Suspicious Mammographic Lesions Research Articles

Developing a new case based computer-aided detection scheme and an adaptive cueing method to improve performance in detecting mammographic lesions

The purpose of this study is to evaluate a new method to improve performance of computer-aided detection (CAD) schemes of screening mammograms with two approaches. In the first approach, we developed a new case based CAD scheme using a set of optimally selected global mammographic density, texture, spiculation, and structural similarity features computed from all four full-field digital mammography images of the craniocaudal (CC) and mediolateral oblique (MLO) views by using a modified fast and accurate sequential floating forward selection feature selection algorithm. Selected features were then applied to a ‘scoring fusion’ artificial neural network classification scheme to produce a final case based risk score. In the second approach, we combined the case based risk score with the conventional lesion based scores of a conventional lesion based CAD scheme using a new adaptive cueing method that is integrated with the case based risk scores. We evaluated our methods using a ten-fold cross-validation scheme on 924 cases (476 cancer and 448 recalled or negative), whereby each case had all four images from the CC and MLO views. The area under the receiver operating characteristic curve was AUC = 0.793 ± 0.015 and the odds ratio monotonically increased from 1 to 37.21 as CAD-generated case based detection scores increased. Using the new adaptive cueing method, the region based and case based sensitivities of the conventional CAD scheme at a false positive rate of 0.71 per image increased by 2.4% and 0.8%, respectively. The study demonstrated that supplementary information can be derived by computing global mammographic density image features to improve CAD-cueing performance on the suspicious mammographic lesions.

Breast MR Imaging for Equivocal Mammographic Findings: Help or Hindrance?

Breast magnetic resonance (MR) imaging, because of its extremely high sensitivity in detecting invasive breast cancers, is sometimes used as a diagnostic tool to evaluate equivocal mammographic findings. However, breast MR imaging should never substitute for a complete diagnostic evaluation or for biopsy of suspected, localizable suspicious mammographic lesions, whenever possible. The modality's high cost, in addition to only moderate specificity, mandate that radiologists use it sparingly and with discrimination for problematic mammographic findings. It is rare that the reality or significance of a noncalcified mammographic finding remains equivocal or problematic at diagnostic mammography evaluation, which usually includes targeted ultrasonography (US). There are several reasons for this infrequent occurrence: (a) an asymmetry may persist on diagnostic views but be visible only on craniocaudal or mediolateral oblique projections, precluding three-dimensional localization for US or biopsy, or a lesion may persist on some diagnostic spot views but dissipate or efface on others; (b) uncertainty may exist as to whether apparent change is clinically important or owing to technical factors such as compression or positioning differences; or (c) a lesion may be suspected but biopsy options are limited owing to lack of a US correlate and lesion inaccessibility for stereotactic biopsy, or biopsy of a vague or questionably real lesion has been attempted unsuccessfully. This article will discuss the indications for problem-solving MR imaging for equivocal mammographic findings, present cases illustrating appropriate and inappropriate uses of problem-solving MR imaging, and present false-positive and false-negative cases affecting the specificity of breast MR imaging. (©)RSNA, 2016.

The localisation and distribution of endothelin receptors in normal and cancer colon tissues: Confirmation by autoradiography, immunohistochemistry and quantum dot targeting

ductal carcinoma of the breast. Methods: Peripheral venous blood samples were collected prior to diagnostic biopsy from women with suspicious non-palpable mammographic lesions. Plasma ET-1 and Big ET-1 levels were determined in 30 patients with IDC, 30 with DCIS and 30 with benign lesions (controls), by performing ELISA. ET-1 and VEGF tissue expression was immunohistochemically determined. Potential correlationswith histological grade, hormone receptor status, Her2/neu amplification, tumor size, lymph node involvement and disease stage were investigated in IDC. Results: Big ET-1 plasma levels were significantly higher in IDC and DCIS patients compared to controls (p b 0.001 and p b 0.01, respectively). No significant differences in ET-1 levels were observed between the three groups. Moderate to strong IHC staining for ET-1 was observed in 3/29 and 7/23 IDC and DCIS patients, respectively. VEGF was significantly expressed in 8/27 and 8/23 IDC and DCIS patients, respectively. In IDC, plasma and tissue expression of ET-1 and plasma expression of Big ET-1 did not correlate with any of the analyzed clinicopathological characteristics or VEGF tissue expression. Conclusions: Plasma levels of Big ET-1 were a more sensitive indicator of ET-1 deregulation than those of ET-1 in our study. Our results support the potential clinical application of Big ET-1 as a breast cancer biomarker.

