MAMMOGRAPHY: REPORT ON ITS USE IN WOMEN WITH BREASTS ABNORMAL AND NORMAL ON PHYSICAL EXAMINATION.

Abstract

This paper is a presentation of the roentgenographic findings in benign and malignant diseases of the breast, showing (a) the results of mammography in 2,000 women with breasts abnormal on clinical examination and (b) the preliminary results of a screening program. The use of mammography was limited until Egan (1) reported his experience in 1,000 examinations (634 patients) at the M. D..Anderson Hospital and Tumor Institute, Houston, Texas. Only sporadic reports appeared in the literature following its popularity in the early 1930's, Gershon-Cohen (2) contributing many articles on the examination and Leborgne (3) publishing his important observations of tumor calcifications. Technic The technic employed in this study was much like that described by Egan: low kilovoltage, high milliampere seconds, unfiltered x-ray beam, and industrial x-ray film (Table I). Two changes are considered to offer distinct advantages. No axillary view was obtained. It is necessary to include all the tail of the breast which can be accomplished readily on the lateral view; this roentgenogram shows the main breast mass, portions of the chest wall, all the tail and the contents of the axilla. The thickness of the soft tissues encountered differed considerably, and this was allowed for by the use of two films simultaneously during the exposure—Eastman Kodak Type M and AA. The M film permits an adequate roentgenographic image of the main breast mass. The AA film gives proper exposure of the tail of the breast, contents of the axilla, and structures near the chest wall. It also results in an overexposed image of the breast itself, which is frequently of some value. The cephalocaudad projection of the breast was obtained in the usual manner. Dosimetry Measurements of the dose received in small-and large-breasted women were made with entrance and exit determinations, including the axilla for each view. The dosimeters, of thermal luminescent lithium fluoride (Fig. 1), were also left in place during both exposures. The results were then averaged between the small and large breasts, and the difference between them approximated 25 per cent at the entrance ports. All figures are in rads except when specified as millirads. It is significant that depletion is nearly complete within the breast: 3.19 r entrance dose on the cephalocaudad projection with 150 mr exit dose. There is only one area of overlapping exposure; this is in the upper medial quadrant. Classificanon A classification of the patterns of benign and malignant disease as seen on the roentgenograms is of value. It must be approached, however, with the knowledge that the radiologist can duplicate the morphologic terms of the pathologist only up to a point. Benign Conditions The radiograph will usually reveal a dominant pattern of a benign condition of the breast. For convenience, two great groups may be recognized: mammary dysplasia (generalized and localized) and miscellaneous.