8 results on '"Paola Clauser"'
Search Results
2. Can supplementary contrast-enhanced MRI of the breast avoid needle biopsies in suspicious microcalcifications seen on mammography? A systematic review and meta-analysis
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Nina Pötsch, Panagiotis Kapetas, Barbara Fueger, Paola Clauser, Pascal A. T. Baltzer, and Thomas H. Helbich
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medicine.medical_specialty ,Stereotactic biopsy ,Biopsy ,Contrast Media ,Microcalcifications ,Breast Neoplasms ,lcsh:RC254-282 ,03 medical and health sciences ,Magnetic resonance imaging ,0302 clinical medicine ,medicine ,False positive paradox ,Humans ,Mammography ,Breast ,030212 general & internal medicine ,medicine.diagnostic_test ,business.industry ,Biopsy, Needle ,Calcinosis ,General Medicine ,Nomogram ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Pre- and post-test probability ,Sensitivity and specificity ,030220 oncology & carcinogenesis ,Meta-analysis ,Original Article ,Female ,Surgery ,Radiology ,Microcalcification ,medicine.symptom ,business - Abstract
Purpose To analyze the rate of potentially avoidable needle biopsies in mammographically suspicious calcifications if supplementary Contrast-Enhanced MRI (CE-MRI) is negative. Methods Using predefined criteria, a systematic review was performed. Studies investigating the use of supplemental CE-MRI in the setting of mammographically suspicious calcifications undergoing stereotactic biopsy and published between 2000 and 2020 were eligible. Two reviewers extracted study characteristics and true positives (TP), false positives, true negatives and false negatives (FN). Specificity, in this setting equaling the number of avoidable biopsies and FN rates were calculated. The maximum pre-test probability at which post-test probabilities of a negative CE-MRI met with BI-RADS benchmarks was determined by a Fagan nomogram. Random-effects models, I2-statistics, Deek’s funnel plot testing and meta-regression were employed. P-values, Highlights • A negative breast MRI can downgrade up to 80.6% of suspicious microcalcifications, potentially avoiding vacuum-assisted breast biopsies. • Up to a pretest probability of 22% , a negative breast MRI result would not exceed the 2% cancer rate required for a BI-RADS 3 category assignment.
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- 2021
3. Can we predict lesion detection rates in second-look ultrasound of MRI-detected breast lesions? A systematic analysis
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Katja Pinker, Pascal A. T. Baltzer, Maria Bernathova, Paola Clauser, Thomas H. Helbich, Panagiotis Kapetas, Alexander Bumberger, and Michael Kolta
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Adult ,medicine.medical_specialty ,Clinical Decision-Making ,Breast Neoplasms ,Multimodal Imaging ,Sensitivity and Specificity ,030218 nuclear medicine & medical imaging ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Biopsy ,medicine ,Humans ,Breast MRI ,Radiology, Nuclear Medicine and imaging ,Breast ,Aged ,Retrospective Studies ,Univariate analysis ,medicine.diagnostic_test ,Lesion detection ,business.industry ,Ultrasound ,Second look ultrasound ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,Magnetic Resonance Imaging ,030220 oncology & carcinogenesis ,Female ,Ultrasonography, Mammary ,Radiology ,medicine.symptom ,business - Abstract
Purpose To predict detection rates (DR) in second-look ultrasound of MRI-detected breast lesions by systematically combining clinical and anthropomorphic features. Methods A total of 104 suspicious breast-lesions, that were initially detected on breast MRI and underwent subsequent SLU from January 2013 through December 2013, were evaluated in this retrospective analysis. All images were reviewed by an experienced radiologist for this study. Both anthropomorphic, spatial and BI-RADS lesion features were recorded. Uni- and multivariate Classification and Regression Trees (CRT) statistics were used to predict SLU DR by these features. Results Among 104 MRI-detected lesions, 58 (55.8%) showed a correlate on SLU. In univariate analysis, homogeneous fatty or dense fibro-glandular-tissue-composition (FGT) as assessed by ultrasound, segmental non-mass-distribution pattern and small breast size as assessed by MRI were significantly associated with higher DR on SLU. The remaining BI-RADS features did not significantly affect SLU DR according to our data. The predictive model could stratify the likelihood of SLU correlates as high, intermediate and low according to FGT, lesion type, size and position. Conclusions By systematically combining the features FGT, lesion type, size and position, we could predict SLU DR of MRI-detected breast lesions. This may help to decide the preferable method for lesion biopsy or follow-up in clinical practice.
