descriptive statistics through SPSS version 16.0.Result: Majority 14 (70%) had moderate knowledge on breast cancer, 6 (30%) had poor knowledge and none (0%)were having good knowledge on breast cancer. The study also revealed that 30% were aware of mammogramand majority 70% were not. The risk factors for breast cancer among women aged 35 years also revealed that15% women had menarche at the age of ≤ 12 years, 5% have the history of having sister diagnosed with breastcancer, 15% did not deliver baby till now and 30% women did not breast feed. There were 5% women who hadthe history of breast biopsy, 10% had the history of taking oral contraceptives within 5 years period and 100%did not have the history of taking alcohol in their life.

Outcomes of freehand transperineal prostate biopsy with omission of antibiotic prophylaxis.

To assess the utility of antimicrobial prophylaxis when performing freehand systematic transperineal (TP) biopsy. From January 2012 to February 2020, freehand TP prostate biopsy via angiocatheters or the PrecisionPoint Transperineal Access System was performed on consecutive men with clinical suspicion of prostate cancer (PCa) or confirmed PCa. Biopsies were performed by a single urologist (developer of the PrecisionPoint system). Clinical data were collected retrospectively. Pre-procedural antibiotics were given to all patients up until 6 September 2016. After this date, antibiotics were omitted from those without risk factors (chronic catherization, concurrent endoscopic procedure, history of sepsis after transrectal [TR] biopsy, history of TR biopsy within the last year, prosthetic joints/heart valves). Patients were assessed 1 week after biopsy for symptoms, emergency department visits, and hospital admissions. Patients who received antimicrobial prophylaxis were compared with those who did not, and infectious complications were analysed. Additionally, oncological outcomes were reported. A total of 988 biopsies (median prostate-specific antigen level 7.7 ng/mL) were included in the analysis on 756 patients. Prophylaxis was given in 538 of the biopsies (54.4%) and in 450 (48.6%) it was not. There was a statistical difference in median age (67 vs 69 years; P < 0.001), abnormal digital rectal examination (13% vs 5%; P < 0.001), and history of multiparametic magnetic resonance imaging (15% vs 31%; P < 0.001) between the prophylaxis and no-prophylaxis cohorts, respectively. There were no documented complications in those who received antibiotics. Within the no-prophylaxis cohort, there were three (0.66%) complications (P = 0.09). Two patients (0.44%) had urinary tract infections and one patient (0.22%) experienced post-procedural urinary retention. No patient required hospital admission or an emergency department visit. Clinically significant cancer was detected in 152 (40.0%) and 64 patients (39.0%) on initial biopsy and prior negative biopsy, respectively. These data suggest that antimicrobial prophylaxis may be safely omitted in selected patients when using the freehand TP approach.

A Case Report on 2 years Child: Hirschprung’s Disease

Introduction: Hirschsprung's disease is the most common cause of large intestinal obstructing in neonates. Hirschsprung's disease is a congenital anomaly caused by migratory failure of neural crest cells leading to abnormal innervations of the bowel .The defect begins in the internal and sphincter and extends proximally for a variable length of gut. Hirschprung's disease is a disorder of the gut caused due to congenital absence of ganglion cells in the sub-mucosal and myenteric plexus of intestine. This disease is also known as megacolon or congenital Aganglionic megacolon. Case presentation: A 2 years old male child, known case of Hirschprung’s disease, was brought to AVBRH for further management. As narrated by the mother, the child was not passing stool since birth. There was no history of abdominal distention, vomiting or fever. The child pass the stool with the help of enema which was given to the child in the morning and evening. Mast. Devansh has past history of NICU stay. In View of not passing stools, USG of abdomen and pelvis done. Endorectal pull through surgery was done on 4/02/2021 under general anesthesia. No any past surgical history. There is a past history of rectal biopsy done in 1 1/2 month of age. Conclusion:The patient was admitted in AVBRH for further management. Then the report mainly focused on surgical management and quality nursing care due to which patient was discharged without any further complication and satisfaction.

Association of Maternal Cervical Disease With Human Papillomavirus Vaccination Among Offspring

Barriers to childhood vaccination against vaccine-preventable diseases, such as those due to human papillomavirus (HPV), are well known. However, the role of salience bias-the change in perception of risk due to increased familiarity with the outcome-in decisions to vaccinate children has not been explicitly studied. To assess for salience bias in parental decisions to vaccinate children. This retrospective cohort study used a time-to-event (survival) analysis to compare vaccination rates of children whose mothers had a history of cervical cancer or a cervical biopsy, who have experienced adverse vaccine-preventable outcomes, and for whom vaccination may be more salient, with a control group of children whose mothers had no such history. Participants were accrued from the MarketScan Commercial Database, including US children who turned 11 years old, when HPV vaccination is recommended, from January 1, 2014, to December 31, 2018. Data were analyzed from December 29, 2020, to September 17, 2021. Maternal history of cervical cancer or cervical biopsy. Vaccination against HPV. A total of 757 428 children (370 878 girls [49.0%] and 386 550 boys [51.0%]) were identified, of whom 38 366 had mothers with a history of cervical biopsy alone and 1084 had mothers with a history of cervical cancer. Overall, 54.2% of children (55.7% of girls and 52.7% of boys) received at least 1 vaccination by 16 years of age. In a time-to-event analysis, HPV vaccination did not differ between children whose mothers had cervical cancer vs those whose mothers did not (hazard ratio [HR] for girls, 0.99 [95% CI, 0.86-1.13]; HR for boys, 1.08 [95% CI, 0.94-1.24]). Maternal history of cervical biopsy was associated with a minimally increased hazard of vaccination (HR for girls, 1.06 [95% CI, 1.04-1.09]; HR for boys, 1.04 [95% CI, 1.01-1.06]). There were no clinically meaningful differences between groups for the tetanus/diphtheria/acellular pertussis and meningococcal vaccinations, which are also recommended at 11 years of age. In this analysis of salience bias in childhood vaccination decisions, mothers' personal history of cervical cancer or cervical biopsy was not associated with greater vaccination rates among children against HPV. These findings suggest that salience of vaccine-preventable outcomes may not have a major impact on childhood vaccine hesitancy in HPV; the role of salience should be investigated for other vaccines.

The effect of the use of the Gail model on breast cancer diagnosis in BIRADs 4a cases.

The BI-RADS classification system and the Gail Model are the scoring systems that contribute to the diagnosis of breast cancer. The aim of the study was to determine the contribution of Gail Model to the diagnosis of breast lesions that were radiologically categorized as BI-RADS 4A. We retrospectively examined the medical records of 320 patients between January 2011 and December 2020 whose lesions had been categorized as BI-RADS 4A. Radiological parameters of breast lesions and clinical parameters according to the Gail Model were collected. The relationship between malignant BI-RADS 4A lesions and radiological and clinical parameters was evaluated. In addition, the effect of the Gail Model on diagnosis in malignant BI-RADS 4A lesions was evaluated. Among radiological features, there were significant differences between lesion size, contour, microcalcification content, echogenicity, and presence of ectasia with respect to the pathological diagnosis (p <0.05). No significant difference was found between the lesions' pathological diagnosis and the patients' Gail score (p> 0.05). An analysis of the features of the Gail model revealed that there was no significant difference between the age of menarche, age at first live birth, presence of a first-degree relative with breast cancer, and a history of breast biopsy and the pathological diagnosis (p> 0.05). As a conclusion Gail Model does not contribute to the diagnosis of BC, especially in patients with BI-RADS 4A lesions.