1
|
Amitai Y, Freitas VAR, Golan O, Kessner R, Shalmon T, Neeman R, Mauda-Havakuk M, Mercer D, Sklair-Levy M, Menes TS. The diagnostic performance of ultrafast MRI to differentiate benign from malignant breast lesions: a systematic review and meta-analysis. Eur Radiol 2024:10.1007/s00330-024-10690-y. [PMID: 38512492 DOI: 10.1007/s00330-024-10690-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES To assess the diagnostic performance of ultrafast magnetic resonance imaging (UF-DCE MRI) in differentiating benign from malignant breast lesions. MATERIALS AND METHODS A comprehensive search was conducted until September 1, 2023, in Medline, Embase, and Cochrane databases. Clinical studies evaluating the diagnostic performance of UF-DCE MRI in breast lesion stratification were screened and included in the meta-analysis. Pooled summary estimates for sensitivity, specificity, diagnostic odds ratio (DOR), and hierarchic summary operating characteristics (SROC) curves were pooled under the random-effects model. Publication bias and heterogeneity between studies were calculated. RESULTS A final set of 16 studies analyzing 2090 lesions met the inclusion criteria and were incorporated into the meta-analysis. Using UF-DCE MRI kinetic parameters, the pooled sensitivity, specificity, DOR, and area under the curve (AUC) for differentiating benign from malignant breast lesions were 83% (95% CI 79-88%), 77% (95% CI 72-83%), 18.9 (95% CI 13.7-26.2), and 0.876 (95% CI 0.83-0.887), respectively. We found no significant difference in diagnostic accuracy between the two main UF-DCE MRI kinetic parameters, maximum slope (MS) and time to enhancement (TTE). DOR and SROC exhibited low heterogeneity across the included studies. No evidence of publication bias was identified (p = 0.585). CONCLUSIONS UF-DCE MRI as a stand-alone technique has high accuracy in discriminating benign from malignant breast lesions. CLINICAL RELEVANCE STATEMENT UF-DCE MRI has the potential to obtain kinetic information and stratify breast lesions accurately while decreasing scan times, which may offer significant benefit to patients. KEY POINTS • Ultrafast breast MRI is a novel technique which captures kinetic information with very high temporal resolution. • The kinetic parameters of ultrafast breast MRI demonstrate a high level of accuracy in distinguishing between benign and malignant breast lesions. • There is no significant difference in accuracy between maximum slope and time to enhancement kinetic parameters.
Collapse
Affiliation(s)
- Yoav Amitai
- Department of Medical Imaging, Tel Aviv University, Sackler School of Medicine, Sourasky Medical Center, Weizmann 6, 6423906, Tel Aviv-Yafo, Israel.
| | - Vivianne A R Freitas
- Joint Department of Medical Imaging - University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, 610 University Avenue - M5G 2M9, Toronto, Ontario, Canada
| | - Orit Golan
- Department of Medical Imaging, Tel Aviv University, Sackler School of Medicine, Sourasky Medical Center, Weizmann 6, 6423906, Tel Aviv-Yafo, Israel
| | - Rivka Kessner
- Department of Medical Imaging, Tel Aviv University, Sackler School of Medicine, Sourasky Medical Center, Weizmann 6, 6423906, Tel Aviv-Yafo, Israel
| | - Tamar Shalmon
- Department of Medical Imaging, Tel Aviv University, Sackler School of Medicine, Sourasky Medical Center, Weizmann 6, 6423906, Tel Aviv-Yafo, Israel
| | - Rina Neeman
- Department of Medical Imaging, Tel Aviv University, Sackler School of Medicine, Sourasky Medical Center, Weizmann 6, 6423906, Tel Aviv-Yafo, Israel
| | - Michal Mauda-Havakuk
- Department of Medical Imaging, Tel Aviv University, Sackler School of Medicine, Sourasky Medical Center, Weizmann 6, 6423906, Tel Aviv-Yafo, Israel
| | - Diego Mercer
- Department of Medical Imaging, Tel Aviv University, Sackler School of Medicine, Sourasky Medical Center, Weizmann 6, 6423906, Tel Aviv-Yafo, Israel
| | - Miri Sklair-Levy
- Department of Medical Imaging, Sackler School of Medicine, Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Derech Shiba 2, 52621, Ramat-Gan, Israel
| | - Tehillah S Menes
- Department of Surgery, Sackler School of Medicine, Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Derech Shiba 2, 52621, Ramat-Gan, Israel
| |
Collapse
|
2
|
Shoham G, Haran O, Singolda R, Madah E, Magen A, Golan O, Menes T, Arad E, Barnea Y. Our Experience in Diagnosing and Treating Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). J Clin Med 2024; 13:366. [PMID: 38256500 PMCID: PMC10816524 DOI: 10.3390/jcm13020366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon T-cell lymphoma detected in association with textured implants. It presents as a fluid accumulation around the implant, usually years after the implantation. We present our experience in diagnosing and treating four patients with BIA-ALCL, each widely differing from the other. Data on patients' surgical history, relevant medical information, and findings on pathological slides were retrieved from their medical charts and retrospectively reviewed. Each of the four patients was diagnosed with BIA-ALCL, one after breast augmentation, one after breast reconstruction with an implant, one after breast reconstruction with a latissimus dorsi flap and implant, and the fourth after the removal of breast implants. The cases were presented to a multidisciplinary team and subsequently underwent surgery. All four are currently free of tumors, as established by a negative follow-up via positron emission tomography-computed tomography. Although the incidence of BIA-ALCL is rare, these cases emphasize the need to rule out the diagnosis of BIA-ALCL in patients with textured implants or a history of implanted textured devices who present with symptoms such as late seroma or peri-implant mass. This pathology is typically indolent and slow-growing and heightened awareness for an early diagnosis could lead to quicker intervention and enhanced patient management.
Collapse
Affiliation(s)
- Gon Shoham
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Oriana Haran
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Roei Singolda
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ehab Madah
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ada Magen
- Breast Health Center, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Orit Golan
- Breast Imaging Center, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6423906, Israel
| | - Tehillah Menes
- Meirav Breast Center, Sheba Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Hashomer 5262000, Israel
| | - Ehud Arad
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Yoav Barnea
- Department of Plastic and Reconstructive Surgery, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| |
Collapse
|
3
|
Bernstein E, Lev-Ari S, Shapira S, Leshno A, Sommer U, Al-Shamsi H, Shaked M, Segal O, Galazan L, Hay-Levy M, Sror M, Harlap-Gat A, Peer M, Moshkowitz M, Wolf I, Liberman E, Shenberg G, Gur E, Elran H, Melinger G, Mashiah J, Isakov O, Zrifin E, Gluck N, Dekel R, Kleinman S, Aviram G, Blachar A, Kessler A, Golan O, Geva R, Yossepowitch O, Neugut AI, Arber N. Data From a One-Stop-Shop Comprehensive Cancer Screening Center. J Clin Oncol 2023; 41:2503-2510. [PMID: 36669135 DOI: 10.1200/jco.22.00938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Cancer is the second leading cause of death globally. However, by implementing evidence-based prevention strategies, 30%-50% of cancers can be detected early with improved outcomes. At the integrated cancer prevention center (ICPC), we aimed to increase early detection by screening for multiple cancers during one visit. METHODS Self-referred asymptomatic individuals, age 20-80 years, were included prospectively. Clinical, laboratory, and epidemiological data were obtained by multiple specialists, and further testing was obtained based on symptoms, family history, individual risk factors, and abnormalities identified during the visit. Follow-up recommendations and diagnoses were given as appropriate. RESULTS Between January 1, 2006, and December 31, 2019, 8,618 men and 8,486 women, average age 47.11 ± 11.71 years, were screened. Of 259 cancers detected through the ICPC, 49 (19.8%) were stage 0, 113 (45.6%) stage I, 30 (12.1%) stage II, 25 (10.1%) stage III, and 31(12.5%) stage IV. Seventeen cancers were missed, six of which were within the scope of the ICPC. Compared with the Israeli registry, at the ICPC, less cancers were diagnosed at a metastatic stage for breast (none v 3.7%), lung (6.7% v 11.4%), colon (20.0% v 46.2%), prostate (5.6% v 10.5%), and cervical/uterine (none v 8.5%) cancers. When compared with the average stage of detection in the United States, detection was earlier for breast, lung, prostate, and female reproductive cancers. Patient satisfaction rate was 8.35 ± 1.85 (scale 1-10). CONCLUSION We present a proof of concept study for a one-stop-shop approach to cancer screening in a multidisciplinary outpatient clinic. We successfully detected cancers at an early stage, which has the potential to reduce morbidity and mortality as well as offer substantial cost savings.