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- 2019
4. Correct determination of the enhancement curve is critical to ensure accurate diagnosis using the Kaiser score as a clinical decision rule for breast MRI
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Pascal A. T. Baltzer, Panagiotis Kapetas, Cristina Grippo, Paola Clauser, Thomas H. Helbich, and Pooja Jagmohan
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medicine.medical_specialty ,Contrast enhancement ,Contrast Media ,Breast Neoplasms ,Delayed enhancement ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Clinical Decision Rules ,medicine ,Humans ,Breast MRI ,Radiology, Nuclear Medicine and imaging ,Breast ,Clinical decision ,Retrospective Studies ,Receiver operating characteristic ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,Image Enhancement ,medicine.disease ,Magnetic Resonance Imaging ,ROC Curve ,Area Under Curve ,030220 oncology & carcinogenesis ,Time curve ,Radiology ,business - Abstract
the Kaiser score is increasingly recognized as a valuable tool to improve breast MRI interpretation. Contrast enhancement kinetics are the second most important diagnostic criterion, thus defining the curve type plays a crucial role in Kaiser score assessment. We investigate whether the timepoint used to determine the initial enhancement (earlyor peak) for the signal-intensity time curve analysis affects the diagnostic performance of the Kaiser score.This IRB-approved, retrospective, single-center study included 70 consecutives histologically verified breast MRI cases. Two off-site breast radiologists independently read all examinations using the Kaiser score, assessing the initial enhancement using three approaches: -first (1 st), second (2nd) and peak (maximum) of either 1 st or 2nd post-contrast timepoints. The initial enhancement was then compared to the last timepoint (delayed enhancement) to determine the curve type. Visual assessment of curve types was used for this study. Diagnostic performance was evaluated by receiver operating characteristics (ROC) analysis.Kaiser score reading results using the peak enhancement of either the first or second timepoint performed significantly better than the other approaches (P 0.05, respectively) and specifically achieved higher sensitivity. Diagnostic accuracy (AUC area under the curve) ranged between 85.4 % and 91.6 %, without significant differences between the two readers (P 0.5).Diagnostic performance of the Kaiser score is significantly influenced by how the initial enhancement timepoint is determined. Peak enhancement should be used as initial timepoint to avoid pitfalls due to timing or physiological differences.
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- 2021
5. A new method to reduce false positive results in breast MRI by evaluation of multiple spectral regions in proton MR-spectroscopy
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Magda Marcon, Paola Clauser, Matthias Dietzel, and Pascal A. T. Baltzer
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Breast Neoplasms ,Diagnostic accuracy ,Signal-To-Noise Ratio ,Sensitivity and Specificity ,Choline ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Breast MRI ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Medical diagnosis ,Prospective cohort study ,medicine.diagnostic_test ,business.industry ,Water ,Magnetic resonance imaging ,Mean age ,General Medicine ,Magnetic Resonance Imaging ,CHAID ,Proton mr spectroscopy ,Radiography ,Area Under Curve ,030220 oncology & carcinogenesis ,Female ,Protons ,Nuclear medicine ,business ,Methane ,Algorithms - Abstract
Objectives To investigate whether the evaluation of multiple spectral regions can increase the diagnostic performance of 1 H-MRS of the breast and reduce false positive findings. Methods 93 patients (mean age 56 years, range 23–79) undergoing breast MRI for routine clinical indications on a 1.5 T scanner were eligible for this IRB-approved prospective study. Suspicious enhancing lesions ≥8 mm underwent single-voxel point-resolved 1 H-MRS (PRESS, TR = 2000 ms, TE = 272 ms). Histology showed 69 malignant and 24 benign lesions. The Signal-to-Noise ratio of choline, olefinic acids and the water-to-methylene ratio were measured. The area under the ROC-curve (AUC) was used to evaluate single measurements. Combined diagnostic accuracy was explored using a 10-fold cross-validated Chi-squared automatic interaction detection (CHAID) analysis. Inter-reader agreement was evaluated in a subset of patients. Results A significant AUC for differentiation between benign and malignant lesions was identified for choline (0.733, P = 0.001), olefinic acids (0.769, P = 0.0001) and water-to-methylene ratio (0.704, P = 0.003). All three variables were included in a classification algorithm using CHAID methodology. Using this classification, 70.8% (17/24) false positive diagnoses in benign lesions would have been avoided. Inter-reader agreement was almost perfect. Conclusions The combined evaluation of multiple spectral regions can increase the diagnostic performance of 1 H-MRS and potentially reduce false positive findings.
