Screening Mammogram in Health Center: Medical Audit for Six Years

PURPOSE: To report the findings of a six-year medial oudit performed at our mammographic screening centre, comparing those findings with the follow-up data stored at our hospital and at the Korea Central Cancer Registry. MATERIALS AND METHODS: We analyzed the findings of 32,289 mammographic examinations of 25,541 women performed at our screening center between 1994 and 1999. For follow-up and outcome monitoring, the guideline of the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) was used. All mammograms were categorized by means of BI-RADS, and cases in categories 0, 4, and 5 were followed up through a review of our hospital information system. To determine whether any cases were false negative, we compared breast cancer patients registered in our medical record department and in the Korean Central Cancer Registry during the study period, with women whose mammograms were interpreted as normal or benign at our screening center within a year prior to cancer diagnosis. RESULTS: The mean age of women enrolled in this study was 48.6 years, ten years less than reported in the West. The recall rate was 6.2%. Among 256 women whose final assessment category was 4 or 5, breast cancer was diagnosed in 51. The cancer detection rate was 2.0/1,000 women; positive predictive value 1 (PPV1: PPV, based on abnormal findings at screening examination) was 2.5% of cases and PPV2 (PPV when biopsy or surgical consultation was recommended) was 20%. The most common mammographic finding was microcalcifications only (45%). The rate of minimal breast cancer, including invasive cancer less than 1 cm in diameter and ductal carcinoma in situ, was 72.5%. Node positivity was 27%. Sensitivity was 85.0% based on the tumor registry of our institution's medical record department, and 78.5% based on the tumor registry of the Korea Central Cancer Registry. Specificity was 99.0%. CONCLUSION: In our study, the cancer detection rate at screening mammography was 2.0/1,000 women. The rate of minimal breast cancer (72.5%) was very high but measurable sensitivity was 78.5%, somewhat lower than the ACR guideline of 85%. To improve the performance of screening mammography, appropriate interpretation of mammography and constant, follow-up and outcome monitoring are important.

Diagnostic Accuracy of Mammography and Ultrasonography in Detection of Early Breast Cancer

PURPOSE: To determine the value of mammography and ultrasonography in the detection of early breast cancer, and the usefulness of combining the two modalities for the diagnostic study of this condition. MATERIALS AND METHODS: The mammographic and ultrasonographic features of 47 female patients aged 23-68 (average, 46) years with pathologically proven early breast cancer were analyzed retrospectively. Mammography was performed in 46 patients and ultrasonography in 38, and 37 underwent both mammography and ultrasonography. Analysis of the mammographic and/or ultrasonographic features focused on mass, microcalcification, mass with microcalcification, multiple nodules, duct dilatation, and architectural distortion. RESULTS: Mammography revealed microcalcification in 29 (63%) patients, mass in 13 (28%) patients, mass with microcalcification in 8 (17%) patients, multiple nodules in 2 (4%) patients, architectural distortions in 1 (2%) patient, and negative finding in 9 (20%) patients. Ultrasonography revealed mass in 25 (66%) patients, microcalcifcation in 9 (24%) patients, mass with microcalcification in 8 (21%) patients, multiple nodules in 2 (5%) patients, duct dilatation in 3 (8%) patients, and negative finding in 7 (18%) patients. On combined study of mammography and ultrasonography of the 37 patients, mammography or ultrasonography revealed mass in 25 (68%) patients, microcalcification in 20 (54%) patients, multiple nodules in 2 (5%) patients, duct dilatation in 3 (8%) patients, and architectural distortion in 1 (3%) patient. In one (3%) patient among them, both mammography and ultrasonography revealed negative findings. The false negative rate of mammography, ultrasonography or both was 20%, 18%, and 3%, respectively, which was statistically significant difference (p < 0.05). CONCLUSION: Combined study of mammography and ultrasonography is the most useful as a diagnostic study for early breast cancer. So, ultrasonography seems to be the important additional method for detection of early breast cancer.

