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PubMed1980

Further experience with microfocal spot magnification mammography in the assessment of clustered breast microcalcifications.

This prospective study evaluates the ability of a single microfocal spot magnification (1.5X) mammogram to aid in the diagnosis of isolated clustered breast microcalcifications. Of the 429 patients studied, there were 117 pathologically proved cases for which concurrent convential contact (1X) mammography resulted in an equivocal interpretation. The superior image quality of the additional magnification mammogram resulted in an equivocal interpretation. The superior image quality of the additional magnification mammogram resulted in improved visualization of microcalcifications in every instance, permitting a definitive and correct radiographic interpretation (benign or malignant) in over 70% of the cases. Microfocal spot magnification mammography as an adjunct to the conventional mammography examination can greatly improve diagnostic accuracy in the evaluation of isolated clustered microcalcifications, and should permit a substantial reduction in the number of biopsies for benign breast lesions.

Biopsy↗
PubMed1983

Analysis of mammography: a blind interpretation of BCDDP radiographs.

An ROC curve analysis of mammography is presented. This study is based on a blind interpretation of radiographs of patients who underwent screening during the Oklahoma Breast Cancer Detection Demonstration Project (BCDDP). In particular, we evaluated the accuracy of mammography based on 38 incidence cancer cases. Incidence cases are those that develop in a patient after an initial visit and at least one additional annual visit before a biopsy is performed. Using 40 normal subjects, a sensitivity of 72% was attained at a 28% false positive rate. We also evaluated the contribution of viewing radiographs of both breasts (right and left) simultaneously as compared with viewing radiographs of the individual breasts singly. In cases on the threshold of detectability, the breast that did not result in the cancer diagnosis was occasionally identified as the most suspicious for cancer. When mammograms of the two breasts were compared, the false positive rate was lower. These results can be used to assess various screening strategies and to yield a more realistic accuracy estimate of mammography on a rescreened population than is currently available.

Biopsy↗
PubMed1987

Development and implementation of a quality assurance program for mammography.

As a pilot study for a national campaign to promote the use of screening mammography, the Virginia Division of the American Cancer Society conducted a breast cancer awareness project with mammography screening. An important part of the program was the development of a quality assurance program for mammography. Guidelines were established for equipment, image recorders, processing, dose, and patient positioning. A survey of information about the mammographic equipment was conducted, and the mammograms from each facility were reviewed. A total of 63 mammographic units in 56 facilities statewide were included in the month-long program during which approximately 9,000 women were screened.

Breast Neoplasms↗
PubMed1987

Utilization of screening mammography: comparison of different physician specialties.

Data obtained on 426 consecutive patients referred to a breast center by 122 physicians, including family practitioners, general surgeons, and other specialists, showed that the obstetricians-gynecologists referred the greatest average number of patients per physician, with more than 50% of these referrals for screening mammography. Internists referred fewer patients by nearly a factor of ten, with only one-third of these patients referred for screening mammography. Internists may be the weakest link in the utilization of screening mammography.

Adolescent↗
PubMed1987

Automated management of screening and diagnostic mammography.

We designed an automated system for managing large-scale screening and diagnostic mammography. The system collects coded mammographic findings from the radiologist and records a history directly from the patient. This information is stored in an integrated clinical data base to which the results of subsequent examinations or surgery are added. In addition, the system generates letters to the patient and her physician that describe mammographic findings and letters reminding them of routine screening visits. For patients who have positive results on examinations, it checks for records of biopsy or repeat mammography and generates follow-up letters if appropriate intervention is not found. While this system is part of a comprehensive computerized hospital information system, mammography management tools with most of the features described can be designed for relatively inexpensive microcomputers.

Breast Neoplasms↗
PubMed1988

Mammography screening and the self-referred woman.

