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Eggleston B, Patience M, Edwards S, Adamkiewicz T, Buchanan GR, Davies SC, Dickerhoff R, Donfield S, Feig SA, Giller RH, Haight A, Horan J, Hsu LL, Kamani N, Lane P, Levine JE, Margolis D, Moore TB, Ohene-Frempong K, Redding-Lallinger R, Roberts IAG, Rogers ZR, Sanders JE, Scott JP, Sleight B, Thompson AA, Sullivan KM, Walters MC. Effect of myeloablative bone marrow transplantation on growth in children with sickle cell anaemia: results of the multicenter study of haematopoietic cell transplantation for sickle cell anaemia. Br J Haematol 2007; 136:673-6. [PMID: 17223910 DOI: 10.1111/j.1365-2141.2006.06486.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [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: 11/28/2022]
Abstract
Although haematopoietic cell transplantation (HCT) is curative for sickle cell anaemia (SCA), concerns about its short- and long-term toxicities limit its application. A potential toxicity is an adverse effect on growth. To identify an HCT growth effect, serial height and weight measurements from 53 children and adolescents with SCA after receiving a transplant were compared to historical controls. Hierarchical Linear Models for longitudinal data were used for analysis. In general growth was not impaired by HCT for SCA in young children; however, diminished growth may occur if HCT is carried out near or during the adolescent growth spurt.
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Affiliation(s)
- B Eggleston
- Blood and Marrow Transplantation Program, Children's Hospital and Research Center, Oakland, CA 94609, USA
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2
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Alonzo TA, Wells RJ, Woods WG, Lange B, Gerbing RB, Buxton AB, Neudorf S, Sanders J, Smith FO, Feig SA. Postremission therapy for children with acute myeloid leukemia: the children's cancer group experience in the transplant era. Leukemia 2005; 19:965-70. [PMID: 15830007 DOI: 10.1038/sj.leu.2403763] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [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: 11/09/2022]
Abstract
We reviewed consolidation therapy results and analyzed postremission outcomes for 1464 children less than 21 years old at diagnosis in five consecutive Children's Cancer Group acute myeloid leukemia trials between 1979 and 1996. Children in remission were allocated to allogeneic bone marrow transplantation (BMT) (N=373) in first remission, if a matched family donor was available. Remaining children were assigned consolidation chemotherapy (N=688) or autologous purged BMT (N=217), or withdrew from study before assignment, or with unknown data (N=186). Overall and disease-free survival were superior for children assigned allogeneic transplants. High (>50,000/microl) diagnostic white blood cell (WBC) count was prognostic for inferior outcome, but French-American-British (FAB) subtypes were not. Inv(16) is a favorable karyotypic feature for children in first remission and t(8;21) is not. Allogeneic transplantation benefit was evident in most children, including those with high or low diagnostic WBC count, each FAB subtype, and t(8;21), but was not seen in children with inv(16). Therefore, these data suggest reserving matched related donor allogeneic transplantation for children with inv(16) for second remission, but not those with t(8;21).
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Affiliation(s)
- T A Alonzo
- University of Southern California Keck School of Medicine, Los Angeles, CA 91066-0064, USA.
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3
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Wells RJ, Arthur DC, Srivastava A, Heerema NA, Le Beau M, Alonzo TA, Buxton AB, Woods WG, Howells WB, Benjamin DR, Betcher DL, Buckley JD, Feig SA, Kim T, Odom LF, Ruymann FB, Smithson WA, Tannous R, Whitt JK, Wolff L, Tjoa T, Lampkin BC. Prognostic variables in newly diagnosed children and adolescents with acute myeloid leukemia: Children's Cancer Group Study 213. Leukemia 2002; 16:601-7. [PMID: 11960339 DOI: 10.1038/sj.leu.2402390] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [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] [Received: 03/19/2001] [Accepted: 11/20/2001] [Indexed: 11/08/2022]
Abstract
The objective of this study was to identify biologic parameters that were associated with either exceptionally good or poor outcome in childhood acute myeloid leukemia (AML). Among the children with AML who entered Children's Cancer Group trial 213, 498 patients without Down syndrome or acute promyelocytic leukemia (APL) comprise the basis for this report. Univariate comparisons of the proportion of patients attaining complete remission after induction (CR) indicate that, at diagnosis, male gender, low platelet count (< or =20 000/microl), hepatomegaly, myelodysplastic syndrome (MDS), French-American- British (FAB) category M5, high (>15%) bone marrow (BM) blasts on day 14 of the first course of induction, and +8 are associated with lower CR rates, while abnormal 16 is associated with a higher CR rate. Multivariate analysis suggests high platelet count at diagnosis (>20 000/microl), absence of hepatomegaly, < or =15% day 14 BM blast percentage, and abnormal 16 are independent prognostic factors associated with better CR. Univariate analysis demonstrated a significant favorable relationship between platelet count at diagnosis (>20 000/microl), absence of hepatomegaly, low percentage of BM blasts (< or =15%), and abnormal 16 with overall survival. Absence of hepatomegaly, < or =15% day 14 BM blast percentage, and abnormal 16 were determined to be independent prognostic factors associated with better survival.
