Lars Grimm

Positions:

Associate Professor of Radiology

Radiology, Breast Imaging
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

B.S. 2004

Stanford University

M.D. 2009

Yale University School of Medicine

M.H.S. 2009

Yale University

Residency, Diagnostic Radiology

Duke University School of Medicine

Fellowship, Radiology, Breast Imaging

Duke University School of Medicine

Grants:

Tomosynthesis Mammographic Imaging Screening Trial (TMIST)

Administered By
Radiology, Breast Imaging
Role
Principal Investigator
Start Date
End Date

Prediction of upstaging DCIS to invasive disease: performance comparison between breast radiologists and computer vision algorithms

Administered By
Radiology, Breast Imaging
Awarded By
Radiological Society of North America
Role
Principal Investigator
Start Date
End Date

Tomosynthesis Mammographic Imaging Screening Trial (TMIST)

Administered By
Radiology, Breast Imaging
Awarded By
ECOG-ACRIN Medical Research Foundation Inc.
Role
Principal Investigator
Start Date
End Date

Mixed Methods Study of Trainee Perceptions of Radiology with a Focus on Gender and Racial Inequality

Administered By
Radiology, Breast Imaging
Awarded By
Association of University Radiologists Research and Education Foundation
Role
Principal Investigator
Start Date
End Date

Machine Learning for Risk-Adjusted Breast MRI Screening

Administered By
Radiology, Breast Imaging
Awarded By
City College of New York
Role
Principal Investigator
Start Date
End Date

Publications:

Role of digital breast tomosynthesis in the evaluation of focal breast pain.

RATIONAL AND OBJECTIVE: To investigate the utility of digital breast tomosynthesis (DBT) in the evaluation of focal breast pain, considering breast density and breast cancer risk. METHODS: Ninety-one cases of focal breast pain evaluated with DBT and ultrasound (US) from 12/30/2014 to 11/9/2017 with 2-year follow-up were identified. Exclusion criteria were non-focal, axillary, or radiating pain; palpable or skin changes; pregnancy or lactation; and history of ipsilateral cancer, trauma, or infection. Demographic data, Tyrer-Cuzick Score (TCS), medical history, breast density, imaging results, and pathology were recorded. Descriptive statistics were reported. RESULTS: Eighteen percent (16/91) of cases demonstrated findings, all benign. Of these, 6% (1/16) were detected by DBT only, 88% (14/16) by US only, and 6% (1/16) by DBT and US. US resulted in 3 benign biopsies. Ninety-nine percent (75/76) of cases with no findings at the site of pain on US also had no findings on DBT. Ninety-eight percent (89/91) of cases with no cancer detected at the site of pain on US also did not have cancer on DBT. DBT detected 2 incidental cancers not associated with pain. DBT and US agreed that there was no finding at the site of pain in 82% (75/91) of cases. A high degree of agreement between DBT and US was seen when stratified by breast density and TCS. CONCLUSION: DBT may be appropriate for the evaluation of focal pain. Low breast cancer incidence was observed at the site of focal pain across all mammographic breast densities and breast cancer risks.
Authors
Taylor-Cho, MW; Peacock, S; Wolf, S; Thomas, S; Grimm, LJ; Johnson, KS
MLA Citation
Taylor-Cho, Michael W., et al. “Role of digital breast tomosynthesis in the evaluation of focal breast pain.Clin Imaging, vol. 82, Feb. 2022, pp. 73–76. Pubmed, doi:10.1016/j.clinimag.2021.11.003.
URI
https://scholars.duke.edu/individual/pub1501767
PMID
34798561
Source
pubmed
Published In
Clin Imaging
Volume
82
Published Date
Start Page
73
End Page
76
DOI
10.1016/j.clinimag.2021.11.003

Geographic Trends in Publications and Submissions in Radiology Journals: Decade Report (2010 - 2020).

