Mammographically guided ultrasound: a new technique for assessment of impalpable breast lesions.

A new technique for the assessment and localization of breast lesions is described. The position of a lesion is identified mammographically using a fenestrated compression plate. This allows access for an ultrasound probe directly over the lesion. This technique has proved valuable in the assessment of breast lesions and a simple inexpensive, reliable method of localization. We give a preliminary report of our results.

Unusual hyperechoic ultrasound appearance of testicular Leydig cell tumour.

Patients with a testicular mass are usually investigated by ultrasound and the ultrasound appearances have been correlated with the histology. The authors describe two patients with Leydig cell tumours. The first had bilateral tumours which although histologically typical of Leydig cell tumours, had differing ultrasound appearances, one with a previously unreported hyperechoic appearance. The second patient had an impalpable tumour with similar ultrasound appearances to those previously described. The paper illustrates the difficulty of giving an accurate diagnosis of solid testicular lesions and also shows that the previously described appearance of Leydig cell tumour is not pathognomonic.

Ultrasound demonstration of small breast cancers detected by mammographic screening.

The visibility on ultrasound (US) of 79 screen-detected small breast cancers was studied retrospectively. Overall visibility on US was 61% (48/79). Cancers presenting as microcalcification alone on mammography were rarely demonstrated (1 of 26 tumours). However, the US visibility of cancers with other mammographic appearances was 88.7% (47/53). The majority of cancers were impalpable but were demonstrated using free-hand ultrasound. All cancers visible on US appeared as hypoechoic masses with three quarters of these showing distal attenuation. US is useful in assessing and localizing small cancers detected by mammographic screening.

Screening for breast cancer detects tumours at an earlier biological stage.

Between August 1988 and July 1990, 17,678 women in the Gateshead, Sunderland, South Tyneside and Durham districts attended the national breast screening programme. A total of 131 cancers were detected. The morphology of cancers detected by screening was compared with that of tumours in 71 patients presenting clinically in the same period. Screen-detected cancers included a higher proportion of tumours of more favourable histological grade and type, were smaller in size and had less axillary lymph node involvement than those detected clinically. Survival was predicted from the Nottingham Prognostic Index. Patients with screen-detected cancer had an expected survival advantage (95 per cent confidence interval) of 26.5 (12.3-40.6) per cent at 5 years, 26.5 (11.8-41.2) per cent at 10 years and 29.1 (14.5-43.7) per cent at 15 years. This survival advantage in screened patients expected at 5, 10 and 15 years is consistent with the 30 per cent reduction in mortality rate demonstrated in the Health Insurance Plan study and the Swedish two counties trial.