4.Supplementary breast ultrasound screening in Asian women with negative but dense mammograms-a pilot study.
Lester C H LEONG ; Apoorva GOGNA ; Rita PANT ; Fook Cheong NG ; Llewellyn S J SIM
Annals of the Academy of Medicine, Singapore 2012;41(10):432-439
INTRODUCTIONDense breasts are common in Asian women and they limit the sensitivity of mammography. This study evaluates the performance of supplementary breast ultrasound screening in Asian women with dense mammograms.
MATERIALS AND METHODSThe study was approved by the hospital's Institutional Review Board. A prospective clinical trial was performed between September 2002 and November 2004. Asymptomatic Asian women with negative and dense mammograms were offered supplementary ultrasound screening for breast cancer. Ultrasound assessment was categorised as U1 to U4. U1 and U2 cases were recommended routine interval screening mammography. U3 cases were recommended follow-up ultrasound in 6 months and routine interval screening mammography and U4 cases were recommended biopsy.
RESULTSOne hundred and forty-one women with mean age of 45.1 years were enrolled into the study. Mean scan time was 13.0 minutes (± 5.6 minutes) for bilateral vs 11.0 minutes (± 1.4 minutes) for unilateral scans. There were 10 patients and 14 patients in the in the U3 and U4 categories, respectively. Two U4 category patients were diagnosed with malignancy-a-6 mm ductal carcinoma-in-situ and a 13- mm invasive ductal carcinoma. The breast cancer detection rate was 1.4%. Sensitivity and specifi city were 100% (2/2) and 88.5% (92/104) respectively. The positive predictive value was 14.3% (2/14) and the negative predictive value was 100% (92/92).
CONCLUSIONThis pilot study reveals the usefulness of supplementary ultrasound screening in detecting early stage mammographically and clinically occult breast cancers in Asian women with dense breasts. A larger long-term study is, however, needed to assess its feasibility and impact on breast cancer prognosis.
Adult ; Asian Continental Ancestry Group ; Breast Neoplasms ; diagnostic imaging ; ethnology ; Carcinoma, Ductal, Breast ; diagnostic imaging ; ethnology ; Carcinoma, Intraductal, Noninfiltrating ; diagnostic imaging ; ethnology ; Early Detection of Cancer ; methods ; Female ; Follow-Up Studies ; Humans ; Mammography ; Middle Aged ; Pilot Projects ; Prospective Studies ; Sensitivity and Specificity ; Ultrasonography, Mammary
5.Inter-hospital trends of post-resuscitation interventions and outcomes of out-of-hospital cardiac arrest in Singapore.
Julia Li Yan JAFFAR ; Stephanie FOOK-CHONG ; Nur SHAHIDAH ; Andrew Fu Wah HO ; Yih Yng NG ; Shalini ARULANANDAM ; Alexander WHITE ; Le Xuan LIEW ; Nurul ASYIKIN ; Benjamin Sieu Hon LEONG ; Han Nee GAN ; Desmond MAO ; Michael Yih Chong CHIA ; Si Oon CHEAH ; Marcus Eng Hock ONG
Annals of the Academy of Medicine, Singapore 2022;51(6):341-350
INTRODUCTION:
Hospital-based resuscitation interventions, such as therapeutic temperature management (TTM), emergency percutaneous coronary intervention (PCI) and extracorporeal membrane oxygenation (ECMO) can improve outcomes in out-of-hospital cardiac arrest (OHCA). We investigated post-resuscitation interventions and hospital characteristics on OHCA outcomes across public hospitals in Singapore over a 9-year period.
METHODS:
This was a prospective cohort study of all OHCA cases that presented to 6 hospitals in Singapore from 2010 to 2018. Data were extracted from the Pan-Asian Resuscitation Outcomes Study Clinical Research Network (PAROS CRN) registry. We excluded patients younger than 18 years or were dead on arrival at the emergency department. The outcomes were 30-day survival post-arrest, survival to admission, and neurological outcome.
RESULTS:
The study analysed 17,735 cases. There was an increasing rate of provision of TTM, emergency PCI and ECMO (P<0.001) in hospitals, and a positive trend of survival outcomes (P<0.001). Relative to hospital F, hospitals B and C had lower provision rates of TTM (≤5.2%). ECMO rate was consistently <1% in all hospitals except hospital F. Hospitals A, B, C, E had <6.5% rates of provision of emergency PCI. Relative to hospital F, OHCA cases from hospitals A, B and C had lower odds of 30-day survival (adjusted odds ratio [aOR]<1; P<0.05 for hospitals A-C) and lower odds of good neurological outcomes (aOR<1; P<0.05 for hospitals A-C). OHCA cases from academic hospitals had higher odds ratio (OR) of 30-day survival (OR 1.3, 95% CI 1.1-1.5) than cases from hospitals without an academic status.
CONCLUSION
Post-resuscitation interventions for OHCA increased across all hospitals in Singapore from 2010 to 2018, correlating with survival rates. The academic status of hospitals was associated with improved survival.
Hospitals, Public
;
Humans
;
Out-of-Hospital Cardiac Arrest/therapy*
;
Percutaneous Coronary Intervention
;
Prospective Studies
;
Singapore/epidemiology*