[Diffusion-weighted breast imaging. Clinical implementation procedure]. / Diffusionsgewichtete Brustbildgebung. Klinische Implementierungsverfahren.

Diffusion-weighted imaging (DWI) of the breast provides additional contrast information in breast magnetic resonance imaging (MRI). The DWI procedure can easily be implemented in the routine breast MRI protocol with little time expenditure regarding image acquisition and evaluation. Evaluation of the DW images can be performed with or without the routine breast MRI sequences (T2w and T1w with contrast material) but evaluation in combination with the routine program is highly recommended. Objective analysis of the tissue diffusion can be achieved by calculating the apparent diffusion coefficient (ADC) value with the scanner software. The choice of the DW sequence, evaluation and determination of the ADC threshold to differentiate between benign and malignant lesions should be scanner adapted. The use of DW imaging qualifies for routine use regarding the differentiation between malignant and benign breast lesions. Non-mass-like lesions and monitoring neoadjuvant chemotherapy can also be evaluated with DW sequences. The benefit of the additional information from DW-MR mammography to characterize non-mass-like lesions and in the course of neoadjuvant chemotherapy remains unclear to date.

[Sebaceous breast carcinoma: report of a rare histological special subtype]. / Sebaziöses Mammakarzinom: Fallbericht eines seltenen speziellen Subtyps.

We report on a case of sebaceous carcinoma of the breast as a rare histological special subtype of breast cancer. Because these tumors are uncommon, differential diagnostic considerations and the exclusion of Muir-Torre syndrome are emphasized. Finally possible mechanisms of development and therapeutic strategies for this carcinoma are discussed.

[Comparison of dignity determination of mammographic microcalcification with two systems for digital full-field mammography with different detector resolution: a retrospective clinical study]. / Vergleich der Dignitätsbestimmung von mammographischem Mikrokalk mit zwei Systemen zur digitalen Vollfeldmammographie unterschiedlicher Detektorauflösung : Eine retrospektive klinische Studie.

PURPOSE: The aim of this retrospective clinical study was to compare the diagnostic accuracy of the novel 50 µm FFDM (full-field digital mammography) system (DR) with an established 70 µm system (DR) in the differential diagnosis between benign and malignant clusters of microcalcification (n=50) (BI-RADS™ classification 4/5) and to assess the possible incremental value of the 50 µm pixel-pitch on specificity. MATERIAL AND METHODS: From March 2009 to September 2009, 50 patients underwent full-field digital mammography (FFDM) (detector resolution 70 µm) (Novation, Siemens, Erlangen, Germany). As there were suspicious signs of microcalcification classified with BI-RADS™ 4/5 after diagnosis and preoperative wire localization, control images were made with the new FFDM system (detector: resolution 50 µm) (Amulet, Fujifilm, Tokyo, Japan) with the same exposure parameters. The diagnosis was determined after the operation by five radiologists with different experience in digital mammography from randomly distributed mediolateral views (monitor reading) whose results were correlated with the final histology of all lesions. RESULTS: Histopathology revealed 19 benign and 31 malignant lesions in 50 patients after open biopsy. The results of the five readers showed a higher sensitivity of the new FFDM system (80.0%) in the ability to recognize malignant microcalcification in comparison to the established system (74.8%). The specificity (75.8 versus 71.6%) was slightly higher for the new system but these results were not statistically significant (p<0.001). Considering the diagnostic accuracy, the new system (detector: resolution 50 µm) was also slightly superior to the well-known system (detector: resolution 70 µm) (80.1% versus 76.4%). CONCLUSIONS: Our study has shown that the new full-field digital mammography system using the novel detector compared with the already established FFDM system with respect to the assessment of microcalcification is at least equivalent.

[First experiments for the detection of simulated mammographic lesions: digital full field mammography with a new detector with a double plate of pure selenium]. / Erste Untersuchungen zur Detektion simulierter mammographischer Läsionen : Digitale Vollfeldmammographie mit einem Doppelschicht-Selen-Detektor.

