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PubMed1976

[Film quality in film mammography. Article II: Signal/noise ratio of the recording system as a quantitative measure of quality. Final evaluation of recording systems (author's transl)].

During consideration of three film mammographic systems (see article I), the concept of signal/noise ratio is developed as a quantitative measure of film quality. The ability to recognise detail related to detail size, film blackening and exposure geometry was studied for various systems, and the quality profiles are discussed. There is a considerable difference in quality between industrial films without screens and film-screen combinations; however, exposure geometry during mammography has a considerable effect which tends to reduce the difference. Consequently, detail sizes of 200 mu to 1,000 mu (including the majority of mammographic micro-calcifications) are shown about equally well. Contrast for the lo-dose system (D = 1.1) is somewhat less than for adequately exposed industrial film (D = 2.0) or for Cronex 75 m with lo-dose screen (D = 1.5 to 2.0). The lo-dose system (D = 1.1) is 8.6 times more sensitive than Cronex 75 m (D = 2.0), and the system Cronex 75 m with lo-dose screens is 11.6 times more sensitive. Over-exposure with the lo-dose system, contrary to industrial film, rapidly leads to unsatisfactory results (loss of contrast and increased granularity for D greater than 1.5). On the other hand it is often not possible to obtain an adequate exposure (D = 2.0) when using industrial film. For these reasons it is often an advantage to examine large breasts (with considerable geometric unsharpness) and the dense breasts of young women with a film-screen combination (eg. lo-dose system) which requires approximately one eighth of the dose necessary for industrial film. For small or easily compressable breasts (little geometric unsharpness) best results are obtained, using an adequate exposure by employing industrial film; radiation dose it then acceptable. Detailed analysis of the systems has shown that the recording system unsharpness of film-screen combinations in mammography should be reduced.

Female↗
PubMed1977

[Mammography and age (author's transl)].

Following Egan (2), Gros et al. (8,9), Ingleby and Gershon-Cohen (11) and Witten (18) the appearances of mammograms were divided into four groups: I. Dense, II. Atrophic, III. Shrunken-fibrous and IV. Cotton-wool, diffuse. In young women up to the age of 30 a dense structure is the most common (74.8%). On the basis of available statistics, the use of mammography for routine detection of carcinoma of the breast cannot be justified in women under the age of 30; not only is this condition very rare at this age, but proper evaluation of the relevant signs is only possible in one woman in four because of the structure of the breast. On the other hand, if there is any suspicion of the presence of a carcinoma, then mammography should be carried out and additional forms of examination, such as thermography and xerography, should not be neglected.

Adolescent↗
PubMed1979

[Mammography in the diagnosis and treatment of non-puerperal mastitis (author's transl)].

Circumscribed or diffuse non-puerperal mastitis is usually associated with local signs of inflammation. In two-thirds of these cases it is possible to demonstrate the radiological features of mastitis. Mammography is an important diagnostic procedure in the demonstration of acute mastitis and its differentiation from an inflammatory carcinoma; it is also valuable in the control of treatment. The success of intensive antibiotic therapy with recovery of normal appearances in the chest can be observed objectively by mammography. In distinguishing mastitis from an inflammatory carcinoma, radiological evidence of regression under the influence of antibiotics is evidence in favour of mastitis.

Adult↗
PubMed1979

[Clinical experience with mammography using grids (author's transl)].

Duplicate examinations were carried out on 122 patients in order to compare the results of mammography using a grid technique (Diagnost U. Müller) with a film-screen systemadn also a conventional set without screens (Mamma-Diagnost, Müller). The results were compared with reference to film quality and dose. The new technique was superior to the conventional method in all respects, independent of the size of the gland. Another advantage of the grid technique was the larger available film size. Dose requirements for grid mammography with a film-screen system was less than for conventional techniques by a factor of about 1.8. The results speak for increased use of the grid technique in clinical practice.

Breast Neoplasms↗
PubMed2000

[Full-field digital mammography: a phantom study for detection of microcalcification].

