Specificity Of Mammography Research Articles

Sensitivity and specificity of mammography and adjunctive ultrasonography to screen for breast cancer in the Japan Strategic Anti-cancer Randomized Trial (J-START): a randomised controlled trial

Mammography is the only proven method for breast cancer screening that reduces mortality, although it is inaccurate in young women or women with dense breasts. We investigated the efficacy of adjunctive ultrasonography. Between July, 2007, and March, 2011, we enrolled asymptomatic women aged 40-49 years at 42 study sites in 23 prefectures into the Japan Strategic Anti-cancer Randomized Trial (J-START). Eligible women had no history of any cancer in the previous 5 years and were expected to live for more than 5 years. Randomisation was done centrally by the Japan Clinical Research Support Unit. Participants were randomly assigned in 1:1 ratio to undergo mammography and ultrasonography (intervention group) or mammography alone (control group) twice in 2 years. The primary outcome was sensitivity, specificity, cancer detection rate, and stage distribution at the first round of screening. Analysis was by intention to treat. This study is registered, number UMIN000000757. Of 72,998 women enrolled, 36,859 were assigned to the intervention group and 36,139 to the control group. Sensitivity was significantly higher in the intervention group than in the control group (91·1%, 95% CI 87·2-95·0 vs 77·0%, 70·3-83·7; p=0·0004), whereas specificity was significantly lower (87·7%, 87·3-88·0 vs 91·4%, 91·1-91·7; p<0·0001). More cancers were detected in the intervention group than in the control group (184 [0·50%] vs 117 [0·32%], p=0·0003) and were more frequently stage 0 and I (144 [71·3%] vs 79 [52·0%], p=0·0194). 18 (0·05%) interval cancers were detected in the intervention group compared with 35 (0·10%) in the control group (p=0·034). Adjunctive ultrasonography increases sensitivity and detection rate of early cancers. Ministry of Health, Labour and Welfare of Japan.

Diagnostic Value of Ultrasound in Female Patients With Nipple Discharge

The purpose of this study was to assess the contribution of ultrasound to the evaluation of patients with pathologic nipple discharge. A retrospective review was conducted of the records of females who presented with nipple discharge between January 1, 2009, and December 31, 2011. Pathologic nipple discharge was defined as discharge with one or more of the following features: unilateral, clear or bloody, and spontaneous. Patients underwent bilateral mammography followed by ultrasound directed at the subareolar portion of the affected breast. Radiologic findings and pathologic results were reviewed. Over a 3-year period, 327 females (mean age, 48 years; range, 13-88 years) presented with nipple discharge. Among these patients, 273 (83%) underwent surgical excision or clinical or radiographic follow-up at least 2 years after presentation and composed the study population. Among the 273 patients, 262 (96%) underwent mammography and 246 (90%) underwent sonography. Among 252 patients who had at least one pathologic feature of nipple discharge and underwent surgical excision or at least 2 years of follow-up, a total of 20 (8%) cases of ductal carcinoma in situ (DCIS) or invasive adenocarcinoma were diagnosed. DCIS or invasive adenocarcinoma was diagnosed in eight patients with normal sonographic findings. For the detection of DCIS and invasive adenocarcinoma, the sensitivity and specificity of ultrasound were 56% (10/18) and 75% (170/228); the sensitivity and specificity of mammography were 15% (3/20) and 98% (237/242). For females presenting with pathologic nipple discharge, ultrasound is a useful diagnostic tool and may be worth including in the routine evaluation.