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Affiliation(s)
- R J Wells
- Children's Hospital Research Foundation, University of Cincinnati Medical Center, Cincinnati, OH, USA
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4
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Haus AG, Yaffe MJ, Feig SA, Hendrick RE, Butler PA, Wilcox PA, Bansal S. Relationship between phantom failure rates and radiation dose in mammography accreditation. Med Phys 2001; 28:2297-301. [PMID: 11764036 DOI: 10.1118/1.1408283] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [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: 11/07/2022] Open
Abstract
The American College of Radiology Mammography Accreditation Program (ACR MAP) reviews both clinical mammograms and a phantom image to assess clinical and technical quality from each mammography unit. The phantom contains details representing fibers (speculations), speck groups (microcalcifications), and masses. The depiction of these structures by the mammographic system is scored by medical physicists. The phantom image is taken using the facility's exposure technique for a 4.2-cm thick breast of average composition. The mean glandular dose (MGD) is determined from a set of thermoluminescent dosimeters placed on top of the chest wall edge of the phantom. Phantom scores and MGD data collected from 1993 to 1999 based on 31 535 unit evaluations are presented in this paper. The relationship between the failure rate for phantom image quality and MGD has been analyzed. While over all doses the phantom failure rate was 11%, for doses of 0.26 to 0.50 mGy the failure rate was 43%. The phantom failure rate fell continuously to about 6% for MGDs in the range of 1.51-2.0 mGy. With further increases in dose, failure rates began to rise. Factors that may account for these results are presented and discussed.
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Affiliation(s)
- A G Haus
- Sunnybrook & Womens College Health Sciences Center, Toronto, Canada.
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5
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Abstract
The association of bone marrow failure and skeletal defects has been frequently noted, however, the genetic basis for most of these syndromes remains unclear. We describe a previously uncharacterized autosomal dominant syndrome of amegakaryocytic thrombocytopenia associated with radial-ulnar synostosis. The clinical features of this syndrome appear to be distinct from other similar conditions, including Fanconi's anaemia and thrombocytopenia-absent radii (TAR). The physical findings at diagnosis and clinical management of each case are detailed, as well as a discussion of this disorder in the context of other syndromes in which marrow failure and skeletal defects are prominent features. We also review recent developments in molecular genetics that may provide important clues to the underlying aetiology of this condition.
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Affiliation(s)
- A A Thompson
- Departments of Paediatrics, University of California, Los Angeles School of Medicine, Los Angeles, CA, USA.
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6
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Abstract
Improved treatment and supportive care have increased the survival of children diagnosed with cancer. This success has resulted in a growing population at risk of long-term complications of therapy, including secondary malignancy. These neoplasms may result from the direct effect of the modalities used in treatment of the primary tumor, more indirect effects of the treatment or supportive care, the genetic predisposition of the patient, or to interactions among these factors. The increasing success of cancer therapy is producing a rapidly growing population of patients at risk of second malignancy. This is a result of the increasing intensity of treatments and the increasing duration of survival, which provides the time to manifest the late effects of therapy. The concept that a patient is "cured" at some arbitrary time after treatment does not diminish the need for follow-up of all cancer survivors to identify and treat secondary malignancies. These risks have led to an increased effort to define phenotypic and genotypic categories of patients that may be cured with less intensive therapy and to develop molecularly targeted drugs that have fewer noxious effects on normal tissues.
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Affiliation(s)
- S A Feig
- Gwynne Hazen Cherry Memorial Laboratories, The UCLA-Jonsson Comprehensive Cancer Center, Los Angeles, CA 90095, USA.
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Ziegner UH, Ochs HD, Schanen C, Feig SA, Seyama K, Futatani T, Gross T, Wakim M, Roberts RL, Rawlings DJ, Dovat S, Fraser JK, Stiehm ER. Unrelated umbilical cord stem cell transplantation for X-linked immunodeficiencies. J Pediatr 2001; 138:570-3. [PMID: 11295723 DOI: 10.1067/mpd.2001.112511] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Banked unrelated umbilical cord blood matched at 5 of 6 human leukocyte antigen loci was used to reconstitute the immune system in 2 brothers with X-linked lymphoproliferative syndrome and 1 boy with X-linked hyperimmunoglobulin-M syndrome. Pretransplant cytoreduction and posttransplant graft-versus-host prophylaxis were given. Hematopoietic engraftment and correction of the genetic defects were documented by molecular techniques. Two years after transplantation, all 3 patients have normal immune systems. These reports support the wider use of banked partially matched cord blood for transplantation in primary immunodeficiencies.
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Affiliation(s)
- U H Ziegner
- Division of Immunology/Allergy/Rheumatology, Mattel Children's Hospital at UCLA, Los Angeles, California 90095-1752, USA
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8
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Brenner RJ, Bassett LW, Fajardo LL, Dershaw DD, Evans WP, Hunt R, Lee C, Tocino I, Fisher P, McCombs M, Jackson VP, Feig SA, Mendelson EB, Margolin FR, Bird R, Sayre J. Stereotactic core-needle breast biopsy: a multi-institutional prospective trial. Radiology 2001; 218:866-72. [PMID: 11230668 DOI: 10.1148/radiology.218.3.r01mr44866] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.4] [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: 11/11/2022]
Abstract
PURPOSE To assess the accuracy of stereotactic core-needle biopsy (CNB) of nonpalpable breast lesions within the context of clinically important parameters of anticipated tissue-sampling error and concordance with mammographic findings. MATERIALS AND METHODS CNB was performed in 1,003 patients, with results validated at surgery or clinical and mammographic follow-up. Mammographic findings were scored according to the American College of Radiology Breast Imaging Reporting and Data System with a similar correlative scale for histopathologic samples obtained at either CNB or surgery. Agreement of CNB findings with surgical findings or evidence of no change during clinical and mammographic follow-up (median, 24 months) for benign lesions was used to determine results. Three forms of diagnostic discrimination measures (strict, working [strict conditioned by tissue sampling error], applied [working conditioned by concordance of imaging and CNB findings) were used to evaluate the correlation of CNB, surgical, and follow-up results. RESULTS Strict, working, and applied sensitivities were 91% +/- 1.9; 92% +/- 1.8, and 98% +/- 0.9, respectively; strict, working, and applied specificities were 100%, 98% +/- 0.8, and 73% +/- 0.9; strict, working, and applied accuracies were 97%, 96%, and 79%. CONCLUSION Percutaneous stereotactic CNB is an accurate method to establish a histopathologic diagnosis of nonpalpable breast lesions. Accuracy increases when additional surgery is performed for lesions with anticipated sampling error or when CNB findings are discordant with mammographic findings. An understanding of the interrelationship among these parameters is necessary to properly assess results.
