Detection of breast lesions by holographic interferometry.

The holographic interferometry (HI) technique commonly used for nondestructive testing of laminate materials was applied to create fringe contour distortion near the site of indwelling breast lesions. For this medical imaging application, the HI technique was successful in demonstrating abnormal mechanical properties of living tissue. Adequate density and contrast of fringes, crucial factors necessary for analysis of surface deformation of an object, can be made only with an appropriate stressing method. We have applied vibration and mild pressure to the surface of female breasts for the purpose of detecting localized densities and mass alterations of the tissue, which may be indicative of an abnormality of that tissue. Even though each stressing method had both positive and negative aspects, pneumatic pressure was adopted for the present study because it was more suitable for a noninvasive and noncontact breast examination. We also developed a computer based holographic imaging system to precisely control the stressing phase for the pressure and laser triggering so the resultant holograms had manageable fringe density and repeatability. © 1999 Society of Photo-Optical Instrumentation Engineers.

Use of biostereometric analysis as a screen for breast cancer.

Biostereometric analysis, a photographic surface imaging technology that is noninvasive, was tested for its effectiveness in selecting breast pathology in a sample of 1000 female subjects, including 80 with cancers, 635 normals, and 285 with benign breast conditions. These individuals were recruited from the population of women undergoing routine mammographic examination. The project was designed specifically to determine whether biostereometric analysis could identify the individuals in the sample with malignant breast disease in the hope of providing information to aid in future development of a breast cancer screening protocol. The overall sensitivity of the method for cancers of all sizes was 76%. Biostereometric analysis was 85% sensitive for selection of cancers in the subjects over 50 years of age, and identified 80% (4 of 5) of the subjects with clinically confirmed breast cancers less than 1 cm in size. The method was 69% specific, but identified benign breast disease in only 51% of cases.

Breast volume measurement of 598 women using biostereometric analysis.

A study of the volumes of the right and left breasts of 598 subjects was undertaken using biostereometric analysis. This measurement uses close-range stereophotogrammetry to characterize the shape of the breast, and is noncontact, noninvasive, accurate, and rapid with respect to the subject involvement time. Using chi-square tests, volumes and volumetric differences between breast pairs were compared with handedness, perception of breast size by each subject, age, and menstrual status. No significant relationship was found between the handedness, age, or menstrual status of the subject and the breast volume. Several groups of subjects were accurate in their perception of breast size difference. Analysis did confirm the generally accepted clinical impression of left-breast volume dominance. These results are shown to be consistent with those of a previous study using 248 women.

Angiosarcoma of the breast: report of two long-term survivals.

Angiosarcoma of the breast is a rare mesenchymal malignancy with a poor prognosis. One hundred sixty-four cases have been reported in the literature with 19 five-year, and 7 ten-year disease-free survivals. Two new cases of angiosarcoma of the breast are presented here, with disease-free survivals of five and ten years. In most series reviewed, angiosarcoma of the breast demonstrates as a rapidly fatal disease. Because axillary lymph node metastasis is rare, simple mastectomy with wide surgical margins is the procedure of choice. The mammographic and histologic findings may appear deceptively benign. A correlation exists between the histologic characteristics and the prognosis. Although there have been reports of increased survival with Actinomycin D, adjuvant therapy has failed to significantly alter the course of the disease in most series.

Biostereometric analysis for breast cancer detection.

A measurement technique has been developed for noninvasive breast cancer detection. The process involves the use of close-range stereophotogrammetry as a data acquisition device for the determination of breast surface concavities. We report the methodology used to detect these surface depressions, the rationale for the study, and our preliminary findings.

Breast volume measurement of 248 women using biostereometric analysis.

A study of volumes of the right and left breasts of 248 subjects was undertaken using biostereometric analysis. This measurement technique uses close-range stereophotogrammetry to characterize the shape of the breast and is noncontact, noninvasive, accurate, and rapid with respect to the subject involvement time. Volumes and volumetric differences between breast pairs were compared, using chi-square tests, with handedness, perception of breast size by each subject, age, and menstrual status. No significant relationship was found between the handedness of the subject and the larger breast volume. Several groups of subjects based on age and menstrual status were accurate in their perception of breast size difference. Analysis did not confirm the generally accepted clinical impression of left breast volume dominance. Although a size difference in breast pairs was documented, neither breast predominated.

Right and left breast volume and volume distribution comparisons in normal and tumor-containing breasts.

A measurement technique involving the use of close-range stereophotogrammetry has been developed for the study of breast volume and volume distribution (shape) comparison. This biostereometric method has been shown to be able to measure volume to within 0.63% of that determined by water displacement. This study describes the rapid and non-invasive data acquisition methodology as well as the mathematical algorithms used to determine breast volume. Additionally, the paper discusses the application of this process to documenting the presence or absence of total volume and volume distribution differences existing in normal breasts and those containing benign and malignant tumors.

