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    <recommendedItem id="20100101_19_304"
                     title="&apos;Virtual&apos; Colon Scans Effective in Seniors (CME/CE)"
                     score="0.004"
                     href="http://www.medpagetoday.com/HematologyOncology/ColonCancer/tb/18164?impressionId=1265777060666"
                     
      Patients 65 and older are as suitable as younger individuals for CT colonography, said researchers conducting a large retrospective study.&lt;br&gt;
&lt;br&gt;Advanced neoplasias were detected with CT colonography  --  often called &quot;virtual colonoscopy&quot;  --  in older patients at more than double the rate in the general screening population, reported David H. Kim, MD, of the University of Wisconsin in Madison, Wis., and colleagues in the February issue of &lt;em&gt;Radiology&lt;/em&gt;.&lt;br&gt;
&lt;br&gt;They found that 7.6% of older patients had advanced neoplasias, compared with 3.2% of all patients screened in the university&apos;s clinic (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).&lt;/p&gt;
&lt;p&gt;On the basis of this and other findings in 577 individuals 65 and older versus the entire group of 3,120 patients undergoing the procedure, Kim and colleagues concluded that &quot;CT colonography performance is maintained in an older cohort.&quot;&lt;/p&gt;
&lt;p&gt;&quot;Overall, the observations from this clinical experience confirm that CT colonography may be a valuable screening modality in the older population,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;On the other hand, the study did not address several objections raised by the Centers for Medicare and Medicaid Services (CMS) in its decision last year to deny Medicare coverage for the procedure. (See &lt;a href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Medicare/14186&quot; mce_href=&quot;http://www.medpagetoday.com/PublicHealthPolicy/Medicare/14186&quot; target=&quot;_blank&quot;&gt;Medicare Finalizes Denial of Virtual Colonoscopy Coverage&lt;/a&gt;)&lt;/p&gt;
&lt;p&gt;CMS had pointed to relatively low sensitivity of CT colonography compared with optical colonoscopy in prospective trials, especially for small lesions.&lt;/p&gt;
&lt;p&gt;The agency also determined that CT colonography increased the costs of positive findings, since abnormalities in the CT scans must be confirmed with optical colonoscopy. In addition, CMS said there was no evidence to support claims that the less invasive imaging procedure would be more acceptable to patients and therefore would raise screening rates.&lt;/p&gt;
&lt;p&gt;The data analyzed by Kim and colleagues did not allow for calculations of false-negative rates or predictive values of positive or negative findings. Nor did the researchers report cost information.&lt;/p&gt;
&lt;p&gt;Mean age of their older cohort was 69.2 (SD 3.8). The oldest was 79.&lt;/p&gt;
&lt;p&gt;The researchers reported that 15.3% of the older patients were referred for optical colonoscopy on the basis of the CT results, compared with 7.9% of the overall screening group.&lt;/p&gt;
&lt;p&gt;Less than 4% of positive findings were determined to be false with the optical procedure (3.6% for polyps 6 to 10 mm in diameter, 2.1% for larger lesions).&lt;/p&gt;
&lt;p&gt;Of the 59 advanced neoplasias identified in the older patients, all but three were at least 10 mm in size.&lt;/p&gt;
&lt;p&gt;The scans also suggested abnormalities outside the colon in 89 (15.4%) patients. Of these, 45 received a full workup, which revealed substantial and previously unsuspected diagnoses in 21 cases  -- 18 were vascular aneurysms. The other three included one lung tumor, a femoral hernia, and a malrotation.&lt;/p&gt;
&lt;p&gt;Kim and colleagues reported that no &quot;substantial complications&quot; such as perforations or major hemorrhage occurred in the older patients, either with the CT scan or follow-up colonoscopy.&lt;/p&gt;
&lt;p&gt;They also indicated that the ratio of large to small neoplasias was similar in the older patients compared with their CT screening group as a whole. Histologic and morphologic findings were similar as well.&lt;/p&gt;
&lt;p&gt;The researchers cited the observational nature of the study, in which negative findings were not corroborated with optical colonoscopy, and its restriction to a single center as its main limitations.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding for the study was reported.&lt;/p&gt;&lt;p&gt;Kim and one co-author reported relationships with Viatronix and Medicsight and are co-founders of a company called VirtuoCTC, which produces educational materials on CT colonography.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_242"
                     title="Ultrasound Aids Early Ovarian Cancer Detection (CME/CE)"
                     score="-0.001"
                     href="http://www.medpagetoday.com/Radiology/DiagnosticRadiology/tb/18096?impressionId=1265777060666"
                     
