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Usefulness of mammoscintigraphy with thallium-201 single photon emission computed tomography to differentiate palpable breast masses of young Taiwanese women when comparing with mammography.

Sixty young Taiwanese women with palpable breast masses detected by mammography and/or physical examinations underwent mammoscintigraphy with thallium-201 (Tl-201) single photon emission computed tomography (SPECT) to assess its value for differentiating breast masses. The results showed that 42 of the 45 cases of breast carcinoma were detected by Tl-201 SPECT mammoscintigraphy. Fourteen of the 15 of benign breast lesions were differentiated by Tl-201 SPECT mammoscintigraphy. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of Tl-201 SPECT mammoscintigraphy were 93%, 93%, 98%, 82%, and 93%, respectively. Thirty-eight of the 45 cases of breast carcinoma were detected by mammography. Twelve of the 15 of benign breast lesions were differentiated by mammography. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of mammography were 84%, 80%, 93%, 63%, and 83%, respectively. We concluded that Tl-201 SPECT mammoscintigraphy significantly improves the accuracy when comparing with mammography for the differentiating breast cancer in Taiwanese women.

Adult↗

Mammography coding and reimbursement.

This article describes mammography coding and reimbursement, coding responsibilities for personnel and the importance of coding accuracy. After completing this article, the reader will: Recognize basic terms associated with mammography coding and reimbursement. Explain reimbursement differences between screening and diagnostic mammography. Understand the responsibilities of mammography facility personnel in accurate coding. Recognize the impact of coding, reimbursement and regulation on the economics of mammography practice. Explain basic coding concepts for screening, diagnostic and follow-up mammographic studies. Describe some new breast imaging technologies reimbursed by Medicare.

Breast Diseases↗

Screening mammography among Chinese Canadian women.

BACKGROUND: Though breast cancer is the most common malignancy among Chinese women, screening mammography is underutilized. This study examined barriers and facilitators of screening mammography among Chinese Canadian women. METHODS: Using community-based sampling, Chinese women in British Columbia were interviewed in 1999 about multiple preventive health behaviours. We included 213 women in the mammography analysis; main outcome measures were ever having a mammogram and routine mammography. RESULTS: Seventy-five percent of women 50 to 79 years old reported ever having had a mammogram, and 53% had two or more mammograms within the last five years. Receiving a recommendation for a mammogram from medical personnel or from a family member, and believing that cancer cannot be prevented by faith were independently associated with both screening outcomes. CONCLUSIONS: A multifaceted approach to screening mammography promotion in Chinese Canadian women is suggested. Interventions that include education of and by medical providers and family members should be considered.

Aged↗

[The use of echography and US-guided percutaneous puncture in addition to mammography for the detection of malignant breast tumors].

At present, mammography is the most effective means to detect breast cancers, especially in the early stages. However, it lacks sensitivity and specificity in women with dense breasts. Moreover, indeterminate lesions are often seen on mammograms, which should undergo further examination before surgery. Due to recent improvement in the technique--i.e., the use of high-resolution 10-MHz transducers--US can now detect also nonpalpable breast lesions, about 1 cm phi. Fine-needle biopsy (FNB) under US guidance, which is complementary to US, allows a correct diagnosis of malignancy in a high number of cases. A total of 1821 women with indeterminate lesions at mammography underwent US, and 491 of them underwent US-guided FNB, in the Leno Hospital (Brescia, Italy), in the period 1988-90. Thirty-one breast cancers which had been missed at mammography and clinical examination were found. Three cases were carcinomas in situ, 23 invasive cancers were classified as pathological stage T1, and 15 cases had no axillary lymph node involvement. The routine use of US and FNB in addition to mammography when indeterminate lesions are seen on mammograms and in women with dense breasts may significantly reduce the number of both false-negative cases at mammography and unnecessary biopsies.

Biopsy, Needle↗

[A multicenter study for the evaluation of the diagnostic efficiency of mammography and echography in nonpalpable breast neoplasms].

