乳腺X线摄影检出的恶性微钙化在MR上的影像表现

目的:探讨乳腺X线摄影检出的恶性微钙化病变在MR上的影像表现。方法:回顾性分析乳腺X线摄影上表现为微钙化且手术病理证实为乳腺癌的80例患者资料,均行乳腺MR检查及X线引导下金属丝定位。分析其X线、MR表现及两者的关系。统计学采用卡方检验或Fisher's 精确检验。结果:共83个病灶,导管内癌45个,浸润性癌38个。X线表现:67个为单纯钙化,16个钙化伴局部密度增高;细小多形性（49个）及簇状分布（35个）是最常见的钙化形态及分布方式。MR表现:非肿块样强化57个,肿块样强化16个,未见异常强化10个。92.9%（26/28）的段样分布钙化MR上表现为段样分布强化。段样分布钙化灶在MR上以段样分布强化更常见（P=0.000）。81.3%（13/16）的肿块样强化见于簇状分布钙化。肿块样强化更多见于簇状分布的钙化灶（P=0.000）。MR上假阴性钙化灶多见于簇状分布钙化灶,但没有显著差异（P=0.061）。结论:恶性微钙化在MR上的强化类型以非肿块样强化常见,少部分表现为肿块样强化。其强化表现与钙化在X线上的分布方式有关。     

Three-dimensional mr imaging of mammographically detected suspicious microcalcifications

BACKGROUND: The purpose of this study was to evaluate the diagnostic value and clinical significance of three-dimensional MR imaging of the breast in patients with mammographically detected suspicious microcalcifications. METHODS: Forty patients with suspicious microcalcifications on mammography were evaluated with three-dimensional MR imaging. MR findings were grouped mainly by distribution of abnormal enhancement (linear, focal-clumped, segmental-clumped, segmental-stippled and diffuse-stippled). These findings were compared with the mammography findings according to the criteria of the Breast Imaging Reporting and Data System (BI-RADS) and histopathologic data. RESULTS: Twenty patients had proven malignancies, most frequently ductal carcinoma in situ. For all the cases, linear (100%) and segmental-clumped type (100%) enhancement on MR imaging showed a significantly higher risk for malignancy. Diffuse stippled type (7%) and no enhancement (0%) on MR imaging indicated the lowest possibility of malignancy. 3D-MR imaging showed a sensitivity of 90%, a specificity of 95% and an overall accuracy of 93% in this study. CONCLUSIONS: Three-dimensional MR imaging of the breast can more accurately diagnose ductal carcinoma in situ. Combined with mammography, this procedure is useful for reducing the number of false-positive biopsies and helpful for deciding the better management of patients with mammographically detected suspicious microcalcifications.     

Improved accuracy in differentiating malignant from benign mammographic abnormalities: a simple, improved magnetic resonance imaging method

BACKGROUND: Although several refinements have been reported for breast magnetic resonance imaging (MRI), there has been no uniform agreement by researchers on the optimal method. The authors report a simple and effective MRI method that incorporated the best qualities of other breast MRI methods yet eliminated the complexity of dynamic sequences and computer subtraction. This new method used fat-suppression, a 3D technique, a dedicated breast coil, and quantitation of lesion enhancement. METHODS: Sixty-one mammographically suspicious lesions were evaluated with a fat-suppressed T1-weighted 3D FLASH sequence before and after administration of Gd-DTPA. Abnormalities were evaluated primarily by the degree of lesional enhancement; lesional morphology was assessed as a secondary criterion. For small or multiple lesions, the authors reformatted images to produce MRI findings that corresponded to the mammographic abnormality. To allow accurate pathologic correlation, all subjects underwent stereotactic or excisional biopsy of the suspicious lesions. RESULTS: Using this new method, all 15 breast carcinomas were enhanced with a signal intensity (SI) increase of > or = 180% (mean = 337%). No benign lesions enhanced at a SI of > 180%. The difference in degree of enhancement between malignant and benign lesions was statistically significant (P < 0.05). There were overlapping degrees of postcontrast enhancement among fibroadenomas (n = 13; mean SI = 70%) and atypical hyperplasias (n =; 11; mean SI = 82%), but morphologic characteristics allowed for discrimination between these two entities. In the remaining benign breast disease lesions, there was minimal enhancement. CONCLUSIONS: 3D fat-suppressed sequencing using this new MRI method accurately discriminated between benign and malignant mammographic abnormalities and eliminated the time-intensive and complex MRI methods without sacrificing accuracy.     

