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PubMed1999

Experimental study of X-ray mammography in a fluid bath: reduced radiation dose and improved detail resolution.

OBJECTIVE: To determine the effects on x-ray mammography of embedding the breast in a fluid bath. METHODS: A plexiglass phantom in the shape of a compressed breast was x-rayed in air and water with a mammography unit, and the radiation dose was measured by 20 thermoluminescence dosimeters placed in 20 representative positions on the surface of the phantom. Udders from slaughtered sheep as an animal model and phantoms were examined by mammography in identical positions surrounded by air and different fluids. The images were evaluated for detail resolution subjectively (animal model) and objectively (phantom containing quantifiable structures) by 6 and 15 blinded readers, respectively. The readers' results were analyzed and compared for visualization of the objects in air versus fluid. RESULTS: Mammographic examination in the fluid bath reduced the radiation dose and improved detail resolution in the rounded margin of the breast. Also, viewing conditions in the central region were improved as a result of the uniform optical density across the entire film area. CONCLUSIONS: Performing x-ray mammography in a fluid bath has advantages that make the technical realization of this method desirable.

Air↗
PubMedDate not supplied

Multiple enhancing lesions detected on dynamic helical computed tomography-mammography.

OBJECTIVES: To review pathologic diagnoses of multiple enhancing lesions in a unilateral breast detected on dynamic helical computed tomography (CT)-mammography and to correlate imaging findings with pathologic results. METHODS: From May 1998 to July 2001, preoperative contrast-enhanced helical CT scanning of the breast was performed in 200 female patients clinically diagnosed with breast cancer. The patients were scanned in the prone position in a specially designed CT-compatible device, with rapid intravenous bolus injection of 100 mL contrast material. Three-dimensional maximum intensity projection images were reconstructed. The cases with multiple enhancing lesions in a unilateral breast were retrospectively reviewed. The maximum diameter of the largest stain in each breast was measured, the patterns of multiple enhancing lesions were classified, and imaging findings were correlated with surgical and pathologic outcomes. RESULTS: Twenty-five of 200 (12.5%) patients (age range: 39-86 years, mean age: 56 years) showed multiple stains on CT-mammography. Two patients showed multiple stains in bilateral breasts. The maximum diameter of the largest stain in each breast ranged from 5 to 55 mm (average: 22 mm). Among cases with multiple stains, 21 (78%) were shown to be invasive ductal carcinoma with multiple satellite cancer nodules. Four cases were ductal carcinoma in situ with multiple satellite nodules. One case revealed multiple fibroadenomas, and another showed intraductal papilloma. CONCLUSIONS: Multiple enhancing lesions on CT-mammography in patients with breast cancer were relatively common, and most of them represented multiple cancer lesions. Dynamic CT-mammography is potentially useful in evaluating the spread of breast cancer.

Adult↗
PubMed1994

Strategies to increase mammography utilization.

This study compared the effects of theoretically driven interventions on compliance with mammography utilization. A 2 x 2 factorial design yielded four groups: a control group, a belief intervention group, an informational intervention group, and a belief/informational intervention group. A probability sample of 301 women, age 35 and older, without a history of breast cancer were randomly assigned to groups. Subjects in the intervention groups received individually tailored messages to alter beliefs or provider information related to mammography screening. Belief messages were developed from Health Belief Model constructs. Belief interventions significantly influenced all belief variables except perceived susceptibility in the desired direction. Women in the belief/informational intervention group were almost four times more likely than those in the control group to comply with mammography recommendations in the year following intervention (odds ratio = 3.75). In addition, belief variables and intervention significantly predicted mammography compliance 1 year postintervention.

Adult↗
PubMedDate not supplied

Testing theoretical explanations of mammography use.

The theory of care-seeking behavior was tested in the context of mammography use among midwestern women (N = 178). In multivariate logistic regressions, mammography adherence in the past 5 years was related to habit, the interaction of anxiety and barriers, belief in one's risk of breast cancer, age, and family history of breast cancer. Recent use of mammograms (i.e., in the past 1 or 2 years, depending on age) was related to norm and habit. Intention was related to utility beliefs regarding mammography, norm, habit, and belief in one's risk of breast cancer. As proposed from theory, anxiety and barriers interacted to influence adherence, the variables of habit, utility beliefs, and norm were related to either recent use or intention. Contrary to theory, belief in one's risk of breast cancer, age, and family history of breast cancer were related to adherence or intention after controlling for theoretically derived variables. The explanatory variables for each outcome were not identical, indicating that these mammography-related outcomes are characteristically different.