      &lt;p&gt;Serum biomarkers identified through proteomic analysis, coupled with contrast-enhanced ultrasound, ultimately may provide a means for early diagnosis of ovarian cancer, researchers say.&lt;/p&gt;
&lt;p&gt;&quot;Exciting preliminary data have shown that specific combinations of peptides from molecules, such as &lt;em&gt;BRCA2&lt;/em&gt;, exist in the serum of epithelial ovarian cancer patients,&quot; Sonia Dutta, MD, of Mount Sinai School of Medicine in New York, and colleagues reported in the February&lt;em&gt; American Journal of Roentgenology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;This discovery suggests that &quot;highly discriminatory proteins&quot; may serve as biomarkers for early epithelial cell ovarian cancer, although the findings must be further validated, the authors wrote.&lt;/p&gt;
&lt;p&gt;Despite advances in surgery and chemotherapy, survival from advanced stage ovarian cancer is only 30%, and the authors cite a &quot;dire need&quot; for a validated screening method to detect the disease early.&lt;/p&gt;
&lt;p&gt;Unsuccessful efforts find a biomarker for this deadly malignancy have focused primarily on a single cancer-specific marker, which the authors concede is a &quot;mission impossible.&quot;&lt;/p&gt;
&lt;p&gt;Impediments to the identification of cancer-specific markers include the molecular heterogeneity that characterizes different tumors, the sharing of pathophysiologic events among cancer and other diseases, and low marker production and concentration.&lt;/p&gt;
&lt;p&gt;To overcome these difficulties, a new approach known as proteomics is being used to analyze the entire protein complement of a cell.&lt;/p&gt;
&lt;p&gt;The rationale for this analytical technique lies in a significantly greater understanding of the tumor microenvironment. It is now known that tumor cells participate in complex interactions with surrounding structures and other cell populations.&lt;/p&gt;
&lt;p&gt;&quot;This biochemical cross-talk is hypothesized to generate a cascade of specific and sensitive biomarkers elaborated directly from the tumor cell population, indirectly from the interacting non-tumor cells or extracellular molecules, or a specific product of the microecology,&quot; they explained.&lt;/p&gt;
&lt;p&gt;In fact, the most specific cancer markers may turn out to be molecules that normally are not malignant but that have been modified by that tumor microenvironment  --  clipped, cleaved, phosphorylated, or glycosylated  --  and carry a detailed picture of the local pathophysiology.&lt;/p&gt;
&lt;p&gt;Previous techniques used in the hunt for markers, such as two-dimensional gel electrophoresis, were unable to detect these altered or clipped molecules, which occupy the low molecular weight range of the proteome.&lt;/p&gt;
&lt;p&gt;Mass spectrometry, which is most sensitive in the low molecular weight range, is now a tool used to explore these modified protein molecules and has already revealed a vast number of previously unknown biomarkers.&lt;/p&gt;
&lt;p&gt;The next steps, the researchers explained, will be to develop capture reagents that can measure the markers and, using reverse-phase protein array, to further characterize proteins of interest.&lt;/p&gt;
&lt;p&gt;But any diagnostic information gained through proteomic analysis must be verified by some imaging technique. Conventional ultrasound has proven inadequate, but pulse-inversion harmonic ultrasound currently appears to differentiate malignant from benign lesions.&lt;/p&gt;
&lt;p&gt;For example, although the time to peak enhancement with contrast-enhanced ultrasound is similar in benign and malignant masses, a small study found that malignant lesions have: &lt;ul&gt; &lt;li&gt;Greater peak enhancement (23.3 versus 12.3 dB, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Longer half wash-out time (139.9 versus 46.3 seconds, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.01)&lt;/li&gt; &lt;li&gt;Greater area under the enhancement curve (2,012.9 versus 523.9 seconds, &lt;em&gt;P&lt;/em&gt;=0.07)&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The authors noted that these enhancement kinetics data were from just 17 patients and are therefore limited, but stated that the technique &quot;shows great promise.&quot;&lt;/p&gt;
&lt;p&gt;In addition, the diagnostic capacity of ultrasound can be further increased by the use of intravenous contrast agents, which may help visualize the early microvascular changes typical of malignancy.&lt;/p&gt;
&lt;p&gt;The researchers predicted that, by using a combination of clinically relevant biomarkers identified through proteomic analyses plus contrast-enhanced ultrasound, &quot;we will likely be able to shift from an era of diagnosing advanced-stage ovarian cancer to that of early-stage disease and, most important, save the lives of many women.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No disclosures were provided.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_230"