Thermal damage of the specimen during breast biopsy with the use of the Breast Lesion Excision System: does it affect diagnosis?

Stereotactic vacuum assisted breast biopsy (VABB) procedures remain of key importance in the diagnostic evaluation of suspicious non-palpable mammographic lesions. The Breast Lesion Excision System(®) (BLES) is an image-guided percutaneous biopsy method that utilizes radiofrequency (RF) in order to retrieve an intact-tissue biopsy specimen. The purpose of this study is to determine the effects of RF application on the tissue specimen and the possible interference with the histopathologic results. In this study we included 265 patients with suspicious non-palpable mammographic lesions who underwent 273 stereotactic VABB procedures using the BLES. All biopsies were performed by the same surgical-radiology team under local anesthesia. The specimen thermal damage was classified according to the pathology report in 3 categories: Severe (extensive thermal damage or inability to diagnose), medium (ability to diagnose but either circumferential damage >1.5mm or diffuse areas of thermal damage) and mild (circumferential thermal damage <1.5mm but >0.5mm). Radiofrequency-associated thermal damage of the specimen was observed in 14 cases (5.13%), and was classified as severe in 5, medium in 5, and mild in 4 specimens. Within the group of RF damaged specimens, we found a significant (p<0.05) positive correlation between fat cell content and classification of thermal damage. Although thermal damage is of concern during BLES breast biopsy, the incidence is low, and the outcome of the histopathologic assessment is not affected even in severely damaged specimens. Increased thermal damage seems to correlate with higher fat cell content of the specimen.

A Typical Fat Necrosis of the Breast Mimicking Cancer Following Breast Reduction

Traumatic fat necrosis can result in a spectrum of imaging appearances that range from characteristically benign to those indistinguishable from malignancy in mammography. In such cases, biopsy might be required for diagnosis. The present case demonstrates a suspicious mammographic mass lesion appearing following a reduction mammoplasty

Circulating levels of endothelin-1 (ET-1) and its precursor (Big ET-1) in breast cancer early diagnosis

Deregulation of the endothelin system, comprised of endothelin-1 (ET-1), its isoforms (ET-2 and ET-3) and their receptors (ET(A)R and ET(B)R), is under investigation in various types of human cancer. ET-1 has been suggested to participate in breast cancer development and progression, while Big ET-1, its biological precursor, has also been found elevated in breast cancer patients. In the present study, we investigated plasma ET-1 and Big ET-1 levels in patients with suspicious mammographic lesions, in order to assess their potential application as diagnostic biomarkers in the early estimation of breast disease. The study consisted of 94 patients (Group A to 30 patients with invasive ductal carcinoma: Group B, 30 with ductal carcinoma in situ; and group C, 34 with papilloma or ductal hyperplasia), who underwent an image-guided vacuum-assisted breast biopsy, and 30 healthy controls (group D). ET-1 and Big ET-1 plasma levels were measured with enzyme-linked immunosorbent assay. ET-1 levels did not exhibit significant differences between patients and healthy controls (Group A to 0.92 fmol/mL; Group B: 0.90 fmol/mL; Group C: 0.66 fmol/mL; and Group D: 0.86 fmol/mL). In contrast, Big ET-1 levels were significantly higher in patients with invasive or in situ carcinoma compared to healthy controls (Group A: 0.69 fmol/mL; Group B, 0.62 fmol/mL; and group D: 0.39 fmol/mL; p < 0.001 and p < 0.01). Plasma Big ET-1 may provide a useful tool for the early detection of invasive or noninvasive ductal breast cancer. The utilization of such a diagnostic tool would greatly assist in the modern management of breast cancer.

