Breast cancer detection: one versus two views.

Mammographic examinations of 169 patients with 172 biopsy-proved carcinomas, and of 194 healthy subjects, were interpreted independently and retrospectively by three experienced mammographers, initially as single-view oblique examinations and 6 months later as two-view oblique-cephalocaudal examinations. For the single-view examinations of the cancer patients, 67% of the cancers were correctly recommended for biopsy, additional views were requested for 23%, and a "negative" interpretation was made for 10%. For the single-view examinations of healthy subjects, biopsy was recommended for 7% and additional views were recommended for 32%. For the two-view examinations of women with cancer, 80% of the cancers were correctly recommended for biopsy, additional views were requested for 4%, and a "negative" interpretation was made for 16%. For two-view examinations of healthy subjects, biopsy was recommended for 7% and additional views were requested for only 5%. The authors conclude that single-view screening should not be performed, because it would lead to an excessive number of "call-back" examinations of healthy patients, producing additional cost and anxiety that would outweigh any theoretical benefit.

Efficacy of combined film-screen/xeromammography: preliminary report.

Mediolateral and craniocaudal film-screen mammograms and a mediolateral noncontact xeromammogram obtained for 53 women with breast cancer were randomly evaluated, alone and in combination, by four mammographers in a blind, randomized fashion. Cancer detection was improved the greater the number of views evaluated. Certain cancers, by virtue of their position in the breast, can be obscured by superimposed dysplastic tissue on one view while being detectable on another which images the breast in a different projection. Some cancers posterolaterally located within the breast may be obscured by the rib cage on the mediolateral noncontact xeromammogram, but may be easily identified on the mediolateral or craniocaudal film-screen mammograms. Other posteriorly situated carcinomas may be projected off the film edge on the mediolateral and craniocaudal film-screen mammograms performed with compression, but may be imaged on the mediolateral noncontact xeromammogram. Xeromammography better images fine detail and microcalcifications, while film-screen mammography permits greater broad-area contrast. A combined film-screen/xeromammographic examination optimizes complementary projections and imaging techniques.