There are no easy answers to the question of whether a mammography screening practice should accept self-referred women. The major reason for doing so is the fact that many women are not being screened either because their primary care physicians do not initiate mammography screening referrals or because they do not have a physician at all. However, this compelling argument is at least partially countered by the numerous problems encountered when practices accept self-referred women, including potential adverse medicolegal consequences, tedious and time-consuming reporting requirements, the possibility of turf battles with referring physicians, and, especially if breast physical examination is not offered, somewhat increased costs of screening. The ultimate decision of whether self-referred women are accepted will probably be based on an analysis of the prevailing conditions in each radiologist's local environment. Because local conditions vary greatly, so may the final decision vary. However, once the choice is made, steps should be taken to provide ready access to screening while also reducing the frequency with which self-referral-related problems occur. To this end, those radiologists who decide to accept self-referred women, particularly if screening is done with mammography alone, should attempt to convert as many self-referred cases as possible into patient-initiated physician referrals. Similarly, radiologists who decide to screen on a referral-only basis should develop mechanisms that make it very easy for self-referred women to obtain physician referrals.

Breast Neoplasms↗
PubMed1988

Comparison of two screen-film combinations in contact and magnification mammography: detectability of microcalcifications.

A new dual-screen, dual-emulsion-film combination that allows a decrease in radiation dose of approximately 66% was compared with a widely used single-screen, single-emulsion-film system in contact and magnification mammography. Clustered microcalcifications randomly superimposed on a breast phantom were detected, and the location and number of individual calcifications were determined by four observers. The detectability of calcifications, determined with a receiver operating characteristic (ROC) analysis area, was 0.92 for magnification and 0.82 for contact mammography with the single-emulsion-film system, compared with 0.84 and 0.72, respectively, with the dual-emulsion-film system. More clusters were correctly located and more individual calcifications were counted with magnification than with contact mammography. The dual-emulsion-film system with the magnification technique performs as well as the single-emulsion-film system with the contact technique, while retaining a decrease in required dose of approximately 40%.

Breast Diseases↗
PubMed1988

Advanced primary breast cancer: assessment at mammography of response to induction chemotherapy.

The response to induction chemotherapy is an important prognostic factor in patients with nonmetastatic, locally advanced breast carcinomas. Assessment at mammography of the response of 60 breast cancers in 59 women was performed between 1974 and 1986. Responses were excellent in 13 tumors, moderate in 34, and poor in 13 (excellent moderate = 78%). Assessment of response of discrete masses in a fatty breast was easiest; assessment of response of tumor areas that were poorly defined-such as a focal area of architectural distortion or mass in dense breast parenchyma-was more difficult. Of 17 patients with excellent pathologic responses-that is, minimal or no residual tumor-15 (88%) had complete responses (no residual tumor) as determined with mammography, physical examination, or both. Mammography provides information complementary to physical examination and is essential in the accurate assessment of the response to chemotherapy of locally advanced breast cancer.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1989

Mammography after prosthesis placement for augmentation or reconstructive mammoplasty.

Mammograms of 59 women who underwent placement of a prosthesis for augmentation or reconstructive mammoplasty were retrospectively reviewed. Free silicone was used in five women, retroglandular prostheses in 40, and subpectoral implants in 14. Abnormalities of prosthesis contour were seen only in eight women with retroglandular implants. In another four women, retroglandular prostheses became calcified. In women who received free-silicone injections, coarse calcifications developed in three, and gross nodularity with calcified silicone granulomas developed in one. Five palpable masses developed, three of which were malignant; four masses were in breasts augmented with a retroglandular prosthesis, and they could not be detected with mammography. The mass that developed in a woman with a subpectoral prosthesis could be seen at mammography. The only nonpalpable malignancy detected with mammography was in a breast with a retroglandular prosthesis and contained microcalcifications. The authors conclude that in women with retroglandular prostheses, masses may often be obscured on mammograms by compressed, dense glandular tissue.

Adult↗
PubMed1989

Why women resist screening mammography: patient-related barriers.

Mammography utilization remains below the level needed to achieve the National Cancer Institute's year-2000 goals for reducing breast cancer mortality by 50%. Previous research has identified both patient and physician barriers. The authors interviewed 600 randomly selected women who were offered a free mammographic examination. Interviews were conducted by professional interviewers using a brief, structured questionnaire. Data were analyzed with chi 2 Wilcoxon and Kruskal-Wallis rank-sum statistics and discriminant analysis. Noncompliant subjects reported more barriers than compliant subjects. The former were more likely to believe that mammography is unnecessary in the absence of symptoms and that it is inconvenient. In both the bivariate and multivariate analyses, the woman's belief that her doctor believes in regular mammography was an important predictor of compliance.