Avaliação de uma estratégia para ampliar a adesão ao rastreamento do câncer de mama no Nordeste brasileiro

To evaluate the actions of the "Um Beijo Pela Vida" Program developed in a Brazilian Northeast city to increase adherence to breast cancer screening by women registered by the Brazilian Family Health Strategy for breast cancer screening. A quantitative approach was used to evaluate the coverage of screening actions for aged 40 years-old or more. Community workers from the nine Family Health Teams of the town carried out an active search. The percentage of eligible women who were screened for breast cancer by clinical breast examination or mammography, mammogram classification according to BI-RADS®, women screened who were referred for further testing and treatment, and the number of breast cancers detected were collected by means of a structured questionnaire, analyzed with the EPI-INFO TM software and compared to previously defined patterns. 3,608 women were included, corresponding to 68.4% of the target population registered in the Brazilian Family Health Strategy. Coverage rates of clinical breast examination for women aged 40 to 49 years-old and of mammograms for women aged 50 to 69 years-old were 58.9 and 56.7%, respectively. All women with highly suspicious mammographic lesions were submitted to fine needle aspiration or core biopsy (100%). Six new cases of cancer were detected and 80% of the standards established for this evaluation were carried out. The evaluation of the actions of the Program suggests its adequacy considering the degree of fulfillment of the previously defined requirements.

Serum calcitonin gene-related neuropeptide (CGRP) in patients with benign and malignant breast lesions: Correlation with mammographic breast density.

78 Background: The aim of this study was to assess the variation of the serum neo-angiogenic neuropeptide CGRP in patients with benign and malignant breast lesions and to evaluate its possible correlation with mammographic findings. Methods: Our study included forty eight women with histologically confirmed breast lesions: mild epithelial hyperplasia (MEH): n=12, florid epithelial hyperplasia (FEH): n=5, atypical hyperplasia (AH): n=4, ductal carcinoma in situ (DCIS): n=5, mixed in situ with invasive ductal carcinoma (DCIS+IDC): n=9 and pure IDC: n=13. Serum CGRP levels were measured by RIA methods and compared among the various groups by Mann-Whitney test. Mammographic breasy density (BD%) was calculated using computer-assisted methods and was correlated with serum CGRP concentration by applying linear regression analysis. Results: Serum CGRP concentration (mean±SD: pg/mL) in the various groups, was: MEH: 96.8±22.5, FEH: 135.5±33.5, AH: 139±44.4, DCIS: 131.4±37.5, DCIS+IDC: 1167.5±927.5, pure IDC: 198±82. DCIS+IDC lesions presented statistically significantly higher serum CGRP levels (versus: MEH p&lt;0.001, FEH p&lt;0.001, AH p&lt;0.001, DCIS p&lt;0.001 and IDC p&lt;0.001). Serum CGRP concentration presented statistically significant correlation with BD% (r=0.947, p&lt;0.0001). Conclusions: Statistically increased serum CGRP concentration was determined in women with DCIS+IDC lesions. The significant correlation between serum CGRP levels and BD, enhances the suggestion that DCIS+IDC represents a distinct pathological entity, associated with an interactive mechanism between BD and serum CGRP expression. Therefore, serum CGRP levels could constitute a future useful preoperative index of the nature or type of suspicious mammographic lesions, in order to schedule the appropriate therapeutic treatment, and potentially propounds the perspective of adjunctive therapeutic administration of anti-CGRP peptides.

Predictive factors for complete excision and underestimation of one-pass en bloc excision of non-palpable breast lesions with the Intact® breast lesion excision system

Image-guided percutaneous biopsy is the recommended initial diagnostic procedure for suspicious mammographic lesions. This study was conducted to determine the accuracy of the Intact(®) breast lesion excision system (BLES) and to identify predictive factors for complete excision and underestimation. A prospective study was conducted between January 28, 2008 and April 30, 2009 on 166 biopsy procedures using Intact(®) biopsy device. Diagnoses obtained from biopsy specimen were compared with to final diagnosis on surgical excision specimen. Of the 166 patients, 15 (9%) displayed lesions with cell atypia, 28 (17%) had an intra ductal carcinoma (IDC) and 9 (5%) had an invasive carcinoma. Eight of 15 patients with cell atypia had open surgical excision, and none showed underestimation. All patients with IDC underwent surgical excision: we found an invasive carcinoma in 6 cases (21.4% underestimation) and a complete removal of the lesion by the Intact(®) BLES in 11 cases (39%). All 9 patients with invasive carcinoma had a surgical excision, with 1 complete removal of the lesion by Intact(®) BLES. Multivariate analyses did not identify predictive factors for underestimation; clear margins ≥1mm on biopsy specimen was the only independent predictive factor of complete excision (OR=8.51, p=0.02). Intact(®) BLES provides a safe alternative to vacuum assisted core needle biopsy (VACNB) with an underestimation rate comparable to those previously reported for VACNB. The high rate of complete removal of the lesions, particularly ISC, offers an interesting perspective of avoiding subsequent excisional surgery for small lesions and thus requires further confirmational study.

