Negative predictive value of sonography with mammography in patients with palpable breast lesions

OBJECTIVE: This study was performed to determine the negative predictive value of sonography with mammography in evaluating palpable breast lesions. MATERIALS AND METHODS: Four hundred twenty patients with 455 palpable breast lesions were retrospectively identified from our mammography database as having negative mammographic and sonographic results. For patients diagnosed with breast cancer, images and medical records were reviewed to determine whether the palpable lesion evaluated on sonography and mammography corresponded to the patient's breast cancer. On the basis of the number of breast cancers that correlated to the palpable areas imaged, the negative predictive value of sonography with mammography was determined. RESULTS: Sixty-two of the 420 patients in the study group were already diagnosed with breast carcinoma, and eight new carcinomas were diagnosed during the study period. Only one of six ipsilateral cancers corresponded to a palpable lesion that had a negative imaging evaluation. This lesion was diagnosed as an invasive lobular cancer, hard and fixed at physical examination. Imaging and clinical follow-up of the remaining patients showed no abnormality at the sites of previously investigated palpable abnormalities. The mean imaging follow-up was 25 months. The negative predictive value of sonography and mammography in the setting of a palpable lesion was 99.8%. CONCLUSION: The negative predictive value of sonography with mammography is high, and together these imaging modalities can be reassuring if follow-up is planned when the physical examination is not highly suspicious. However, if the physical examination is suspicious, biopsy should not be delayed.     

Usefulness of mammography and sonography in women less than 35 years of age

Indications, clinical history, mammographic findings, and clinical outcome were reviewed in 1,016 women younger than 35 years who underwent mammography during an 8-year period. The indications for mammography were a palpable mass in 454 (44.7%), findings at routine screening in 237 (23.3%), lumpiness in 29 (14.9%), unilateral nipple discharge in seven (3.5%), localized breast tenderness in six (5.1%), adenopathy in three (1.9%), diffuse tenderness in two (2.9%), bilateral nipple discharge in two (1.5%), and miscellaneous in four (2.2%). In 405 women (39.9%), at least two-thirds of the breast tissue was radiodense; however, in 299 (29.4%) women the breast was predominantly fatty, allowing for excellent mammograms. Six women had carcinomas: Mammographic findings prompted biopsy in one patient, indicated a benign-appearing mass (found to be solid at sonography or aspiration) in three patients with a palpable mass (contributing to delay in biopsy in two), and were negative in two. Sonography was performed in 389 women and was useful in preventing unnecessary biopsy of cysts but was not useful in differentiating benign from malignant solid masses. Younger women with persistent localized breast symptoms should undergo a tailored mammographic examination, but negative findings or findings of a benign lesion should not preclude biopsy of a palpable solid mass.     

The Role of Sonography in Patients with Breast Cancer Presenting as an Axillary Mass

Objective

To compare sonography and mammography in terms of their diagnostic value in breast cancer cases which initially presented as an axillary mass without a palpable mass or other clinical symptoms.

Materials and Methods

Seven patients with enlarged axillary lymph nodes who first presented with no evidence of palpable breast lesions and who underwent both mammography and sonography were enrolled in this study. In six of the seven, the presence of metastatic adenocarcinoma was confirmed preoperatively by axillary needle aspiration biopsy; in four, subsequent sonographically-guided breast core biopsy performed after careful examination of the primary site indicated that primary breast cancer was present. In each case, the radiologic findings were evaluated by both breast sonography and mammography.

Results

Breast lesions were detected mammographically in four of seven cases (57%); in three of the four, the lesion presented as a mass, and in one as microcalcification. In three of these four detected cases, fatty or scattered fibroglandular breast parenchyma was present; in one, the parenchyma was dense. In the three cases in which lesions were not detected, mammography revealed the presence of heterogeneously dense parenchyma. Breast sonography showed that lesions were present in six of seven cases (86%); in the remaining patient, malignant microcalcification was detected at mammography. Final pathologic examination indicated that all breast lesions except one, which was a ductal carcinoma in situ, with microinvasion, were infiltrating ductal carcinomas whose size ranged from microscopic to greater than 3 cm. At the time of this study, all seven patients were alive and well, having been disease free for up to 61 months after surgery.

