Enhanced-image mammography.

A blurred-mass subtraction technique has been developed for mammography, which enhances small-object contrast and visibility throughout the breast area. The procedure is easy to implement and requires no additional exposure. Perception of low-contrast objects is improved by eliminating extreme light- and dark-image areas. Contrast of structures within certain portions of the breast is increased by compression into the high-contrast portion of the film characteristic curve. Detail visibility is also increased by the edge enhancement produced by this process. This paper describes the enhancement process and gives an analysis of its capabilities and limitations.

Whole-breast sonography.

Ultrasound has been found to be useful as an adjunct to mammography and physical examination of the breast. It has detected lesions not identified by any other modality and has allowed more precise diagnosis of palpable and/or radiographically demonstrated lesions. Ultrasound should not be used as the sole breast imaging modality, however, because of its inability to detect microcalcifications and its difficulty in demonstrating small solid lesions, particularly in the fatty breast.

Intramammary lymph nodes.

Radiographic, gross, and histopathologic studies on 158 whole breasts with primary operable carcinoma revealed intramammary lymph nodes in 28%, and of these breasts, 10% contained a metastatic deposit of carcinoma. Cancerous and noncancerous nodes were found in all quadrants of the breast with the positive ones being in the same quadrant as the carcinoma only 50% of the time. There was no demonstrable connection with the usual lymphatic drainage of the breast. With Stage II carcinoma, positive intramammary lymph nodes had no direct effect on prognosis, merely representing advanced disease and indicating a greater likelihood of axillary metastatic disease. There was a trend toward poorer prognosis in Stage I lesions with positive intramammary lymph nodes. This may indicate the Stage I carcinomas that have a similar prognosis as Stage II tumors. Conceivably, a Stage Ia, positive intramammary lymph node(s) but normal axillary lymph nodes, could be defined and used.

Mammographic parenchymal patterns and risk of breast cancer.

A 15-year prospective study of mammographic parenchymal patterns in 7,123 women over 30 with 658 prevalent and 131 incident primary breast neoplasms demonstrated that no pattern is a reliable indicator of initial or developing cancer. Cancer in glandular breasts is less frequent, more difficult to detect by mammography, and tends to remain prevalent compared with the more frequent tumors in fatty breasts. As women get older, their breasts assume similar patterns and the incidence of both prevalent and incident tumors increases. Parenchymal patterns cannot signify which breasts may remain glandular, nor which women may be at risk of cancer.

Transvaginal sonography: comparison with transabdominal sonography in the diagnosis of pelvic masses.

In a retrospective study, we compared transvaginal sonograms with transabdominal sonograms in 67 women referred for evaluation of palpable pelvic masses. The diagnoses included ovarian cyst (27), endometrioma (12), complex cyst (four), dermoid (three), infection (three), ovarian malignancy (two), and uterine fibroid (three). The final diagnosis was made surgically in 41 patients (61%) and by a combination of sonographic and clinical correlation in the remaining patients. More information about the internal architecture or anatomy of the mass was provided by the transvaginal images than by the transabdominal scans in 51 (76%) of the patients. Transabdominal sonography did not provide more diagnostic information in any of the patients examined. Transvaginal sonography was helpful in obese patients, in those with a large amount of bowel gas, and in those unable to achieve adequate bladder filling. Six simple cysts and four complex pelvic masses were identified solely on transvaginal sonograms. The results suggest that transvaginal sonography has considerable advantages over conventional transabdominal sonography in the evaluation of pelvic masses in women.

Enhanced image mammography.

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

X-ray calcifications as the only basis for breast biopsy.

Two hundred fifty-one consecutive patients were treated between 1964 and 1982 with mammographic calcifications as the only reason for breast biopsy. Patients with either clinical or x-ray findings other than calcifications were excluded. A correlation of the x-ray, pathology, and clinical experience is the basis of this report. Specimen radiography with paraffin section histology (i.e., no frozen section) was performed on all biopsy material. The procedure of specimen radiography that was utilized is described. A team approach involving radiologists, pathologists, and surgeons has been essential both to confirm excision of the calcifications and localize them for pathology study. Carcinoma was found in 45 patients (17%). A retrospective study of the calcifications was also undertaken to determine characteristics that would permit definitive radiographic diagnosis of benign or malignant disease.

Grids in mammography.

A special soft-tissue grid reduced scattered radiation to the receptor and resulted in improved contrast and visibility of small structures to the degree that increased kVp could be used during screen-film mammography. The reduction in radiation to the skin that is associated with the more penetrating higher kVp technique more than compensated for the Bucky factor of the grid. This technique allowed for better penetration of the base of large, dense breasts without the use of vigorous compression. Results that were obtained with a faster (2X) film are also presented and discussed.

Intramammary calcifications without an associated mass in benign and malignant diseases.

During a 16-year period, 42,888 clinical and radiographic breast studies were performed on 8,000 women. Of this number, 1,161 malignant and 5,270 benign lesions were histologically confirmed. Biopsy of 468 of the 721 breasts that had clustered calcifications not associated with a mass and that were subject to a five- to 16-year follow-up demonstrated 353 benign and 115 malignant lesions. Radiography of the biopsy specimen assured removal and proper study of the area of concern. Radiographic characteristics of the calcifications provide clues to estimate the risk of carcinoma. However, these signs are so nonspecific that all radiographically demonstrable clusters of stippled calcification require histopathologic study. Treatment prior to the formation of a mass provides an excellent prognosis.

Inflammatory carcinoma of the breast: A correlation of clinical, radiologic and pathogic findings.

In a study of 75 patients with inflammatory carcinoma of the breast seen at Emory University Clinic over a 38 year period, the average longevity from the time of diagnosis was 22 months and the 5-year survival 5.6%. The results of treatment were poor with all methods used, although supervoltage therapy improved local control, and when followed by mastectomy, gave the longest average local control and survival. The designation of inflammatory carcinoma as primary and secondary is often not applicable and should be dropped. Instead, the terms inflammatory carcinoma and recurrent inflammatory carcinoma seem more appropriate. It is suggested that in a number of patients fulfilling certain criteria, surgery should be contemplated and all others treated by non-surgical means. The diagnosis of inflammatory cancer is still primarily clinical. However, radiologic and pathology examination are invaluable to confirming the clinical impression and occasionally suggest the diagnosis before inflammatory signs appear.

Magnetic resonance imaging in the diagnosis of breast disease: use of transverse relaxation times.

The ability of magnetic resonance imaging (MR) to demonstrate breast carcinoma depends upon significantly different relaxation times in benign and malignant tissues. The authors conducted an in vitro study of transverse relaxation times (T2) of 393 breast tissue samples in order to establish a range of values for normal tissue, benign lesions, and carcinoma. All T2 values were multiexponential. Benign lesions were readily distinguished from both invasive and noninvasive carcinoma in samples containing fat or a mixture of fat and fibrous tissue; however, in purely fibrous samples there was some overlap of T2 values in benign and malignant tissues. Although the data acquisition and analysis requirements involved in this in vitro study exceed the capabilities of present whole-body MR imagers, the added understanding gained through efforts of this type may aid both interpretation of current images and future developments.