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Showing papers on "Mammography published in 1983"


Book
01 Jan 1983
TL;DR: This fourth edition of the bestselling Teaching Atlas of Mammography, readers are again invited to share in the authors' experience of analyzing and evaluating mammograms and provide the requisite knowledge and tools to arrive at a highly accurate differential diagnosis.
Abstract: The names Tabar and Dean are associated with high-quality mammography worldwide. In this fourth edition of the bestselling Teaching Atlas of Mammography, readers are again invited to share in the authors' experience of analyzing and evaluating mammograms. Their systematic approach not only instills a full understanding of the principles of mammography but also provides the requisite knowledge and tools to arrive at a highly accurate differential diagnosis. Rather than starting with the diagnosis and demonstrating typical findings, the approach of this atlas is to teach the reader how to analyze the image and reach the correct diagnosis through proper evaluation of the mammographic signs. Prerequisites for the perception and evaluation of the mammographic findings are optimum technique, knowledge of anatomy, and understanding of the pathological processes leading to the mammographic appearances. Special features: * Revised and expanded case studies, based on 40 years of imaging experience, provide instructive long-term follow-up of patients over a period of up to 25 years * Offers a unique comparison of imaging findings with the corresponding large thin-section and subgross thicksection (3D) histologic images to facilitate an understanding of the pathologic processes and the mammographic appearances they lead to * Includes an abundance of coned-down compression views, microfocus magnification views, and specimen radiographs to support the analytic workup Teaching Atlas of Mammography and the Breast Cancer book series by the same authors are essential for residents in radiology and practicing radiologists who need the highest level of training in the radiologic anatomy of the normal breast and the changes associated with benign and malignant lesions. They will help ensure that all clinicians acquire the optimal technique and knowledge of pathologic processes necessary to reach a correct diagnosis, and achieve the best long-term outcomes for their patients.

273 citations


Journal ArticleDOI
TL;DR: It is suggested that radiologists who wish to improve the cancer-detecting ability of their current breast imaging operation should upgrade their mammography to state-of-the-art status before adding an automated whole-breast ultrasound scanner.
Abstract: This prospective study, involving 1,000 women referred for routine mammography, compares the breast cancer detecting abilities of state-of-the-art mammography and sonography using an automated water-path scanner. Mammography was found to be the superior technique, detecting 62 (97%) of the 64 pathologically proven cancers, while sonography detected only 37 (58%). When considering those cancers most amenable to cure, mammography detected over 90% in all categories, but sonography detected only 48% of the cancers that had not yet spread to axillary lymph nodes, only 30% of the nonpalpable malignancies, and only 8% of the cancers smaller than 1 cm. These data indicate that sonography is not an acceptable substitute for mammography in the detection and diagnosis of breast cancer. The data further suggest that radiologists who wish to improve the cancer-detecting ability of their current breast imaging operation should upgrade their mammography to state-of-the-art status before adding an automated whole-breast...

143 citations


Journal ArticleDOI
TL;DR: Review of the effects of a normal mammogram on the treatment of 36 women with palpable breast carcinomas during a two-year period showed that 17 patients had biopsies performed within two months of their normal mammograms and 19 patients hadBiopsies delayed for three to 24 months.
Abstract: • Review of the effects of a normal mammogram on the treatment of 36 women with palpable breast carcinomas during a two-year period showed that 17 patients had biopsies performed within two months of their normal mammograms and 19 patients had biopsies delayed for three to 24 months. Of the 17 who had biopsies within one month of a normal mammogram, three (17.6%) had extension of disease to axillary nodes. Of 19 patients whose biopsy was delayed, cancer was found in axillary nodes of 11 (57.9%). Normal mammograms should not preclude biopsy of a breast mass. ( Arch Surg 1983;118:23-24)

80 citations


Journal ArticleDOI
TL;DR: It is found that mammography can advance the stage at detection and have a reasonably high predictive value compared with the isoprobability baseline, and clinical examination can lower threshold over current threshold levels, but only at the expense of a very high biopsy rate.
Abstract: The primary goal of screening for breast cancer is to detect the disease at a smaller size and presumably earlier stage. A review of the literature is presented, which evaluates the ability of thermography, mammography, and clinical examination to lower the threshold size at detection and evaluate the predictive value of a positive test as compared with the prevalence of cancer existing in the population reported. We have found little evidence to indicate that clinical thermography lowers the stage at detection, and neither does a positive thermogram in screening seem to have a strong predictive value. Clinical examination can lower threshold over current threshold levels, but only at the expense of a very high biopsy rate. The data reported in the literature show that mammography can advance the stage at detection and have a reasonably high predictive value compared with the isoprobability baseline.

