57 research outputs found
Magnetic resonance spectroscopy and breast cancer
No full textArticle first published online: 21 JAN 2008Peter Malycha and Carolyn Mountfor
MR spectroscopy in the breast clinic is improving
No full textCarolyn E. Mountford, Christian Schuster, Pascal A.T. Baltzer, Peter Malycha and Werner A. Kaise
Proton spectroscopy provides accurate pathology on biopsy and in vivo
No full textIn the last 25 years, MR spectroscopy (MRS) has moved from being a basic research tool into routine clinical use. The spectroscopy method reports on those chemicals that are mobile on the MR time scale. Many of these chemicals reflect specific pathological processes but are complicated by the fact that many chemicals change at one time. There are currently two clinical applications for spectroscopy. The first is in the pathology laboratory, where it can be an adjunct to, and in some cases replacement, for difficult pathologies like Barrett's esophagus and follicular adenoma of the thyroid. The spectroscopy method on a breast biopsy can also report on prognostic indicators, including the potential for spread, from information present in the primary tumor alone. The second application for spectroscopy is in vivo to provide a preoperative diagnosis and this is now achievable for several organs including the prostate. The development of spectroscopy for clinical purposes has relied heavily on the serially-sectioned histopathology to confirm the high accuracy of the method. The combination of in vivo MRI, in vivo MRS, and ex vivo MRS on biopsy samples offers a modality of very high accuracy for preoperative diagnosis and provision of prognostic information for human cancers.Mountford, Carolyn ; Lean, Cynthia ; Malycha, Peter ; Russell, Pete
Specificity of choline metabolites for in vivo diagnosis of breast cancer using 1H MRS at 1.5 T
No full textThe purpose was to determine if in vivo proton magnetic resonance spectroscopy ((1)H MRS) at 1.5 T can accurately provide the correct pathology of breast disease. Forty-three asymptomatic volunteers including three lactating mothers were examined and compared with 21 breast cancer patients. Examinations were undertaken at 1.5 T using a purpose-built transmit-receive single breast coil. Single voxel spectroscopy was undertaken using echo times of 135 and 350 ms. The broad composite resonance at 3.2 ppm, which includes contributions from choline, phosphocholine (PC), glycerophosphocholine (GPC), myo-inositol and taurine, was found not to be a unique marker for malignancy providing a diagnostic sensitivity and specificity of 80.0 and 86.0%, respectively. This was due to three of the asymptomatic volunteers and all of the lactating mothers also generating the broad composite resonance at 3.2 ppm. Optimised post-acquisitional processing of the spectra resolved a resonance at 3.22 ppm, consistent with PC, in patients with cancer. In contrast the spectra recorded for three false-positive volunteers, and the three lactating mothers had a resonance centred at 3.28 ppm (possibly taurine, myo-inositol or GPC). This improved the specificity of the test to 100%. Careful referencing of the spectra and post-acquisitional processing intended to optimise spectral resolution of in vivo MR proton spectra from human breast tissue resolves the composite choline resonance. This allows the distinction of patients with malignant disease from volunteers with a sensitivity of 80% and specificity of 100%. Therefore, resolution of the composite choline resonance into its constituent components improves the specificity of the in vivo (1)H MRS method, but does not overcome the problem of 20% false-negatives.Peter Stanwell, Laurence Gluch, David Clark, Boguslaw Tomanek, Luke Baker, Bruno Giuffrè, Cynthia Lean, Peter Malycha, Carolyn Mountfor
Proton MRS of the breast in the clinical setting
No full textInformation for determining whether a primary breast lesion is invasive and its receptor status and grade can be obtained before surgery by performing proton MRS on a fine-needle aspiration biopsy (FNAB) specimen and analyzing the MRS information by a pattern recognition method. Two-dimensional MRS, on either specimens or cells, allows the unambiguous assignment of most resonances. When correlated with the spectral regions selected by the pattern recognition method, there are strong indications for the biochemical markers responsible for prognostic information of invasive capacity and metastatic spread. Spectral assignments and biological correlations can be made using cell models. In vivo MRS can distinguish invasive from benign lesions. This pathological distinction can be made from the presence of resonances at discrete frequencies. To achieve this level of spectral resolution and signal-to-noise ratio, there are stringent requirements when acquiring and processing the data. The challenge now is to implement two-dimensional MRS in vivo. Until this is realized, the combination of in vivo MR, for diagnosis and spatial location, and MRS, for image-guided biopsy to provide information on tumor spread, promises to provide a higher level of preoperative diagnosis than previously achieved.Carolyn Mountford, Saadallah Ramadan, Peter Stanwell and Peter Malych
Psychological impact and cosmetic outcome of surgical breast cancer strategies