PURPOSE: The article describes an experimental phantom study of a system for digital full field mammography with a new digital detector with a double plate of pure selenium. MATERIALS AND METHODS: The experiments were carried out with the new full field digital mammography system Amulet from FujiFilm. This system has a new detector (18×24 cm(2)) on the basis of highly purified amorphous selenium (a-Se) with a pixel size of 50 µm. The x-rays are converted into electric signals in the first plate which are read into the second plate with the help of an optical switch and demonstrated in the form of an image. In this way a better pixel size/volume and signal-to-noise ratio should be achieved. The object of the investigation was the Wisconsin Mammographic Random Phantom, Model 152 A (Technical Performance Mo/Mo, 28 kV, 100 mAs). Five investigators with different experiences in mammography each received three images on a monitor with different random positions of the simulated lesions in the phantom for assessment. The detection rates were compared under the same conditions with the results of two other full field digital mammography systems. RESULTS: The median detection rate for all images and investigators for the new doubled plated a-Se detector with optical switch was 98.7%. For both other systems with a-Si or and a-Se detectors the detection rate was 89.8% or 97.3%, respectively. There were no significant differences in the detection rate of the simulated breast lesions for all three systems considering the interobserver and intraobserver variation. CONCLUSION: The first phantom study for the detection of simulated breast lesions with the new full field digital mammography system Amulet demonstrates equivalent results with the other systems used in the clinical routine. The trend towards superiority of the new system has to be confirmed in further clinical studies.

[Experimental investigations for dose reduction by optimizing the radiation quality for digital mammography with an a-Se detector]. / Experimentelle Untersuchungen zur Dosisreduktion durch Optimierung der Strahlungsqualität bei digitaler Vollfeldmammografie mit einem Detektor auf Selenbasis.

PURPOSE: Reduction of radiation exposure at an adequate image quality by optimizing the radiation quality for a new system of full-field digital mammography using a digital detector (a-Se). MATERIALS AND METHODS: The investigations were performed using a digital mammography system Novation (Siemens, Erlangen). The system was constructed with a bimetal anode (molybdenum and tungsten) and the possibility of changing the filter (molybdenum/rhodium). The test object was the Wisconsin Mammography Random Phantom Model 152 A (Radiation Measurements Inc.) of which images were acquired using the digital technique with the tungsten anode and rhodium filter at different tube voltages (26-35 kV) and tube loads (40-100 mAs) and compared to images in the molybdan/molybdan molybdenum/molybdenum technique. To quantify the image quality, we used the detection rate of the simulated lesions in the phantom. RESULTS: Increasing the tube voltage significantly decreases the average glandular dose when using AEC (Automatic Exposure Control), i. e., constant detector dose. At the same time, the image quality decreases significantly with respect to the detection rate (26 kV, 1 mGy, 95.1 %; 35 kV, 0.7 mGy, 82.7 %). As a good compromise between the necessary diagnostic image quality and the lowest dose exposition, 28 kV and 60 mAs were selected for imaging with the tungsten/rhodium anode/filter combination. A further change to the tube load did not make sense because a decrease of 10 % resulted in a significant decrease in the detection rate while only a 2 % increase in detection rate was achieved for a 65 % increase in radiation exposure. CONCLUSION: The results of this phantom study demonstrate that the routine use of the tungsten anode in combination with a rhodium filter for full-field digital mammography with an a-Se detector in contrast to a molybdan/molybdan molybdenum/molybdenum anode/filter combination results in a reduction of the average glandular dose of up to 30 % without loss of diagnostic image quality.

[Comparing the clinical value of spot view mammography with reduced pixel size to monitor zooming by reporting microcalcifications in digital mammography]. / Vergleich der klinischen Wertigkeit von Zielaufnahmen mit reduzierter Pixelgrösse des Detektors und digitalem Monitorzooming bei der Beurteilung von Mikrokalzifikationen in der digitalen Mammografie.

PURPOSE: Evaluation of the diagnostic value of breast specimen imaging with a digital mammographic system using a detector system with changeable pixel size compared to standard mode imaging in different monitor display modes. MATERIALS AND METHODS: Using the digital mammographic system SenoScan (Fischer Imaging, Denver, USA), 50 diagnostic breast specimens with microcalcifications were visualized in both standard mode (pixel size 54 microm) and high resolution mode (pixel size 27 microm). The resulting radiographs were displayed 1:1 on a monitor. Standard mode images (pixel size 54 microm) were additionally displayed in a 2:1 mode. A total of 5 readers with different mammographic experience analyzed the type of the microcalcifications on the basis of the different display modes. The images were presented randomly. The findings were subsequently compared to the histology. RESULTS: The high resolution mode yielded slightly but not significantly better results than the standard mode on average for all 5 readers. Compared to a sensitivity of 80 % and a specificity of 72 % (PPV = 74 %, NPV = 78 %) in the standard mode, the high resolution mode provided a sensitivity of 86 % and a specificity of 74 % (PPV = 77 %, NPV = 83 %). The standard mode images on a 2:1 monitor display yielded 84 % and 74 % (PPV = 76 %, NPV = 82 %). CONCLUSION: The high resolution mode did not significantly increase the sensitivity and specificity of the microcalcification reading. A similar improvement was achieved by the 2:1 display mode, i. e. digital monitor zooming. For the clinical situation this means that there is no diagnostic advantage from using a high resolution target view with this mammographic system.