RATIONALE AND OBJECTIVE: The Radiology Research Alliance (RRA) of the Association of University Radiologists (AUR) organized a task force to quantify geographic changes in submissions to and publications within radiology journals over time. MATERIALS AND METHODS: Twenty journals were selected: 7 US-based general, 4 European-based general, and 9 subspecialty radiology journals. Journals were solicited for submissions and publications based on country of origin from 2010 -2020. Regression models assessed changes over time across countries, and by continent, with an emphasis on the US and China, for each journal category. RESULTS: There were 104,679 publications and 92,446 submissions from 149 countries. Overall, there were significant increases in numbers of publications from Asia (R2 = 0.66, p <0.01), and specifically, China (R2 = 0.87, p <0.01). For US journals, there were increased numbers of publications from Asia (R2 = 0.72, p <0.01) and China (R2 = 0.98, p <0.01), but decreased numbers from North America (R2 = 0.41, p = 0.03). For European journals, there were increased numbers of publications from Asia (R2 = 0.79, p <0.01), North America (R2 = 0.75, p <0.01), and China (R2 = 0.82, p <0.01). For subspecialty journals, there were increased numbers of publications from North America (R2 = 0.38, p = 0.04) and China (R2 = 0.73, p <0.01). There was an acute COVID spike in submissions during 2020, with a continuous increase most notable in China (R2 = 0.96, p <0.01). CONCLUSION: In the last decade, the numbers of submissions to and publications within general and subspecialty US and European radiology journals have generally increased around the world, with the largest growth in Asia and in particular China.
Authors
Grimm, LJ; Ballard, DH; Beckman, NM; Mansoori, B; Solnes, LB; Sodagari, F; Zohrabian, VM
MLA Citation
Grimm, Lars J., et al. “Geographic Trends in Publications and Submissions in Radiology Journals: Decade Report (2010 - 2020).Acad Radiol, vol. 29, no. 8, Aug. 2022, pp. 1248–54. Pubmed, doi:10.1016/j.acra.2021.12.010.
URI
https://scholars.duke.edu/individual/pub1506924
PMID
35031153
Source
pubmed
Published In
Acad Radiol
Volume
29
Published Date
Start Page
1248
End Page
1254
DOI
10.1016/j.acra.2021.12.010

Breast Imaging for Transgender Individuals: Assessment of Current Practice and Needs.

PURPOSE: The aim of this study was to investigate breast radiologists' practices related to recording sex and gender in the electronic medical record, knowledge and attitudes about breast cancer screening recommendations for transgender individuals, and experience and willingness to enter screening mammography data from transgender patients into databases that document service provision and outcomes of cancer detection protocols. METHODS: A 19-question anonymous survey was distributed by e-mail to all active physician members of the Society of Breast Imaging. Response characteristics were assessed as frequencies and percentages and compared between groups using the Fisher exact test or χ2 test. The degree of agreement between questions was assessed using the McNemar test. RESULTS: Four hundred one radiologists across the United States and Canada responded (response rate 18%). Recording birth-assigned sex distinct from gender identity was reported by 44 of 352 respondents (13%). Depending on geographic region, 38% to 62% of breast radiologists followed screening guidelines for transgender women, and 226 of 349 (65%) did not provide screening recommendations for transgender men. Of 400, 324 (81%) believed that the evidence base for screening transgender individuals is incomplete, and 247 of 352 (70%) were either unsure of or had no Lesbian, Gay, Bisexual, Transgender, Queer competency training. A majority (247 of 401 [62%]) of respondents reported that they would enroll transgender patients in existing or novel national databases. CONCLUSIONS: In the practice of breast imaging, there is a substantial need to record transgender and other gender-nonconforming information. Breast radiologists differ in their practice and knowledge regarding screening of transgender women and men but expressed interest in contributing data to facilitate longitudinal databases needed to inform cancer screening guidelines.
Authors
Sonnenblick, EB; Lebron-Zapata, L; Yang, R; Dodelzon, K; Sevilimedu, V; Milch, H; Dialani, V; Dontchos, BN; Destounis, S; Grimm, L
MLA Citation
Sonnenblick, Emily B., et al. “Breast Imaging for Transgender Individuals: Assessment of Current Practice and Needs.J Am Coll Radiol, vol. 19, no. 2 Pt A, Feb. 2022, pp. 221–31. Pubmed, doi:10.1016/j.jacr.2021.09.047.
URI
https://scholars.duke.edu/individual/pub1504112
PMID
34902332
Source
pubmed
Published In
Journal of the American College of Radiology : Jacr
Volume
19
Published Date
Start Page
221
End Page
231
DOI
10.1016/j.jacr.2021.09.047

Impact of the COVID-19 Pandemic on Breast Imaging: An Analysis of the National Mammography Database.

