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Roentgenography and Biopsy in Mammary Cancer 1 Simon M. Berger , M.D. , Helen Ingleby , M.D. and J. Gershon-Cohen , M.D., D.Sc. Albert Einstein Medical Center, Northern Division, Philadelphia 41, Penna. Excerpt Roentgenography of the breast is a routine diagnostic measure accepted by only a few radiologists. One reason for reluctance to use this type of examination has been misunderstanding of the rationale. To bother with x-ray studies of the mammary gland, which is so accessible to physical examination and biopsy, seems superfluous. The low accuracy of roentgen diagnosis in earlier studies has also deterred surgeons and radiologists from adopting this procedure. The present communication will summarize our experience with breast roentgenography and its relationship to diagnostic surgical resection. The cardinal roentgen criteria of carcinoma of the breast are: The presence of an irregular or spiculated opacity, usually seen in scirrhous carcinoma. Advanced neoplasms are also accompanied by such secondary changes as distortion of breast architecture, thickening of the skin, nipple retraction, and increased vascularity. A rounded opacity with localized notching or infiltration as in medullary or adenopapillary types of carcinoma. Needle-point calcifications arranged in clumps, sometimes linearly and at other times widely scattered, frequently noted in “duct” carcinoma. We have encountered a few examples of this type of calcification when the carcinoma still remained in situ . Accuracy of Roentgenography of the Breast During the past two years, 536 patients from a total of 1,500 who had breast examinations underwent subsequent surgery, affording an opportunity to check the accuracy of the x-ray findings. Of 919 women reported to have benign breast lesions, 234 were operated upon, with confirmation of the x-ray diagnosis in 229, or 98 per cent. Of 118 reported to have malignant mammary lesions, 108 were operated upon and 106 of these, or 98 per cent, proved to have cancer. In 173 women who had lesions reported as probably benign by the roentgenologist, 91 were operated upon and in 83, or 91 per cent, the condition was found actually to be benign. In another group of 122 women in whom the radiologist could make no definite diagnosis but suspected the possibility of cancer, 92 were operated upon and 48, or 52 per cent, were found to have malignant disease. Since this last figure is hardly better than guesswork, we have come to recognize that in about 10 per cent of all x-ray examinations the results are non-contributory and the radiologist is better advised so to state his findings. In other words, where the experienced radiologist can make a definite diagnosis of the lesion, whether it be benign or malignant, the percentage of accuracy is better than 95 per cent. For those lesions of which he is uncertain, but which he believes are probably benign, accuracy falls to 90 per cent; and finally, in about 10 per cent of all examinations, he is apt to find himself in a position where he cannot give a reliable opinion. In another series of 209 consecutive cancers, 151 were diagnosed correctly by the surgeon, but the roentgenologist increased this number to 194.
Radiology – Radiological Society of North America, Inc.
Published: Dec 1, 1959
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