Showing papers on "Mammography published in 1982"
TL;DR: Results from the randomized trial conducted by the Health Insurance Plan (HIP) to determine the efficacy of breast cancer screening with mammography and palpation are reported for longer periods than previously available.
Abstract: Results from the randomized trial conducted by the Health Insurance Plan (HIP) to determine the efficacy of breast cancer screening with mammography and palpation are reported for longer periods than previously available. By the end of 10 years after entry, the study group's mortality due to breast cancer was about 30% below the control group's. Arithmetic gains due to screening were maintained through year 14; relative gains declined. With increases in the period of follow-up, cumulative survival rates among cases detected by mammography alone (palpation negative during screening), decreased more rapidly than rates among other subgroups, but survival rates for mammography cases remained relatively high. Study women aged 40-49 years at entry began to show lower breast cancer mortality than those in the control group as duration of follow-up increased. Reservations are advanced about the acceptance of this finding as evidence of the efficacy of screening under age 50 under the conditions of the HIP study. The reservations are based on the observation that the decrease of mortality among the study group aged 45-49 at entry is concentrated entirely among cases diagnosed after they reached 50 years of age.
912 citations
651 citations
TL;DR: In the cases studied, there was close correlation between the size of the metastatic lesion at palpation and mammography, a feature also characteristic of the well-circumscribed carcinomas.
Abstract: Metastatic foci to the breast from a wide variety of primary malignancies appear on mammograms as circumscribed spheroid shadows with only slightly irregular margins, and without evidence of microcalcifications, spiculations, or other signs of desmoplastic response that characterize many primary scirrhous carcinomas. In the cases studied, there was close correlation between the size of the metastatic lesion at palpation and mammography, a feature also characteristic of the well-circumscribed carcinomas. This is not the case with most scirrhous breast carcinomas, whose associated desmoplastic reaction results in an apparent larger size by palpation than observed on mammography.
174 citations
TL;DR: Mammographic dysplasia is strongly associated with breast cancer, is present in a substantial proportion of patients with the disease, and may offer opportunities for prevention, and mammograms contain information about risk of breast cancer.
Abstract: We have carried out a case-control study to examine the relationship between mammographic signs and breast cancer. The mammographic signs assessed were prominent ducts and dysplasia. The cases were a group of 183 women with histologically verified unilateral breast cancer. The controls were a group of women attending a screening centre. Cases and controls were individually age-matched. Mammograms from the non-cancerous breast of the cases were randomly assembled with those of the controls and classified by 3 radiologists without knowledge of which films were from cases and which from controls. Mammographic dysplasia was found to be strongly associated with breast cancer, particularly in women aged less than 50. Prominent ducts were only weakly associated with breast cancer. Multivariate analysis showed that the association between dysplasia and breast cancer could not be explained on the basis of other risk factors for breast cancer, and that classification of dysplasia discriminated more strongly between cases and controls than did classification of Wolfe's mammographic patterns. These results show that mammograms contain information about risk of breast cancer. Mammographic dysplasia is strongly associated with breast cancer, is present in a substantial proportion of patients with the disease, and may offer opportunities for prevention.
161 citations
TL;DR: Women whose mammogram showed the P2 or DY parenchymal patterns were at elevated risk compared to women with the N1 pattern, and risk increased regularly with increases in the percentage of the breast that showed nodular densities and with rises in the average size and concentration of these densities.
Abstract: The authors conducted a case-control study at two Boston, Massachusetts, are hospitals to evaluate the relation of anatomic features of the breast, visible on the xeromammogram, to the risk of breast cancer. The cases were 408 women with newly diagnosed breast cancer and the controls were 1021 women without signs or symptoms of breast disease. The features of the breast assessed were the "parenchymal pattern" as defined by Wolfe (Am J Roentgenol 1976; 126:1132-9), and specific radiologic characteristics which are components of the parenchymal pattern classification. Women whose mammogram showed the P2 or DY parenchymal patterns were at elevated risk compared to women with the N1 pattern. Further, risk increased regularly with increases in the percentage of the breast that showed nodular densities and with increases in the average size and concentration of these densities. Women with extensive homogeneous density were also at elevated risk. These findings were observed only among women aged 20-59 years. In this group, women with nodular densities in 60% or more of the breast appeared to have a five-fold increase in risk compared to women without nodular densities in the breast.
146 citations
TL;DR: The technique for computed tomographic examination of the breasts using a conventional body scanner is described, and experience with 67 patients is reported, and CT mammography appears to have the capability to detect breast cancers that are occult to other methods.