Prediction of Residual Malignancy After Excisional Biopsy for Breast Cancer With Suspicious Microcalcifications: Comparison of Mammography and Magnetic Resonance Imaging

BackgroundWhether surgery should be performed after excisional biopsy based on mammography or magnetic resonance imaging (MRI) findings has not been evaluated for breast cancer with suspicious microcalcifications on mammography. This study investigated the ability of mammography and MRI to predict residual malignancy after excisional biopsy for suspicious microcalcifications and whether background parenchymal enhancement (BPE) influences the diagnostic performance of MRI.Patients and MethodsFifty-one patients with breast cancer who underwent excisional biopsy for suspicious microcalcifications between January 2009 and February 2019 were enrolled in this single-center retrospective study. Two expert readers independently evaluated the ability of mammography and MRI to predict residual malignancy at the surgical site. The diagnostic value of mammography and MRI was evaluated using histopathology as the standard.ResultsThirty-two patients had residual malignancy. The average overall sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and area under the curve for residual malignancy were 78.1%, 42.1%, 69.4%, 42.1%, 62.7%, and 0.601 for mammography and 81.2%, 57.8%, 76.4%, 57.8%, 73.5%, and 0.696 for MRI; the respective values for residual malignancy were 88.8%, 57.1%, 72.7%, 57.4%, 76.5%, and 0.73 in the low BPE group and 71.4%, 60%, 83.3%, 57.4%, 65.7%, and 0.657 in the high BPE group.ConclusionsMRI is more accurate than mammography for prediction of residual malignancy after excisional biopsy for breast cancer with suspicious microcalcifications. However, the BPE of MRI influences diagnostic performance, so careful assessment is needed in patients with moderate or marked BPE.     

乳腺X线摄影术及DCE-MRI对非肿块型乳腺钙化病变的诊断价值研究

目的:探讨非肿块型乳腺钙化病变在动态增强MR（dynamic contrast enhanced MR images,DCE-MRI）图像上的表现及DCE-MRI联合乳腺X线摄影术（mammography,MG）对该类病变的诊断价值。方法:回顾性分析102例非肿块型单纯钙化的乳腺病变在MG及MRI上的影像学特征,并以病理结果为金标准,比较MG及DCE-MRI的诊断结果差异。结果:102例病变中,良性病变43例,恶性病变59例。良恶性病变的钙化形态及分布之间的差异具有统计学意义(P<0.001)。良性病变以单发点状钙化为主（13/43,30.23%）,恶性病变则以成簇分布的点状钙化为主（22/59,37.29%）。DCE-MRI图像上,可疑良性钙化病变多表现为无强化,可疑恶性钙化病变以非肿块样强化多见,TIC曲线以平台型为主（P<0.001）。DCE-MRI检查对非肿块型乳腺钙化病变的诊断准确率高于MG,并且差异具有统计学意义(P<0.001）。另外,DCE-MRI检查的灵敏度明显优于MG（P=0.012）且具有较高特异度（P=0.5）。与单用MG检查相比,MG与DCE-MRI检查相结合可显著提高灵敏度（P=0.001）。结论:不同钙化形态及分布的病变在MRI上的表现不同。对于MG检出的非肿块型乳腺钙化病变,结合DCE-MRI能够显著提高临床诊断的效能。     

The use of colour-coded and spectral Doppler ultrasound in the differentiation of benign and malignant breast lesions.

The aim of this study was to evaluate the role of colour-coded and spectral Doppler sonography to predict the benign or malignant nature of breast lesions. A total of 112 women with mammographically suspicious breast lesions were investigated prior to surgery. Thirty-nine breast carcinomas and 73 benign lesions were evaluated for the resistance index, pulsatility index and the flow velocity. A resistance index of > or = 0.70 was characteristic of malignant tumours with a sensitivity of 82% and a specificity of 81%. The positive predictive value was 70% and the negative predictive value 89%. Doppler sonography offers one possible method for further investigation of patients with mammographic abnormalities.     