OBJECTIVES: The study compares direct full-field digital mammography (FFDM) to the state-of-the-art conventional screen-film mammography (SFM) concerning the detectability of simulated microcalcifications. MATERIALS AND METHODS: The investigations were performed with a FFDM system (Senographe 2000D, GEMS) and a SFM system (Senographe DMR, GEMS, Fuji UM MA film with Fuji UM MAMMO FINE screen). An anthropomorphic breast phantom with superimposed microcalcifications (50-200 microns) was used to evaluate the detectability of microcalcifications with a confidence level ranging from 1 to 5. Contact mammograms and magnification spot views (m = 1.8) of the FFDM and SFM systems were compared. A receiver operating characteristic (ROC) analysis was performed by three well-experienced readers. RESULTS: The ROC analysis revealed a higher performance of the digital images compared to the conventional screen-film mammograms. The area under the ROC-curve (Az) in the digital contact mammograms was 0.68 versus 0.63 in the conventional technique. The results were not significantly different. In digital spot views, Az was 0.79 versus 0.70 in the conventional spot views. CONCLUSIONS: The results suggest that FFDM is at least equivalent or--as far as spot views are concerned--may be superior to conventional SFM in the detection of microcalcifications.

Breast Diseases↗
PubMed2000

[Influence of histopathological factors on dynamic MR mammography].

AIM: To assess the histopathological background of enhancement mechanisms in dynamic MR mammography studies. METHODS: The dynamic MR mammography (MRM) examinations were done with a 1.5 T MR imager (Magnetom Vision, Siemens) using a double breast coil and a coronal FLASH-3D sequence. Enhancement data were acquired during 9 minutes post contrast medium injection (Gd-DTPA 0.2 mmol/kg). Acquisition time was 87 sec/slab. Early enhancement at the first post contrast measurement (E1) and slope of wash-out (SE2-L) were calculated. In immunohistology, proliferation was assessed by the monoclonal antibody Ki 67, capillaries were stained by a CD 31 antibody. Of a total of 48 operated patients, 58 lesions and 46 surrounding tissues were evaluated. RESULTS: Cellularity, capillary density and proliferation showed statistically significant correlations with E1 (p < 0.01). In multiple regression analysis, E1 was significantly associated only with high cellularity (p = 0.002) and the combination of high cellularity and high microvessel density (p = 0.002); a negative slope of wash out was significantly associated only with malignant histology (p = 0.027). CONCLUSIONS: Our findings indicate a direct influence of cellularity and microvessel density on early enhancement. The expression of the proliferation marker Ki 67 was not an independent predictor for contrast enhancement.

Adult↗
PubMed2004

[Clinical value of mammography, ultrasound and MR imaging during the first year after breast conserving therapy of breast cancer].

PURPOSE: To compare the accuracy of lesion detection and characterization and to determine the agreement of observers, methods and timing of mammography (MX), ultrasound (US) and MR imaging (MRI) during the first year after breast conserving therapy. MATERIALS AND METHODS: The study included 20 patients diagnosed with breast cancer of stages equal or inferior to T2 N1bi M0 after breast conserving therapy and subsequent radiotherapy. Patients with any history of breast diseases in the affected or contralateral breast were excluded. Patients were examined before and at 3, 6 and 12 months after adjuvant radiotherapy with MX, US and dynamic MR mammography. Additional US and MRI were performed 3 months after radiotherapy. All 220 examinations were retrospectively read in a randomized order by two independent readers, blinded for the results of the other examinations. The outcome after 2.5 years of follow-up was used as gold standard. Histological examination was available in one case. Lesion detection and specificity were assessed including kappa values for different reliabilities between observers, timing and methods. The kappa values were used to characterize the degree of agreement as follows: > 0.8 very good; 0.6 - 0.8 good; 0.4 - 0.6 fair; 0.2 - 0.4 minimal; and < 0.2 negligible. RESULTS: Based on the interpretation of all available findings (clinical examination, MX, US, MRT and histology in one case), 20 patients observed for a mean period of 2.5 years had no evidence of intramammary recurrence. Therefore the sensitivity of the various methods could not be assessed. The reading of certainly no lesion was given by MRI in 43 %, by MX in 30 % and by US in 5 % of all examinations (p < 0.05). True negative findings were observed by MRI in 94.4 %, by MX in 90.4 % and by US in 82.5 %. Reliability between observers, timing and imaging methods was 0.496, 0.411, and 0.215 for lesion detection and 0.303, 0.282, and 0.030 for lesion characterization. CONCLUSION: Within the first year after breast conserving therapy, MRI was the most confident method for the exclusion of lesions and presented the highest true negative rate. The assessment of dignity of a particular lesion was difficult by all imaging methods, reflected by the weak agreement between observers, methods and timing. The difference between times of readings were marginal in the first year after therapy. Agreement between the different diagnostics methods was minimal to negligible.

