Mammographic follow-up of nonpalpable low-suspicion breast abnormalities: one versus two views

Article Abstract:

Mammography is the X-raying of the breasts and is most often used in screening for breast cancer. Many abnormalities may be seen on mammograms, but most do not involve cancer. A biopsy is usually needed for a final diagnosis of cancer. Because of the invasive nature of the biopsy procedure and because certain mammographic abnormalities rarely indicate cancer, follow-up mammography performed at a later date rather than immediate biopsy is suggested in some cases. The follow-up mammography is usually performed from two views. Few cancers are missed by this technique. This study examined whether follow-up mammography taken from only one view was as effective as from two views in evaluating mammographic abnormalities with a low chance of being cancerous. Mammograms from 498 women showing a total of 666 low-suspicion abnormalities were reviewed. Mammograms were taken from two views (head-to-toe, or from the side), both initially and at follow-up. From the initial mammograms, the view was selected which provided the best image of the abnormality. The same view was used for evaluation at follow-up as the single view. If both initial views were equally good, the head-to-toe view was used at follow-up. After evaluation with the single view at follow-up, evaluation was made with both views to see if interpretation of results was enhanced or altered. In 607 cases, the adequacy of the single view interpretations at follow-up were thought quite good and in 59 cases adequacy was questionable. Only two of the 607 cases (0.3 percent) showed changes in the breast with two views that were not detectable with a single view. In six of the 59 cases, changes in the breasts were diagnosed with one-view interpretations. In all six cases, no changes actually existed when two views were interpreted for follow-up. Overall, interpretation of follow-up results with a single view was altered after examination of two views in 1 percent of the cases. One-view mammographic follow-up can be safe and effective for selected patients while saving time and money. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Mammography in the eighties

Article Abstract:

Mammography (X-ray of the breast) has undergone a number of changes in recent years. Improvements in technology as well as increased encouragement for women to have such examinations regularly have brought tremendous changes to the field. During the time period from 1985 to 1988, the number of facilities for mammography in the United States increased by 60 percent. The Nationwide Evaluation of X-ray Trends (NEXT) Program was begun in 1985. Part of the program involved two surveys of mammography facilities, one in 1985 and the other in 1988. This study examines the two surveys to reveal changes that have occurred in mammography. The results show that the type of mammography being used shifted from an approximately even split between xeromammography (which uses a charged plate) and screen-film mammography to a predominance of screen-film mammography. There was a large increase in the number of facilities using grids (which increase image quality) and automatic exposure control (AEC) units (used to limit exposure to X-rays). The quality of the images being produced increased in both systems using grids and those not using them. On the negative side, exposure to X-rays (as measured by mean glandular dose) increased in both systems using grids and those not using them. However, the levels seen were within recommended limits, and for the non-grid systems, there was a decrease in the number of facilities exceeding maximum levels. The increases in exposure were attributed to a number of factors, all related to improving the technique as a whole. The results indicate that the small increases in exposure are more than offset by improvements in imaging quality, and that the changes that occurred during this time period in mammography have a very positive overall effect. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation

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Immediate postoperative mammogram for failed surgical excision of breast lesions

Article Abstract:

When abnormal breast tissue is discovered by palpation (touch) or mammography (X-ray), the lesions are surgically removed and examined to determine whether any further treatment is needed. The tissue removed is immediately examined and X-rayed to ensure that the lesion is actually contained. The time element is important because the patient and the surgeon remain in the operating room until the results are known. In a small number of cases, the X-ray of the removed tissue does not show signs that the lesion was removed. This requires additional samples to be removed, and causes increased anxiety to the patient and the doctor, and a delay in diagnosis. Possible reasons for failure to find the lesion are that it was simply not removed or else the surgical process destroyed the lesion and made it undetectable. This study examined the use of postoperative mammography as a possible remedy for this problem. The procedure just requires a mammogram of the patient after surgery. Two hundred cases where lesions were removed after being found by mammography were reviewed. In only 11 cases did postoperative radiography of the excised tissues fail to show evidence of the lesions. These 11 patients were then examined by postoperative mammography. Results showed that five of the 11 patients' operations failed to remove their lesions. The postoperative mammographies were then useful in the repeat surgery. The other six patients showed no sign of the original lesions, and unnecessary anxiety and further surgery were avoided. These results indicate that postoperative mammography is an easy, useful tool when radiographs of excised tissues fail to reveal that the lesions to be removed actually were. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery, Breast surgery

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