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Affiliation(s)
- R J Brenner
- Joyce Eisenberg Keefer Breast Center, John Wayne Cancer Institute, St Johns Health Center, 1328 22nd St, Santa Monica, CA 90404, USA.
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Pisano ED, Cole EB, Major S, Zong S, Hemminger BM, Muller KE, Johnston RE, Walsh R, Conant E, Fajardo LL, Feig SA, Nishikawa RM, Yaffe MJ, Williams MB, Aylward SR. Radiologists' preferences for digital mammographic display. The International Digital Mammography Development Group. Radiology 2000; 216:820-30. [PMID: 10966717 DOI: 10.1148/radiology.216.3.r00se48820] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.5] [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: 11/11/2022]
Abstract
PURPOSE To determine the preferences of radiologists among eight different image processing algorithms applied to digital mammograms obtained for screening and diagnostic imaging tasks. MATERIALS AND METHODS Twenty-eight images representing histologically proved masses or calcifications were obtained by using three clinically available digital mammographic units. Images were processed and printed on film by using manual intensity windowing, histogram-based intensity windowing, mixture model intensity windowing, peripheral equalization, multiscale image contrast amplification (MUSICA), contrast-limited adaptive histogram equalization, Trex processing, and unsharp masking. Twelve radiologists compared the processed digital images with screen-film mammograms obtained in the same patient for breast cancer screening and breast lesion diagnosis. RESULTS For the screening task, screen-film mammograms were preferred to all digital presentations, but the acceptability of images processed with Trex and MUSICA algorithms were not significantly different. All printed digital images were preferred to screen-film radiographs in the diagnosis of masses; mammograms processed with unsharp masking were significantly preferred. For the diagnosis of calcifications, no processed digital mammogram was preferred to screen-film mammograms. CONCLUSION When digital mammograms were preferred to screen-film mammograms, radiologists selected different digital processing algorithms for each of three mammographic reading tasks and for different lesion types. Soft-copy display will eventually allow radiologists to select among these options more easily.
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Affiliation(s)
- E D Pisano
- Dept of Radiology, University of North Carolina CB7510, Chapel Hill, NC 27599-7510, USA.
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10
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Abstract
Most breast imaging centers today operate under financial strain. Among strategies designed to improve their bottom line, more efficient use of the radiologist's time is the most fundamental strategy and the one most likely to succeed in all breast imaging centers. Tasks performed by the radiologist that are not directly related to interpretation and consultation should be shifted to other personnel. Other strategies that may help some breast imaging centers include accepting only self-paying patients, renegotiating the hospital contract, performing more interventional procedures, and extending the hours of operation. Measures that can improve the economic efficiency of screening mammography include batch interpretation of mammograms; paperwork reduction; brief automated reports; limiting requests for previous films from other facilities to only potentially necessary cases; dedicated screening mammography examination rooms; reduction in recall rates; and, in certain circumstances, extension of breast center hours. Measures that can improve the economic efficiency of diagnostic mammography performance and interpretation include dedicated diagnostic mammography examination rooms, automated film rotators, improved scheduling, and efficient work-flow patterns for examination performance. Measures that can improve the economic efficiency of both screening and diagnostic mammography include improved triage of screening and diagnostic patients, reminder telephone calls to confirm mammography appointments, greater use of medical assistants to help the radiologists and technologists, and streamlined film library procedures and operations. Measures that can improve the economic efficiency of breast interventional procedures include preprocedure work-up, establishment of scheduling protocols, and greater involvement of technologists and medical assistants in assisting the radiologist who performs the interventional procedures. All of these methods are intended to create a breast imaging center that is cost efficient while maintaining a patient-friendly atmosphere and diagnostic accuracy.
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Affiliation(s)
- S A Feig
- Department of Radiology, Mount Sinai Hospital, Mount Sinai School of Medicine, New York, New York, USA
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11
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Abstract
Ductal carcinoma in situ (DCIS) now represents 20% of all newly diagnosed breast cancers because of increased detection by screening mammography. Twenty year relative survival rates are 97%. Postsurgical and histological studies and recent molecular biological studies indicate that most cases of DCIS will progress to invasive carcinoma if not detected by mammography. Screening mammography studies support the need for annual versus less frequent screenings to detect DCIS before further progression.
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Affiliation(s)
- S A Feig
- Department of Radiology, Mount Sinai School of Medicine, Mount Sinai Hospital, New York, New York, USA
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12
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Feig SA, Hall FM, Ikeda DM, Mendelson EB, Rubin EC, Segel MC, Watson AB, Eklund GW, Stelling CB, Jackson VP. Society of Breast Imaging residency and fellowship training curriculum. Radiol Clin North Am 2000; 38:915-20, xi. [PMID: 10943286 DOI: 10.1016/s0033-8389(05)70209-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 10/25/2022]
Abstract
A recently developed Society of Breast Imaging curriculum for residency training is intended to provide guidance to residents and their mentors, and to practicing radiologists who want to keep up to date in screening, diagnosis, and interventional procedures. The curriculum contains lists of key concepts in 14 subject areas: epidemiology; anatomy; pathology, and physiology; equipment and technique; quality control; interpretation; problem-solving mammography; ultrasound; interventional procedures; reporting and medicolegal aspects; screening; MR imaging; therapeutic considerations; and patient management principles. The curriculum also makes recommendations about residency training, including the number of examinations the resident should interpret, and the time the resident should spend in breast imaging. Recommendations for fellowship training are also discussed.
