Breast imaging fellowship programs. A survey of the fellows of the Society of Breast Imaging.

RATIONALE AND OBJECTIVES: Breast imaging, a subspecialty of diagnostic radiology, is becoming more important with the increased performance of screening mammography. Fellowships in breast imaging are being offered at many institutions. Information regarding the contents and structure of such fellowships is important for potential trainees and departments considering offering such programs. METHODS: All 79 fellows of the Society of Breast Imaging (SBI) were surveyed by mail. Those with breast imaging fellowships were asked questions about their program. All were asked their opinions about the appropriate features of a breast imaging fellowship. RESULTS: Forty-six (58%) surveys were returned. Nineteen respondents described breast imaging fellowships offered at 18 different institutions. CONCLUSIONS: This information may be useful as radiologists consider establishing fellowship standards within this subspecialty.

Screening mammography in 350 women with breast implants: prevalence and findings of implant complications.

OBJECTIVE: A series of screening mammograms in asymptomatic women with breast implants was reviewed to determine the prevalence of clinically silent sequelae of breast augmentation and to analyze the mammographic findings. MATERIALS AND METHODS: The screening mammograms of 350 consecutive women with implants were reviewed retrospectively by experienced mammographers. Any women who reported problems had a diagnostic examination and therefore were not included in our sample. Mammographic features of sequelae specific to implantation such as development of a fibrous capsule, periprosthetic calcification, implant herniation, and silicone leaks were tabulated. Additionally, modified compression (push-back) views, when obtained, were evaluated for their usefulness. RESULTS: Fibrous encapsulation of breast implants was seen in 257 (73%) of 350 women. Periprosthetic calcification was seen in 90 (26%), and 60 women (17%) had implant herniations. Sixteen women (5%) had implant failure as evidenced by silicone leak. Two of these women had bilateral implant failures. Surgical confirmation was attainable in only five of 16 women. Analysis of modified compression views demonstrated an overall improvement in visualization of breast tissue with this technique. Although the sample size is small, there was a significant increase in the amount of breast tissue seen with push-back views in women with submuscular implants. CONCLUSION: Our analysis revealed a wide range of mammographic findings in this group of asymptomatic women with breast augmentation. Especially worrisome is the 5% prevalence of unsuspected silicone extravasation. Additionally, we have demonstrated the usefulness of push-back views in this screening group, especially in women with submuscular implants.

Mammographic appearance following implant removal.

Potential complications of augmentation mammaplasty with silicone gel breast implants have been the subject of much recent debate in the medical and lay communities. Some women have undergone implant removal, and others may follow. The mammographic appearance following submammary implant removal in four women and the histologic appearance in one case are described. Bilateral symmetric soft-tissue masses posterior to the glandular tissue with accompanying calcifications should suggest the diagnosis. The radiologist should be familiar with the mammographic appearance following implant removal. Such knowledge may prevent unnecessary concern and unwarranted biopsy.

A screening mammography program. Staying alive and making it work.

The success of a mammography screening program requires thorough planning. A dependably high volume and a streamlined efficient operation are essential to survival of the program. Factors that warrant consideration prior to designing such a program include the following: Distinction between screening and diagnostic mammography examinations. Selection of a site that will meet the needs of the community and yet provide a consistently high volume. Low examination cost for screening mammography coupled with a detailed financial analysis and reappraisal on an ongoing basis. A customized marketing program that incorporates methods to increase awareness, compliance, and utilization by women and referring physicians. Well-trained, efficient, and dedicated personnel. An operation that is designed for rapid throughput and expeditious patient flow. An efficient plan for film handling, interpretation, reporting, and storage. Timely communication of examination results. A reliable mechanism for follow-up evaluation and outcome data collection. Establishment of a consistent and reliable quality assurance program and the production of high quality mammograms.

Carcinoma within fibroadenomas: mammographic features.

The mammographic features of carcinoma originating within a fibroadenoma in 24 patients were studied by means of retrospective review of pathologic slides. Histologic examination showed that the lesions were lobular carcinoma in situ (LCIS) (seven patients), ductal carcinoma in situ (DCIS) (13 patients), synchronous LCIS and invasive lobular carcinoma (one patient), and synchronous LCIS and DCIS (three patients). In all patients the mammographic manifestation was a mass 1.0 cm or greater in diameter; 14 masses were 1-2 cm in diameter, and the remainder were more than 2 cm in diameter. Features that were considered suspect included large size, indistinct margins, and clustered microcalcifications. In three patients, microcalcifications within the mass raised suspicion of malignancy. At histologic examination these microcalcifications were associated with the intraductal carcinoma harbored in the fibroadenoma in only one of these patients. Fibroadenomas that harbor carcinoma may be indistinguishable from common benign fibroadenomas, but their occurrence is rare. In this study, a single patient had invasive lobular carcinoma; all the other lesions were in situ lesions.