Glycogen-Rich Carcinoma of the Breast: A Case Report

Glycogen-rich carcinoma of the breast, defined as one in which more than 90% of neoplastic cells have abundant clear cytoplasm containing glycogen, is very rare. We report a case occurring in a 50-year old woman, and include the mammographic and ultrasonographic findings.

Tubular Carcinoma of the Breast: Clinical and Imaging Findings

PURPOSE: To evaluate the clinical and imaging findings of tubular carcinoma of the breast. MATERIALS AND METHODS: We retrospectively assessed the clinical and imaging findings of ten lesions of pathologically proven tubular carcinoma in nine patients, also evaluating the mammographic findings and categorizing the mass according to the ACR BI-RADS classification. The ultrasonographic findings were assessed in terms of shape, echogenicity, margin and posterior shadowing, and in four cases the size of nodules at physical examination was compared with the mammographic, ultrasonographic and pathologic findings. RESULTS: Nine lesions were palpable at physical examination. Bilateral tubular carcinoma of the breast was found in one patient, and unilateral single lesions in the others. There was no metastasis and no death within an average of 666 (range, 163) days of surgery. At mammography, masses were detected in six cases; the features, observed were a lobular or irregular shape (6/6), a spiculated margin (3/6) and high density (5/6). Ultrasonography showed that all unilateral lesions were hypoechoic (8/8), with a lesion height-to-width ratio of greater than 1.0 in seven of these, an ill-defined margin in sis, and posterior acoustic shadowing in seven. Mean nodule diameter was 1.17 cm at physical examination, 1.09 cm at mammography, 0.86 cm at ultrasonography and 0.80 cm at pathological evaluation. CONCLUSION: Most tubular carcinomas were palpable in spite of their small size, and their postoperative prognosis was good. Ultrasonography is useful in the detection of mammographically occult tubular carcinoma and for measuring the size of lesions.

The Role of Sonography in Patients with Breast Cancer Presenting as an Axillary Mass

OBJECTIVE: To compare sonography and mammography in terms of their diagnostic value in breast cancer cases which initially presented as an axillary mass without a palpable mass or other clinical symptoms. MATERIALS AND METHODS: Seven patients with enlarged axillary lymph nodes who first presented with no evidence of palpable breast lesions and who underwent both mammography and sonography were enrolled in this study. In six of the seven, the presence of metastatic adenocarcinoma was confirmed preoperatively by axillary needle aspiration biopsy; in four, subsequent sonographicallyguided breast core biopsy performed after careful examination of the primary site indicated that primary breast cancer was present. In each case, the radiologic findings were evaluated by both breast sonography and mammography. RESULTS: Breast lesions were detected mammographically in four of seven cases (57%); in three of the four, the lesion presented as a mass, and in one as microcalcification. In three of these four detected cases, fatty or scattered fibroglandular breast parenchyma was present; in one, the parenchyma was dense. In the three cases in which lesions were not detected, mammography revealed the presence of heterogeneously dense parenchyma. Breast sonography showed that lesions were present in six of seven cases (86%); in the remaining patient, malignant microcalcification was detected at mammography. Final pathologic examination indicated that all breast lesions except one, which was a ductal carcinoma in situ, with microinvasion, were infiltrating ductal carcinomas whose size ranged from microscopic to greater than 3 cm. At the time of this study, all seven patients were alive and well, having been disease free for up to 61 months after surgery. CONCLUSION: In women with a palpable axillary mass confirmed as metastatic adenocarcinoma, breast sonography may be a valuable adjunct to mammography.

