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Statistical comparison of patients undergoing breast biopsy at a community hospital over a 16-year period indicates the impact of mammography on the management of breast cancer. Three study groups were surveyed: (a) patients biopsied during the 5 years preceding the use of mammography, (b) patients given mammography during the next 10 years, and (c) those studied during the final year. A 19% increase in detection of Stage I cancer was seen. The overall end results of breast cancer therapy should be significantly improved if mammography is employed routinely in the evaluation of such patients.

Modified radical mastectomy was performed in 162 patients with minimal breast cancer between 1953 and 1972 (JAU). The majority of lesions were small infiltrating cancers (52), non-infiltrating duct cancer (37), lobular carcinoma in situ (49), Paget's disease with non-infiltrating cancer (12), and also a small group of miscellaneous low-grade cancers (7), and malignant cystosarcoma phyllodes (5). Major indications for surgery were the presence of a mass, nipple ulceration, positive mammograms, and the discovery of an occult cancer on contralateral biopsy. Mammography was accurate in 60% of patients with minimal breast cancer. Contralateral biopsy proved to be a very sensitive diagnostic technique, and was positive in 35 patients, most of whom were negative by clinical examination and mammography. Residual cancer was found in the mastectomy specimens in 52% after generous excisional biopsies. Sixteen percent of patients with minimal infiltrating cancer and clinically negative axillae had micrometastases (2mm or less) in axillary nodes. The crude survival rate free of disease was 93 of 95 patients (98%) at 5 years, and 42 of 44 patients (95%) at 10 years. There were no local recurrences. No postoperative radiation was used on these patients. Modified radical mastectomy is recommended as the ideal treatment for minimal breast cancer as it yields excellent long term salvage, complete local control, and is more acceptable cosmetically than the classical radical mastectomy. It is to be preferred over extended lumpectomy (tylectomy) with radiation therapy since it avoids the potential long-term carcinogenic effects of ionizing radiation. The excellent results obtained by adequate treatment of minimal breast cancers attest to the need for reliable mass screening techniques to detect occult, asymptomatic breast cancer, and for the availability of these techniques to the public at large.

The incidence of calcification and appearance of opacities in specimen roentgenograms of 228 consecutive breast specimens representing a variety of disorders are presented. Although some diseases manifest distinctive roentgenographic features, overlapping is noted. This, as well as an inherent technical difficulty, appears to be reflected by the relatively high incidence of false-negative and false-positive diagnoses conveyed by clinical mammography. The detection of only 0.7% occult carcinomas (clinically and pathologically non-palpable) by specimen mammography in calcifications unassociated with a dominant mass and only 7.4% of all calcifications, including those in the latter group, tends to minimize the practical significance of clinical mamography for the detection of occult cancer of the breast. The occult carcinomas detected by specimen mammography in this study were found only in breasts with overt carcinomatous lesions, which represents an incidence of 9% multicentric cancers. Recognition of a similar incidence of such lesions by the histopathologic study of single sections from randomly selected blocks obtained from the uninvolved quadrants of breasts harboring an overt carcinoma, and the detection of such noninvasive carcinomas in benign breast disease by “extended” histopathologic study, signify the limitations of specimen mammography for the detection of these occult cancers. It is concluded that specimen mammography represents a useful but not essential adjunct to the pathologic study of mammary disease.

A case is presented of plasma-cell mastitis that clinically appeared to be scirrhous carcinoma. The 10-year history of a mass in the breast was significant in the differential diagnosis. Diagnosis by frozen section can be accurate only if a representative portion of the tissue is examined. Mastectomy is indicated only if the mass proves to be carcinoma.

Mammography occasionally reveals the presence of suspicious appearing clustered microcalcifications without an associated mass. Clinical localization of these microcalcifications within the breast is difficult, even using the 2 dimensional effect of a mammogram. Percutaneous needle localization of these microcalcifications is recommended for its accuracy, patient acceptance, and reduction in size of the biopsy specimen. No complications of this procedure have been encountered.

The authors describe an improved mammographic technique employing a single-emulsion film in combination with a high-definition intensifying screen. This technique significantly reduces the radiation dosage per exposure and enhances the contrast of the soft-tissue structures of the breast. Optimum film-screen contact is obtained by means of a vacuum cassette system. Short exposure times minimize motion unsharpness, favoring the preservation of radiographic detail.

