bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breast Cancer Epidemiology
Authors: Smith Robert A. , DeSantis Carol E. 
Published: March 2018

Abstract
The epidemiology of breast cancer measures the occurrence of the disease and trends in various populations. Breast cancer is the most common cause of cancer and the leading cause of cancer death in the world. Most risk factors have a modest effect, but lifestyle changes could reduce the risk of breast cancer, and we can also better identify women at greater risk who are candidates for more aggressive prevention and early detection strategies. The absence of an organized health system is a barrier to ensuring that women get the best advice about risk and prevention and identifying those at high risk early to offer tailored prevention and screening. Radiologists can play a greater role in breast care, through support and communication with referring practices, and to insure more complete risk assessment and education for their patients.
Overview of Digital Breast Tomosynthesis
Authors: Conant Emily F. 
Published: March 2018

Abstract
Digital breast tomosynthesis (DBT) is a relatively new X-ray technique that allows quasi–three-dimensional imaging of the breast to overcome limitations of conventional 2-D digital mammography (DM). Several early screening studies have shown that DBT reduces the number of false-positive recalls while simultaneously improving the cancer detection rate. Cost-effectiveness studies have shown that incorporating DBT in screening has the potential to save health care dollars due to lower recall rates as well as reduced treatment costs resulting from the earlier detection of breast cancer. In the diagnostic setting, DBT imaging may allow a more efficient work-up of breast lesions due to improved lesion conspicuity and the ability to better localize lesions within the breast.
Multiple Circumscribed Masses
Authors: Prince Erin L. , Umphrey Heidi R. 
Published: March 2018

Abstract
A circumscribed mass is a mass with margins demonstrating a sharp demarcation between the lesion and surrounding tissue. On mammography, at least 75% of the margin must be well defined in order for the mass to qualify as circumscribed. Multiple circumscribed masses may be seen unilaterally or bilaterally and can be seen on up to 1.7% of screening mammograms. After mammography, these masses may need to be further evaluated with ultrasound and correlated with clinical information. This chapter, appearing in the section on asymmetry, mass, and distortion, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for multiple circumscribed masses. Topics discussed include cysts, fibroadenomas, oil cysts, metastases, lymph nodes, and neurofibromas.
Mass in Male (Gynecomastia, Cancer)
Authors: Foo Eric , Joe Bonnie N. 
Published: March 2018

Abstract
Gynecomastia is a benign condition manifesting as enlarged breasts in men and boys. This increased breast tissue is caused by excess fibroglandular deposits and is caused by hormonal imbalances, commonly due to estrogen excess or from various drugs, such as spironolactone, ketoconazole, cimetidine, ranitidine, and specific HIV therapies. Patients generally present with bilateral subareolar enlarged breasts (however, unilateral gynecomastia also occurs), which commonly exhibit tenderness on palpation, swelling, palpable lumps, or nipple discharge. This chapter reviews the important imaging protocols, pitfalls, differential diagnoses, radiology–pathology correlation, and management recommendations for gynecomastia and cancer of the male breast. Topics discussed include gynecomastia, breast cancer, pseudogynecomastia, hypogonadism, and lymphangioma.
Architectural Distortion (Radial Scar)
Authors: Butler Reni S. 
Published: March 2018

Abstract
Radial scars are benign lesions of the breast characterized pathologically by a fibroelastic core containing entrapped ducts and lobules that radiate outwards in a stellate pattern. This chapter, highlighting radial scar as a cause of architectural distortion, reviews its imaging features and differential diagnosis on mammography, digital breast tomosynthesis, ultrasound, and MRI; its diagnostic workup using multiple modalities; and its histological confirmation with image-guided core needle biopsy. The particular challenge of radial scar presenting as architectural distortion seen only with tomosynthesis is discussed, along with an algorithm for imaging evaluation and biopsy guidance in this setting. As radial scar, which is histologically related to complex sclerosing lesion and radial sclerosing lesion, is considered a high-risk lesion, management recommendations are also reviewed.
Dystrophic Calcifications
Authors: Holbrook Anna I. 
Published: March 2018

Abstract
Dystrophic calcifications are typically large (usually &gt;1 mm), coarse, irregular or plaque-like and associated with lucent centers. They also may be thin, smooth, and round or oval, with lucent centers, called “rim” (previously also known as “eggshell”) calcifications. They form in response to trauma, including surgery or irradiation. They can be seen in association with other findings of breast trauma, including surgical clips, architectural distortion, skin retraction, skin thickening, oil cysts, or trabecular thickening. This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols, differential diagnoses, and management recommendations for dystrophic calcifications. Topics discussed include findings after breast trauma or surgery/radiation treatment and the evolution of fat necrosis.
Secretory Calcifications
Authors: Ho Christopher P. 
Published: March 2018

