Indications and guidelines for mammographic examinations.

The value of mammography in evaluating the asymptomatic patient has been clearly demonstrated by the HIP program, as well as the National Cancer Institute's breast demonstration projects. A one-third reduction in mortality from breast cancer in mammographically screened women has been substantiated. Nonetheless, questions concerning the long-term effects of repeated radiation exposure associated with mammography have been raised, and for this reason judicious selection of women is urged. In general, women who are asymptomatic or at high risk for breast carcinoma should be evaluated with a planned regimen. Mammographic guidelines and recommendations for attaining the greatest benefit at the lowest possible risk are suggested.

Selection of patients with lymphedema for compression therapy.

Seventeen patients with lymphedema were treated with intermittent external pneumatic compression. Two patients with hemodynamically significant venous obstruction showed no response to therapy. The response of the remaining fifteen patients varied with the degree of subcutaneous tissue fibrosis. Xeroradiographic estimates of tissue compressibility provided valuable prognostic information. Intermittent external pneumatic compression is an effective nonsurgical method of treatment in patients selected by xeroradiography.

Factors influencing false negative rates in xeromammography.

Xeromammographic false negatives were analyzed to ascertain the cause of the errors and determine what corrective measures could be taken. Of 52 cancers miscalled, 52% were not visualized and 48% were categorized as misinterpretations. The causes of these errors are discussed. The error rate in all but 8% of the former group appears to be irreducible, yet errors discussed in the latter group are thought to be correctable in a high percentage of cases. Recommendations to reduce the number of false negatives in this group are presented.

Xeroradiography of axillary lymph node disease.

Xeroradiographic evaluation of the axillary lymph nodes permits differentiation of characteristic patterns, including normal nodes and those enlarged as the result of fatty infiltration, inflammation, metastases from a breast primary, or primary nodal disease such as lymphoma or hyperplasia. The author describes his experience with this technique in selected patients.

An improved needle for localization of nonpalpable breast lesions.

The author describes an inexpensive 22-gauge flat head needle which permits rapid and virtually painless preoperative localization of nonpalpable breast lesions. The lesion is transfixed and anchored by the needle to the skin after a mammogram is obtained.

Epidermoid inclusion cysts of the phalanx, radiological and clinical correlation.

A patient with an epithelial inclusion cyst of the distal phalanx has been presented. The radiographic and clinical findings have been described and are felt to be pathognomonic. The importance of recognizing its benign nature has been stressed.

Galactography.

Galactography is a quick effective means of evaluating nipple discharge. It is especially indicated when the effluent is bloody. A description of the procedure is discussed. The radiographic findings in both normal and abnormal studies are presented. Abnormal findings include filling defects, duct cut-off, duct encasement, extravasation, and duct ectasia. The radiographic diagnosis corresponded with pathologic findings in 12 of 16 cases (75%), although in two cases no radiographic or pathologic abnormality was found to explain the bloody discharge.

Mammographic features of hidradenitis suppurativa axillaris.

The mammographic features of hidradenitis suppurativa axillaris, a common clinical entity, are described for the first time in this report. Lucent axillary masses with a small central density appear to be a pathognomonic radiographic finding. Other entities seen on mammography such as lipomas, lucent galactoceles, traumatic oil cysts, axillary hibernomas and benign lymph nodes, should not be confused with hidradenitis suppurative axillaris.

The breast as a mirror of systemic diseases.

This paper reemphasizes that xeromammographic changes in the skin, parenchyma, and vascular structures of the breast may be manifestations of a host of systemic diseases. Xeromammographic examples of such diseases as congestive heart failure, diabetes mellitus, collagen vascular diseases, and endocrine diseases are presented and discussed.

Case report: an unusual stress fracture in a jogger.

Stress fractures of the proximal fibula are uncommon, but do occur in the distal fibula in long-distance runners. A case is presented of a 71-year-old jogger who presented with a 2-month history of left knee pain. Radiographs showed an apparent destructive lesion of the proximal fibula which resembled a malignant bone lesion. Excision revealed a healing fracture.