Experimental phantom lesion detectability study using a digital breast tomosynthesis prototype system.

PURPOSE: To compare the sensitivity of conventional two-dimensional (2D) projection imaging with tomosynthesis with respect to the detectability of mammographic phantom lesions. MATERIALS AND METHODS: Using a breast tomosynthesis prototype based on a commercial FFDM system (Siemens MAMMOMAT Novation), but modified for a wide angle tube motion and equipped with a fast read-out amorphous selenium detector, we acquired standard 2D images and tomosynthesis series of projection views. We used the Wisconsin mammographic random phantom, model RMI 152A. The anode filter combinations Mo/Mo and W/Rh at two different doses were used as typical radiographic techniques. Slice images through the phantom parallel to the detector were reconstructed with a distance of 1 mm employing a filtered back-projection algorithm. The image data sets were read by five radiologists and evaluated with respect to the detectability of the phantom details. RESULTS: For all studied radiographic techniques, the detection rate in the tomosynthesis mode was 100 %, i. e. 75 true positive findings out of 75 possible hits. In contrast, the conventional projection mode yielded a detection rate between 80 and 93 % (corresponding to 60 and 70 detected details) depending on the dose and X-ray spectrum. CONCLUSION: Tomosynthesis has the potential to increase the sensitivity of digital mammography. Overlapping structures from out-of-plane tissue can be removed in the tomosynthesis reconstruction process, thereby enhancing the diagnostic accuracy.

Detection of coronary artery stenoses by contrast-enhanced, retrospectively electrocardiographically-gated, multislice spiral computed tomography.

BACKGROUND: Multislice spiral computed tomography (MSCT) with retrospectively ECG-gated image reconstruction permits coronary artery visualization. We investigated the method's ability to identify high-grade coronary artery stenoses and occlusions. METHODS AND RESULTS: A total of 64 consecutive patients were studied by MSCT (4x1 mm cross-sections, 500-ms rotation, table feed 1.5 mm/rotation, intravenous contrast agent, retrospectively ECG-gated image reconstruction). All coronary arteries and side branches with a luminal diameter >/=2.0 mm were assessed concerning evaluability and the presence of high-grade stenoses (>70% diameter stenosis) or occlusions. Results were compared with quantitative coronary angiography. Of 256 coronary arteries (left main, left anterior descending, left circumflex and right coronary artery, including their respective side branches), 174 could be evaluated (68%). In 19 patients (30%), all arteries were evaluable. Artifacts caused by coronary motion were the most frequent reason for unevaluable arteries. Overall, 32 of 58 high-grade stenoses and occlusions were detected by MSCT (58%). In evaluable arteries, 32 of 35 lesions were detected, and the absence of stenosis was correctly identified in 117 of 139 arteries (sensitivity, 91%; specificity, 84%). If analysis was extended to all stenoses with >50% diameter reduction, sensitivity was 85% (40 of 47) and specificity was 76% (96 of 127). CONCLUSIONS: MSCT with retrospective ECG gating permits the detection of coronary artery stenoses with high accuracy if image quality is sufficient, but its clinical use may presently be limited due to degraded image quality in a substantial number of cases, mainly due to rapid coronary motion.

[Digital mammography with high-resolution storage plates (CR) versus full-field digital mammography (CCD) (DR) for microcalcifications and focal lesions -- a retrospective clinical histologic analysis (n = 102)]. / Digitale Mammographie mit hochauflösenden Speicherfolien (CR) versus digitaler Vollfeldmammographie (CCD) (DR): Mikrokalzifikationen und Herdbefunde -- eine retrospektiv klinisch-histologische Analyse (n = 102).