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- 2017
6. Diagnostic performance of digital breast tomosynthesis with a wide scan angle compared to full-field digital mammography for the detection and characterization of microcalcifications
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Pascal A. T. Baltzer, Michael Weber, Panagiotis Kapetas, Katja Pinker-Domenig, Paola Clauser, Thomas H. Helbich, Georg Nagl, and Maria Bernathova
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Adult ,Image-Guided Biopsy ,medicine.medical_specialty ,Digital mammography ,Breast Neoplasms ,030218 nuclear medicine & medical imaging ,Cohort Studies ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Humans ,Medicine ,Mammography ,Single-Blind Method ,Radiology, Nuclear Medicine and imaging ,Breast ,Scan angle ,Aged ,Breast Density ,Retrospective Studies ,Aged, 80 and over ,Observer Variation ,medicine.diagnostic_test ,business.industry ,Carcinoma, Ductal, Breast ,Calcinosis ,General Medicine ,Digital Breast Tomosynthesis ,Middle Aged ,medicine.disease ,Full field digital mammography ,Tomosynthesis ,Radiographic Image Enhancement ,Carcinoma, Intraductal, Noninfiltrating ,030220 oncology & carcinogenesis ,Female ,Radiology ,Detection rate ,business ,Follow-Up Studies - Abstract
To assess the diagnostic performance of digital breast tomosynthesis (DBT), with a wide scan-angle, compared to full-field digital mammography (FFDM), for the detection and characterization of microcalcifications.IRB approval was obtained for this retrospective study. We selected 150 FFDM and DBT (50 benign and 50 malignant histologically verified microcalcifications, 50 cases classified as BI-RADS 1). Four radiologists evaluated, in separate sessions and blinded to patients' history and histology, the presence of microcalcifications. Cases with microcalcifications were assessed for visibility, characteristics, and grade of suspicion using BI-RADS categories. Detection rate and diagnostic performance were calculated. Visibility, lesions' characteristics and reading time were analysed.Detection rate and visibility were good for both FFDM and DBT, without intra-reader differences (P=0.510). Inter-reader differences were detected (P0.018). Only two lesions were not detected by any reader on either FFDM or DBT. Diagnostic performance with DBT was as good as that of FFDM, but a significant inter-reader difference was found (P=0.041). High inter-reader variability in the use of the descriptors was found. Reading time for DBT was almost twice that for FFDM (44 and 25s, respectively).Wide scan-angle DBT enabled the detection and characterization of microcalcifications with no significant differences from FFDM. Inter-reader variability was seen.