Adult↗
PubMed2005

[Self-organizing neural networks for automatic detection and classification of contrast (media) enhancement of lesions in dynamic MR-mammography].

PURPOSE: Investigation and statistical evaluation of "Self-Organizing Maps," a special type of neural networks in the field of artificial intelligence, classifying contrast enhancing lesions in dynamic MR-mammography. MATERIAL AND METHODS: 176 investigations with proven histology after core biopsy or operation were randomly divided into two groups. Several Self-Organizing Maps were trained by investigations of the first group to detect and classify contrast enhancing lesions in dynamic MR-mammography. Each single pixel's signal/time curve of all patients within the second group was analyzed by the Self-Organizing Maps. The likelihood of malignancy was visualized by color overlays on the MR-images. At last assessment of contrast-enhancing lesions by each different network was rated visually and evaluated statistically. RESULTS: A well balanced neural network achieved a sensitivity of 90.5 % and a specificity of 72.2 % in predicting malignancy of 88 enhancing lesions. Detailed analysis of false-positive results revealed that every second fibroadenoma showed a "typical malignant" signal/time curve without any chance to differentiate between fibroadenomas and malignant tissue regarding contrast enhancement alone; but this special group of lesions was represented by a well-defined area of the Self-Organizing Map. DISCUSSION: Self-Organizing Maps are capable of classifying a dynamic signal/time curve as "typical benign" or "typical malignant." Therefore, they can be used as second opinion. In view of the now known localization of fibroadenomas enhancing like malignant tumors at the Self-Organizing Map, these lesions could be passed to further analysis by additional post-processing elements (e.g., based on T2-weighted series or morphology analysis) in the future.

Algorithms↗
PubMed1995

[Focal and diffuse lesions in dynamic MR-mammography of healthy probands].

PURPOSE: To evaluate the range of normal contrast enhancement behaviour in dynamic MR mammography of healthy breast parenchyma, and to reduce false-positive results caused by incidental contrast enhancing lesions. MATERIALS AND METHODS: We performed a prospective two-armed study on 20 healthy premenopausal volunteers who were examined four times within one month (Group 1) or during four consecutive months (Group 2). Incidence, prevalence, morphology, and contrast enhancement pattern of lesions were evaluated. RESULTS: 82% (9/11 of Group 1) and 78% (7/9 of Group 2) showed at least one of a total of 60 contrast enhancing lesions. In 54% or 33% (Group 1 or 2), lesions with enhancement velocity beyond the malignancy threshold were found. 72% or 75% of lesions resolved completely during follow-ups. 69% of lesions were focal with irregular border. Time/signal intensity diagrams were almost always not suspicious; no wash-out phenomenon was seen. CONCLUSION: In MR mammography of premenopausal breast parenchyma, focal contrast enhancing lesions-even with enhancement beyond the malignancy threshold-may occur without any underlying pathology.

Adult↗
PubMed1988

[The role of mammography in the diagnosis of simultaneous second cancers in the contralateral breast].