PURPOSE: To determine the diagnostic accuracy of microcalcifications and focal lesions in a retrospective clinical-histological study using high-resolution digital phosphor storage plates (hard copy) and full-field digital mammography (hard copy). MATERIALS AND METHODS: From May 2003 to September 2003, 102 patients underwent digital storage plate mammography (CR), using a mammography unit (Mammomat 3000 N, Siemens) in combination with a high resolution (9 lp/mm) digital storage phosphor plate system (pixel size 50 microm) (Fuji/Siemens). After diagnosis and preoperative wire localization, full-field digital mammography (CCD) (DR) was performed with the same exposure parameters. The full-field digital mammography used a CCD-detector (SenoScan) (Fisher Imaging) with a resolution of 10 Ip/mm and a pixel size of 50 microm. Five investigators determined the diagnosis (BI-RADS I - V) retrospectively after the operation from randomly distributed mediolateral views (hard copy reading). These results were correlated with the final histology. RESULTS: The diagnostic accuracy of digital storage plate mammography (CR) and full-field digital mammography (CCD) (DR) was 73 % and 71 % for all findings (n = 102), 73 % and 71 % for microcalcifications (n = 51), and 72 % and 70 % for focal lesions (n = 51). The overall results showed no difference. CONCLUSION: Our findings indicate the equivalence of high-resolution digital phosphor storage plate mammography (CR) and full-field digital mammography (CCD) (DR).

The influence of patient positioning in breast CT on breast tissue coverage and patient comfort.

PURPOSE: The presented study aimed at optimizing a patient table design for breast CT (BCT) systems with respect to breast tissue coverage and patient comfort. Additionally, the benefits and acceptance of an immobilization device for BCT using underpressure were evaluated. MATERIALS AND METHODS: Three different study parts were carried out. In a positioning study women were investigated on an MRI tabletop with exchangeable inserts (flat and cone-shaped with different opening diameters) to evaluate their influence on breast coverage and patient comfort in various positioning alternatives. Breast length and volume were calculated to compare positioning modalities including various opening diameters and forms. In the second study part, an underpressure system was tested for its functionality and comfort on a stereotactic biopsy table mimicking a future CT scanner table. In the last study part, this system was tested regarding breast tissue coverage. RESULTS: Best results for breast tissue coverage were shown for cone-shaped table inserts with an opening of 180 mm. Flat inserts did not provide complete coverage of breast tissue. The underpressure system showed robust function and tended to pull more breast tissue into the field of view. Patient comfort was rated good for all table inserts, with highest ratings for cone-shaped inserts. CONCLUSION: Cone-shaped tabletops appeared to be adequate for BCT systems and to allow imaging of almost the complete breast. An underpressure system proved promising for the fixation of the breast during imaging and increased coverage. Patient comfort appears to be adequate.

The Influence of Patient Positioning in Breast CT on Breast Tissue Coverage and Patient Comfort.

PURPOSE: The presented study aimed at optimizing a patient table design for breast CT (BCT) systems with respect to breast tissue coverage and patient comfort. Additionally, the benefits and acceptance of an immobilization device for BCT using underpressure were evaluated. MATERIALS AND METHODS: Three different study parts were carried out. In a positioning study women were investigated on an MRI tabletop with exchangeable inserts (flat and cone-shaped with different opening diameters) to evaluate their influence on breast coverage and patient comfort in various positioning alternatives. Breast length and volume were calculated to compare positioning modalities including various opening diameters and forms. In the second study part, an underpressure system was tested for its functionality and comfort on a stereotactic biopsy table mimicking a future CT scanner table. In the last study part, this system was tested regarding breast tissue coverage. RESULTS: Best results for breast tissue coverage were shown for cone-shaped table inserts with an opening of 180 mm. Flat inserts did not provide complete coverage of breast tissue. The underpressure system showed robust function and tended to pull more breast tissue into the field of view. Patient comfort was rated good for all table inserts, with highest ratings for cone-shaped inserts. CONCLUSION: Cone-shaped tabletops appeared to be adequate for BCT systems and to allow imaging of almost the complete breast. An underpressure system proved promising for the fixation of the breast during imaging and increased coverage. Patient comfort appears to be adequate. KEY POINTS: Tissue coverage in breast CT is highly dependent on patient table design. An underpressure fixation system shows potential to increase breast coverage. The proposed breast CT patient table design combines good coverage and patient comfort.

Benign meningioma: partially resected, biopsied, and recurrent intracranial tumors treated with combined proton and photon radiotherapy.