Abstract: The technique for computed tomographic (CT) examination of the breasts using a conventional body scanner is described, and experience with 67 patients is reported. In the diagnosis of both malignant and benign breast lesions, the results with a body scanner were equal to those of a dedicated CT/M mammographic unit. Although the CT study of the breast cannot replace conventional mammography in screening or in routine diagnostic workup, the unique capability of demonstrating both anatomic changes and increased iodide concentration in a cancer provides many advantages over conventional mammography. CT mammography appears to have the capability to detect breast cancers that are occult to other methods. Indications for a CT study of the breasts are: (1) clinically suspected breast cancer, especially with a mammographically occult lesion; (2) questionable mammographic findings, including microcalcifications, tumor shape, architectural distortion, and uncertain lesion location; and (3) evaluation of postbiopsy or postlumpectomy breast cancers when a primary irradiation therapy is contemplated. Breast CT also appears to be a valuable diagnostic tool in searching for a second primary breast cancer, follow-up study of postirradiation of breast cancer, followup study for postmastectomy patients, and screening procedure for genetically high-risk patients, especially those with dense breasts.
111 citations
TL;DR: It is suggested that women with dense breasts be screened more frequently, using more views and modalities and with broader criteria for advising surgical biopsy, as well as the two‐year interval between screenings is probably longer than the optimal interval.
Abstract: Within a population-based breast cancer screening programs, 209 cancers were detected by regular mammographic screening. Additionally, 66 cancers were discovered between two consecutive screenings after one, two, or three negative screening examinations (interval cancers). The study group consisted of 25,920 women who have been participating since 1975 in a breast cancer screening program in Nijmegen, the Netherlands. In this program, single view mammography (lateromedial projection) was administered as the sole screening examination every two years. Physical examination was not part of the screening program. All previous histologic and radiologic material from 64 of those "interval" patients was available and was reviewed. In 19 of the 64 patients, direct or indirect signs of tumor were seen on the previous screening mammogram on review (observers error). In four cases the site of the tumor lay outside the imaging field (technical error). In 41 cases, no signs of tumor could be seen on the mammograms even on review. By calculated tumor doubling times, 20 of these 41 cases were probably too small to be detected at the last screening ("real" interval cancers). However, 21 cases were probably large enough but were somehow masked from radiologic detection. The mean reasons for this "masking" proved to be: 1) dense breast, 2) poorly outlined tumor mass of diffuse infiltrative type, mainly invasive lobular carcinomas, and 3) intraductal localization. The authors suggest that women with dense breasts be screened more frequently, using more views and modalities and with broader criteria for advising surgical biopsy. They also note that in general the two-year interval between screenings is probably longer than the optimal interval.
99 citations
TL;DR: Thin-needle aspiration cytology is a benign procedure that appears to be superior to physical examination, mammography, and needle biopsy in establishing the diagnosis of clinically suspicious breast masses.
Abstract: Eighty-one consecutive patients with breast masses clinically suspicious for malignancy were evaluated prospectively. There were 31 benign lesions and 50 malignancies. Clinical diagnosis was correct in 85% (2.5% false negative, 12.5% false positive). Mammography was diagnostic in 52.8% (31.5% false negative, 15.7% false positive). Needle biopsy was accurate in 78.9% (21.1% false negative, 0% false positive). Aspiration cytology was diagnostic in 96.2% (3.8% false negative, 0% false positive). Statistical comparison of all four tests revealed that aspiration cytology was slightly more accurate than physical examination for all lesions (p = 0.07), but significantly more accurate for benign lesions (p = 0.005). Overall, aspiration cytology was significantly more accurate than mammography (p = 0.000001) and needle biopsy (p = 0.008). Only one minor complication, a superficial infection, occurred with aspiration cytology and needle biopsy. Thin-needle aspiration cytology is a benign procedure that appears to be superior to physical examination, mammography, and needle biopsy in establishing the diagnosis of clinically suspicious breast masses.
95 citations
TL;DR: Results confirmed previous observations that geometric unsharpness is the limiting factor in microcalcification detectability for most conventional mammography systems and indicated superior microCalcification detection for: xeroradiographic over screen-film recording systems, positive-mode over negative-mode xer oradiography, microfocal spot contact over conventional contact techniques, and microFocal spot magnification over all contact techniques.
