[Automated mammary sonography and mammography: the differentiation of benign and malignant breast lesions]. / Automatisierte Mammasonographie und Mammographie: Differenzierung benigner und maligner Mammaläsionen.

PURPOSE: A prospective study on the differentiation of breast lesions was carried out using experimental combination schemes of mammography and automatic sonography. MATERIALS AND METHODS: X-ray mammograms and a B image from automatic sonography of 39 malignant and 41 benign lesions as well as 40 cases without lesions were separately examined by four experienced diagnosticians. The observers differentiated the findings mammographically and by measurement in the B images. RESULTS: For two examiners the combination of mammography and automatic sonography gave with regard to the differentiation of breast lesions an improvement in sensitivity of 3 or 5% and in specificity of 31 and 18%, respectively, as compared to mammography alone while for the other two examiners an improved specificity of 21 and 36%, respectively, was accompanied by an 8 and 10% decrease in sensitivity as compared to mammography alone. CONCLUSIONS: The differentiating criteria from automatic sonography and mammography can, in principle, be used to evaluate the dignity of breast lesions. However, an optimization is necessary since the improvement in specificity does not compensate the loss in sensitivity.

[Combination of mammography with automated ultrasound (Sono-X) in routine diagnosis?]. / Kombination der Mammographie mit einer automatisierten Sonographie (Sono-X) in der Routinediagnostik?

A new technique for breast imaging is presented. This technique combines radiographic mammography directly with automated ultrasound. The combined examination, which is performed without decompression of the breast, yields the conventional mammography films as well as a complete set of B-mode scans and ultrasound projections. These can be geometrically matched with each other in a definitive manner. A prototype of the device was first used in a pilot study of 50 patients followed by a study of an additional 450 patients with a total of 492 breast lesions, of which 269 were confirmed by histology or cytology. The results show that X-ray and ultrasound are complementary in the detection of cancer. The use of an experimental mode of image interpretation for combined mammography and automated ultrasound reduced the number of mammographically suspicious findings that ultimately turned out to be benign. These results were also confirmed in two blind studies including a total of 160 histologically or cytologically confirmed lesions and 40 cases without lesions. With further technical advancement of the technique aimed at rapid and easy application and confirmation of the results obtained so far, the combination of mammography and automated ultrasound might be introduced into a routine clinical setting.

Detection of malignant and benign breast lesions with an automated US system: results in 120 cases.

PURPOSE: To evaluate clinically an automated ultrasound (US) system for detecting benign and malignant breast lesions. MATERIALS AND METHODS: A prototype automated US system was used to examine 119 patients: 38 patients with 39 proved malignant breast lesions (7-50 mm), 41 patients with 41 proved benign breast lesions (8-40 mm), and 40 patients without breast lesions. The device yields a three-dimensional set of B-mode scans and reconstructed US images comparable to mammograms. All patients had undergone mammography. Four radiologists who had not performed the examinations independently assessed the mammograms and US images to detect benign and malignant breast lesions. RESULTS: Each of the four readers did not recognize one to three detectable malignant lesions on mammograms, one to two detectable malignant lesions on US images, two to four detectable benign lesions on mammograms, and five to seven detectable benign lesions on US images. All readers identified the 39 cancers with at least one of the modalities. The 40 cases without lesions were diagnosed correctly more frequently on the US images by three readers and on the mammograms by one reader. CONCLUSION: Depiction of breast lesions at automated US is reproducible. Automated US is complementary to mammography.

Description and first clinical use of a new system for combined mammography and automated clinical amplitude/velocity reconstructive imaging breast sonography.

RATIONALE AND OBJECTIVES: The authors tested a new automated system for clinical amplitude/velocity reconstructive imaging (CARI) breast sonography and compared the results with those of a manual laboratory model of this imaging modality, conventional sonography, and mammography. METHODS: Fifty-one patients with breast lesions were examined by mammography, conventional breast sonography, a laboratory version of a mammography-like breast compression device for breast sonography, and an automated system that allows sonography while in compression and reconstructs an image of the whole breast. The automated device allows reconstruction of one image per breast from an automatically acquired sonographic data set and simultaneous performance of mammography. The results of mammography and all modes of sonography were compared with histopathology in 36 surgically treated lesions of which 20 were benign and 16 malignant. In addition, 17 lesions confirmed to be benign by different imaging modalities were examined with the three different sonographic devices. RESULTS: All 16 histopathologically proven malignant lesions were identified correctly by compression sonography (laboratory and automated device) compared with 14 by conventional sonography. Of the 20 benign lesions, 16 were interpreted correctly by conventional sonography, 19 with the laboratory version, and 18 with the automated device, whereas mammography identified 12 benign lesions correctly and missed 1 malignant lesion. Only 16 of 17 lesions diagnosed to be benign by outpatient imaging could be examined with all three modes of study sonography and were found to be benign with all three modes in all cases. CONCLUSIONS: Compared with the laboratory version, the automated device facilitates acquisition and evaluation of compression breast sonography and is similar in lesion detection and differentiation. It should be tested in a larger number of patients.