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Pneumocystography was performed regularly in mammographically benign tumours. During 1974 and 1975 16892 breast were investigated radiographically of which 1031 had palpable tumours. In 614 cases the results of palpation correlated with radiography and indicated a cyst. These tumours were punctured with the aim of demonstrating the cyst wall by air filling and subsequent pneumocystography. This procedure enabled 4 out of 10 women (430 out of 1031) to avoid operation despite clinically palpable tumours. In 184 cases biopsy was necessary. In 12 cases the pneumocystogram showed tumours needing excision in addition to unremarkable cysts, in 11 cases the cyst walls showed radiological changes, 161 tumours were apparently solid. Since December 1975 we have started to aspirate breasts with radiographically suspected cysts in the absence of palpable tumour and to perform a pneumocystogram. This attempt was successful in all 19 cases. Removal of unremarkable cysts should not be accepted any longer. Prior to removal of a palpable tumour of the breast radiological investigated is indicated.

In 614 breasts tumours assumed to be harmless cysts on palpation were aspirated. In 430 cases aspiration was the definitive treatment. In the other 184 cases excision was necessary in order to obtain histology. 11 cysts were radiologically suspect after air filling. In one case excision demonstrated an undifferentiated milk duct carcinoma. 12 cysts had radiologically suspicious areas outside their margins. In 4 cases lobular carcinoma in situ was present. 161 excisions were necessary because no fluid was aspirated at puncture of the tumour. In 10 cases histology showed malignancy: half of these were metastases from a known primary tumour and half were primary breast carcinomas. Out of 17 precancerous states neoplasia could be demonstrated in two cases in addition to papillary and proliferative duct changes. We have classified this neoplasia as lobular carcinoma in situ.