[Dosimetric and qualitative evaluations of the use of rhodium filtration in mammography]. / Valutazioni dosimetriche e qualitative sull'utilizzo della filtrazione al rodio in mammografia.

The value of rhodium filtration in mammography was compared with that of conventional molybdenum; dosimetric and qualitative tests were performed on a phantom and in vivo on informed and consenting patients. Phantom dosimetric tests confirmed a dose reduction with rhodium filtration changing according to thickness and primary beam energy. With rhodium filtration the dose decreased by 40% on the average topping 67% in breasts thicker than 6.5 cm. No significant differences were observed between rhodium and molybdenum filtration in clinical and phantom qualitative tests. Four radiologists--three of them in double blind--studied 29 mammograms repeated in the same technical setting and expressed a very slight preference for molybdenum also in thick and dense breasts. The slight preference was not based on higher diagnostic yield and therefore clinically irrelevant. Preferences appeared to be subjective, differing from one radiologist to another. In conclusion, the authors suggest the use of rhodium filtration in thick breasts because of the lower administered dose and of shorter exposure time with direct magnification.

[Diagnostic imaging in non-palpable breast lesions. Targeted++ ultrasonography versus direct radiologic magnification]. / Approfondimenti diagnostici nelle lesioni mammarie non palpabili. Ecotomografia mirata versus ingrandimento radiologico diretto.

The main target of mammography in asymptomatic women is the early diagnosis, or rather the identification, of non-palpable breast cancers. Doubtful or suspicious findings on conventional mammograms with no clinical evidence call for radiologic or other complementary imaging techniques to assess the exact lesion nature. Direct magnification and US are targeted techniques to employ as additional investigations after conventional mammography. Fifty consecutive patients were referred to our department of radiology for the preoperative localization of non-palpable breast lesions previously identified on conventional mammograms. The diagnostic or complementary roles of direct magnification and of US were thus investigated. US was always repeated during the preoperative localization; a 10-MHz immersion sectorial probe was used. Magnification was performed if absent or poor in conventional mammograms. The contribution of each technique to conventional mammography was graded as valuable (A), medium (B), or null (C). The lesions were grouped according to their structure: microcalcifications (a), nodules (b), scars (c), and complex lesions (a+b, a+c, b+c, ecc.). Six cases are included in our series which had been diagnosed as questionable or suspicious on previous mammograms. In our department, they were diagnosed as benign. Two of them were operated on because biopsy was required by the gynecologist and the other underwent stereotaxic FNB: negative cytology was considered the final diagnosis. Forty-six histologic and 4 cytologic examinations diagnosed 25 malignant and 25 benign lesions. Direct magnification was of great value in all cases, whereas US was useless in microcalcifications and useful in nodular or complex lesions, especially those with a nodular component. However, the incidence of US false-negatives was high, even in very suspicious cases on mammography, which suggests that US negativity cannot be considered an adequate sign to rule malignancy out.

Localization and management of occult breast lesions.

Mammography is an effective method for finding lesions of the breast which are occult at clinical examination. For occult lesions biopsy, including as little surrounding tissue as possible, it is necessary that they be located before surgery in order to improve the pathological process and the cosmetic outcome for the patients. Among the clinically occult lesions shown only by mammography, the frequency of breast cancers ranges from 10% to 47%. There are several different techniques for locating hidden lesions of the breast. We have employed the insertion of a single rigid needle into the breast, with X-ray confirmation of correct positioning. Forty-nine patients underwent this technique in our Institution and in all cases we were able to achieve a correct insertion of the needle at the X-ray check (the tip of the needle was less than 1 cm from the lesion). The target lesion was removed (as confirmed by X-ray of the surgical specimen) in all cases at the first attempt. In our study we found 11 invasive and 7 in situ tumours (36%). No complications delaying the surgical biopsy or the recovery of the patients were observed.