Jay Baker

Overview:

As a radiologist in the Division of Breast Imaging, I am interested in studying techniques to better detect and assess breast lesions that may represent breast cancer. The major focus of my research activity involves identifying features of breast lesions on mammography/tomosynthesis, ultrasound and MRI that reliably indicate breast cancer or, equally important, reliably indicate a lesion is not breast cancer and biopsy can be safely avoided. 

Breast cancer is the most common malignancy occurring in women and the second most frequent cause of non-skin cancer deaths among women. Screening mammography programs have repeatedly shown a reduction in the mortality from breast cancer by 30 to 50%. However, breast imaging suffers from a lack of specificity. The result is that 60 to 80% of breast biopsies performed in this country are for benign lesions and are therefore - in retrospect - unnecessary. Because of the overlap in imaging features of benign and malignant lesions, however, these lesions cannot be differentiated without tissue sampling, and the extraordinary number of breast biopsies performed markedly increases the cost of breast cancer prevention programs and is an impediment to breast screening for some women. To overcome this limitation, we are working to identify previously unrecognized features of breast lesions.  Some of these features appear to confirm that a lesion is definitively benign without the need for biopsy.  Other features have identified a particular appearance for breast cancer with features that mimic other benign lesions, thus allowing earlier diagnosis and fewer overlooked breast cancers. We are assessing these features with large reader studies to both determine the accuracy and to confirm that the features can be taught and recognized by radiologists at all levels of breast imaging experience.  If successful, widespread adoption and recognition of these features may greatly reduce the number of women who undergo a needle biopsy for a benign breast lesion.  Conversely, widespread recognition of other features may reduce delays in diagnosis of breast cancer.

Positions:

Professor of Radiology

Radiology, Breast Imaging
School of Medicine

Chief, Breast Imaging

Radiology, Breast Imaging
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.A. 1988

University of Pennsylvania

M.D. 1992

Duke University

Resident, Radiology

Duke University

Grants:

Breast Elemental Composition Imaging

Administered By
Radiology
Awarded By
National Institutes of Health
Role
Investigator
Start Date
End Date

Publications:

Location, Location, Location

Authors
MLA Citation
Baker, J. A. “Location, Location, Location.” Journal of Breast Imaging, vol. 3, no. 4, July 2021, pp. 405–06. Scopus, doi:10.1093/jbi/wbab047.
URI
https://scholars.duke.edu/individual/pub1499495
Source
scopus
Published In
Journal of Breast Imaging
Volume
3
Published Date
Start Page
405
End Page
406
DOI
10.1093/jbi/wbab047

Impact of Sodium Bicarbonate-Buffered Lidocaine on Patient Pain During Image-Guided Breast Biopsy.

PURPOSE: This randomized, double-blind controlled study evaluated the effectiveness of sodium bicarbonate-buffered lidocaine on reducing pain during imaging-guided breast biopsies. MATERIALS AND METHODS: This prospective, HIPAA-compliant study randomly assigned 85 women undergoing ultrasound- or stereotactic-guided core-needle breast biopsies to receive intradermally and intraparenchymally either 1% lidocaine buffered with sodium bicarbonate (9:1 ratio) (bicarbonate study group) or 1% lidocaine alone (control group). Pain was evaluated using a 0-to-10 Likert pain scale during both intradermal and intraparenchymal anesthesia injections and during tissue sampling. Prebiopsy breast pain, anxiety, medical history, demographics, biopsy type, radiologist level of training, breast density, and lesion histology were recorded. Data were analyzed using analysis of variance and analysis of covariance. RESULTS: Unadjusted mean pain scores were 1.47 and 2.07 (study and control groups, respectively; P = .15) during intradermal injections, and 1.84 and 2.98 (study and control groups, respectively; P = .03) during intraparenchymal injections. Tissue sampling mean pain scores were .81 and 1.71 (study and control groups, respectively; P = .07). Moderator analyses found (1) among patients with preprocedural pain, those in the bicarbonate group experienced less intradermal injection pain (0.85 ± 1.23) than patients in the control group (2.50 ± 2.09); (2) among patients with fatty or scattered fibroglandular tissue, those in the bicarbonate group (1.35 ± 1.95) experienced less intraparenchymal injection pain than the control group (3.52 ± 3.13); and (3) during ultrasound-guided biopsies, patients in the bicarbonate group experienced less tissue-sampling pain (0.23 ± 0.63) than the control group (1.79 ± 3.05). CONCLUSIONS: Overall, buffering lidocaine with sodium bicarbonate significantly reduced pain during intraparenchymal injections, and additional pain reduction was found in certain patient subgroups during intradermal injections, intraparenchymal injections, and tissue sampling.
Authors
MLA Citation
Vasan, Alison, et al. “Impact of Sodium Bicarbonate-Buffered Lidocaine on Patient Pain During Image-Guided Breast Biopsy.J Am Coll Radiol, vol. 14, no. 9, Sept. 2017, pp. 1194–201. Pubmed, doi:10.1016/j.jacr.2017.03.026.
URI
https://scholars.duke.edu/individual/pub1254715
PMID
28527821
Source
pubmed
Published In
Journal of the American College of Radiology : Jacr
Volume
14
Published Date
Start Page
1194
End Page
1201
DOI
10.1016/j.jacr.2017.03.026