PURPOSE/OBJECTIVE: To evaluate the recurrence-free survival and complications of combined proton and photon radiotherapy of patients with incompletely resected or recurrent histologically-confirmed benign meningioma. METHODS AND MATERIALS: Between May 1981 and November 1996, 46 patients with partially resected, biopsied, or recurrent meningiomas (median age of 50 years; range 11-74 years) were treated with combined photon and 160-MeV proton beam therapy at the Massachusetts General Hospital (MGH) and the Harvard Cyclotron Laboratory, using computed tomography-based conformal 3D treatment planning. Nine patients were treated after incomplete tumor resection, 8 patients after tumor biopsy only, and 29 patients after tumor recurrence following gross total (10/29 patients) or progression after subtotal (19/29 patients) resection. All patients were classified as benign meningioma on review slides at MGH. The median dose to the macroscopic gross tumor volume was 59.0 CGE (range 53.1-74.1 CGE, CGE = proton Gy x 1.1 RBE). The median follow-up was 53 months (range 12-207). RESULTS: Overall survival at 5 and 10 years was 93 and 77%, respectively, and the recurrence-free rate at 5 and 10 years was 100% and 88%, respectively. Survival without severe toxicity was 80% at 5 and 10 years. Three patients presented with local tumor recurrence at 61, 95, and 125 months. One patient developed distant intradural metastasis at 21 and 88 months. No patient died from recurrent meningioma; however, 4 patients died of other causes. A fifth patient died from a brainstem necrosis after 22 months. Eight patients developed severe long-term toxicity from radiotherapy, including ophthalmologic (4 patients), neurologic (4 patients), and otologic (2 patients) complications. All patients with ophthalmologic toxicity received doses higher than those allowed for the optic nerve structures in the current protocol. CONCLUSION: Combined proton and photon radiotherapy is an effective treatment for patients with recurrent or incompletely resected benign intracranial menigiomas. Observed toxicity appears to be dose-related; with currently employed dose constraints, toxicity should not exceed that seen in patients treated with conformal fractionated supervoltage photon radiotherapy.

Experimental investigations of image quality in X-ray mammography with a conventional screen film system (SFS) and a new full-field digital mammography unit (DR) with a-Se-detector.

PURPOSE: Determination of image quality of a new digital mammography system with an a-Se-detector. MATERIAL AND METHOD: Radiograms of the Wisconsin Mammographic Random Phantom, Modell 152 A (Radiation Measurements Inc., Wisconsin) were acquired using a conventional film screen and a digital system. RESULTS: With the conventional film screen system there were detected 191/a 38.2 and with the digital mammography 219/a 43.8 of 225 possible details. CONCLUSION: Based on these results there is the possibility to replace the conventional film screen system by the digital mammography with a-Se-detector--this has to be confirmed in further clinical trials.

[Do tissue marker clips after sonographically or stereotactically guided breast biopsy improve follow-up of small breast lesions and localisation of breast cancer after chemotherapy?]. / Verbessert die Clipmarkierung im Rahmen der sonographischen oder stereotaktischen Brustbiopsie die Verlaufsbeurteilung kleiner Mammaläsionen und Lokalisation von Tumoren nach Chemotherapie?

PURPOSE: We wanted to determine if tissue marker clips after sonographically or stereotactically guided breast biopsy improve the follow-up of small breast lesions classified BI-RADS 4/5 and the localisation of breast cancer (TNM stage 2 or 3) after neoadjuvant chemotherapy. MATERIAL AND METHODS: Prospective analysis was performed of 108 breast lesions 1 cm or smaller mammographically classified as BI-RADS 4/5 and 14 breast lesions larger than 2 cm mammographically classified as BI-RADS 5. 33 of the 108 breast lesions 1 cm or smaller underwent sonographic core cut breast biopsy (group 1) and 75 stereotactic vacuum-assisted breast biopsy (group 2). All 14 lesions greater than 2 cm were stereotactically vacuum-assisted breast biopsied (group 3). The centre of the lesion was marked by a clip after the biopsy. Mammographies were performed in all patients of group 1 and 2 with a histologically benign finding (n = 31, n = 69, respectively) and in all patients of group 3 directly after clip placement and after 6 and 12 months. Clip localisation and possible divergence from the original position were verified by a grid. RESULTS: Two patients of group 1 and 6 patients of group 2 had breast conservative surgery (BET) because of the histological diagnosis of a ductal carcinoma in situ or invasive breast cancer. The tissue marker clips of the remaining 31 patients of group 1 and 69 patients of group 2 diverged with a mean value of 0.4 cm (standard deviation +/- 0.23 cm; range 0.1 cm to 0.9 cm) from their placement position after 6 months. After 12 months the marker clips deviated with a mean value of 0.4 cm (standard deviation +/- 0.21 cm; range 0.1 cm to 0.9 cm) in 94 patients and 0.8 cm (standard deviation +/- 0.25 cm; range 0.1 cm to 0.9 cm) in 6 patients from their original location. No tumour progression of the benign lesions in group 1 and 2 was diagnosed in follow-up mammograms. In all patients of group 3 the tissue marker clips were the only possibility to localize the tumour after neoadjuvant chemotherapy as all other diagnostic methods showed inconsistent results. CONCLUSION: Positioning a tissue marker clip in the tumour centre seems to be reasonable after interventional biopsy of breast lesions of 1.0 cm or smaller and before neoadjuvant chemotherapy.