Mammographic Findings Predicting an Extensive Intraductal Component in Early Stage Invasive Breast Cancer: Analysis on Microcalcification

Purpose: To analyze the mammographic findings of extensive intraductal compenent (EIC)-positive early invasive breast carcinoma and to determine the mammographic features which predict an EIC positivity in aninvasive carcinoma. MATERIALS AND METHODS: The mammographic and pathologic findings in 71 patients aged 34 -79 (mean 50) years in whom stage I or II invasive breast carcinoma had been diagnosed were etrospectively analysed. The m a mmographic findings were assigned to one of three groups: mass, mass with microcalcification, or microcalci-fication only. The shape and distribution of a calcification were classified according to the BI-RADS TMl exicon, and its extent was classified as either more or less than 3cm. To detect the presence or absence of EIC and the type of ductal carcinoma in situ (DCIS), the findings were reexamined by means of slide mappings. Results: Twenty-eight of 71 patients (39%) showed EIC positivity. The mammographic findings of EIC-posi-tive invasive cancer (n=28) were mass with microcalcification (n=14), microcalcification only (n=7) and mass only (n=7). The mammographic finding which predicted EIC positivity was mass with microcalcification (P-PV: 0.67, NPV: 0.33, p=0.02). A mammographic of mass only (n=39) showed a significantly high negative predictive value for EIC positivity. (PPV 0.18, NPV 0.82, p<0.01). A comparison of cases with or without calci-fication showed that those with microcalcifications (n=32) showed a significantly high PPV of 0.66 (NPV: 0.34, p<0.01 ) while those without calcification (n=39) showed a significantly high NPV of 0.82 (PPV:0.18, p<0.01 ). There were no significant differences in positive predictive values for EIC between the shape, distribution and extent of calcifications. Conclusion: Whenever microcalcification with or without mass is seen on mammograns obtained during early breast cancer, we can predict EIC-positivity, regardless of shape or distribution according to the BI-RADS TM lexicon.

Mammographic Findings Corresponding to Histologic Subtypes of Ductal Carcinoma in Situ

PURPOSE: To compare the mammographic features and histologic subtypes of ductal carcinoma in situ(DCIS) of the breast. MATERIALS AND METHODS: Mammograms of 34 patients with DCIS of the breast detected between January 1992 and November 1998 were retrospectively analyzed. Histologic subtypes were classified as either comedo or noncomedo. Mammographic findings were classified in one of four ways : microcalcification only, microcalcification with mass, mass or asymmetrical density only, or normal. Microcalcifications was classified as either predominantly casting or granular. We also determined whether microcalcification was multifocal. RESULTS: Histologic examination revealed the comedo type in eight patients and the noncomedo type in 26. Among the eight comedo-type cases, mammography demonstrated microcalcification only in five and micro-calcification with mass in three. Among 26 noncomedo-type cases, microcalcifications only was seen in ten, microcalcification with mass in two, mass or asymmetrical density only in six, and normal features in eight. Six of the comedo type were predominantly casting and two were predominantly granular. Predominantly casting calcification was present in four of 12 cases of the noncomedo type and predominatly granular was in eight. Multifocality was seen in four comedo-type cases, but in none of those that were of the noncomedo type. CONCLUSION: We conclude that the comedo subtype of DCIS of the breast is more likely than the noncomedo subtype to be accompanied by microcalcification of the predominantly casting type. Multifocally located microcalcification is a more frequent feature of the comedo subtype than of the noncomedo subtype.

Variable Causes of False-Negative Mammogram

Mammography is an invaluable method for the in detection of breast cancer, especially in asymptomaticpa-tients. Occasionally, however, mammography fails to detect cancer, resulting in false reassurance and delayeddi-agnosis. In this paper we describe various causes and the mammographic findings of false-negative mammo-grams.