Adult↗
PubMed1999

99Tcm-MIBI scintimammography in the evaluation of breast lesions and axillary involvement: a comparison with mammography and histopathological diagnosis.

The aim of this prospective study was to determine the diagnostic value of prone lateral 99Tcm-MIBI scintimammography in the detection of primary breast cancer and axillary lymph node involvement in patients with breast lesions. We evaluated 83 palpable and 22 non-palpable lesions in 77 consecutive patients with a clinically palpable mass and/or suspicious mammographic finding. Early and late scintimammograms were performed after the intravenous injection of 740 MBq 99Tcm-MIBI. The overall sensitivity of both scintimammography and mammography in the detection of primary breast cancer was 94%. The overall specificity was 84% and 56% for scintimammography and mammography respectively. In the patients with palpable masses, the sensitivity of scintimammography was 97% and the specificity was 84%; in those with non-palpable masses, the sensitivity was 35% and the specificity 100%. For the detection of axillary lymph node involvement, the sensitivity and specificity of scintimammography were 68% and 93% respectively. However, conventional mammography showed 37% sensitivity and 86% specificity. In conclusion, scintimammography is an accurate and clinically valuable tool for evaluating palpable and non-palpable breast abnormalities. In addition to its high sensitivity, it improves the specificity of mammography both in the evaluation of breast masses and in the detection of axillary involvement.

Adolescent↗
PubMedDate not supplied

Establishing a statewide mammography database in Arkansas: overcoming the barriers.

To determine patterns of mammography utilization in Arkansas, the Arkansas Mammography Data Collection Project (MDCP) was established. The project's objective was to compile into one database statewide information about mammograms performed. All mammography centers were invited to participate in the project. Many barriers were encountered that were center related, data related, or personnel related; different interventions were implemented for each barrier. At the conclusion of the project, 92 out of 112 centers (82%) participated in the project, creating a database of 157,976 mammography data sets. Identifying and overcoming many of the barriers were crucial steps in the project's success.

Arkansas↗
PubMed2003

Personalized targeted mailing increases mammography among long-term noncompliant medicare beneficiaries: a randomized trial.

OBJECTIVES: The study purpose was to increase mammography screening among older women by identifying female Medicare beneficiaries without a recent mammogram and assesses the cost-effectiveness of a personalized targeted mailing encouraging them to have a mammogram. METHODS: A randomized paired controlled trial included 1229 pairs of women matched on zip code, race, and urban or rural county. Postintervention mammography claims were measured from November 1997 through December 1998. The subjects were female Medicare beneficiaries age > or = 70, living in Michigan for > or = 5 years, having no significant comorbidity likely to affect screening, and no mammogram for > or = 5 years. Intervention subjects received a personally addressed letter from the Medical Director of Michigan Medicare with materials emphasizing the individual's lack of use of the Medicare mammography screening benefit, reasons for screening, and how to be screened. RESULTS: Women who received the mailing were 60% more likely to have a subsequent mammogram (OR 1.6, P <0.005), with diagnostic mammograms increasing more than screening mammograms (2.8% vs. 0.8%). The absolute increase was greatest for women age 70 to 79, 10.6% in the intervention group versus 6.5% for controls, odds ratio 1.7 (P <0.02). A statewide Medicare intervention in Michigan would cost of 108,000 US dollars to 238,000 US dollars, producing 3500 to 4300 additional mammograms at 31 US dollars to 55 US dollars per additional mammogram. CONCLUSION: The intervention increased mammography among long-term noncompliant older women, particularly increasing diagnostic mammograms. This approach can be directly implemented in other states and nationally. It may also be useful for other preventive services.

Aged↗
PubMed2001

Authenticity and integrity of digital mammography images.

Data security becomes more and more important in telemammography which uses a public high-speed wide area network connecting the examination site with the mammography expert center. Generally, security is characterized in terms of privacy, authenticity and integrity of digital data. Privacy is a network access issue and is not considered in this paper. We present a method, authenticity and integrity of digital mammography, here which can meet the requirements of authenticity and integrity for mammography image (IM) transmission. The authenticity and integrity for mammography (AIDM) consists of the following four modules. 1) Image preprocessing: To segment breast pixels from background and extract patient information from digital imaging and communication in medicine (DICOM) image header. 2) Image hashing: To compute an image hash value of the mammogram using the MD5 hash algorithm. 3) Data encryption: To produce a digital envelope containing the encrypted image hash value (digital signature) and corresponding patient information. 4) Data embedding: To embed the digital envelope into the image. This is done by replacing the least significant bit of a random pixel of the mammogram by one bit of the digital envelope bit stream and repeating for all bits in the bit stream. Experiments with digital IMs demonstrate the following. 1) In the expert center, only the user who knows the private key can open the digital envelope and read the patient information data and the digital signature of the mammogram transmitted from the examination site. 2) Data integrity can be verified by matching the image hash value decrypted from the digital signature with that computed from the transmitted image. 3) No visual quality degradation is detected in the embedded image compared with the original. Our preliminary results demonstrate that AIDM is an effective method for image authenticity and integrity in telemammography application.

