Lester Kalisher

99mTc-Diphosphonate Concentration in Primary Breast Carcinoma

In two patients with breast carcinoma images of the skeleton were obtained with 99mTc-diphosphonate. In both cases there was increased uptake of the scanning agent in the area of the breast mass.

Mammography Parenchymal Patterns and the Prevalence of Breast Cancer1

An investigation of the relationship between breast parenchymal patterns and breast cancer prevalence in a large referral population is presented. Mammograms were assigned to one of four categories according to our interpretation of Wolfes classification. Cancer prevalence for the four patterns was similar when uncorrected for age,, and was very high compared to that in the general population. Under age 50, the prominent duct pattern (P2) was associated with a very high relative cancer risk and DY carried a smaller increased risk. After age 50, prevalences for the patterns were nearly equal. Relationship between these findings and epidemiology of breast cancer are discussed and suggestions made for utilizing parenchymal patterns to guide examination frequency.

Breast metastasis: An unusual manifestation of a malignant carcinoid tumor

A metastasis from a bronchial carcinoid tumor presented as an isolated breast mass in a 58‐year‐old female. A review of the English literature revealed four cases of metastatic carcinoid to the breast that presented as an isolated breast mass. In each case, radical mastectomy was performed after the lesion had been interpreted clinically and pathologically as a primary carcinoma. When the primary tumor was excised, all cases had either regional lymph node or liver involvement. A mass was the usual presenting sign of the metastatic deposit. No metastasis was reported to be greater than 2 cm in diameter. No axillary lymph nodes were reported to contain tumor. Frozen section preparations may not be adequate to differentiate a primary carcinoma of the breast from a metastatic carcinoid tumor, thereby necessitating permanent sections, special stains, review of previously resected neoplasms, or electron microscopy. The first mammogram of a metastatic carcinoid to the breast is reported with this case. Cancer 40:3102‐3106, 1977.

Xeroradiography of axillary lymph node disease.

Xeroradiographic evaluation of the axillary lymph nodes permits differentiation of characteristic patterns, including normal nodes and those enlarged as the result of fatty infiltration, inflammation, metastases from a breast primary, or primary nodal disease such as lymphoma or hyperplasia. The author describes his experience with this technique in selected patients.

Breast MRI: The Importance of Bilateral Imaging

4Department of Radiology, Hatch MR Research Center, Columbia University, New York, NY 10032. ne of the most controversial issues related to the use of MRI for the breast is the lack of standardization of imaging protocols. The absence of standardization has not only led to a vast array of imaging techniques performed on different MRI machines with different coils and capabilities, but it has also generated a consequent series of questions for radiologists who specialize in breast MRI. Among these questions are, Should unilateral or bilateral imaging be performed? What is the appropriate length of dynamic sequences? What is the correct amount of contrast material injection? Answers to these and other questions are continually being evaluated in the medical literature and are constantly being debated by radiologists. The objective of this commentary is to highlight the importance and advantages of performing bilateral breast MRI versus unilateral breast MRI. Also discussed are the improved ease of interpretation with bilateral imaging, its technical simplicity, the improved patient comfort and satisfaction generated from this technique, its potential economic benefits, and the improved detection of breast cancer in both breasts obtained with bilateral imaging. Breast MRI is continually recognized for its high sensitivity in breast cancer detection, which in some studies approaches 100%. Although not currently recommended for routine screening, breast MRI may benefit women with high-risk factors including genetic predisposition, dense breast composition, personal history of breast cancer, atypia, lobular carcinoma in situ, and family history. MRI can provide additional information for evaluating the extent of disease in women diagnosed with breast cancer, including identification of multicentric and multifocal disease in the ipsilateral breast and additional sites of cancer in the contralateral breast. Patients who have undergone a lumpectomy, patients with positive axillary nodes and unknown primary carcinomas, and patients with breast implants may also benefit from breast MRI [1–3]. However, breast MRI is still questioned because of its low specificity, which ranges from 37–97% [4]. This low specificity often makes breast MRI the less desirable option for patients and referring physicians because of fear of unnecessary biopsies, patient discomfort and anxiety, and higher cost. The low specificity of breast MRI may in part be related to lack of a universally accepted standard technique within the medical community for using MRI. In this commentary, we present our assessment, based on a 30-month analysis of more than 3,000 cases, that bilateral breast MRI, using the axial plane, has significant advantages over other techniques.

Clinicopathological Correlation of Xeroradiography in Determining Involvement of Metastatic Axillary Nodes in Female Breast Cancer

Xeroradiographic evaluation of the axilla is useful in the presence of mammary carcinoma, as radiographic examination of this area can be highly accurate in predicting its malignant involvement if certain strict criteria are employed. The ability to diagnose nodal metastases with near certainty has important implications for treatment planning and prognostication.

An improved needle for localization of nonpalpable breast lesions.

The author describes an inexpensive 22-gauge flat head needle which permits rapid and virtually painless preoperative localization of nonpalpable breast lesions. The lesion is transfixed and anchored by the needle to the skin after a mammogram is obtained.

Incidence of Bone Metastases in Women with Minimal and Occult Breast Carcinoma

A total of 42 women with proved minimal (14) or occult (28) breast carcinoma were evaluated for up to 48 months (mean = 28 months). Bone scans, radiographs, blood chemistries, enzyme levels, and operative findings demonstrated metastases only in those 6 patients (14%) who presented with symptomatic metastases from an unknown primary source. The other 36 women are free of metastases. Preoperative radionuclide bone scans may not be necessary for women with minimal and asymptomatic occult breast cancers.

Efficacy of the Lateral View Mammogram in the Detection of Breast Malignancy

Previous studies suggest that single-view lateral mammography alone results in a small decrease in detection of malignancies. Detection rates for lateral view only and two-view examinations in 200 cases (100 malignant, 100 nonmalignant) were compared. Four to six per cent of cases originally found positive were reinterpreted as negative in both situations. Preliminary findings suggest that the lateral view alone is sufficient, provided a second view is requested in suspicious cases.

Evaluation of Mammographic Screen-Film Systems

Four screen-film systems were evaluated for their imaging properties in mammography, Modulation-transfer functions were measured at 40 kVp. Absolute screen-film sensitivities in mR and entrance exposures were measured with tungsten and molybdenum target tubes. Five radiologists viewed radiographs of a phantom containing microgranules of SiC ranging in diameter from 590 to 120 micrometer. The Rarex-B screen--composed of yttrium oxysulfide--performed best, allowing phantom radiographs at 185 mR with image quality sufficient to demonstrate microgranules greater than 330 micrometer in dimension.