Mammographic Evaluation of Suspicious Malignant Lesions Based on ACR(American College of Radiology) Breast Imaging Reporting and Data System( BI-RADS )

PURPOSE: The purpose of this study was to assess the mammographic features and pathologic outcome of category 4 lesions using the Breast Imaging Reporting and Data System(BI-RADS), and to evaluate the significance of final assessment categories. MATERIALS AND METHODS: Using BI-RADS, the interpretations of 8,134 mammograms acquired between January 1997 and May 1998 were categorized. From among 161 lesions categorized as "4"("suspicious abnormality") and pathologically confirmed by surgery or biopsy, we analysed 113, found in 66 patients. RESULTS: The pathologic outcome of these 113 lesions was as follows: infiltrating ductal carcinoma, 17.7%(20/113); DCIS(ductal carcinoma in sitv), 8.0 %(9/113); ADH(atypical ductal hyperplasia), 5.3 % (6/113); DEH(ductal epithelial hyperplasia), 1.8 %(2/113); ductectasia, 0.9 %(1/113), FCD(fibrocystic change), 27 .4 %(31/113); fibroadenoma, 7.1 %(8/113); stromal fibrosis, 9.7%(11/113); normal parenchyma, 7.1 % (8/113); other pathology, 15.0 %(17/113). The most frequent mammographic features of BI-RADS category 4 lesions were irregular mass shape(41.2 %), spiculated mass margin(52.3%), amorphous calcification(47.3%) and clustered calcification distribution(37.1% ). CONCLUSION: Because category 4 lesions account for about 25.7 % of all breast malignancies, mammographic lesions in this category ("suspicious abnormality")should be considered for supplementary study and breast biopsy rather than short-term follow-up. Initial pathologic findings can thus be confirmed.

Mammographic Evaluation of Suspicious Malignant Lesions Based on ACR(American College of Radiology) Breast Imaging Reporting and Data System( BI-RADS )

PURPOSE: The purpose of this study was to assess the mammographic features and pathologic outcome of category 4 lesions using the Breast Imaging Reporting and Data System(BI-RADS), and to evaluate the significance of final assessment categories. MATERIALS AND METHODS: Using BI-RADS, the interpretations of 8,134 mammograms acquired between January 1997 and May 1998 were categorized. From among 161 lesions categorized as "4"("suspicious abnormality") and pathologically confirmed by surgery or biopsy, we analysed 113, found in 66 patients. RESULTS: The pathologic outcome of these 113 lesions was as follows: infiltrating ductal carcinoma, 17.7%(20/113); DCIS(ductal carcinoma in sitv), 8.0 %(9/113); ADH(atypical ductal hyperplasia), 5.3 % (6/113); DEH(ductal epithelial hyperplasia), 1.8 %(2/113); ductectasia, 0.9 %(1/113), FCD(fibrocystic change), 27 .4 %(31/113); fibroadenoma, 7.1 %(8/113); stromal fibrosis, 9.7%(11/113); normal parenchyma, 7.1 % (8/113); other pathology, 15.0 %(17/113). The most frequent mammographic features of BI-RADS category 4 lesions were irregular mass shape(41.2 %), spiculated mass margin(52.3%), amorphous calcification(47.3%) and clustered calcification distribution(37.1% ). CONCLUSION: Because category 4 lesions account for about 25.7 % of all breast malignancies, mammographic lesions in this category ("suspicious abnormality")should be considered for supplementary study and breast biopsy rather than short-term follow-up. Initial pathologic findings can thus be confirmed.

Comparison between Palpable and Nonpalpable Breast Cancers: Mammographic and Pathological Findings

