| 1. |
- Muth, Andreas, 1974, et al.
(författare)
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Patient-reported impacts of a conservative management programme for the clinically inapparent adrenal mass.
- 2013
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Ingår i: Endocrine. - : Springer Science and Business Media LLC. - 1559-0100 .- 1355-008X. ; 44:1, s. 228-236
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to assess patient-reported impacts and health-related quality of life (HRQL) of a 2-year follow-up programme in a large cohort of patients with stationary, non-functioning, adrenal incidentalomas (AIs) in western Sweden. 145 patients (mean age 68years, 62% females) with AI from a prospective study in western Sweden were studied. All had completed a 2-year follow-up programme by November 2007, without evidence of adrenal malignancy or hormone over-production. To evaluate patient-reported impacts and HRQL, an eight-item adrenal incidentaloma impact questionnaire was used retrospectively, together with the hospital anxiety and depression scale, and the short form-36. There were 111 patients (mean age 67years, 63% females) who responded to the questionnaire (response rate 77%). 77% reported that the AI diagnosis had caused them to be worried; however, fewer than 20% had thought about the lesion often during the follow-up programme, and only 3% had felt that it had a large impact on their current daily life. Only 4% stated that the follow-up programme had been a negative experience, nevertheless 10% reported a negative impact on their HRQL during the follow-up programme. Only 2% stated that release from follow-up caused worry to any degree. In total, 29% had possible anxiety, and 30% had possible depression, probably reflecting significant co-morbidity. Possible anxiety correlated with a more negative experience of the follow-up programme. In conclusion, the 2-year follow-up programme for patients with AI was well tolerated. Nonetheless, a small number remained worried throughout follow-up, suggesting the need for tailored counselling in individual patients to ameliorate negative impacts of follow-up.
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| 2. |
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| 3. |
- Muth, Andreas, 1974, et al.
(författare)
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Cohort study of patients with adrenal lesions discovered incidentally.
- 2011
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Ingår i: The British journal of surgery. - : Oxford University Press (OUP). - 1365-2168 .- 0007-1323. ; 98:10, s. 1383-91
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Tidskriftsartikel (refereegranskat)abstract
- This prospective cohort study investigated the incidence, clinical features and natural history of incidentally discovered adrenal mass lesions (adrenal incidentaloma, AI) in an unselected population undergoing radiological examination.
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| 4. |
- Bjurstam, Nils, et al.
(författare)
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Updated results of the Gothenburg Trial of Mammographic Screening
- 2016
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Ingår i: Cancer. - : Wiley. - 0008-543X .- 1097-0142. ; 122:12, s. 1832-1835
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDThere remain uncertainties about age-specific effects of breast cancer screening on mortality due to the disease. METHODSIn 1982, a randomized trial of mammographic screening every 18 months was started in Gothenburg, Sweden. Women between the ages of 39 and 49 years were randomized to an invitation to screening (intervention group; n = 11,792) or to usual care (the control group; n = 14,321). The corresponding numbers for women between the ages of 50 and 59 years were 10,112 and 15,997. Follow-up data for breast cancer mortality were available up to the end of 2007. Data were analyzed by Poisson regression with conservative variance estimates. RESULTSThere were 79 breast cancer deaths in the intervention arm and 156 in the control arm, and this meant a significant 30% reduction in breast cancer mortality with the offer of screening (relative risk [RR], 0.70; 95% confidence interval [CI], 0.53-0.93; P = .01). In women aged 39 to 49 years, there was a significant 40% reduction in breast cancer mortality (RR, 0.60; 95% CI, 0.43-0.85; P = .003). In the 50- to 59-year age group, there was a nonsignificant 18% breast cancer mortality reduction (RR, 0.82; 95% CI, 0.54-1.26; P = .4). CONCLUSIONSThe policy of offering mammographic screening substantially reduces breast cancer mortality and can do so in women younger than 50 years. Cancer 2016;122:1832-5. (c) 2016 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. In a randomized trial of breast cancer screening, a significant reduction in breast cancer mortality is found with the offer of mammographic screening. The results suggest that screening can be effective in women younger than 50 years. and distribution in any medium, provided the original work is properly cited, the use is non- commercial and no modifications or adaptations are made.
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| 5. |
- Duffy, S. W., et al.