In 1048 breast cancer patients, operated in the period 1969-1985 at the University of Erlangen Clinic of Obstetrics and Gynecology, estimations were made to determine the relative contribution of mammography and meticulous histology to the diagnosis of simultaneous contralateral cancer. The incidence of a bilateral simultaneous disease was 17% (6.1% invasive forms, 10.6% in situ). Complete histological examination of the extirpated tissue as well as the occurrence of discrete radiological signs could account for the detection of 41% of all invasive and 39% of all in situ forms respectively. Those contralateral breast cancer cases detected just by means of mammography, but without any presence of clinical signs, recorded an average diameter of 9 mm and in 20% had metastacised to the axillary lymph nodes. Comparatively, clinically and radiologically diagnosed cases were 17 mm on average and the occurrence of axillary lymph node involvement was 41%. The conclusion is drawn, that a meticulous diagnostic effort is necessary in view of the high incidence of occurrence of simultaneous cancer on the other breast and the prognostic importance of an early diagnosis for many patients. Every minute radiologically detected sign in the other breast of patients with mammary carcinoma requires careful diagnostic clarification. However, it should be considered that the data presented were gathered in a situation in which the radiologist performed the X-ray examination, knowing that an excision would have been carried out in 85 percent of all cases even without his specific localisation. The presence of additional risk factors (lobular cancer, multicentricity and family history of breast cancer) make such an effort justified and obligatory as well.

Biopsy↗
PubMed1993

[Determinants of observer variability in early diagnostic mammography--a ROC analysis].

As part of the German mammographic study, the participating doctors were given test films of 30 histologically confirmed cases. Regarding the indications for biopsy there was good sensitivity (the median amongst 25 doctors was 0.87). Specificity (median 0.86) could be improved. Comparison of individual results with the majority showed considerable variability within the group of doctors performing mammography. ROC analysis indicated that there was considerable observer variability which was independent from the specialty or praxis characteristics of the participants. The inclusion of mammography in an early diagnostic programme requires continuing education of the participants in this technique. This should be supported by further methods of quality assurance.

Germany↗
PubMed1991

[The radiological diagnosis of the male breast. Mammography, sonography and pathohistological correlation].

61 men with breast enlargement underwent mammography; complementary sonography was performed in 34 cases. Diagnoses included gynaecomastia in 53 cases, pseudo-gynaecomastia in 9 cases, 3 carcinomas, 2 inflammatory lesions and 1 lipoma. Gynaecomastias of up to four month's duration are histologically of the florid type and show a nodular or nodular-dendritic mammographic pattern; sonography usually demonstrates a focal hypo-echogenic area. Gynaecomastias of longer duration representing the fibrous type show mammographically a dendritic or diffuse pattern and sonographically a hyper-reflexive breast parenchyma. Mammography and sonography can differentiate reliably true gynaecomastia from pseudo-gynaecomastia. Gynaecomastia and especially inflammatory lesions may not always be readily differentiated from carcinoma. Sonography can be helpful by demonstrating hyper-reflexive glandular tissue, whereas carcinomas are usually hypoechoic.

Adolescent↗
PubMed1981

[Ultrasound mammography:special applications (author's transl)].

Clinical observations on more than 700 patients between September 1979 and October 1980 are reported. If cysts are suspected clinically, ultrasound mammography provides the most reliable diagnosis and is superior to all other methods for localization, fine-needle biopsy and follow-up. Since it is difficult to assess (due to summation effects), the radiologically dense breast (DY) is a further indication for sonography. In case of excentrically located palpatory findings, pregnant or immobile patients, ultrasound mammography can provide valuable diagnostic information.

Adult↗
PubMed1986

[Results of real-time sonography and raster mammography of 200 breast cancers].

The article reports on 200 patients with histologically verified carcinomas of the breast in whom both real time mammasonography and grid mammography were performed. The indications for additional use of real time sonography in the diagnosis of malignant diseases of the female breast were a palpable node or a suspicious finding in mammography. All patients were examined with a high resolution realtime scanner with a 7.5 MHz transducer. The diagnostic criteria of sound deep to the mass (type I-IV), the regularity of the conteur of the mass, and the presence or absence of internal echoes. The typical sonographic features of histologically different types of carcinoma of the female breast are demonstrated by means of case examples. Mammasonography offers a high degree of accuracy in preoperative differential diagnostic assessment of tumour status in malignant processes of the breast. The combined mammographic-sonographic evaluation is the method of choice in clinical evaluation of masses of the female breast.

Adult↗
PubMedDate not supplied

Mammography screening behavior in older women caregivers.