Calcification of breast implant capsule.

We have presented a case of bilateral capsular calcification, an extremely rare but clinically important complication of augmentation mammoplasty. Little is known about its pathogenesis, but it is believed to be related to the presence of molecular silicone and/or Dacron patches in the pericapsular environment. This condition may mask calcifications of the breast due to carcinoma, and it often exacerbates the symptoms of capsular contracture. We recommend removal of the calcified capsules and replacement of the implants in the submuscular position.

Ascending lower limb phlebography: comparison of ioversol and iothalamate meglumine.

Fifty patients undergoing ascending phlebography of a lower limb were evaluated, in a randomized double-blind fashion, to compare the efficacy, patient tolerance, and safety of two different contrast agents. Ioversol-240 (MP-238), a new nonionic agent, and iothalamate-202 (Conray 43), an established ionic agent, were the contrast agents used. Twenty-five patients were injected with iothalamate and 25 with ioversol. The phlebograms were evaluated for diagnostic quality and the patients for symptoms, with special reference to complaints of heat and pain. No significant difference was demonstrated between the two agents in either examination quality or patient tolerance. No major contrast-related reactions were recorded. We conclude that ioversol-240 appears to be a safe and acceptable alternative to iothalamate-202.

Nipple simulating a breast mass on a mammogram.

On a mediolateral mammogram obtained during routine screening, a mass was noted deep within the breast. However, no mass could be palpated, and additional views showed no mass. Observation of the patient during imaging demonstrated the nipple of the opposite breast was inadvertently projected onto the image. Radiologists should be aware of this cause of pseudotumor of the breast.

The self-referred mammography patient: a new responsibility for radiologists.

A mammography screening program was initiated in which self-referred women were accepted for examination. Two views of each breast were obtained, and no physical examination was performed. Reports were sent to each patient and to the patient's primary care physician, if she had one. The program was successful in that the number of examinations performed per day increased from 36 to 80 within 6 months. Approximately 50% of the women who came for screening did so at their own request. Self-referred women with abnormal findings on mammograms who did not have a primary care physician were contacted by phone and told of the results. Advice was given for further evaluation, and the patient was referred to a local physician if she still did not know of one. Further workup in patients with abnormal findings was verified with the use of computer tracking and follow-up phone calls. Self-referral is an important component of screening mammography, but it places added responsibility on the radiologist in cases in which there is no referring physician.

Multispectral analysis of MR images of the breast.

Preliminary investigations were conducted into the potential of magnetic resonance (MR) images for tissue classification of the breast on the basis of relative signal intensity. Multispectral techniques originally developed by the National Aeronautics and Space Administration for satellite image analysis were used in sequence selection, image data correction, image standardization, and image interpretation. Numerous sequence combinations with varying repetition times (TR) and echo times (TE) were considered, and a triplet was selected consisting of long TR/long TE, short TR/short TE, and an opposed phase sequence with intermediate TR and TE. Correction to remove system-imposed intensity inhomogeneities was required for all images. Image standardization based on fat and pectoral muscle signals was necessary for intercase comparisons. Multispectral images obtained based on this analysis suggest the feasibility of intensity-based image classification.

Light scanning versus mammography in breast cancer detection.

Transillumination light scanning of the breast was compared with screen-film mammography in a prospective study of 1,110 women referred to an outpatient imaging department. Each method was interpreted independently of the other but with knowledge of physical examination findings. Of 24 biopsy-proved cancers, 14 (58%) were detected with light scanning and 21 (88%) with mammography. The 77 false-positive light scan examinations were attributed to technical factors and the inability of light scanning to distinguish malignant from benign conditions on the basis of imaging features. Of the ten false-negative light scan examinations, two were retrospectively reclassified as positive, but light scans in the other eight cases remained normal in appearance. The authors conclude that transillumination light scanning is not competitive with mammography as a screening method for breast cancer detection. furthermore, they were unable to identify a select subpopulation of women who might benefit from light scanning as an adjunct to mammography.

Light scan evaluation of nonpalpable breast lesions.

Transillumination light scanning of the breast was performed immediately before needle localization of 112 nonpalpable mammographic abnormalities detected in 103 patients. Twenty-four cancers were diagnosed in 23 patients. The positive predictive value for mammography was 21%. Ten (42%) of these nonpalpable cancers were not visible on transillumination light scanning. Eleven of 16 invasive ductal cancers and three of seven intraductal cancers were evident on transillumination light scans, but a single case of lobular carcinoma in situ was not evident. There were 12 false-positive light scan examinations. Transillumination light scanning had a 58% sensitivity, an 86% specificity, a 54% positive predictive value, and an 88% negative predictive value for small breast lesions. Therefore, the authors are unable to recommend delaying biopsy in patients with mammographic abnormalities on the basis of a negative light scan study.