The Breast Section of the Italian Society of Radiology set up a cooperative study which included 17 Departments of Radiology and Breast Diagnosis in order to evaluate the diagnostic accuracy of US versus mammography in nonpalpable breast lesions. From January 1, 1989 to december 31, 1990, 400 nonpalpable breast lesions (142 benign lesions, 59 in situ and 199 infiltrating carcinomas) were detected by mammography and/or US; they had questionable/suspicious findings which called for further investigation by means of cytology and/or histology. US proved much less sensitive in non-palpable carcinomas than mammography (49.2% vs 93.8%), also in younger women, and failed to detect 50% of the benign/malignant nonpalpable lesions identified by mammography. US sensitivity was directly related to lesion diameter and probe frequency: 38.7% in infiltrating carcinomas < or = 5 mm vs 56.8% in those > 10 mm; 12% in the patients examined with a 5-MHz probe vs 57.7% in those examined with a > or = 7.5-MHz probe. Furthermore, the most significant US patterns of nonpalpable lesion were irregular contours, posterior attenuation and irregular internal echoes, while an irregular skin line and Cooper ligaments had no significant relation with carcinoma. Thus, breast US cannot be used as a screening test on asymptomatic patients not even on young women with radiologically dense breasts. On the contrary, US performed with high-frequency probes is useful in the assessment of nonpalpable lesions identified by mammography, and allows, in many cases, US-guided cytology and preoperative localization.

Adult↗

Female employee participation in a worksite mammography screening program.

We conducted a survey of 1,184 women 35 years of age or older who were employees of a company in Los Angeles County, California, to determine why some women participated in a worksite mammography screening program whereas others did not. Of the 111 who accepted a mammogram, 90 responded to the survey; of the 1,073 who declined mammography, 620 responded. The women were predominantly white, were well educated, and had health insurance. Of the 111 women who received mammograms, one was diagnosed with carcinoma. Seventy-three percent of the respondents to the survey 40 years of age or older who declined mammograms had already fulfilled American Cancer Society (ACS) guidelines for mammography screening at the time of the program. Women who accepted a mammogram were more likely to have had at least one previous mammogram than were women who had not met ACS guidelines yet who declined screening. We conclude that many female employees who are white, are well educated, and have health insurance may not participate in a worksite mammography screening program because they have been screened elsewhere. Companies providing worksite mammography screening should target education to women who have not met ACS guidelines, especially those who have never had a mammogram.

Adult↗

Mammography quality assurance.

A poor-quality mammogram is worse than no mammogram. This is particularly true in the screening situation. Quality assurance in mammography is defined as all of the practices that monitor and improve the delivery of mammographic services, including technical performance of the equipment, personnel qualifications, patient interactions, communication, and follow-up. Quality control is the component of quality assurance focusing on the technical performance of mammography equipment. The effectiveness and success of screening mammography depend on consistent production of high-resolution, low-dose mammographic images and their accurate interpretation. This article describes the American College of Radiology's Mammography Accreditation Program as it relates to mammography quality assurance.

Accreditation↗

Factors influencing adherence to guidelines for screening mammography among women aged 40 years and older.

OBJECTIVE: To explore patterns of adherence to guidelines for screening mammography among participants in the Colorado Mammography Project (CMAP) surveillance database. METHODS: An algorithm was developed to assess factors associated with adherence to mammography screening guidelines. RESULTS: Of the 27,778 women ranging from 40-90 years of age included in the analysis, 41.4% were adherent with mammography screening guidelines. According to the model tested in this study, race/ethnicity (Black vs White, OR=0.76, 95% CI=0.64-0.91); educational attainment (high school vs 55,000 dollars vs <15,000 dollars, OR 1.14, 95% CI=1.03-1.26) were statistically significant predictors of adherence to guidelines. A significant interaction between age and family history of breast cancer (BC) was also found. Younger females with a family history of BC were less likely to be adherent than their counterparts without a family history (OR=0.93, 95% CI=0.90-0.96). In general, elderly women were more likely to be adherent compared with the youngest group in this cohort (OR=1.21, 95% CI=1.11-1.33). Inclusion or exclusion of women aged 70 years and older did not change the outcome of the analysis. CONCLUSION: Adherence with screening mammography guidelines was found to be associated with women's personal characteristics including race/ethnicity, age, and family history of BC. In addition, socioeconomic status, as measured by educational level and community economic status, are important predictors of adherence. Efforts to increase adherence may need to be specific to race/ethnic group and age, but the effect of age is mediated by family history of BC and vice versa.

Adult↗

[The attitude before subclinical breast lesions on mammography].

