CT evaluation of mediastinal masses

CT is an important modality for imaging mediastinal masses, and certain CT attenuation features (fat, calcium, or water attenuation, contrast enhancement) are well known to suggest specific diagnoses. In a series of 132 consecutive patients with tissue-proven mediastinal masses, these specific CT features were present in only 16. We evaluated the ability of CT to differentiate soft tissue mediastinal masses based on morphology and distribution of disease. Metastatic disease and lymphoma accounted for 69% of masses in this series, and CT could not generally differentiate them. However, CT was helpful in differential diagnosis in certain settings. CT demonstration of multiple mediastinal masses when conventional radiographs showed a single mass generally excluded diagnoses such as thymoma and teratoma. CT demonstration of a single middle mediastinal mass, frequently missed by conventional radiography, made metastatic disease a much more likely diagnosis than lymphoma. Finally, CT demonstration of certain ancillary findings strongly favored a diagnosis of lymphoma (axillary adenopathy) or metastatic disease (solitary pulmonary mass, focal liver lesions, bone lesions).Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26707/1/0000257.pd

How to Minimize Patient Anxiety From Screening Mammography

AbstractAnxiety has been portrayed by the media and some organizations and societies as one of the harms of mammography. However, one experiences anxiety in multiple different medical tests that are undertaken, including screening examinations; it is not unique to mammography. Some may argue that because this anxiety is transient, the so-called harm is potentially overstated, but for some women the anxiety is significant. Anxiety can increase or decrease the likelihood of obtaining a screening mammogram. There are multiple ways that anxiety associated with screening mammography can be diminished, including before, during, and after the examination. These include simple measures such as patient education, improved communication, being aware of the patient’s potential discomfort and addressing it, validating the patient’s anxiety as well as providing the patient with positive factual data that can easily be implemented in every breast center. More complex interventions include altering the breast center environment with multisensory stimulation, reorganization of patient flow to minimize wait times, and relaxation techniques including complementary and alternative medicine. In this article we will review the literature on measures that can be taken to minimize anxiety that would maximize the likelihood of a woman obtaining an annual screening mammogram.</jats:p

Breast Cancer Screening Recommendations: African American Women Are at a Disadvantage

Abstract Since 1990, breast cancer mortality has decreased by 40% in white women but only 26% in African American women. The age at diagnosis of breast cancer is younger in black women. Breast cancer diagnosed before age 50 represents 23% of all breast cancers in African American women but only 16% of all breast cancers in white women. White women have a higher incidence of breast cancer over the age of 60. Tumor subtypes also vary among racial and ethnic groups. The triple-negative (TN) subtype, which has a poorer outcome and occurs at a younger age, represents 21% of invasive breast cancers in black women but only 10% of invasive breast cancers in white women. The hormone receptor–positive subtype, which is more common in older women and has the best outcome, has a higher incidence in white women (70%) than in black women (61%). The BRCA2 mutation is also more common in black women than in white women (other than those who are of Ashkenazi Jewish ancestry). There are also many barriers to screening. Major ones include the lack of contact with a primary health care provider as well as a decreased perceived risk of having breast cancer in the African American population. Given the younger age of onset and the higher incidence of the TN molecular subtype, following breast cancer screening guidelines that do not support screening before the age of 50 may disadvantage black women.</jats:p