Stereotactic vacuum-assisted breast biopsy in 2874 patients: a multicenter study

BACKGROUND: Vacuum-assisted breast biopsy (VAB) can replace surgical biopsy for the diagnosis of breast carcinoma. The authors evaluated the accuracy and clinical utility of VAB in a multicenter setting using a strict quality assurance protocol. METHODS: In the current study, VABs were performed successfully for 2874 patients at 5 sites. Benign lesions were verified by follow-up. Surgery was recommended for malignant and borderline lesions. VAB was performed on patients with lesions rated as highly suspicious (6%), intermediate to suspicious (85%), or probably benign (9%). Fifty-eight percent of the lesions were < 10 mm and 70% had microcalcifications. RESULTS: The authors identified 7% of patients with invasive carcinomas, 15% with ductal carcinomas in situ (DCIS), 5% with atypical ductal hyperplasias (ADH), and 0.6% with lobular carcinomas in situ. The results of the VAB necessitated an upgrade of 24% of patients with ADH to DCIS or DCIS and invasive carcinoma. Twelve percent of patients with DCIS proved to have invasive carcinoma. Seventy-three percent of the patients had benign lesions. Only 1 false-negative result was encountered (negative predictive value, 99.95%). Minor side effects were reported to occur in 1.4% of patients and 0.1% of patients required a subsequent intervention. Scarring relevant for mammography was rare among patients (i.e., 0.3% of patients had relevant scarring). CONCLUSIONS: Quality-assured VAB was found to be highly reliable. VAB effectively identified patients with benign lesions and assisted therapeutic decisions. Most important, only a single case of malignancy was missed. A close interdisciplinary approach assured optimal results.     

Evaluation of breast cancer with a computer-aided detection system by mammographic appearance and histopathology

BACKGROUND: The objective of this study was to evaluate the performance of a computer-aided detection (CAD) system for the detection of breast cancer, based on mammographic appearance and histopathology. METHODS: From 1000 consecutive screening mammograms from women with biopsy-proven breast carcinoma, 273 mammograms were selected randomly for retrospective evaluation by CAD. The sensitivity of the CAD system for breast cancer was assessed from the proportion of masses and microcalcifications detected. The corresponding tumor histopathologies also were evaluated. Normal mammograms (n = 155 patients) were used to determine the false-positive rate of the system. RESULTS: Of the 273 breast carcinomas, 149 appeared mammographically as masses, and 88 appeared as microcalcifications, including 36 carcinomas that presented as mixed lesions. The CAD system marked 125 of 149 masses correctly (84%), marked 86 of 88 microcalcifications correctly (98%), and marked 32 of 36 of mixed lesions correctly (89%.). The system showed a high sensitivity for the detection of ductal carcinoma in situ (95%; 73 of 77 lesions), invasive lobular carcinoma (95%; 18 of 19 lesions), invasive ductal carcinoma (85%; 125 of 147 lesions), and invasive mammary carcinoma (90%; 27 of 30 lesions). The highest CAD system sensitivity was for all invasive carcinomas that presented as microcalcifications (100%). On normal mammograms, there was an average of 1.3 false-positive CAD marks per image. CONCLUSIONS: The CAD system correctly marked a large majority of biopsy-proven breast cancers, with a greater sensitivity for lesions with microcalcifications and without significant impact of performance based on tumor histopathology. CAD was highly effective in detecting invasive lobular carcinoma (sensitivity, 95%) and ductal carcinoma in situ (sensitivity, 95%). CAD represents a useful tool for the detection of breast cancer.     

Outcome after treatment of patients with mammographically occult, magnetic resonance imaging-detected breast cancer presenting with axillary lymphadenopathy