Validity and reliability of biostereometric measurement of the human female breast.

A measurement technique has been developed for application in the area of noninvasive breast cancer detection. The measurement process involves the use of close-range stereophotogrammetry as a data acquisition device necessary for determination of breast volume and volume distribution. This report details the methodology used to acquire and analyze stereopair photographs necessary to document the validity and reliability of this application. The volume of a test object was determined by both water displacement and stereophotogrammetric analysis to estimate the precision of the proposed methodology. Additionally, the reliability component of the study was documented by analyzing variability of coordinates representing a series of locations marked on the surface of an irregularly shaped object. Both tests confirm that this stereometric analysis is a reliable and valid method of measurement and may be well suited for further development in the field of breast cancer detection.

Use of the computerized tomographic scan in the diagnosis and treatment of abscesses.

Over a 5 year period, 89 patients underwent one or more computerized tomographic scans to locate an abscess during 92 hospitalizations. The scans were a most sensitive (93 percent), specific (98 percent), and accurate (96 percent) means of abscess detection. Thirty-nine patients had positive scans. Sixteen patients were treated directly by open surgical methods, 1 of whom required percutaneous drainage in the postoperative period for incomplete drainage. An additional 23 patients underwent attempted percutaneous abscess drainage. In 17 patients, drainage was successful. Five patients underwent percutaneous drainage and later required laparotomy, two of whom underwent unavoidable surgical procedures and three surgery for incomplete drainage. Overall, percutaneous abscess drainage was successful in 83 percent. Of 11 deaths, 8 occurred in the group with computerized tomographic scans negative for abscess. Three of these were false-negative scans. Three deaths occurred in the group with scans positive for abscess. All were of patients with hepatic abscesses treated by open surgical drainage, one after failed percutaneous drainage. Twelve patients had multiple organ failure, and 8 of these patients died, for a mortality of 67 percent. The computerized tomographic scan is the diagnostic procedure of choice in the diagnosis of abscesses. In selected patients, percutaneous abscess drainage is also a successful means of abscess treatment and avoids the complications of a laparotomy. The onset of multiple organ failure in the surgical patient should alert the diagnostician to the possibility of a septic focus. The role of early laparotomy in these patients is uncertain. We recommend early use of the computerized tomographic scan in the septic surgical patient. Prompt diagnosis and treatment of abscesses, whether by open or percutaneous routes, may avert the development of multiple organ failure and reduce morbidity and mortality.

Breast cancer detection utilizing biostereometric analysis.

Twelve female patients participated in a study designed to employ computer-assisted biostereometric analysis for the detection of breast masses. All breast masses were previously documented by physical examination and followed by xeromammography, stereophotography, and histopathologic confirmation of tumor type. "Contour mammograms" were produced from the biostereometric photographs. These data were analyzed first for tumor detection and location by visual inspection. A second analysis employed a computed algorithm designed to locate and measure surface aberrations that suggest the possibility of underlying breast tumor. Visual analysis yielded the exact location of breast tumors in eight of the ten malignancies; computer analysis exactly located nine of the ten malignancies. In the computer analysis, one malignancy not exactly located by quadrant was, nevertheless, located in the correct breast. The results of the study suggest that the biostereometric process may have future use in screening or prescreening procedures for breast cancer detection. It is noninvasive, applicable to large numbers of women and with suitable refinements, and capable of being fully automated.

Routine operative cholangiography with cholecystectomy.

Four hundred and forty patients who underwent cholecystectomy and routine operative cholangiography were reviewed. False-positive and false-negative examination were 3.8 and 0.2 per cent, respectively. Unsuspected common duct stones were found 0.9 per cent of the time by cholangiography. The yield of common duct exploration was 63.8 per cent. Operative cholangiography spares at least two-thirds of the patients with clinical indications of choledocholithiasis unnecessary common duct explorations. The yield of operative cholangiography in patients with no clinical indication of choledocholithiasis is extremely low, and the cost-to-benefit ratio of routine operative cholangiography is high. Operative cholangiography should be used prior to common duct exploration for any clinical suspicion of common duct pathology. Routine operative cholangiography is not indicated for those patients with no clinical indication of common duct pathology.

The false-normal oral cholecystogram.

Five case reports of patients at Akron City Hospital who underwent cholecystectomy following normal oral cholecystograms and who were found to have cholelithiasis or acalculous gallbladder disease are presented. In spite of the present day 90 to 95 percent accuracy of oral cholecystography, there may be occasional pharmocological and mechanical factors contributing to the nonvisualization of biliary calculi. However, the gallbladder which visualizes normally during cholecystography, on occasion, may contain nonvisualized biliary calculi or may be diseased in the acalculous state, resulting in the so-clled false-normal x-ray and presents several means by which the surgeon may prove or disprove biliary disease. We conclude the emphasis must be placed on surgical judgment when a patient presents with symptoms of cholelithiasis in the face of normal oral cholecystography.