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Biomedical subjects

M Pamilo

Publications and source records attributed to M Pamilo.

At least 19 recordsLinked to original sources
PubMed1999

Screening mammography in Finland--1.5 million examinations with 97 percent specificity. Mammography Working Group, Radiological Society of Finland.

A nationwide mammography screening program including women aged 50 59 years at the time of the first invitation and involving more than 100 radiologists was started in Finland in January, 1987. From 1987 through 1997, a total of 1690496 invitations to biennial two-view mammography screening was sent out. The compliance for screening was 88.5% with 1 495744 screening examinations performed during this 11-year period. There were 49020 recalls (3.28% of those attending) for further work-up studies and 9689 women (0.65% of those attending) were referred for surgery. The total number of screening-detected breast cancers was 5595, giving a detection rate of 3.7 cancers per 1000 screening studies. More than half (57.7%) of all surgical biopsies revealed breast cancer and 67.8% of the invasive cancers were at Stage I. The positive predictive value of referral to surgical biopsy increased from 33.2% in 1987 to 65.5% in 1997. and the ratio of malignant to benign biopsies more than tripled from the first to the fifth year of screening. The observed/expected ratio of invasive cancer detection was 2.44. Only 0.27% (1 out of every 372) of all screening mammograms were followed by a benign biopsy, and 2.90% (1 out of every 34) of all screening mammograms were followed by the women being recalled for further studies and not found to have breast cancer. This gave a specificity of recall after screening mammography greater than 97.0% and a specificity of referral to surgical biopsy greater than 99.7%. Measures of specificity improved considerably during the first three years of the screening program. The high specificity of screening mammography can be attributed to the nature of the screening process as well as to the opportunity for individual radiologists to attain a greater level of experience and competence. The decision to recall appears to have been crucial in determining the specificity.

Biopsy↗
PubMed1998

Ultrasonography as a guidance method in the evaluation of mammographically detected nonpalpable breast lesions of suspected malignancy.

PURPOSE: To evaluate the role of ultrasonography (US) as a method of guidance for fine-needle aspiration biopsy or preoperative wire localization in the demonstration of nonpalpable mammographically detected breast lesions. MATERIAL AND METHODS: A total of 168 nonpalpable mammographically detected breast lesions were examined by means of high-resolution real-time US. RESULTS: US depicted: 55% of all the lesions (92/168); 88% of the circumscribed densities (45/51); 80% of the stellate densities (35/44); 47% of the asymmetric densities (7/15); and 9% of the microcalcifications (5/58). CONCLUSION: US was useful in guiding needle biopsy or wire localization in most of the circumscribed and stellate breast lesions, even in fatty breasts. However, with the equipment that is currently available, US was of no value in localizing microcalcifications.

Adult↗
PubMed1996

Pain and discomfort during mammography.

The aim of this prospective study was to investigate associations of mammography pain and discomfort with sociodemographics, personal history and psychological and situational factors. Subjects were women with a negative screening finding (n = 883) from a random sample of 50-year-old Finnish women attending their first breast cancer screening. Questionnaires were sent 1 month before the screening invitation and 2 months after screening. Sixty-one per cent reported painful and 59% uncomfortable mammograms (4% severely). Linear regression analyses showed that anticipation of pain and discomfort was the most powerful factor explaining pain and discomfort among women with earlier mammography. However, it had no effect among women without earlier mammography, for whom screening-related nervousness and perceptions of staff were crucial. Suggested interventions include better information before screening, a friendly screening atmosphere and empathetic, supportive staff behaviour, especially towards women having their first mammogram, encouraging them to feel more at ease and distracted from pain.

Attitude to Health↗
PubMed1993

Double reading of mammography screening films--one radiologist or two?

The effect of double reading on the number of breast cancers detected and the number of women recalled was examined in 15,457 women aged 50-59 years attending for mammographic breast screening. All the screening mammograms were interpreted independently by two radiologists without knowledge of each other's findings. All the cases selected by either radiologist were then reviewed by both radiologists and a consensus decision made on whom to recall for further studies. This method of double reading increased the number of breast cancers detected by 9% (P < 0.05) and decreased the number of women recalled by 45% (P < 0.001). Double reading of mammography screening films together with consensus decisions on the selected cases is recommended.

Breast Neoplasms↗
PubMed1991

Classification of findings in mammography screening--a method to minimise recall anxiety?