47 citations



Journal ArticleDOI
TL;DR: There was overlap in the appearance of benign and malignant disease on images of each modality alone, and the use of both modalities in the examination of each patient is believed to improve diagnostic accuracy.
Abstract: Both ultrasonography and x-ray mammography were performed on a male patient who had breast carcinoma. While the x-ray mammographic features were highly suggestive of malignancy, the sonographic findings were subtle. Because of the technical difficulties associated with x-ray mammography of the male breast, ultrasound has been advocated for the evaluation of gynecomastia and breast masses in men. A review of both the ultrasound scans and x-ray mammograms obtained over a three year period of 41 men who had breast enlargement shows the two modalities to be complementary. There was overlap in the appearance of benign and malignant disease on images of each modality alone, and the use of both modalities in the examination of each patient is believed to improve diagnostic accuracy.

43 citations


Journal Article
TL;DR: The results from this study point out the need to better educate primary care physicians about the use of mammography in screening for breast cancer, especially in regard to its safety and reliability.
Abstract: A survey of 509 family physicians in New York State was conducted to assess opinions about mammography and use of mammography in screening asymptomatic women of different ages. Findings indicate that most family physicians believe that mammography is an effective procedure for detecting breast cancer in its early stages, but many do not utilize mammography as a screening procedure in their own practices. The major deterrents to the use of mammography in screening asymptomatic women relate to concerns about the safety and reliability of the procedure, the low probability of detecting breast cancer through screening, the patient's willingness to accept a recommendation to have a mammogram, and cost. The results from this study point out the need to better educate primary care physicians about the use of mammography in screening for breast cancer, especially in regard to its safety and reliability.

42 citations


Journal Article
TL;DR: Family practice residents participated in a federally funded breast and uterine cancer-screening project as a part of their training experience and significant relationships were found among compliance and the self-reporting of breast symptoms, the physical findings on physician examination, and the source of payment for mammography.
Abstract: Family practice residents participated in a federally funded breast and uterine cancer-screening project as a part of their training experience. During the 2.5-year grant period, more than 1,800 women were screened and 12 cancers detected. Patient compliance with referral for Pap smear findings was significantly greater when there were also positive pelvic findings or when the Pap smear indicated a malignant or premalignant condition. Compliance with referral for clinical follow-up of breast findings was comparable to that for diagnostic mammography, and both were significantly greater than compliance with referral for a screening mammogram. Significant relationships were found among compliance and the self-reporting of breast symptoms, the physical findings on physician examination, and the source of payment for mammography. The health belief model provides a conceptual framework for consideration of study findings relating to patient motivation for preventive and curative care.

37 citations


Journal ArticleDOI
TL;DR: The result of delay in diagnosing and treating a breast cancer because of a falsely negative mammogram (Archives1983;118:23-24) deserves attention by all physicians.
Abstract: To the Editor. —The result of delay in diagnosing and treating a breast cancer because of a falsely negative mammogram (Archives1983;118:23-24) deserves attention by all physicians. Because of the highly publicized results of screening mammography, with the roentgenographic detection of unsuspected and impalpable breast cancers, many physicians and their patients have come to rely on a negative radiology report as assurance that no malignant neoplasm is present, even if a palpable abnormality is present. In a series of 106 consecutive breast cancers operated on, I reported the role of mammography. 1 In 31% the preoperative mammogram was considered negative (demonstrating no pathologic features). The radiologist incorrectly described 10% of the lesions as benign, as either a cyst or fibroadenoma. A malignant neoplasm was suspected or correctly diagnosed in only 59% of these patients. A biopsy was not performed initially in 12 patients because a cancer had not been diagnosed

35 citations



Journal ArticleDOI
30 Apr 1983-Tumori
TL;DR: Any single procedure improved the overall sensitivity, and taken together this diagnostic triplet appears to be the most effective noninvasive diagnostic combination that provides in a short time with minimal cost and discomfort, a diagnosis of certain malignancy in about 50% of carcinomas with a predictivity close to 100%, when cytology detectedmalignancy.
Abstract: Physical examination, mammography and fine-needle aspiration cytology were performed in 1498 consecutive cases with a solitary solid lump of the female breast. The intent was to verify the validity of this diagnostic triplet in the accuracy of the preoperative diagnosis of breast cancer. Clinically sure cancers were excluded from the study. The collected data were evaluated in terms of sensitivity, specificity and predictivity of any procedure alone or in combination. In 1138 cases confirmed by histology (514 carcinomas and 669 benign or non-neoplastic lesions), the physical examination and mammography were very sensitive (respectively 96% and 84%) but with a high rate of false-positive reports (respectively 20% and 18%). The cytologic diagnosis was less sensitive (65%), mostly due to many inadequate smears, but highly specific (93%) and predictive for malignancy (99%) when the cytologic report was frankly positive. Any single procedure improved the overall sensitivity, and taken together this triplet appears to be the most effective noninvasive diagnostic combination that provides in a short time with minimal cost and discomfort, a diagnosis of certain malignancy in about 50% of carcinomas with a predictivity close to 100%, when cytology detected malignancy.