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Affiliation(s)
- S A Feig
- Department of Radiology, Mount Sinai Medical Center, New York, New York, USA
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13
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Abstract
Marked increases in national health care costs, along with governmental coverage of health care costs for the elderly under Medicare, have resulted in increased government regulation of medical reimbursement rates. Private insurers and HMOs now provide reimbursements that are frequently the same or lower than those from Medicare. Reimbursement rates for mammography have been particularly restricted. Although screening mammography appears to be as cost-effective as other commonly accepted medical interventions, some third-party payors have been reluctant to reimburse screening mammography because of its perceived effect on overall health care costs. An objective analysis shows that inclusion of coverage for screening mammography, however, even beginning at age 40 years, has only a slight effect on total health care costs. Adequate reimbursement for screening mammography supports an effort that provides substantial reduction in deaths from breast cancer.
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Affiliation(s)
- D Farria
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
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14
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Bassett LW, Farria DM, Bansal S, Farquhar MA, Wilcox PA, Feig SA. Reasons for failure of a mammography unit at clinical image review in the American College of Radiology Mammography Accreditation Program. Radiology 2000; 215:698-702. [PMID: 10831687 DOI: 10.1148/radiology.215.3.r00jn32698] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [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: 11/11/2022]
Abstract
PURPOSE To identify the most common deficiencies in the quality of mammograms submitted for clinical image evaluation (evaluation of image from actual patient referred for mammography). MATERIALS AND METHODS In 1997, the American College of Radiology Mammography Accreditation Program reviewed clinical images for 2,341 mammography units. For each mammography unit, the facility submitted bilateral mediolateral oblique and craniocaudal mammograms obtained in a woman with fatty breasts and a woman with dense breasts. Images were reviewed independently by two experienced radiologists. Reviewers listed the general categories and specific deficiencies that led to a decision to fail the unit that produced the clinical images. RESULTS Of the 2,341 mammography units, 1,034 (44%) failed the clinical image evaluation process. Of 6,128 categories cited by reviewers as deficient, 1,250 (20%) involved problems in positioning; 944 (15%), exposure; 887 (14%), compression; 806 (13%), sharpness; 785 (13%), contrast; 703 (11%), labeling; 465 (8%), artifacts; and 288 (5%), noise. A significantly higher proportion of failures was attributed to positioning deficiencies for fatty breasts than for dense breasts (P =.028). Higher proportions of failures in dense breasts were related to compression (P <.001) and exposure (P <.001) deficiencies. CONCLUSION Common problems in clinical image quality have been identified. This information should be useful for educators and facilities striving to improve the quality of mammography.
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Affiliation(s)
- L W Bassett
- Iris Cantor Center for Breast Imaging, University of California Los Angeles School of Medicine, USA
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15
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Warren Burhenne LJ, Wood SA, D'Orsi CJ, Feig SA, Kopans DB, O'Shaughnessy KF, Sickles EA, Tabar L, Vyborny CJ, Castellino RA. Potential contribution of computer-aided detection to the sensitivity of screening mammography. Radiology 2000; 215:554-62. [PMID: 10796939 DOI: 10.1148/radiology.215.2.r00ma15554] [Citation(s) in RCA: 349] [Impact Index Per Article: 14.5] [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: 11/11/2022]
Abstract
PURPOSE To determine the false-negative rate in screening mammography, the capability of computer-aided detection (CAD) to identify these missed lesions, and whether or not CAD increases the radiologists' recall rate. MATERIALS AND METHODS All available screening mammograms that led to the detection of biopsy-proved cancer (n = 1,083) and the most recent corresponding prior mammograms (n = 427) were collected from 13 facilities. Panels of radiologists evaluated the retrospectively visible prior mammograms by means of blinded review. All mammograms were analyzed by a CAD system that marks features associated with cancer. The recall rates of 14 radiologists were prospectively measured before and after installation of the CAD system. RESULTS At retrospective review, 67% (286 of 427) of screening mammography-detected breast cancers were visible on the prior mammograms. At independent, blinded review by panels of radiologists, 27% (115 of 427) were interpreted as warranting recall on the basis of a statistical evaluation index; and the CAD system correctly marked 77% (89 of 115) of these cases. The original attending radiologists' sensitivity was 79% (427 of [427 + 115]). There was no statistically significant increase in the radiologists' recall rate when comparing the values before (8.3%) with those after (7.6%) installation of the CAD system. CONCLUSION The original attending radiologists had a false-negative rate of 21% (115 of [427 + 115]). CAD prompting could have potentially helped reduce this false-negative rate by 77% (89 of 115) without an increase in the recall rate.
