[Early motherhood: sociodemographic profiles of 220 teenage mothers in Seine-Saint-Denis]. / Maternités précoces : profils sociodémographiques de 220 mères adolescentes en Seine-Saint-Denis.

OBJECTIVE: As part of teenage pregnancies, it is often found vulnerability and pregnancy follow-up of poorer quality. This investigation aims to establish profiles of young women and to assess what followed. METHODS: A retrospective study (2007-2011) of 220 births to women aged 12 to 17. RESULTS: The monitoring of these teenage pregnancies remains generally lower than France national averages, but significant differences are observed when one takes into account the socio-demographic factors. Three profiles appear: 66 teenagers (group A) reported a chaotic pregnancy monitoring, with a poorly enquired social, professional, familial situation. One hundred and two teenagers (group B) have a better follow-up but pregnancy is often unwanted with an unstable social situation. Finally, 52 teenagers (group C) have a rather good quality monitoring with a more assertive investment of pregnancy. CONCLUSION: To consider the lives of these young women is essential to study early motherhood and mitigate the vulnerabilities of this fragile population. An identification of factors favoring an optimal monitoring of pregnancy among young women is paralleled with reduced obstetric and social risks.

[Endometriosis with massive hemorrhagic ascites: a case report and review of the literature]. / Endométriose et ascite hémorragique massive récidivante: cas clinique et revue de la littérature.

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It generally involves the peritoneum, ovaries and rectovaginal septum. Its characteristic symptoms include dysmenorrhea, pelvic pain, deep dyspareunia and infertility. It may also involve the gastrointestinal tract, urinary tract or extra abdominal sites, giving rise to a wide variety of clinical symptoms such as bloody stools, renal haemorrhage, hemoptysis and pleural effusion during menstruation. Recurrent hemorrhagic ascites secondary to endometriosis is an unusual occurrence, 41 cases have been reported since 1954. Here we report an additional case, in order to draw attention to this condition. A 28 years-old black nulligravida woman was seen for the first time in april 2000 with a chief complaint of infertility. Her past medical history was unremarkable. She had regular menses but associated with severe dysmenorrhea. She also recalled abdominal and pelvic pain for several years. She underwent an ovulation induction with gonadotrophin, which resulted in a progressive increase of pelvic pain. A first laparoscopy was performed, revealing voluminous ascites (10 I). Two years later the ascites recurred spontaneously. Ultrasound examination revealed suspect "para uterine masses". A second exploratory laparoscopy showed a voluminous bloody ascites (71), and extensive adhesions. On histologic examination all specimens (peritoneal biopsies) were compatible with endometriosis and ruled out malignancy. Treatment with Gn RH analog was performed and full remission was obtained after 6 months. One year later the ascites recurred again spontaneously, leading to a third laparoscopy in an other medical institution. Histologic examination showed endometrial stromal tissue and fibrous proliferation. Later she became pregnant after in vitro fertilization. In the first trimester of pregnancy, the pelvic ultrasound showed only a small effusion in the pouch of Douglas. Still, the ascites did not progress during pregnancy. The patient was hospitalized from 27 to 33 weeks of gestational age for threatened labor, but she finally had a normal vaginal delivery at 36 weeks of gestational age. Four months later, she had no complaint, but the pelvic ultrasound showed the recurrence of the ascites. She will have a drainage. The future treatement will consists of GnRH analog for about six months, which will be relayed by a long term progestative therapy. A diagnosis of endometriosis should always be considered in middle-age women who presents with bloody ascites. Long follow-up is advisable for patients who undergo conservative treatment because of thehigh risk of recurrence.

Two- and three-dimensional sonographic assessment of the fetal face. 2. Analysis of cleft lip, alveolus and palate.