Abstract
Secretory calcifications are large rod-like calcifications that are often seen in a linear or segmental distribution. They can often be easily differentiated from more malignant-appearing calcifications because they are smooth and much coarser than calcifications seen with ductal carcinoma in situ (DCIS). Secretory calcifications are thought to be associated with duct ectasia and have been historically referred to as “plasma cell mastitis” because of the close association of plasma cells within the ductal infiltrates and epithelial hyperplasia. This chapter, appearing in the section on calcifications, reviews the key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations for secretory calcifications. Topics discussed include appropriate use of magnification views, how to differentiate the calcifications from more suspicious ones, and appropriate follow-up.
Pleomorphic Calcifications
Authors: Lee-Felker Stephanie A. , Wells Colin J. 
Published: March 2018

Abstract
Pleomorphic calcifications are categorized among calcifications with suspicious morphology: amorphous, coarse heterogeneous, fine linear or fine-linear branching, and fine pleomorphic calcifications. Unlike amorphous calcifications, pleomorphic calcifications are more conspicuous, with discernible shapes that appear predominantly irregular, and are variable in size and configuration. A segmental distribution, seen as a triangular shape with its apex centered at the nipple, is especially suspicious for ductal carcinoma in situ (DCIS) or multifocal breast cancer, as its pattern of calcium deposition suggests involvement of a duct system within the breast. This chapter, appearing in the section on calcifications, reviews the key clinical and imaging features, imaging protocols, differential diagnoses, and management recommendations for pleomorphic calcifications. Topics discussed include characteristic morphology and distribution of pleomorphic calcifications, BI-RADS assessments, core needle biopsy, and radiological–pathological correlation.
Intracystic/Intraductal Mass
Authors: Winkler Nicole S. 
Published: March 2018

Abstract
This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews the key clinical features, associated imaging findings, imaging protocols and pitfalls, differential diagnoses, and management recommendations for intracystic and intraductal masses. The differential diagnoses of intraductal and intracystic masses are similar, with papilloma the most common cause for both. Therefore, we review descriptive terms for both together, with similar implications and management recommendations. Intracystic masses have a higher association with malignancy than intraductal masses, due in part to overlap of imaging appearances of intracystic mass and complex cystic and solid mass. Topics discussed include intraductal and intracystic masses, evaluation of ducts, papilloma, papillary carcinoma and nipple discharge.
Lymphadenopathy
Authors: Stein Matthew A. 
Published: March 2018

Abstract
Lymphadenopathy is a pathological or abnormal state of one or more lymph nodes in a nodal basin that occurs in response to pathogens, immunogens, or malignant cells that are detected within the lymph. Malignant lymphadenopathy may be detected by physical exam and/or imaging findings, but it is ultimately confirmed or excluded by histological evaluation. This chapter, appearing in the section on nipple, skin, and lymph nodes, reviews key imaging and clinical features, imaging protocols and pitfalls, differential diagnoses, and management recommendations of lymphadenopathy detected by mammography, tomosynthesis, and ultrasound (US). Topics include the anatomy and physiology of breast lymphatic function, the anatomy and imaging features of lymph nodes, differential diagnosis of lymphadenopathy, and the imaging assessment of the axillary nodal basin in the context of known breast cancer.
Pre-Operative Localization
Authors: Loving Vilert A. 
Published: March 2018

Abstract
Non-palpable, surgical breast lesions require image guidance to direct the site of excision. With the widespread adoption of screening mammography and increased identification of non-palpable breast cancers, image guidance is critical to support the surgeon in successful breast-conserving surgery. Pre-operative localization procedures are typically performed under mammography guidance or ultrasound guidance, and less commonly under magnetic resonance imaging (MRI) guidance. This chapter, appearing in the section on interventions and surgical changes, reviews protocols and pitfalls, pre-/peri-/post-procedure clinical management, and imaging follow-up of pre-operative localization procedures. Topics discussed include mammography-guided, ultrasound-guided, and MRI-guided localization procedures. This chapter also introduces the radioactive seed and radiofrequency identification localization procedures and discusses post-operative specimen radiographs.
Post-Lumpectomy/Post-Radiation Breast
Authors: Lee Amie Y. , Joe Bonnie N. 
Published: March 2018

Abstract
Mammography is currently the primary imaging modality for post-operative evaluation and surveillance of the conservatively treated breast. Tumor recurrence has been shown to occur at a rate of approximately 1–2% per year, and the goal of imaging surveillance is to detect recurrent and new cancers at the earliest stages while avoiding unnecessary biopsies for characteristically benign findings. The radiologist should be familiar with the expected mammographic appearance and evolution of benign post-lumpectomy/post-radiation change, while also recognizing findings suspicious for residual and recurrent disease. This chapter, appearing in the section on intervention and surgical changes, reviews the key imaging and clinical features, imaging protocols and pitfalls, and clinical recommendations for the post-lumpectomy and post-radiation breast. Topics discussed include the evolution of benign post-surgical/post-radiation findings and the detection of suspicious lesions. The primary emphasis will be on mammographic surveillance. The role of ultrasound and MRI will also be discussed.
Livedoid Vasculopathy Presenting in a Patient With Sickle Cell Disease
Authors: Reagin Heather , Marks Etan , Weis Stephen , Susa Joseph 
Published: March 2018

