Imaging of the breast.

A multitude of techniques for imaging and evaluating the breast have been described. Based upon current evidence, thermography does not appear to have any established clinical indications. Computed tomography, ultrasonography, lightscanning, and NMR may be useful as adjuncts to mammography, and further research seems warranted. Mammography remains the "gold standard" in breast imaging, however. Its ability to detect clinically occult disease makes it the superior imaging technique in the breast, and the only technique indicated for screening. In light of the information presented in this article, it is hoped that the trend away from mammography in favor of so-called "noninvasive" breast imaging techniques will be reversed until such time that the efficacy of these other modalities has been proven. A proper process for the evaluation and clinical testing of the newer breast imaging modalities has been defined. Using this as a guideline, it is hoped that the indiscriminate clinical use of unproven techniques will be avoided.

Sonography of the breast: findings following conservative surgery and irradiation for early carcinoma.

A dedicated-waterpath ultrasound breast scanner was used to examine 25 patients who had early breast carcinomas that were treated with conservative surgery (lumpectomy, tylectomy) and irradiation. Sonographic findings following such therapy included asymmetry in breast size, skin deformity and thickening, nipple retraction and/or distortion, and thickening of the Cooper ligaments. Disruption of the central echogenic cone of fibroglandular tissue, and general architectural distortion and internal asymmetry when the breasts were compared were also present in a large percentage of patients. The single case of recurrent carcinoma revealed only enlargement of the treated breast when the breasts were compared; no other pertinent sonographic findings were evident. The significance of sonography in the evaluation of the breast after conservative therapy for carcinoma remains to be determined. However, many of the sonographic findings in this group of patients are similar to those of the secondary signs of carcinoma. Knowledge of the sonographic changes of the conservatively treated breast therefore assumes importance for the sonographer.

Fat necrosis of the breast: characteristic xeromammographic appearance.

Eight cases of fat necrosis of the breast were examined by xeromammography and confirmed pathologically. They showed a spectrum of mammographic appearances, from mimicking other benign diseases to suggesting a malignant lesion. Three of the eight cases showed the benign ring-like calcification associated with fat necrosis; this is a higher percentage than reported in previous series. In our experience this radiological presentation of fat necrosis is not infrequent and biopsy of these lesions is not necessary unless other clinical or radiological signs suggest malignancy.

Mammographic and pathologic correlation of microcalcification in disease of the breast.

Fifty-five patients with isolated microcalcification clusters and no palpable tumor of the breast were studied. All patients underwent appropriate localization biopsies and had roentgenographic, specimen roentgenographic examination of histologic confirmation that the area of microcalcification was removed. Fifteen patients proved to have a malignant lesion at biopsy and in 40 patients, it proved to be benign. Of the proved cancers, ten were noninvasive. Fourteen of the patients with cancer were free of axillary metastases. The results of the follow-up study, with a mean time of four years, revealed a 100 per cent survival rate and no recurrence of disease. Careful study of the microcalcification clusters, at preoperative mammographic examination, did not show significant differences between the malignant and benign group that could be helpful to the clinician, in predicting the nature of the lesion. Due to the reasonably high, 27 per cent, rate of malignant disease, we believe all patients with isolated microcalcification clusters at preoperative mammographic examination should have a localization biopsy.

Ultrasound demonstration of giant malignant breast cyst undetected by xeromammography.

The present case is unusual because, despite the underlying fatty breast pattern, the large size of the mass, and the presence of carcinoma, an essentially normal xeromammogram was obtained. This case demonstrates the necessity of performing a subsequent ultrasound examination on any patient in whom a palpable breast mass is not detected by xeromammography. The present case report clearly demonstrates that cyst aspiration plays a vital role in the evaluation of cystic breast masses.

Lymphoma with herpes zoster.

A herpes zoster infection in patients with lymphoma has been associated with subsequent metastatic disease involving the spinal cord and vertebrae of the affected dermatome segment. This correlation can be used in planning radiation therapy to avert neurologic complications secondary to spinal cord involvement.

Pectus excavatum deformities simulating mediastinal masses.

Three patients with various pectus excavatum deformities in whom radiographic findings suggested hilar and mediastinal masses are presented. Computed tomography of the chest yielded valuable diagnostic information and made it possible to exclude the existence of these masses. Compression deformity of the heart and great vessels by the pectus deformity is the most likely explanation for these findings.

Scapular defects: a normal variation.

Sharply marginated defects were observed in the scapulae of five patients. In all cases the defects were benigh in appearance and unrelated to symptoms. These patients have been observed up to 5 years without change in the radiographic appearance. Recognition of the benign nature of these defects is important to avoid confusion with pathologic conditions.

Duodenal pseudotumor with ball-valve syndrome.

Prolapse of the gastric mucosa into the duodenum must be considered when a round soft tissue mass is seen in the right upper quadrant on scout abdominal film. Gastric prolapse may mimic tumor in the duodenum when the prolapse is large. Examination with barium meal is necessary to exclude prolapse of the gastric mucosa into the duodenum as a cause of epigastric pain and vomiting. Medical treatment is suggested for patients with mild symptoms, but patients with severe symptoms, repeated hemorrhage, anemia, severe intermittent epigastric pain and vomiting due to ball-valve syndrome should have operation.

Irregularity of Silastic breast implants mimicking a soft tissue mass.

Seven patients were identified who developed a palpable breast mass following augmentation mammoplasty. Xeromammography showed the "mass" to be a puckering or bulge in the Silastic implant.