Journal ArticleDOI
TL;DR: Computed tomography was useful if the interpretation of the mammogram was equivocal, regional lymph node enlargement was questioned, invasion of the chest wall by tumor was suspected, and for planning radiotherapy treatment.
Abstract: Thirty-three patients with breast lesions demonstrated by mammography were examined with computed tomography (CT) using a standard whole body scanner. Although the CT images were of good diagnostic quality, the amount of new information gained was limited. The diagnostic accuracy of mammography in the hands of an experienced reader was higher than that with CT. We conclude that, although technically a whole body scanner is capable of producing good images of the breast, the number of patients in whom CT should be used instead of or in addition to mammography is limited. The indication for its use was primarily for patients in whom quality mammograms could not be produced because either the breast was unusually dense or extensive breast disease caused technical difficulties in performing mammograms. Computed tomography was also useful if the interpretation of the mammogram was equivocal, regional lymph node enlargement was questioned, invasion of the chest wall by tumor was suspected, and for planning radiotherapy treatment.


Journal ArticleDOI
TL;DR: A blurred mass subtraction technique has been developed for mammography that will enhance small object contrast and visibility throughout the breast area and an analysis of its capabilities and limitations is given.
Abstract: A blurred mass subtraction technique has been developed for mammography that will enhance small object contrast and visibility throughout the breast area. The procedure is easy to implement and requires no additional exposure. Perception of low-contrast objects is improved by eliminating extreme light and dark image areas. Contrast of structures within certain parts of the breast is increased by compression into the high-contrast part of the film characteristic curve. Detail visibility is also increased by the edge enhancement produced by this process. This paper describes the enhancement process and gives an analysis of its capabilities and limitations.

Journal ArticleDOI
15 Jun 1983-Cancer
TL;DR: Between 1975 and 1980, 392 patients with a palpable mass or masses were referred for breast evaluation, including risk factor assessment, physical examination, and selective ultilization of aspiration cytology and mammography, with a benign diagnosis in 65% of the patients and cancer in 35%.
Abstract: Between 1975 and 1980, 392 patients with a palpable mass or masses were referred for breast evaluation, including risk factor assessment, physical examination, and selective utilization of aspiration cytology and mammography. Three-hundred and thirty-one (85%) were biopsied, with a benign diagnosis in 65% of the patients and cancer in 35%. The 61 patients (15%) who were not biopsied consisted of 32 patients in whom the mass disappeared on follow-up examination, 20 with stabilization on long-term follow-up, and nine with decreased mass size. Most breast masses must be biopsied, but a few can be followed and biopsy avoided. However, a decision not to biopsy requires more precise clinical judgement and experience than a decision to proceed with biopsy. Absolute indications for breast biopsy include a clinically suspicious mass, a mammogram considered malignant or suspicious, aspiration cytologic findings reported as malignant or suspicious, and a persisting, dominant mass, even if clinically benign.

Journal ArticleDOI
TL;DR: An appreciation of the frequency and natural history of postaspiration hematoma formation should either encourage physicians to request mammography before carrying out invasive procedures, or to defer mammography until 2 weeks after aspiration, since mammography then should more clearly portray the benign characteristics of truly benign masses, thereby possibly obviating biopsy.
Abstract: Hematoma resulting from attempted aspiration of a palpable breast mass can cause incorrect mammographic interpretation by rendering irregular and indistinct the otherwise smooth and sharply defined margins characteristic of a benign lesion. In this study of recently aspirated breast masses, we found 17 benign lesions that demonstrated poorly defined, irregular margins on mammograms that suggested malignancy. All these false-positive interpretations occurred when aspiration preceded mammography by less than 2 weeks (17 of 47, 36 percent); no such diagnostic error occurred in the 31 cases when mammography was delayed for 2 weeks or more after aspiration. An appreciation of the frequency and natural history of postaspiration hematoma formation should either encourage physicians to request mammography before carrying out invasive procedures, or alternatively, to defer mammography until 2 weeks after aspiration, since mammography then should more clearly portray the benign characteristics of truly benign masses, thereby possibly obviating biopsy.