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Pisano ED, Yaffe MJ, Hemminger BM, Hendrick RE, Niklason LT, Maidment AD, Kimme-Smith CM, Feig SA, Sickles EA, Braeuning MP. Current status of full-field digital mammography. Acad Radiol 2000; 7:266-80. [PMID: 10766101 DOI: 10.1016/s1076-6332(00)80478-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- E D Pisano
- Department of Radiology, University of North Carolina, Chapel Hill 27599-7510, USA
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17
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Affiliation(s)
- S A Feig
- Department of Radiology, The Mount Sinai Hospital, Mount Sinai School of Medicine, New York, NY, USA
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18
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Sievers EL, Lange BJ, Sondel PM, Krailo MD, Gan J, Tjoa T, Liu-Mares W, Feig SA. Children's cancer group trials of interleukin-2 therapy to prevent relapse of acute myelogenous leukemia. Cancer J Sci Am 2000; 6 Suppl 1:S39-44. [PMID: 10685657] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
PURPOSE Up to 80% of children with acute myelogenous leukemia treated with intensive chemotherapy achieve remission; however, a large proportion of patients develops recurrent disease. Because interleukin (IL)-2 can induce remission in patients with overt evidence of acute myelogenous leukemia, we hypothesized that it might prevent relapse when administered to patients in first remission after intensive consolidation chemotherapy. A pilot Children's Cancer Group (CCG) trial (CCG-0941) demonstrated the feasibility of this approach, and we initiated a prospective randomized trial (CCG-2961) to further evaluate the safety and potential efficacy of IL-2 therapy in preventing relapse of acute myelogenous leukemia. PATIENTS AND METHODS In trial CCG-0941, 21 pediatric patients in complete remission following induction and consolidation chemotherapy on protocol CCG-2941 received IL-2 therapy. In CCG-2961, 79 patients in complete remission were randomized as of February 1999 to receive either IL-2 (n = 39) or no further therapy. In both trials, recombinant IL-2 was given at a dose of 9 million IU/m2/d by continuous intravenous infusion for 4 days. After 4 days of rest, IL-2 was resumed at a dose of 1.6 million IU/m2/d for 10 days by continuous infusion. We monitored patients for toxicity and relapse. RESULTS The majority of patients treated with IL-2 in these two trials experienced some degree of fever. Seven of 60 patients (12%) had clinically significant rashes, and grade 3 vascular leak syndrome and hypotension have each been observed in five patients (8%). Hypotension resolved promptly after treatment with intravenous fluids. No patients have experienced renal toxicity or required cardiac vasopressors or transfer to an intensive care unit; there have been no treatment-related deaths. Overall, the incidence and severity of adverse events remain similar in the two trials. Total projected accrual to the IL-2 randomization is anticipated to be 326 patients, and relapse and survival data remain blinded. CONCLUSION The dose and schedule of IL-2 used in these two trials continue to be reasonably well tolerated by children with acute myelogenous leukemia in first remission. Any conclusions with regard to efficacy must await completion of the randomized trial.
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Affiliation(s)
- E L Sievers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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19
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Dovat S, Roberts RL, Wakim M, Stiehm ER, Feig SA. Immune thrombocytopenia after umbilical cord progenitor cell transplant: response to vincristine. Bone Marrow Transplant 1999; 24:321-3. [PMID: 10455373 DOI: 10.1038/sj.bmt.1701888] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [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: 11/09/2022]
Abstract
An 8-month-old male with X-linked lymphoproliferative disease underwent an unrelated, partially matched (with major mismatch at DR locus), cord blood stem cell transplant. Four months following the transplant, he developed immune thrombocytopenia with hemolytic anemia (Evans syndrome). He received multiple courses of intravenous immunoglobulin, anti-Rh D immunoglobulin, a pulse of high-dose corticosteroids and cyclosporine with some improvement of hemolytic anemia, but no improvement of the thrombocytopenia. Addition of vincristine, resulted in long-term resolution of thrombocytopenia and anemia. No major toxicity was observed during treatment. Vincristine should be considered as a treatment for refractory immune thrombocytopenia after hematopoietic stem cell transplantation.
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Affiliation(s)
- S Dovat
- Department of Pediatrics, UCLA School of Medicine, UCLA Children's Hospital, Los Angeles, CA 90095-1752, USA
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20
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Abstract
PURPOSE To show that benign asymmetric breast tissue detected mammographically may increase over time. MATERIALS AND METHODS Serial mammograms obtained in 21 women with negative physical examination results and mammographically detected developing asymmetric breast tissue were reviewed, and findings were correlated with results of biopsy (n = 16), ultrasonography (US) (n = 8), and contrast material-enhanced magnetic resonance (MR) imaging (n = 3). Five patients who did not undergo biopsy were followed up for 13-84 months. Thirteen of 16 biopsy specimens were reviewed. RESULTS At the time of mammographic change, 12 patients without baseline asymmetric tissue had a mean age of 41.7 years and a mean size of asymmetric tissue of 2.4 cm. The mean age of nine patients with baseline asymmetric tissue was 46.9 years. In eight patients, the mean size increase was 2.5 cm. One patient showed increased tissue density but stable size. All US and MR images were negative. Pseudoangiomatous stromal hyperplasia was present in all 13 biopsy specimens reviewed and extensive in 12. No malignancies have been reported in five of the followed-up patients, and two have had continued enlargement of asymmetric tissue. CONCLUSION Pseudoangiomatous stromal hyperplasia is a common histopathologic finding in developing asymmetric breast tissue. Follow-up, rather than biopsy, is a management option if benign imaging and clinical criteria are met.
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Affiliation(s)
- C W Piccoli
- Department of Radiology, Jefferson Medical College, Philadelphia, PA, USA
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21
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Bassett LW, Cardenosa G, D'Orsi CJ, Dempsey PJ, Dershaw DD, Destouet JM, Evans WP, Feig SA, Hendrick RE, Jackson VP, Kopans DB, Linver MN, Mendelson EB, Monsees B, Racenstein MJ, Sickles EA, Stelling CB, Warren L. Risk of risk-based mammography screening, ages 40 to 49. American College of Radiology Task Force on Breast Cancer. J Clin Oncol 1999; 17:735-8. [PMID: 10080624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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22
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Abstract
Mammographic screening of women age 40 and older can reduce breast cancer deaths by at least 30% to 40%. However, not all cancers are detected by mammography. Although a new supplementary modality for screening could, in theory, fill in this detection gap, such utilization must be based on rigorous demonstration of its ability to consistently and frequently find early cancers missed by mammography, such as those occurring in dense breasts or rapidly growing interval cancers that surface clinically between mammographic screens. After an abnormality is found at mammographic screening, supplementary mammographic views and/or ultrasound are now used to match the finding with an ACR BIRADS final diagnostic assessment category to indicate the relative likelihood of a normal, benign, or malignant diagnosis so that routine screening, short interval follow-up, or biopsy can then be advised. Appropriate categorization will maximize early cancer detection and minimize false-positive biopsies. Application of a new imaging method to this type of diagnostic evaluation requires well-designed studies to determine its effectiveness for this purpose.