Can breast cancer molecular subtype help to select patients for preoperative MR imaging?

PURPOSE: To assess whether breast cancer molecular subtype classified by surrogate markers can be used to predict the extent of clinically relevant disease with preoperative breast magnetic resonance (MR) imaging. MATERIALS AND METHODS: In this HIPAA-compliant, institutional review board-approved study, informed consent was waived. Preoperative breast MR imaging reports from 441 patients were reviewed for multicentric and/or multifocal disease, lymph node involvement, skin and/or nipple invasion, chest wall and/or pectoralis muscle invasion, or contralateral disease. Pathologic reports were reviewed to confirm the MR imaging findings and for hormone receptors (estrogen and progesterone subtypes), human epidermal growth factor receptor type 2 (HER2 subtype), tumor size, and tumor grade. Surrogates were used to categorize tumors by molecular subtype: hormone receptor positive and HER2 negative (luminal A subtype); hormone receptor positive and HER2 positive (luminal B subtype); hormone receptor negative and HER2 positive (HER2 subtype); hormone receptor negative and HER2 negative (basal subtype). All patients included in the study had a histologic correlation with MR imaging findings or they were excluded. χ(2) analysis was used to compare differences between subtypes, with multivariate logistic regression analysis used to assess for variable independence. RESULTS: Identified were 289 (65.5%) luminal A, 45 (10.2%) luminal B, 26 (5.9%) HER2, and 81 (18.4%) basal subtypes. Among subtypes, significant differences were found in the frequency of multicentric and/or multifocal disease (luminal A, 27.3% [79 of 289]; luminal B, 53.3% [24 of 45]; HER2, 65.4% [17 of 26]; basal, 27.2% [22 of 81]; P < .001) and lymph node involvement (luminal A, 17.3% [50 of 289]; luminal B, 35.6% [26 of 45]; HER2, 34.6% [nine of 26]; basal 24.7% [20 of 81]; P = .014). Multivariate analysis showed that molecular subtype was independently predictive of multifocal and/or multicentric disease. CONCLUSION: Preoperative breast MR imaging is significantly more likely to help detect multifocal and/or multicentric disease and lymph node involvement in luminal B and HER2 molecular subtype breast cancers. Molecular subtype may help to select patients for preoperative breast MR imaging.
MLA Citation
Grimm, Lars J., et al. “Can breast cancer molecular subtype help to select patients for preoperative MR imaging?Radiology, vol. 274, no. 2, Feb. 2015, pp. 352–58. Pubmed, doi:10.1148/radiol.14140594.
URI
https://scholars.duke.edu/individual/pub1048320
PMID
25325325
Source
pubmed
Published In
Radiology
Volume
274
Published Date
Start Page
352
End Page
358
DOI
10.1148/radiol.14140594

Is surgical excision of core biopsy proven benign papillomas of the breast necessary?

