Laurie Margolies - Academia.edu (original) (raw)
Papers by Laurie Margolies
Journal of breast imaging, Apr 19, 2021
Objective: To define MRI features of free liquid silicone injection (FLSI) of the breast in trans... more Objective: To define MRI features of free liquid silicone injection (FLSI) of the breast in transgender women considering surgical management. Methods: This study was IRB-approved. MRI images from transgender women with FLSI imaged between 2009 and 2019 were reviewed. Presence and location of fibrotic masses (FMs) in the breast(s) and pectoralis muscle and patterns of granulomas were correlated with clinicopathologic findings. Background enhancement was quantified. Comparisons were performed using twotailed Fisher exact and Student's t test. Results: Of 21 transgender women with FLSI (mean age 46.8 years), 13/21 (61.9%) had a dominant FM measuring over 4 cm; these were limited to breast and pectoralis in 6/21 (28.6%), breast in 9/21 (42.9%), and pectoralis only in 2/21 (9.5%). Four of 21 patients (19.0%) had no FMs, and 4/21 (19.0%) had masses under 4 cm. Mean size of the dominant FM was 7.4 cm (range 4-12 cm). FMs were enhancing in 5/13 (38.5%) and contained T2 high signal granulomas in 8/13 (61.5%). While 18/21 (85.8%) of cases showed mild to moderate overall background enhancement, the majority 7/13 (61.5%) of dominant FM were non-enhancing. About half of cases (11/21, 52.4%) had diffuse foci, and half (10/21, 47.6%) had diffuse foci and masses throughout the breast and pectoralis muscle. These foci and masses displayed T2 high signal in 13/21 (61.9%). There were no occult carcinomas observed. Conclusion: MRI performed on symptomatic FLSI patients considering surgical treatment is helpful in assessing the extent of silicone infiltration and fibrotic reaction of the breast and pectoralis muscle.
Applied Radiology, 2016
CASE SUMMARY A 57-year-old woman presented for her annual breast screening. The patient had three... more CASE SUMMARY A 57-year-old woman presented for her annual breast screening. The patient had three prior benign left breast biopsies, which demonstrated fibrocystic changes and a fibroadenoma. She had no personal history of breast cancer. There is a family history of breast cancer, including her mother, her paternal grandmother, and her paternal aunt, all diagnosed at peri-menopausal ages. On mammography, an irregular mass with spiculated margins was identified in the outer right breast with a BI-RADS score of 5. Ultrasound imaging was performed to determine whether this mass would be amenable to biopsy under ultrasound guidance and to evaluate the remainder of the breast and axilla. Ultrasound imaging confirmed that the suspicious mass was amenable to ultrasound biopsy, which revealed carcinoma.
SSRN Electronic Journal, 2022
Translational Lung Cancer Research, 2021
Low-dose CT screening for lung cancer provides images of the entire chest and upper abdomen. Whil... more Low-dose CT screening for lung cancer provides images of the entire chest and upper abdomen. While the focus of screening is on finding early lung cancer, radiology leadership has embraced the fact that the information contained in the images presents a new challenge to the radiology profession. Other findings in the chest and upper abdomen were not the reason for obtaining the screening CT scan, nor symptomprompted, but still need to be reported. Reporting these findings and making recommendations for further workup requires careful consideration to avoid unnecessary workup or interventions while still maximizing the benefit that early identification of these other diseases provided. Other potential findings, such as cardiovascular disease and chronic pulmonary obstructive diseases actually cause more deaths than lung cancer. Existing recommendations for workup of abnormal CT findings are based on symptom-prompted indications for imaging. These recommendations may be different when the abnormalities are identified in asymptomatic people undergoing CT screening for lung cancer. I-ELCAP, a large prospectively collected multi-institutional and multinational database of screenings, was used to analyze CT findings identified in screening for lung cancer. These analyses and recommendations were made by radiologists in collaboration with clinicians in different medical specialties.
