In the past M.J. Michell has collaborated on articles with Z. Kaufman and L.J. Yeoman. One of their most recent publications is Original PaperThe mammographic parenchymal patterns of women on hormonal replacement therapy. Which was published in journal Clinical Radiology.

More information about M.J. Michell research including statistics on their citations can be found on their Copernicus Academic profile page.

M.J. Michell's Articles: (6)

Original PaperThe mammographic parenchymal patterns of women on hormonal replacement therapy

In this study 383 mammograms of women on hormone replacement therapy (HRT) for more than one year and 216 mammograms of women performed before HRT was started were examined to identify any mammographic features which are associated with a higher incidence of developing breast cancer according to Wolfe's criteria. There was no significant difference in the proportion of high and low risk parenchymal patterns as the duration of HRT increased.A significantly higher proportion of low risk patterns with ageing was observed in 216 women who had never been on HRT when compared to 194 mammograms of women who had been on HRT for more than 5 years. This difference becomes more obvious in women on HRT with less than three children compared to a similar group not taking HRT. Women who had not taken HRT appeared to undergo normal involutional changes which were reflected by an increase in the proportion of low risk patterns with increasing age. We may conclude from these findings that HRT appears to inhibit involutional processes within the breast and therefore this group have higher risk parenchymal patterns for a longer period of time and subsequently may have a higher risk of developing breast cancer.

Case report: Computed tomography appearances in a right paraduodenal hernia

The computed tomography (CT) appearances of a right paraduodenal hernia are described. The working diagnosis at the time of the scan was of acute pancreatitis and we discuss the differentiation of the two conditions on CT. The CT findings are compared with those previously reported in other types of internal hernia.

Prediction of the presence of invasive disease from the measurement of extent of malignant microcalcification on mammography and ductal carcinoma in situ grade at core biopsy

AimTo determine whether the extent of microcalcification and ductal carcinoma in situ (DCIS) grade can be used to accurately predict the presence and size of invasive cancer in cases of malignant microcalcification.Materials and methodsOver a 10-year period, 402 cases of malignant microcalcification from an NHS screening programme were analysed. For each case, measurement of mammographic microcalcification extent, DCIS grade, and the presence and size of invasive carcinoma from the excised surgical specimen were recorded.ResultsThe final histological diagnosis was DCIS only in 71% (284/402) and DCIS with a focus of invasive disease in 29% (118/402). The risk of invasive disease increased with increasing size of microcalcification from 20% (27/136) for cluster size less than 11 mm, to 45% (18/40) for cluster size more than 60 mm. The risk of invasive disease also increased with increasing histological grade of DCIS from 13% (4/31) with low-grade DCIS to 36% (86/239) with high-grade DCIS. There were significant associations with the presence of invasive disease for cluster size (p = 0.0001) and DCIS grade (p = 0.003), and when using univariate analysis with simple [cluster size (p = 0.01) and grade (p = 0.01)] and multiple [cluster size (p = 0.02) and grade (p = 0.02)] logistic regression, respectively. The Hosmer–Lemeshow goodness-of-fit test suggests that the multiple logistic regression model has a good fit (p = 0.99).ConclusionThe multidisciplinary team can use these data in individual cases to estimate the risk of invasive cancer and decide whether to carry out an axillary staging procedure.

Medico-legal issues in breast imaging

AimTo identify medico-legal issues that occur in the diagnosis and radiological management of breast disease and to propose measures to reduce the risk of patient complaints and legal action in breast radiology and diagnosis.Materials and methodsInstitutional review board approval was not applicable for this study. A retrospective study was undertaken and records of 120 medico-legal investigations over a 10 year period were examined. The reports were compiled by two consultant breast radiologists.ResultsThe mean age of the patients represented in this study was 48.3 years. The main complaint in this series was a delay in diagnosis (92%) followed by inappropriate or inadequate treatment (8%). 81% of cases were patients who had presented to the symptomatic clinic. The main presenting symptom was a palpable lump (65%). Substandard care was cited in 49/120 cases (41%). The mean average delay in diagnosis was 15.6 months. Of the cases cited as substandard care, 61% were considered the fault of the radiologist and 14% considered the fault of the breast surgeon. Of the cases where the radiologist was considered to be at fault, microcalcification was the most common mammographic sign to be missed or misinterpreted (12/26 cases, 46%).ConclusionThe most common complaint in this series was delay in diagnosis with microcalcification being the main mammographic sign that was either not seen or misinterpreted by the radiologist. Clear and precise written protocols are recommended for all breast imaging practice to ensure that medico-legal investigations will be greatly reduced.

An audit of mammographic screen detected lesions of uncertain malignant potential (B3) diagnosed on initial image guided needle biopsy: how has our practice changed over 10 years?

Highlights•The upgrade rates in this audit are in line with previously published literature.•The use of second line VAB/VAE can be used in place of surgical biopsies for B3 lesions with a lower risk of malignant potential.•B3 lesions with a higher risk of malignant potential should be followed up following further image-guided sampling.

Review articleManifestations of extramammary disease seen on imaging the breast

AbstractInvolvement of the breast in disease processes not inherent to the breast can prove a diagnostic challenge. A variety of cases is presented of both common and uncommon conditions, some of which show unique mammographic features, while others have a wide and non-specific imaging differential diagnosis. The cases are grouped into four categories: calcifications in the breast; changes confined to the skin; masses in the breast; and generalized changes in the breast. Some conditions overlap into several of these categories.

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