Conclusion

In women with a palpable axillary mass confirmed as metastatic adenocarcinoma, breast sonography may be a valuable adjunct to mammography.     

Mammography in women with axillary lymphadenopathy and normal breasts on physical examination: value in detecting occult breast carcinoma.

OBJECTIVE. The purpose of this study was to determine the value of mammography in detecting occult carcinoma in patients with axillary adenopathy and normal breasts on physical examination. MATERIALS AND METHODS. We analyzed the results of mammography performed in 17 patients; all women had palpable axillary lymphadenopathy of unknown origin and all had normal breasts on physical examination. RESULTS. In 10 of the 17 patients, mammographic findings were abnormal. The mammographic finding of axillary adenopathy in seven patients was inconsequential because the nodes were evident on physical examination. Three patients had abnormal mammographic findings that were potentially significant, including one with a poorly defined mass suggestive of breast carcinoma, one with a subcutaneous nodule, and one with parenchymal breast edema. Two of 17 patients had an occult breast cancer. In only one of the patients was the cancer detected on mammography. The other patient had undergone prior left mastectomy and was thought to have metastases to the right axilla from the contralateral breast. Mammographic findings in this latter patient were normal. CONCLUSION. While occult breast carcinoma was relatively common in our series (two of 17 patients), the ability to detect the tumor with mammography was disappointing (one of two patients). This may be explained by the fact that one postmastectomy patient with occult carcinoma had metastatic disease to the contralateral axilla and a normal remaining breast, which was pathologically confirmed at mastectomy. Our experience suggests that mammography is valuable in patients with normal breasts on physical examination who have primary carcinoma involving ipsilateral axillary lymph nodes. The procedure should be included in the diagnostic evaluation of patients with axillary adenopathy in order to detect the unusual case of occult breast carcinoma.     

Benign breast lesions: ultrasound detection and diagnosis

Experience with 2500 patients over age 30 studied by physical examination, x-ray mammography, and sonography enabled definition of several specific clinical situations in which sonography adds meaningful diagnostic information not provided by either of the other examinations. These include: palpable breast masses for cyst-solid differentiation; nonpalpable mammographic masses for cyst-solid differentiation; and women with a symptomatic area in the breast that shows only uniformly dense fibro-glandular tissue on x-ray mammograms. For women with radiographically dense breasts who have no breast symptoms, abnormal physical findings, or mammographic lesions, sonography will identify many benign cysts and also some benign solid lesions, but at best only rarely (none of the 587 cases in this study) will it detect an otherwise occult breast cancer. Our data suggest that sonography should not be a substitute for physical examination and mammography in women over age 30, but rather that in three specific clinical situations it can be a valuable addition to the standard diagnostic evaluation.     

Differentiation of benign and malignant local tumor recurrence after lumpectomy

During a 5-year period, 28 women who had been treated conservatively for breast carcinoma had 29 reexcisions of the lumpectomy site because of suspicion of a recurrent malignant tumor. Biopsy results were benign in 19 cases and malignant in 10 cases. Sixteen of the 19 benign tumors had developed within 2 years after therapy. In 16 benign cases, a palpable lump developed at the scar and was found on biopsy to be fat necrosis or fibrosis. Seven of these cases had normal mammographic findings. Three women with abnormal mammographic findings but a normal breast examination had punctate microcalcifications develop at the scar; these were due to fibrosis in two and sclerosing adenosis in the other. Of the 10 malignant recurrent tumors, seven were palpable, four of which also were identifiable by mammography. Of seven mammographically identifiable recurrent tumors at the surgical site, four were palpable. Mammographic findings were a single mass in two cases, multiple masses in one, microcalcification in three, and a mass with microcalcifications in one. Malignant microcalcifications were all linear, irregular, and in one case branching. Mean time to recurrence in these 10 women was 3 years. This experience suggests that benign disease usually occurs at the scar within 2 years after the original therapy and when palpable may not show changes on mammography. When microcalcifications do occur, they are usually punctate.     