Although magnetic resonance imaging (MRI) for patients with mammographically occult breast cancer with axillary lymphadenopathy has been accepted for staging, treatment outcome data in this patient group is lacking. In this study, 16 patients, median age of 45 years (range, 27-66 years), presented with malignant axillary lymphadenopathy, negative mammograms, negative breast physical examination, and abnormal breast MRI. All 16 patients were found to have >/= 1 suspicious lesions on breast MRI. Ten patients had a solitary enhancing lesion; 1 patient had 2 enhancing lesions; 3 patients had 3 enhancing lesions; 1 patient had a mass lesion and diffuse patchy enhancement in the breast; and 1 patient had regional enhancement but no discrete lesion on MRI. Six patients underwent breast-conservation surgery using MRI-guided wire localization and 10 patients had modified radical mastectomy. Fourteen patients received adjuvant chemotherapy and the remaining 2 patients received neoadjuvant chemotherapy. With a median follow-up of 5 years (range, 1.2-7.6 years), the 5-year actuarial local control was 100%, relapse-free survival was 74%, and overall survival was 87%. Three patients developed distant metastases. Two patients died from distant metastases, and 1 patient is alive with metastatic disease. One patient had a relapse in the contralateral axilla and was treated with paclitaxel and is disease free. Although the patient population is small, the outcome after treatment for this group of patients with a mammographically occult, MRI-detected breast cancer presenting with axillary adenopathy is similar to the expected outcome for patients with breast cancer with positive axillary lymph nodes.     

A prospective comparison of stereotaxic fine-needle aspiration versus stereotaxic core needle biopsy for the diagnosis of mammographic abnormalities

BACKGROUND: Confidence in a negative stereotaxic breast biopsy result allows for safe clinical and mammographic follow-up, whereas a positive or equivocal diagnosis leads to excision. Direct comparison of stereotaxic core needle biopsy (SCBX) and fine-needle aspiration (SFNA) is needed, and should be based on the use of appropriate current methods of practice, and address the indication of each for different types of mammographic lesions. METHODS: The diagnostic accuracy of SFNA, SCBX, and combined SFNA with SCBX performed at a community radiology practice were assessed for different mammographic lesions and levels of radiologic suspicion. Negative predictive values (NPVs) measured the confidence that a negative diagnosis (failure to identify atypia or malignancy) was benign and therefore suitable for follow-up. A benign outcome was accepted only after surgical excision or > or =24 months' follow-up of the lesion. Positive predictive values (PPVs) [final diagnoses at least atypical (A) or carcinoma (CA)] also were calculated. RESULTS: SFNA was performed for 495 lesions and was combined with SCBX for 252 of these. Nondiagnostic (SFNA, 2%; SCBX, 8%) and atypical (SFNA, 7%; SCBX, 3%) rates were low. The authors obtained 94% follow-up (81% > or = 24 months). NPVs were all SFNAs, 99%; SCBXs, 95% (corresponding SFNAs, 98%); and SFNA with SCBX, 99%. NPVs were 100% for masses, ill-defined densities, and architectural distortions. NPVs for microcalcifications (for low, moderate, and high suspicion) were all SFNAs, 97% (100, 95, and 75); SCBXs, 93% (94, 93, and 67), corresponding SFNAs, 96% (100, 94, 75); and SFNA with SCBX, 98% (100, 97, 75). All false-negative lesions were microcalcifications. Calcium was recognized in 98% of SFNA specimens and in 89% of SCBX specimens from microcalcifications. No calcium was identified in the histologic sections in 63% (5 of 8) SCBX false-negative specimens. PPVs(A) were atypical (SFNA, 46%; SCBX, 88%) and suspicious (SFNA, 93%). PPVs(CA) were SFNA carcinoma, 100%; SCBX in situ, 89%; and SCBX invasive, 100%. CONCLUSIONS: SFNA identified benign lesions more reliably for follow-up, particularly microcalcifications. Based on these results, the authors suggest 1) added SCBX if on-site SFNA assessment is nondiagnostic, atypical, or positive (and needs preoperative confirmation of invasion); 2) either SCBX or SFNA for masses, architectural distortions, and ill-defined densities; 3) SFNA for microcalcifications, with SCBX added for moderately and highly suspicious lesions; and 4) surgical excision for all highly suspicious microcalcifications.     