Abstract: Controlled in vitro studies of breast microcalcification detectability were done comparing a wide variety of standard and state-of-the-art mammography techniques (conventional and microfocal spot x-ray tubes, screen-film and xeroradiographic recording systems, contact and magnification techniques). Results confirmed previous observations that geometric unsharpness is the limiting factor in microcalcification detectability for most conventional mammography systems. Results also indicated superior microcalcification detection for: xeroradiographic over screen-film recording systems, positive-mode over negative-mode xeroradiography, microfocal spot contact over conventional contact techniques, and microfocal spot magnification over all contact techniques. No differences were found between a standard screen-film technique and a screen-film technique requiring about one-half the radiation exposure. On the other hand, although there was no differences between standard xeroradiography and a modest-added-filtrati...
63 citations
TL;DR: Results from the randomized trial to determine the efficacy of periodic screening with mammography and palpation of the breast have been examined and the elimination of the unfavorable status among non-Whites through screening does not appear to be explained by various artifacts explored.
Abstract: Results from the randomized trial underway in the Health Insurance Plan of Greater New York to determine the efficacy of periodic screening with mammography and palpation of the breast have been examined to determine the effect of screening on racial differences in breast cancer survival rates. Consistent with experience in general populations, the control group showed a lower five-year survival rate among non-White women with breast cancer than among White women. In the study group, 65 per cent of whom participated in the screening program, there was no differential in the survival rates of the two racial groups. The elimination of the unfavorable status among non-Whites through screening does not appear to be explained by various artifacts explored. Secondary prevention measures may offer the possibility of reducing or closing the gap in breast cancer survival rates between White and non-White women.
49 citations
TL;DR: The identification of a suspicious occult breast lesion with mammography should, in most instances, result in roentgenographically guided localization followed by surgical excision, and the preferred method is a modified hookwire for lesion localization.
Abstract: • The identification of a suspicious occult breast lesion with mammography should, in most instances, result in roentgenographically guided localization followed by surgical excision. Over a three-year period, we performed 180 roentgenographically guided preoperative localizations for occult breast lesions, 32% (57/180) of which were malignant. Of the total, there were 85 masses and 95 clustered microcalcifications. We prefer to use a modified hookwire for lesion localization. (Arch Surg1982;117:65-68)
TL;DR: A strong and statistically significant association was found between mammographic dysplasia and breast cancer when controls from the screening centre were compared to cases, but not when cases wereCompared to women referred for the diagnostic evaluation of breast disease.
Abstract: We have carried out a case-control study to evaluate the association between Wolfe's mammographic patterns and the risk of breast cancer, and to examine the influence of control selection and the radiologist who read the films upon the results obtained. Mammograms of the non-cancerous breast of 183 women with unilateral breast cancer were compared with mammograms from two age-matched control groups: a group of asymptomatic women attending a screening centre, and a group of symptomatic women referred for the diagnostic evaluation of suspected breast disease. Films were arranged in random sequence and independently classified by 3 radiologists. A strong and statistically significant association was found between mammographic dysplasia and breast cancer when controls from the screening centre were compared to cases, but not when cases were compared to women referred for the diagnostic evaluation of breast disease. This result appears to arise in part because of an association between symptoms of benign breast disease and mammographic dysplasia, and suggests that some previous negative studies of the association of mammographic patterns with breast cancer may have arisen from the inclusion of symptomatic subjects as controls.
TL;DR: The results indicate that mammography can contribute significantly to the management of patients undergoing tylectomy and primary radiotherapy for breast cancer.
Abstract: The value of mammography in treatment planning for early breast cancer following excisional biopsy was studied in 38 patients. One-third of the post-biopsy mammograms yielded information useful for therapy or follow-up, specifically the presence or absence of gross residual tumor [11] and detection of occult lesions in the opposite breast or axillary nodes [3]. They also proved valuable as base-line studies, since scars seen on post-therapy mammograms may simulate new or recurrent tumor [3]. Approximately half [21] of the post-biopsy studies were nondiagnostic because of dense parenchyma [14] or biopsy-related distortion [7]. Four were considered falsely positive for residual tumor. These results indicate that mammography can contribute significantly to the management of patients undergoing tylectomy and primary radiotherapy for breast cancer.
TL;DR: A population, originally 6,845 women, 40 years of age and over, was screened for breast cancer by single oblique-view mammography in 1974, 1977, and 1980, and this method was considered very suitable for screening.
Abstract: A population, originally 6,845 women, 40 years of age and over, was screened for breast cancer by single oblique-view mammography in 1974, 1977, and 1980. Of the 5,789 women remaining in their parish in 1980, 94% had attended the screening at least once. Of 111 breast cancers diagnosed in the 6.25-year study period, 78% were detected at screening, 15% as interval cancers, and 7% among nonresponders. Sixty-three percent of the women had tumors in clinical stage I, and 59% had tumors less than or equal to 10 mm. The predictive value for biopsy recommendations by mammography was 79%. This method was considered very suitable for screening. In the older age groups there was probably some overdiagnosis of cancers that would never have become symptomatic.