Collapse
Affiliation(s)
- Ezra Bernstein
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel.,NYU Langone Medical Center, New York, NY
| | - Shahar Lev-Ari
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shiran Shapira
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ari Leshno
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Udi Sommer
- Tel Aviv University Faculty of Social Sciences, School of Political Science, Government and International Relations, Tel Aviv, Israel
| | - Humaid Al-Shamsi
- Burjeel Cancer Institute, University of Sharjah, Sharjah, United Arab Emirates
| | - Meital Shaked
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ori Segal
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Lior Galazan
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Mori Hay-Levy
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Miri Sror
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Amira Harlap-Gat
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Michael Peer
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Menachem Moshkowitz
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Wolf
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Eliezer Liberman
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Shenberg
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Eyal Gur
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Plastic and Reconstructive Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Hanoch Elran
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel.,Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Gustavo Melinger
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,The Gynecological and Obstetric Ultrasound Unit, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jacob Mashiah
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Division of Dermatology and Venerology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ofer Isakov
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Gastrointestinal and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Elad Zrifin
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel.,Oral and Maxillofacial Surgery Unit, Otolaryngology-Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Nathan Gluck
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Gastrointestinal and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Roy Dekel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Gastrointestinal and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Shlomi Kleinman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Oral and Maxillofacial Surgery Unit, Otolaryngology-Head and Neck Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Galit Aviram
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Arye Blachar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ada Kessler
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Orit Golan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Radiology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ravit Geva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ofer Yossepowitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Urology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Alfred I Neugut
- Columbia University Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY
| | - Nadir Arber
- Health Promotion and Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Gastrointestinal and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| |
Collapse
|
4
|
Golan O, Bord S, Satran C. Who is following me? Public attitude towards government tracing apps in the covid Era in Israel. Eur J Public Health 2022. [PMCID: PMC9594449 DOI: 10.1093/eurpub/ckac131.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background In the battle to decrease coronavirus infection and mortality, Israel has employed emergency tools, e.g., tracking civilians’ locations via their cellphones or activating the HaMagen app that identifies when a person is near someone who has been diagnosed with the virus. While the aim of these tools is to ensure the public’s health, they could harm human rights. Objective To examine the Israeli public’s attitudes towards enhancing public health during the pandemic while preserving privacy, by examining the relationship between trust in the healthcare system, threat perceptions, cellphone tracking, and HaMagen App. Methods Surveys (distributed by iPanel) was completed by 741 adults, aged ≥18. Results About half the respondents (47.1%) perceived cellphone tracking as harmful to privacy, yet one-quarter (24.4%) reported that this increases their sense of security. About half (48.4%) agreed/greatly agreed with the item whereby the government uses the gathered data for non-coronavirus purposes. Jewish respondents had more positive attitudes towards government tracking than Arab ones, yet the latter reported higher downloading of HaMagen. The findings indicate that threat perceptions and positive attitudes towards cellphone tracking were related to greater chances of downloading the app. Moreover, attitudes towards such tracking were mediated by the relationship between trust levels/threat perceptions and downloading the app, whereby the former was association with more positive attitudes towards cellphone tracking, which in turn was related to greater app downloading. Conclusions and Recommendations Trust plays a central role in people’s willingness to forgo their privacy for the good of public health. To enhance trust, messages must be suited to a range of communities, presented in a suitable language by local professionals. Key messages • Trust plays a central role in people’s willingness to forgo their privacy for the good of public health. • Concern for public health must include ethical considerations.
Collapse
Affiliation(s)
- O Golan
- Health Systems Management, Yezreel Valley College, Yokneam ilit, Israel
- Contact:
| | - S Bord
- Health Systems Management, Yezreel Valley College, Yokneam ilit, Israel
| | - C Satran
- Health Systems Management, Yezreel Valley College, Yokneam ilit, Israel
| |
Collapse
|
5
|
Barkai E, Namir Y, Golan O, Barnea Y, Arad E, Menes TS. Patient Satisfaction and Surgical Outcome After Oncoplastic Reconstruction following Radical Lumpectomy Versus Standard Lumpectomy: A Retrospective Cohort Study. Eur J Breast Health 2022; 18:127-133. [DOI: 10.4274/ejbh.galenos.2022.2021-12-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/19/2022] [Indexed: 12/01/2022]
|
6
|
Bar Y, Bar K, Itzhak I, Niselbaum CS, Dershowitz N, Shachar E, Weiss-Meilik A, Golan O, Wolf I, Menes T, Sonnenblick A. The impact of tumor detection method on genomic and clinical risk and chemotherapy recommendation in early hormone receptor positive breast cancer. Breast 2021; 60:78-85. [PMID: 34509707 PMCID: PMC8437822 DOI: 10.1016/j.breast.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/16/2021] [Accepted: 09/03/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Symptomatic breast cancers share aggressive clinico-pathological characteristics compared to screen-detected breast cancers. We assessed the association between the method of cancer detection and genomic and clinical risk, and its effect on adjuvant chemotherapy recommendations. PATIENTS AND METHODS Patients with early hormone receptor positive (HR+) HER2neu-negative (HER2-) breast cancer, and known OncotypeDX Breast Recurrence Score test were included. A natural language processing (NLP) algorithm was used to identify the method of cancer detection. The clinical and genomic risks of symptomatic and screen-detected tumors were compared. RESULTS The NLP algorithm identified the method of detection of 401 patients, with 216 (54%) diagnosed by routine screening, and the remainder secondary to symptoms. The distribution of OncotypeDX recurrence score (RS) varied between the groups. In the symptomatic group there were lower proportions of low RS (13% vs 23%) and higher proportions of high RS (24% vs. 13%) compared to the screen-detected group. Symptomatic tumors were significantly more likely to have a high clinical risk (59% vs 40%). Based on genomic and clinical risk and current guidelines, we found that women aged 50 and under, with a symptomatic cancer, had an increased probability of receiving adjuvant chemotherapy recommendation compared to women with screen-detected cancers (60% vs. 37%). CONCLUSIONS We demonstrated an association between the method of cancer detection and both genomic and clinical risk. Symptomatic breast cancer, especially in young women, remains a poor prognostic factor that should be taken into account when evaluating patient prognosis and determining adjuvant treatment plans.
Collapse
Affiliation(s)
- Yael Bar
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kfir Bar
- School of Computer Science, The College of Management, Rishon LeZion, Israel; School of Computer Science, Tel Aviv University, Tel Aviv, Israel
| | - Itay Itzhak
- School of Computer Science, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Eliya Shachar
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Orit Golan
- Radiology Department, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Wolf
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tehillah Menes
- Department of Surgery, Chaim Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Amir Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
7
|
Tvito Green R, Weiser R, Golan O, Menes TS. ASO Visual Abstract: In Search of the Lost Clip-Outcome of Women After Needle-Guided Lumpectomy of a Marking Clip. Ann Surg Oncol 2021. [PMID: 33876354 DOI: 10.1245/s10434-021-09921-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Roi Weiser
- Department of Surgery, Tel Aviv University, Tel Aviv, Israel
| | - Orit Golan
- The Breast Imaging Unit, Tel Aviv Soursaky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Tehillah S Menes
- Department of Surgery, Tel Aviv University, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Surgery C and Surgical Oncology, Meirav Comprehensive Breast Health Center, Chaim Sheba Medical Center, Ramat Gan, Israel.
| |
Collapse
|
8
|
Goldfarb Y, Gal E, Golan O. Mental health of israeli employees with autism spectrum disorders following COVID-19-related changes in employment status. Eur Psychiatry 2021. [PMCID: PMC9528502 DOI: 10.1192/j.eurpsy.2021.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction The COVID-19 pandemic caused employment related challenges worldwide. Adults diagnosed with Autism Spectrum Disorders (ASD) are especially vulnerable, due to pre-existing employment challenges, intolerance to changes and uncertainty and high levels of related anxiety. Objectives To examine COVID-19 related changes in work experiences and mental health of employees with ASD who held a steady job before the COVID-19 outbreak. Methods
Data were collected from 23 participants diagnosed with ASD (4 females), aged 20–49, who answered an online administered survey at two timepoints: prior to the COVID-19 outbreak, and during the outbreak. Self-reports included measures of background and employment status; mental health (General Health Questionnaire-12); job satisfaction (Minnesota Satisfaction Questionnaire); and satisfaction of psychological needs at work (Psychological Need Satisfaction and Frustration – Work domain). Results
Participants who continued to physically attend work maintained pre-COVID-19 levels on all assessed variables. Participants who transitioned to remote work from home preserved their salary levels and job satisfaction, but showed a marginally significant deterioration in mental health and a significant decrease in the satisfaction of their needs for competence and autonomy at work. Unemployed participants showed a significant decrease in mental health. Conclusions
Results highlight employment as a protective factor from the potential negative implications of COVID-19 on mental-health of employees with ASD. Employees who transition to working from home require personalized work-support plans due to the possible negative effects of this transition on mental health. Maintaining the routine of physically reporting to work should be preferred, when possible.