Abstract P6-02-04: Breast Lesion Excision System — Intact®(B.L.E.S): A Novel Stereotactic Method of Biopsy Utilizing Radiofrequency for Suspicious Non-Palpable Mammographic Lesions

Abstract AIM: The Breast Lesion Excision System by Intact®(B.L.E.S) is a novel stereotactic, vacuum-assisted breast biopsy device that utilizes radiofrequency in order to completely excise any suspicious (BIRAD ≥4) non palpable mammographic lesion. The purpose of this clinical study is to evaluate the efficiency and success rate of the B.L.E.S system in the accurate diagnosis of any suspicious non-palpable mammographic lesions. MATERIAL AND METHODS: This study included 105 patients with suspicious non palpable mammographic lesions that visited the Breast Unit of the First Propaedeutic Surgical Clinic at Ippocration hospital from January 2008 to April 2010. The mammographic findings included suspicious microcalcifications, solid lesion and radial scars, all classified as BIRAD ≥4. The method was performed by the same surgical-radiologist team utilizing the Fisher's stereotactic table which includes a breast compression plate, incorporated digital mammography device, a robotic arm that carries the biopsy needle and a vacuum apparatus. The system is controlled by a central computer that performs the stereotactic localization. We utilize the 15mm or the 20mm tissue basket depending on the size of the lesion, trying to completely excise it with healthy margins, if possible. The procedure is performed under local anaesthesia (20ml of 2% Lydokaine) and is completed with a single needle pass. A 5-6 mm skin incision is performed and a retrieval basket is deployed to circumscribe the lesion, while radiofrequency is used to ablate the surrounding breast tissue. The basket containing the captured specimen is removed through the incision and the wound is dressed with steril strip. We routinely perform mammography on the specimen to insure the success of the biopsy and we place a titanium clip in the biopsy cavity to mark the area. RESULTS: One hundred and five patients with non palpable mammographic lesions underwent biopsy with the BLES — Intact® system. All lesions were excised completely, but not all with healthy margins especially in cases of DCIS with intraductal component. The histological findings included: Fibroadenoma: 38 (36.1 %), Invasive Ductal Breast Cancer with associated DCIS 14 (13.3 %), papilloma: 11 (10.4 %), Fibrocystic changes 11 (10.4 %), Papillary Apocrine Metaplasis 7 (6.6 %), Stromal Fibrosis: 7 (6.6%), mammary duct ectasia: 6 (5.71%), DCIS :5 (4.7%), Liponecrosis: 2 (1.9 %), Intramamary lymph node: 2 (1.9%), Invasive Ductal Carcinoma: 1 (0.95%), Invasive Ductal Carcinoma with associated lobular in situ (LCIS): 1 (0.95%). CONCLUSION: Suspicious non palpable mammographic lesions can be safely removed for histologic diagnosis utilizing the BLES — Intact® system. The method has the unique advantage of completely removing the lesion without cutting through it. This way the specimen retains its original architectural structure intact, which means even more accurate histologic diagnosis and thus lower underestimation rates. Furthermore, the BLES system alliviates all concern for possible tumor dissemination through the needle tract since it comes in no contact with the tumor and can remove the lesion with healthy margins. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-02-04.