Clinical Indications for Mammography in Men and Correlation With Breast Cancer

PurposeThe purpose of this study is to examine the correlation between presenting clinical symptoms and imaging findings in men with breast cancer.Method and MaterialsFour hundred twenty-nine male patients who presented for mammography at one institution between January 2004 and December 2014 were retrospectively evaluated. Of the 429 patients, 291 presented with clinical symptoms for diagnostic mammography. The presenting clinical symptoms in 291 patients were recorded and correlated with imaging and histopathologic findings.ResultsTwo hundred ninety-one male patients were included. Some presented with multiple symptoms, for a total of 318 clinical symptoms. One hundred and ninety (65%) men presented with palpable abnormalities, 44 (15%) with nonfocal pain, 31 (11%) with breast swelling, 14 (5%) with breast enlargement, 13 (4%) with focal pain, 7 (2%) with skin changes, 6 (2%) with nipple discharge/changes and 13 (4%) with other symptoms (itching, throbbing and breast heaviness). A total of 290 patients underwent mammography and 176 underwent sonography. Forty-one malignancies were diagnosed, of which 24 (59%) were invasive ductal carcinoma. Nipple changes/discharge had a 100% positive predictive value for malignancy while breast pain showed a 0% positive predictive value. Fifty-two patients showed either a mass or a focal asymmetry on mammography, of which 38 (73%) were malignant. Three patients (1%) without a mass or focal asymmetry were diagnosed with malignancy.ConclusionCorrelating clinical symptoms and imaging findings can help with timely and accurate diagnosis of breast cancer in men. Nipple discharge/changes and skin changes with palpable abnormalities and mammographic findings of masses and focal asymmetries were associated with breast cancer. Pain, breast enlargement, and breast swelling were unlikely to be associated with malignancy     

Tubular carcinoma of the breast: mammographic, sonographic, clinical and pathologic findings

PURPOSE: To determine and quantitate the radiological characteristics of tubular carcinoma of the breast, to report clinical and pathologic findings and to define findings at follow-up. MATERIALS AND METHODS: A retrospective review of records of 2872 women who received a diagnosis of breast carcinoma between January 1988 and January 2006 revealed 32 histopathologically proven pure tubular carcinoma of the breast. Analysis included history; findings at physical examination, mammography, and sonography (US) at the time of diagnosis and in postoperative follow-up and histopathological results. RESULTS: Fifty-nine percent of the patients (n=19) presented with a palpable mass. The mammographic findings were a mass in 23 (72%), a mass with microcalcifications in 2 (6%), asymmetric focal density in 1 (3%), architectural distortion in 1 (3%) and negative in 5 (16%) of the 32 patients. Most (96%) masses had spiculated margins. US depicted 30 masses in 29 patients, all of which were hypoechoic, mostly (n=27, 90%) with posterior acoustic shadowing. The cancer was clinically occult in 41% (n=13), mammographically occult in 16% (n=5), and sonographically occult in 6% (n=2) of the patients. Histologically, the tumor was multifocal in 3% (n=1) of the patients. Four (13%) patients developed contralateral breast carcinoma at follow-up. CONCLUSION: Tubular carcinoma has a variety of presentations, but it is mostly seen on mammography as a small spiculated mass, and on sonography as an irregular mass with posterior acoustic shadowing. Although tubular carcinoma is known as a well-differentiated tumor with excellent prognosis, the mammographic follow-up of the contralateral breast is important.     