Upright stereotactic vacuum-assisted needle biopsy of suspicious breast microcalcifications

Stereotactic core needle biopsy is a useful technique for evaluation of suspicious breast microcalcifications. The development of the 11-G vacuum-assisted biopsy system offers another method of minimally invasive biopsy carried out on a conventional mammography unit. We evaluate its usefulness, efficacy and safety in Asian women. Vacuum-assisted biopsy was carried out through the lateral approach using an add-on stereotactic device attached to a mammography unit. One hundred and five lesions were sampled in 97 patients. Excisional biopsy was subsequently Carried out for diagnosis of atypical ductal hyperplasia or carcinoma in high-risk patients. Patients with benign diagnosis underwent mammographic follow up. The technical success rate was 97%. An average of 13.5 tissue cores were retrieved for each lesion. The histopathological result obtained from mammotome was benign in 84.8% and malignant in 15.2%. The benign microcalcifications were predominantly fibrocystic change (n = 42) whereas the malignant microcalcifications included ductal carcinoma in situ (n = 15) and invasive carcinoma (n = 1). Twenty-two patients underwent subsequent open surgical biopsy but no underestimation of disease was seen. Only two patients had vasovagal syncope and three others felt unwell during the biopsy. Nine patients had small haematomas, which resolved spontaneously. Vacuum-assisted biopsy carried out on an upright stereotactic mammography unit is a safe and effective method for evaluation of suspicious microcalcifications.     

Isolated breast metastases from gastrointestinal carcinomas: report of two cases

Two patients with metastatic gastrointestinal adenocarcinoma in the breast are reported. Metastases in the breast are usually painless upper outer quadrant masses. On mammography they are typically well-circumscribed lesions without microcalcifications. A breast mass in a patient with a history of cancer, even if clinically or mammographically benign, should raise suspicion of a metastasis. Pathological features include a histologic pattern similar to the primary neoplasm and an absence of in situ carcinoma which characterizes primary breast cancer. Surgical excision for local control and systematic therapy is the most appropriate treatment.     

Angiogenesis and dynamic MR imaging gadolinium enhancement of malignant and benign breast lesions

Purpose. To determine whether dynamic magnetic resonance (MR) imagingenhancement parameters are associated with vessel density of malignant andbenign breast lesions. Materials and methods. Forty-five patients with 48breast lesions underwent gadolinium-enhanced spoiled gradient-recalled echo(SPGR) MR imaging followed by excisional biopsy and Factor VIII staining andvessel density measurement in the lesions. Results. The vessel densitieswere not significantly different in 25 malignant breast lesions as comparedto 23 benign breast lesions. Among all 48 lesions, greater MR enhancementshowed an association with increased vessel density. Seventy-four percent ofall lesions with MRI enhancement amplitude greater or equal to three timespost-precontrast ratio had vessel densities greater than the median of 172as compared to 34% of lesions with enhancement amplitude less thanthree times, p = 0.02. The rate and washout of MR enhancement showedno significant association with vessel density. Conclusion. Although thereis an overall significant association between greater MRI enhancementamplitude and vessel density, MRI gadolinium enhancement of breast lesionsis not an accurate predictor of vessel density.     

Ultrasound demonstration of mammographically detected microcalcifications in patients with ductal carcinoma<Emphasis Type="Italic">in situ</Emphasis> of the breast

BACKGROUND: Breast microcalcifications are difficult to depict by ultrasound (US). However, recent advances in US equipment and the refinement of breast imaging techniques have improved the detection and characterization of small breast lesions. The present study attempts to determine whether US examination is able to demonstrate nonpalpable breast lesions associated with mammographically detected microcalcifications without mass density or distortion, and to evaluate the clinical reliability of US-guided procedures, especially in cases of ductal carcinoma in situ(DCIS)of the breast. METHODS: The subjects consisted of 73 patients with breast cancer diagnosed preoperatively as DCIS by stereotactic core needle biopsies, all of whom had microcalcifications without other abnormalities on mammography. The radiological appearance and size of the clustered microcalcifications were evaluated. US examinations were performed preoperatively, and the detection rates were assessed. Sonographically detected lesions underwent US-guided wire localization followed by surgical excision. RESULTS: The lesions associated with microcalcifications were identified sonographically in 54 of 73 cases (74%), and the pathological examination revealed breast cancer in all of the corresponding specimens. Lesions with linear-branching shape, segmental-linear distribution and category-5 calcifications on mammography had a high level of visibility on US. The US visible cases had a larger size of calcified area on mammography when compared with US invisible cases. Pathologically, the lesions were more frequently seen on US in cases with minimally invasive cancer or with comedo type DCIS. CONCLUSIONS: US examination is an effective method for identifying and localizing breast microcalcifications, and can be used as an alternative to stereotactic localization in selected patients with early breast cancer.     

