Preoperative Mammograms Research Articles

Immediate postoperative mammogram for failed surgical excision of breast lesions.

In a series of 200 consecutive preoperative needle localizations of non-palpable breast lesions, 128 lesions (64%) were calcified and 72 lesions (36%) were noncalcified on preoperative mammograms. Radiographs of the surgical specimen failed to confirm excision of 11 lesions (5.5%), seven calcified and four noncalcified. These 11 patients were taken directly from the surgical suite to the radiology suite, where an immediate postoperative mammogram was obtained. In five patients (2.5%), immediate postoperative mammograms showed surgical failure with the lesion still present. In six patients (3.0%), immediate postoperative mammograms showed that the lesion had been removed, even though the lesion had not been identified on surgical-specimen radiographs. No errors occurred in the interpretation of immediate postoperative mammograms, a fact corroborated by examination of surgical specimens obtained at repeat surgery in three patients and identification of skin calcifications in two patients, and with follow-up mammograms in six patients. Whenever a discrepancy between preoperative localization radiographs and surgical-specimen radiographs exists, the authors suggest immediate postoperative mammography to improve the diagnostic process.

Mammography in the pre-operative assessment and post-operative surveillance of patients treated by excision and radiotherapy for primary breast cancer

To evaluate the place of mammography in the selection of patients for excision and radiotherapy for primary breast cancer a detailed analysis of pre-operative mammograms was performed in (i) a study group of 37 patients who developed local recurrence; (ii) a matched control group with a median local recurrence free survival of 57 months. There were significantly more multifocal tumours in the study group. Tumours were significantly larger (P = 0.02) and closer to the nipple (P = 0.008) in the study group compared to the control group. Regular follow-up mammograms were available in 26 of the study group. Twenty-one patients had mammographic evidence of either residual or recurrent tumour. We conclude that pre-operative mammography is essential in the selection of patients for excision and radiotherapy. Following treatment, mammography is useful in detecting residual or recurrent disease.

The accuracy of mammographic diagnosis in surgically occult breast lesions

This paper reports a retrospective study of 69 breast biopsies carried out for surgically occult but radiologically apparent lesions. Specimen radiography was required to confirm excision. The group included 17 carcinomas. Review of the pre-operative mammogram reports provided by a 'pool' of general radiologists demonstrated a high sensitivity (88%), but poor specificity (32%), with an overall accuracy of 46%. 'Blind' review of the mammograms by one experienced mammographic radiologist showed high sensitivity (100%), good specificity (73%) and overall accuracy of almost 80%. This result shows the need for the most experienced radiologist available to be involved in deciding which of these difficult lesions require biopsy. This will reduce unnecessary breast surgery and highlights the role of clinical and radiological review instead of biopsy, the need for continuing self audit by radiologists and the need for regular communication between clinicians, radiologists and pathologists.

Occult Breast Cancer Presenting With Axillary Metastases

An isolated axillary lymph node metastasis in a woman without an obvious clinical primary site most frequently originates from the breast. Mastectomy has been the historical treatment of choice. A retrospective study of 35 patients was undertaken to evaluate the roles of modern mammography, breast preservation, and adjuvant systemic therapy in the management of these patients. Twenty-eight patients underwent a mastectomy, while 7 were managed by a combination of limited resection and/or axillary dissection and radiation therapy. Twenty-two (67%) of the 33 breast specimens contained carcinoma. Comparison of the pathologic results with the preoperative mammograms showed a specificity of 73%, while the sensitivity was only 29%. Actuarial 5-year survival after mastectomy or breast preservation was similar (77% and 65%, respectively). Patients with more than one positive lymph node benefited from adjuvant therapy. Mammography does not locate the majority of occult stage II breast cancers, and both breast preservation and adjuvant therapy may have roles in the management of these patients.

Lipomatous pseudomass of the breast: diagnosis suggested by discordant palpatory and mammographic findings.

Focal fat collections or lipomas in the breast occasionally present as dominant palpable masses. A retrospective review was done of tissue obtained from 14 breast biopsies performed on the basis of palpatory findings; the specimens consisted almost entirely of fat. Preoperative mammograms were available in nine of these women and all showed the breasts to be composed largely of fat. In three patients there was virtually complete replacement of breast tissue by fat. In selected patients with fatty replacement of breast parenchyma, discordant palpatory and mammographic findings should suggest the diagnosis of a fatty mass or pseudomass and possibly obviate biopsy for purposes of tissue diagnosis.