Stereotactic large-core needle breast biopsy: analysis of pain and discomfort related to the biopsy procedure

The purpose of this study was to determine the significance of variables such as duration of the procedure, type of breast tissue, number of passes, depth of the biopsies, underlying pathology, the operator performing the procedure, and their effect on women’s perception of pain and discomfort during stereotactic large-core needle breast biopsy. One hundred and fifty consecutive patients with a non-palpable suspicious mammographic lesions were included. Between three and nine 14-gauge breast passes were taken using a prone stereotactic table. Following the biopsy procedure, patients were asked to complete a questionnaire. There was no discomfort in lying on the prone table. There is no relation between type of breast lesion and pain, underlying pathology and pain and performing operator and pain. The type of breast tissue is correlated with pain experienced from biopsy (P = 0.0001). We found out that patients with dense breast tissue complain of more pain from biopsy than patients with more involution of breast tissue. The depth of the biopsy correlates with pain from biopsy (P = 0.0028). Deep lesions are more painful than superficial ones. There is a correlation between the number of passes and pain in the neck (P = 0.0188) and shoulder (P = 0.0366). The duration of the procedure is correlated with pain experienced in the neck (P = 0.0116) but not with pain experienced from biopsy.

Comprendre et utiliser le CAD (Aide informatisée au diagnostic) en mammographie

Generalization of breast screening programs requires efficient double reading of mammograms, which allows reduction of false negative interpretations, but it may be difficult to achieve. CAD (Computed Aided Detection) systems are dramatically improving and can now assist in the detection of suspicious mammographic lesions, either suspicious microcalcifications, masses or architectural distortion. Characterization of the lesions is improving as well. CAD mammography might complete or substitute to “human“ double reading. The aim of this review is to present the main CAD systems commercially available, review the principles of CAD and discuss the results of CAD mammography. Specifically, the role of CAD within breast screening program, according to the results of recent prospective studies will be discussed.

Recognizing pitfalls in early and late migration of clip markers after imaging-guided directional vacuum-assisted biopsy.

Directional vacuum-assisted biopsy has become an irreplaceable tool in the management of suspicious mammographic lesions. Often, the entire lesion is removed and clips are used to localize the biopsy site. Postbiopsy mammograms are used to determine the adequacy of clip placement and the location of the clip. Clip displacement from the site of deployment is not an uncommon finding. Clips may migrate within the same quadrant where the lesion was located or to another quadrant of the breast. Clip migration may occur immediately after biopsy or may be seen on later follow-up mammograms. Clip migration can affect interpretation of mammographic findings and localization for future surgery. It should not be assumed that the clip is correctly located at the biopsy site on subsequent mammograms. It is essential to recognize the relationship of the clip to the targeted lesion to ensure accurate localization of lesions that require surgical excision.

Differentiation of Mammographically Suspicious Lesions: Evaluation of Breast Ultrasound, MRI Mammography and Electrical Impedance Scanning as Adjunctive Technologies in Breast Cancer Detection

AIM: Various modalities are used as an adjunct to mammography for differentiation of potentially suspicious breast lesions. Electrical impedance scanning (EIS) is a new technique based upon the principle that cancer cells exhibit altered local dielectric properties and thus show measurably higher conductivity values. The accuracy of differentiation of benign and malignant breast lesions was evaluated to determine whether EIS duplicates or supplements the results obtainable from ultrasound (US) or magnetic resonance imaging (MRI). MATERIALS AND METHODS: One hundred mammographically suspicious lesions were examined using US, MRI and EIS. Definitive histology was acquired through either lesion biopsy or surgical excision. RESULTS: Fifty of 62 malignant lesions were correctly identified using EIS (81% overall sensitivity), 24/38 benign lesions were correctly identified as benign (63% specificity). Negative predictive value and positive predictive value of 67 and 78% were observed, respectively. κ-factor evaluation revealed a value of 0.82 between MRI and EIS and 0.62 between US and EIS. CONCLUSIONS: EIS may be a valuable adjunct for differentiation of suspicious mammographic lesions. Based upon the calculated κ-factor, EIS results supplement US examinations. Artifacts (superficial skin lesions, poor contact, air bubbles) currently result in the high false-positive rate of EIS. Malich, A. et al. (2001). Clinical Radiology56, 278–283.

Estabilidad mamográfica de lesiones malignas: presentación de dos casos

We present two cases of suspicious mammographic images that remained stable over long periods of time (44 and 24 months). The biopsies revealed infiltrating ductal carcinoma and ductal carcinoma in situ. In one case, the lesion consisted of a cluster of microcalcifications, while the other was characterized by architectural distortion. There are very few references to this subject in the literature. We conclude that all suspicious mammographic lesions should be biopsied, despite previous evidence suggesting their stability, even over long periods of time.