Clinical Imaging, 2020
Background: Massage therapy's ability to mitigate breast imaging associated anxiety has not been ... more Background: Massage therapy's ability to mitigate breast imaging associated anxiety has not been previously studied. Anxiety is, however, often cited as a harm of screening mammography with few options offered to diminish anxiety other than not screening. Reducing anxiety may improve compliance, and reduce breast cancer mortality and morbidity. A complimentary massage therapy program evaluated patient acceptance, anxiety perception and perceived value of massage. Methods: Over 10 weeks, verbal agreement was obtained from 113 breast imaging patients who desired a hand or shoulder/neck massage. Licensed massage therapists performed massages before, and/or during, or after, or in between imaging tests. After the massage, questionnaires assessed patients' self-rated perceptions of anxiety before and after massage on a scale from 0 to 10. Participants' age-group, reason for appointment, self-rated value of massage service, and willingness to return to and willingness to refer to the facility were reported. Changes in perceived average anxiety were estimated using a linear mixed effects model. Fisher's exact test was used to evaluate associations among categorical variables. Results: A significant decrease in perceived anxiety was observed following massage (d = −3.2, p < 0.001). 107/108 (99%) of respondents reported an improved patient experience with massage. 84/106 (79%) reported willingness to pay at least $5 for massage service. Conclusion: Massage therapy improves the patient experience and decreases perceptions of anxiety. It may be associated with improved breast imaging compliance. Patients' willingness to pay for the service may defray some cost of a massage program.
Clinical Imaging, 2018
To assess the ability of chest CT to identify patients needing further evaluation of the breasts.... more To assess the ability of chest CT to identify patients needing further evaluation of the breasts. Methods: IRB approval was obtained with a waiver of consent. Women with chest CT and mammogram within 12 months formed the cohort. A breast assessment and recommendation CT score (BARCS) analogous to mammographic BI-RADS was created and compared to the mammogram BI-RADS. Results: BARCS and mammographic BI-RADS management recommendations were concordant for 77.1%. 11 invasive cancers were detected; all by mammogram while CT missed 2. Conclusion: BARCS score should be studied in prospective trials. Chest CT might be the earliest opportunity to detect breast cancer.
Clinical Imaging, 2020
The goal of this work is to determine the optimal projection to detect breast masses on Chest CT.... more The goal of this work is to determine the optimal projection to detect breast masses on Chest CT. Methods: Institutional Review Board (HIPPA compliant) approval was obtained with a waiver of consent. 10 image pairs of Chest CT images containing breast masses were selected for review by 10 chest radiologists: the pairs consisted of axial, sagittal, coronal and axial MIP images (MIP images) with each projection compared to a MIP and with one another. For each pair, the image where the mass was most conspicuous was recorded. Results: MIPs were preferred to any cross sectional projection 82% of the time; sagittal (63%) or coronal (63%) images were preferred to the axial projection. When sagittal and coronal images were compared there was no preference. Conclusions: MIP images should be obtained and reviewed for breast pathology; sagittal or coronal projections may provide additional information.
![Research paper thumbnail of Corrigendum to “Reactivation tuberculosis presenting with unilateral axillary lymphadenopathy” [Radiology Case Reports 13 (2018) 1188–1191]](https://attachments.academia-assets.com/110077857/thumbnails/1.jpg)
](Radiology Case Reports, 2019
American Journal of Roentgenology, 2019
OBJECTIVE The purpose of this study was to determine patient attitudes about mammographic reporti... more OBJECTIVE The purpose of this study was to determine patient attitudes about mammographic reporting of breast arterial calcification (BAC), result communication, and action. SUBJECTS AND METHODS A self-administered survey was created for this project and was offered to mammography patients presenting for screening or diagnostic mammography over a 1-month period. RESULTS Among those who accepted questionnaires, 61.8% (419/678) responded with varying response rates to specific questions. A large percentage (95.8% [363/379]) preferred to have BAC reported. All 107 patients who were unaware of a personal history of heart disease wanted notification about BAC. There were 552 communication responses from 354 women. Among these responses, 62.5% (345/552) indicated a preference for notification from the radiology department by letter or telephone call. Among those who had a single preference, 76.6% (180/235) preferred notification by the radiology department in the patient results letter or by telephone call. Of those who chose one action option, 87.4% (181/207) indicated that they would undergo coronary artery CT before making a decision. Among those who selected multiple options, 53.2% (272/511) expressed a desire for coronary artery CT before making a decision. Age, level of education, and race were not associated with patients' attitudes toward BAC. CONCLUSION Patients had an overwhelming preference to be informed about BAC found at mammography. Given the ease of reporting BAC and the calls by preventive cardiologists to have the information, the widespread adoption of BAC reporting on mammography reports can promote prevention, diagnosis, and if needed, treatment of cardiovascular disease.