OBJECTIVES: To describe the sonographic appearance of cleft lip with or without cleft palate (CL +/- P) using two-dimensional and three-dimensional (3D) ultrasound imaging. Also, to evaluate the accuracy of ultrasound to delineate with precision the bony extent of facial clefts, i.e. to differentiate clefts limited to the lips, or extending to the alveolus/premaxilla or the secondary palate. METHODS: This was a retrospective study based on the examination of fetuses diagnosed with an isolated CL +/- P. Cases included were either discovered at systematic screening or referred for further investigation. Clefts were characterized by their precise anatomical location and extent. The defect could include a cleft lip (CL), a cleft alveolus (CA), or a cleft of the secondary palate (CSP). RESULTS: We analyzed 96 cases of CL +/- P. The mean gestational age at examination was 28.2 +/- 4.1 weeks. The sonographic appearance of CL, CA, and CSP was depicted. Strict concordance of the sonographic report with the anatomical defect was present in 84 cases (87.5%). In eight cases, the severity of the cleft was underestimated: three cases of CA, four of CA + CSP and one of CSP were missed. In four cases, the cleft was overestimated as CA was incorrectly suspected. CONCLUSIONS: Systematic screening with sonography to detect prenatally CL +/- P requires the imaging of at least the mid-sagittal and the anterior coronal 'nose-mouth' views. Once the presence of a facial cleft is suspected, the three reference orthogonal planes are imaged in order to characterize the anatomical defect, and for each plane, the serial scans are thoroughly examined. This protocol allows precise delineation of the defect. Inclusion of 3D and 4D ultrasound imaging in the examination protocol allows easier and more rapid screening and more precise evaluation of the different cleft constituents.

Two- and three-dimensional sonographic assessment of the fetal face. 1. A systematic analysis of the normal face.

OBJECTIVES: To detail fetal facial examination in utero using ultrasound, to distinguish between requirements for routine screening and those for precise analysis of fetal facial features, and to assess the use of three-dimensional (3D) ultrasound imaging in fetal facial examination. METHODS: This was a retrospective study, based on the examination of approximately 10,500 fetuses. The usual age at screening ultrasound examination was 22 +/- 1 gestational weeks. RESULTS: The sonographic anatomy of the normal fetal face was depicted, and the relevance of the three reference scanning planes, sagittal, coronal and axial, was specified. CONCLUSIONS: At routine screening using two-dimensional sonography, at least two selected views must be imaged: the mid-sagittal plane (search for facial dysmorphology) and the anterior 'nose-mouth' coronal plane (search for disruption in lip continuity or deformation of the narinal bend). Precise analysis of fetal facial anomalies requires visualization and thorough step-by-step analysis in the three planes. The difference between routine screening and precise facial features' analysis has been greatly decreased since 3D and 4D sonography have become readily available. Using this modality, after surface analysis of the fetal face, the three reference planes are simultaneously imaged, using the multiplanar modality, and detailed. 3D/4D ultrasound imaging allows easier, more rapid screening and more precise evaluation of the different facial features.

The fetal mandible: a 2D and 3D sonographic approach to the diagnosis of retrognathia and micrognathia.

OBJECTIVE: To define parameters that enable the objective diagnosis of anomalies of the position and/or size of the fetal mandible in utero. DESIGN: Fetuses at 18-28 gestational weeks were examined by two- and three-dimensional ultrasound. The study included normal fetuses and fetuses with syndromes associated with known mandible pathology: Pierre Robin sequence or complex (n = 8); hemifacial microsomia (Treacher-Collins syndrome, n = 3); postaxial acrofacial dysostosis (n = 1). Fetuses with Down syndrome (n = 8) and cleft lip and palate without Pierre Robin sequence or complex (n = 18) were also studied. Retrognathia was assessed through the measurement of the inferior facial angle, defined on a mid-sagittal view, by the crossing of: 1) the line orthogonal to the vertical part of the forehead at the level of the synostosis of the nasal bones (reference line); 2) the line joining the tip of the mentum and the anterior border of the more protruding lip (profile line). Micrognathia was assessed through the calculation of the mandible width/maxilla width ratio on axial views obtained at the alveolar level. Mandible and maxilla widths were measured 10 mm posteriorly to the anterior osteous border. RESULTS: In normal fetuses, the inferior facial angle was constant over the time span studied. The mean (standard deviation) value of the inferior facial angle was 65.5 (8.13) degree. Consequently, an inferior facial angle value below 49.2 degree (mean - 2 standard deviations) defined retrognathism. All the fetuses with syndromes associated with mandible pathology had inferior facial angle values below the cut-off value. Using 49.2 degree or the rounded-up value of 50 degree as a cut-off point, the inferior facial angle had a sensitivity of 1.0, a specificity of 0.989, a positive predictive value of 0.750 and a negative predictive value of 1.0 to predict retrognathia. In normal fetuses, the mandible width/maxilla width ratio was constant over the time interval studied. The mean (standard deviation) value was 1.017 (0.116). Consequently, a mandible width/maxilla width ratio < 0.785 defined micrognathism. Mandible width/maxilla width ratio values were below this cut-off point in eight and in the normal range in four fetuses with syndromes associated with mandible pathology. CONCLUSIONS: Retrognathia and micrognathia are conditions that can be separately assessed. The use of inferior facial angle and mandible width/maxilla width ratio should help sonographic recognition and characterization of fetal retrognathic and micrognathic mandibles in utero.