Computer Security↗
PubMedDate not supplied

Reduction of discomfort during mammography utilizing a radiolucent cushioning pad.

The purpose of this study was to evaluate the use of a radiolucent cushioning pad during routine screening mammography to determine the degree of reduction in discomfort, any correlation of that reduction with various clinical factors, and the pad's impact on image quality, compression force, and radiation dose. A total of 512 patients presenting for routine screening mammography were evaluated. The radiolucent cushioning pads (MammoPad, Biolucent Inc., Aliso Viejo, CA) were placed on the bucky and compression paddle of the mammographic equipment (M-IV, Lorad Corp., Danbury, CT). For each patient, the radiolucent pads were used for imaging one breast while the opposite breast, which served as a control, was imaged without the pads. In all patients, the breast was positioned and compressed in standard fashion, using routine craniocaudal (CC) and mediolateral oblique (MLO) views. Patients completed a questionnaire before and after the mammogram. A visual analog scale (VAS) was used to record anticipated discomfort as well as the discomfort experienced during compression with and without the pads. Age, hormone replacement status, prior experience with mammography, compression force, and breast composition were recorded, as were dose parameters (mAs and kVp), from which midglandular dose values were calculated. On the side where the pads were used to cushion the breast, 73.5% (371/505) of women experienced a significant decrease in discomfort. Of those who benefited, there was a 47% decrease in discomfort. On the pad side, compression force was increased an average of 14%, and there was a 4% decrease in dose for the CC view and no increase in dose for the MLO view. When comparing benefit versus nonbenefit groups, a significant reduction in discomfort did not correlate with any of the clinical factors evaluated, with the exception of experienced discomfort reported after the mammogram. Use of the MammoPad radiolucent cushion on the bucky and compression paddle was an effective means of reducing discomfort during compression for a majority (73.5%) of our patients undergoing screening mammography. Image quality and the ability to detect all pertinent anatomy were maintained.

Breast Neoplasms↗
PubMedDate not supplied

Negative predictive value of sonography and mammography in patients with focal breast pain.

The purpose of this study was to determine the negative predictive value of mammography and sonography in a population of patients with focal breast pain referred for imaging evaluation. Eighty-six consecutive patients with focal breast pain in the absence of a breast mass were retrospectively identified from an imaging database. The electronic inpatient and outpatient records for the 86 patients were reviewed. For patients who were diagnosed with breast cancer, pathology reports were reviewed to determine whether the painful area corresponded to the patient's cancer. In addition, patient records were linked to the institution's cancer registry. Of the 86 patients, 26 patients were lost to follow-up and did not appear in the institution's cancer registry. Four patients were diagnosed with breast carcinoma, two of whom had incidental cancers that were detected mammographically by microcalcifications and were separate from and unrelated to the area of pain. Seven patients underwent biopsy at the site of breast pain with benign diagnosis. Imaging and clinical follow-up for the 51 patients with benign or negative imaging at the site of pain showed no abnormality with a mean follow-up of 26.5 months. The negative predictive value of mammography and sonography in patients with breast pain was 100%. The negative predictive value of mammography and sonography for focal breast pain is high. Negative mammography and sonography can be reassuring to the treating clinician if follow-up is planned when physical examination is not suspicious. However, if physical examination is suspicious, biopsy should not be delayed.

Adult↗
PubMedDate not supplied

Radial scars of the breast: contrast-enhanced magnetic resonance mammography appearance.