No full textThe definitive version is available at www.blackwell-synergy.comBackground: Current surgical treatment modalities for breast cancer include breast conserving surgery, mastectomy alone and mastectomy with breast reconstruction. There are recognized benefits of breast conservation and breast reconstruction over mastectomy but there are few studies assessing this area in Australia. The aim of the present study was to compare the various surgical strategies for breast cancer treatment in terms of quality of life, cosmesis and patient satisfaction. Methods: A chart analysis was conducted of all patients who underwent Breast Cancer Reconstruction at the Royal Adelaide Hospital Breast Unit between 1990 and 2002. Patients were then traced and asked to take part in an interview. Mastectomy and breast conservation patients who attended outpatient clinic for follow up were also approached. All three groups were interviewed and self-assessment quality of life questionnaires (Functional Assessment of Cancer Therapy−Breast, body image) were administered. The breast conservation and reconstruction groups also underwent assessment of satisfaction and cosmesis. Results: A total of 78 mastectomy, 109 breast conservation and 123 breast reconstruction patients were interviewed. Quality of life assessment was similar between the three groups but the breast conservation and reconstruction patients’ body image scores were superior to the mastectomy group. Patient satisfaction was higher in the reconstruction group than the breast conservation group of patients, while cosmesis was similar. Conclusion: While little difference was seen on quality of life assessment, body image is improved with the use of breast conservation and reconstruction. The high satisfaction and cosmesis scores in the breast reconstruction group are an indication of the superior results that can be achieved with breast reconstruction.Maria Teresa Nano, Peter Grantley Gill, James Kollias, Melissa Anne Bochner, Peter Malycha and Helen R. Winefiel
Andreas Malycha: Die Akademie der Pädagogischen Wissenschaften der DDR 1970 – 1990. Zur Geschichte einer Wissenschaftsinstitution im Kontext staatlicher Bildungspolitik (Beiträge zur DDR-Wissenschaftsgeschichte; Reihe C, Studien, Band 1). Leipzig: Akademische Verlagsanstalt 2008 (394 S.) [Annotation]
No full textAnnotation zu: Andreas Malycha: Die Akademie der Pädagogischen Wissenschaften der DDR 1970 – 1990. Zur Geschichte einer Wissenschaftsinstitution im Kontext staatlicher Bildungspolitik (Beiträge zur DDR-Wissenschaftsgeschichte; Reihe C, Studien, Band 1). Leipzig: Akademische Verlagsanstalt 2008 (394 S.; ISBN 978-3-931982-55-3; 39,00 EUR)
Quality assurance in a multidisciplinary symptomatic breast assessment clinic
No full textBackground: Although quality assurance guidelines for surgeons have been issued and adopted for use in population-based breast screening programs in Australia, similar guidelines are unavailable for women referred with symptomatic breast problems. Methods: Six hundred and ninety-six women who attended the Royal Adelaide Hospital Women’s Health Centre between February and November 1998 for investigation and management of a new breast-related complaint were prospectively evaluated. Investigation strategies and outcomes of the initial consultation were determined and the results compared with the performance quality standards for symptomatic breast disease according to the British Association of Surgical Oncology (BASO) Breast Surgeons’ Group. Results: A breast lump was the presenting symptom in 45%, while breast pain was present in 26%. Ninety per cent of women referred with breast symptoms were given a definitive benign or malignant diagnosis at the initial clinic visit. Although the median time delay between the date of general practitioner referral and breast clinic appointments for all patients was ≤ 7 days, the time delay for ‘urgent’ cases was not met according to BASO performance indicators. All other Royal Adelaide Hospital Breast Clinic audit data were within the range suggested by BASO performance indicators for new consultations in a symptomatic breast assessment clinic. Conclusions: A multidisciplinary breast clinic in a public hospital setting is able to provide clinical services to symptomatic women, with the majority of patients obtaining a confident diagnosis at the first presentation. Performance indicators for symptomatic breast disease are useful in identifying inadequacies at the clerical or clinical level which, following the implementation of subsequent changes, may lead to improvement in patient outcomes.James Kollias, Melissa A. Bochner, P. Grantley Gill, Peter Malycha and Brendon J. Coventr
Survival from breast cancer: an analysis of Australian data by surgeon case load, treatment centre location, and health insurance status
No full textOBJECTIVE: Early invasive breast cancer data from the Australian National Breast Cancer Audit were used to compare case fatality by surgeon case load, treatment centre location and health insurance status. METHOD: Deaths were traced to 31 December 2007, for cancers diagnosed in 1998–2005. Risk of breast cancer death was compared using Cox proportional hazards regression. RESULTS: When adjustment was made for age and clinical risk factors: (i) the relative risk of breast cancer death (95% confidence limit) was lower whensurgeons’ annual case loads exceeded 20 cases, at 0.87 (0.76, 0.995) for 21–100 cases and 0.83 (0.72, 0.97) for higher case loads. These relative risks were not statistically significant when also adjusting for treatment centre location (P_0.15); and (ii) compared with major city centres, inner regional centres had a relative risk of 1.32 (1.18, 1.48), but the risk was not elevated for more remote sites at 0.95 (0.74, 1.22). Risk of death was not related to private insurance status. CONCLUSION: Higher breast cancer mortality in patients treated in inner regional than major city centres and in those treated by surgeons with lower case loads requires further study.David Roder, Primali de Silva, Helen M. Zorbas, James Kollias, Peter L. Malycha, Chris M. Pyke and Ian D. Campbel
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