Radiology Case Reports, 2018
Unilateral axillary lymphadenopathy has various benign and malignant etiologies. Although benign ... more Unilateral axillary lymphadenopathy has various benign and malignant etiologies. Although benign causes are more common, it is important to exclude malignant causes, including metastasis from primary breast carcinoma. Benign etiologies include reactive adenopathy, granulomatous disease, and collagen vascular disease. We present a case of unilateral right axillary lymphadenopathy in a patient with rheumatoid arthritis. The pathologic diagnosis of granulomatous lymphadenitis and interval discovery of patient's history of latent tuberculosis led to a second biopsy for special mycobacterial staining and cultures with a final diagnosis of reactivation tuberculosis. The extrapulmonary manifestation of reactivation tuberculosis with tuberculous lymphadenitis is uncommon and particularly rare in the axillary lymph nodes.
Clinical imaging, Jan 24, 2017
Ectopic or accessory breasts describe residual breast tissue that fails to regress during normal ... more Ectopic or accessory breasts describe residual breast tissue that fails to regress during normal embryologic development anywhere outside the expected locations. Ectopic breast tissue is seen in 2-6% of the population and is categorized into two types: supernumerary and aberrant breast tissue . The extent of development of this accessory tissue varies from rudimentary to complete with organized glandular and ductal development. Given this, it is possible for the same pathology that affects normally positioned breast tissue to also affect accessory breast tissue.
Breast Diseases: A Year Book Quarterly, 2016
American Journal of Roentgenology, 1988
Journal of Breast Imaging, 2020
Objective To understand physicians’ comprehension of breast cancer screening guidelines and the e... more Objective To understand physicians’ comprehension of breast cancer screening guidelines and the existing literature on breast cancer screening, and whether this contributes to how patient screening is implemented in clinical practice. Methods A survey of 18 questions was distributed across the United States via e-mail and social media resources to physicians and medical students of all disciplines and levels of training. Responses from 728 physicians and medical students were reviewed. Respondents were from over 200 different institutions and over 60 different medical specialties. Results Our survey demonstrates that more than half of the participants felt uncomfortable in their knowledge of breast cancer screening recommendations (399/728, 54.8%) and existing literature on breast cancer screening (555/728, 76.2%). When stratified based on level of training, those at the attending level reported a greater level of comfort in their knowledge of breast cancer screening recommendations...
Journal of Breast Imaging, 2022
Objective This study assessed mentorship interest within the breast radiologist community to guid... more Objective This study assessed mentorship interest within the breast radiologist community to guide development of a mentorship program through the Society of Breast Imaging (SBI). Methods A 19-question survey developed by the SBI mentorship committee was distributed electronically to its members March 16, 2021, to May 7, 2021, to gauge interest in forming a society-sponsored mentorship program. Responses were analyzed, with subgroups compared using chi-square analysis. Results There was an 18% response rate (598/3277), and 65% (381/588) professed interest in an SBI-sponsored mentorship. Respondents were evenly distributed between academic (241/586, 41%) and private practice (242/586, 41%). Most were breast imaging fellowship-trained (355/593, 60%) and identified as female (420/596, 70%). For practice years, 50% (293/586) were late career (11+ years) with the remainder early-mid career (201/586, 34%) or trainees (92/586, 16%). For mentorship content areas, work/life balance was the m...