English

Breast cancer is the second leading cause of cancer deaths in women today (After lung cancer) and is the most common cancer among women, excluding non-invasive non-melanoma skin cancers. Worldwide, breast cancer comprises 22.9% of invasive cancers in women and 16% of all female cancers.1 Mammography has been the basic imaging method in breast diagnostics, and the only tool suitable for screening.2 breast cancer Mammography is still the first line of the imaging investigation. USG has emerge as the most important adjunct to mammography in patients with breast lumps and normal or inconclusive mammographic findings. This is the prospective study on 50 patients reporting with complaints of breast lump in surgical OPD at Mahatma Gandhi Hospital, Sitapura, Jaipur. INTRODUTION: Worldwide, breast cancer comprises 22.9% of invasive cancers in women and 16% of all female cancers (WHO, 2008). According to an Indian health news report, one in 22 women's in India is likely to suffer from breast cancer during their life time. The figure is definitely more in America with one in eight being a victim of this deadly cancer.3 However the incidence of breast cancer is rising in every country of the world especially in developing countries such as India, especially in metropolitan cities. This is because more and more women in India are beginning to work outside their homes which allow the various risk factors of breast cancer to come into play. Mammography & sonomammography are widely used for the radiological evaluation of breast lumps. Both these procedures can be used individually or in adjunction to each other for the detection of nature (benign or malignant) of breast lump. Mammography has been the basic imaging method in breast diagnostics, and the only tool suitable for screening breast cancer (Tabar et al. 2000). Mammography is still the first line of the imaging investigation. The aim of interpreting mammograms is to find asymmetric densities, mostly circular or stellate lesions; parenchymal contour changes; architectural distortion and micro calcifications with or without associated tumor, which may indicate breast malignancy. 4 The sensitivity and specificity of mammography in detecting breast cancers are highly dependent on the composition of the breast parenchyma. Detection of cancer is difficult in patients with dense breast parenchyma (young, pregnant or lactating patients and patients on HRT) and mammographically non calcified tumours. A definite differentiation between cyst and tumours is also not possible in most of the cases. In response to these diagnostic deficiencies of mammography various modalities have been evaluated for the diagnosis of the breast cancer, including light-scanning, thermography, ultrasonography (US), isotope scanning, digital subtraction angiography, computed tomography and MR imaging, USG and MR being the most reliable of these.

Diagnostic value of breast MRI in patients with microcalcifications on mammography

Objective To investigate the diagnostic value of breast MRI in patients presenting with microcalcifications on mammography. Methods Eight four patients were retrospectively analyzed, who had mammographically detected BI-RADS (breast imaging reporting and data system) 3 to 5 microcalcifications and underwent breast MRI before surgical biopsy. All mammography and MR images were reviewed with BI-RADS.With histopathological diagnosis as golden standard, the sensitivity, specificity and accuracy of the two methods were calculated and compared with χ2 test or Fisher exact test. The diagnostic efficacy of the two methods was compared with ROC curve. Results Pathologic examination revealed 91 lesions in 84 patients including 49 benign lesions and 42 malignant lesions. For 21 lesions of category 3 microcalcifications, the specificity of mammography and MR was 100.0% (21/21) and 95.2% (20/21), which had no significant difference (P=1.000). For 51 lesions of category 4, sensitivity, specificity and accuracy of mammography were 100.0%(23/23), 0 and 45.1%(23/51). The corresponding values for MR were 91.3%(21/23), 82.1% (23/28) and 86.3% (44/51). The difference for specificity and accuracy between the two methods was statistical significant(χ2 value was 30.030 and 19.182, respectively, with P<0.01), but not for sensitivity(χ2= 0.523, P=0.470). Nineteen lesions of category 5 were all correctly diagnosed on mammography and MRI. For all the 91 lesions, the sensitivity, specificity and accuracy of mammography were 100.0% (42/42), 42.9% (21/49) and 69.2% (63/91), respectively. The corresponding values for MRI were 95.2 % (40/42), 87.8% (43/49) and 91.2% (83/91). There was significant difference for specificity and accuracy between the two methods (χ2 value was 21.798 and 13.851, respectively, with P<0.05), but not for sensitivity (χ2=0.512, P= 0.474). The areas under ROC curve for mammography and MR were 0.844, 0.945(P<0.01), for the estimation of the benign and the malignent. Conclusions Compared with mammography, breast MRI significantly improved the diagnosis of category 4 microcalcifications with increased specificity and accuracy. But for microcalcifications of category 3 and 5, MR didn't improve the diagnostic effect. Key words: Breast neoplasms; Mammography; Magnetic resonance imaging