Breast biopsy for mammographically detected non-palpable lesions using a vacuum-assisted biopsy device (Mammotome) and an upright-type stereotactic mammography unit.

BACKGROUND: It is planned to start screening mammography throughout Japan in the near future. However, a minimally invasive biopsy procedure for mammographically detected non-palpable breast lesions is not available in almost all Japanese hospitals. It is crucial to develop a useful minimally invasive biopsy method which can be applied without difficulty. METHODS: Eighty-nine biopsies for 88 mammographically detected non-palpable breast lesions, consisting of 70 lesions with microcalcifications alone, eight masses without calcifications and 10 with both masses and microcalcifications, were performed using the combination of a vacuum-assisted biopsy device (Mammotome) and an upright-type stereotactic mammography unit. RESULTS: Microcalcifications were confirmed radiographically in the tissue obtained from 78 biopsies among 81 biopsies for the lesions with microcalcifications (96.3%). All the lesions without calcifications were considered to be biopsied successfully. Five patients complained of nausea or fainted during the localization or biopsy procedure and an additional patient suffered from hyperventilation syndrome. Five cases experienced mild subcutaneous bleeding in the breasts. CONCLUSIONS: The biopsy technique using the combination of a vacuum-assisted biopsy device and an upright-type stereotactic mammography unit is a cost-effective, safe and very useful method for mammographically detected non-palpable breast lesions. It is expected to be a standard method of biopsy for such lesions in many developed countries other than the USA. However, it is important to make the patients relaxed during the biopsy to prevent mental strain.     

MRI对乳腺含粘液良、恶性肿瘤的鉴别诊断价值

目的:探讨磁共振成像对乳腺含黏液良、恶性肿瘤鉴别诊断价值。方法:回顾性分析2018年12月至2021年02月经我院病理证实的乳腺含黏液肿瘤25例共26个病灶的术前MRI图像及临床病理资料,依据病理分为良性组及恶性组,比较良、恶性组的临床及MRI表现差异性。结果:25例患者共26个病灶纳入研究,良性肿瘤10例共10个病灶,恶性肿瘤15例共16个病灶。恶性组发病年龄高于良性组（P＜0.01）;病变的边缘多不规则,与良性组比较差异具有统计学意义（P＜0.01）;而两组间肿块大小、形态、动态增强曲线类型及ADC值无统计学差异（P＞0.05）。恶性组出现由周围向中央填充式渐进性强化,而良性组未出现,差异具有统计学意义（P＜0.01）。恶性组T2WI上的低信号分隔纤细并在增强后图像显示不清（31.25%,5/16）,良性组T2WI上的低信号分隔增强后显示清晰（30.00%,3/10）,差异具有统计学意义（P＜0.05）。结论:乳腺含黏液的恶性肿瘤患者发病年龄较良性肿瘤大,边缘多不规则,以不均匀强化为主,出现由周围向中央填充渐进性强化方式,T2WI序列的低信号分隔于增强后显示不清为较特征性表现。     

Computer aided diagnosis of breast cancer on mammograms

Computer-aided diagnosis (CAD) is a diagnosis made by a physician who takes into account the computer output of quantitative analysis of mammograms. CAD schemes in mammography have been developed to detect lesions such as clustered microcalcifications and masses, and also to distinguish between benign and malignant lesions. Computerized schemes are composed of three major steps which are image processing, quantitation of image features, and data classification. The current performance level of detecting clustered microcalcifications by computer is approximately 85% at a false positive rate of 0.5 per mammogram, whereas the detection accuracy of masses is approximately 90% at a false positive rate of 2 per mammogram. Observer performance studies indicated that computer output can improve the performance of radiologists in detecting clustered microcalcifications by increasing the dtection accuracy to 90% from 80% at a specificity of 90%. The automated classification of clustered microcalcifications is based on quantitative analysis of image features of individual microcalcifications and cluster, followed by artificial neural networks (ANNs) for data classification. With our database, the computer scheme correctly identified 82% of patients with benign lesions, all of whom had biopsies (ie, the radiologist thought the microcalcifications were suspicious for malignancy), and 100% of patients with malignant lesions. On the same set of images, the average of five radiologists was only 27% correct in classifying lesions as benign at 100% sensitivity. The automated classification of masses is made by the quantitation of image features of masses together with a rule-based and ANNs method for data classification. The computer scheme achieved, at 100% sensitivity, a positive predictive value of 83%, which was 12% higher than that of the experienced mammographer and 21% higher than that of the average of less experienced mammographers. The first prototype intelligent workstation for mammography was developed at the University of Chicago, and applied to approximately 12000 screening cases for the detection of early breast cancers. Promising initial results were obtained with the workstation.     