PURPOSE: The aim of this study was to quantify the initial decline and subsequent rebound in breast cancer screening metrics throughout the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Screening and diagnostic mammographic examinations, biopsies performed, and cancer diagnoses were extracted from the ACR National Mammography Database from March 1, 2019, through May 31, 2021. Patient (race and age) and facility (regional location, community type, and facility type) demographics were collected. Three time periods were used for analysis: pre-COVID-19 (March 1, 2019, to May 31, 2019), peak COVID-19 (March 1, 2020, to May 31, 2020), and COVID-19 recovery (March 1, 2021, to May 31, 2021). Analysis was performed at the facility level and overall between time periods. RESULTS: In total, 5,633,783 screening mammographic studies, 1,282,374 diagnostic mammographic studies, 231,390 biopsies, and 69,657 cancer diagnoses were analyzed. All peak COVID-19 metrics were less than pre-COVID-19 volumes: 36.3% of pre-COVID-19 for screening mammography, 57.9% for diagnostic mammography, 47.3% for biopsies, and 48.7% for cancer diagnoses. There was some rebound during COVID-19 recovery as a percentage of pre-COVID-19 volumes: 85.3% of pre-COVID-19 for screening mammography, 97.8% for diagnostic mammography, 91.5% for biopsies, and 92.0% for cancer diagnoses. Across various metrics, there was a disproportionate negative impact on older women, Asian women, facilities in the Northeast, and facilities affiliated with academic medical centers. CONCLUSIONS: COVID-19 had the greatest impact on screening mammography volumes, which have not returned to pre-COVID-19 levels. Cancer diagnoses declined significantly in the acute phase and have not fully rebounded, emphasizing the need to increase outreach efforts directed at specific patient population and facility types.
Authors
Grimm, LJ; Lee, C; Rosenberg, RD; Burleson, J; Simanowith, M; Fruscello, T; Pelzl, CE; Friedewald, SM; Moy, L; Zuley, ML
MLA Citation
Grimm, Lars J., et al. “Impact of the COVID-19 Pandemic on Breast Imaging: An Analysis of the National Mammography Database.J Am Coll Radiol, vol. 19, no. 8, Aug. 2022, pp. 919–34. Pubmed, doi:10.1016/j.jacr.2022.04.008.
URI
https://scholars.duke.edu/individual/pub1524435
PMID
35690079
Source
pubmed
Published In
Journal of the American College of Radiology : Jacr
Volume
19
Published Date
Start Page
919
End Page
934
DOI
10.1016/j.jacr.2022.04.008

Ductal Carcinoma in Situ: State-of-the-Art Review.

Ductal carcinoma in situ (DCIS) is a nonobligate precursor of invasive cancer, and its detection, diagnosis, and management are controversial. DCIS incidence grew with the expansion of screening mammography programs in the 1980s and 1990s, and DCIS is viewed as a major driver of overdiagnosis and overtreatment. For pathologists, the diagnosis and classification of DCIS is challenging due to undersampling and interobserver variability. Understanding the progression from normal breast tissue to DCIS and, ultimately, to invasive cancer is limited by a paucity of natural history data with multiple proposed evolutionary models of DCIS initiation and progression. Although radiologists are familiar with the classic presentation of DCIS as asymptomatic calcifications at mammography, the expanded pool of modalities, advanced imaging techniques, and image analytics have identified multiple potential biomarkers of histopathologic characteristics and prognosis. Finally, there is growing interest in the nonsurgical management of DCIS, including active surveillance, to reduce overtreatment and provide patients with more personalized management options. However, current biomarkers are not adept at enabling identification of occult invasive disease at biopsy or accurately predicting the risk of progression to invasive disease. Several active surveillance trials are ongoing and are expected to better identify women with low-risk DCIS who may avoid surgery.
Authors
Grimm, LJ; Rahbar, H; Abdelmalak, M; Hall, AH; Ryser, MD
MLA Citation
Grimm, Lars J., et al. “Ductal Carcinoma in Situ: State-of-the-Art Review.Radiology, vol. 302, no. 2, Feb. 2022, pp. 246–55. Pubmed, doi:10.1148/radiol.211839.
URI
https://scholars.duke.edu/individual/pub1504860
PMID
34931856
Source
pubmed
Published In
Radiology
Volume
302
Published Date
Start Page
246
End Page
255
DOI
10.1148/radiol.211839