Galactography: the diagnostic procedure of choice for nipple discharge

Galactography was performed in 204 women with a nipple discharge and the secretion confirmed histopathologically. All 116 intraductal tumors (papilloma, papillomatosis, carcinoma), which were associated with a serous or bloody discharge, were detected preoperatively. A palpable mass had little diagnostic significance, and exfoliative cytology was positive in only 11% (2/18) of the patients with carcinoma. The authors recommend that all patients with a spontaneous bloody or serous discharge from a single lactiferous orifice undergo galactography in addition to physical, cytological, and mammographic examination. Intraductal injection of methylene blue dye will demonstrate the affected duct system to the surgeon and can often make surgery less radical or even unnecessary.

Magnification immersion radiography: better soft tissue visualization in the hands

We have combined microfocal magnification with immersion radiography and mammographic technique to produce superb soft tissue and bone detail in the hand using a single PA exposure. The lateral projections provide excellent demonstration of the flexor and extensor tendons and joint capsules. This method has proved valuable as the primary radiologic examination in the evaluation of soft tissue lesions in the hands, particularly in patients suspected of having rheumatoid arthritis.

Mammographic parenchymal patterns. Risk indicator for breast cancer?

Mammographic parenchymal patterns, originally presented as a new risk factor for breast cancer, have been prospectively studied in a large (27,157 examinations) consecutive screening population. Although there is a significantly higher risk of breast cancer in the so-called dysplastic breasts (P2 and DY pattern groups), the classification is of little practical value, as more than 72% of the cancers in the prevalent population were found in the so-called low-risk breasts (N1 and P1 pattern groups). A similar trend occurred at repeated screening of younger women, in which most of the "incident" cancers were found in the "low-risk" breasts. These patterns should not be used to influence patient management or screening programs.

The diagnostic and therapeutic value of breast cyst puncture and pneumocystography

Out of 53,459 women undergoing mammography, 434 pneumocystographic examinations were performed in 338 patients. Thirteen benign and 13 malignant intracystic tumors were detected, for a frequency of 6.0%. Intracystic cancers comprised 1.3% of all malignant tumors. Neither visual nor cytological examination of cyst fluid was sufficient to detect or rule out cancer, and the authors feel that pneumocystography is the only reliable method. Excision is the preferred therapy, and histological examination is the definitive method of differentiating benign from malignant tumors. In more than 97% of cases, pneumocystography of simple cysts is therapeutic. Without evidence of intracystic tumor on pneumocystography, cyst removal is unnecessary. The patient can be followed up with mammography, and any recurrent or new cysts can be diagnosed and treated by pneumocystography alone.

Breast cancer screening in Sweden. The single modality approach

Four population-based breast cancer screening projects are in progress in Sweden, three of which are randomized studies. Mammography is the only screening method. 51% of all carcinomas detected at the first screening were either in situ or invasive with a diameter of 10 mm or less. Axillary metastases were found in 16% of the patients. Sensitivity was over 90% in all projects. The ultimate aim of the randomized projects is to demonstrate the effect of screening on breast cancer mortality. It is estimated that mortality statistics will reach significant levels in 1983.,

Interventional radiologic procedures in the investigation of lesions of the breast

The interventional radiologist who performs mammography does far more than read films; he examines every patient, punctures cysts, and localizes other breast lesions for precise excisional biopsy. With specimen radiography, he can confirm that suspicious lesions are completely removed by the surgeon and that the tissue in question is selected by the pathologist for examination. Pneumocystography can save the patient the unnecessary, disfiguring surgical removal of benign cysts. Those patients requiring biopsy may be scheduled for the procedure at once, and close cooperation with the surgeon greatly reduces the time the patient must wait to find out whether or not she has breast cancer. Thus, the interventional radiologist can improve the accuracy and speed of diagnosis of breast lesions, establish a definitive diagnosis and expedite the therapeutic management of benign cysts, and save the patient much of the anxiety commonly experienced in waiting for diagnostic results. The end result is better care at a lower cost to the patient and to society.

[Mammographic mass examinations for breast cancer among rural population selected via physical examination and epidemiologic questionnaire (author's transl)]

The authors report on their four years' experience in oncologic mass examinations focused on the age group above 30. After 43980 serial examinations, they performed mammography in 3082 women with mammary cancer risk. 156 operations were performed, and 33 histologically established cases of mammary carcinoma were recorded, with 21 early-stage cases. Of 21 occult tumors, 18 did not manifest any metastases. Thanks to the epidemiologic questionnaire, 10 mammary cancer patients were registered. The score of confirmed findings exceeded quantitatively, and, especially, qualitatively, the mammary carcinoma morbidity of the region. The results prove the feasibility of the combined method. The major part of the population did not appear for mass examination. The advanced stage of the 55 cases of breast cancer belonging to this group, as well as that of the 10 cases of which became manifest during the examination interval, would indicate that much is to be said for a more effective health promotion campaign among the population.

Pneumocystography of benign and malignant intracystic growths of the female breast

Pneumocystography established the preoperative diagnosis of 20 intracystic breast tumours including 9 benign intracystic papillomas and 11 cases of intracystic carcinoma generally considered to be a rarity. The method is described and details about the clinical and radiologic appearances of both benign and malignant intracystic tumours are given. The importance and advantages of the method are emphasized.

Tuberculosis of the breast

Tuberculosis of the breast is rare and very difficult to differentiate from breast cancer both clinically and radiologically. The authors summarize the clinical and radiographic characteristics of the disease on the basis of 6 cases.

[Fibro-Adeno-Lipoma of the BREAST]

The Fibor-Adeno-Lipoma is a rarely seen benign lesion of the breast. The encapsulated tumor is smoothly outlined. The capsule can be well visualized by mammography. The lesion contains different amount of fibroglandular tissue. In that way the mammographic appearance is characteristic and diagnosis becomes easy. The authors discuss the clinical and radiological appearance of the Fibro-Adeno-Lipoma on the basis of 7 cases.