Analysis of normal breast tissue and of solid breast masses using three-dimensional ultrasound mammography.

OBJECTIVES: To describe the appearance of normal breast tissue and breast masses with three-dimensional ultrasound mammography, and evaluate the contribution of this to the diagnosis of breast masses. MATERIALS AND METHODS: A total of 186 solid hypoechoic breast masses were analyzed with two- and three-dimensional ultrasonography. Three-dimensional planar reformatted sections were reconstructed along planes either orthogonal or parallel to the skin surface. RESULTS: With parallel planar reformatted sections all the masses tended to be round. Margins were clearly demonstrated. In case of carcinomas, circumferential jagging was present in the equatorial planes. In case of fibroadenomas, complete wall continuity of the mass was readily apparent. The hyperechoic bands of fibrous tissue peripheral to the masses appeared either as distinct from the central image (compressive pattern) or converged towards the hypoechoic central core of the mass, producing a stellar pattern (converging pattern). These two patterns were preferentially associated with benign lesions and carcinomas, respectively. Three-dimensional ultrasound mammography had higher specificity, but lower sensitivity, than two-dimensional ultrasound mammography. CONCLUSIONS: Three-dimensional reconstruction, in particular parallel planar reformatted sections, represents a valuable adjunct to the characterization of breast masses using ultrasongraphy. Further studies are necessary to assess the validity of the present findings, particularly with regard to the rarer, more unusual types of carcinoma.

Comparison of growth hormone responses to growth hormone-releasing factor and clonidine in women with normal or poor ovarian response to gonadotropin stimulation.

OBJECTIVE: To assess the reliability of growth hormone (GH) secretion tests using provocative agents in women of different ovarian status. DESIGN: Comparison of GH secretion in response to clonidine (Catapressan; Boehringer Ingelheim, Reims, France) and growth hormone-releasing factor (GH-RF). SETTING: University Hospital, Hôpital Tenon, Paris, France. PATIENTS: Women categorized as "normal" (n = 6) or "poor" responder (n = 7) to ovarian stimulation with gonadotropins, depending on the follicular development attained at previous IVF attempts. INTERVENTIONS: Clonidine (0.300 mg administered orally) once and GH-RF (1 micrograms/kg IV) repeated twice. The tests were performed in random order in each individual on following cycles. MAIN OUTCOME MEASURES: Basal and peak GH values, area under the curve (AUC). RESULTS: Poor responder patients show significantly higher basal levels of FSH, GH, and insulin-like growth factor 1; FSH and basal GH levels are positively correlated. Peak GH levels and AUC are not significantly different in both categories of patients, whether GH-releasing factor or clonidine are used as provocative agents. True positive rate is 56.4% at the cutoff value of 7 micrograms/L, with no significant difference between the patients of the normally or poorly responding groups. At the 10-micrograms/L cutoff level, the true positive rate is almost half in the poor responder group (19.0% versus 38.9%), but the difference is not significant. CONCLUSIONS: These results raise concern about using the GH secretory response to a single clonidine administration as a predictive test of the therapeutic benefit that could be obtained by co-stimulating the somatotropic axis during a treatment with gonadotropins in poor responder patients, especially when their FSH basal levels are elevated.

Ultrasonographically guided fine needle aspiration cytology and core-needle biopsy in the diagnosis of breast tumors.