Journal Article•
TL;DR: This work reports the experience in 66 needle localization procedures for nonpalpable lesions of which fourteen were carcinoma, and emphasizes the ease and accuracy of this technique with minimal loss of breast substance.
Abstract: Localizing nonpalpable suspicious lesions seen by mammography is a challenge to the surgeon. Using a previously reported technique we report our experience in 66 needle localization procedures for nonpalpable lesions of which fourteen were carcinoma. We emphasize the ease and accuracy of this technique with minimal loss of breast substance.
Dissertation•
01 Jan 1982
TL;DR: The sonographic appearance of 130 breast carcinomas imaged by a dedicated breast scanning system is reviewed and examples of each category with corresponding xeromammograms are presented.
Abstract: The sonographic appearance of 130 breast carcinomas imaged by a dedicated breast scanning system is reviewed. Five separate categories are identified and examples of each category with corresponding xeromammograms are presented.
TL;DR: The American College of Surgeons Commission on Cancer Short‐term Survey of Breast Cancer showed that 73% of malignant tumors are found by patients, 23% by physicians, and 4% by mammography.
Abstract: The American College of Surgeons Commission on Cancer Short-term Survey of Breast Cancer in 12,315 patients showed that 73% of malignant tumors are found by patients, 23% by physicians, and 4% by mammography. It also indicated that younger women are more likely to discover tumors than older women, and that mammography is more likely to detect small tumors with negative axillary nodes. The effectiveness of mammography is most evident in women 50 to 74 years of age, although in women 45 to 49 years, the frequency of tumors detected by mammography nearly equals that for other groups. In black women, mammography may not be currently fully utilized. Analysis of the survey data would indicate that patients appear to demonstrate adequate skill in detecting tumors, as compared to physicians. A delay in diagnosis of longer than 3 months is associated with larger tumors and increased likelihood of axillary metastasis.
TL;DR: It is suggested that thermography is not a sufficiently precise modality for use in routine breast diagnosis, despite specific criteria, and thermographic interpretation was inconsistent except in thermograms reported as “normal.”
Abstract: The role of two types of thermography in the diagnosis of breast disease was studied in 502 women seen over a two-year period. Thirteen cancers were diagnosed in eleven women. The most significant finding was the large number of equivocal or abnormal thermograms in women with normal breasts of benign disease, while in patients with proven cancer, the thermogram was abnormal in less than half. Clinical diagnosis of breast cancer was not enhanced by either or both types of thermogram. Despite specific criteria, thermographic interpretation was inconsistent except in the thermograms reported as "normal." On the basis of the findings, the authors could not recommend that an abnormal thermogram be used as an indication for mammography, since this would result in an inordinate number of these studies, particularly in young women. The findings suggest that thermography is not a sufficiently precise modality for use in routine breast diagnosis.
TL;DR: The biopsy method described was fully acceptable to patients and the cosmetic results were excellent, and the radiologic-histologic correlation is tabulated and the significance of preclinical breast cancer detection is emphasized.
Abstract: During a 1-year period, 2,909 symptomatic women were referred for physical examination of the breast and mammography. In 44 women (1.5%), mammography discovered a total of 45 impalpable breast lesions that might represent an early cancer. Mammographic wire-guided biopsy was performed using a self-retaining hook wire for the marking of the lesion. The radiographic localization was facilitated by using a perforated compression plate with holes visible on the mammograms. The biopsy method showed high precision and accuracy. Only 1 guide wire was needed in each instance. In 96% of cases, the wire transfixed the lesion or was placed in close proximity (within 1 cm) to the lesion. Correct biopsy was achieved in all instances, but in some cases more than 1 biopsy was necessary. The malignancy rate was 29% of biopsies and 30% of patients. The metastatic rate to axillary lymph nodes was 17%. Generally, the histologic pattern showed great variety with several different components in most specimens. The radiologic-histologic correlation is tabulated and the significance of preclinical breast cancer detection is emphasized. The biopsy method described is reliable and highly recommended. We found the procedure easy to handle and time-saving. The method was fully acceptable to patients and the cosmetic results were excellent.
TL;DR: This paper identifies the long run average British National Health Service screening costs in one particular screening clinic for various different regimes, and identifies mammography with single reporting together with a single clinical examination as 'the best buy'.