Journal ArticleDOI
TL;DR: Screening for breast cancer using the combination of physical examination of the breasts and mammography was effective in women age 50 or more in the HIP study, but major questions remain, especially the benefit of screening women age 40–49, and the independent effect of mammography.
Abstract: Screening for breast cancer using the combination of physical examination of the breasts and mammography was effective in women age 50 or more in the HIP study. However, major questions remain, especially the benefit of screening women age 40–49, and the independent effect of mammography. Such questions can only be answered by large-scale randomized controlled trials, and trials to answer these questions are now underway in Canada (the NBSS) and Sweden. Only the NBSS, however, is attempting to replicate the HIP study in women age 40–49, and to evaluate the additional contribution of mammography to annual physical examination in women age 50–59. The Swedish studies are evaluating the effectiveness of mammography alone, while studies in Britain will help to evaluate breast self-examination (BSE) and biannual mammography with annual physical examination. Because much of the benefit in HIP could have derived from the physical examination, it is necessary to complete the present trials before population-based screening for breast cancer using mammography can be advocated. Trials are justifiable because the risk of mammographic screening seems likely to be negligible, and the use of the combination of annual mammography and physical examination to be cost-effective.

Journal ArticleDOI
TL;DR: If a new method, such as thermography, sonography, computed tomognaphy (Cl), or diaphanognaphY, is not proven to detect very small, highly curable breast cancer, its wide use may delay diagnosis significantly and lead to otherwise avoidable loss of life.
Abstract: Since breast cancer will affect one out of 1 1 American women during their lifetimes, it is a major target of medical research. Mammography has been in the forefront of this effort because of accumulating evidence that early detection improves prognosis and because of the demonstrated ability of mammography to detect cancer at a nonpalpable stage [1 ]. However, its widespread use has been tempered by the issue of possible risk from low doses of ionizing radiation as well as by the fact that, although more accurate than any other detection method, including physical examination, it may still find only 80%-9O% of breast cancers [1]. These factors have served to stimulate some medical investigators and manufacturers of equipment to explore alternative breast imaging procedures such as telethenmognaphy, graphic stress thermography, cholesterol plate thenmography, sonography, and diaphanography. For several reasons these studies have not always had the rigorous evaluation they deserve. In some cases commercial incentives have led to the hasty marketing of equipment before its accuracy (or lack of accuracy) was fully known. In other instances personal and professional motives have caused some investigators to announce a research “breakthrough” based on poorly designed and/or poorly analyzed studies. Companies may provide these investigators with professional forums and research funds at a time when government grants are in short supply. Thus, the investigators may become unwitting partners in unscientific misadventures. That many women are highly aware of breast cancer yet unnecessarily apprehensive of the medical x-ray exposure is ironic. Many seek reassurance that they do not have a breast cancer yet hesitate to get a mammognam because they have heard from the news media about the possible radiation risk. The potential tragedy is that large numbers of tiny cancers could be lost to early detection through such misguided apprehension. The risk may be much greaten than the theoretical risk from properly executed mammography [2-4]. New imaging methods are understandably attractive but their evaluation has been relatively inefficient. Through trial and error new methods find some level of acceptance by the medical community. The process has been expensive, time-consuming, and unscientific. In terms of breast disease, however, this may not be its main failure. If a new method, such as thermography, sonography, computed tomognaphy (Cl), or diaphanognaphy, is not proven to detect very small, highly curable breast cancer, its wide use may delay diagnosis significantly and lead to otherwise avoidable loss of life. Diagnostic imaging procedures that do not detect lesions at an earlier stage than current clinical practice do nothing but add unproductive expense to the cost of medical care and set attitudes that may be difficult to change. For example, the widespread implementation of thenmography before its role in breast cancer detection was firmly determined led to unrealistic expectations, followed by ne-



Journal ArticleDOI
TL;DR: Patients with a high risk of bilateral breast cancer needing size and/or shape symmetry correction should be considered for mastectomy and immediate reconstruction.
Abstract: Surgery on the contralateral breast was performed in 64 of 100 patients for adjustment of size and shape or for diagnostic purposes. The patients found it more desirable to adjust size than shape asymmetry on the contralateral breast. There was only one early complication and six late ones. The former was a postoperative hematoma after a reduction mammaplasty. The latter were three cases of capsular contractures after augmentation mammaplasties. In these cases the implant was placed in a submuscular position. In three cases, patients asked for a secondary reduction mammaplasty because of poor symmetry. There were some difficulties in comparing pre- and postoperative mammography after augmentation mammaplasty. In the other adjustment procedures, there were only minor difficulties in a few cases comparing pre- and postoperative mammography. Patients with a high risk of bilateral breast cancer needing size and/or shape symmetry correction should be considered for mastectomy and immediate reconstruction.