Significance of Quadruple assessment of breast lump–A hospital based study

Background: Approximately 10% of breast masses are breast cancer. It is important for women with a breast lump to receive appropriate evaluation. Mammography has been the “gold standard” in breast cancer detection for &gt;40 years. Ultrasonography is non-invasive easily available, cheaper and accurate tool while Fine needle aspiration cytology has a high diagnostic accuracy rate in hands of experienced cytopathologist. Materials and methods: This was a retrospective and prospective study of 173 women attending radiology department in Manipal Teaching Hospital, Pokhara for mammography during a period of 18 months from January 2011 to June 2012.The age ranged from 20yrs to 75yrs. BIRADS score was given for both mammography and sonomammography. All malignant and suspicious cases had undergone fine needle aspiration cytology. Cytology reports were correlated with imaging study. Results: The most common age group for the breast lump was 40-49 years showing 65(37.57%) cases. Most lumps were seen on the left side 54.3% (94/ 173) cases and were seen in upper outer quadrant of the breast (74 cases). 11 cases each were given the BIRADS score of 4 in both mammography and sonomammography. Sensitivity and specificity of mammography and sonomammography were compared to cytologyreports. The sensitivity for mammogram was 73.7% while specificity was 96.3%. The sensitivity and specificity for sonomammogram was 78.9% and 95% respectively. Conclusion: Quadruple assessment i.e. clinical assessment, mammography, sonomammography and cytological study are the new “gold standard” in the investigation of breast disease. DOI: http://dx.doi.org/10.3126/jpn.v4i8.11499 Journal of Pathology of Nepal; Vol.4,No. 8 (2014) 630-634

Contrast-enhanced X-ray detection of breast microcalcifications in a murine model using targeted gold nanoparticles.

Microcalcifications are deposits of hydroxyapatite (HA) mineral within breast tissue and the most common abnormality detected by mammography when screening for breast cancer due to exhibiting greater X-ray attenuation than the surrounding tissue. However, the detection of microcalcifications is limited by the sensitivity and specificity of mammography. Therefore, the objective of this study was to investigate in vivo targeted delivery of bisphosphonate-functionalized gold nanoparticles (BP-Au NPs) for contrast-enhanced detection of microcalcifications using computed tomography (CT). A murine model was developed for precise, a priori control over the level of microcalcification burden by injecting varying concentrations of HA crystals in a Matrigel carrier into mammary glands. The measured X-ray attenuation of microcalcifications containing varying HA concentrations demonstrated that the model was reproducible and able to recapitulate varying levels of microcalcification burden, including levels undetectable by CT in the absence of contrast enhancement. After intramammary delivery, BP-Au NPs provided enhanced contrast for the detection of microcalcifications that were otherwise below the CT detection limit. BP-Au NPs targeted microcalcifications due to specific binding to HA crystal surfaces, resulting in contrast between the HA microcalcification site and surrounding tissue which was visibly apparent (∼30-135 HU) within 2 days after delivery. Therefore, targeted BP-Au NPs enabled improved sensitivity and specificity for the detection of microcalcifications.

Is clinical breast examination effective in Japan? Consideration from the age-specific performance of breast cancer screening combining mammography with clinical breast examination.

There is controversy about the value of clinical breast examination (CBE) in breast cancer screening programs that include mammography. In Fukui Prefecture, a screening combining mammography with CBE was employed on 62,447 women from 2004 to 2009. We examined the sensitivity and specificity of mammography alone, and mammography and CBE together for each age group (40-49, 50-59, 60-69, and 70-79). 167 breast cancers and 49 false-negative cancers were detected during 5 years. For the combined screening, the sensitivities were 73.1, 74.1, 78.3, and 86.5 %, and the specificities were 83.8, 87.5, 89.8, and 90.9 % in the groups of 40-49, 50-59, 60-69, and 70-79 years, respectively. In the mammography-specific analysis, sensitivity decreased to 69.8 % (-3.3 %), 66.7 % (-7.7 %), 77.3 % (-1.0 %), and 83.8 % (-2.7 %) in the groups of 40-49, 50-59, 60-69, and 70-79 years, respectively. There were greater reductions in the groups of 40-49 and 50-59 years than in those of 60-69 and 70-79 years, but there was no statistically significant decrease. Specificity generally increased with increasing age and there was a significant improvement in specificity among all age groups, except that of 70-79 years. Our findings suggest that there is a trade-off between sensitivity and specificity associated with CBE added to mammography. This tendency is greater in those 40-50 years of age than in those 60-70 years of age. We consider that CBE may be omitted from breast cancer screening among women aged 60 and 70 years. Furthermore, another modality to complement mammography screening in younger Japanese women is expected.