Xeromammography in early detection of breast cancer.

Sixty-four carcinomas were detected in 1,315 women examined by xeromammography in 1973. Seventeen carcinomas were occult and 14 were detected in women referred for clinically benign lesions. The remaining 33 carcinomas were diagnosed on the basis of both clinical and roentgenographic examination. There were three false-negatives. Two of these lesions were obscured by very dense fibrocystic disease. The third lesion was called benign due to an error in interpretation. There were eight false-positives; four of these demonstrated intraductal hyperplasia and asymmetry, which may be a precursor to frank malignant change. Xeromammography is suggested as a highly accurate means of detecting occult mammary carcinomas and clarifying the nature of clinically suspected lesions.

Efficacy of the lateral view mammogram in the detection of breast malignancy.

Previous studies suggest that single-view lateral mammography alone results in a small decrease in detection of malignancies. Detection rates for lateral view only and two-view examinations in 200 cases (100 malignant, 100 nonmalignant) were compared. Four to six per cent of cases originally found positive were reinterpreted as negative in both situations. Preliminary findings suggest that the lateral view alone is sufficient, provided a second view is requested in suspicious cases.

Breast metastasis: an unusual manifestation of a malignant carcinoid tumor.

A metastasis from a bronchial carcinoid tumor presented as an isolated breast mass in a 58-year-old female. A review of the English literature revealed four cases of metastatic carcinoid to the breast that presented as an isolated breast mass. In each case, radical mastectomy was performed after the lesion had been interpreted clinically and pathologically as a primary carcinoma. When the primary tumor was excised, all cases had either regional lymph node or liver involvement. A mass was the usual presenting sign of the metastatic deposit. No metastasis was reported to be greater than 2 cm in diameter. No axillary lymph nodes were reported to contain tumor. Frozen section preparations may not be adequate to differentiate a primary carcinoma of the breast from a metastatic carcinoid tumor, thereby necessitating permanent sections, special stains, review of previously resected neoplasms, or electron microscopy. The first mammogram of a metastatic carcinoid to the breast is reported with this case.

Metastatic disease to the breast: clinical, pathologic, and radiographic features.

Metastatic lesions to the breast are unusual. We add 21 cases to the previously reported 131 clinical cases. The most common sources are malignant melanomas and the lymphoma/leukemia group. Metastatic lesions to the breast tend to be painless discrete lumps that are generally small at the time of discovery. They usually occur in the upper outer quadrant and are commonly associated with axillary adenopathy. Occasionally, they are the initial manifestation of an occult extramammary primary cancer. Prognosis is poor but appears slightly improved since availability of more refined chemo- and immunotherapeutic regimens. The clinical, pathologic, and radiographic features of this problem are described.

Incidence of bone metastases in women with minimal and occult breast carcinoma.

A total of 42 women with proved minimal (14) or occult (28) breast carcinoma were evaluated for up to 48 months (mean = 28 months). Bone scans, radiographs, blood chemistries, enzyme levels, and operative findings demonstrated metastases only in those 6 patients (14%) who presented with symptomatic metastases from an unknown primary source. The other 36 women are free of metastases. Preoperative radionuclide bone scans may not be necessary for women with minimal and asymptomatic occult breast cancers.

Xerographic manifestations of male breast disease.

Male breast disease, although overshadowed by its female counterpart, is still a problem which often comes to the attention of the radiologist. The major importance of mammography is differentiating unilateral gynecomastia from cancer. We now recognize four xeroradiographic patterns of gynecomastia: (1) increased ducts only; (2) ductal hyperplasia mimicking adenosis; (3) small ducts with stromal proliferation; and (4) fatty replacement only. These reflect the duration of the process. Gynecomastic masses are central, smooth, and most important, extend from the nipple outward, usually bisecting the midplane. Ducts may be visible. Carcinoma is usually central, dense, with irregular spiculated margins and, unlike gynecomastia is rarely in the midplane of the nipple, although it can be retroareolar in location. There may be concomitant skin changes or lymphadenopathy seen on the xerogram and these never occur in gynecomastia. There are numerous etiologies for gynecomastia, and these have been discussed in detail. It is thought that the radiologist should be aware of the pathophysiology of male breast disease and understand its significance.

