Non-palpable breast lesions in asymptomatic women: diagnostic value of initial ultrasonography and comparison with mammography.

AIM: This prospective double-blind study was designed to assess (i) if primary breast screening by ultrasonography is capable of detecting breast cancer independent of tissue density and (ii) if the rate of unnecessary biopsies remains acceptable when diagnostics are based on ultrasonography. PATIENTS AND METHODS: Bilateral breast ultrasonography was performed in 448 asymptomatic women as the initial diagnostic method. Sonograms were interpreted using a set of standardized diagnostic criteria. Subsequently, mammograms were obtained. The radiologists reading the mammograms were blinded to the sonographic results. RESULTS: Overall, 3 non-palpable breast cancers were detected by ultrasound and mammography. All 3 ultrasonographically detected breast cancers were smaller than 1 cm (0.7, 0.7, 0.6 cm). All 3 carcinomas were correctly detected by both methods. For ultrasonography, the false positive rate was 1.1% (n=5) and for mammography 0.6% (n=3). When both methods were combined, the rate of unnecessary open biopsies was 1.6% (n=7). The ratio of benign to malignant lesions was 3.7/1. CONCLUSION: Without prior mammography, primary high-resolution breast ultrasonography is capable of detecting non-palpable breast carcinomas in asymptomatic women at an early stage. The rate of unnecessary open biopsies is low and the ratio of benign to malignant biopsies acceptable.

Papillary intracystic carcinoma of the female breast--role of ultrasonography.

We report on a 76-year-old patient with papillary intracystic breast carcinoma. Papillary intracystic carcinomas represent a rare entity. Among all malignant breast tumors, this lesion has an incidence of 0.5-2%. Palpation is not sufficient to distinguish benign from malignant findings. The same applies to mammography, unless the tumor infiltrates the cyst wall. The method of pneumocystography has become obsolete. Sonography is the preferred diagnostic modality to distinguish cystic from solid lesions and to differentiate simple cysts from cysts with intracystic growth. In this respect, Doppler and power Doppler sonography can be instrumental. It is feasible to obtain preoperative ultrasound guided FNAC or core biopsies of the cystic and solid components for cytological or histological verification. Complete excision of the cyst which should include the intracystic growth is considered the treatment of choice.

Juvenile papillomatosis (JP) of the female breast (Swiss Cheese Disease) -- role of breast ultrasonography.

This report summarises the imaging findings of juvenile papillomatosis (JP) in a 16-year-old woman. Sonographically, the lesion was oval, well defined, heterogeneous with multiple small, cystic spaces. Ultrasonography can be helpful in differentiating between JP and similar cystic lesions, fibroadenomas, phyllodes tumours, intracystic papillomas and carcinomas. A core needle biopsy is still needed to confirm the diagnosis. An open biopsy with excision of the lesion is mandatory, mere observation is inadequate because of insufficient knowledge about the direct relationship between JP and subsequent cancer.

[The Borstal of Göttingen and sterilization of adolescents in Nazi Germany]. / Das Provinzial-Erziehungsheim in Göttingen und die praktische Umsetzung des Gesetzes zur Verhütung erbkranken Nachwuchses.

The Nazi regime established a law in 1933 that led to approximately 360,000 involuntary sterilizations. This paper explores the application of this law in the Borstal of Göttingen, an institute for "corrective training" of male adolescents. Between the years 1934 and 1941, about 60 adolescents were legally sterilized at this institution - in most cases upon the recommendation of Walter Gerson, a psychiatrist and the institute's Director. The diagnosis was generally "congenital idiocy," a term used to classify boys who were considered to suffer from "psychopathology", antisocial behaviour or "hereditary burdens." In about a third of the cases, the adolescent or his parents attempted to prevent the sterilization, but such attempts were unsuccessful. Even after the war, victims' attempts to become rehabilitated were thwarted - both by the reinstalled Gerson and the justice of Göttingen. It was only in recent years that the financial rehabilitation of the victims was put into practice.