Complementary Role of Semiquantitative Analysis of Breast-Specific Gamma Imaging in the Diagnosis of Breast Cancer

We investigated whether the interpretation of breast-specific gamma imaging (BSGI) with visual and semiquantitative analyses can improve the diagnosis of breast cancer. The records of 114 women (mean age±SD, 49.6±9.8 years) who underwent BSGI, mammography, and ultrasound to evaluate a breast lesion or lesions were reviewed retrospectively. The breast lesions identified with BSGI were compared with those identified with mammography and ultrasound. BSGI was first interpreted visually, and then a semiquantitative analysis was performed. For the semiquantitative analysis, the uptake ratio for each breast lesion was calculated by dividing the tumor uptake by the contralateral normal breast uptake. Four of the 114 patients had two breast lesions, so a total of 118 breast lesions (42 malignant lesions and 76 benign lesions) were evaluated. A BSGI uptake ratio cutoff of 1.5, with values less than 1.5 indicating negative for cancer, as determined by receiver operating characteristic curve analysis of our data (area under curve, 0.874), was used for semi-quantitative analysis. The sensitivity and specificity of BSGI with visual analysis alone for assessing malignant breast lesions were 76.2% (32/42) and 81.6% (62/76), respectively. For BSGI with visual and semiquantitative analyses, the sensitivity and specificity were 76.2% (32/42) and 92.1% (70/76), respectively. The sensitivity and specificity for mammography were 57.1% (24/42) and 81.6% (62/76), respectively. For ultrasound, the respective values were 97.6% (41/42) and 61.8% (47/76). BSGI with visual and semiquantitative analyses had a significantly higher specificity than BSGI with visual analysis alone, mammography, and ultrasound (all, p<0.01). Semiquantitative analysis of BSGI with visual interpretation may be a useful complementary method for evaluating malignant breast lesions.

Breast screening revisited

Breast screening is the medical screening of asymptomatic, apparently healthy women for breast lump in an attempt to achieve an earlier diagnosis. The assumption is that the early detection will improve outcomes. In western countries, breast screening programs have led to a significant reduction in mortality and improved prognosis of patients with breast cancer. However in India, although the number of breast cancer are on the rise there is no such organized program. This article emphasizes on the importance of breast screening and protocol to be followed in our country where it can have significant impact on the prognosis.

Bisphosphonate-functionalized gold nanoparticles for contrast-enhanced X-ray detection of breast microcalcifications

Microcalcifications are one of the most common abnormalities detected by mammography for the diagnosis of breast cancer. However, the detection of microcalcifications and correct diagnosis of breast cancer are limited by the sensitivity and specificity of mammography. Therefore, the objective of this study was to investigate the potential of bisphosphonate-functionalized gold nanoparticles (BP-Au NPs) for contrast-enhanced radiographic detection of breast microcalcifications using two models of breast microcalcifications, which allowed for precise control over levels of hydroxyapatite (HA) mineral within a low attenuating matrix. First, an in vitro imaging phantom was prepared with varying concentrations of HA uniformly dispersed in an agarose hydrogel. The X-ray attenuation of HA-agarose compositions labeled by BP-Au NPs was increased by up to 26 HU compared to unlabeled compositions for HA concentrations ranging from 1 to 10 mg/mL. Second, an ex vivo tissue model was developed to more closely mimic the heterogeneity of breast tissue by injecting varying concentrations of HA in a Matrigel carrier into murine mammary glands. The X-ray attenuation of HA-Matrigel compositions labeled by BP-Au NPs was increased by up to 289 HU compared to unlabeled compositions for HA concentrations ranging from 0.5 to 25 mg/mL, which included an HA concentration (0.5 mg/mL) that was otherwise undetectable by micro-computed tomography. Cumulatively, both models demonstrated the ability of BP-Au NPs to enhance contrast for radiographic detection of microcalcifications, including at a clinically-relevant imaging resolution. Therefore, BP-Au NPs may have potential to improve clinical detection of breast microcalcifications by mammography.