Sclerosing adenosis: mammographic and ultrasonographic findings with clinical and histopathological correlation

OBJECTIVE: To evaluate the mammographic and ultrasonographic findings of sclerosing adenosis, a relatively uncommon entity which may sometimes mimic carcinoma. MATERIALS AND METHODS: A retrospective review of the records of 33,700 women, who have undergone mammographic examination at our institution between January 1985 and July 2001 revealed 43 histopathologically proven sclerosing adenosis. The history, physical examination, mammographic and ultrasonographic findings were analyzed in all patients. In 30 patients, the nonpalpable lesions were preoperatively localized by the needle-hookwire system under the guidance of mammography (n=22) or ultrasonography (US) (n=8). Radiological features were correlated with histopathological findings. RESULTS: The age of the patients varied between 32 and 55 years (mean, 43.7 years). Only two patients had a family history of breast cancer. In six patients, the presenting complaint was mastalgia. A palpable mass was present in 13 cases. The mammographic findings were; microcalcifications in 24 (55.8%) (clustered in 22, diffuse in two), mass in five (11.6%), asymmetric focal density in three (6.9%), and focal architectural distortion in three (6.9%) patients. Four of the masses were irregularly contoured, while one was well-circumscribed. On US, focal acoustic shadowing without a mass configuration was noted in the three patients who showed asymmetrical focal density on mammography. In eight patients, who showed normal mammograms, a solid mass was detected on US. Two masses had discrete well-circumscribed oval or lobulated contours, while six showed microlobulation and irregularity. In one case, the irregularly contoured mass had marked posterior acoustic shadowing. Two of the three patients, who had focal architectural distortion on mammograms, had an irregularly contoured solid mass, while the third presented as focal acoustic shadowing without a mass configuration. CONCLUSION: Sclerosing adenosis mostly presents as a nonpalpable lesion with different mammographic and sonographic appearances. The most common finding is microcalcifications on mammograms. Awareness of the possible imaging features will enable us to consider sclerosing adenosis in the differential diagnosis. The radiological features may sometimes mimic malignancy, so histopathologic examination is mandatory for definite diagnosis.     

Apparent ipsilateral decrease in breast size at mammography: a sign of infiltrating lobular carcinoma

PURPOSE: To assess if infiltrating lobular carcinoma (ILC) is associated with an ipsilateral mammographic decrease in breast size. MATERIALS AND METHODS: Mammographic change in size was evaluated by measuring the distance from the nipple to the pectoralis major muscle on the mediolateral oblique view of the diagnostic mammogram and on a preceding mammogram in 30 patients with ILC. Clinical, mammographic, and histopathologic findings were retrospectively reviewed. RESULTS: Five patients (17%) had an ipsilateral decrease in mammographic size. No patients noticed a physical decrease in breast size. Patients with an ipsilateral decrease in mammographic size most commonly had breast thickening at examination (four of five patients [80%], P < .001) and either a focal asymmetry density (three of five patients [60%]) or architectural distortion (one of five patients [20%]) at mammography; those patients with no change in size most commonly had a palpable mass (six of 25 patients [24%]) or normal findings (19 of 25 patients [76%]) and a mass (13 of 25 patients [52%]) at mammography. The mean tumor size was 66 mm for those with an ipsilateral size decrease and 16 mm for those with no size decrease (P < .001). At histologic analysis, tumors associated with an ipsilateral decrease in mammographic size had more diffuse involvement of the breast, and discrete masses were not seen. CONCLUSION: An apparent decrease in mammographic size may help identify cases of ILC, especially when associated with thickening at clinical examination and focal asymmetric density at mammography.     

Mammographic detection of recurrent cancer in the irradiated breast

Recurrence of cancer in the irradiated breast is an uncommon but potentially curable problem. Posttreatment mammograms were studied in 45 patients who had biopsies of an irradiated breast for suspected local recurrence to evaluate the usefulness of mammography in detecting such recurrences. Of 23 biopsy-proven recurrences, eight (35%) were detected by mammography only, nine (39%) were detected by physical examination only, and six (26%) were detected by both. Mammographic findings in recurrent malignancy included microcalcifications in six, microcalcifications associated with a mass in four, soft-tissue masses in three, and inflammatory changes in one. The results show that mammographic follow-up is complementary to physical examination in the detection of local recurrence in women who have undergone radiation therapy for early breast cancer.     

Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases

The author prospectively evaluated the value of periodic mammographic surveillance among 3,184 consecutive cases of nonpalpable, probably benign breast lesions detected with mammography. Follow-up consisted of four mammographic examinations during a 3- or 3.5-year period. Clinical outcome was ascertained in each case after the study period, whether or not patients complied with the protocol. Probably benign lesions were subsequently found to be malignant in 17 cases (positive predictive value for cancer, 0.5%). Fifteen of the 17 cancers were identified by means of interval mammographic change prior to development of a palpable mass; all 17 were stage 0 or stage 1 tumors. All 17 women who had cancer currently show no evidence of tumor recurrence (median duration of follow-up, 5 years). These results should help establish the validity of managing mammographically detected, probably benign lesions with periodic mammographic surveillance. By decreasing the number of biopsies of benign lesions and thereby substantially reducing costs, this approach may help overcome a major barrier to widespread use of mammographic screening.     

Paget's disease of the breast: clinical, mammographic, sonographic and pathologic findings in 52 cases

PURPOSE: To determine and quantitate radiologic characteristics of Paget's disease of the breast and to report clinical and pathologic findings. MATERIALS AND METHODS: A retrospective review of records of 2872 women who received a diagnosis of breast carcinoma between January 1988 and January 2006 revealed 52 histologically proved Paget's disease of the breast. Analysis included history, findings at physical examination, mammography and sonography (US) and histologic type of Paget's disease. RESULTS: At physical examination, palpable mass (n=33, 63%), nipple erythema-eczema-ulceration (n=17, 33%) and blood-stained nipple discharge (n=5, 10%) were noted. Among 17 patients who had clinically evident Paget's disease, the mammographic findings were isolated microcalcifications in 3 (18%), mass associated with microcalcifications in 5 (29%), mass in 2 (12%) and negative in 7 (41%) patients. In the 35 patients with clinically inevident Paget's disease, these mammographic findings were 43% (n=15), 34% (n=12), 20% (n=7) and 3% (n=1), respectively. US depicted 43 masses in 35 patients, all of which were lobulated or irregularly contoured, mostly (n=41, 95%) without posterior acoustic shadowing. The cancer was clinically occult in 10% (n=5), mammographically occult in 15% (n=8) and radiologically occult in 13% (n=7) of the 52 patients. Histologically, the tumor was multifocal and/or multicentric in 11 (21%) patients. CONCLUSION: The clinical features of Paget's disease are characteristic and should alert the clinician to the likelihood of an underlying carcinoma, which should be evaluated radiologically. However, as Paget's disease is primarily a clinical diagnosis and mammograms may be negative, screening programs without clinical examination may result with delay in diagnosis. As a result, both clinical and imaging findings are complementary and should be correlated to confirm or exclude a diagnosis of Paget's disease.     

Specificity of mammography and US in the evaluation of a palpable abnormality: retrospective review

PURPOSE: To determine the number of patients who received a diagnosis of breast cancer after having an area of clinical concern at presentation and combined negative mammographic and ultrasonographic (US) findings. MATERIALS AND METHODS: During a 4-year period, 829 patients with a palpable abnormality at presentation and combined negative mammographic and US findings were identified. The number of women who went on to receive a diagnosis of breast cancer was determined retrospectively. The authors searched the breast imaging database and the pathology database, sent a contact letter to the referring physicians, and linked their data to the State Cancer Registry. They also analyzed the breast parenchymal density among all patients who had more than 2 years of follow-up. RESULTS: Of the 829 women, 374 had follow-up information. Two-hundred thirty-three patients had negative imaging findings with more than 2 years of follow-up. The other 141 women were presumed to be cancer free, as they were not identified by the State Cancer Registry. Six (2.6%) of the 233 women had a diagnosis of breast cancer in the area of the palpable abnormality. The six cancers were diagnosed among the 156 women who had radiographically dense breast tissue (Breast Imaging Reporting and Data System category 3 or 4). Among the 77 women with predominantly fatty tissues, no cancers were diagnosed. CONCLUSION: A negative mammographic and US finding of a palpable abnormality does not exclude breast cancer, but the likelihood of breast cancer is low, approximately 2.6%-2.7%. It may be higher if the breast tissues are dense and lower if they are predominantly fatty.     