Six cases of occult carcinoma of the breast were detected by histologic examination of 244 consecutive grossly benign breast biopsies (2.4%). Half of the cancers were found in a routine random sample of ten tissue blocks, while the others were detected only after the entire biopsy was examined. The detection of the additional cases appeared directly related to the amount of tissue examined microscopically. More complete histologic examination of breast biopsies appears indicated to detect occult breast cancer.

4621 completely asymptomatic women underwent thermographic screening followed by clinical examination for breast cancer. 628 of the women were found to have abnormal thermograms and were referred for mammography. Of these 326 were abnormal but negative for malignancy 198 were negative 42 were positive for malignancy and 62 were suspicious of malignancy. Of the 62 9 were found positive at repeat roentgenogram indicating that thermography may indicate a malignant change at a time when the lesion is too small to be demonstrated radiographically. A positive thermogram should be considered as an indication for further study rather than biopsy. The false negative rate was 1.7 per 1000 women screened. Advantages of thermography are: 1) it provides simplicity of performance and repetition with no radiation hazard 2) it can provide an indication for further examination and 3) all women have nondeviating thermographic patterns except for older women who become progressively less vascular. Disadvantages include: 1) the "coldness" of scirrhous cancer 2) bilateral cancers may be interpreted as negative 3) there is no spatial relationship to the cancer and 4) thermographic signs of cancer occur in benign conditions.

This communication represents a summary of the results of a 74-question survey-type questionnaire developed by the Committee on Radiological Equipment of the American College of Radiology and submitted to the membership of the college in March 1971. Highlights of the survey are reviewed and briefly compared to a 1962 survey conducted by the RSNA. The questionnaire was designed to establish the type and extent of the respondents practice, type of equipment used, levels of satisfaction with current equipment and areas of perceived improvements, satisfaction with current servicing of equipment, and degree of communication between the profession and the manufacturers of radiographic equipment.

As radiologic techniques have improved in the past decade an increasing number of nonpalpable breast lesions is being found by mammography. Specimen radiography is a simple procedure which can be incorporated into the routine activities of the pathology laboratory to facilitate the diagnosis of these minimal lesions. When calcifications are present they provide a useful marker that can be used to localize the lesions radiologically for histologic examination. Employing a team approach that involves radiologists, pathologists, and surgeons, we have developed an efficient procedure to perform specimen radiography of biopsies to confirm the excision of lesions that had been shown to contain calcifications by prior mammography, and to localize them for histologic study. In addition to a detailed description of a procedure for specimen radiography, this report presents the results of 125 consecutive biopsies that involved specimen radiography during surgery. Carcinoma was identified in 32 (25%). The benign lesions that most often suggested carcinoma because of calcification in the mammograms were papillomatosis and sclerosing adenosis.

Contrast can be increased by superimposing identical radiographic images, either by combining a radiograph taken with intensifying screens with a photographic duplicate or by exposing two films simultaneously in the beam. Patient exposure can be reduced by creating a low-contrast radiograph with low exposure and enhancing contrast in the image. This technique is most useful in mammography, where patient exposure is high, and in examinations in which contrast is inherently low, such as intravenous cholangiography.

The mammographic and thermographic appearance of ten cases of fat necrosis of the breast are described. A spectrum of mammographic appearances ranging from that mimicking cancer to cases in which no mammographic abnormality is seen are presented. Thermographic findings in fat necrosis of the breast are discussed for the first time. Two of four cases with recent trauma had asymmetrical thermograms. Thermograms in cases without history of recent trauma were negative.

Localization of pertechnetate ion in malignant breast tumors has been described by several groups. The authors tested pertechnetate mammography (scintigraphy following intravenous 89mTc pertechnetate) in a group of 36 volunteers with palpable breast nodules, and compared diagnostic results with roentgen mammograms obtained for each patient. A significant incidence of “false–negative” pertechnetate mammograms (1 of 6 proved carcinomas) and “false-positive” (6 of 30 proved or presumed benign nodular disease) suggests that this procedure does not fulfill requirements for a successful screening test.