Delayed Diagnosis of Breast Cancer as a Result of Normal Mammograms

To the Editor. —The result of delay in diagnosing and treating a breast cancer because of a falsely negative mammogram (Archives1983;118:23-24) deserves attention by all physicians. Because of the highly publicized results of screening mammography, with the roentgenographic detection of unsuspected and impalpable breast cancers, many physicians and their patients have come to rely on a negative radiology report as assurance that no malignant neoplasm is present, even if a palpable abnormality is present. In a series of 106 consecutive breast cancers operated on, I reported the role of mammography. 1 In 31% the preoperative mammogram was considered negative (demonstrating no pathologic features). The radiologist incorrectly described 10% of the lesions as benign, as either a cyst or fibroadenoma. A malignant neoplasm was suspected or correctly diagnosed in only 59% of these patients. A biopsy was not performed initially in 12 patients because a cancer had not been diagnosed

The detection and significance of calcifications in the breast: a radiological and pathological study.

The radiological detection of calcification is compared using xeroradiography, non-screen film and a film-screen combination. The "threshold" values of the smallest detectable size of calcification, under simulated clinical conditions, are found to be approximately 100 mum for xeroradiography and 400 mum for both the film techniques in this study. The incidence of calcification seen on the preoperative mammograms of patients with carcinoma of the breast is 48-5 per cent. Further calcification revealed by histological examination raises the overall incidence of calcification in mammary carcinomas to 63 per cent. The incidence on preoperative mammograms in benign breast disease is 20 per cent. The radiological features of calcification occurring in malignant and benign breast lesions are recorded, and no definitive distinguishing features are established. The histological appearance of calcification in malignant and benign breast disease is discussed.

Experience with opposite breast biopsy in patients with operable breast cancer.

One hundred and nine patients with unilateral breast carcinoma and no palpable abnormality of the contralateral breast were evaluated by opposite breast biopsy. Our patient population yielded four noninfiltrating carcinomas, and one infiltrating carcinoma for an incidence of 4.5%. The one infiltrating cancer was suspected on a preoperative mammogram. We have discontinued the routine use of the opposite breast biopsy as a diagnostic tool in patients with unilateral breast cancer, in patients with no palpable abnormality and a normal mammogram.

Proceedings: How vital is mammography in the diagnosis and management of breast carcinoma?

Of 309 patients with verified breast carcinomas, preoperative mammograms were positive for 66%. This detection rate probably would have been higher if mammograms had not been omitted for many clinically obvious breast carcinomas during the seven-year period of study. The significant occurrence of false-negative examination results when mammography is used under day-to-day clinical conditions emphasizes the prime importance of physical examination in the recognition of breast carcinoma. The procedure is of greater than supportive diagnostic value, however, in the detection of breast carcinoma, because a significant number (11% in this study) can be detected early only, or primarily, by mammography. Categorizing patients into high-risk or problem cases provides selection for the vital and practical use of mammography in periodic screening and supports decisions in clinical management.

Specimen radiography--a mandatory adjunct to mammography.

The surgical specimens from 400 consecutive breast biopsies performed at the Virginia Mason Medical Center, Seattle, Washington, were radiographically examined, and the results were correlated with preoperative mammograms as well as clinical findings. Mammography was performed on 88.5% of the cases, and a total of 54 biopsies (13.5%) were performed because of suspicious radiographic microcalcifications without a palpable clinical mass. Specimen radiography was essential in these situations in order to document the adequacy of the biopsy and to localize the suspicious area for histologic examination. Fourteen (3.5%) clinically occult carcinomas were demonstrated in this manner. Seven of these were of microscopic size and most surely would have been missed had it not been for this procedure. Radiographic examination of the remaining 346 biopsy specimens yielded one additional microscopic occult carcinoma containing calcifications visible by specimen radiography but not mammographically. The application of this procedure in the pathology laboratory is discussed, and its essential relationship to preoperative mammography is stressed.

Roentgenographic features of multicentric carcinoma of the breast.

ROENTGENOGRAPHIC FEATURES OF MULTICENTRIC CARCINOMA OF THE BREASTDAVID A. LEGGE, M.B., D.M.R.D. and DAVID M. WITTEN, M.D.Audio Available | Share