RATIONALE AND OBJECTIVES: The aim of this study was to determine if core biopsy-proven benign papillomas of the breast need to be surgically excised. MATERIALS AND METHODS: Mammographic and pathologic database review from January 1994 to January 2004 revealed 178 papillary lesions diagnosed by core biopsy in 176 women (mean age, 59 years). All lesions had >or=24 months of imaging follow-up (n = 75) or surgical correlation (n = 103). Details regarding core biopsy technique, lesion appearance, pathologic results, imaging-histopathologic concordance, and follow-up imaging were recorded. Core and surgical pathologic results were correlated. RESULTS: Of the 178 papillary lesions diagnosed at core needle biopsy, 120 (67%) were initially diagnosed as benign without atypia. The core biopsy diagnoses of benignity were confirmed for all 120 lesions by either surgical excision (n = 45) or stability after >or=2 years of imaging follow-up (n = 75). Of the remaining 58 papillary lesions, 50 were found to be atypical at core needle biopsy; 15 of those 50 (29%) were upgraded to malignancies at surgical excision. Eight of the 178 lesions (5%) were initially diagnosed as malignant papillary lesions at core needle biopsy. Seven of these eight (88%) were confirmed malignant at excision. None of the surgically proven cancers was diagnosed as benign at core biopsy. CONCLUSIONS: Close imaging follow-up rather than excision of core biopsy-proven benign papillomas was adequate given careful imaging-histopathologic correlation and excision of all atypical and discordant lesions. Individual centers should evaluate their own data and tailor their practices accordingly.
Authors
Bennett, LE; Ghate, SV; Bentley, R; Baker, JA
MLA Citation
Bennett, Lisa E., et al. “Is surgical excision of core biopsy proven benign papillomas of the breast necessary?Acad Radiol, vol. 17, no. 5, May 2010, pp. 553–57. Pubmed, doi:10.1016/j.acra.2010.01.001.
URI
https://scholars.duke.edu/individual/pub719066
PMID
20223685
Source
pubmed
Published In
Acad Radiol
Volume
17
Published Date
Start Page
553
End Page
557
DOI
10.1016/j.acra.2010.01.001

Comparison of LCD and CRT displays based on efficacy for digital mammography.

RATIONALE AND OBJECTIVES: To compare two display technologies, cathode ray tube (CRT) and liquid crystal display (LCD), in terms of diagnostic accuracy for several common clinical tasks in digital mammography. MATERIALS AND METHODS: Simulated masses and microcalcifications were inserted into normal digital mammograms to produce an image set of 400 images. Images were viewed on one CRT and one LCD medical-quality display device by five experienced breast-imaging radiologists who rated the images using a categorical rating paradigm. The observer data were analyzed to determine overall classification accuracy, overall lesion detection accuracy, and accuracy for four specific diagnostic tasks: detection of benign masses, malignant masses, and microcalcifications, and discrimination of benign and malignant masses. RESULTS: Radiologists had similar overall classification accuracy (LCD: 0.83 +/- 0.01, CRT: 0.82 +/- 0.01) and lesion detection accuracy (LCD: 0.87 +/- 0.01, CRT: 0.85 +/- 0.01) on both displays. The difference in accuracy between LCD and CRT for the detection of benign masses, malignant masses, and microcalcifications, and discrimination of benign and malignant masses was -0.019 +/- 0.009, 0.020 +/- 0.008, 0.012 +/- 0.013, and 0.0094 +/- 0.011, respectively. Overall, the two displays did not exhibit any statistically significant difference (P > .05). CONCLUSION: This study explored the suitability of two different soft-copy displays for the viewing of mammographic images. It found that LCD and CRT displays offer similar clinical utility for mammographic tasks.
Authors
Saunders, RS; Samei, E; Baker, J; Delong, D; Soo, MS; Walsh, R; Pisano, E; Kuzmiak, CM; Pavic, D
MLA Citation
Saunders, Robert S., et al. “Comparison of LCD and CRT displays based on efficacy for digital mammography.Acad Radiol, vol. 13, no. 11, Nov. 2006, pp. 1317–26. Pubmed, doi:10.1016/j.acra.2006.07.017.
URI
https://scholars.duke.edu/individual/pub710687
PMID
17070449
Source
pubmed
Published In
Academic Radiology
Volume
13
Published Date
Start Page
1317
End Page
1326
DOI
10.1016/j.acra.2006.07.017