Mammographic screening and improvement of mammography resolution have resulted in the increasingly frequent identification of small-size mammary lesions that have no clinical expression. If in Western countries, approximately one quarter of breast cancers are discovered when clinically occult, in Romania such cases are rare and, most of the times, discovered merely by chance. Infraclinical mammary lesions identified by mammography pose problems concerning the appropriate response. The paper assesses the various diagnosis and therapy choices as well as the localization techniques to be employed in order to establish the best approach. We describe twelve cases of infraclinical mammary lesions identified by mammography. In two of this cases fine needle aspiration biopsy with cytological examination was used, and in one case we performed core biopsy and histological examination. In those cases, lesion localization has been performed using stereotactic X-ray devices. In nine cases, we performed excisional biopsy with histologic assessment. In four of those cases, the lesions proved to be malignant. Preoperative localization was performed with hookwires placed in the proximity of the lesion under mammographic control. In five of those cases, lesion coordinates have been determined by stereotaxy. Using this technique, we removed, in all cases, the clinical lesions identified by mammography. We believe surgical excision to be the best approach in such lesions. Total removal of the lesion enables a thorough histopathological examination resulting in more accurate diagnosis. Curative surgery is also possible within the same surgical procedure. Unless preoperative localization is performed the surgeon is in the position to excise an image that has no clinical expression. Under this circumstances surgical removal is performed blind, as the lesion is hard to be found even intraoperatory. Preoperative localization provides guidance to the surgeon, ensures removal of the lesion that has been identified by mammography and helps avoids unnecessary mammary resection.

Biopsy, Needle↗

[Mammogram results in ambulatory care--a mammography quality circle in Braunschweig, Germany, between 1998 and 2001].

Radiologists from seven independent practices in Germany (average number of cases 3,500 in 2001) combined to form a mammography quality control group. Documentation and follow up were standardised for all cases that resulted in a referral for open biopsy. A quantitative analysis of the data would be expected to clarify the quality achieved in ambulatory care and to show further possibilities for quality assurance measures. The first overall analysis of 2,500 referrals for biopsy from 1998 to 2001 shows differences between practices as regards the frequency of referral for biopsy and the proportion of referrals for suspected malignancy, which are based on practice-specific conditions (referral behaviour, age structure of patients) and individual case management. Practices are very close in relation to positive predictive value (ppv) and detection rate. The biopsy rate in 2001 slightly exceeded 3%, the overall detection rate was 1.7%, and ppv 81%. For asymptomatic women detection rate and ppv were 0.5% and 70%, respectively. Quality parameters for all mammography referrals in total exceed those of screening programmes. When restricted to asymptomatic women, results have been achieved that are comparable to those of established screening programmes. Naturally the patients involved here are those in whom mammography was indicated. Nonetheless, these results demonstrate a high quality of detection on the part of those performing mammography in routine ambulatory care, and can be used as a reference for other types of care. With consistent quality assurance in relation to technical considerations and personnel, a performance quality can be achieved in independent practices which to date has not been surpassed by specialist mammography centres.

Adult↗

A prospective study of perceived susceptibility to breast cancer and nonadherence to mammography screening guidelines in African American and White women ages 40 to 79 years.

This prospective study examined the influence of perceived susceptibility to breast cancer on nonadherence to recommended mammography screening guidelines. The study population included 1,229 African American and White women ages 40 to 79 years who obtained an index mammography screening examination at one of five urban hospitals in Connecticut between October 1996 and January 1998. Information on perceived susceptibility to breast cancer and on multiple covariates was obtained by telephone interview on average 1.5 months after the index screening. Subsequent adherence to mammography screening guidelines was ascertained by follow-up interview on average 29 months after the index exam. Across race, age, and family breast cancer history, women who believed that their susceptibility was high (i.e., "very likely" to develop breast cancer) were less likely to adhere to screening guidelines than women who believed that their susceptibility was moderate [adjusted odds ratio (OR), 2.83; 95% confidence interval (CI), 1.51-5.30], but the effect was stronger in older women. Women ages 40 to 49 years (but not ages 50-79 years) who believed that their susceptibility was low (i.e., "not likely" or "a little likely" to develop breast cancer) were also less likely to adhere to guidelines than those who reported moderate susceptibility (adjusted OR, 3.07; 95% CI, 1.66-5.68, and adjusted OR, 2.78; 95% CI, 1.63-4.73). In contrast to most previous studies that found a positive linear relationship between perceived susceptibility to breast cancer and mammography screening, these findings suggest a more complex relationship that should be considered when developing interventions to improve adherence to mammography screening guidelines.

Adult↗

Self-report and primary care medical record documentation of mammography and Pap smear utilization among low-income women.

