Control of breast cancer through screening mammography

Comparison of Image Quality and Mean Absorbed Dose to the Breast for Two Mammographic Films

A film intended for mammography (Kodak SO 155 MRH-1) was tested and compared to one (Kodak SO 177 Ortho M) used earlier. Both films including the cassette could resolve 20 lp/mm. For a processing time of 90 s the new film gave the same overall image quality and irradiation dose to the breast as the old system. If, instead, the processing time was increased to 150 s, a 43% reduction in kerma could be attained with the new film. With a developing temperature of 36°C and 150 s processing time, the noise is clinically acceptable. A nonparametric test showed no significant difference between the 2 films on the 0.01 level. At an X-ray tube potential difference of 25 kV, the mean absorbed dose to a 4.5-cm-thick breast was reduced from 1.7 mGy with the old combination to 1.0 mGy with the new one. The measurements were made with a moving grid.

The randomized trials of breast cancer screening: what have we learned?

Eight randomized controlled trials of mammography screening have been conducted to date. In addition to evaluating the efficacy of screening with an experimental design, the trials provided investigators with access to information about breast cancers much earlier in their development than had previously been available. The trials of mammographic screening provide conclusive evidence that the policy of offering screening is associated with a significant and substantial reduction in breast cancer mortality.

Young Jordanian women's health beliefs about mammography

This descriptive study assesses the beliefs held by a group of young Jordanian women toward mammography utilization as a screening procedure for breast cancer. The Health Belief Model (HBM) is the theoretical framework of this study. Champion's (1993) translated HBM tool was utilized as the self-administered questionnaire that was filled in by all participants in this study. The sample consisted of young (< or = 45 years) Jordanian women chosen out of convenience from among those visiting one of the largest maternal and child health centers in Amman. The overall results indicated favorable beliefs toward the use of mammography, coupled with the majority of women (76%) voicing their agreement with the overall benefits of mammography, and 24% were either not in agreement with or unsure about these benefits. Although about half of the sample (49%) perceived barriers to utilizing mammography, the vast majority (85%), reported an overall agreement with the statements of the health motivation subscale. There were no significant differences in women's beliefs as a function of their subgroups of age, education, or insurance status. Nevertheless, when compared with a group of older women who had undergone mammography, significant differences (in favor of the older group) were reported between the two samples, especially in terms of the responses given to selected preventive statements such as "wanting to discover health problems early" (t = 2.27, p = .024) and "eating a well-balanced meal" (t = 1.92, p = .05). Implications for nursing practice, such as recognizing culturally specific barriers and enhancing health education programs to trigger mammography utilization, were addressed.

Minimal access breast surgery

Minimal access procedures have great potential for providing patients with equal, if not superior, forms of breast cancer diagnosis and treatment. Many of these procedures are in a process of evolution. The reliability of each method probably depends heavily on the training, ability, and experience of the operator. Surgeons should be aware of the advantages and pitfalls of these techniques and exercise caution during the initial phases of their learning experience.

The Advanced Breast Biopsy Instrumentation (ABBI) Experience at a Community Hospital

The Advanced Breast Biopsy Instrumentation (ABBI; U.S. Surgical Corp., Norwalk, CT) system is the newest technology available for the evaluation and diagnosis of nonpalpable breast lesions. It requires the breast imaging specialist, often a radiologist, to localize the suspicious lesion to x, y, and z coordinates in a digital mammogram unit The coordinates are then used by the surgeon to operate and direct the ABBI biopsy device around the lesion to obtain an excisional biopsy. Mammographic confirmation of the specimen is then immediately obtained. First introduced in the United States in April 1996, the ABBI system is aimed at rivaling the previously relied upon methods of needle-localized and core needle breast biopsies. In this study, we analyzed the first 15 months of use of the ABBI system in a community hospital to evaluate its applicability and efficacy in the diagnosis of nonpalpable breast lesions. Eighteen surgeons and three radiologists performed a total of 230 cases on 223 patients (seven patients had bilateral breast biopsies). The lesions biopsied included 114 clustered microcalcifications, 115 masses, and 1 retained guidewire from a previous needle-localized breast biopsy. The average time for the complete procedure was 65 minutes. Breast cancer was identified in 36 patients (36 of 230,15.7%) and 1 additional patient had an incidental finding of lobular carcinoma in situ. The malignancies included 20 cases of invasive ductal carcinoma, 12 cases of ductal carcinoma in situ, and four cases of invasive lobular carcinoma. Overall, 84 per cent of the patients had a definitive benign diagnosis and required no further surgical treatment of their mammographic finding. There have been no known missed lesions after use of the ABBI procedure. In conclusion, our experience has shown the ABBI system to be a valuable option in the management of selected patients with nonpalpable breast lesions.

Stereotactic excisional breast biopsies utilizing the advanced breast biopsy instrumentation system

OBJECTIVE

To compare the stereotactic excisional breast biopsy ABBI (Advanced Breast Biopsy Instrumentation) system with "open" excisional breast biopsy with needle localization.

METHODS

Twenty-three women underwent excisional breast biopsy using the ABBI system, 23 women concomitantly underwent needle localization and excisional breast biopsy. All women had mammograms displaying microcalcifications or nonpalpable noncystic nodular densities suspicious for cancer.