Relevance of Mammography Associated with Echography in the Breast Cancer Screening

INTRODUCTION: the echographic evaluation may reveal small breast cancers uncharacterized with mammography. OBJECTIVE: To compare the diagnostic yield, defined as the proportion of women with positive screen test results and positive reference standard, and performance of screening with mammography versus mammography plus echography in women with breast cancer. METHODS: 5609 women participated, from November 2009 to March 2011, submitted to mammographic screening, following age criterion (> 40 years) in the absence of clinically palpable lump, coming from the Diagnostic Center for Detection and Monitoring of the Oswaldo Cruz Alemao Hospital (DCDM -OCAH). All underwent cynical, mammographic and echographic assessment. The imaging tests were performed by two radiologists indistinctly. The reference standard was defined as a combination of pathology and 12 months follow-up for and was available for 4483 (79. 9%) of the 5609 eligible women. We calculated the diagnostic yield, sensitivity, specificity of mammography, echography and the combination of both methods, as well as the positive predictive value of biopsy recommendations for mammography versus the other forms of study considered. RESULTS: One hundred and nineteen women (122 breasts) were diagnosed with cancer: 45 suspects on mammography alone, 30 on mammography plus echography, and 46 with echography alone. In only one case, none of the imaging methods showed malignancy. The diagnostic yield of mammography was 10. 0 per thousand women screened (45 of 4483), increasing to 16. 7 per thousand (75 of 4483) when combined with echography. The additional income was 6. 7 per thousand women screened (95% CI, P = 0. 002). The diagnostic sensitivity of mammography was increased from 37% to 72% when combined with echography (P = 0. 001). of the 46 tumors detected by echography alone, 30 (65%) were invasive, with an average size of 16mm (range 09- 41mm) and 37 of them (80%) had negative lymph nodes. The specificity of mammography versus mammography plus echography was 97% and 96% respectively. The positive predictive value for biopsy after mammography diagnostic investigation was 57% and by both methods 60%. CONCLUSIONS: the addition of echography to mammography improves your diagnostic yield of 10. 0 to 16. 7 per thousand women over 40 years, increase discreetly the ratio of false positives.

Mammography and Ultrasonography Reports Compared with Tissue Diagnosis - An Evidence Based Study in Iran, 2010

Breast cancer is the most prevalent cancer and the fifth cause of cancer death in Iranian women. Early detection and treatment are important for appropriate management of this disease. Mammography and ultrasonography are used for screening and evaluation of symptomatic cases and the main diagnostic test for breast cancer is pathological. In this study we evaluated mammography and ultrasonography as diagnostic tools. In this cross-sectional study 384 mammography and ultrasonography reports for 255 women were assessed, divided into benign and malignant groups. Suspected cases were referred for pathology evaluation. The radiologic and pathologic reports were compared and also comparison was performed based on age groups (more and less than 50 years old), history of breastfeeding and gravidity. Statistical analysis was performed by SPSS. The mean ages of malignant and benign cases were 49±11.6 and 43±11.2 years, respectively. Sensitivity and specificity for mammography were 73% and 45%, respectively. Sensitivity and specificity for ultrasonography were 69% and 49%, respectively. There were statistical differences between specificity of mammography in patients based on factors such as history of gravidity, breastfeeding and sensitivity in patients equal or more than 50 years old and less. Factors affecting different results in mammography and ultrasonography reports were classified into three groups, consisting of skill, experience and training of medical staff, and setting of instruments. It is recommended that health managers in developing countries pay attention the quality of setting and man power more than current status. Policy-makers and managers must establish guidelines regarding breast imaging in Iran.

