Imaging of the female breast with ultrasound was first performed in the early 1950s by Wild and Neal (1951, 1952), but the method did not gain wide acceptance due to the need for specially designed machines that were not available commercially. Only after ultrasound diagnosis became firmly established in other areas were special breast scanners developed, most notably through the efforts of the Japanese groups of Kobayashi (1974) and Wagai et al. (1967) and the Australian groups of Kossoff and Jellins (from 1971 to 1975). The introduction of the gray-scale technique by the same groups, combined with the use of automated water-bath scanners, provided greatly enhanced images of the female breast. It must be emphasized, however, that while instruments have been specially developed for breast examination, their capabilities are not inherently superior to those of good real-time scanners, because they have the same limitations of resolution. Nevertheless, the over view provided by immersion-type scanners is a definite advantage. There is no one breast scanner that is ideal in all situations.

Diagnosis of Breast Disease

In 1952 Wild and Reid performed the initial studies that laid the groundwork for the development of breast sonography. The Japanese groups of Wagai and Kobayashi and the Australian groups of Kossoff and Jellins published the first clinically important results in the early 1970s. Their work stimulated a widespread implementation and refinement of breast sonography using real-time instrumentation. Today, computer-controlled systems have given ultrasound an established place in the diagnosis of breast diseases and have made it competitive with other noninvasive modalities.

Basic Technical and Methodologic Aspects of Breast Sonography

PURPOSE: Presentation of the suitability of breast ultrasound for detecting DCIS of the breast. MATERIALS AND METHODS: Review of literature on the topic and description of the sonographic features of DCIS illustrated by cases. RESULTS: Breast ultrasound is currently capable of detecting DCIS with a comparable success rate to that of mammography. The advantages of sonography become obvious in cases of DCIS without microcalcifications and DCIS in dense or very dense breasts. The assessment of the sonographic architecture of the whole lobe, not just circumscribed lesions, is becoming increasingly important. CONCLUSION: Breast ultrasound represents an important tool for detecting DCIS in addition to mammography.

[The suitability of high-resolution ultrasound for the detection of DCIS].

Breast sonographic imaging and evaluation of microcalcifications

Es wurden in den letzten Jahren immer wieder Arbeiten publiziert — vor allem Einzelfalldarstellungen — in denen die sonographische Abbildung von Mikrokalzifikationen gelang [1–4, 6, 7]. Bei unserer Untersuchung wurde in erster Linie nicht von der Moglichkeit ausgegangen, Mikrokalzifikate als einzelne Partikel sichtbar machen zu konnen, sondern von der Hypothese, das Mikrokalzifikationen in einem sonographisch abbildbaren Gewebekorrelat liegen konnten. Die Suche konzentrierte sich einerseits auf echoarme Herdbefunde mit hellen punktoder strichformigen Echos (Mikrokalkkorrelat (MKK) mit Herdbefund, Abb. 1). Andererseits interessierten Bezirke mit hyperreflexiven Echos ohne abgrenzbaren Herdbefund (MKK ohne Herdbefund, Abb. 2).

Mammasonographische Darstellung und Bewertung von Mikrokalzifikationen

Sonography can yield indirect visualization only of microcalcifications in the female breast. In order to obtain an image of the echo pattern of the grouped microcalcifications, it is essential that the device employed possesses suitable dynamic characteristics, and it is also necessary to employ the technique of additive tomography. The investigator must familiarize himself with the proper interpretation of reflex patterns. Microcalcifications cannot be detected via sonography with the same degree of accuracy as with the help of mammography. However, sonographic detection is easier if the microcalcifications are more closely grouped. Nevertheless, the authors were able to show in a small comparative series that grouped calcifications can be detected even without previous information of their presence.

[Microcalcifications in mammography and visualization by ultrasound (author's transl)].

1,344 women were examined in the course of 3 years by means of the ultrasonic system Multiplanar MS 3 which was coupled direct to the skin. This direct coupling to the skin of the breast and the freely mobile sound head enable immediate puncture of tumours of the breast in direct ultrasonic vision. In multiple cysts it will be possible to puncture all cysts--including the occult ones--in one session. In the first 229 examined tumours, the rate of accuracy of the diagnosis "cyst" was 98%. Successful punctures, including the non-palpable cysts, were effected down to a minimum volume of 0.1 ml. The problem of the nonpalpable cysts can be considered as solved from the sonographic angle. In our case, this entailed omission, and hence saving in cost, of every third biopsy of the mammae (approximately 200 out of 600 biopsies per annum).

A. Knüpfer

Papers

[Microcalcifications in mammography and visualization by ultrasound (author's transl)].

[Possibilities of ultrasonic examination of the mammae (author's transl)].