Visibility of simulated microcalcifications--a hardcopy-based comparison of three mammographic systems.

Full-field digital mammography systems are currently available for clinical use. These digital systems offer improved image quality, flexible image processing, display, storage, retrieval, and transmission. These systems employ a variety of different x-ray detectors based on storage phosphors (in computed radiography), charge-coupled devices (CCDs), or amorphous silicon flat panels (FPs). The objective of this study is to compare three different types of mammographic detectors: screenfilm (SF) combination, a CsI-based FP detector, a CCD and x-ray phosphor-based detector for their performance in detection of simulated microcalcifications. Microcalcifications (MCs) were simulated with calcium carbonate grains of various sizes (90-355 microm). They were overlapped with a slab of simulated 50% adipose/50% glandular breast tissue for a uniform background or an anthropomorphic breast phantom for a tissue structure background. Images of the phantoms, acquired with and without magnification, were reviewed by mammographers, physicists, and students. A five-point confidence level rating was given for each MC reviewed. Average ratings from the mammographers were used to compare the performances of the three imaging systems, various MC size groups, and two magnification modes. The results indicate that with uniform background and no magnification, the FP system performed the best while the SF system did slightly better than the CCD system. With magnification added, all detection tasks were improved except for the smallest and largest one or two size groups. In particular, detection in the SF and CCD images was significantly improved over that in the FP images. With tissue structure background and no magnification, the FP system was outperformed by the SF and the CCD systems. With magnification added, the performance of the FP and the CCD systems was improved significantly. With this improvement, the SF and FP systems were outperformed by the CCD system.

Role of sonography in diagnosing and staging invasive lobular carcinoma.

PURPOSE: The goal of this study was to compare the sensitivity of sonography with that of mammography in the detection of invasive lobular carcinoma (ILC), to identify ILC's typical imaging characteristics, and to further show the important role of ultrasound in the staging and treatment planning of this elusive tumor. METHODS: We identified all patients with ILC seen at our institution from 1998 through 2001; 62 had pathologically proven pure ILC. We retrospectively reviewed and analyzed the sonographic appearances in correlation with mammographic, pathologic, and clinical findings. We reviewed the results of sonographic examinations of the nodal basins and fine-needle aspiration (FNA) of suspicious nodes and correlated them with initial clinical and final pathologic staging. We noted all cases of multicentricity or multifocality and analyzed the relative sensitivity of mammography and sonography according to tumor size. RESULTS: Sonography had a sensitivity of 98% versus 65% for mammography. The most common mammographic pattern was a spiculated mass or architectural distortion (39%). On sonography the most common pattern was a hypoechoic mass with (58%) or without (27%) shadowing. An infiltrative pattern was observed in 13% of the cases. Ultrasound-guided FNA confirmed disease was present in the axillary lymph nodes in 21% of the patients, and sonographic examination of the nodal basins resulted in a change of clinical staging from N0 to N1 in 75% and from N1 to N0 in 30% of the cases. Multicentricity/multifocality was identified sonographically and proved by FNA in 21% of patients. CONCLUSIONS: Sonography has a much higher sensitivity than mammography in detecting ILC and therefore is an important adjunctive tool in the diagnosis of this form of cancer. Routine examination of node-bearing areas in patients with ILC proved useful in refining the disease staging.

Accuracy of core needle biopsy diagnosis in assessing papillary breast lesions: histologic predictors of malignancy.

The purpose of this study was to determine the accuracy of core needle biopsy (CNB) diagnosis of papillary breast lesions and to identify histologic features that can predict malignancy. We retrospectively reviewed 2876 CNB performed at MD Anderson Cancer Center (01/95-08/02) and identified 50 papillary lesions: 30 papillomas, eight atypical papillomas and 12 papillary carcinomas. Histopathological parameters were evaluated and radiographic findings were reviewed. When available, the CNB was compared with the excisional biopsy (EB) material. Carcinoma was confirmed by EB in 11/12 cases and invasion was correctly assessed in 67% of them. In EB, 6/8 (75%) atypical papillomas revealed carcinoma in situ or atypia and the remaining two (25%) were benign, six out of 30 (20%) papillomas had been excised and none had shown atypia; the remaining patients had clinical and radiological follow-up with no evidence of disease progression. We conclude that CNB is effective for assessing papillary breast lesions and that EB is more accurate in determining invasion. Cellular monotony, lack of myoepithelial cells, and cytologic atypia are more accurate predictors of malignancy (P<0.0001) than is the presence of mitoses (P<0.053). A diagnosis of carcinoma or atypical papilloma by CNB should warrant an EB, whereas benign papillomas may be followed if imaging findings are concordant.