[Experimental investigations at the new digital mammographic system]. / Experimentelle Untersuchungen an einem neuen digitalen Mammographiesystem.

PURPOSE: Experimental investigations of a new digital mammography system. MATERIALS AND METHODS: The digital mammography system SenoScan (Fischer Imaging) is based on 4 charged coupled devices (CCD) (slot detector). The pixel size is 50 micro m, field of view 21 x 29 cm (2), effective quantum efficiency (DQE) (0) 50 %, spatial resolution 10 lp/mm, and memory depth 12 bit. The object of investigation was the Wisconsin Mammographic Random Phantom, Model 152 A (Radiation Measurements Inc., Wisconsin). The radiograms were acquired using the digital mammography system. RESULTS: The digital mammography detected 225 of 225 possible details. The surface dose was 6.95 mGy. CONCLUSIONS: These experimental results support the use of the digital mammography in practice. This has to be confirmed in further clinical trials.

[Phantom study for the detection of simulated lesions in five different digital and one conventional mammography system]. / Phantomstudie zur Detektion simulierter Läsionen an fünf verschiedenen digitalen und einem konventionellen Mammographiesystem.

PURPOSE: Experimental phantom study for the detection of simulated lesions with five different digital and one conventional screen-film mammography system. MATERIALS AND METHODS: Three radiographs were obtained at various configurations of the phantom with one conventional screen-film system (Mammomat 3000 N) (Siemens), five digital systems (high resolution computed radiography system [Fuji/Siemens], one a-Si detector [GE Medical Systems], two a-Se detectors [Siemens; Hologic / Lorad] and one CCD detector [Fischer Imaging]), applying the same exposure parameters. The Wisconsin Mammographic Random Phantom, Model 152 A, was used. Five investigators with different experience in mammography (3 months to more than 4 years) evaluated the 18 randomly selected radiographs. RESULTS: No significant differences were found in the detection rate of simulated breast lesions for conventional screen-film mammography (84.9 %), high resolution computed radiography (86.7 %) and digital mammography with an a-Si detector (89.8 %). Highly significantly better results (p < 0.001) were found with the two a-Se systems (97.3 %) and the CCD system (100 %). CONCLUSION: Conventional screen-film mammography can be replaced by high resolution computed radiography and digital mammography with a-Si-, a-Se- and CCD-detectors. This has to be confirmed in further clinical studies.

[Film-screen mammography versus digital storage plate mammography: hard copy and monitor display of microcalcifications and focal findings--a retrospective clinical and histologic analysis]. / Film-Folien-Mammographie versus digitale Mammographie mit Speicherfolien: Mikrokalzifikationen und Herdbefunde, Hartkopie- und Monitorbefundung--eine retrospektiv klinisch/histologische Analyse (n = 76).

PURPOSE: A retrospective clinical-histological study to determine the diagnostic accuracy of mammography using conventional screen-film cassettes (hard copy), high-resolution digital phosphor storage plates (hard copy) and monitor display (soft copy) for microcalcifications and focal lesions (BI-RADS (TM) category 4 or 5). MATERIALS AND METHODS: From April to November 2001, 76 patients underwent conventional film-screen mammography and, after diagnosis and preoperative wire localization, digital mammography with the same exposure parameters. Five investigators retrospectively determined the diagnosis after the operation from randomly distributed mediolateral views (hard-copy reading) and from the monitor display (soft-copy reading). These results were correlated with the final histology. RESULTS: The accuracy of conventional screen-film mammography, digital mammography and monitor-displayed mammography was 67%, 65% and 68% for all findings, (n = 76), 59%, 59% and 68% for microcalcifications (n = 44) and 75%, 72% and 63% for focal lesions (n = 32). The overall results showed no difference. CONCLUSION: Our findings indicate equivalence of conventional screen-film mammography, high-resolution digital phosphor storage plate mammography and monitor-displayed mammography.