PURPOSE: To analyze the differences in mammographic and pathologic findings between palpable and non-palpable breast carcinoma. MATERIALS AND METHODS: Among 362 patients with surgically proven breast carcinoma, 317, whose chief com-plaint during preoperative evaluation was a palpable mass, Comprised group I, and 45 with no masses com-prised group II. We compared mammographic and pathologic findings between the two groups. RESULTS: As regards the pattern of mammographic presentation, mass alone accounted for 51.4 % of group I and 33.3 % of group II, while calcification alone was seen in 7.6 % of group I and 24.4 % of group II(p<0.05). In group I, 48.6 % of masses were of irregular shape, and in group II, 46.2 % were round. According to ACR-BIRADS, 47.6 % of group I was classified as category 5, and 51.1 % of group II as category 4 (p<0.05). On the other hand, the margin of the mass showed no statistical difference. Among the 362 patients, the mean age of group I was 48.1(range, 28 -79) years, while that of group II was 51. 7(range, 30 -73) years (p<0.05). Histologically, infiltrative ductal carcinoma was seen in 84.9% of group I, and DCIS in 8.5%, while for group II the respective figures were 62.2% and 28.9 % (p<0.05). For group I, mean lesional size was 3.01cm, with 4 7 .9 % lymph node metastasis in the axilla, while for group II the corresponding figures were 1.93 c m ( p < 0 . 0 5 ) and 28.2%(p<0.05). Differences were statistically significant. Under the TMN system, 30% of group I were at stage II, while 35.6 % of group II were at stage I (p<0.05). CONCLUSION: Palpable and non-palpable cancers showed statistically significant differences in mammographic findings such as mass shape and category, but not in the margin of the mass. There were also statistically sig-nificant differences with regard to age, histology, lesion size, axillary lymph node metastasis, and staging.

Infiltrating Ductal Carcinoma with Mammographic 'Halo Sign' Correlation with Histopathology

PURPOSE: To analyze and correlate mammographic/ sonographic features with pathologic findings in patientswith infiltrative ductal carcinoma with the mammographic 'halo sign'. MATERIALS AND METHODS: We retrospectivelyreviewed 27 cases of surgically confirmed infiltrative ductal breast carcinoma with the mammographic 'halo sign',analysing the mammographic/sonographic findings, clinical records and pathologic findings. RESULTS: Twenty-sevenpatients with infiltrating ductal breast carcinoma with the mammographic 'halo sign' were aged 32-72 (mean 49+/-12)years. For periods of between 2 days and 5 months(mean, 1.9 months), all had complained of a palpable mass.Histologic sections indicated parenchymal compression(27/27), microscopic infiltration of tumor margin(11/27) andparenchymal fat compression(15/27), without a true capsule. Infiltrating ductal carcinomas with the mammographic'halo sign' were nuclear grade 1 (17/27) or histologic grade III (14/27). Mammography (complete halo:3;partialhalo:24) showed a round(15/27) or macrolobulated (9/27) mass (size : 2.5+/-1cm) which showed partialspiculation(17/27) or-rarely-calcification(2/27). Sonography revealed a hypoechoic mass with a thinboundary(13/15);in five of these 13 cases, pathologic examination revealed microscopic infiltration of the tumormargin. Bilateral shadowing (8/15), posterior enhancement(13/15), and heterogeneous internal echogenicity(13/15)were also noted on sonography. CONCLUSION: When correlated with the histopathologic findings, infiltrating ductalbreast carcinoma with the 'halo sign' showed a relatively poor pathologic grade, which is known to be one of theprognostic factors. Surrounding parenchyma and fat compression at the margin of a tumor are considered to be oneof the causes of the mammographic 'halo sign'.

Nonpalpable Breast Cancer: Mammographic and Clinical findings

PURPOSE: To evaluate the mammographic and clinical findings of nonpalpable breast cancer. MATERIALS AND METHODS: In 28 of 607 breast cancer patients examined between January 1994 and April 1997, lesions werenonpalpable. We retrospectively analyzed the mammographic, clinical and pathologic features of 25 patients (28lesions) whose mammograms we obtained. RESULTS: Among these 25 patients (28 lesions) screening was abnormal in22; other symptoms were bloody nipple discharge(n=4), and nipple eczema(n=2). The patients were 34-62 (mean 52)years old. Invasive ductal carcinoma(n=13), DCIS(ductal carcinoma in situ, n-12), Paget's disease (n=2), andLCIS(lobular carcinoma in situ, n=1) were found during surgery. Six of 28 lesions(21%) showed evidence of axillarynodal metastasis;the majority arose from the upper outer quadrant of the breast (n=21). The mammographic findingswere mass (50%), (and mass with microcalcification, 11%); microcalcification(29%); asymmetrical density(14%); andnormal (7%). According to the mammographic density of breast parenchyma, the major finding in the low densitygroup(N1+P1) was mas (9/9), and in the high density group(P2+DY) was microcalcification (12/19). CONCLUSION: Themost common mammographic findings of nonpable breast cancer were mass (50%) and microcalcification(29%). Itsfeatures varied according to the mammographic density of breast parenchyma;mass was the main finding in the lowdensity group and microcalcification in the high density group.