The purpose of this study was to evaluate the appearance of contrast-enhanced magnetic resonance mammography (CE-MRM) in patients with suspected radial scar on mammography. Thirty women with radial opacities or black star findings at mammography, preoperatively underwent CE-MRM. Examinations were performed with a 1.5 T magnet with a bilateral surface coil using a FS T2-weighted turbo spin echo (TSE) and three-dimensional (3D) dynamic T1-weighted fast low-angle shot (FLASH) sequences. Criteria for lesion evaluation included morphologic patterns and signal intensity curves. Mammography and CE-MRM findings were compared with pathologic findings. CE-MRM suggested the presence of radial scar in 18 of 30 cases and the presence of malignancy in 11 of 30 cases; 1 lesion was classified as borderline. At surgery 22 radial scars (including 4 with associated ductal carcinoma in situ) and 8 carcinomas were detected. CE-MRM provided a specificity of 89%, sensitivity of 83%, and accuracy of 87%. Differently from breast cancer, radial scars are nonenhancing at CE-MRM. Nevertheless, the possibility of nonenhancing carcinomatous foci existing within radial scars implies that surgical excision should be performed in all cases.

Aged↗
PubMedDate not supplied

Are there downsides to mammography screening?

Most Americans clearly believe that routine screening mammography is beneficial. Given its widespread acceptance, it is useful to consider what the downsides of mammography screening are so that patients are fully informed in the decisions they make. This article lists some less well-recognized risks of mammography, such as false negatives and their accompanying false reassurance, as well as the direct and indirect costs to women and society. Three important downsides-radiation hazard, overdiagnosis of breast cancer, and the paradoxical increase in breast cancer mortality observed in screened women compared to controls age 40-49 years-are addressed. The article also considers the reasons that women are poorly informed about the downsides of mammography. There is, however, agreement that early diagnosis and treatment are important, and that new methods to reduce breast cancer deaths must be sought.

Adult↗
PubMed1997

Compression in mammography and the perception of discomfort.

Breast compression in mammography is an uncomfortable experience for most women. The discomfort experienced has the potential to deter women from attending regular breast screening by mammography. The aim of the present study was to assess factors related to the degree of discomfort experienced by women attending for first-time mammography at the Central and Eastern Sydney BreastScreen Service. Prior to the mammogram, expectations of discomfort, menstrual status, existing breast pain, and other breast problems were recorded on a questionnaire. At the time of the mammogram, breast size and weight were estimated. During the mammogram one of the craniocaudal views of the breast was taken at a slightly lower level of compression and after the procedure the participants were asked if they perceived any difference in discomfort between the normally compressed view and the less compressed view. Radiologists were asked to comment on any differences in image quality between the same two cranio-caudal films. A total of 200 women, including non-English-speaking women, participated in the present study. A total of 29% of women reported moderate, considerable or severe discomfort, a much higher level than reported in previous studies. The source of expectations (P = 0.001) had a significant relationship to the expectation of discomfort. Prior expectations (P = 0.01) and breast weight (P = 0.001) were the only factors found to have a significant relationship to the experience of discomfort. The analysis of differences in level of compression and discomfort indicates that the relationship between mammography discomfort and level of compression is complex and not simply the result of the amount of compression applied. However, analysis of the relationship of varying compression and image quality suggests that a slight lowering in the level of compression is unlikely to significantly compromise perceived image quality. Directions for further research are suggested.

Adult↗
PubMed2006

Usefulness of scintimammography as an adjunct to mammography and ultrasound in the diagnosis of breast diseases.

This study was undertaken to evaluate the diagnostic efficacy of 99mtechnetium methoxyisobutylisonitrile scintimammography (SM) and combined use of mammography and ultrasound in the detection of the breast lesions in the symptomatic breast. Histopathological findings were the gold standard. Eighty patients with symptomatic breasts underwent mammography and/or ultrasound breast followed by SM. In 25 patients there were 27 lesions that were malignant and 55 patients had 65 lesions that were benign. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of SM were found to be 92, 72, 58, 96 and 78%, respectively, as compared with the combined use of mammography and ultrasound, which showed these parameters to be 89, 94, 86, 95 and 92%, respectively. In this study, SM showed slightly better sensitivity than combined mammography and ultrasound, whereas the specificity was clearly shown as higher in the latter.

Adult↗
PubMed2006

Breast specimen ultrasound and mammography in the prediction of tumour-free margins.