Collapse
|
9
|
Menes TS, Golan O, Weiser R, Tvito Green R. ASO Author Reflections: Facing the Challenge of the Missing Clip in Breast Lumpectomy Specimens. Ann Surg Oncol 2021; 28:4981-4982. [PMID: 33683523 DOI: 10.1245/s10434-021-09801-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 12/24/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Tehillah S Menes
- Department of Surgery, Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Orit Golan
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Roi Weiser
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.,Surgery Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ravit Tvito Green
- Surgery Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| |
Collapse
|
10
|
Green RT, Weiser R, Golan O, Menes TS. In Search of the Lost Clip: Outcome of Women After Needle-Guided Lumpectomy of a Marking Clip. Ann Surg Oncol 2021; 28:4974-4980. [PMID: 33677760 DOI: 10.1245/s10434-021-09800-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Needle localization of a marking clip is required to guide accurate removal of many breast lesions. When the clip is not visualized on specimen radiography, concerns regarding the completeness of cancer removal and long-term outcomes arise. Using a large cohort of women undergoing breast conservation, we examined the magnitude of the problem and the outcome of women with a missing clip. METHODS We conducted a case-control study including all women undergoing mammographic wire-guided localization between 2013 and 2018 with a specimen radiograph showing a missing clip. The control group included women with successful removal of the clip(s). Data included demographics, cancer and treatment characteristics, and outcome. The groups were compared in regard to margin status, repeat surgery, and recurrence rates. RESULTS The research group included 43 women [5% of the cohort; 95% confidence interval (CI) 3.9-7.2] with a missing clip. Positive margins were comparable (7, 17% of cases; 29, 15% of 196 cases in the control group; p = 0.96). Eleven women (33%) had a residual clip visualized on post-operative mammography; in four cases, a percutaneous biopsy of the clip was successful, all with no residual tumor. There was no significant difference in re-excision rates (14% vs. 8%, p = 0.23) or in local or distant recurrence. CONCLUSIONS In the majority of women with a missing clip, the clip is not visualized on post-operative mammography. Those with a residual clip can be managed with percutaneous biopsy as long as the lesion was removed with clear margins, with comparable outcomes as women in whom the clip is visualized on specimen radiograph.
Collapse
Affiliation(s)
- Ravit Tvito Green
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Roi Weiser
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Orit Golan
- The Breast Imaging Unit, Tel Aviv Soursaky Medical Center, Tel Aviv, Israel
| | - Tehillah S Menes
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Surgery C and Surgical Oncology, Meirav Comprehensive Breast Health Center, Chaim Sheba Medical Center, Ramat Gan, Israel.
| |
Collapse
|
11
|
Rabin SJ, Laugeson EA, Mor-Snir I, Golan O. An Israeli RCT of PEERS®: Intervention Effectiveness and the Predictive Value of Parental Sensitivity. J Clin Child Adolesc Psychol 2020; 50:933-949. [PMID: 32780594 DOI: 10.1080/15374416.2020.1796681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES A Randomized Controlled Trial was conducted to evaluate the effectiveness of the Hebrew adaptation of the Program for the Education and Enrichment of Relational Skills (PEERS®), a parent-assisted intervention. Parental sensitivity (PS), measured in conflict and support contexts, was assessed as a predictor of adolescents' intervention-related outcomes. DESIGN Eighty-two Hebrew-speaking adolescents (9 females), aged 12-17 years, and their parents (62 mothers), were randomly allocated into immediate intervention (II; n = 40) or delayed intervention control (DI; n = 42) groups. Participants were tested at three time-points (Pre-Post-Follow Up for II, Pre-Pre-Post for DI). Outcome measures included behavioral assessments of adolescents' social communication (SC), a social-skills knowledge test, and self, parent, and teacher reported questionnaires. PS was assessed using support and conflict parent-adolescent interactions. Repeated measures ANOVAs were used to assess intervention effectiveness. SEM was used to examine PS pre- and post-intervention as predictors of adolescents' immediate and follow-up outcomes. RESULTS The II group improved on adolescents' measured SC and social knowledge, on parent-(but not teacher-) reported social skills, and on self-reported empathy. Gains maintained at follow-up. The DI group showed similar gains following their intervention. Adolescents' intervention-related SC gains were negatively predicted by pre-intervention PS, and positively predicted by intervention-related PS changes in the support context. Pre-intervention PS in the conflict context positively predicted adolescent SC at follow-up. CONCLUSIONS The Hebrew-adapted PEERS® is an effective intervention for adolescents with ASD. PS plays an important role in the promotion of SC in adolescents with ASD and should receive clinical attention.
Collapse
Affiliation(s)
- S J Rabin
- Department of Psychology, Bar-Ilan University
| | - E A Laugeson
- UCLA PEERS® Clinic, Semel Institute for Neuroscience and Human Behavior, UCLA
| | - I Mor-Snir
- The Autism Treatment and Research Center, Association for Children at Risk
| | - O Golan
- Department of Psychology, Bar-Ilan University.,The Autism Treatment and Research Center, Association for Children at Risk.,Autism Research Centre, Department of Psychiatry, University of Cambridge
| |
Collapse
|
12
|
Ben-David MA, Corn BW, Evron E, Goldberg H, Pfeffer RM, Abdah-Bortnyak R, Matceyevsky D, Weinstein Y, Golan O, Sklair-Levy M. Prophylactic breast irradiation reduces background parenchymal enhancement (BPE) on MRI: A secondary analysis. Breast 2019; 49:70-73. [PMID: 31734591 PMCID: PMC7375590 DOI: 10.1016/j.breast.2019.10.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/07/2019] [Accepted: 10/22/2019] [Indexed: 01/01/2023] Open
Abstract
PURPOSE We recently showed that prophylactic breast irradiation (PBI) reduces the risk of contralateral breast cancer in BRCA mutation carriers undergoing treatment for early breast cancer. It has been suggested that Background Parenchymal Enhancement (BPE) may be a biomarker for increased risk of breast cancer. METHODS For participants in the trial we reviewed the MRI prior to enrollment and following radiation treatment and scored the contralateral breast for BPE and density. RESULTS Significant reduction of BPE was more commonly noted following PBI (p = 0.011) compared to the control group. CONCLUSION Reduction of BPE by PBI may contribute to its prophylactic effect.
Collapse
Affiliation(s)
- Merav A Ben-David
- Department of Radiation Oncology, Sheba Medical Center, Ramat-Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Benjamin W Corn
- Shaare Zedek Medical Center, Jerusalem, Israel; Hadassah Medical School, The Hebrew University, Jerusalem, Israel.
| | - Ella Evron
- Oncology, Kaplan Medical Institute, Rehovot, Israel; Hadassah Medical School, The Hebrew University, Jerusalem, Israel
| | | | | | - Roxoliana Abdah-Bortnyak
- Oncology Division, Rambam Health Care Campus, Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | | | | | - Orit Golan
- Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Miri Sklair-Levy
- Department of Radiation Oncology, Sheba Medical Center, Ramat-Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| |
Collapse
|
13
|
Allweis TM, Menes T, Rotbart N, Rapson Y, Cernik H, Bokov I, Diment J, Magen A, Golan O, Levi-Bendet N, Givon Madhala O, Grubstein A. Ultrasound guided tattooing of axillary lymph nodes in breast cancer patients prior to neoadjuvant therapy, and identification of tattooed nodes at the time of surgery. Eur J Surg Oncol 2019; 46:1041-1045. [PMID: 31801656 DOI: 10.1016/j.ejso.2019.11.501] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/10/2019] [Accepted: 11/15/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Breast cancer patients with lymph node (LN) metastases at diagnosis often undergo neoadjuvant therapy (NAT). Identification of a LN which regressed after NAT remains a challenge. OBJECTIVE To evaluate marking of involved nodes by tattooing with carbon suspension, and identifying these nodes during surgery. METHODS A small amount (0.2-0.5 ml) of carbon suspension was injected into one or two axillary LNs under ultrasound guidance at the time of LN biopsy or before or shortly after starting NAT for LN positive breast cancer. During surgery an attempt was made to identify and remove the tattooed LN as a separate specimen. All patients underwent sentinel LN mapping and biopsy and/or axillary LN dissection as mandated by their clinical status. RESULTS Sixty three patients underwent tattooing of axillary LNs with no complications or adverse events. At surgery a tattooed node was identified in 60 patients (95%; 95% CI 87, 98). Of 56 patients who underwent sentinel mapping with Tc99, in 51 (91%; 95% CI 81, 96) at least one radioactive LN was identified. Of 50 patients in whom both radioactivity and tattoo were identified in axillary LNs, in 40 (80%; 95% CI 67, 89) LNs were radioactive and tattooed, however in 10 patients (20%; 95% CI 11, 33), the tattooed LN was not radioactive. CONCLUSIONS Tattooing of axillary LNs is safe and easily performed. Tattooing was helpful in identifying the marked LN in the majority of cases. This technique helps to ensure that metastatic LNs are identified and removed at surgery after NAT.