STUDY OBJECTIVE: The aim was to find out if it is possible, by classifying screening mammograms according to the likelihood of malignancy, to divide the recalled women to a group in which there is high suspicion of malignancy, most having breast cancers, and a group with more obscure findings. DESIGN: Screening mammograms of recalled women were classified according to the likelihood of malignancy. 0 = technically insufficient, 1 = normal, 2 = benign tumour, 3 = malignancy cannot be excluded, 4 = strongly suspicious for malignancy, 5 = malignant. SETTING: This study was a population based survey of mammography screening in Helsinki and surroundings in Finland. PATIENTS: 21,417 women (aged 50-59 years) were invited to be screened, 18,012 (84.10%) participated. Of these 579 (3.21% of those screened) were recalled for further studies; 124 of these were referred for surgical biopsy and 82 had breast cancer. MEASUREMENTS AND MAIN RESULTS: All cases classified as 5, 60% of the cases classified as 4, 6.5% of the cases classified as 3, 0% of the cases classified as 2 or 1, and 1.2% of the cases classified as 0 proved to have breast cancers. However classification 5 represented 5.9% of all recalled women and 41.5% of all screening detected breast cancers; classification 4, 6.0% of all recalled women and 25.6% of all screening detected breast cancers; classification 3, 68.9% of all recalled women and 31.7% of all screening detected breast cancers; classification 2, 11.7% and classification 1, 2.9% of all recalled women. No breast cancers were detected with these classifications. Classification 0 represented 4.5% of all recalled women and 1.2% of all screening detected breast cancers. Classifications 5 and 4 represented only 11.9% of all recalled women but 67.1% of all screening detected breast cancers. CONCLUSIONS: By classifying screening mammograms according to the likelihood of malignancy, recalled women can be divided into two groups: (1) a quite small subgroup in which everyone or almost everyone will be shown to have breast cancer; and (2) a much larger subgroup in which only a few will be proven to have breast cancer. The invitation procedure for the further studies should be improved on this basis of minimising anxiety among recalled women.

Anxiety↗
PubMed1991

Ultrasonography of breast lesions detected in mammography screening.

Mammography screening was carried out in 18,012 women (aged 50-59) of whom 579 (3.21%) had to be recalled for clinical mammography. After completion of the clinical mammography each woman also had ultrasonography (US) with a hand-held real-time apparatus using a 7.5 MHz probe. There were 79 verified breast cancers; 32 of these were palpable and were also depicted at US, but only 29 (61.7%) of non-palpable breast cancers (n = 47) were found at US. Twenty-two of the non-palpable breast cancers were seen at US as a tumor-like lesion, 2 because of local echo-architecture distortion, and 5 only because of acoustic shadowing. The US image did not help to differentiate between malignant and benign lesions.

Breast Neoplasms↗
PubMed1990

Mammography screening--reasons for recall and the influence of experience on recall in the Finnish system.

The reasons for recall and the influence of experience on recall were studied in 579 women (3.21%) recalled from mammography screening. The proportion of recalls for further studies was the greatest (6.30%) at the onset of screening. With increased experience, the proportion decreased by stages and in the second screening round it was only 2.04%. The proportion of cases referred for surgical biopsy in the first screening round was 0.7% and the proportion of screening-detected breast cancers was 0.52%. These change little with increasing experience. In the second screening round, however, the proportion of referrals for surgical biopsy (0.43% of those screened) and of screening-detected breast cancers, (0.30%) were both low. A tumour-like density was the commonest finding resulting in recall for further studies, and the number caused by superimposition of normal parenchymal structures decreased with experience, while the proportion of breast cancers and benign tumours increased. The proportion of cases with parenchymal distortion resulting in recall for further studies was similar in both screening rounds but the number of those referred for biopsy fell dramatically in the second screening round. The number of recalls for microcalcification also fell with experience and the proportion of breast cancers in this group increased over the two screening rounds. A high ratio of malignancies in surgical biopsies can be expected when the radiologists undertaking primary screening also perform all further studies.

Biopsy↗
PubMed1989

Mammography screening for breast cancer: first year results from Helsinki and surroundings.

11,789 women aged 50-59 years were invited for screening by the mammography screening centre of the Cancer Society of Finland in Helsinki. 9829 women (83.37%) attended and 3.85% of those were recalled for further studies. After complete examination seventy-one women (0.72%) were referred for surgical biopsy and breast cancer was histologically detected in 44 (0.45%) of those screened. The proportion of Stage I + TIS breast cancers detected was 75%, and of Stage II or more advanced, 25%. With modern mammography techniques and proper training of technicians and radiologists, with double reading of all the films, it is possible to minimise both the recall rate and the number of women who are referred for surgical biopsy, and still find cancers in their early stages.

Breast Neoplasms↗
PubMed1989

Real-time ultrasound, axillary mammography, and clinical examination in the detection of axillary lymph node metastases in breast cancer patients.

The axillary node status is important in the prognosis of breast cancer. To evaluate the accuracy of various preoperative examination methods in detecting metastatic axillary lymph nodes, we compared the findings of clinical examination, axillary ultrasonography, and axillary mammography of 41 breast cancer patients who underwent axillary dissection and histological examination. The sensitivity was 72.7% for ultrasonography, 38.9% for axillary mammography, and 32.3% for clinical examination. Ultrasonography provides good information about the axillary nodal status. The specificity can be increased by fine-needle biopsy under ultrasound guidance.

Adult↗
PubMed1989

Baseline screening mammography with one versus two views.

Two-view baseline screening mammograms (oblique and cranial views) of 303 women recalled for further studies from among 7,245 women screened were reviewed by four experienced radiologists separately to evaluate the importance of the number of views taken for screening. As compared with the oblique view only, two views, increased the number of cancers detected and decreased the number of false-positive cancer diagnoses of two radiologists, but increased that of the other two.

Breast Neoplasms↗
PubMed1987

[Mammography].

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Biopsy, Needle↗