PURPOSE: To determine whether self-report of mammography and Pap smear utilization was accurate and to determine whether racial/ethnic differences existed. METHODS: Face-to-face surveys were administered to 314 consecutively selected women over 40 attending two low-income inner-city family practice sites. Medical records were reviewed for documentation of mammography and Pap smear utilization. Level of agreement between self-report and chart review was reported. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. MAIN FINDINGS: Puerto Rican women had lower income levels and were less educated than African-American and non-Latina white women. Self-report of mammograms and Pap smears were higher than medical record documentation. Level of agreement was higher for more recent tests. Negative predictive values for mammography were high (75-95.5%). Lower sensitivity, specificity, positive predictive value and negative predictive value for mammography were seen among Puerto Rican women compared to African-American and non-Latina white women. CONCLUSIONS: High negative predictive values suggest that asking women about mammography use may be an inexpensive, easy intervention in the primary care setting to increase screening among women currently not being screened by increasing conversations between patients and providers to address personal barriers to screening.

Adult↗

Physician compliance with mammography guidelines: barriers and enhancers.

BACKGROUND: Primary care physicians are increasingly the gatekeepers to clinical preventive services including mammography utilization. Moreover, lack of physician recommendation is a major reason for patient failure to obtain screening. A study was designed to examine the attitudes, beliefs, and practices with regard to breast cancer screening as self-reported by primary care physicians. The variables associated with compliance or lack of compliance with screening guidelines are emphasized. METHODS: One hundred sixteen primary care physicians practicing in two New England communities responded to a mailed survey. The survey included questions on attitudes and beliefs about breast cancer screening, as well as questions about perceived barriers and actual screening practices. RESULTS: Fifty-seven percent of the respondents reported ordering annual mammograms for their female patients aged 50 to 75 years. An additional 21 percent reported ordering biannual mammograms for women in this age group. Strongly associated with ordering annual mammograms were beliefs in the benefits of mammography and the perception of community consensus regarding breast cancer screening. A strong positive association of practicing in a group setting and mammography guideline compliance was documented. Middle-aged physicians in solo practice reported the poorest screening compliance. CONCLUSIONS: The level of physician compliance with the standard of annual mammography screening is low (57 percent). The three most important determinants of annual screening suggest ways to improve physician compliance: improve physician attitudes about the benefits of mammography, build further on the medical community's consensus regarding the appropriateness and importance of the annual guidelines, target the poorest compliers with special messages or programs.

Age Factors↗

Mammography utilization in Canadian women aged 50 to 69: identification of factors that predict initiation and adherence.

OBJECTIVE: To identify factors that predict initiation of mammography and adherence with biennial screening among Canadian women aged 50-69 years. METHODS: Using data from a longitudinal panel of Canadian women interviewed in the National Population Health Survey (NPHS) in 1994/95 and 2 and 4 years later, we estimated the relative risks (RR) of mammography initiation and adherence according to socio-demographic, health and lifestyle characteristics. RESULTS: Among 505 women with no history of mammography use at baseline, 23.0% and 41.4% initiated mammography by 2 and 4 years, respectively. Urban residence (RR = 2.85) was most strongly associated with initiation by 2 years; younger age (50-54) and lower education also predicted initiation by 2 years. Younger age, birthplace outside Canada, and having a recent (< 2 years) blood pressure check were associated with initiation by 4 years. Among 873 women reporting a recent (< 2 years) mammogram at baseline, 88.7% also reported a recent mammogram within 2 years while 73.0% reported one at both the 2- and 4-year follow-up. Being a non-smoker was the strongest predictor of maintaining adherence both at the 2- (RR = 1.18) and the 4-year (RR = 1.37) follow-up. INTERPRETATION: Previously identified underserved groups of Canadian women (e.g., those with lower educational levels or born outside of Canada) were most likely to initiate mammography. Approximately 1 in 6 women aged 50 to 69 years remained never-users during follow-up, and fewer than half reported recent mammograms at all three survey cycles, suggesting the need to reinforce regular screening participation.

Age Factors↗

201Tl scintigraphy in the evaluation of palpable and nonpalpable breast lesions: correlation with mammography and ultrasonography.

