H.C. Burrell

Randomized clinical trial comparing radioisotope occult lesion localization and wire-guided excision for biopsy of occult breast lesions

Accurate localization of impalpable breast lesions that require biopsy is important. This randomized trial compared radioisotope occult lesion localization (ROLL) with the standard hooked‐wire technique.

The positive predictive value of mammographic signs: A review of 425 non-palpable breast lesions

The sensitivity of mammography in cancer detection needs to be high but is also important to achieve a high diagnostic specificity to avoid the morbidity associated with unnecessary surgical biopsy. We have reviewed the mammographic features of non-palpable breast lesions to identify factors which may improve the specificity of mammographic interpretation and reduce the number of open surgical biopsies for benign lesions. Four hundred and twenty-five surgical biopsies of non-palpable breast lesions were performed following image-guided localization between January 1987 and April 1994. The mammographic features of these lesions were reviewed and correlated with their histology. Two hundred and twenty-five of the excised lesions were malignant and 200 were benign giving a benign to malignant ratio of 0.88:1 and a positive predictive value (PPV) for malignancy of 53%. Pre-operative fine needle aspiration cytology was performed in 359 cases (84%). The PPV for the various mammographic abnormalities following the assessment process ranged from 4% for well defined masses to 94% for spiculate masses. The PPV for all microcalcifications was 45%. For impalpable lesions it is our policy to recommend surgical excision of all spiculate masses, parenchymal deformities and high risk microcalcifications. Ill defined masses are managed according to fine needle aspiration cytology (FNAC) and/or core biopsy results. Masses which are entirely well-defined are regarded as benign and are not recalled for assessment unless they are new or enlarging. Needle core biopsy has been added to our preoperative assessment of mammographically indeterminate microcalcifications with the aim of reducing the number of benign surgical biopsies.

Significant plain film findings in sigmoid volvulus

The aim of this study was to evaluate the plain abdominal radiographs of patients thought clinically to have a sigmoid volvulus. Strict diagnostic criteria based on the findings at barium enema and/or surgery were applied to establish or refute a diagnosis of sigmoid volvulus. The presenting plain abdominal radiographs were assessed for 10 radiological signs considered valuable in the diagnosis of sigmoid volvulus. Of the 17 patients with a volvulus, 88% had 6 or more signs, and in the 5 patients without a volvulus, 80% had 4 signs or less. Five signs achieved significance in differentiating between the groups. Three signs, apex of the loop under the left hemi-diaphragm, inferior convergence on the left and the left flank overlap sign, were 100% specific as well as being highly sensitive. The signs which were least specific were a distended ahaustral sigmoid loop and an air fluid ratio greater than 2:1.

Accuracy of GE digital breast tomosynthesis versus supplementary mammographic views for diagnosis of screen-detected soft tissue breast lesions

Objective: To compare the accuracy of standard supplementary views and GE digital breast tomosynthesis (DBT) for assessment of soft-tissue mammographic abnormalities. Methods: Women recalled for further assessment of soft-tissue abnormalities were recruited and received standard supplementary views (typically spot compression views) and two-view GE DBT. The added value of DBT in the assessment process was determined by analysing data collected prospectively by radiologists working up the cases. Following anonymization of cases, there was also a retrospective multireader review. The readers first read bilateral standard two-view digital mammography (DM) together with the supplementary mammographic views and gave a combined score for suspicion of malignancy on a five-point scale. The same readers then read bilateral standard two-view DM together with two-view DBT. Pathology data were obtained. Differences were assessed using receiver operating characteristic analysis. Results: The study population was 342 lesions in 322 patients. The final diagnosis was malignant in 113 cases (33%) and benign/normal in 229 cases (67%). In the prospective analysis, the performance of two-view DM plus DBT was at least equivalent to the performance of two-view DM and standard mammographic supplementary views—the area under the curve (AUC) was 0.946 and 0.922, respectively, which did not reach statistical significance. Similar results were obtained for the retrospective review—AUC was 0.900 (DBT) and 0.873 (supplementary views), which did not reach statistical significance. Conclusion: The accuracy of GE DBT in the assessment of screen detected soft-tissue abnormalities is equivalent to the use of standard supplementary mammographic views. Advances in knowledge: The vast majority of evidence relating to the use of DBT has been gathered from research using Hologic equipment. This study provides evidence for the use of the commercially available GE DBT system demonstrating that it is at least equivalent to supplementary mammographic views in the assessment of soft-tissue screen-detected abnormalities.