Adult↗
PubMed1990

Medical audit of a rapid-throughput mammography screening practice: methodology and results of 27,114 examinations.

Medical audit results from the entire experience of a rapid-throughput mammography screening practice are presented, comprising 27,114 examinations conducted from April 1985 to September 1989. The authors screened a self-selected physician-referred population, almost 94% of whom were asymptomatic. Estimated sensitivity of initial mammography interpretation was 93.1% with a specificity of 94.2% and a positive predictive value of 10.0%. Biopsies prompted by screening yielded a diagnosis of malignancy in 32.1% of cases; 170 breast cancers were identified, 67.1% requiring mammographic needle localization. Median cancer size was 12 mm, the rate of axillary nodal metastasis was 11.0%, and the systemic metastasis rate was 1.2%. Of the cancers found, 76.5% were stage 0 or stage 1. Conducting a medical audit is the most convincing way to demonstrate the success of a mammography screening practice, thereby providing this important information for the benefit of screenees, referring physicians, third-party payers, and the personnel who perform the screening.

Adult↗
PubMed1991

Measurement of force applied during mammography.

The discomfort that patients experience during mammography is probably related to a variety of factors, one of which might be the amount of compression used. The authors measured the amount of force applied to the breasts during mammography and the resulting breast thickness in 560 women and correlated these measurements with the patient's subjective impression of the examination. The amount of force applied ranged from 49 to 186.2 N (median, 122.5 N). Breast thickness ranged from 10 to 88 mm (median, 46.5 mm). Forty-seven women (8%) rated the examination as painful (ie, mammography was either "very uncomfortable" or "intolerable"). Logistic regression analysis revealed a highly significant relationship between probability of a painful response and ratio of force to thickness (P = .007). Current guidelines suggest that maximum available force be at least 160 N but not more than 200 N. However, because increasing force is associated with increasing likelihood of pain, technologists should be aware that these recommended maximum limits are not intended to be used routinely for all women. In this study, high-quality mammograms were obtained in a majority of women with forces less than the maximum available level.

Breast↗
PubMed1992

Improvement in mammography interpretation skills in a community radiology practice after dedicated teaching courses: 2-year medical audit of 38,633 cases.

The authors conducted a complete audit of results of 38,633 mammographic examinations performed by 12 general radiologists during a 2-year period with a computerized reporting system. During this period, 11 group members attended 17 dedicated mammography courses. Audit results were analyzed for each radiologist and the entire group. In the 2nd year, the number of breast cancers diagnosed increased 50% (from 121 to 181), with a 6.5% increase in patient volume. Sensitivity increased from 80% to 87%, and there was no change in the positive predictive value of 32%. Median tumor size and node positivity decreased. Most major variables of population and technical factors were unchanged. Diagnostic approach was altered during the 2nd year, as shown by a 50% increase in the use of spot compression, magnification views, and sonography. Analysis of each radiologist's performance before and after attending mammography courses showed similar changes. These data suggest that dedicated mammography courses can help improve radiologists' performance and alter their interpretive approach.

Breast Neoplasms↗
PubMed1993

Impact of patient-controlled compression on the mammography experience.

The authors tested the hypothesis that giving women control over the compression portion of the mammography examination results in a less painful experience, greater overall patient satisfaction, and a radiographic image as good as that produced by means of technologist-controlled compression. One hundred nine women undergoing screening mammography at a hospital-based outpatient clinic were studied. Each underwent two-view, screen-film mammography performed in routine fashion except that, by random assignment, one breast was compressed by the technologist and the other breast, by the patient. Patient-controlled compression was significantly (P = .003) less painful than technologist-controlled compression. Overall patient satisfaction (96% [105 of 109]) and willingness to repeat the experience were extremely high. The majority of images (93.5% [202 of 216]) were rated as having good to excellent compression. With minimal patient education, self-compression resulted in an image at least as good as that produced with technologist-applied compression. Further study of this technique is warranted.