RESULTS

Biopsies with ABBI were undertaken with local anesthesia whereas needle localization biopsies were undertaken using general anesthesia. The ABBI system allowed completion mammography. Although preoperative mammograms were comparable, biopsy specimen diameter, volume, and weight were less with ABBI, and patient acceptance was higher. Efficacy, procedural duration, and blood loss were not different between the techniques.

CONCLUSIONS

The ABBI system is a minimally invasive yet efficacious excisional breast biopsy technique. It is utilized with local anesthesia in an environment more relaxed and less expensive than the operating room. It allows for smaller biopsy specimens and higher patient acceptance and is as efficacious as needle localization biopsy techniques. The ABBI system belongs in the surgical armamentarium against indeterminant nonpalpable mammographic breast lesions.

High resolution CT mammography of surgical biopsy specimens

PURPOSE

Our goal was to assess the performance of high resolution CT on breast biopsy specimens before considering the reevaluation of refined CT techniques in patients with breast abnormalities.

METHOD

High resolution CT was done in 44 surgical biopsy specimens following conventional X-ray specimen mammography. The specimens comprised 38 palpable and nonpalpable soft tissue abnormalities with mean size of 19 mm and 6 specimens with clustered microcalcifications only. There were 21 carcinomas, 10 fibroadenomas, and 13 other benign conditions. Evaluation of CT and conventional images was done separately, and a feature-grading list was used to compare the two modalities.

RESULTS

In fatty specimens, grading of morphologic features of masses and the confidence to detect a soft tissue abnormality were equal with both techniques. CT significantly improved the confidence to detect a mass in 17 specimens with dense tissue: On a scale of 0-10, the mean score for detection was 3.8 with radiography and 5.8 with CT (p<0.008). For clustered microcalcifications, X-ray was superior to CT. The mean CT attenuation of 18 malignant masses (82 HU) was significantly lower than the mean attenuation of 10 fibroadenomas (131 HU; p = 0.003). CT scans of the American College of Radiology test phantom met the requirements for X-ray accreditation.

CONCLUSION

For soft tissue abnormalities, CT specimen mammography performed equally as or better than specimen radiography. These in vitro results suggest potential advantages for increased sensitivity and specificity with CT and justify further investigations.

Breast disease: the radiologist's expanding role

The role of the diagnostic radiologist in breast cancer has expanded during the eight-decade history of breast imaging. The radiologist's role now encompasses both breast cancer diagnosis and treatment. This article traces the expansion of the radiologist's role through the history of mammography. The current roles of the radiologist in breast cancer diagnosis are discussed, including screening mammography in the asymptomatic patient, problem-solving breast imaging, breast ultrasound, and galactography. The radiologist's roles in breast cancer treatment that are discussed include preoperative needle localization, percutaneous breast biopsy, and evaluation of the postoperative breast.

Evolving medical-legal concepts for clinicians and imagers in evaluation of breast cancer

The past decade has seen an intense focus on the evaluation of American women for the detection and diagnosis of breast cancer. A concomitant increase in lawsuits filed for delay in diagnosis of breast cancer has occurred, creating consternation in the medical community. Efforts in responding to this public health challenge, comprised by fear of legal reprisal, may be supported by careful and deliberate planning that incorporates risk management principles and an understanding of different goals to be attained with consequent medical and legal responsibilities.

Calculation of dose and contrast for two mammographic grids

To aid in selecting optimal conditions for screening mammography practice in Sweden, the performance of two mammographic grids (one moving and one stationary) has been investigated. Monte Carlo techniques were used to simulate photon transport in the breast. Transport through the breast support, grid covers, grid and image receptor (33.9 mg cm-2 Gd2O2S) was treated analytically. The contrast of a 100 microns calcification has been evaluated for three tissue compositions (adipose, glandular, 50:50 fractions by weight of adipose and glandular tissue) as a function of breast thickness (2-8 cm) and potential difference (25-30 kV, Mo anode). Contrast for a 5 cm 'average' breast at 28 kV was improved by 40% using the moving grid and by 30% using the stationary one; the corresponding increases in breast absorbed dose, keeping the energy imparted to the image receptor constant, were 90% and 150%, respectively. The superior properties of the moving grid were due to (i) equal scatter rejection ability and higher transmission of primary photons yielding lower scatter-to-primary ratios behind the grid, and (ii) less attenuation and filtering of the primary photons in the interspace material yielding lower degradation of primary contrast.

Mammographic detection of breast cancer and preoperative needle localization

Since its early clinical use during the 1960s, mammography has become a widely accepted screening method for breast cancer. Its utilization may be capable of diminishing mortality by 40%. Screening programs have been instituted, and their cost effectiveness depends on the locale and age of the population screened. Mass screening has resulted in large numbers of nonpalpable lesions being biopsied. Needle localization techniques allow for these to be performed with a minimal chance of missing the lesion, while removing only a small volume of breast tissue. Although most lesions biopsied will be benign, 20-30% of those excised at any institution should be malignant. Consultation with experienced mammographers may be desirable when recommending mammography-based biopsy. The rate of detection of malignancy is higher in women who have a prior history of ipsilateral or contralateral breast cancer.