AIM: Our goal was to determine the clinical usefulness of Tl-201 to identify breast cancer in patients with suspicious breast lesions on clinical examination, and/or abnormal radiologic (mammography and/or ultrasonography) findings. METHODS: Tl-201 scintigraphy were performed in sixty-eight patients with 70 breast abnormalities (51 palpable, 19 nonpalpable) and compared with mammography and ultrasonography (US). Early (15 min) and late (3 h) images of the breasts were obtained following the injection of 111 MBq (3 mCi) of Tl-201. Visual and semiquantitative interpretation was performed. RESULTS: Final diagnosis confirmed 52 malignant breast lesions and 18 benign conditions. Tl-201 visualized 47 of 52 (90%) overall malignant lesions. Thirty-eight of 40 (95%) palpable and 9 of 12 (75%) nonpalpable breast cancers were detected by Tl-201 scintigraphy. The smallest mass lesion detected by Tl-201 measured 1.5 x 1.0 cm. Eleven breast lesions were interpreted as indeterminate by mammography and/or sonography. Tl-201 scintigraphy excluded malignancy in 7 of 8 (88%) patients with benign breast lesions interpreted as indeterminate. Five of the 18 (28%) benign breast lesions showed Tl-201 uptake. None of the fibroadenoma and fibrocystic changes accumulated Tl-201. Tl-201 scintigraphy, mammography and ultrasonography showed 90%, 92%, 85% overall sensitivity and 72%, 56%, 61% overall specificity respectively. Twenty-one of the 28 (75%) axillary nodal metastatic sites were also detected by Tl-201. In malignant and benign lesions, early and late lesion/contralateral normal side (L/N) ratios were 1.58 +/- 0.38 (mean +/- SD) and 1.48 +/- 0.32 (p > 0.05), 1.87 +/- 0.65 and 1.34 +/- 0.20 (p < 0.05) respectively. The mean early and late L/N ratios of malignant and benign groups did not show statistical difference (p > 0.05). CONCLUSION: Overall, Tl-201 scintigraphy was the most specific of the three methods and yielded favourable results in palpable breast cancers, while it showed lower sensitivity in nonpalpable cancers and axillary metastases. Combined use of Tl-201 scintigraphy with mammography and US seems to be useful in difficult cases, such as dense breasts and indeterminate breast lesions.

Adult↗

Mammography: a surgeon's experience.

Most reports advocating mammography have been written by radiologists rather than by clinicians who are frequently confronted by women with breast complaints. The value of mammography in managing patients with breast problems was studied by reviewing its role in 1026 breast consultations; there were 129 patients with cancer. Mammography was performed in 95 patients. The procedure hastened the diagnosis of one comedocarcinoma, and in another patient was suspicious 3 years before she presented with a locally advanced lesion. It missed six cancers. In seven patients it recognized clinically obvious cancers, though in one of these it had given negative results 10 months before the patient presented with a lesion 15 cm in diameter. It also falsely suggested the possibility of cancer in 28 women. In the other 52 patients the clinical diagnosis of a benign condition was usually fairly evident. The morbidity caused by mammography does not seem to have been widely appreciated, no doubt because of the hope that clinically unrecognized cancers would be found by it. Most breast problems can be diagnosed without mammography.

Attitude of Health Personnel↗

Prevalence of mammography use in a nursing home population.

A cross-sectional study was performed to estimate the utilization of screening mammography in a nursing home population. Included in the study were 139 women over 50 years of age who had been residing in a skilled nursing home in Connecticut for at least 1 year. Charts were reviewed to estimate screening mammography and chest x-ray examination use. Functional status of each subject was assessed by supervisory nurses using set criteria. One of the 139 subjects had received a mammogram, whereas 129 subjects (93%) had received chest x-ray examinations. Average length of stay in the nursing home was 6.5 years. No association was noted between functional status and use of mammography. It was concluded that in this clinical setting mammography appears to be underutilized as a screening test for breast cancer. The comparative data on chest x-ray examination use suggest strategies that may be useful in increasing compliance with current screening recommendations for mammography in the institutional setting.

Aged↗

Breast cancer: evaluating mammography in early diagnosis.

The high incidence of breast cancer among American women has made early diagnosis the focus of large scale research efforts. X-ray mammography plays a key role in achieving the goal of early diagnosis inasmuch as mammography is currently the best proven imaging modality for the diagnosis of breast cancer. Data demonstrating the efficacy and safety of mammography are summarized and radiographic features of breast cancer are outlined. Newer, more invasive methods used in conjunction with mammography are also discussed. It is hoped that the emphasis on practical considerations will enhance the understanding of the primary physician caring for women in order to increase the current under-utilization of mammography.

Breast Neoplasms↗