Magnetic resonance imaging is a major component of breast imaging. Many studies have shown that m... more Magnetic resonance imaging is a major component of breast imaging. Many studies have shown that magnetic resonance imaging is the most sensitive imaging method for detecting invasive breast cancer in comparison with mammography. ultrasound, and clinical breast examinations. Evidence-based clinical indications for breast magnetic resonance imaging include screening patients at high risk for breast cancer, including those with breast/ovarian cancer genes (BRCAl and BRCA2), those who are untested first-degree relatives of carriers of these genes, those whose lifetime risk of developing breast cancer is 20% to 25% or greater, those who had chest
Journal of breast imaging, Apr 19, 2021
Objective: To define MRI features of free liquid silicone injection (FLSI) of the breast in trans... more Objective: To define MRI features of free liquid silicone injection (FLSI) of the breast in transgender women considering surgical management. Methods: This study was IRB-approved. MRI images from transgender women with FLSI imaged between 2009 and 2019 were reviewed. Presence and location of fibrotic masses (FMs) in the breast(s) and pectoralis muscle and patterns of granulomas were correlated with clinicopathologic findings. Background enhancement was quantified. Comparisons were performed using twotailed Fisher exact and Student's t test. Results: Of 21 transgender women with FLSI (mean age 46.8 years), 13/21 (61.9%) had a dominant FM measuring over 4 cm; these were limited to breast and pectoralis in 6/21 (28.6%), breast in 9/21 (42.9%), and pectoralis only in 2/21 (9.5%). Four of 21 patients (19.0%) had no FMs, and 4/21 (19.0%) had masses under 4 cm. Mean size of the dominant FM was 7.4 cm (range 4-12 cm). FMs were enhancing in 5/13 (38.5%) and contained T2 high signal granulomas in 8/13 (61.5%). While 18/21 (85.8%) of cases showed mild to moderate overall background enhancement, the majority 7/13 (61.5%) of dominant FM were non-enhancing. About half of cases (11/21, 52.4%) had diffuse foci, and half (10/21, 47.6%) had diffuse foci and masses throughout the breast and pectoralis muscle. These foci and masses displayed T2 high signal in 13/21 (61.9%). There were no occult carcinomas observed. Conclusion: MRI performed on symptomatic FLSI patients considering surgical treatment is helpful in assessing the extent of silicone infiltration and fibrotic reaction of the breast and pectoralis muscle.
Applied Radiology, 2016
CASE SUMMARY A 57-year-old woman presented for her annual breast screening. The patient had three... more CASE SUMMARY A 57-year-old woman presented for her annual breast screening. The patient had three prior benign left breast biopsies, which demonstrated fibrocystic changes and a fibroadenoma. She had no personal history of breast cancer. There is a family history of breast cancer, including her mother, her paternal grandmother, and her paternal aunt, all diagnosed at peri-menopausal ages. On mammography, an irregular mass with spiculated margins was identified in the outer right breast with a BI-RADS score of 5. Ultrasound imaging was performed to determine whether this mass would be amenable to biopsy under ultrasound guidance and to evaluate the remainder of the breast and axilla. Ultrasound imaging confirmed that the suspicious mass was amenable to ultrasound biopsy, which revealed carcinoma.
SSRN Electronic Journal, 2022
Translational Lung Cancer Research, 2021
Low-dose CT screening for lung cancer provides images of the entire chest and upper abdomen. Whil... more Low-dose CT screening for lung cancer provides images of the entire chest and upper abdomen. While the focus of screening is on finding early lung cancer, radiology leadership has embraced the fact that the information contained in the images presents a new challenge to the radiology profession. Other findings in the chest and upper abdomen were not the reason for obtaining the screening CT scan, nor symptomprompted, but still need to be reported. Reporting these findings and making recommendations for further workup requires careful consideration to avoid unnecessary workup or interventions while still maximizing the benefit that early identification of these other diseases provided. Other potential findings, such as cardiovascular disease and chronic pulmonary obstructive diseases actually cause more deaths than lung cancer. Existing recommendations for workup of abnormal CT findings are based on symptom-prompted indications for imaging. These recommendations may be different when the abnormalities are identified in asymptomatic people undergoing CT screening for lung cancer. I-ELCAP, a large prospectively collected multi-institutional and multinational database of screenings, was used to analyze CT findings identified in screening for lung cancer. These analyses and recommendations were made by radiologists in collaboration with clinicians in different medical specialties.