Collapse
Affiliation(s)
- Tanir M Allweis
- Kaplan Medical Center, Dept of Surgery and Breast Health Center, Rehovot, Israel; Hadassah Hebrew University Medical School, Jerusalem, Israel.
| | - Tehillah Menes
- Tel Aviv Sourasky Medical Center, Dept of Surgery, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Rotbart
- Rabin Medical Center- Beilinson, Dept of Radiology, Petach Tikva, Israel
| | - Yael Rapson
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Rabin Medical Center- Beilinson, Dept of Radiology, Petach Tikva, Israel
| | - Hana Cernik
- Kaplan Medical Center, Dept of Radiology and Breast Health Center, Rehovot, Israel
| | - Inna Bokov
- Kaplan Medical Center, Dept of Radiology and Breast Health Center, Rehovot, Israel
| | - Judith Diment
- Kaplan Medical Center, Dept of Pathology, Rehovot, Israel
| | - Ada Magen
- Rabin Medical Center- Beilinson, Dept of Surgery, Petach Tikva, Israel
| | - Orit Golan
- Tel Aviv Sourasky Medical Center, Dept of Radiology, Tel Aviv, Israel
| | - Noa Levi-Bendet
- Rabin Medical Center- Hasharon, Dept of Surgery, Petach Tikva, Israel
| | | | - Ahuva Grubstein
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Rabin Medical Center- Beilinson, Dept of Radiology, Petach Tikva, Israel
| |
Collapse
|
14
|
Nissan N, Allweis T, Menes T, Brodsky A, Paluch-Shimon S, Haas I, Golan O, Miller Y, Barlev H, Carmon E, Brodsky M, Anaby D, Lawson P, Halshtok-Neiman O, Shalmon A, Gotlieb M, Faermann R, Konen E, Sklair-Levy M. Breast MRI during lactation: effects on tumor conspicuity using dynamic contrast-enhanced (DCE) in comparison with diffusion tensor imaging (DTI) parametric maps. Eur Radiol 2019; 30:767-777. [DOI: 10.1007/s00330-019-06435-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/12/2019] [Accepted: 08/27/2019] [Indexed: 12/18/2022]
|
15
|
Bernstein E, Isakov O, Galazan L, Leshno A, Shaked M, Liberman E, Gur E, Elran H, Sror M, Harlap-Gat A, Kleinman S, Steiner M, Aviram G, Blachar A, Kessler A, Golan O, Shapira S, Geva R, Wolf I, Arber N. Data from an integrated cancer prevention center screening for multiple cancer types. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e13069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e13069 Background: Cancer is the second leading cause of death globally, and was responsible for ~9.6 million deaths in 2018. Importantly, between 30–50% of cancers can be prevented by avoiding risk factors and implementing existing evidence-based prevention strategies. Methods: We present the results of 15758 adults who came to our clinic between 2006 and 2018. Patients were counseled on reducing risk factors and screened for early detection of 11 of the most common cancer types. Patients were examined by specialists in internal medicine, surgery, plastic surgery, OBGYN, urology, oncology, oral surgery, gastroenterology, and others. Women underwent vaginal US, pap smear, mammography (40yr) and US/MRI of the breast with a clinical indication. Men underwent PSA/free PSA ( > 40yr). LDCT for moderate smokers. Colonoscopy was recommended to all subjects ( > 40yr). Results: A total of 7900 (50.1%) men and 7857 women (49.9%) mean age 46.9±11.3 years were screened. A total of 418 (2.7%) malignant lesions were detected in patients who had been screened, 245 (1.6%) of which were detected through our screening: skin 66 (0.4%), prostate 30 (0.2%), thyroid 28 (0.2%), breast 28 (0.2%), colorectal 19 (0.1%), urinary 13 (0.08%), lung 11 (0.07%), cervical 11 (0.07%), other/unknown 9 (0.06%), hematologic 8 (0.05%), ovarian 5 (0.03%), uterine 5 (0.03%), pancreas 3 (0.02%), testicular 3 (0.02%), oropharyngeal 2 (0.01%), hepatobiliary 2 (0.01%), stomach 1 (0.01%), larynx 1 (0.01%). A total of 17 (0.1%) malignant lesions were missed: breast 3 (0.02%), colorectal 3 (0.02%), skin 2 (0.01%), thyroid 2 (0.01%), hematologic 2 (0.01%), pancreas 2 (0.01%), kidney 1 (0.01%), lung 1 (0.01%), brain 1 (0.01%). A total of 147 (0.9%) malignant lesions developed > 1year after a visit. Only forty-nine of the cancer patients (12.5%) died after 18.9±17.8 months at a mean age of 66.5±12.2 years. Significantly, better than the expected cancer mortality in general. First-degree family member with cancer (HR = 1.46) and advanced age (HR = 21.8) was associated with increased cancer risk (P < 0.05). Conclusions: One stop shop cancer screening, in the setting of a multidisciplinary outpatient clinic is feasible, can detect cancer at an early stage, and can significantly improve survival.
Collapse
Affiliation(s)
- Ezra Bernstein
- Integrated Cancer Prevention Center, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Ofer Isakov
- Integrated Cancer Prevention Center, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Lior Galazan
- Integrated Cancer Prevention Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ari Leshno
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | - Meital Shaked
- Integrated Cancer Prevention Center, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Eliezer Liberman
- Integrated Cancer Prevention Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Eyal Gur
- Department of Plastic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | | | - Miri Sror
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Shlomi Kleinman
- Department of Oral and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | | | - Galit Aviram
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | - Arye Blachar
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ada Kessler
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | - Orit Golan
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | - Shiran Shapira
- Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ravit Geva
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Wolf
- Sheba Medical Center, Or-Yehuda, Israel
| | - Nadir Arber
- Integrated Cancer Prevention Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| |
Collapse
|
16
|
Golan O, Amitai Y, Barnea Y, Menes TS. Yield of surveillance magnetic resonance imaging after bilateral mastectomy and reconstruction: a retrospective cohort study. Breast Cancer Res Treat 2018; 174:463-468. [PMID: 30511241 DOI: 10.1007/s10549-018-05077-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE There are no evidence-based guidelines for surveillance of women after bilateral mastectomy and reconstruction. Several societies recommend against routine breast imaging in this setting. Despite these recommendations, magnetic resonance imaging (MRI) is frequently used to follow these women. We sought to examine the findings on MRI studies done in this setting. METHODS This is a retrospective cohort study including all consecutive MRI exams done after bilateral mastectomy and reconstruction between January 2010 and April 2018. Data collected included demographic information, family history, BRCA status, indication for bilateral mastectomy, type of reconstruction, findings on MRI, and work-up of MRI findings. Cancer detection rate and interval cancer rates were calculated. RESULTS One hundred fifty-nine women had 415 surveillance MRI exams. Most (372, 90%) studies were done in women with implant-based reconstruction. Four hundred and five (98%; 95% confidence interval (CI) 96-99%) of the studies were negative. One breast recurrence was found on MRI (cancer detection rate 2.4 per 1000 MRI exams, 95% CI 0.4-13); however, this woman was simultaneously diagnosed with metastatic disease. The false-positive rate was 90% (95% CI 54-99%). During follow-up three women were diagnosed with local recurrence (interval cancer rate 5 per 1000, 95% CI 1.3-17) and 4 women were diagnosed with metastatic disease. CONCLUSION The yield of surveillance MRI in women with bilateral mastectomy and reconstruction is very low. As most of the cohort had retro-pectoral implant-based reconstruction, it appears safe to recommend against surveillance MRI in this setting regardless of the indication for mastectomy.