Usefulness of Mammography of Mastectomy Site for Breast Cancer

PURPOSE: To evaluate the usefulness of routine mammography in the detection of local recurrence of breast cancer after mastectomy. MATERIALS AND METHODS: The clinical and mammographic records of 45 patients whounderwent modified mastectomy due to breast cancer were prospectively reviewed. The methods of mastectomy wereAuchincloss (n=36), Patey (n=8) and simple resection (n=1). RESULTS:s Among the 45 patients, five palpable lesionswere detected on physical examination: two of the five were confirmed as tumor recurrence; on mammography, anodule with microcalcifications and low-density lesion was seen, but the other three were benign. In 40 patientsthe results of palpation were negative and during follow-up (mean, 10.9 months ) no newly developed lesions wereseen. On mammography, ten of 45(22.2%) patients showed abnormalities, namely local skin thickening(n=4,40%),increased density in subcutaneous tissue(n=2,20%), nodules(n=2,20%), benign calcification(n=1,10%) and focallow-density lesion(n=1,10%), but only one case with a nodule was confirmed to be recurrence. CONCLUSION: Routinemammography of a mastectomy site was not useful for the differentiation of palpable lesions.

Small Cell Carcinoma of the Ovary Metastasizing to the Breast: A Case Report

Small cell carcinoma of the ovary is rare and occurs primarily in young women. It has a very poorprognosis-the results of chemotheraphy and rediotherapy have been generally disappointing and early recurrence ordistant metastasis is common. Metastasis to the breast is very rare; such tomors account for about 1% of totalbreast malignancies. We describe the case of a 37-year-old-woman with muiltiple metastases to both breasts fromleft ovarian small cell carcinoma : the radiologic findings are also included. On pelvic ultrasonography and MRimaging, small cell carcinoma of the ovary was seen as a lobulationg mass lesion admixed with cystic and solidcomponents, and present in the pelvic cavity. Two months later, mammography and ultrasonography revealedrelatively well marginated multiple solid mass lesions in both breasts.

Metaplastic Carcinoma of the Breast: A Case Report

Metaplastic carcinoma of the human mammary gland is a very rare disease that undergoes metaplastic changes,including squamous cell, spindle cell, and heterologous mesenchymal growth. We report a case of metaplasticcarcinoma of the breast, together with its radiologic and pathologic findings.

Role of Mammography in Evaluating Residual Cancer after Neo-adjuvant Chemotherapy of Locally Advanced Breast Carcinoma: Compared with Clinical Examination