(författare)
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Overdiagnosis and overtreatment of breast cancer: estimates of overdiagnosis from two trials of mammographic screening for breast cancer
- 2005
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Ingår i: Breast Cancer Res. - 1465-542X. ; 7:6, s. 258-65
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Tidskriftsartikel (refereegranskat)abstract
- Randomised controlled trials have shown that the policy of mammographic screening confers a substantial and significant reduction in breast cancer mortality. This has often been accompanied, however, by an increase in breast cancer incidence, particularly during the early years of a screening programme, which has led to concerns about overdiagnosis, that is to say, the diagnosis of disease that, if left undetected and therefore untreated, would not become symptomatic. We used incidence data from two randomised controlled trials of mammographic screening, the Swedish Two-county Trial and the Gothenburg Trial, to establish the timing and magnitude of any excess incidence of invasive disease and ductal carcinoma in situ (DCIS) in the study groups, to ascertain whether the excess incidence of DCIS reported early in a screening trial is balanced by a later deficit in invasive disease and provide explicit estimates of the rate of 'real' and non-progressive 'overdiagnosed' tumours from the study groups of the trials. We used a multistate model for overdiagnosis and used Markov Chain Monte Carlo methods to estimate the parameters. After taking into account the effect of lead time, we estimated that less than 5% of cases diagnosed at prevalence screen and less than 1% of cases diagnosed at incidence screens are being overdiagnosed. Overall, we estimate overdiagnosis to be around 1% of all cases diagnosed in screened populations. These estimates are, however, subject to considerable uncertainty. Our results suggest that overdiagnosis in mammography screening is a minor phenomenon, but further studies with very large numbers are required for more precise estimation.
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| 6. |
- Kheddache, Susanne, 1949, et al.
(författare)
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Storage phosphor and film-screen mammography: performance with different mammographic techniques
- 1999
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Ingår i: European Radiology. - 0938-7994 .- 1432-1084. ; 9:4, s. 591-597
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to compare the image quality of storage phosphor plates with that in screen-film radiograms in mammography. Two anode/filter combinations were also compared ± Mo/ Mo and W/Rh. Storage phosphor plates, generation IIIN (Fuji, Tokyo, Japan) and a conventional screenfilm system (Kodak, Rochester, N.Y.) were evaluated using two mammographic units. One unit had a 0.6-mm focal spot, an anode/filter combination of Mo/Mo and no grid (A-Mo); the other had a 0.3-mm focal spot, a grid, and two possible combinations of anode/filter Mo/Mo (B-Mo) and W/Rh (B-W). Simulated tumours and microcalcifications were randomly positioned in an anthropomorphic breast phantom (RMI model 165, no. 210±009, Radiation Measurements Inc., Middleton, Wisconsin). The image quality was evaluated using a modified version of receiver operating characteristics analysis. Five observers evaluated 300 films and 300 hard copy images each. Radiation doses were also determined. The image Quality of the conventional screen-film images was significantly better than that for the storage phosphor plate mammograms. The B-Mo system rated best, for the detection of both tumours and microcalcifications, although it was not significantly different from the B-W system. Systems B-Mo and B-W rated significantly better than the A-Mo system for both image receptors studied. The mean absorbed dose was twice as high for the B-Mo system as for the A-Mo and B-W systems for both conventional and digital technique. The mammograms produced with the screen-film combination gave a significantly better detectability than the storage phosphor plates used in this study. Substantial dose reduction could be achieved using an anode/filter combination of W/Rh instead of Mo/Mo with no significant loss of information in the images.
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| 7. |
- Lanhede, B, et al.
(författare)
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The influence of different technique factors on image quality of chest radiographs as evaluated by modified CEC image quality criteria.
- 2002
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Ingår i: The British journal of radiology. - : British Institute of Radiology. - 0007-1285 .- 1748-880X. ; 75:889, s. 38-49
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Tidskriftsartikel (refereegranskat)abstract
- The Commission of the European Communities (CEC) research project "Predictivity and optimisation in medical radiation protection" addressed fundamental operational limitations in existing radiation protection mechanisms. The first part of the project aimed at investigating (1) whether the CEC image quality criteria could be used for optimization of a radiographic process and (2) whether significant differences in image quality based on these criteria could be detected in a controlled project with well known physical and technical parameters. In the present study, chest radiographs on film were produced using healthy volunteers. Four physical/technical parameters were varied in a carefully controlled manner: tube voltage (102 kVp and 141 kVp), nominal speed class (160 and 320), maximum film density (1.3 and 1.8) and method of scatter reduction (grid (R=12) and air gap). The air kerma at the entrance surface was measured for all patients and the risk-related dose H(Golem), based on calculated organ-equivalent dose conversion coefficients and the measured entrance air kerma values, was calculated. Image quality was evaluated by a group of European expert radiologists using a modified version of the CEC quality criteria. For the two density levels, density level 1.8 was significantly better than 1.3 but at the cost of a higher patient radiation exposure. The correlation between the number of fulfilled quality criteria and H(Golem) was generally poor. An air gap technique resulted in lower doses than scatter reduction with a grid but provided comparable image quality. The criteria can be used to highlight optimum radiographic technique in terms of image quality and patient dose, although not unambiguously. A recommendation for good radiographic technique based on a compromise between image quality and risk-related radiation dose to the patient is to use 141 kVp, an air gap, a screen-film system with speed 320 and an optical density of 1.8.
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