Collapse
Affiliation(s)
- Orit Golan
- Department of Breast Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yoav Amitai
- Department of Breast Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital, Toronto, ON, Canada
| | - Yoav Barnea
- Department of Plastic Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tehillah S Menes
- Department of General Surgery, Tel Aviv Sourasky Medical Center, 6 Weizmann St, Tel Aviv, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| |
Collapse
|
17
|
Amitai Y, Golan O, Barnea Y, Klausner J, Menes TS. Follow-up of patients undergoing oncoplastic surgery - more palpable masses and benign biopsies. Breast Dis 2018; 37:115-121. [PMID: 28984579 DOI: 10.3233/bd-170284] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Oncoplastic reconstruction is increasingly used in the management of women undergoing breast conserving surgery. We examined the findings on breast exam and imaging of patients who underwent breast conservation with or without oncoplastic reconstruction. OBJECTIVE We hypothesized that patients undergoing immediate breast reconstruction would present with more palpable and imaging abnormalities compared to lumpectomy alone and undergo therefore more biopsies. METHODS All patients undergoing breast conservation with oncoplastic reconstruction for breast cancer between 2009 and 2014 were included in the study group. The control group was created by matching 4 women that underwent lumpectomy alone during the same week to each patient in the study group. The two groups were compared regarding demographics, tumor characteristics, post-operative complaints, breast exam, imaging and biopsies done during follow-up. RESULTS The study group included 67 women who had lumpectomy and immediate oncoplastic reconstruction and 268 women that underwent lumpectomy alone.Patients undergoing immediate oncoplastic reconstruction had more advanced disease; larger mean tumor size (3.1 cm versus 1.9 cm, P < 0.001), higher rate of involved lymph nodes (48% versus 26%; P < 0.001) and use of neoadjuvant treatment (39% versus 15%; P < 0.001).After oncoplastic reconstruction, new lumps (18% versus 5%; P = 0.004) were found more frequently, and there was a higher rate of women undergoing biopsies (31% versus 11%; P < 0.001). This finding remained significant after controlling for age, type of tumor, use of neoadjuvant treatment and volume of tissue removed. Over ninety percent of biopsies in the oncoplastic group were benign, most commonly-fat necrosis (N = 15, 60% of the biopsies). CONCLUSIONS Immediate oncoplastic reconstruction is associated with increased palpable masses and imaging abnormalities, requiring biopsies. Patients and clinicians should be aware of the benign nature of most of these findings.
Collapse
Affiliation(s)
- Yoav Amitai
- Departments of Radiology, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orit Golan
- Departments of Radiology, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoav Barnea
- Departments of Plastic Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Klausner
- Departments of Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tehillah S Menes
- Departments of Surgery, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
18
|
Nissan N, Furman-Haran E, Allweis T, Menes T, Golan O, Kent V, Barsuk D, Paluch-Shimon S, Haas I, Brodsky M, Bordsky A, Granot LF, Halshtok-Neiman O, Faermann R, Shalmon A, Gotlieb M, Konen E, Sklair-Levy M. Noncontrast Breast MRI During Pregnancy Using Diffusion Tensor Imaging: A Feasibility Study. J Magn Reson Imaging 2018; 49:508-517. [DOI: 10.1002/jmri.26228] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/01/2018] [Indexed: 01/09/2023] Open
Affiliation(s)
- Noam Nissan
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Edna Furman-Haran
- Department of Biological Services; Weizmann Institute of Science; Israel
| | - Tanir Allweis
- Department of General Surgery; Kaplan Medical Center; Israel
| | - Tehillah Menes
- Department of General Surgery; Souraski Medical Center; Israel
| | - Orit Golan
- Department of Radiology; Souraski Medical Center; Israel
| | - Varda Kent
- Department of Radiology; Assaf Harofeh Medical Center; Israel
| | - Daphna Barsuk
- Department of General Surgery; Assuta Medical Center; Israel
| | | | - Ilana Haas
- Department of General Surgery; Meir Medical Center; Israel
| | - Malka Brodsky
- Meirav Center of Breast Care, Sheba Medical Center; Israel
| | - Asia Bordsky
- Department of General Surgery; Bnai Zion Medical Center; Israel
| | | | - Osnat Halshtok-Neiman
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Renata Faermann
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Anat Shalmon
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Michael Gotlieb
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Eli Konen
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| | - Miri Sklair-Levy
- Department of Radiology; Sheba Medical Center; Israel
- Sackler School of Medicine; Tel Aviv University; Israel
| |
Collapse
|
19
|
Amitai Y, Menes TS, Weinstein I, Filyavich A, Yakobson I, Golan O. What is the yield of breast MRI in the assessment of palpable breast findings? Clin Radiol 2017; 72:930-935. [PMID: 28754486 DOI: 10.1016/j.crad.2017.06.120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/02/2017] [Accepted: 06/26/2017] [Indexed: 11/25/2022]
Abstract
AIM To examine the contribution of magnetic resonance imaging (MRI) to characterise palpable breast masses after conventional imaging was found to be non-contributory. MATERIALS AND METHODS The breast MRI database was reviewed for studies performed between January 2010 and December 2015 for the clinical indication of palpable breast finding with negative standard imaging. Medical files were reviewed for demographic data, clinical information, radiology, and pathology reports. Benign versus malignant outcomes were determined at histopathology or a minimum of 12 month follow-up. RESULTS Investigation of palpable breast finding was the clinical indication for 167 of 7,782 (2%) examinations. Thirty-two (19%) women in the study had positive MRI findings. Most (20, 63%) findings corresponded to the palpable area, resulting in three carcinomas being diagnosed. Only one carcinoma required MRI-guided biopsy for diagnosis. Eighteen women with negative MRI underwent ultrasound-guided biopsy from the palpable area, which resulted in a diagnosis of one carcinoma. One carcinoma was incidentally detected in another location. Within the present population, the sensitivity for detecting malignancy was 80%, specificity 78%, negative predictive value 99%, and positive predictive value 13%. CONCLUSIONS Although cancer was found in four cases in the palpable area, the biopsy was directed using MRI in only one case. A new palpable finding with non-contributory standard imaging should prompt a needle-guided biopsy and not further evaluation using MRI.
Collapse
Affiliation(s)
- Y Amitai
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 64239, Israel.
| | - T S Menes
- Department of Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - I Weinstein
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - A Filyavich
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - I Yakobson
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| | - O Golan
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 64239, Israel
| |
Collapse
|
20
|
Wolf I, Leshno A, Liberman E, Gur E, Elran H, Sror M, Harlap-Gat A, Jean M, Steiner M, Galazan L, Av G, Blachar A, Kessler A, Golan O, Shapira S, Geva R, Arber N. Ten year experience of an integrated cancer prevention center screening for multiple cancer types. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.1549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1549 Background: Cancer is the leading cause of mortality worldwide. Prevention and early detection are pivotal tools for reducing cancer burden. Methods: We describe the 10 year experience (2006-2016) of an integrated cancer prevention center that provides screening for prevention and early detection of 11 most common cancer types. Healthy individuals (20-80 yr) were included. Extensive clinical and epidemiological data was obtained. DNA was extracted from all participants and genotyped for APC I1307K and E1317Q. Patients were examined by specialists in internal medicine, surgery, plastic surgery, OBGYN, urology, oncology, oral surgery, gastroenterology, and others. Women underwent vaginal US and pap smear and (40yr) mammography and US/MRI with a clinical indication. PSA and free PSA for Men ( > 40yr). LDCT for heavy smokers. Colonoscopy was recommended to all subjects ( > 40yr). Results: A total of 6258 (49%) men and 6461 (51%) women mean age 47.0±11.5 year were screened. New malignant lesions were detected in 389 (1.75%) of screeners. The most common cancers were of skin (74, 0.6%), prostate (62, 0.5%), thyroid (51, 0.4%), breast (36, 0.3%), colorectal (22, 0.2%), ovarian (19, 0.1%), uterus (14, 0.1%), testis (12, 0.09%) urinary (9, 0.07%) and lung (10, 0.08%). In 28 patients (0.22%) more than one cancer was detected. Twenty eight of the cancer patients (7.2%) died after 32.4±28.1 months at a mean age of 69.4±14.2 years. Significantly, better than the expected cancer mortality. The APC I1307K and E1317Q variants were detected in 572 (4.8%) and 182 (1.5%) subjects respectively. First degree family member with cancer (OR = 2.02), I1307K carrier ship (OR = 1.53), female gender (OR = 1.23) and advanced age (OR = 1.06) were all associated with statistically significant (P < 0.05) increased cancer risk. Advanced age and first degree family history were also associated with detection of more than one cancer types. Conclusions: One stop shop screening, in the setting of a multidisciplinary outpatient clinic, is feasible and can prevent and detect cancer at an early stage. It significantly improve morbidity and mortality. Impressively the APC I1307K carries an overall increase cancer risk.