The value of postlumpectomy mammogram in the management of breast cancer patients presenting with suspiciouis microcalcifications

PURPOSE: It is recommended that patients with breast cancer who present with mammographically detected microcalcification should undergo postlumpectomy mammogram with magnification views to ensure adequate removal of all clinically demonstrable disease. The value of postlumpectomy mammogram has not been adequately examined in the literature. This report aims to quantify the value of such a study. MATERIALS AND METHODS: Retrospective review identified 90 breast cancer patients referred to our department between 1992 and 1997 who met all of the following criteria: (1) patients were considered for breast conserving management; (2) patients had suspicious microcalcifications on diagnostic mammograms; (3) the mammographic lesions were thought to be removed entirely on postexcision specimen radiographs; (4) surgical excisions were thought to be adequate on the basis of a review of the histologic pathology reports; and (5) postlumpectomy mammograms with magnification views were obtained. Fifty patients had invasive adenocarcinoma and 40 patients had ductal carcinoma in situ. The margins of last resection were clear, close, or focally involved in 70, 13, and seven patients, respectively. Patient records were reviewed to determine whether postlumpectomy mammograms demonstrated residual microcalcifications. RESULTS: Sixteen patients (17%) were found to have residual microcalcifications on postlumpectomy mammograms. Twelve patients underwent either local re-excision (seven patients) or simple mastectomy (five patients). Re-excision was not performed in four patients. Residual malignant cells were found in eight patients (67% of the re-excision group and 9% of the whole group). Six of these patients had their tumors initially resected with clear margins and the remaining two patients had their tumors initially resected with close margins. CONCLUSIONS: Postlumpectomy mammograms with magnification views detected residual clinical disease in a significant proportion of patients. Our result supports the routine use of this test, even when satisfactory postexcision specimen radiographs and adequate lumpectomy resection margins are obtained. This finding is particularly true for patients with ductal carcinoma in situ.     

Core imprint cytology of screen-detected breast lesions is predictive of the histologic results

BACKGROUND: In multidisciplinary assessment clinics for screen-detected breast lesions, onsite cytopathologists provide immediate results of fine-needle aspiration biopsies (FNABs) and this information is used for patient counseling and treatment planning. Such consultation is not possible for the increasing proportion of lesions that are being assessed by core biopsy. If core imprint cytology (CIC) of breast cores can be shown to be reliable in a significant proportion of screen-detected lesions, this technique may be of clinical value in such clinics. METHODS: In the setting of a large, accredited, population-based breast cancer screening program, prospective results of CIC were gathered on 567 lesions and correlated with the results of core biopsy to determine the performance indicators for CIC. RESULTS: The positive predictive value of a diagnosis of malignancy on CIC was 98.2% and the negative predictive value was 77.8%. The absolute sensitivity was 42.2%, complete sensitivity (inclusive of suspicious and atypical results) was 86.4%, absolute specificity was 56.3%, and total specificity (inclusive of acellular imprints) was 83.7%. The 2 false-positive imprints had atypical ductal hyperplasia on core histology but were found to be ductal carcinoma in situ (DCIS) on excision. False-negative imprints are a greater challenge, with 13.6% of malignant lesions producing benign-appearing or acellular imprints. Low-grade DCIS, lobular, and special type cancers account for most such lesions. The results of the current study also demonstrated significant variations in the accuracy of CIC in microcalcifications versus parenchymal lesions. In particular, the results of acellular imprints are analogous to benign CIC findings for microcalcifications but not in parenchymal lesions. CONCLUSIONS: The current study may be the largest prospective series on CIC to date, and the only direct comparison of its results for microcalcifications versus parenchymal lesions. Breast CIC is a reliable predictor of core histology. The information this study provides can be used to clinical advantage.