Case report: fibromatosis of the breast in a male patient.

Fibromatosis of the breast is an uncommon disease, although several series of this condition in females have been reported in the literature. We present the first case to be described in a male patient.

Mammographic sensitivity in women under 50 years presenting symptomatically with breast cancer

Abstract The sensitivity of mammography with respect to age in women with symptomatic palpable invasive breast cancers has been assessed. The mammogram reports of 257 women less than 50 years old were compared with those of 143 women between 50 and 70 years old. The reports were classified as malignant, indeterminate, or normal/benign. Mammography demonstrated a lesion classified as suspicious of malignancy in 83 % of women over-50 compared to 65 % of those under 50 (p =

Mammographic and pathological features of breast cancer detected at first incident round screening

Abstract This study investigated the proportion of first incident screen detected cancers diagnosable at prevalent round. The prevalent mammogram was classified as truly negative (no abnormality) or falsely negative (cancer diagnosable) after blinded review. Of 54 incident cancers, 63% were true and 26% false negatives. Five cancers were assessed at the prevalent round but dismissed as normal. The possible consequence of delayed diagnosis was inferred from the pathological prognostic indicators and calculated Nottingham prognostic index of the incident tumours, and comparison with prevalent screen, symptomatic and interval cancers. Compared to the true negatives, a significantly greater proportion of false negative incident tumours were in the very good prognostic group, i.e. in many of the latter the prognosis is probably unaffected, although in part this is because a number of the fast growing false negative tumours will result in interval cancers. Significantly fewer incident tumours were of good prognosis compared to the prevalent round, possibly an adverse affect of 3-yearly screening. Parenchymal deformities and calcifications were the most frequent false negative mammography signs and appear to represent good prognosis lesions.

Accuracy of GE digital breast tomosynthesis vs supplementary mammographic views for diagnosis of screen-detected soft-tissue breast lesions

OBJECTIVE To compare the accuracy of standard supplementary views and GE digital breast tomosynthesis (DBT) for assessment of soft-tissue mammographic abnormalities. METHODS Women recalled for further assessment of soft-tissue abnormalities were recruited and received standard supplementary views (typically spot compression views) and two-view GE DBT. The added value of DBT in the assessment process was determined by analysing data collected prospectively by radiologists working up the cases. Following anonymization of cases, there was also a retrospective multireader review. The readers first read bilateral standard two-view digital mammography (DM) together with the supplementary mammographic views and gave a combined score for suspicion of malignancy on a five-point scale. The same readers then read bilateral standard two-view DM together with two-view DBT. Pathology data were obtained. Differences were assessed using receiver operating characteristic analysis. RESULTS The study population was 342 lesions in 322 patients. The final diagnosis was malignant in 113 cases (33%) and benign/normal in 229 cases (67%). In the prospective analysis, the performance of two-view DM plus DBT was at least equivalent to the performance of two-view DM and standard mammographic supplementary views-the area under the curve (AUC) was 0.946 and 0.922, respectively, which did not reach statistical significance. Similar results were obtained for the retrospective review-AUC was 0.900 (DBT) and 0.873 (supplementary views), which did not reach statistical significance. CONCLUSION The accuracy of GE DBT in the assessment of screen detected soft-tissue abnormalities is equivalent to the use of standard supplementary mammographic views. ADVANCES IN KNOWLEDGE The vast majority of evidence relating to the use of DBT has been gathered from research using Hologic equipment. This study provides evidence for the use of the commercially available GE DBT system demonstrating that it is at least equivalent to supplementary mammographic views in the assessment of soft-tissue screen-detected abnormalities.

Do mammographic features of locally recurrent breast cancer mimic those of the original tumour

Abstract The aim of this study was to compare the mammographic features of locally recurrent breast cancer after conservative surgery with those of the original tumour. The mammograms of 31 patients who developed local recurrence were reviewed retrospectively. In 7 out of 9 (78%) patients where the original tumour was primarily a soft tissue abnormality (mass or architectural distortion) the recurrence also appeared as a soft tissue abnormality. In 5 out of 6 (83%) patients where the original tumour appeared as microcalcification the recurrence was also detected owing to the presence of new microcalcification ( P P

Role of targeted reassurance breast ultrasound in women with symptoms of a breast lump and normal clinical examination

Ultrasound has a well-established role in the triple assessment of breast lumps. The purpose of this study was to review the value of targeted breast ultrasound in women presenting with symptoms of a breast lump but normal clinical examination.