Biochemical radiological and cytological comparisons among 127 women 21-48 years old using a megestrol serial contraceptive a similar group of 127 women using oral nortestosterone preparations and a control group of 269 women who were not using oral contraceptives were made. The mean weight of the women using the megestrol compound was significantly lower than either of the other groups. 19-nortestosterone significantly increased systolic blood pressure when compared with the megestrol group and the control group. When compared with the control group the 19-nortestosterone group showed a significant increase in mean diastolic blood pressure a reduced triglyceride level SGOT level and a lower bilirubin level. The megestrol group showed a lowered hemoglobin value higher triglyceride levels and lower bilirubin values. There were no cytological differences among the groups nor were there any differences in mammary nodules.

A group of 2684 women, selected as being at higher than average risk of breast cancer, has been screened by clinical examination, thermography, and mammography. The pickup rate for preclinical breast cancer is 19.3 per 1000. False positive and false negative rates are discussed. Cancer 33:1671–1679, 1974.

Summary The findings of the reproducibility study indicate that the technic of mammography developed by Egan can be learned by other radiologists, that films of acceptable quality can be produced, and that the interpretations provide information which is useful in the clinical management of breast disease.

The evaluation of nipple discharges unrelated to gestation should proceed in an orderly fashion. Our experience, based on evaluation of 257 ducts from 182 patients, suggest that location of the lesion can be assured with or without a palpable mass by using contrast mammography. Serous and bloody discharges are the most important types of secretions. Eleven of the papillary lesions and cancers presented this fluid, except 4 papillomas which had clear secretions. Nonspontaneous discharges of all types arc followed and exploration delayed until either a mass, positive Pap smear, or contrast mammogram is evident. Even though cancer is suspect in patients after the age of 40, our series shows that papillomas are the most frequent lesion encountered in the fourth and fifth decades. However, in the sixth decade, cancer comprised 50 percent of all lesions causing nipple discharge. Needless mastectomy can be avoided in patients without a palpable mass by locating and removing the duct of discharge and basing surgical treatment on die microscopic report.

Perhaps for the first time, a surgeon as distinct from a radiologist makes in this review an assessment of the value of mammography to a surgeon. The experience gained in a review of 300 cases of breast pathology at the Royal Adelaide Hospital is presented. The detection of occult carcinoma is discussed. The limitations and dangers of mammography are emphasized.

The authors have trained and tested registered radiological technologists to determine whether they can function as scanners in a simulated screening situation. “Logic flow sheets” or “decision trees” were used as the principal teaching device. It was found that the scanners were able to perform creditably when compared to an expert radiologist tested by the same examination ; however, in many instances true-positive rates were attained at the sacrifice of a good true-negative rate. The accuracy of the scanners is reported, as well as sources of error and a discussion of error correction.

Although there have been no major clinical or laboratory breakthroughs in the treatment of cancer, there continues to be a slow but steady progress in the diagnosis, care, and survival of many patients with malignant disease. The purpose of this paper is to touch upon briefly several areas of clinical activity which appear to exemplify clinical advances in the treatment of the patient with cancer.

More than 1,100 patients have been evaluated in an unique multiphasic mobile cancer screening unit. Screening of target organs includes rectum, colon (proctosigmoidoscopy), prostate, pelvic area, skin, lymphatics, oral cavity, and breast, including mammography and instructions on self-palpation. In addition, cancer education is disseminated emphasizing such problems as protection against the sun's rays and admonishment against cigarette smoking. Histologically confirmed cancers detected include those of colon, breast, prostate, and lung. Many cancers of the skin have been diagnosed at an early stage. A vigorous effort at follow-up is in progress but it is incomplete due, in part, to an element of physician delay. Screening of multiple sites seems preferable to focusing upon single sites. Mobile cancer screening is worth trying. This approach could undoubtedly succeed in improving cancer control if supported by the medical community.