Clinical Imaging, 2020
Background: Massage therapy's ability to mitigate breast imaging associated anxiety has not been ... more Background: Massage therapy's ability to mitigate breast imaging associated anxiety has not been previously studied. Anxiety is, however, often cited as a harm of screening mammography with few options offered to diminish anxiety other than not screening. Reducing anxiety may improve compliance, and reduce breast cancer mortality and morbidity. A complimentary massage therapy program evaluated patient acceptance, anxiety perception and perceived value of massage. Methods: Over 10 weeks, verbal agreement was obtained from 113 breast imaging patients who desired a hand or shoulder/neck massage. Licensed massage therapists performed massages before, and/or during, or after, or in between imaging tests. After the massage, questionnaires assessed patients' self-rated perceptions of anxiety before and after massage on a scale from 0 to 10. Participants' age-group, reason for appointment, self-rated value of massage service, and willingness to return to and willingness to refer to the facility were reported. Changes in perceived average anxiety were estimated using a linear mixed effects model. Fisher's exact test was used to evaluate associations among categorical variables. Results: A significant decrease in perceived anxiety was observed following massage (d = −3.2, p < 0.001). 107/108 (99%) of respondents reported an improved patient experience with massage. 84/106 (79%) reported willingness to pay at least $5 for massage service. Conclusion: Massage therapy improves the patient experience and decreases perceptions of anxiety. It may be associated with improved breast imaging compliance. Patients' willingness to pay for the service may defray some cost of a massage program.
Clinical Imaging, 2018
To assess the ability of chest CT to identify patients needing further evaluation of the breasts.... more To assess the ability of chest CT to identify patients needing further evaluation of the breasts. Methods: IRB approval was obtained with a waiver of consent. Women with chest CT and mammogram within 12 months formed the cohort. A breast assessment and recommendation CT score (BARCS) analogous to mammographic BI-RADS was created and compared to the mammogram BI-RADS. Results: BARCS and mammographic BI-RADS management recommendations were concordant for 77.1%. 11 invasive cancers were detected; all by mammogram while CT missed 2. Conclusion: BARCS score should be studied in prospective trials. Chest CT might be the earliest opportunity to detect breast cancer.
Clinical Imaging, 2020
The goal of this work is to determine the optimal projection to detect breast masses on Chest CT.... more The goal of this work is to determine the optimal projection to detect breast masses on Chest CT. Methods: Institutional Review Board (HIPPA compliant) approval was obtained with a waiver of consent. 10 image pairs of Chest CT images containing breast masses were selected for review by 10 chest radiologists: the pairs consisted of axial, sagittal, coronal and axial MIP images (MIP images) with each projection compared to a MIP and with one another. For each pair, the image where the mass was most conspicuous was recorded. Results: MIPs were preferred to any cross sectional projection 82% of the time; sagittal (63%) or coronal (63%) images were preferred to the axial projection. When sagittal and coronal images were compared there was no preference. Conclusions: MIP images should be obtained and reviewed for breast pathology; sagittal or coronal projections may provide additional information.
Radiology Case Reports, 2019
American Journal of Roentgenology, 2019
OBJECTIVE The purpose of this study was to determine patient attitudes about mammographic reporti... more OBJECTIVE The purpose of this study was to determine patient attitudes about mammographic reporting of breast arterial calcification (BAC), result communication, and action. SUBJECTS AND METHODS A self-administered survey was created for this project and was offered to mammography patients presenting for screening or diagnostic mammography over a 1-month period. RESULTS Among those who accepted questionnaires, 61.8% (419/678) responded with varying response rates to specific questions. A large percentage (95.8% [363/379]) preferred to have BAC reported. All 107 patients who were unaware of a personal history of heart disease wanted notification about BAC. There were 552 communication responses from 354 women. Among these responses, 62.5% (345/552) indicated a preference for notification from the radiology department by letter or telephone call. Among those who had a single preference, 76.6% (180/235) preferred notification by the radiology department in the patient results letter or by telephone call. Of those who chose one action option, 87.4% (181/207) indicated that they would undergo coronary artery CT before making a decision. Among those who selected multiple options, 53.2% (272/511) expressed a desire for coronary artery CT before making a decision. Age, level of education, and race were not associated with patients' attitudes toward BAC. CONCLUSION Patients had an overwhelming preference to be informed about BAC found at mammography. Given the ease of reporting BAC and the calls by preventive cardiologists to have the information, the widespread adoption of BAC reporting on mammography reports can promote prevention, diagnosis, and if needed, treatment of cardiovascular disease.