Abstract:
We report a case in which a 43-year-old African American male with medical history of sickle cell disease (SCD) presented with a nonhealing ulcer. Biopsy revealed features of livedoid vasculopathy. Previously, livedoid vasculopathy had only been described in a patient with sickle cell trait, but never in a patient with SCD. Livedoid vasculopathy most commonly affects the distal lower extremities and is characterized by irregular, punched-out, painful ulcers that heal with stellate white scars of atrophie blanche. Histologically, it reveals segmental hyalinizing vessels, focal thrombosis, and endothelial proliferation. The etiology is currently unclear, but it has been shown to be related to procoagulant states and a diagnosis of livedoid vasculopathy should prompt a thorough hypercoagulable workup, including testing for SCD in high-risk patients.
Giant Pilomatricoma Arising as a Rapidly Growing Vascularized Tumor in a Child
Authors: Yannoutsos Alexandra , Malloizel-Delaunay Julie , Tournier Emilie , Abid Abdelaziz , Bura-Rivière Alessandra 
Published: March 2018

Abstract:
In this observation, we report an unusual presentation of a pilomatricoma in an 8-year-old girl who was initially referred to the department of vascular medicine for diagnosis and care of a suspected mixed lymphatic venous malformation. The lesion on her left shoulder presented as a giant bluish-purple red solitary mass, painful and rapidly growing, measuring 7 cm in anteroposterior diameter. This mass did not present the typical characteristics of a lymphatic venous malformation but exhibited warning signs of malignancy on clinical examination and imaging. The diagnosis of pilomatricoma was reached by fine-needle aspiration biopsy of the mass, showing mummified “ghost” squamous cells and a granulomatous inflammatory reaction stroma with scattered multinucleated giant cells and no sign of malignancy. Complete surgical excision associated with plastic surgery was curative. Diagnostic and management approach to skin lesion in childhood is subject of great concern for health care professionals, including dermatologists and vascular medicine specialists who may be confronted with this atypical presentation of one of the most common causes of superficial neck masses in children.
Human Papillomavirus–Driven Squamous Lesions: High-Risk Genotype Found in Conjunctival Papillomas, Dysplasia, and Carcinoma
Authors: Moyer Amanda B. , Roberts Jordan , Olsen Randall J. , Chévez-Barrios Patricia 
Published: March 2018

Background:
Human papillomavirus (HPV) is a causative agent for intraepithelial squamous neoplasms, particularly on mucosal surfaces. HPV has a well-established association with squamous cell carcinoma (SCC) of the oropharynx and genital tract, and recent studies suggest a potential role in ocular and periocular squamous neoplasms. Multiple high-risk HPV genotypes are associated with histologically similar squamous neoplasms, and some HPV genotypes have been differentially associated with high- or low-grade lesions.

Methods:
Squamous lesions were screened with immunohistochemical markers p16 and Ki-67 to compare expression in conjunctival papillomas (n = 21) to papillomas with high-grade dysplasia, SCC in situ, and invasive SCC (n = 40). Polymerase chain reaction was performed using the Roche COBAS HPV assay to identify the 14 most common high-risk HPV genotypes.

Results:
Compared with squamous papillomas, the lesions showing high-grade dysplasia or worse expressed p16 with greater intensity and in a greater percentage of the lesion. A trend toward mild Ki-67 expression in papillomas versus marked Ki-67 expression in high-grade squamous lesions was also observed. HPV-16 was present in 7 of the SCC in situ and invasive SCC lesions but none of the papillomas.

Conclusions:
HPV may have an important role in squamous lesions of the conjunctiva. In addition to positive polymerase chain reaction results, strong and diffuse p16 expression with marked Ki-67 is strongly suggestive of an HPV-driven lesion.
Vaginal estrogen and mammogram results: case series and review of literature on treatment of genitourinary syndrome of menopause (GSM) in breast cancer survivors
Authors: Zuo Stephanie Wang , Wu Harold , Shen Wen 
Published: March 2018

Abstract

Objective:
To examine mammographic density before and after at least 1 year of vaginal estrogen use in a small cohort of healthy postmenopausal women and women with a personal history of breast cancer.

Methods:
We extracted data via chart review of patients from a single practitioner's menopause specialty clinic in Baltimore, MD. Mammographic change was primarily determined via the Bi-RADS scoring system, including the Bi-RADS density score. In addition, we conduct a narrative review of the current literature on the usage of local estrogen therapy, and systemic and local alternatives in the treatment of genitourinary syndrome of menopause (GSM) in breast cancer survivors.