                     title="Radiation Benefit of Digital Mammogram Not Clear (CME/CE)"
                     score="-0.001"
                     href="http://www.medpagetoday.com/HematologyOncology/BreastCancer/tb/18087?impressionId=1265777060666"
                     
      &lt;p&gt;Digital mammography exposes women to a lower radiation dose than standard film mammography, but digital imaging is likely to require more than four normal views in about 20% of women screened, according to a subset analysis of data from a study of almost 50,000 women.&lt;/p&gt;
&lt;p&gt;The mean glandular dose per view was 2.37 mGy for film mammography versus 1.86 mGy for full-field digital mammography, a difference of 22%, R. Edward Hendrick, PhD, of the University of Colorado-Denver, and colleagues reported in the February issue of the &lt;em&gt;American Journal of Roentgenology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;But only 12% of women screened with traditional mammography required more than four normal views compared with 21% of the women imaged with digital systems.&lt;/p&gt;
&lt;p&gt;When the need for additional views was factored in, they wrote, the difference in radiation exposure between the two modalities dropped to 17%, 4.14 mGy for digital versus 4.98 mGy for standard mammography.&lt;/p&gt;
&lt;p&gt;Furthermore, these differences were not standard  --  there was a wide variation across manufacturers. For example, the average mean glandular dose per view was 3.77 for Fischer digital versus 5.03 for Hologic Selenia, which was also the only manufacturer in which the digital dose was higher than the standard film dose.&lt;/p&gt;
&lt;p&gt;Doses were compared on a manufacturer basis  --  film mammography versus digital: &lt;ul&gt; &lt;li&gt;5.36 mGy for Fischer standard film versus 3.77 mGy for Fischer digital&lt;/li&gt; &lt;li&gt;4.02 mGy for Fugifilm standard film versus 4.45 mGy for Fugifilm digital&lt;/li&gt; &lt;li&gt;5.03 mGy for GE standard film versus 4.02 mGy for GE digital&lt;/li&gt; &lt;li&gt;5.01 mGy for Hologic CCD standard film versus 4.60 for Hologic CCD digital&lt;/li&gt; &lt;li&gt;4.24 mGy for Hologic Selenia versus 5.03 for Hologic Selenia digital &lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The analysis of parameters and radiation dose was culled from data collected by the American College of Radiology Imaging Network Digital Mammographic Imaging Screening (DMIST) trials, which enrolled 49,528 women from October 2001 through October 2003.&lt;/p&gt;
&lt;p&gt;The primary goal of DMIST was to compare the accuracy of the two technologies. The results, reported in 2005, found that digital mammography was superior for younger women and for women with dense breasts, but when results from all 50,000 women were considered there was no significant difference.&lt;/p&gt;
&lt;p&gt;This latest study was based on technical data compiled on 5,102 women of which 4,366 cases yielded &quot;clean&quot; data that were included in the analysis.&lt;/p&gt;
&lt;p&gt;The researchers did find a significant difference in the pressure each modality exerted on the breast. &quot;Mean compression force was 10.7 dN for screen-film mammography and 10.1 dN for full-field digital mammography (5.5% difference, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.001),&quot; they wrote.&lt;/p&gt;
&lt;p&gt;There was also a 1.7% statistically significant difference in mean compressed breast thickness  --  5.3 cm for screen-film mammography versus 5.4 cm for digital.&lt;/p&gt;
&lt;p&gt;But the difference in breast compression, while statistically significant, was &quot;likely clinically insignificant,&quot; Hendrick and colleagues concluded.&lt;/p&gt;
&lt;p&gt;The authors noted that the study was limited by the advances in imaging technology  --  since the study was conducted, film manufacturers have introduced &quot;new screen-film combinations, such as double-sided screens and double-emulsion films that were not available during DMIST.&quot;&lt;/p&gt;
&lt;p&gt;For that reason, &quot;breast dose along with image quality and other parameters should be carefully compared between existing screen-film mammography and any new [digital] system being considered for integration into a breast imaging practice.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The DMIST trial was supported by the National Cancer Institute and by the Lynn Safe Breast Cancer Research Foundation.&lt;/p&gt;&lt;p&gt;Hendrick disclosed that he is a consultant to GE Healthcare on digital breast tomosynthesis and other breast imaging projects not related to DMIST.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_443"
                     title="RSNA: Investigational Technology Sharpens Accuracy of Digital Mammography"
                     score="-0.005"
                     href="