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- 2016
7. MRI-based quantification of residual fibroglandular tissue of the breast after conservative mastectomies
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Georg Pfeiler, Katja Pinker, Maria Adele Marino, Thomas H. Helbich, Alex Farr, Veronika Schöpf, Panagiotis Kapetas, Maria Bernathova, Paola Clauser, Julia Furtner, Pascal A. T. Baltzer, Ramona Woitek, Woitek, Ramona [0000-0002-9146-9159], and Apollo - University of Cambridge Repository
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Adult ,medicine.medical_specialty ,medicine.medical_treatment ,Breast Neoplasms ,Risk Assessment ,Article ,030218 nuclear medicine & medical imaging ,Imaging ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,Breast cancer ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Postoperative Period ,Mastectomy ,Retrospective Studies ,Mammary glands ,medicine.diagnostic_test ,business.industry ,Reproducibility of Results ,Magnetic resonance imaging ,Prophylactic Mastectomy ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Exact test ,Patient Satisfaction ,030220 oncology & carcinogenesis ,Nipples ,Female ,Radiology ,Neoplasm Recurrence, Local ,Risk assessment ,business ,Organ Sparing Treatments - Abstract
PURPOSE: Skin-sparing and nipple-sparing mastectomies (SSM; NSM) remove the breast’s fibroglandular tissue (FGT), thereby reducing breast cancer risk. The postoperative presence of residual FGT (RFGT) is associated with remaining cancer risk. This study evaluated the role of MRI in the quantitative assessment of RFGT and its impact on the estimation of the remaining breast cancer risk. METHODS: The postoperative MRI scans (following EUSOMA recommendations) of 58 patients who had undergone SSM or NSM between 2003 and 2013, as well as preoperative MRI scans that were available in 25 of these patients, were retrospectively evaluated for the presence and location of RFGT by three radiologists. Two different observers quantitatively assessed the volume and percentage of retromamillary and other RFGT (RFGT(rm) and RFGT(other)) were assessed. The Fisher’s exact test, the Student’s t-test, and intraclass coherence were used to compare patient groups and to assess reproducibility. RESULTS: RFGT was found in 20% of all breasts and significantly more frequently after NSM than SSM (50% vs. 13%, p = .003). RFGT(rm) and RFGT(other) were more prevalent after NSM (p < 0.001; p = .127). RFGT ranged from 0.5 to 26% of the preoperative FGT, with higher percentages after NSM than SSM (p = .181). CONCLUSIONS: The prevalence and percentage of RFGT found on MRI indicate a considerable remaining postoperative breast cancer risk in some women.
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- 2019
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8. Work-up of the Incidental Adrenal Mass
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Jochen Walz, Paola Clauser, Pascal A. T. Baltzer, and Tobias Klatte
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education.field_of_study ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Urology ,Population ,Context (language use) ,Magnetic resonance imaging ,Metanephrines ,medicine.disease ,Diagnostic tools ,Work-up ,030218 nuclear medicine & medical imaging ,Pheochromocytoma ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Carcinoma ,Medicine ,Radiology ,business ,education - Abstract
Context Incidental adrenal masses (or adrenal incidentalomas [AI]) are a common finding during imaging and are present in up to 5% of the computed tomography (CT) scans performed on the general population. The best way to manage these lesions is still under discussion. Objective To evaluate recent literature and available guidelines regarding the work-up of AIs. Evidence acquisition We used a medical search engine to identify studies published in the past 5 yr regarding AIs. We also evaluated current guidelines and the most relevant papers published before 2010. Evidence synthesis Unenhanced and contrast-enhanced CT, with laboratory tests to exclude functional lesions, are the most sensitive and specific methods currently available for the characterisation of adrenal masses. Magnetic resonance imaging, positron emission tomography–CT and fine-needle aspiration biopsy can be used as adjunct diagnostic tools in indeterminate lesions but are rarely indicated. In a relatively high number of indeterminate nodules, follow-up or surgery is suggested, although most of these lesions turn out to be benign. Conclusions Various imaging modalities, with CT being most important, are available to diagnose malignant and functional lesions in AIs. An improved identification of benign lesions is warranted to reduce the number of unnecessary surgeries and follow-up examinations in patients with benign lesions. Patient summary We performed a review of the literature on and guidelines for the management of incidental adrenal masses. It is possible to detect the presence of lesions that require surgery in the majority of cases. Follow-up is required for lesions that are not treated surgically.
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- 2016
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