Stereotactic 14G Core Biopsy of Non-palpable Breast Cancer: What is the Relationship Between the Number of Core Samples Taken and the Sensitivity for Detection of Malignancy?

AIM: Percutaneous 14-gauge core biopsy (CB) guided by digital stereotactic mammography is now an established technique in the investigation of women with non-palpable suspicious mammographic lesions. Diagnostic sensitivity of CB is affected both by the nature of the mammographic abnormality and by the number of core samples taken.METHODS AND RESULTS: A retrospective review of 500 women who have undergone CB in our institution showed that in 235 cases, invasive or non-invasive carcinoma was found on final surgical histology. Correlation between CB result and surgical histology revealed a significant increase in sensitivity for the diagnosis of malignancy if a larger number of cores were taken (84.3% for two cores and 90.2% for five cores vs. 97.9% for six or more cores). This trend was maintained when patients were subdivided according to mammographic abnormality, either soft tissue mass or microcalcifications. The effect on diagnostic sensitivity of increasing the number of tissue cores obtained was most pronounced in patients with microcalcifications graded as low or moderately suspicious for malignancy (70.1% for two cores and 79.1% for five cores vs 94.0% for six or more cores). The presence of an invasive component in a malignant lesion was correctly diagnosed using CB in 79.2% overall if at least six cores were taken. If the mammographic lesion was a soft tissue mass, this figure rose to 95.7%, but was only 35.7% if the visible lesion was composed of microcalcifications alone.CONCLUSION: Our series confirms the reliability of stereotactic CB in the diagnosis of breast carcinoma. Diagnostic sensitivity is improved by increasing the number of cores taken (to six or more), particularly in women with mammographic microcalcifications of an equivocal nature.Rich, P. M. (1999) Clinical Radiology54 , 384–389.

Stereotactic excisional breast biopsy performed by interventional radiologists using the advanced breast biopsy instrumentation system.

The Advanced Breast Biopsy Instrumentation (ABBI) system, which uses surgical cannulas up to 20 mm in diameter, is an alternative to conventional surgical biopsy for the diagnosis of non-palpable breast lesions. Since the need for radiological skill outweighs the surgical content of the technique, we evaluated the feasibility of complete management of the procedure by interventional radiologists. 35 of the 111 patients originally scheduled for the procedure were excluded, three because the lesion could not be visualized and 32 because of insufficient thickness of the compressed breast. The procedure had to be abandoned in one case due to a technical failure. 77 stereotactic excisional breast biopsy procedures were performed using the ABBI system in 75 patients with suspicious non-palpable mammographic lesions. The procedure was carried out under local anaesthesia in the radiology department, using a dedicated Lorad (R) radiographic system. 31 (40%) masses without calcifications, 11 (14%) masses with calcifications and 35 (46%) clusters of microcalcifications without tumour mass were sampled. 43 (56%) benign lesions and 34 (44%) malignant lesions were diagnosed. The overall mean diameter of the lesions was 8.7 mm (range 3-22 mm). All 34 patients with malignancies and lobular carcinoma in situ subsequently underwent surgery, the results of which are reported. Three (4%) haematomas were detected and aspirated percutaneously. Two technical problems occurred: an ABBI cannula malfunction, and a computer failure of the digital imaging system during the procedure. The average procedure time was 80 min and the cost of each procedure was 2,800,000 Italian lire (1555 US$). It is concluded that tissue sampling with the ABBI system can be performed entirely by radiologists without significant problems. The procedure was well tolerated by all patients. The quality of the biopsy specimen was identical to that of a surgical specimen but with the advantages of stereotactic precision for localization of the lesion.

Stereotactic breast biopsy as an alternative to excisional biopsy.

The current widespread use of modern mammography has increased the detection of suspicious mammographic lesions, which has led to a greater number of diagnostic surgical biopsies. Most of these lesions referred for surgical biopsy have been benign. The reduction in the number of benign surgical biopsies can reduce medical costs and unnecessary invasive breast surgery. Stereotactic large-core needle biopsies in patients with suspicious mammographic lesions can preselect the breast lesions that need further evaluation with surgical excisional biopsy. Our results with stereotactic large-core needle biopsies support this alternative approach to the workup of suspicious mammographic lesions.