Collapse
Affiliation(s)
- Ido Wolf
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | - Ari Leshno
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | - Eliezer Liberman
- Integrated Cancer Prevention Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Eyal Gur
- Department of Plastic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | | | - Miri Sror
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | | | - Maayan Jean
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | | | - Lior Galazan
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | - Galit Av
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | - Arye Blachar
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ada Kessler
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | - Orit Golan
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | | | - Ravit Geva
- Sourasky Medical Center, Tel Aviv, Israel
| | - Nadir Arber
- Integrated Cancer Prevention Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| |
Collapse
|
21
|
Even-Sapir E, Golan O, Menes T, Weinstein Y, Lerman H. Breast Imaging Utilizing Dedicated Gamma Camera and (99m)Tc-MIBI: Experience at the Tel Aviv Medical Center and Review of the Literature Breast Imaging. Semin Nucl Med 2016; 46:286-93. [PMID: 27237439 DOI: 10.1053/j.semnuclmed.2016.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The scope of the current article is the clinical role of gamma cameras dedicated for breast imaging and (99m)Tc-MIBI tumor-seeking tracer, as both a screening modality among a healthy population and as a diagnostic modality in patients with breast cancer. Such cameras are now commercially available. The technology utilizing a camera composed of a NaI (Tl) detector is termed breast-specific gamma imaging. The technology of dual-headed camera composed of semiconductor cadmium zinc telluride detectors that directly converts gamma-ray energy into electronic signals is termed molecular breast imaging. Molecular breast imaging system has been installed at the Department of Nuclear medicine at the Tel Aviv Sourasky Medical Center, Tel Aviv in 2009. The article reviews the literature well as our own experience.
Collapse
Affiliation(s)
- Einat Even-Sapir
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Orit Golan
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Breast Imaging Unit, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Tehillah Menes
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Breast surgery unit, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yuliana Weinstein
- Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel; Breast Imaging Unit, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Hedva Lerman
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
22
|
Arber N, Leshno A, Shapira S, Liberman E, Gur E, Elran H, Kraus S, Sror M, Harlap-Gat A, Galazan L, Jean M, Av G, Kessler A, Blachar A, Golan O, Benjamin S, Geva R, Moshkowitz M. One stop screening for multiple cancer types: 10 year experience of an integrated cancer prevention center. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nadir Arber
- Integrated Cancer Prevention Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ari Leshno
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | | | - Eliezer Liberman
- Integrated Cancer Prevention Center, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Eyal Gur
- Department of Plastic Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | | | | | - Miri Sror
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | | | - Lior Galazan
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | - Maayan Jean
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | - Galit Av
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | - Ada Kessler
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | - Arye Blachar
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Orit Golan
- Tel Aviv Sorasky Medical Center, Tel Aviv, Israel
| | | | - Ravit Geva
- University Hospital Gasthuisberg, Leuven, Belgium
| | | |
Collapse
|
23
|
Golan O, Amitai Y, Menes T. Does change in microcalcifications with neoadjuvant treatment correlate with pathological tumour response? Clin Radiol 2016; 71:458-63. [PMID: 26897334 DOI: 10.1016/j.crad.2016.01.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/29/2015] [Accepted: 01/11/2016] [Indexed: 11/27/2022]
Abstract
AIM To determine whether change in microcalcification density and extent after neoadjuvant treatment (NAT) can predict tumour response. MATERIALS AND METHODS This single-institution, retrospective study included all women with breast cancer who underwent NAT between 1 January 2008 and 31 December 2014, and fulfilled the following criteria: mammography before NAT with pathological microcalcifications, mammography performed after NAT, and tumour resection at Tel-Aviv Sourasky Medical Center. Correlation was made between mammography features and clinicopathological information. RESULTS Fifty-four patients met the inclusion criteria. Post-NAT, the number of calcifications remained stable in 30 (55.5%) patients, decreased in 23 (42.6%) patients, and increased in one (1.9%) patient. Patients with a decreased number of malignant calcifications post-NAT had higher rates of pathological complete response compared to patients with no change (59% versus 20%, p=0.009). Patients with triple negative and human epidermal growth factor receptor 2 (HER2) receptor subtypes had higher rates of decreased number of calcifications post-NAT (50% versus 35%) and pathological complete response (57% versus 11%, p=0.007) compared to patients with luminal receptor subtype. In addition, patients who received a combination of chemotherapy and biological treatment had more cases of decreased number of calcifications compared to patients who received chemotherapy alone (56% versus 39%). No significant correlation was observed between calcification change post-NAT and calcification morphology or distribution pattern. CONCLUSIONS Patients with breast carcinoma and decreased number of pathological calcifications post-NAT had higher rates of pathological complete response compared to patients with no change in calcifications; however, a substantial number of patients with complete pathological response had no change in microcalcification distribution with treatment, questioning the need to completely excise all calcifications post-NAT.
Collapse
Affiliation(s)
- O Golan
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Weizmann 6, Tel-Aviv, 4946123, Israel
| | - Y Amitai
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Weizmann 6, Tel-Aviv, 4946123, Israel.
| | - T Menes
- Department of Surgery, Tel-Aviv Sourasky Medical Center, Weizmann 6, Tel-Aviv, 4946123, Israel
| |
Collapse
|
24
|
Amitai Y, Menes T, Aviram G, Golan O. Do All Women With Abnormal Sonographic Axillary Lymph Nodes Need a Biopsy? Can Assoc Radiol J 2016; 67:173-8. [PMID: 26847811 DOI: 10.1016/j.carj.2015.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/21/2015] [Accepted: 08/01/2015] [Indexed: 10/22/2022] Open
Abstract
PURPOSE With the increased use of breast ultrasound for different indications, sonographically abnormal axillary lymph nodes are not a rare finding. We examined clinical and imaging characteristics in correlation with pathological reports of the sonographic guided biopsies to assess the yield of needle biopsy of these nodes. METHODS Clinical, imaging and pathology data were collected for 171 consecutive patients who underwent sonographic guided needle biopsy of an abnormal lymph node between 2008 and 2013. Malignancy rates were examined for different clinical settings: palpable axillary mass, previous history of breast cancer, findings suggestive of a systemic disease, and those with a breast finding of low suspicion or an incidental abnormal axillary lymph node. Patients with newly diagnosed breast cancer were excluded. RESULTS Twelve patients (7%) were found to have a malignancy on their axillary lymph node biopsy. Malignancy rates increased with age, and varied with clinical presentation: Axillary mass (8, 26%); history of breast cancer (2, 11%); systemic disease (0%) and breast finding of low suspicion or incidental abnormal lymph node on screening (1, 1%). Low rates of malignancy were found when the cortex was <6 mm (1, 0.8%). The most important imaging finding associated with malignancy was lack of a preserved hilum, in which case almost a third (10, 29%) of the biopsies were malignant. Only 1 of 89 women with a breast finding of low suspicion or an incidental abnormal axillary lymph node was found to have malignancy. In this case the lymph node had no hilum. CONCLUSIONS In women without breast cancer, a highly suspicious breast mass or an axillary mass, more stringent criteria should be used when evaluating an abnormal axillary lymph node on sonography, as the malignancy rates are very low (1%).
Collapse
Affiliation(s)
- Yoav Amitai
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
| | - Tehillah Menes
- Department of Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Galit Aviram
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Orit Golan
- Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| |
Collapse
|
25
|
Menes TS, Zissman S, Golan O, Sperber F, Klausner J, Schneebaum S. Yield of Selective Magnetic Resonance Imaging in Preoperative Workup of Newly Diagnosed Breast Cancer Patients Planned for Breast Conserving Surgery. Am Surg 2012. [DOI: 10.1177/000313481207800437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The role of routine preoperative magnetic resonance imaging (MRI) in newly diagnosed breast cancer patients planned for breast conserving surgery is presently being debated. In our medical center we practice selective use of preoperative MRI; we sought to examine the yield of MRI in this highly selected group of patients. A retrospective study of all newly diagnosed breast cancer patients presenting between January 2007 and July 2010 to the Tel Aviv Sourasky Medical Center (Tel Aviv, Israel) was completed. Patients planned for breast conserving surgery who underwent preoperative MRI were included in this study. Patients and tumor characteristics, indication for MRI, findings on MRI, consequent workup, and impact on surgical treatment were recorded. Association between preoperative characteristics and yield of MRI was examined. During the study period, 105 patients that were candidates for breast conserving surgery underwent pre-operative evaluation with MRI. Use of breast MRI increased over time. Rates of mastectomy were stable throughout the study years. Dense mammogram was the most frequent (51, 68%) indication for MRI. Additional suspicious findings were found in 41 (39%) patients, prompting further workup including 36 biopsies in 25 patients, of which 22 (61%) were with cancer. These additional findings prompted a change in the surgical plan in a third of the patients. In most patients (92; 88%) clear margins were achieved. Limiting the use of MRI in the preoperative workup of breast cancer patients to a selected group of patients can increase the yield of MRI.