64P Mammography and Ultrasonography Reports Compared with Tissue Diagnosis: An Evidence-Based Study, Iran, 2010

IntroductionBreast cancer is the most prevalent cancer and the fifth most frequent cause of cancer death in Iranian women. Early detection and treatment are important for appropriate management of this disease. Mammography and ultrasonography are used for screening and evaluation symptomatic cases and the main diagnostic test for breast cancer is pathology. In this study we evaluate mammography and ultrasonography as diagnostic tools. MethodsIt is a cross-sectional study evaluating 384 mammography and ultrasonography reports belonging to 255 women. According to these reports, patients were divided into two groups. The suspected cases were referred for pathology evaluation. The radiologic and pathologic reports were compared and comparison was performed based on age groups (more or less than 50 years old), history of breastfeeding and gravidity. Statistical analysis was performed by SPSS. ResultsThe mean ages of malignant and benign cases were 49 ± 11.6 and 43 ± 11.2 years, respectively. Sensitivity and specificity for mammography were 73% and 55%, respectively. Sensitivity and specificity for ultrasonography were 69% and 51%, respectively. There were statistical differences between the specificity of mammography in patients with or without history of gravidity, with or without history of breastfeeding and sensitivity between patients aged 50 or more and those less than 50 years old. ConclusionFactors affecting different results in mammography and ultrasonography reports were classified into three groups consisting of: skill, experience and training of medical staff, and setting of instrument. It is recommended that health managers in developing countries pay attention to the quality of setting and manpower more than is currently the status. Policy makers and managers must develop guidelines regarding breast imaging in Iran. DisclosureAll authors have declared no conflicts of interest.

Background Parenchymal Enhancement on Breast MRI: Impact on Diagnostic Performance

Breast density is documented to reduce sensitivity and specificity of mammography. However, little is known regarding the effect of normal background parenchymal enhancement on accuracy of breast MRI. The purpose of this study was to evaluate the effect of background parenchymal enhancement on MRI diagnostic performance. A review of our established MRI data identified all women undergoing breast MRI from March 1, 2006, through June 30, 2007. Prospectively reported background parenchymal enhancement categories of minimal, mild, moderate, or marked (anticipated BI-RADS MRI lexicon definitions) and assessments were extracted from the database for each patient. Outcomes were determined by pathologic analysis, imaging, and linkage with the regional tumor registry with a minimum of 24 months of follow-up. Patients were dichotomized into categories of minimal or mild versus moderate or marked background parenchymal enhancement. Associations with patient age, abnormal interpretation rate, positive biopsy rate, cancer yield, sensitivity, and specificity were compared using chi-square and z score tests. The study cohort included 736 women. Moderate or marked background parenchymal enhancement was significantly more frequent among patients younger than 50 years compared with those 50 years old and older (39.7% vs 18.9%; p < 0.0001). Moderate or marked background parenchymal enhancement was also associated with a higher abnormal interpretation rate compared with minimal or mild background parenchymal enhancement (30.5% vs 23.3%; p = 0.046). Positive biopsy rate, cancer yield, sensitivity, and specificity were not significantly different according to background parenchymal enhancement category. Increased background parenchymal enhancement on breast MRI is associated with younger patient age and higher abnormal interpretation rate. However, it is not related to significant differences in positive biopsy rate, cancer yield, sensitivity, or specificity of MRI.