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Affiliation(s)
- S A Feig
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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23
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Rovno HD, Feig SA, Hughes JS, Hurford MT, Karasick D, Filippone E. Breast imaging case of the day. Spontaneously disappearing benign calcifications of the breast. Radiographics 1998; 18:1599-604. [PMID: 9821202 DOI: 10.1148/radiographics.18.6.9821202] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- H D Rovno
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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Affiliation(s)
- A N Wilkes
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107-5563, USA
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25
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Abstract
Although direct evidence of carcinogenic risk from mammography is lacking, there is a hypothetical risk from screening because excess breast cancers have been demonstrated in women receiving doses of 0.25-20 Gy. These high-level exposures to the breast occurred from the 1930s to the 1950s due to atomic bomb radiation, multiple chest fluoroscopies, and radiation therapy treatments for benign disease. Using a risk estimate provided by the Biological Effects of Ionizing Radiation (BEIR) V Report of the National Academy of Sciences and a mean breast glandular dose of 4 mGy from a two-view per breast bilateral mammogram, one can estimate that annual mammography of 100,000 women for 10 consecutive years beginning at age 40 will result in at most eight breast cancer deaths during their lifetime. On the other hand, researchers have shown a 24% mortality reduction from biennial screening of women in this age group; this will result in a benefit-to-risk ratio of 48.5 lives saved per life lost and 121.3 years of life saved per year of life lost. An assumed mortality reduction of 36% from annual screening would result in 36.5 lives saved per life lost and 91.3 years of life saved per year of life lost. Thus, the theoretical radiation risk from screening mammography is extremely small compared with the established benefit from this life-saving procedure and should not unduly distract women under age 50 who are considering screening.
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Affiliation(s)
- S A Feig
- Jefferson Medical College, Philadelphia, PA, USA
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26
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Kopans DB, Feig SA. False positive rate of screening mammography. N Engl J Med 1998; 339:562-4. [PMID: 9714625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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27
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Abstract
Proof of the benefit for mammographic screening of women ages 40-49 years is now available. Randomized controlled trials (RCTs) conducted in Gothenburg and Malmo, Sweden have shown statistically significant breast cancer mortality reductions of 36% and 45% respectively. A meta-analysis of all five Swedish trials has found a statistically significant mortality reduction of 29% for woman in this age group. Substantially greater reductions in mortality would likely have resulted if women in these trials had been screened annually. Because the benefits are substantial, and the risks from screening are relatively small and acceptable, screening mammography beginning at age 40 is now recommended by the American Cancer Society, as well as the National Cancer Institute.
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Affiliation(s)
- S A Feig
- Department of Radiology, Breast Imaging Center, Thomas Jefferson University Hospital, Philadelphia, PA 19107-5563, USA
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28
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Affiliation(s)
- S A Feig
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107-5563, USA
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29
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Feig SA, D'Orsi CJ, Hendrick RE, Jackson VP, Kopans DB, Monsees B, Sickles EA, Stelling CB, Zinninger M, Wilcox-Buchalla P. American College of Radiology guidelines for breast cancer screening. AJR Am J Roentgenol 1998; 171:29-33. [PMID: 9648758 DOI: 10.2214/ajr.171.1.9648758] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- S A Feig
- Breast Imaging Center, Department of Radiology, Jefferson University Hospital, Philadelphia, PA 19107-5563, USA
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30
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Whitfill CH, Feig SA, Webner D. Breast imaging case of the day. Secondary non-Hodgkin (low-grade B-cell follicular small cleaved cell type) lymphoma of the breast. Radiographics 1998; 18:1038-42. [PMID: 9672987 DOI: 10.1148/radiographics.18.4.9672987] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- C H Whitfill
- Department of Radiology, Breast Imaging Center, Philadelphia, PA, USA
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31
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Affiliation(s)
- C W Piccoli
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA
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32
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Abstract
PROBLEM Therapy of children with relapsed acute lymphoblastic leukemia (ALL) not achieving a second remission (CR2) after an initial reinduction attempt is problematic. METHODS 52 children with ALL in first relapse received high-dose cytosine arabinoside and L-asparaginase (HDAraC/L-Asp) after failed attempts to achieve CR2. AraC was given at a dose of 3 gm/m2 q12 h x 4 on days 0-1 and 7-8. L-asparaginase was given IM 6,000 IU/m2 3 hours after completion of each 2-day cycle of AraC. RESULTS Of the 42 surviving to day 28, 22 (42% of all patients) achieved CR2. Ten died before day 28 (19%); four from leukemia and six from infections or toxicity (12% regimen-related mortality), There were 17 bacterial infections (three fatal), 17 invasive fungal infections (12 fatal), one fatal adenoviral infection, and one-non-fatal Pneumocystis pneumonia. One patient was surviving when lost to follow-up at four months and one patient survives over 5 years after transplant. Sixteen of the 22 patients who entered CR2 subsequently relapsed, five died of non-leukemic causes, and one was lost to follow-up. The median duration of second remission was 3 months (range 0.7 to 19 months). CONCLUSIONS HDAraC/L-Asp rescue reinduction for relapsed childhood ALL achieves CR2 in approximately 40% of patients who fail reinduction, but remissions are short for most patients and maintenance of CR2 remains unsatisfactory.