The present study was designed to assess the performance of fine needle aspiration cytology (FNAC) and core-needle biopsy (CNB) of breast lesions when these procedures are performed under sonographic guidance. The results obtained in 1142 FNAC procedures and 180 CNB procedures were analysed. The study took place in a University Hospital and a private practice clinic. The patients eligible for this study were a series of women, in whom at least one hypoechoic, limited mass was found at breast ultrasonography. Cystic masses were excluded from the study. Each individual mass was investigated using either FNAC or CNB under sonographic guidance. Accuracy characteristics to suspect or diagnose malignant and pre-malignant breast lesions, such as sensitivity and specificity, were calculated. The cytological results were classified into four categories according to standard criteria: benign; atypical and/or suspicious for cancer (hyperplasia with atypia); malignant; and unsatisfactory for diagnosis specimen. Tissue specimens were classified according to the W.H.O. The 1142 lesions submitted to FNAC included 66 invasive carcinomas, 4 intraductal carcinomas, and 4 atypical hyperplasias. FNAC led to 6 false-negative examinations, equally distributed between small (volume < or = 1 cm3), and larger lesions, and 1 false-positive examination. There were 12.9% (147/1142) inadequate smears. Only 3 inadequate samples were obtained in the presence of a discrete pathologic lesion (3/363, or 0.1%). All 3 corresponded to invasive carcinomas. The majority of inadequate samples (144/147, or 98.0%) were obtained in the normal/dystrophic group. Overall, the sensitivity is 92.1%, and the specificity is 84.8%. The 180 lesions submitted to CNB included 31 invasive carcinoma, 5 intraductal carcinomas, and 17 atypical hyperplasias. CNB, in this series, had an accuracy rate of 100%. In conclusion, US guidance increases the accuracy of breast tissue sampling procedures. This is of particular importance as the number of suspicious images to be investigated steadily increases, as the result of mass screening.

The value of ultrasonic examination to detect and diagnose breast carcinomas. Analysis of the results obtained in 125 tumors using radiographic and ultrasound mammography.

A series of 125 breast carcinomas studied by both radiological and ultrasound mammography, and which were observed in 102 patients, is presented. Of the lesions, 76.5% were less than 20 mm in diameter, and 16.8% had a diameter 10 mm or less. Sixteen lesions were in situ or microinvasive. Analysis of the results shows a 40.8% rate of false-negative results with radiological mammography, when only 'highly suspicious' and 'suspicious' images are considered. This figure is reduced to 28% when 'benign-appearing' masses are included in the computation. Using similar diagnostic categories, the false-negative rates obtained with ultrasound mammography were 14.4% and 12.8%, respectively. Combining radiological and ultrasound mammography resulted in a dramatic decrease in the false-negative rate to 4% The number of false-negative results observed with either radiological or ultrasound mammography was in the higher range of reported values when compared to selected studies. However, they may, in fact, closely reflect the real performance of these investigations, as they are available to patients in everyday clinical practice. Analysis of the data shows that radiological mammography is less efficient in younger patients. The mean age of the patients in the radiological mammography positive group was 54.3 +/- 1.2 years, as opposed to 47.5 +/- 2.1 (p = 0.004) in the radiological mammography negative group. In contrast, the efficiency of ultrasound mammography is independent of the patient's age, and consequently of breast density. In this series, no obvious size effect was apparent on tumor visibility using either imaging modality. The present study shows that the false-negative rate of radiological as well as ultrasound mammography is higher than usually perceived. Given the complementarity of radiological and ultrasound mammography, their combination proves highly sensitive and highly specific. However, this conclusion will only apply when both breasts are examined completely, but not when ultrasound examination of the breasts is restricted to the imaging of an anomaly detected with radiological mammography. The time needed to perform a complete breast examination reduces its potential use in a screening program. On the other hand, its use appears of major relevance in patients with breasts where the performance of radiological mammography is questionable, such as younger women, or women with dense breasts.

The significance of circulating antiethinyl-estradiol antibodies (AEEA) in the occurrence of thrombosis in women while taking the pill.

The aim of the study was to investigate the hypothesis that oral contraceptives (OC) lead to antiethinyl-estradiol antibody (AEEA) synthesis which might in turn be responsible for the thrombo-embolic complications observed in women users. The trial included 428 women divided into a) 204 healthy female volunteers as the control group (CONT), b) 139 women who had suffered thrombo-embolic accidents (THR), c) 85 women suffering from recurrent fetal loss (RFL). In each of these three categories, 50% were pill users (OC+) and 50% were not (OC-). Specific immune markers of systemic autoimmunity and anticardiolipin antibodies were looked for, as they are thought to be present in increased amounts in thrombosis or recurrent fetal loss. The AEEA prevalence differed significantly (p less than 0.05) between the CONT OC+ (32%) and the CONT OC- (13%) women. It also differed (p less than 10(-5)) between the RFL OC+ (60%) and the RFL OC- (12%) women. It did not differ between THR OC+ (36%) and THR OC- (39%) women. Within the OC+ women, the difference between the THR and the CONT groups was not found to be significant, whereas it was found to differ significantly between the RFL and the CONT groups (odds-ratio RFL/CONT estimated at 3.20, confidence interval 1.53, 6.69). Within the OC-women, the AEEA prevalence was found to differ significantly between the THR (39%) and the CONT (13%) groups (odds-ratio THR/CONT estimated at 4.40, confidence interval 2.07, 9.38%) but not between the RFL and the CONT groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Three-dimensional imaging of solid breast tumors with ultrasound: preliminary data and analysis of its possible contribution to the understanding of the standard two-dimensional sonographic images.