Adult↗
PubMed1993

Mammography film-labeling practices.

The labeling practices of 390 facilities that consecutively submitted screening mammography images (mediolateral oblique and craniocaudal views) to the American College of Radiology (ACR) Mammography Accreditation Program over a 2-month period were evaluated. Methods for identifying the patient and facility included a flash card at 333 facilities (85%), stick-on paper labels at 54 (14%), and handwriting directly on the film at three (1%). Identification labels included the patient's first and last name at 372 facilities (95%), the date at 370 (95%), the name of the facility at 349 (89%), a unique patient identification number at 328 (84%), the patient's age at 169 (43%), the name of the referring physician at 146 (37%), and the patient's date of birth at 129 (33%). Labeling practices, information provided, and methods used varied considerably from one site to another. Adoption of ACR guidelines for labeling mammography films is encouraged.

Female↗
PubMed1993

Breast cancer recurrence after mastectomy: diagnosis with mammography and US.

The authors reviewed mammograms and/or ultrasound (US) scans of 76 lesions (67 patients) suspected of being recurrent breast cancer. All patients had previously undergone mastectomy. Sixty-one cases were malignant disease and 15 were benign. Mammography and US were complementary to clinical examination in evaluating palpable lesions at the mastectomy site. Both imaging methods revealed nonpalpable recurrences. The sensitivity of US was 91%, whereas the sensitivities of clinical examination and mammography were 79% and 45%, respectively. US was the best imaging method for evaluating tumors in the chest wall far from the scar and in the axilla, as these could not be visualized on mammograms. Most recurrent cancers were seen as circumscribed masses at mammography and as hypoechoic lesions at US. Hyperechoic recurrences could not be differentiated from benign lesions. The value of early detection of recurrences with imaging methods remains to be seen.

Breast Neoplasms↗
PubMed1994

Breast cancer in the elderly patient: early detection with mammography.

PURPOSE: To determine the mammographic features and differences in stage of breast carcinomas in elderly women with malignancies detected with palpation or mammography at presentation. MATERIALS AND METHODS: The mammograms and clinical records of 60 patients (aged 75 years or older) with 62 breast carcinomas, detected during 40 consecutive months, were retrospectively reviewed. A variety of dedicated devices and processing equipment were used. The histologic features, mammographic appearance, mode of detection, and stage of disease were determined. Statistically significant differences between subgroups were calculated with the Student t and chi 2 tests. RESULTS: Sixty cancers (97%) were seen on mammograms. Seventeen tumors detected with annual mammography differed significantly from the 45 carcinomas in nonscreened patients in diameter (1.1 vs 2.1 cm; P < .0005) and stage (14 minimal [82%] of 17 tumors vs 15 minimal [33%] of 45 tumors; P < .0005). Thirty-five nonpalpable malignancies differed significantly from 27 palpable masses in diameter (1.2 vs 2.3 cm; P = .01) and stage (25 tumors minimal [71%] vs four tumors minimal [15%]; P < .0005). CONCLUSION: Screening mammography enabled detection of statistically significantly smaller and earlier-stage tumors, most of which were minimal disease.

Age Factors↗
PubMed1994

Silicone breast implant ruptures in an animal model: comparison of mammography, MR imaging, US, and CT.

PURPOSE: To determine the most accurate imaging modality for detection of silicone implant ruptures. MATERIALS AND METHODS: Forty single-lumen silicone implants were surgically placed in 20 rabbits. Each rabbit received one intact and one ruptured implant and was examined with mammography, magnetic resonance (MR) imaging, ultrasound (US), and computed tomography (CT). Five radiologists reviewed all images in a random fashion and graded each for rupture. The radiologist who performed US also graded her impression during examination with US. Receiver operating characteristic (ROC) analysis was performed. RESULTS: MR imaging and CT were the most accurate modalities in detection of implant ruptures, with areas under the ROC curves (Az) of .95 and .91. Mammography and US were statistically significantly inferior, with Az of .77 for each (P < .05). CONCLUSION: MR imaging and CT are statistically more accurate than US and mammography for detection of intracapsular silicone implant ruptures when only the images are reviewed.

Animals↗