Book•
01 Jan 1982
TL;DR: The benefits and risk of mammography are well discussed enabling the reader to understand the controversy surrounding breast cancer detection techniques.
Abstract: The book begins with a brief discussion of the history of mammography and a good review and discussion of the mammorgraphy controversy. The section on diagnosis is excellent with very good anatomic-pathologic correlation of the mammography signs. The preoperative localization is well described. Section 3 on performing the examination is an excellent discussion of the various modes of mammography and their techniques. Magnification mammography, computed tomographic mammography, thermography, sonomammography, and ductography are very well covered. In Section 4, the benefits and risk of mammography are well discussed enabling the reader to understand the controversy surrounding breast cancer detection techniques.
TL;DR: Among nine cases of men who underwent excision, there were six cases of gynecomastia, two lipomas, and one biopsy revealed normal subcutaneous tissue.
Abstract: Fourteen men referred for ultrasound evaluation of breast enlargement had ultrasound mammography using water path techniques. Gynecomastia, both the localized type and the diffuse type, could be differentiated from the normal soft tissues of the chest wall on the B-scans. Among nine cases of men who underwent excision, there were six cases of gynecomastia, two lipomas, and one biopsy revealed normal subcutaneous tissue. The ultrasound B-scan images are correlated with the histologic findings in these nine cases. Ultrasound mammography using water path techniques is a useful imaging examination for male breast enlargement.
TL;DR: This study confirms the importance of using additional diagnostic modalities for evaluating patients with dysplastic breasts and strongly suggests the value of ultrasound mammography in this group of patients.
Abstract: Evaluation of 135 consecutive patients was made for breast masses by the same surgeon and the patients were subsequently referred for ultrasound mammography of the breast after xeromammography revealed a "dysplastic" (DY) pattern only, with no evidence of malignancy. Three patients had carcinoma of the breast detected by ultrasound mammography that had been missed by xeromammography. Two of the three cancers were similarly diagnosed by fine-needle aspiration cytology. All patients with a normal ultrasound examination have now been followed for a minimum of 15 months without evidence of developing breast cancer. This study confirms the importance of using additional diagnostic modalities for evaluating patients with dysplastic breasts and strongly suggests the value of ultrasound mammography in this group of patients.
Journal Article•
TL;DR: Modern low-dose dedicated x-ray mammography has been demonstrated in large clinical trials to have high efficacy in the detection of occult breast malignancy and warrants further controlled study before its widespread clinical application.
Abstract: Modern low-dose dedicated x-ray mammography has been demonstrated in large clinical trials to have high efficacy in the detection of occult breast malignancy. Such early detection results in decreased fatality rates. A theoretical risk of breast cancer induced from diagnostic ionizing radiation has not been proven for the low doses now used in mammographic techniques. High accuracy can be achieved in the mammographic evaluation of breast lesions. In contrast, nonionizing transillumination of the breast, or diaphanography, remains an investigational approach to the evaluation of breast disease and warrants further controlled study before its widespread clinical application.
Book•
01 Jan 1982
TL;DR: Atlas of mammography histologic and mamographic correlations, Atlas of mammographical correlations, and more.
Abstract: Atlas of mammography histologic and mamographic correlations , Atlas of mammography histologic and mamographic correlations , کتابخانه الکترونیک و دیجیتال - آذرسا
29 Dec 1982
TL;DR: In this article, a multiparameter optimization has been conducted to find the mammography system requiring the lowest patient dose for a given image quality, subject to constraints imposed by technology such as; power limits on tube focal spots, absorption efficiency related to detector resolution and others.
Abstract: Analytical expressions have been written for image quality in mammography. A multiparameter optimization has been conducted to find the mammography system requiring the lowest patient dose for a given image quality. The optimization is subject to constraints imposed by technology such as; power limits on tube focal spots, absorption efficiency related to detector resolution and others. The optimization permits system geometry, kVp, filtration, detector resolution, focal spot size and grid characteristics to vary simultaneously and self consistently subject to an exposure time constraint. Significant dose reductions compared to current mammography systems have been found without assuming radical technological advances.
01 Dec 1982
TL;DR: Ultrasound is a non-invasive and non-ionizing method of imaging soft tissue which may have better patient acceptance than x-ray mammography and, in the B-scan mode, may be useful in scanning patients with radiographically dense breasts.
Abstract: Ultrasound is a non-invasive and non-ionizing method of imaging soft tissue which may have better patient acceptance than x-ray mammography and, in the B-scan mode, may be useful in scanning patients with radiographically dense breasts.1 Several investigators have been developing ultrasound B-scan technology for imaging the breast.2,3