Collapse
Affiliation(s)
| | | | - Orit Golan
- Breast Imaging Unit, Sourasky Medical Center, Tel Aviv, Israel
| | - Fani Sperber
- Breast Imaging Unit, Sourasky Medical Center, Tel Aviv, Israel
| | | | | |
Collapse
|
26
|
Menes TS, Zissman S, Golan O, Sperber F, Klausner J, Schneebaum S. Yield of selective magnetic resonance imaging in preoperative workup of newly diagnosed breast cancer patients planned for breast conserving surgery. Am Surg 2012; 78:451-455. [PMID: 22472404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The role of routine preoperative magnetic resonance imaging (MRI) in newly diagnosed breast cancer patients planned for breast conserving surgery is presently being debated. In our medical center we practice selective use of preoperative MRI; we sought to examine the yield of MRI in this highly selected group of patients. A retrospective study of all newly diagnosed breast cancer patients presenting between January 2007 and July 2010 to the Tel Aviv Sourasky Medical Center (Tel Aviv, Israel) was completed. Patients planned for breast conserving surgery who underwent preoperative MRI were included in this study. Patients and tumor characteristics, indication for MRI, findings on MRI, consequent workup, and impact on surgical treatment were recorded. Association between preoperative characteristics and yield of MRI was examined. During the study period, 105 patients that were candidates for breast conserving surgery underwent preoperative evaluation with MRI. Use of breast MRI increased over time. Rates of mastectomy were stable throughout the study years. Dense mammogram was the most frequent (51, 68%) indication for MRI. Additional suspicious findings were found in 41 (39%) patients, prompting further workup including 36 biopsies in 25 patients, of which 22 (61%) were with cancer. These additional findings prompted a change in the surgical plan in a third of the patients. In most patients (92; 88%) clear margins were achieved. Limiting the use of MRI in the preoperative workup of breast cancer patients to a selected group of patients can increase the yield of MRI.
Collapse
Affiliation(s)
- Tehillah S Menes
- Department of Surgery, Sourasky Medical Center, Tel Aviv, Israel.
| | | | | | | | | | | |
Collapse
|
27
|
Golan O, Issan Y, Isak A, Leipziger J, Robaye B, Shainberg A. Extracellular nucleotide derivatives protect cardiomyocytes against hypoxic stress. Biochem Pharmacol 2011; 81:1219-27. [PMID: 21376706 DOI: 10.1016/j.bcp.2011.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 01/26/2011] [Accepted: 02/15/2011] [Indexed: 11/28/2022]
Abstract
RATIONALE Extracellular nucleotides have widespread effects and various cell responses. Whereas the effect of a purine nucleotide (ATP) and a pyrimidine nucleotide (UTP) on myocardial infarction has been examined, the role of different purine and pyrimidine nucleotides and nucleosides in cardioprotection against hypoxic stress has not been reported. OBJECTIVE To investigate the role of purine and pyrimidine nucleotides and nucleosides in protective effects in cardiomyocytes subjected to hypoxia. METHODS AND RESULTS Rat cultured cardiomyocytes were treated with various extracellular nucleotides and nucleosides, before or during hypoxic stress. The results revealed that GTP or CTP exhibit cardioprotective ability, as revealed by lactate dehydrogenase (LDH) release, by propidium iodide (PI) staining, by cell morphology, and by preserved mitochondrial activity. Pretreatment with various P2 antagonists (suramin, RB-2, or PPADS) did not abolish the cardioprotective effect of the nucleotides. Moreover, P2Y₂ -/- , P2Y₄ -/-, and P2Y₂ -/-/P2Y₄ -/- receptor knockouts mouse cardiomyocytes were significantly protected against hypoxic stress when treated with UTP. These results indicate that the protective effect is not mediated via those receptors. We found that a wide variety of triphosphate and diphosphate nucleotides (TTP, ITP, deoxyGTP, and GDP), provided significant cardioprotective effect. GMP, guanosine, and ribose phosphate provided no cardioprotective effect. Moreover, we observed that tri/di-phosphate alone assures cardioprotection. Treatment with extracellular nucleotides, or with tri/di-phosphate, administered under normoxic conditions or during hypoxic conditions, led to a decrease in reactive oxygen species production. CONCLUSIONS Extracellular tri/di-phosphates are apparently the molecule responsible for cardioprotection against hypoxic damage, probably by preventing free radicals formation.
Collapse
Affiliation(s)
- O Golan
- Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | | | | | | | | | | |
Collapse
|
28
|
Buchs AE, Kalter-Leibovici O, Gorelik O, Cohen N, Golan O, Rapoport MJ. Comparison of modified preadmission glucose-lowering regimen with basal/bolus regimen for glucose control on outcome in general medicine wards. Int J Clin Pract 2010; 64:1802-7. [PMID: 21070530 DOI: 10.1111/j.1742-1241.2010.02384.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND It is undecided whether glucose control as advocated by the professional organisations and the glucose-lowering method by itself affects clinical outcome in patients with diabetes mellitus hospitalised in general medical wards. Our aim was to investigate whether a basal/bolus regimen and a modified prehospitalisation regimen have a different impact on the clinical diabetic patients in general medicine wards. METHODS Glucose control of patients with diabetes hospitalised in two different wards of internal medicine was achieved according to their wards' policy: a modified preadmission regimen (conventional regime) or a basal/bolus regimen (intensive regime). Death and any adverse event were determined during hospitalisation and within 6 months after discharge to assess clinical outcome. RESULTS Median fasting and daily glucose levels were similar in the conventional (n = 116) and intensive regime (n = 129) groups: 161 mg/dl (inter-quartile range: 138-201) and 176 mg/dl (152-215) vs. 155 mg/dl (133-208) and 173 mg/dl (146-208) respectively. Clinical outcome was not affected by the treatment modality. In the subgroup of patients hospitalised with infection, the median fasting glucose was significantly lower in the interventional compared with the conventional regime: 141 and 172 mg/dl respectively (p = 0.041). However, tighter control was associated with a significantly higher incidence of adverse events within 6 months after discharge: 48.9% and 21.4% respectively (p = 0.047). CONCLUSION In general medicine wards, modified prehospital hypoglycaemic regimens and a basal/bolus insulin regimen achieve similar glucose control. The clinical outcome was not affected by the modality of glucose control.
Collapse
Affiliation(s)
- A E Buchs
- Department of Internal Medicine C, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel-Aviv University, Zerifin, Israel.
| | | | | | | | | | | |
Collapse
|
29
|
Fridlender ZG, Cohen PY, Golan O, Arish N, Wallach-Dayan S, Breuer R. Telomerase activity in bleomycin-induced epithelial cell apoptosis and lung fibrosis. Eur Respir J 2007; 30:205-13. [PMID: 17504800 DOI: 10.1183/09031936.00009407] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Epithelial cell injury and apoptosis are recognised as early features in idiopathic pulmonary fibrosis and bleomycin-induced fibrosis in mice. Telomerase is a known apoptosis-alleviating factor. The role of telomerase was studied during bleomycin-induced lung epithelial cell (LEC) apoptosis in vitro in a mouse LEC line, and in vivo in LECs isolated from bleomycin-treated mice. The current authors evaluated changes in murine telomerase reverse transcriptase (mTERT) mRNA levels and changes in telomerase activity with the TRAPeze Detection Kit, telomeric length with the TeloTTAGGG Telomere Length Kit, and LEC apoptosis with FACScan and 4,6-diamino-2-phenylindole dihydrochloride stain. There was a significant elevation in mTERT mRNA and a transient 41% increase in telomerase activity 24 h after in vitro bleomycin treatment. At 72 h, telomerase activity had fallen to 26% below levels in untreated cells. Reduction of telomerase activity over time, or by direct inhibition, significantly elevated LEC apoptosis. No change in average telomeric length was noted. In vivo, telomerase activity of LECs from bleomycin-treated mice increased at 7 and 14 days. In conclusion, telomerase activity may play a protective role against robust bleomycin-induced lung epithelial cell apoptosis. Moreover, stabilising telomerase activity may decrease epithelial cell apoptosis and the resulting lung fibrosis.