Accuracy of mammographic appearances after breast fine-needle aspiration

OBJECTIVE: The objective of this study was to document the observation that fine-needle aspiration of palpable breast masses by use of a modified technique performed shortly before mammography need not adversely interfere with mammographic interpretation nor produce falsely suspicious mammographic lesions that delay meaningful evaluation and management in this breast clinic. STUDY DESIGN: In a retrospective record review 1007 women who were seen in the Breast Diagnostic Center at Women's and Children's Hospital from January 1992 until April 1995 and who had fine-needle aspiration of a palpable solid breast mass within 2 weeks before mammography were analyzed overall and in 10-year age group subsets. The mammographic reports of “suspicious” lesions were correlated with having had a prior fine-needle aspiration (within 2 weeks). RESULTS: Of the 1007 women undergoing fine-needle aspirations, 91 had a cytologic or tissue biopsy specimen diagnosis of malignancy. Of these, 72 had “suspicious” mammograms and 19 had “nonsuspicious” mammograms. The calculated positive predictive value was 58%. The negative predictive value was 98%. Mammographic sensitivity was 79%. Specificity was 94%. Age stratification did not reveal any meaningful trends. Of the 916 patients with benign cytologic results of fine-needle aspiration specimens, 52 had “suspicious” mammograms and 864 had “nonsuspicious” mammograms. CONCLUSION: For patient convenience and expeditious diagnosis of a palpable breast mass, fine-needle aspiration can be performed on the initial visit and mammograms subsequently taken within 2 weeks without undue clinical confusion or misleading mammographic findings. Concordance of the diagnostic triad consisting of (1) clinical impression (by history and examination), (2) fine-needle aspiration, and (3) mammography gives a reliable conclusion and can appropriately be used as the basis for clinical management of a breast mass. However, when there is doubt or anxiety about the diagnosis either on the part of the patient or the physician, a definitive histologic tissue diagnosis should obtained. (Am J Obstet Gynecol 1997;176:1286-92.)

Tc-99m-Tetrofosmin Scintimammography: A Prospective Study in Primary Breast Lesions

Despite low specificity routine mammography is the method of choice to screen women for breast cancer. In addition high frequency ultrasonography (US) or magnetic resonance imaging (MRI) can improve breast cancer diagnosis. However there is a lack of conventional imaging to improve the high rate of false positive results that make biopsy or surgery necessary. The purpose of our study was to evaluate prospectively the sensitivity, specificity, PPV and NPV of scintimammography with a new cationic complex Tc-99m-tetrofosmin. Fourtyeight patients in whom mammography and/or high resolution ultrasonography (10 MHz) revealed suspicious breast lesions were studied with Tc-99m-tetrofosmin scintimammography. In thirtyfour of them biopsy and/or surgery was performed for histological evaluation. After intravenous injection of 555 MBq Tc-99m-tetrofosmin dynamic images over three minutes (1 frame/10 sec.) planar images in anterior and lateral projections (5 min. p.i.) and SPECT imaging including 3-D-reconstruction (20 min. p.i.) were performed. Scintimammography was evaluated as negative, equivocal (+), probably (+2) or definitely (+3) positive Scintimammography with Tc-99m-tetrofosmin was negative in 18 patients (17 t.p., 1 f.n.) and positive in 16 patients (10 t.p., 6 f.p.). The false negative scintimammography was observed in a patient with infiltrating ductal carcinoma pT1, the false positive results in a patient with fibrocystic disease; all of the five fibroadenomas were also "false" positive. Sensitivity of Tc-99m-tetrofosmin scintimammography in this prospective study was 91%, specificity 74%, PPV 63% and NPV 94%. Scintimammographic results in patients with suspicious breast lesion show, that Tc-99m-tetrofosmin accumulates in breast cancer as well as in fibroadenoma. However the high NPV of 94% excludes breast cancer in suspicious mammographic lesions in a very high degree and therefore reduces the need of biopsy and/or surgery in most of these patients Our first results show that scintimammography with Tc-99m-tetrofosmin might play a role as further diagnostic step before surgery for women in whom mammography and/or ultrasonography show suspicious lesions.