BACKGROUND: Adequacy of margins is important for local recurrence control in breast-conserving surgery for breast cancer. This study aims to compare the accuracy of intraoperative specimen ultrasonography (IOUS) and specimen mammography in the prediction of achieving adequate histologically tumour-free margins during breast-conserving surgery. METHODS: Between March 2003 and September 2004, a prospective study was carried out on 25 patients who underwent breast-conserving surgery. After wide excision, IOUS and specimen mammography were used to assess adequacy of margins. Further surgery was undertaken when either method showed an inadequate margin. The margins were assessed histologically and correlated with IOUS and mammographic findings. RESULTS: Using IOUS alone, higher rates of histologically tumour-free margins were achieved compared with mammography alone. Combined IOUS and mammography achieved similar or slightly higher rates of histologically tumour-free margins compared with IOUS alone. If the margin measured on IOUS is twice the desired histological margin, this will result in achieving a histologically tumour-free rate of >90%. Associated ductal carcinoma in situ was the only significant factor found to decrease the rate of achieving adequate margins. CONCLUSION: Intraoperative specimen ultrasonography is useful in predicting histologically tumour-free margins during breast conserving surgery for cancer.

Adult↗
PubMed2001

The relation of household income to mammography utilization in a prepaid health care system.

Managed care organizations should be expected to provide equivalent access to preventive and screening services to all members. We studied mammography in 1,667 women members of one HMO who had an overall utilization rate of 84.9%. Significant correlates of mammography utilization included age, estimated household income, and division of the managed care organization in which the member was enrolled. Each $10,000 increment of income increased mammography rates by 2.5 percentage points (95% confidence interval [CI], 1.4% to 3.6%), independent of age and division. Our findings suggest that coverage for mammography services is not sufficient to ensure equivalent use of screening across income groups.

Adult↗
PubMed2006

Black-white differences in risk perceptions of breast cancer survival and screening mammography benefit.

BACKGROUND: Given differences in cancer survival by race, black women may differ from white women in breast cancer risk perceptions. OBJECTIVE: To evaluate black-white differences in risk perceptions of breast cancer survival and screening mammography benefit. DESIGN: A written survey was administered to a random sample of women attending general internal medicine clinics. PARTICIPANTS: Black and white women, ages 40 to 69. MEASUREMENTS: Risk perceptions were measured regarding (1) average 5-year survival after a breast cancer diagnosis and (2) relative risk reduction of screening mammography. Women's risk perceptions were defined as being accurate, as well as more or less pessimistic. Measured patient characteristics included race, age, family history of breast cancer, income, insurance, education, and numeracy. Unadjusted Pearson chi(2) tests and adjusted multivariable regression analyses were done. RESULTS: Black women were more likely than white women to accurately perceive breast cancer survival in both unadjusted (48% vs 26%, P<.001) and adjusted analyses (adjusted odds ratio (AOR)=3.58; 95% confidence interval (CI)=1.56 to 8.21). Black women were also more likely to accurately perceive the benefit of screening mammography in unadjusted (39% vs 15%, P<.001) and adjusted analyses (AOR=2.70; 95% CI=1.09 to 6.69). Black women were more likely to have a more pessimistic perception of mammography benefit in unadjusted (47% vs 15%, P<.0001) and adjusted analyses (AOR=3.94; 95% CI=1.62 to 9.56). CONCLUSIONS: Awareness of risk perceptions can help physicians to tailor patient education. Physician acknowledgment of more accurate risk perceptions among black women may serve as a basis to improve patient-physician communication.

Adult↗
PubMed2006

Breast cancer risk and provider recommendation for mammography among recently unscreened women in the United States.

BACKGROUND AND OBJECTIVE: Many women with increased breast cancer risk have not been screened recently. Provider recommendation for mammography is an important reason many women undergo screening. We examined the association between breast cancer risk and reported provider recommendation for mammography in recently unscreened women. DESIGN: Cross-sectional study using 2000 National Health Interview Survey. PARTICIPANTS: In all, 1673 women ages 40 to 75 years without cancer who saw a health care provider in the prior year and had no mammogram within 2 years. MEASUREMENTS AND ANALYSIS: We assessed breast cancer risk by Gail score and risk factors. We used multivariable logistic regression models in SUDAAN adjusted for age, race and illness burden, to examine the association between risk and reported recommendation for mammography within 1 year for all women and women ages 50 to 75 years. RESULTS: Of 1673 recently unscreened women, 29% reported a recommendation. Twelve percent of women had increased Gail risk and of these recently unscreened, high-risk women, 25% reported a recommendation. After adjustment, high-risk women were not more likely to report a recommendation than average-risk women. Results were similar for women 50 to 75 years old. No individual breast cancer factors other than age were associated with reporting a recommendation. CONCLUSIONS: Approximately 70% of recently unscreened women seen by a health care provider in the prior year reported no recommendation for mammography, regardless of breast cancer risk. This did not include women who received a recommendation and were screened. Increasing reported recommendation rates may represent an opportunity to increase screening participation among recently unscreened women, particularly for women with increased breast cancer risk.

Adult↗