Collapse
Affiliation(s)
- Z G Fridlender
- Lung Cellular and Molecular Biology Laboratory, Institute of Pulmonary Medicine, Hadassah - Hebrew University Medical Center, Jerusalem, Israel.
| | | | | | | | | | | |
Collapse
|
30
|
Dyugovskaya L, Golan O, Lavie P, Lavie L. P335 Heat shock protein 70 in peripheral blood monocytes of sleep apnea patients. Link with TNF-α expression. Sleep Med 2006. [DOI: 10.1016/j.sleep.2006.07.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
31
|
Malkesman O, Braw Y, Zagoory-Sharon O, Golan O, Lavi-Avnon Y, Schroeder M, Overstreet DH, Yadid G, Weller A. Reward and anxiety in genetic animal models of childhood depression. Behav Brain Res 2005; 164:1-10. [PMID: 16055204 DOI: 10.1016/j.bbr.2005.04.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2005] [Revised: 04/12/2005] [Accepted: 04/12/2005] [Indexed: 11/30/2022]
Abstract
One of the most important criteria for major depressive disorder in adults and in children and adolescents as well, is the loss of interest in or pleasure from typically enjoyable experiences or activities: anhedonia. Anxiety is frequently co-morbid with depression. We examined reward and anxiety in genetic animal models of childhood depression. Two different "depressed" lines were studied: the Flinders Sensitive Line (FSL) and their controls, Sprague-Dawley (SD) rats and the Wistar Kyoto (WKY) line and their controls, Wistar rats. Recently, we found that prepubertal rats (about 35 days old) from these lines exhibited increased immobility in the swim test, and abnormal social play observed after 24-h isolation. We hypothesized that FSL and WKY prepubertal rats will further show anhedonia in two different behavioral assays: the conditioned place preference test (CPP), examining the rewarding aspect of social interaction and the saccharin preference test. Behavior in the open field paradigm and freezing behavior in the CPP apparatus were also used as measures of anxiety. WKY, but not FSL prepubertal rats, consumed less of the saccharin solution compared to their control line. FSL, and WKY prepubertal rats found social interaction to be rewarding to a similar extent as their control lines, in the CPP test. Only the WKY rats showed anxiety in behavior in the open field and freezing behavior in the CPP paradigm. The results suggest that WKY prepubertal rats are anxious and sensitive to stress-induced anhedonia, while FSL prepubertal rats exhibit none of these symptoms.
Collapse
MESH Headings
- Age Factors
- Analysis of Variance
- Animals
- Anxiety/complications
- Anxiety/genetics
- Child
- Conditioning, Classical/physiology
- Depressive Disorder, Major/complications
- Depressive Disorder, Major/genetics
- Disease Models, Animal
- Exploratory Behavior/physiology
- Female
- Freezing Reaction, Cataleptic/physiology
- Humans
- Male
- Rats
- Rats, Inbred Strains
- Rats, Inbred WKY
- Rats, Sprague-Dawley
- Rats, Wistar
- Reward
- Sexual Maturation
- Social Behavior
- Species Specificity
- Stress, Psychological/complications
- Stress, Psychological/genetics
- Taste/genetics
- Taste/physiology
Collapse
Affiliation(s)
- O Malkesman
- Interdisciplinary Program in the Brain Sciences, Bar-Ilan University, Israel
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Abstract
OBJECTIVES To determine if there is added value to oncology studies performed with a dedicated in-line positron emission tomography (PET)/computed tomography (CT) scanner as compared with PET read side by side with diagnostic CT (DCT). METHODS Forty-one consecutive oncology patients referred for PET/CT who had contemporary DCT scans for review were enrolled. Body regions assessed on a DCT scan were assessed on PET/CT and by side-by-side reading of PET and DCT (SBS PET/DCT). Lesions identified on DCT, the CT portion of PET/CT, SBS PET/DCT, and the reading of fused PET/CT images were scored as benign or malignant. The PET portion of the PET/CT study was read by 2 teams: the first read the SBS PET/DCT scan and the other read the complete fused PET/CT scan. For discordant lesions, the final diagnosis was determined by pathologic findings (n = 6) or imaging follow-up (n = 21). RESULTS Twenty-seven (16.1%) of the 168 lesions were discordant when comparing analysis of fused PET/CT and SBS PET/DCT. Sixteen (9.5%) were fundamentally discordant, and 11(6.6%) were discordant in degree of confidence. For all discordant lesions only, the sensitivity, specificity, negative predictive value, positive predictive value, and accuracy for PET/CT were 100%, 33%, 100%, 94%, and 78%, respectively, and for SBS PET/DCT, they were 38%, 50%, 19%, 73%, and 30%, respectively (P < 0.001 for sensitivity, P = not specific for specificity). The 2 main causes for misclassification on SBS PET/DCT were incorrect localization (n = 12) and changes occurring in the time gap between DCT and PET/CT (n = 4). CONCLUSIONS In-line PET/CT offers better lesion localization in comparison to the visual fusion of PET and CT, especially for small lymph nodes, lesions adjacent to mobile organs, or lesions adjacent to the chest or abdominal wall.
Collapse
Affiliation(s)
- Ur Metser
- Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | | | | | | |
Collapse
|
33
|
Aronis A, Melendez JA, Golan O, Shilo S, Dicter N, Tirosh O. Potentiation of Fas-mediated apoptosis by attenuated production of mitochondria-derived reactive oxygen species. Cell Death Differ 2003; 10:335-44. [PMID: 12700633 DOI: 10.1038/sj.cdd.4401150] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The role of reactive oxygen species (ROS) production in death receptor-mediated apoptosis is ill-defined. Here, we show that ROS levels play a role in moderating Fas-dependent apoptosis. Treatment of Jurkat T cells with oligomycin (ATP-synthase inhibitor) or (mitochondrial uncoupler) and Fas-activating antibody (CH11) facilitated rapid cell death that was not associated with decreased ATP production or increased DEVDase activity and cytochrome c release. However, a decrease in cellular ROS production was associated with CH11 treatment, and combinations of CH11 with oligomycin or FCCP further inhibited cellular ROS production. Thus, decreased ROS production is correlated with enhanced cell death. A transition from state 3 to state 4 mitochondrial respiration accounted for the attenuated ROS production and membrane potential. Similar observations were demonstrated in isolated rat liver mitochondria. These data show that ROS production is important in receptor-mediated apoptosis, playing a pivotal role in cell survival.
Collapse
Affiliation(s)
- A Aronis
- Institute of Biochemistry, Food Science and Nutrition, The Hebrew University of Jerusalem, Rehovot, Israel
| | | | | | | | | | | |
Collapse
|
34
|
Wenger NS, Golan O, Shalev C, Glick S. Hospital ethics committees in Israel: structure, function and heterogeneity in the setting of statutory ethics committees. J Med Ethics 2002; 28:177-182. [PMID: 12042404 PMCID: PMC1733581 DOI: 10.1136/jme.28.3.177] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Hospital ethics committees increasingly affect medical care worldwide, yet there has been little evaluation of these bodies. Israel has the distinction of having ethics committees legally required by a Patients' Rights Act. We studied the development of ethics committees in this legal environment. DESIGN Cross-sectional national survey of general hospitals to identify all ethics committees and interview of ethics committee chairpersons. SETTING Israel five years after the passage of the Patients' Rights Act. MAIN MEASUREMENTS Patients' rights and informal ethics committee structure and function. RESULTS One-third of general hospitals have an ethics committee, with committees concentrated in larger facilities. Hospitals without committees tended to lack any structure to handle ethics issues. Committees tend to be interdisciplinary and gender-mixed but ethnic mix was poor. Confidentiality is the rule, however, legal liability is a concern. One-third of patients' rights ethics committees never convened and most committees had considered fewer than ten consults. Access to the consultation process and the consultation process itself varied substantially across committees. Some patients' rights ethics committees attempted to solve cases, others only rendered decisions. Informal committees often refused to consider cases within Patients' Rights Act jurisdiction. CONCLUSIONS Despite statutory requirement, many Israeli patients and clinicians do not have access to ethics committees. The scant volume of cases shows serious discrepancies between practice and Patients' Rights Act regulations, suggesting the need for education or revision of the law. Heterogeneity in committee function demonstrates need for substantial improvement.
Collapse
Affiliation(s)
- N S Wenger
- Division of General Internal Medicine, University of California, Los Angeles, CA 90095, USA.
| | | | | | | |
Collapse
|
35
|
Neumann S, Topper A, Mandel H, Shapira I, Golan O, Gazit E, Loewenthal R. Identification of new mutations in Israeli patients with X-linked adrenoleukodystrophy. Genet Test 2001; 5:65-8. [PMID: 11336405 DOI: 10.1089/109065701750168806] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
X-linked adrenoleukodystrophy (ALD) is a peroxisomal disorder characterized by impaired peroxisomal betaoxidation of very-long-chain fatty acids (VLCFAs). This is probably due to reduced activation of the VLCFAs and results in demyelination of the nervous system and adrenocortical insufficiency. The ALD gene is localized on Xq28, has 10 exons and encodes a protein of 745 amino acids with significant homology to the membrane peroxisomal protein PMP70. Characterizing the disease causing mutations is of importance in prenatal diagnosis because 12-20% of women who are obligatory carriers show false-negative results when tested for VLCFA in plasma. We have analyzed DNA from blood samples of 7 Jewish (5 Sephardi and 2 Ashkenazi) and 3 Arab Israeli families suffering from ALD. Five missense-type mutations were identified: R104H, Y174C, L229P, R401Q, and G512C. A single mutation, R464X, was nonsense, and two, Y171 frameshift and E471 frameshift, were frameshift. Interestingly, a single mutation was identified in three families of Moroccan Jewish descent, probably due to a founder effect.
Collapse
Affiliation(s)
- S Neumann
- Tissue Typing Laboratory, The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | | | | | | | | | | |
Collapse
|