Results:
Twenty healthy postmenopausal women and three breast cancer survivors fit our inclusion criteria. Amongst these two groups, we did not find an increase in mammographic density after at least 1 year and up to 18 years of local vaginal estrogen. Ospemifene use in one patient did not appear to be associated with any change in Bi-RADS score. Our narrative review found little data on the effects of vaginal estrogen therapy or newer alternative systemic therapies such as ospemifene on mammographic density.

Conclusions:
Low-dose vaginal estrogen use for 1 or more years in a small cohort of women with GSM did not appear to be associated with any changes in breast density or Bi-RADS breast cancer risk scores in the majority of study participants, including three breast cancer survivors. Larger long-term controlled clinical trials should be conducted to examine the effects of low-dose vaginal estrogen on mammographic density in women with and without a personal history of breast cancer. Furthermore, relative efficacy and risk of vaginal estrogen compared with other forms of treatment for GSM should also be studied in long-term trials.
Contextual factors that influence quality improvement implementation in primary care: The role of organizations, teams, and individuals
Authors: Shea Christopher M. , Turner Kea , Albritton Jordan , Reiter Kristin L. 
Published: March 2018

Background:
Recent emphasis on value-based health care has highlighted the importance of quality improvement (QI) in primary care settings. QI efforts, which require providers and staff to work in cross-functional teams, may be implemented with varying levels of success, with implementation being affected by factors at the organizational, teamwork, and individual levels.

Purpose:
The purpose of our study was to (a) identify contextual factors (organizational, teamwork, and individual) that affect implementation effectiveness of QI interventions in primary care settings and (b) compare perspectives about these factors across roles (health care administrators, physician and nonphysician clinicians, and administrative staff).

Methods/Approach:
We conducted semistructured interviews with 24 health care administrators, physician and nonphysician primary care providers, and administrative staff representing 10 primary care practices affiliated with one integrated delivery system.

Results:
Participants across all roles identified similar organizational- and team-level factors that influence QI implementation including organizational capacity to take on new initiatives (e.g., time availability of physicians), technical capability for QI (e.g., data analysis skills), and team climate (e.g., how well staff work together). There was greater variation in terms of individual-level factors, particularly perceived meaning and purpose of QI. Perceptions about value of QI ranged from positive impacts on patient care and practice competitiveness to decreased efficiency and distractions from patient care, but differences did not appear attributable to role.

Conclusions:
Successful QI implementation requires effective collaboration within cross-functional teams. Additional research is needed to assess how best to employ implementation strategies that promote cross-understanding of QI among team members and, ultimately, effective implementation of QI programs.

Practice Implications:
Health care managers in primary care settings should strive to create a strong teamwork climate, reinforced by opportunities for staff in various roles to discuss QI as a collective.
Application of Regenerative Treatment for Tympanic Membrane Perforation With Cholesteatoma, Tumor, or Severe Calcification
Authors: Kanemaru Shin-ichi , Kanai Rie , Yoshida Misaki , Kitada Yuji , Omae Kaoru , Hirano Shigeru 
Published: March 2018

Objective:
To apply regenerative treatment for tympanic membrane (TM) perforation to patients with severe calcification of the TM, cholesteatomas, or tumors localized to the tympanic cavity.

Study Design:
Controlled clinical pilot study.

Setting:
General hospitals.

Patients:
Forty-five patients (age: 8–85; M = 19, F = 26) were selected from patients with or without TM perforation for the regenerative treatment. Twenty-five patients had cholesteatomas, 3 had tumors, and 17 had severe TM calcification. Patients were classified into three groups based on TM perforation size: less than 1/3 of the TM as Grade I (n = 5), 1/3 to 2/3 as Grade II (n = 19), and over 2/3 as Grade III (n = 21). Twenty patients who underwent standard tympanoplasty type I were selected as historical controls.

Materials and Methods:
Materials for the TM repair included gelatin sponge with basic fibroblast growth factor and fibrin glue. After lesions were removed through the TM perforation, gelatin sponge immersed in basic fibroblast growth factor was placed over the perforation. Fibrin glue was then dripped onto the sponge. Treatment efficacy was evaluated 6 months posttreatment.

Results:
Complete closure of the TM perforation was achieved in 91% (n = 41/45) of the patients in this regenerative treatment. Improvement in average hearing levels and air-bone gap were much better with this treatment than in the historical control group.

Conclusion:
This new regenerative therapy is useful not only for patients with simple TM perforations but also for those with cholesteatomas, tumors, or severe calcification without requiring conventional surgical procedures. This regenerative therapy is an easy, safe, cost-effective, and minimally-invasive treatment.