Reconstructed three-dimensional sonographic images are presented from patients having different histological types of breast tumors. Scanning is manual and performed using two-dimensional annular array, sector transducers fitted on a mechanical arm, to provide spatial location. The three-dimensional data are displayed using two different modalities. Planar reformatted sections allow the visualization of planes reconstructed along any direction chosen by the operator. Of particular interest are the reconstructions obtained along equatorial planes of the tumors, i.e. planes parallel to the chest wall and, consequently, to the fibroglandular layer of the breast. Volume rendering is obtained using the shaded-surface visualization technique.Three-dimensional imaging provides new information and allows a better interpretation of the standard two-dimensional images. Planar reformatted sections confirm that ductal carcinomas present margin jagging on all views, including the equatorial section planes. Using the shaded-surface visualization technique, these tumors appear with a spiked outer surface. Thus, the most specific sonographic finding associated with ductal carcinomas may be that margin jagging extends over the entire periphery of the mass. On planar reformatted sections, benign tumors are surrounded by a continuous hyperechogenic rim, i.e. the rim is present irrespective of the section plane orientation. Medullary carcinomas are also surrounded by a hyperechogenic rim. However, a clearly distinctive feature of these lesions is found on planar reformatted sections: the rim is discontinuous on certain section planes. A mass can be considered benign only if its rim is continuous, i.e. if it is present all around the tumor.

Pregnancy in women with immune thrombocytopenic purpura.

Thirty-six women with immune thrombocytopenic purpura were studied during 37 pregnancies, and maternal characteristics with predictive value for the fetal platelet count were determined. Nine neonates were thrombocytopenic, with a platelet count of less than 50 x 10(9)/L in eight. Four of these nine neonates delivered to a subgroup of 31 mothers were studied prospectively; the frequency of thrombocytopenia in neonates of women with immune thrombocytopenic purpura was thus 13%. Only two of these nine neonates presented with hemorrhagic syndromes (two, petechial purpura; one, intracranial bleeding). The frequency of neonatal thrombocytopenia was higher in mothers with deep thrombocytopenia and in those who had not responded to corticosteroid treatment following diagnosis. No prognostic value could be assigned to the other maternal characteristics studied, such as a history of splenectomy, maternal treatment at the time of delivery, or the presence of platelet autoantibodies evaluated either with the platelet immunofluorescence test or the platelet Western blot immunoassay.

LHRH-like immunoreactivity in the human placenta is not identical to LHRH.

LHRH-like immunoreactive material was separated from human placental homogenates by chromatography and tested against two antibodies directed respectively against the C- or the N-terminus (N- and C-antibodies) of the synthetic peptide. Extraction yield was 94 per cent as assessed by the recovery of the radiolabelled LHRH added to the homogenates. Placental LHRH-like immunoreactivity in crude extracts appeared largely overestimated, due to interference of endogenous substances non-related to LHRH. After elimination of this contamination, a higher residual activity was detected with the C- than with the N-antibodies. Eluates tested under these conditions contained only 550 pg of LHRH-like material per kg of placenta. This concentration was comparable whether placental tissue had been sampled at 12 weeks of pregnancy or at the end of gestation. The corresponding peptides however neither co-eluted with synthetic LHRH nor with catabolite fragments of the peptide. It is concluded that the human placenta contains a lesser amount of LHRH-like material than anticipated on the basis of earlier results and that this material does not correspond to the native decapeptide.

[Gonadotropic function during its use and after its cessation of a triphasic combination of gestodene]. / Etude de la fonction gonadotrope pendant l'utilisation et après l'arrêt d'une association triphasique au gestodène.