The purposes of this study are to explore older caregivers' mammography participation and the facilitators and barriers to mammography screening. Of the 52 older female caregivers with a mean age of 65 years (range 50-90) interviewed by telephone, 80.8% had had a mammogram within 12 months. Significant facilitators included health care provider recommendation and beliefs in the efficacy of treatment. Significant barriers included health care providers' failure to recommend mammograms, caregiver procrastination, fear of pain, and lack of symptoms. Caregivers with higher burden reported less frequent self- and provider-conducted breast examinations.

Aged↗
PubMed1997

Frequency-domain techniques enhance optical mammography: initial clinical results.

We present a novel approach to optical mammography and initial clinical results. We have designed and developed a frequency-domain (110-MHz) optical scanner that performs a transillumination raster scan of the female breast in approximately 3 min. The probing light is a dual-wavelength (690 and 810 nm, 10-mW average power), 2-mm-diameter laser beam, and the detection optical fiber is 5 mm in diameter. The ac amplitude and phase data are processed with use of an algorithm that performs edge effect corrections, thereby enhancing image contrast. This contrast enhancement results in a greater tumor detectability compared with simple light intensity images. The optical mammograms are displayed on a computer screen in real time. We present x-ray and optical mammograms from two patients with breast tumors. Our initial clinical results show that the frequency-domain scanner, even at the present stage of development, has the potential to be a useful tool in mammography.

Algorithms↗
PubMed2001

Consequences of a National Mammography Screening Program on diagnostic procedures and tumor sizes in breast cancer. A retrospective study of 1540 cases diagnosed and histologically confirmed between 1995 and 1997.

In 1992, a national screening mammography program, including female patients between 50 and 64 years of age, was launched in Luxembourg. The effects of this campaign on the different diagnostic procedures, especially fine needle aspirations (FNA), large core needle biopsies (LCNB), and surgical specimens, were analyzed. From 1983 to 1997, the National Cancer Registry recorded 3167 new cases of invasive female breast cancer, all histologically diagnosed in one central pathology department. In 1996, the population consisted of 418,300 inhabitants (212,900 females). The number of breast cancer, tumor size, the nature of the diagnostic procedures, their diagnostic value as well as the number of physicians, "aspirators", and "biopsists" were evaluated. Between 1992 and 1994, the incidence of invasive breast cancers increased, concomitant with the launching of a National Screening Mammography Program. The diagnosis of in situ cancers tripled, and the mean size of invasive breast cancer decreased from 2.1-2.4 cm to 1.1-1.4 cm. Since 1994, the number of FNA had remained stable, LCNB had increased by 417.5%, and surgical biopsies had decreased by 18.95%. Between 1995 and 1997, 28.37% of 1075 FNA, and only 9.6% of 465 LCNB yielded inadequate samples. FNA were done by 77 different doctors (53.25% being gynecologists) and LCNB by 34 (52.94% being radiologists). The first diagnoses of all invasive cancers (n = 790) were made by using frozen sections from surgical specimens in 58.35% (n = 461), LCNB in 18.23% (n = 144), mastectomy in 10.13% (n = 80), formalin-fixed biopsies in 9.49% (n = 75), and FNA in 3.17% (n = 25). There are beneficial effects (increase in the number of diagnoses of in situ cancer; decrease in tumor sizes) not only for the "target" age group (50-64 years), but also for all female age groups (> 15 years). For quality assurance purposes, it is absolutely recommended to carry out pathological, radiological, and diagnostic work in specialized centers.

Aged↗
PubMed1986

Status of mammography in breast cancer screening.

Doubt no longer exists as to the efficacy of breast cancer detection by mammography. A significant body of evidence supports its value in reducing morbidity and mortality associated with this common malignancy. Physicians must become convinced of its usefulness and recommend the procedure to female patients as part of routine healthcare. Those responsible for reimbursement of healthcare costs should be apprised of its value. Many insurance plans do not reimburse for screening procedures in the absence of clinical symptoms, but with breast cancer, the symptomatic patient may have a greatly diminished possibility of cure. The next decade may hold further diagnostic or therapeutic innovations, and breast cancer may eventually be eradicated. At present, however, no diagnostic method is capable of providing an impact equal to that of screening mammography for those women who have the misfortune of contracting this particular disease. We should all try to maximize the benefits this current technology is capable of providing.

Adult↗