Breast cancers in women 35 years of age and younger: mammographic findings

During an 8-year period, 74 breast cancers were diagnosed in 66 patients 35 years of age and younger who underwent preoperative mammography. Mammograms and clinical data in these women were reviewed retrospectively to evaluate the mammographic findings and the efficacy of mammography. In 58 cases the cancer was detected by means of both clinical examination and mammography; in eight cases, mammography alone enabled readers to find the lesion; in seven cases, the lesion was found by means of clinical examination, but mammograms were negative; and in one case a cancer was found by means of incidental biopsy of the contralateral breast. Although 34 patients (52%) had dense breasts, mammography demonstrated the lesion in 66 cases (89%); the most common mammographic finding was microcalcifications, with or without associated masses (n = 28 [38%]). The authors do not suggest that screening of women younger than 35 years be performed routinely, but they believe that mammography can be valuable in screening young women at high risk for breast cancer or in confirming and suggesting prompt biopsy of a suspicious lesion.     

Tubulolobular carcinoma of the breast: clinical, mammographic and sonographic findings

PURPOSE: To determine and quantitate radiologic characteristics of tubulolobular carcinoma of the breast and to report clinical and pathologic findings. MATERIALS AND METHODS: A retrospective review of records of 2872 women who received a diagnosis of breast carcinoma between January 1988 and January 2006 revealed 26 histopathologically proven tubulolobular carcinoma of the breast. Analysis included history; findings at physical examination, mammography, and sonography (US) at the time of diagnosis and in postoperative follow-up, and histopathological results. RESULTS: At physical examination, palpable mass was present in 85% (n=22) of the patients. The mammographic findings were mass in 17 (65%), asymmetric focal density in 2 (8%), architectural distortion in 2 (8%) and negative mammograms in 5 (19%) of the 26 patients. US depicted 25 masses in 24 patients, all of which were hypoechoic, with spiculated (n=13) or microlobulated (n=12) margins. The cancer was clinically occult in 12% (n=3), mammographically occult in 19% (n=5), and radiologically occult in 4% (n=1) of the patients. Histologically, the mean size of the tumor was 1.7cm and 18 (69%) patients were node negative. CONCLUSION: Tubulolobular carcinoma of the breast usually manifests clinically as a firm, immobile mass and mammographically as a spiculated or ill-defined, irregular, isodense mass without microcalcifications. Common findings on sonography include a homogeneously hypoechoic, spiculated or microlobulated mass with posterior acoustic shadowing or normal acoustic transmission. Tubulolobular carcinoma should be included in the differential diagnosis for breast masses with these imaging features.     

Palpable solid breast masses: retrospective single- and multimodality evaluation of 201 lesions

The diagnostic virtues and limitations of single- and multimodality testing in the evaluation of solid palpable breast masses were studied. Two hundred one consecutive patients who had a solid palpable breast mass and who underwent biopsy between September 1982 and July 1986 were included for blinded retrospective analysis of their physical examination, mammographic, ultrasonographic (US), thermographic, and pathologic characteristics. Benign breast disease was diagnosed histologically in 106 women, while carcinoma was established in 95. The sensitivities of physical examination, mammography, US, and thermography were 0.88, 0.94, 0.78, and 0.49, respectively. US alone had the highest sensitivity in correct diagnosis of a benign solid breast mass and had the highest accuracy (0.84). Use of four modalities increased the preoperative diagnostic true-positive rate to 0.97, with some decline in specificity. Multimodality testing seems particularly beneficial in pre- and perimenopausal patients.     