Journal ArticleDOI
TL;DR: The authors describe the sonographic and xeromammographic findings in a case of angiosarcoma of the breast, suggesting the unusual sonographic features of this entity may be relatively specific in its diagnosis.
Abstract: Angiosarcoma of the breast is a rare, malignant tumor, generally associated with a poor prognosis. Fewer than 100 cases have been reported in the world literature, and previous radiologic imaging of this vascular tumor has been limited to mammography, where its appearance is generally described as a multilobulated mass with poorly defined margins. The authors describe the sonographic and xeromammographic findings in a case of angiosarcoma of the breast. The unusual sonographic features of this entity may be relatively specific in its diagnosis.

Proceedings ArticleDOI
13 Dec 1983
TL;DR: The inability of sonography to routinely identify malignant breast calcifications will severely restrict its use as a screening tool for cancer detection.
Abstract: Sonographic detectability of mammographically demonstrable breast calcifications depends primarily on the size of the calcific particles. Calcifications smaller than 2 mm in size are detected in fewer than 10% of cases, with equally low detection rates for benign and malignant particles. The inability of sonography to routinely identify malignant breast calcifications will severely restrict its use as a screening tool for cancer detection.© (1983) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Journal Article
TL;DR: The early results of the Nottingham study on 14905 women who have attended a teaching programme on the method of self-examination with the advice to practise it regularly report that cancer was detected in 43 women and 56% were lymph node negative.

Journal Article
TL;DR: In the 8 years before 1980, 3958 women were examined in the St. Michael's Hospital breast clinic in Toronto, 87 (29%) had normal mammograms, and breast cancer was found in 34 after at least one clinical and mammographic examination had given normal results.
Abstract: In the 8 years before 1980, 3958 women were examined in the St. Michael's Hospital breast clinic in Toronto. Of 302 women with breast cancer, 87 (29%) had normal mammograms. Breast cancer was found in 34 after at least one clinical and mammographic examination had given normal results. Of these, 6 (18%) cancers were detected only by mammography while, paradoxically, 23 (68%) were detected only by clinical examination. Normal mammograms are significantly (p less than 0.001) more frequent in young women with breast cancer and in those with small palpable breast cancers. Mammography is most productive when used as a routine study in older women who have clinically normal breasts. All women should start having them around the age of 40 to 45 years. How often they should be repeated is debatable. There is no evidence that they should be repeated annually. Under 35 years of age mammography for any reason is unrewarding. Biopsy of a breast lump that is solid on aspiration should never be delayed because of a normal mammogram. Biopsy of a radiologically suspicious lesion in the breast should never be delayed because the findings on clinical examination are normal.


Journal Article
TL;DR: Of the 24 069 women aged 45-64 registered with a Practitioner in the South West Surrey Health District 69% attended for breast cancer screening by clinical examination and mammography, with the resultant cancer detection rate of 5.5/1000 women screened and a cancer: benign biopsy rate of 1:1.77.

Proceedings ArticleDOI
12 Jul 1983
TL;DR: The biostereometric analyzed contour mammograms have the potential to be developed into a process for breast cancer screening and suggested areas for further study include volume differences in individual breasts as well as the volume Differences in individual breast slices and their relationship to breast pathology.
Abstract: This study reports on 29 patients (58 breasts), selected in a stratified manner to include 7 cancers, 13 benign tumors and 38 apparently normal breasts, that were subjected to biostereometric analysis. This process consisted of analysis in a blind setting of contour mammograms made from stereophotographs of the breast which resulted in the correct identification of all 7 cancers, 11 of the 13 benign tumors and 30 of the remaining 38 normal breasts. There were 8 false positives identified. This study, in conjunction with a previous study, indicates that the biostereometric analyzed contour mammograms have the potential to be developed into a process for breast cancer screening. Suggested areas for further study include volume differences in individual breasts as well as the volume differences in individual breast slices and their relationship to breast pathology.© (1983) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Journal Article
TL;DR: It was found that the ultrasound breast examination combined with X-ray mammography optimizes the differentiation benign and malignant masses and therefore may reduce the incidence of breast biopsy.

Journal ArticleDOI
TL;DR: A blind interpretation of radiographs of patients who underwent screening during the Oklahoma Breast Cancer Detection Demonstration Project (BCDDP) are evaluated to yield a more realistic accuracy estimate of mammography on a rescreened population than is currently available.
Abstract: 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 s...