The present data show that the contraceptive studied, a triphasic combination pill with gestodene, strongly depresses gonadotropin levels. Seric levels of both FSH and LH are below 1 mIU/ml as early as the third treatment cycle. Recovery of a normal pituitary function occurs rapidly after the administration is discontinued: both basal and stimulated gonadotropin levels are back to normal during the first cycle following a 3 months treatment course. Prolactin secretion remains unaltered both during and after treatment.

Pyruvate kinase synthesis and degradation by normal and pathologic cells during erythroid maturation.

Mature erythrocytes contain a specific isozyme of pyruvate kinase (R-PK) while immature erythroblasts coexpress R-PK and another isozyme, M2-PK. To determine what roles degradation and decreasing of synthesis played in the disappearance of M2-PK during erythroid maturation, M2-PK and R-PK synthesis and degradation were studied in erythroblasts from fetal liver and blood BFU-E-derived erythroblasts from healthy subjects, an erythroleukemic patient, and a patient with an erythrocyte PK hyperactivity associated with M2-PK persistence in mature erythrocytes. In normal erythroblasts, R-PK synthesis was constant throughout erythroid maturation, whereas M2-PK synthesis decreased to the point of becoming undetectable. R-PK degradation was very low, while M2-PK degradation was more pronounced and steady during erythroid maturation. In leukemic erythroblasts, total protein turnover was higher than in normal cells, but the M2-PK degradation rate was lower. In erythroblasts from the patient with M2-PK persistence in mature erythrocytes, M2-PK synthesis did not decline with cell maturation. In conclusion, our results emphasize the importance of the decrease of M2-PK synthesis in the disappearance of M2-PK during erythroid maturation. Further studies of patients with pathologic persistence of M2-PK synthesis will help in the understanding of this event involved in erythroid maturation.

Predictive value of the FSH:LH ratio on follicular and luteal phase characteristics of the human menstrual cycle.

A prospective study was designed to assess the predictive value of gonadotropin measurements obtained during the early follicular phase upon the hormonal characteristics of the subsequent cycle. The data obtained in 12 normal cycles were used to compute the mean and confidence interval (mean +/- 2 SEM) of the FSH:LH ratio, FSH and LH plasma levels. The limits of the confidence intervals for these different parameters were used to classify the patients. Data of 204 patients were analysed. Low FSH:LH ratios (less than 1.34) are associated with an increase in follicular phase length (+2.4 days), a lower ovulatory rate, but neither luteal phase length nor progesterone levels differ between these two groups. When patients are classified according to FSH levels, our results show that low FSH levels (less than 2.94 mIU/ml) are associated with longer follicular (+2.6 days) and shorter (-1.1 days) luteal phase lengths, but ovulatory rate and progesterone levels in the luteal phase of the ovulatory cycles are similar to those obtained in patients of the normal or high FSH group. High LH levels (greater than 3.15 mIU/ml) are associated with a decreased ovulation rate but follicular and luteal phase characteristics are similar to those obtained in patients in the normal or low LH group. In conclusion, low FSH: LH ratios and low FSH plasma levels measured in the early follicular phase of the cycle are associated with longer follicular phase lengths; but basal gonadotropin measurements have limited predictive value on luteal phase characteristics.

Mass screening for breast cancer with sonomammography: a prospective study.

A prospective study was performed to assess the reliability of sonographic mammography in mass screening for breast lesions and diagnosis of small, presumably early, breast cancers. 1350 women underwent a sonomammographic examination of the breasts. Sonomammographic images were described in terms of their elementary constituents. Final diagnosis was obtained through cytological, and, when indicated, histological analysis. This ultimately led to the diagnosis of 13 breast cancers. Statistical analysis of the elementary sonomammographic image data using a logistic regression found two criteria to be highly associated with cancer. These were: (1) jagged aspect of the margins extending to the anterior or posterior walls; (2) major axis of the lesion not parallel to the skin surface. When combined, these two criteria have a 100% sensitivity and 99.6% specificity. The conclusions of the present study were validated for the screening of young women and may be applied to the screening of small lesions. However, these conclusions should be restricted to tumors 5 mm or more in diameter and of the common histological type, i.e. the infiltrating ductal carcinomas. Within these limitations, sonographic mammography can be considered a reliable technique for mass screening for breast cancer.