The use of xeroradiography in the investigation of diseases occurring in the central nervous system.

A total of 88 cases of normal and pathological conditions of the skull, brain and spinal cord was studied by skull series, pneumoencephalography, and air myelography. The roentgenographic images of these structures were recorded by conventional roentgenograms, xeroradiograms, and tomogrrams and compared with each other. In general the high resolution and wide recording latitude of xeroradiography produced a more pleasing, sharper image than that obtained by conventional roentgenography. However, the individual tomographic image was superior to xeroradiography.

Lobular carcinoma in situ of the breast: clinical, pathologic, and mammographic features.

Lobular carcinoma in situ (LCIS) was diagnosed in 165 surgical specimens (119 patients) at our institution between 1974 and 1987. LCIS was seen more often in younger women (mean age, 49 years) than other breast carcinomas were (mean age, 58 years). Sampling of a single breast revealed multifocal disease in 70% (96/138). When both breasts were sampled, bilateral foci were found in 50% (41/82). Of 165 breasts with foci of LCIS, 37% (61/165) had simultaneously occurring invasive cancers in the same breast. Direct mammographic-pathologic correlation of foci of LCIS was possible in 73 breasts (67 patients). Microcalcifications were an indication for biopsy in 49% (20/41) of breasts with a mammographic abnormality, but were a nonspecific finding often found in tissues adjacent to foci of LCIS. The mammogram was normal in 44% (32/73) of breasts with foci of LCIS. The mammograms of patients with LCIS and those from a group of age-matched control subjects were compared by using a modified form of Wolfe's criteria and the percentage of fibroglandular elements. LCIS was seldom found in an N1 breast (1% vs 29%) or in a breast with less than 25% of its parenchymal area occupied by fibroglandular density (3% vs 33%). Compared with the control group, breasts with LCIS had more than 50% fibroglandular density (85% vs 45%) and a much higher frequency of the DY pattern (56% vs 36%). More fibroglandular density was seen in the LCIS group at all ages. Postmenopausally, the frequencies of the DY pattern and fibroglandular density greater than 50% in LCIS patients were nearly double those in the control group. LCIS patients have disease of the entire breast parenchyma, characterized by multifocality and bilaterality of various forms of lobular disease. Their mammograms reveal a higher rate of the DY pattern and higher percentages of fibroglandular or parenchymal density than those of age-matched controls. In LCIS patients, persistence of the DY pattern, or large amounts of fibroglandular density postmenopausally supports the concept that mammographically dense breasts are a marker for increased cancer risk in women 50 years old and older.

Evaluation of mammographic screen-film systems.

Four screen-film systems were evaluated for their imaging properties in mammography, Modulation-transfer functions were measured at 40 kVp. Absolute screen-film sensitivities in mR and entrance exposures were measured with tungsten and molybdenum target tubes. Five radiologists viewed radiographs of a phantom containing microgranules of SiC ranging in diameter from 590 to 120 micrometer. The Rarex-B screen--composed of yttrium oxysulfide--performed best, allowing phantom radiographs at 185 mR with image quality sufficient to demonstrate microgranules greater than 330 micrometer in dimension.

Indurative mastopathy: a benign sclerosing lesion of breast with elastosis which may simulate carcinoma.

Five cases of a benign sclerosing lesion of breast are described. The lesion is characterized by a stellate, indurated zone of sclerosis and elastosis in a region of benign ductal proliferation. Because of the stellate configuration and frequently retracted cut surface, the lesion may grossly resemble scirrhous carcinoma. Microscopically, there is often entrapment of benign but distorted ducts at the sclerotic margin, which may further cause confusion with cancer. Of special interest is the radiographic appearance, which may be indistinguishable from scirrhous carcinoma. The term "indurative mastopathy" is a descriptively valid designation for these lesions.