Sonographic, mammographic, and histopathologic correlation of symptomatic ductal carcinoma in situ

OBJECTIVE: The purpose of this study was to describe the features of symptomatic ductal carcinoma in situ (DCIS) of the breast shown on high-resolution sonography and to correlate them with findings from mammography and histopathology to evaluate the prognostic ability of sonographic findings. MATERIALS AND METHODS: We retrospectively reviewed mammographic and sonographic images of 60 DCIS lesions from 55 symptomatic women. Images were reviewed by a radiologist who knew that the patients had DCIS but had no other information regarding pathology. Lesions were evaluated pathologically and classified using the Van Nuys classification system. Statistical comparisons were made using Fisher's exact test. RESULTS: Of the 60 lesions, 33 were classified as Van Nuys group 1, 19 as Van Nuys group 2, and eight as Van Nuys group 3. Six (10%) of the 60 lesions were not visible on sonography, and 12 lesions (20%) were not visible on mammography. Sonography revealed a mass in 43 cases (72%), ductal changes in 14 cases (23%), and architectural distortion in four cases (7%). Eight lesions had more than one of these features. A sonographically visualized, irregularly shaped mass with indistinct or angular margins and no posterior acoustic shadowing or enhancement was associated with a high Van Nuys classification (p < 0.05). Microcalcifications were visible on sonography in 13 (22%) of the 60 lesions or on mammography in 25 lesions (42%). Both findings were associated with a high Van Nuys classification (p < 0.05). CONCLUSION: Although sonography can reveal microcalcifications within masses, it is unreliable in depicting and characterizing the morphology and extent of microcalcifications, particularly when they are in isolation. Therefore, sonography should not be used to replace mammography but instead as an adjunctive tool to increase the sensitivity of mammography in breast diagnosis.     

Efficacy of spot compression-magnification and tangential views in mammographic evaluation of palpable breast masses.

To define the role of special mammographic views in evaluating palpable breast masses, 70 consecutive women with palpable breast masses underwent standard two-view examination of each breast and spot compression-magnification and tangential view examination of the palpable mass. Thirty palpable masses were found in 30 patients (43%). Standard views depicted 26 masses (87%). Tangential views also depicted 26 masses. Some of the masses seen on tangential views were not seen on standard views and vice versa. Spot compression-magnification views depicted 29 masses (97%). Special views thus depicted an additional 9% of palpable masses not seen on standard views (four of 44 cases). All lesions not seen on tangential views were central; the one lesion not seen on spot compression-magnification views was peripheral. Special views allowed correct prediction of benign or malignant status in 77% of cases (23 of 30), while standard views allowed correct prediction in 69% of cases (18 of 26).     

99Tcm-MIBI scintimammography in the evaluation of breast lesions and axillary involvement: a comparison with mammography and histopathological diagnosis.

The aim of this prospective study was to determine the diagnostic value of prone lateral 99Tcm-MIBI scintimammography in the detection of primary breast cancer and axillary lymph node involvement in patients with breast lesions. We evaluated 83 palpable and 22 non-palpable lesions in 77 consecutive patients with a clinically palpable mass and/or suspicious mammographic finding. Early and late scintimammograms were performed after the intravenous injection of 740 MBq 99Tcm-MIBI. The overall sensitivity of both scintimammography and mammography in the detection of primary breast cancer was 94%. The overall specificity was 84% and 56% for scintimammography and mammography respectively. In the patients with palpable masses, the sensitivity of scintimammography was 97% and the specificity was 84%; in those with non-palpable masses, the sensitivity was 35% and the specificity 100%. For the detection of axillary lymph node involvement, the sensitivity and specificity of scintimammography were 68% and 93% respectively. However, conventional mammography showed 37% sensitivity and 86% specificity. In conclusion, scintimammography is an accurate and clinically valuable tool for evaluating palpable and non-palpable breast abnormalities. In addition to its high sensitivity, it improves the specificity of mammography both in the evaluation of breast masses and in the detection of axillary involvement.