Evaluation of the clinical performance by using the effective DQE for a prototype digital breast tomosynthesis system

Early experience with the application of tomosynthesis to breast imaging has shown the potential of digital breast tomosynthesis (DBT), which can improve the specificity of mammography with improved marginal visibility of the lesion and early breast cancer detection, especially for women with dense breasts. The purpose of this study is to characterize the physical properties of the DBT system and to optimize the exposure conditions by using the modulation transfer function (MTF), the noise power spectrum (NPS), the scatter fraction, the transmission fraction and the effective detective quantum efficiency (eDQE) for different breast thicknesses. The first-generation KERI prototype digital tomosynthesis system for breast imaging using a CMOS flat panel detector was used in this study. The spatial frequency depend on metrics depend on both the inherent properties of the detector and the imaging geometry including breast thickness. For a thicker breast, the eDQE decreases as the scatter fraction increases at a fixed tube voltage. Moreover, the MTF shows no significant difference with changing tube voltage while the eDQE at 27 kVp is slightly degraded. Consequently, the above critical properties of the DBT system for different exposure conditions and breast thicknesses should be fully considered before building the system and using it application in clinical applications.

Outcome of mammography in women with large breasts

Mammography has been established as an effective screening tool for the early detection of breast cancer. Obesity may lead to increased breast size and has been linked to increased rates of breast cancer. As women with larger breasts may be predisposed to developing cancer, it is important that mammography is an appropriate test in these women. This study investigated the sensitivity and specificity of mammography in women with larger breasts in a population screening program. MethodData was obtained from 848 648 eligible screening episodes of women aged over 40. Of these episodes, 758 860 were eligible for the study, with 7.2% (54 879 screens) deemed to have large breasts. Large breasts were defined as those for whom at least one large cassette was used in the mammographic process. Those women having only four standard cassettes per screen were classified as having average size breasts (703 981 screens, 92.8%). Cancer detection rates, interval cancer rates (false negatives) and recall to assessment rates were compared for women examined on standard sized cassettes versus large cassettes. Chance corrected measures of sensitivity and specificity and 95% confidence intervals (CI) were calculated for women with and without large breasts. ResultsThe study found that the sensitivity and specificity of mammography was greater for larger breasted woman. The incidence of breast cancer was also found to be higher in woman with larger breasts in the combined population (73.1 per 100,000 (95% CI 65.9–80.2) in large breasted women versus 52.8 (95% CI 51.1–54.5) in other women) and in each of the specific age groups. This study confirms the appropriateness of mammographic screening for women with large breasts.

Differential diagnosis of breast calcifications on screening mammography

Objective. Sensitivity of mammography in detection of calcifications in breasts is 97%. Considering the fact that calcifications follow some malignant diseases of breasts, defining the nature of calcifications is significant in diagnosis of breast diseases although, in some cases, there is overlapping of their appearance in benign and malignant changes. Method. In the Ministry of Health National Program for early detection of breast cancer, in Health Center 'Studenica' Kraljevo, 3090 mammography examinations were done on mobile mammography from 01.06.2009. to 10.10.2009. Results. Out of 3090-mammography examinations, there were 290 patients in category BI RADS 3, 93 patients in category BI RADS 4, 3 patients in category BI RADS 5. Microcalcifications were detected at each the eighth mammography examination. Specificity of mammography in differential diagnosis of calcification nature is considerably less than its sensitivity but the mammography is still the most sensitive method of detection of breasts calcification. Conclusion. The mammography is an important method of examination, particularly in screening programs, because it is a reliable and accessible tool and its implementation is simple and fast.

Mammographic evaluation of palpable breast masses with pathological correlation: a tertiary care centre study in Nepal