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Affiliation(s)
- R E Harris
- Stem Cell Transplanting Program, Children's Hospital Medical Center, Cincinnati, Ohio, USA
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33
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Sievers EL, Lange BJ, Sondel PM, Krailo MD, Gan J, Liu-Mares W, Feig SA. Feasibility, toxicity, and biologic response of interleukin-2 after consolidation chemotherapy for acute myelogenous leukemia: a report from the Children's Cancer Group. J Clin Oncol 1998; 16:914-9. [PMID: 9508173 DOI: 10.1200/jco.1998.16.3.914] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [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: 02/06/2023] Open
Abstract
PURPOSE Although remission can be achieved in 80% of children with acute myelogenous leukemia (AML), many patients experience relapse. Because interleukin-2 (IL-2) can induce remission in patients with overt evidence of AML, we hypothesized that IL-2 given to patients in first remission after intensive consolidation chemotherapy might prevent relapse. This study sought to determine whether such an approach was feasible. PATIENTS AND METHODS Twenty-one patients in complete remission received IL-2 after completion of treatment on Children's Cancer Group (CCG) protocol 2941. Recombinant IL-2 9 x 10(6) IU/m2 daily by continuous intravenous infusion (c.i.v.) was given for 4 days. After 4 days rest, IL-2 1.6 x 10(6) IU/m2 daily c.i.v. was resumed for 10 days. We monitored patients for toxicity and measured absolute lymphocyte count, the absolute count of cells that express CD56 and CD3 antigen, and soluble IL-2 receptor alpha-chain (sIL-2R alpha) levels before the start of IL-2 and after completion of each of the two courses of IL-2. RESULTS Observed toxicities included fever (57%), vascular leak (48%), hypotension (38%), tachycardia (14%), rash (29%), septicemia (5%), thrombocytopenia (29%), elevated transaminase (14%), electrolyte disturbance (29%), and hyperglycemia (10%). No patient required cardiac pressors or transfer to an intensive care unit. All patients studied developed an increase in lymphocyte count, CD56 count, CD3 count, and sIL-2R alpha levels after treatment with IL-2. CONCLUSION This schedule of IL-2 was reasonably well tolerated by children with AML in first remission. After treatment, increased levels of sIL-2R alpha were observed. CCG is conducting a randomized prospective trial to assess the efficacy of IL-2 to prevent the relapse of AML (CCG-2961).
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Affiliation(s)
- E L Sievers
- Division of Pediatric Oncology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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34
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Affiliation(s)
- T J Murphy
- Department of Diagnostic Imaging, Phoenixville Hospital, University of Pennsylvania Health Systems, USA
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35
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Seeger RC, Rosenblatt JD, Duerst RE, Reynolds CP, Villablanca JG, Hasenauer B, Feig SA. A Phase I study of human gamma interferon gene-transduced tumor cells in patients with neuroblastoma. Hum Gene Ther 1998; 9:379-90. [PMID: 9508055 DOI: 10.1089/hum.1998.9.3-379] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- R C Seeger
- Division of Hematology-Oncology, Children's Hospital Los Angeles, USA
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36
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Nussbaum SA, Feig SA, Capuzzi DM. Breast imaging case of the day. Fibroadenoma with microcalcification. Radiographics 1998; 18:243-5. [PMID: 9460129 DOI: 10.1148/radiographics.18.1.9460129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- S A Nussbaum
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA 19107-5563, USA
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37
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38
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Feig SA, Harris RE, Sather HN. Bone marrow transplantation versus chemotherapy for maintenance of second remission of childhood acute lymphoblastic leukemia: a study of the Children's Cancer Group (CCG-1884). Med Pediatr Oncol 1997; 29:534-40. [PMID: 9324340 DOI: 10.1002/(sici)1096-911x(199712)29:6<534::aid-mpo3>3.0.co;2-l] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Maintenance of second remission of childhood acute lymphoblastic leukemia (ALL) with intensive chemotherapy is often unsuccessful. The major cause of treatment failure is relapse. MATERIALS AND METHODS Of 96 children with ALL who relapsed in the marrow while on or within 1 year of completing initial therapy, 62 achieved a second remission. Nineteen patients underwent bone marrow transplantation in second remission, 11 from a human leukocyte antigen (HLA)-matched related donor, seven using autologous marrow, and one from a matched unrelated donor. The event-free survival (EFS) of transplanted patients was compared to that of patients treated with intensive chemotherapy using high-dose cytarabine, vincristine, escalating dose methotrexate, L-asparaginase, and an anthracycline (daunorubicin or idarubicin). Only those patients treated with chemotherapy who survived in second remission up to the mean time that patients were transplanted (135 days) were included in the control group (33 of 43 patients who achieved second remission). RESULTS The actuarial 2-year event-free survival of transplanted patients is 37+/-22% (95% C.I.) compared to 18+/-13% for chemotherapy-treated patients (P=0.017). EFS for allo-transplant recipients was similar to that for auto-transplant recipients. Duration of initial remission was a strong predictor of the outcome of retrieval therapy. Patients whose initial remission was greater than 3 years had better EFS after achieving second remission (five of 11 still in remission, compared to four of 41 patients whose initial remission was less than 3 years). Adjustment in the multivariate analysis for duration of initial remission did not diminish the benefit of transplant over chemotherapy. CONCLUSIONS While there remains considerable possibility for further improvement in EFS after achieving second remission of childhood ALL, bone marrow transplant is superior to chemotherapy in maintaining second remission.
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Affiliation(s)
- S A Feig
- UCLA Children's Hospital, Los Angeles, CA, USA
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39
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Dovat S, Feig SA. The use of umbilical cord blood stem cells for hematopoietic reconstitution. West J Med 1997; 166:342-3. [PMID: 9217441 PMCID: PMC1304236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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40
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Abstract
We describe a patient who developed a paradoxical embolus to the brain during infusion of bone marrow. She had a patent foramen ovale through which right-to-left shunting led to multiple cerebral emboli. This complication can be prevented by positioning the tip of the infusion catheter in the main pulmonary artery and reducing the volume of marrow product infused.