PURPOSE: To determine the value of mammography compared to clinical examination in evaluating residual cancer of locally advanced breast carcinoma treated with neoadjuvant chemotherapy. MATERIALS AND METHODS: Among 67 patients with locally advanced breast carcinoma who were treated with neoadjuvant chemotherapy, 18 patients (age:35-67, mean:48) had taken the mammography before and after neoadjuvant chemotherapy. Those 18 sets of mammography were analyzed retrospectively and compared with the result of clinical examination on the basis of histologic diagnosis. RESULTS: On histologic examinations, 16 of 18 patients (88%) had residual cancer, one of them was diagnosed to have no residual cancer in mammography. On mammographic findings, 16 patients were determined to have residual cancer, and one of them was found not to have residual cancer on histologic examination. Clinically, there were 4 patients showed complete response, 11 patients with partial, and 3 with no response. 3 of 4 patients with complete clinical response were found to have residual cancer in histologic examination. In posttreatment mammographic findings, 11 patients were noted to have measurable mass, 8 patients had microcalcifications. All 11 patients with measurable mass in mammography had residual cancer (positive predictive value:100%). However, 5 of 7 patents who showed no measurable mass in mammography had residual cancer. 7 of 8 patients showing microcalcifications in mammography revealed to have residual cancer (positive predictable value: 88%). Sensitivity of mammography in predicting residual cancer was greater than that of clinical examination (94% vs 81%), even when microscopic residual cancer was considered as a complete response (92% vs 77%). Specificity of mammography were same as those of clinical examination (50% vs 50%, 20 % vs 20%). CONCLUSION: Mammography is more accurate and offers more information than clincal examination in evaluating residual cancer of locally advanced breast carcinoma after neoadjuvant chemotherapy. However, prediction of residual cancer with mammography is not accurate enough to replace histologic examination.

Neurofibroma in Breast: A Case Report

Neurofibromas are common benign tumors and can originate from any nerve tissue in the body. A solitary neurofibroma in breast parenchyma has rarely been reported, however. We report a neurofibroma originating from breast parenchyma in a 61-year old woman. On mammography, the mass appeared as a well marginated and circumscribed mass, suggesting a benign tumor, and after excisional biopsy, was pathologically proven to be a neurofibroma.

Mammographic and US Findings of Steatocytoma Multiplex: A Case Report

Steatocystoma multiplex, a cutaneous disorder involving the appearance cysts on the trunk and upper arms, is often inherited as an autosomal dominant trait. The authors present mammographic and US findings of steatocystoma multiplex in a 35-year-old woman with breast masses. On mammograms, multiple uniform thin walled round or oval shaped oil cysts were seen in the peripheral portion of the breasts and axilla, and on US, well-defined or smooth ill-defined round or oval shaped nodules were seen in the subcutaneous layer of the breasts and axilla ; compared with subcutaneous fat, there was iso- or slightly increased echogenicity.

Mammographic Findings of Infiltrating Ductal Carcinoma: Correlation with Histologic Grading and Age

PURPOSE: To investigate the correlation between mammographic findings of infiltrating ductal carcinoma (IDC), patient age and pathologic grading. MATERIALS AND METHODS: The study included 103 cases of infiltrating ductal carcinoma in 102 women who during the preceding three years had undergone mammography and surgery. The mammograms were retrospectively reviewed by two radiologists. The mean age of the patients was 45.2 (range 26-74) years and the age distribution was seven in the 3rd decade, 37 in the 4th, 29 in the 5th, 24 in the 6th, and six in the 7th or above. Thirty-three lesions were histologic. Grade I, 59 were Grade II and 11 were Grade III. RESULTS: Ten (9.7%) of 103 cases, all of whom were younger than 50, were missed during mammographic diagnosis. On mammograms, primary findings of breast malignancy were found in 54 (74%) of 73 patients younger than 50 and 27 (90%) of 30 patients older than 51. Mass with or without microcalcification was found in 45 patients (62%) younger than 50 and in 26 (87%) older than 51. Nine (12%) and 3 (10%) in each age group showed secondary findings. There was no correlation between age distribution and histologic grading. Seventy-three percent of Grade I lesions and 78% of those of Grade III showed primary findings. Five lesions in each of Grade I and II were missed at mammographic interpretation, but this was not statistically significant (p=0.250). In all 11 Grade III cases, breast cancer were manifested as primary findings but this was not statistically significant (p=0.203). CONCLUSION: The majority of IDC were detected by mammography, but 9.7% of IDC patients, all younger than 50, were misdiagnosed. Most IDC was manifested as primary findings, particularly in patients aged over 51. There were no differences in pathlogic grading according to age distribution. All histologic Grade III lesions were detected by mammography.