Introduction: Breast cancer is one of the major health problem for all countries. . In Nepal , breast cancer is the second most common cancer in female. Early detecting tools like mammography can able to detect location , size, morphology, and nature of breast lesions that can help to reduced mortality and morbidity from breast cancer significantly. Methods: This prospective study was carried out at the department of Radiology, Surgery and Pathology for a period of one year. A total of 100 patients with clinically palpable breast lump were subjected to mammography and subsequently to FNA or biopsy. The mammograms were reviewed by two senior consultant radiologists and pathology by a senior pathologist. Results: Out of 100 patients, 65% had mammographic features of benign lesion and 35% had features of malignancy. Pathology revealed 64% of lesion to be benign and 36% of lesion to be malignant. There were four false negative (6.2%) and three false positive (8.6%) cases. The sensitivity and specificity of mammography were 88.9% and 95.53% respectively. The mean age of patient with malignant lesion was 46.3 years (SD=11.5) and 34.7 years (SD=10.6) for benign lesions. Among malignant lesion 37.1% had lobulated, 14.3% had oval, 31.4% round and 17.1% had irregular shape with spiculated margin in 60% and indistinct margins in 34.3%. Among benign 7.7% showed lobulated shape, 41.5% oval and 50.8% round shape. Circumscribed margin was found in 93.9% of benign and 5.7% of malignant lesions. Punctuate and polymorphic calcification was found in malignant lesions (25.7% and 5.7%). Secondary changes were found in only in the malignant cases. Halo sign was found only in benign cases and most common in fibroadenoma (38.4%). Conclusions: Mammography is an effective diagnostic tool for benign and malignant characteristic of palpable breast mass. Keywords: Breast lump; mammography; micro calcification DOI: http://dx.doi.org/10.3126/joim.v32i2.4940 Journal of Institute of Medicine, August, 2010; 32: 21-25

Mammographic evaluation of palpable breast masses with pathological correlation: a tertiary care centre study in Nepal

Introduction: Breast cancer is one of the major health problem for all countries. . In Nepal , breast cancer is the second most common cancer in female. Early detecting tools like mammography can able to detect location , size, morphology, and nature of breast lesions that can help to reduced mortality and morbidity from breast cancer significantly. Methods: This prospective study was carried out at the department of Radiology, Surgery and Pathology for a period of one year. A total of 100 patients with clinically palpable breast lump were subjected to mammography and subsequently to FNA or biopsy. The mammograms were reviewed by two senior consultant radiologists and pathology by a senior pathologist. Results: Out of 100 patients, 65% had mammographic features of benign lesion and 35% had features of malignancy. Pathology revealed 64% of lesion to be benign and 36% of lesion to be malignant. There were four false negative (6.2%) and three false positive (8.6%) cases. The sensitivity and specificity of mammography were 88.9% and 95.53% respectively. The mean age of patient with malignant lesion was 46.3 years (SD=11.5) and 34.7 years (SD=10.6) for benign lesions. Among malignant lesion 37.1% had lobulated, 14.3% had oval, 31.4% round and 17.1% had irregular shape with spiculated margin in 60% and indistinct margins in 34.3%. Among benign 7.7% showed lobulated shape, 41.5% oval and 50.8% round shape. Circumscribed margin was found in 93.9% of benign and 5.7% of malignant lesions. Punctuate and polymorphic calcification was found in malignant lesions (25.7% and 5.7%). Secondary changes were found in only in the malignant cases. Halo sign was found only in benign cases and most common in fibroadenoma (38.4%). Conclusions: Mammography is an effective diagnostic tool for benign and malignant characteristic of palpable breast mass.

Hormone replacement therapy and breast disease

Key content It is the addition of a progestogen that confers the increased risk of breast cancer diagnosis associated with HRT. Risk may be reduced by the use of combined regimens containing progesterone‐derived progestogen or dydrogesterone. The levonorgestrel‐releasing intrauterine system may be associated with an increased risk of breast cancer diagnosis. HRT may reduce the sensitivity and specificity of mammography but there is no direct clinical evidence that this reduces the small mortality benefit derived from the NHS Breast Screening Programme. Although breast cancer diagnosis may be increased with HRT, there is no robust evidence for an adverse effect on breast cancer survival. Learning objectives To understand the limitations of existing evidence. To acknowledge that uncertainty remains. Ethical issues Is it ethical to publicise risk factor data in terms of risk ratios and percentage changes? In the case of an uncertain intervention such as HRT for symptom alleviation, how can risk be balanced against benefit among women at high risk of breast cancer or breast cancer recurrence? Please cite this article as: Marsden J. Hormone replacement therapy and breast disease. The Obstetrician &amp; Gynaecologist 2010;12:155–163.