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Affiliation(s)
- T B Moore
- Division of Pediatric Hematology/Oncology, UCLA School of Medicine, USA
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41
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Buchanan GR, de Alarcon PA, Feig SA, Gilchrist GS, Lukens JN, Moertel CL, Cohen AR, Dickerman JD, Forman EN, Glader BE, Lusher JM. Acute idiopathic thrombocytopenic purpura--management in childhood. Blood 1997; 89:1464-5; author reply 1466. [PMID: 9028973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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42
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Stiehm ER, Roberts RL, Hanley-Lopez J, Wakim ME, Pallavicini MG, Cowan MJ, Ettenger RB, Feig SA. Bone marrow transplantation in severe combined immunodeficiency from a sibling who had received a paternal bone marrow transplant. N Engl J Med 1996; 335:1811-4. [PMID: 8943163 DOI: 10.1056/nejm199612123352405] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- E R Stiehm
- Department of Pediatrics, University of California at Los Angeles, 90095-1752, USA
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43
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Feig SA, Ames MM, Sather HN, Steinherz L, Reid JM, Trigg M, Pendergrass TW, Warkentin P, Gerber M, Leonard M, Bleyer WA, Harris RE. Comparison of idarubicin to daunomycin in a randomized multidrug treatment of childhood acute lymphoblastic leukemia at first bone marrow relapse: a report from the Children's Cancer Group. Med Pediatr Oncol 1996; 27:505-14. [PMID: 8888809 DOI: 10.1002/(sici)1096-911x(199612)27:6<505::aid-mpo1>3.0.co;2-p] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The outcome of children with acute lymphoblastic leukemia (ALL) and bone marrow relapse has been unsatisfactory largely because of failure to prevent subsequent leukemia relapses. Ninety-six patients were enrolled and received vincristine, prednisone, L-asparaginase, and an anthracycline as reinduction therapy. Ninety-two patients were randomized to receive either daunomycin (DNR) or idarubicin (IDR). After achievement of second complete remission (CR2), maintenance chemotherapy included the same anthracycline, IDR or DNR, high-dose cytarabine, and escalating-dose methotrexate. Compared to DNR (45 mg/m2/week x 3), IDR (12.5 mg/m2/week x 3) was associated with prolonged myelosuppression and more frequent serious infections. Halfway through the study, the dose of IDR was reduced to 10 mg/m2. Overall, second remission was achieved in 71% of patients. Reinduction rate was similar for IDR and DNR. Reasons for induction failure differed; none of 15, 1 of 5, and 5 of 7 reinduction failures were due to infection for DNR, IDR (10 mg/m2), and IDR (12.5 mg/m2), respectively. Two-year event-free survival (EFS) was better among patients who received IDR (12.5 mg/m2) (27 +/- 18%) compared to DNR (10 +/- 8%, P = 0.05) and IDR (10 mg/m2) (6 +/- 12%, P = 0.02). However, after 3 years of follow-up, late events in the high-dose IDR group result in a similar EFS to the lower-dose IDR and DNR groups. In conclusion, IDR is an effective agent in childhood ALL. When used weekly at 12.5 mg/m2 during induction, the EFS outcome during the first 2 years of treatment appears better than lower-dose IDR or DNR (45 mg/m2), although this difference was not sustained at longer periods of follow-up. Increased hematopoietic toxicity seen at this dose might be reduced through the use of supportive measures, such as hematopoietins and intestinal decontamination.
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45
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Abstract
Some inherent limitations to further technical improvement in film-screen mammography exist. Many of these limitations can be overcome effectively with digital mammography, in which image acquisition, display, and storage are performed independently, thus allowing the optimization of each. Presented is a brief background of digital and analog imaging with emphasis on the features and drawbacks of digital mammography systems. Image storage, processing, and display, computer-aided detection and diagnosis, as well as telemammography are also discussed.
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Affiliation(s)
- S A Feig
- Department of Radiology, Jefferson Medical College, Philadelphia, PA 19107-5563, USA
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46
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Feig SA. Mammographic screening of elderly women. JAMA 1996; 276:446. [PMID: 8691541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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47
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Feig SA. Strategies for improving sensitivity of screening mammography for women aged 40 to 49 years. JAMA 1996; 276:73-4. [PMID: 8667544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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48
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Feig SA. Assessment of radiation risk from screening mammography. Cancer 1996; 77:818-22. [PMID: 8608469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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49
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50
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Abstract
A recently published meta-analysis of seven randomized trials showed a statistically significant 24% reduction in mortality rate with the use of mammographic screening for women age 40-49 years. The benefit would have been even greater if screening had been performed at shorter annual intervals with the most up-to-date mammographic equipment. Additionally, these trials underestimated benefit due to inclusion of breast cancer deaths among study group women who refused to undergo screening. In contrast to these documented benefits, no woman has ever been shown to have developed breast cancer as a result of mammography, even with multiple examinations at doses many times higher than the current 0.25 cGy from a two-view-per-breast examination. The possibility of low dose risk has been theorized based on excess rates of cancer among populations that have received doses of 100 to more than 1000 cGy, such as atomic-bomb survivors. If there is a risk, it is negligible or nonexistent compared with the screening benefit. The total cost of screening is a summation of the following costs: (1) screening mammogram plus down-stream costs of supplementary mammographic views and/or ultrasound for further evaluation of some screenees; (2) mammographic follow-up; and (3) core or excisional biopsy for those women in whom a suspicious abnormality persists after workup. Based on a range of procedural costs, a 30% reduction in breast cancer deaths due to incidence screening of women age 40-49 will cost $6,930.00-$13,413.00 per year of life expectancy gained.
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Affiliation(s)
- S A Feig
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107-5563, USA
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