Soft-tissue roentgenography of the breast is not new. In the American literature, Leborgne (4) of Uruguay described the technic of examination and the rogentenographic appearance of various mammary tumors. Warren (5) of the United States in 1929 reported on 119 cases, 58 of which were malignant. Interpretative errors were made in but 8 cases, 4 being in the malignant group. He stated: “In many of the cases, there was no unanimity of opinion in the preoperative clinical diagnosis. Several opinions were often held as to the presence of malignant or benign tumors in each case. The opinion from the roentgenogram, on the other hand, was often very definite and, most frequently, correct.” Since Warren's publication an occasional enthusiastic proponent of this method of examination has appeared. However, as of the date of this study, no satisfactory statistical analysis of consecutive mammograms in patients with adequate follow-up has appeared in the American literature. Material One thousand consecutive x-ray e...

Mammography requires extremely fine technical quality for both contrast and detail. This stems directly from the objective of the examination: to identify suspicious small soft-tissue masses and fibrillar structures in fat, as well as punctate calcifications. Such objects are of inherently low contrast, and both clinical experience (1) and physical measurements (2, 3) have shown the importance of low kilovoltage and filtration to enhance contrast. Preferred factors are 24 to 40 pkV with inherent filtration only. These factors require operating x-ray tubes and machines at kilovolt values well below those of ordinary radiography (50 to 150 pkV), and many serious practical problems have been reported (4). For example, measurements on ten machines used for mammography in Philadelphia showed actual values were typically 5 kV greater than dial settings, with one 17 kV greater. In addition, inherent filtration of some tubes was so high they were unsuitable for mammography! This was because of both poor initial c...

A case is presented of primary lymphosarcoma of the right breast in a 75-year-old woman. Am extended simple mastectomy was performed as the therapy of choice. In view of the patient's advanced age and the lack of evidence for metastasis from this primary lesion, possibly a five-year survival may be expected.

A prospective type of analytical study was carried out on 106 patients with breast pain to analyze the causes of breast pain. This study was conducted from August, 2002 to January 2004 at breast clinic of Bangladesh Medical College Hospital (BMCH) and at Department of Surgery of BMCH. Sampling was done purposively and a structured questionnaire was used for data collection by interviewing followed by examining the patient in the first phase. In the second phase, Mammography and FNAC (Fine Needle Aspiration Cytology) was done. Majority of the patients (35.8%) were in the age group of 21- 30 years and the mean age was 27.61± SD10.5 years. About 48.1% breast pains were due to ANDI (Aberration of Normal Development and Involution) and among the other causes nonspecific pain 15.1%, breast abscess 14.2% and carcinoma of breast were only 1.9%. The performance status of all the patients were in between 0- 1. Mammography was done in 54 patients and of them 44 was found positive for fibrocystic disease (41 cases) and fibroadenoma (3 cases). FNAC was done in 50 patients and 36 were found positive with fibroadenoma (22 cases), fibrocystic change (8 cases), chronic breast abscess (2 cases), mitotic lesion (2 cases), and neurofibroma (2 cases). So painful breast diseases are helpful in seeking further medical care for appropriate intervention Keyword: Breast pain, Mastalgia, ANDI. doi: 10.3329/jom.v10i2.2818 J MEDICINE 2009; 10 : 77-81

Mammary skin thickening does not necessarily imply the presence of an underlying carcinoma. We have reviewed the roentgenographic and pathologic manifestations of skin thickening that resulted from 5 conditions other than primary carcinoma. These are breast abscess, fat necrosis, reticulum cell sarcoma, subcutaneous extravasation of pleural fluid after thoracentesis, and lymphatic extension from contralateral breast carcinoma.The roentgenographic appearance of skin thickening was identical in each of these disorders, and provided no clue to its benign or malignant origin. Similarly, except for metastatic carcinoma that infiltrates the mammary skin and plugs the dermal lymphatic channels, the dermal pathologic manifestations in these disorders were nonspecific.The single dermal pathologic feature common to all these conditions, benign and malignant, was a nonspecific, chronic inflammatory response. This response usually took the form of a perivascular, mononuclear cellular infiltration.

The mammographic findings in 892 patients referred to a Breast Clinic have been analysed. In 84 patients with breast cancer, a malignant lesion was suspected or diagnosed on mammography in 74 (88%). In 145 benign breast lesions, malignancy was suspected mammographically in 14 (9·7%). In the authors' experience the combination of clinical examination and drill biopsy is clearly superior to mammography in the differential diagnosis of lumps in the breast. The role of mammography in the management of patients with and without mammary symptoms or signs is discussed.