Radiology Case Reports, 2018
Unilateral axillary lymphadenopathy has various benign and malignant etiologies. Although benign ... more Unilateral axillary lymphadenopathy has various benign and malignant etiologies. Although benign causes are more common, it is important to exclude malignant causes, including metastasis from primary breast carcinoma. Benign etiologies include reactive adenopathy, granulomatous disease, and collagen vascular disease. We present a case of unilateral right axillary lymphadenopathy in a patient with rheumatoid arthritis. The pathologic diagnosis of granulomatous lymphadenitis and interval discovery of patient's history of latent tuberculosis led to a second biopsy for special mycobacterial staining and cultures with a final diagnosis of reactivation tuberculosis. The extrapulmonary manifestation of reactivation tuberculosis with tuberculous lymphadenitis is uncommon and particularly rare in the axillary lymph nodes.
Clinical imaging, Jan 24, 2017
Ectopic or accessory breasts describe residual breast tissue that fails to regress during normal ... more Ectopic or accessory breasts describe residual breast tissue that fails to regress during normal embryologic development anywhere outside the expected locations. Ectopic breast tissue is seen in 2-6% of the population and is categorized into two types: supernumerary and aberrant breast tissue . The extent of development of this accessory tissue varies from rudimentary to complete with organized glandular and ductal development. Given this, it is possible for the same pathology that affects normally positioned breast tissue to also affect accessory breast tissue.
Breast Diseases: A Year Book Quarterly, 2016
American Journal of Roentgenology, 1988
Journal of Breast Imaging, 2020
Objective To understand physicians’ comprehension of breast cancer screening guidelines and the e... more Objective To understand physicians’ comprehension of breast cancer screening guidelines and the existing literature on breast cancer screening, and whether this contributes to how patient screening is implemented in clinical practice. Methods A survey of 18 questions was distributed across the United States via e-mail and social media resources to physicians and medical students of all disciplines and levels of training. Responses from 728 physicians and medical students were reviewed. Respondents were from over 200 different institutions and over 60 different medical specialties. Results Our survey demonstrates that more than half of the participants felt uncomfortable in their knowledge of breast cancer screening recommendations (399/728, 54.8%) and existing literature on breast cancer screening (555/728, 76.2%). When stratified based on level of training, those at the attending level reported a greater level of comfort in their knowledge of breast cancer screening recommendations...
Journal of Breast Imaging, 2022
Objective This study assessed mentorship interest within the breast radiologist community to guid... more Objective This study assessed mentorship interest within the breast radiologist community to guide development of a mentorship program through the Society of Breast Imaging (SBI). Methods A 19-question survey developed by the SBI mentorship committee was distributed electronically to its members March 16, 2021, to May 7, 2021, to gauge interest in forming a society-sponsored mentorship program. Responses were analyzed, with subgroups compared using chi-square analysis. Results There was an 18% response rate (598/3277), and 65% (381/588) professed interest in an SBI-sponsored mentorship. Respondents were evenly distributed between academic (241/586, 41%) and private practice (242/586, 41%). Most were breast imaging fellowship-trained (355/593, 60%) and identified as female (420/596, 70%). For practice years, 50% (293/586) were late career (11+ years) with the remainder early-mid career (201/586, 34%) or trainees (92/586, 16%). For mentorship content areas, work/life balance was the m...
Magnetic resonance imaging is a major component of breast imaging. Many studies have shown that m... more Magnetic resonance imaging is a major component of breast imaging. Many studies have shown that magnetic resonance imaging is the most sensitive imaging method for detecting invasive breast cancer in comparison with mammography. ultrasound, and clinical breast examinations. Evidence-based clinical indications for breast magnetic resonance imaging include screening patients at high risk for breast cancer, including those with breast/ovarian cancer genes (BRCAl and BRCA2), those who are untested first-degree relatives of carriers of these genes, those whose lifetime risk of developing breast cancer is 20% to 25% or greater, those who had chest