Periodic mammographic follow-up of probably benign lesions: results in 3,184 consecutive cases

Article Abstract:

Mammography, X-ray of the breasts, is used primarily to detect breast cancer. Lesions or abnormal breast tissues seen on mammograms are identified, and those that may be cancerous are biopsied. Many lesions that are probably not cancer are not recommended for biopsy, because of the side effects and the high cost of the procedure. These lesions are usually monitored with follow-up mammography. Only one study has evaluated the validity of following these lesions with mammography, rather than performing a biopsy. One study reported only 1 percent of the lesions followed to be cancerous, but the study population was very low. This study examined the issue in a larger population. Clinical outcome of patients with breast lesions discovered by mammography in 3,184 out of 34,282 women who underwent mammography was examined. All the lesions were thought to be benign (not cancerous) and were monitored by mammography for three to three and one half years. Biopsies were performed after the study period to confirm diagnosis in all but 12 subjects. Final results showed that 17 (0.5 percent) of 3,184 lesions were cancerous. Fifteen of these lesions were biopsied because follow-up mammography showed changes. These results indicate this technique for following breast lesions that appear to be benign, rather than performing a biopsy, is both safe and effective. Mammography follow-up instead of biopsy can cut the costs and side effects that result when unnecessary biopsies are performed and may help increase the use of mammography for screening purposes. (Consumer Summary produced by Reliance Medical Information, Inc.)

Medical examination, Breast examination

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The subtle and atypical mammographic features of invasive lobular carcinoma

Article Abstract:

Invasive lobular carcinoma (ILC) is a rare type of breast tumor. It spreads in a pattern of single rows of malignant cells. It has little effect on underlying structures and connective tissue and rarely forms a detectable mass or calcifies in its early stages. These factors make ILC hard to detect. Both mammography (X-ray of the breast) and physical examination often result in atypical findings that inhibit detection of ILC. Unlike other breast cancers, mammograms of ILC often only show abnormalities in one of the three standard views taken. ILC frequently is similar in opaqueness to normal tissue on the mammograms; other types of breast tumors appear more opaque. In its early stages, ILC will only show up as subtle changes on the mammogram, so that there may be no diagnosis of ILC until it reaches its latter stages. This is also an important consideration for medical malpractice. These problems associated with detection of ILC bring into question the need for expanding the criteria used in diagnosing breast cancer from mammograms. Such a revision would hurt more than it would help because of the small number of cases involved, the fact that most can be detected by physical examination, and the increase in false-positive readings, in turn increasing morbidity and costs. Increased awareness of ILC and the problems associated with its detection is the better route to improve diagnosis of this disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

editorial

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Invasive lobular carcinoma: mammographic findings in a 10-year experience

Article Abstract:

Invasive lobular carcinoma (ILC) is responsible for approximately 10 percent of breast cancers. It is difficult to diagnose for a number of reasons. It grows in a diffuse and narrow pattern which usually does not interrupt surrounding structures. On X-rays, its opaqueness is often close to that of normal tissue. This study examined the pathologic data from 137 cases of ILC as seen over a 10-year period in a single hospital. The data revealed that physical examination discovered suspect findings in 89 of the 139 ILC cases. The majority of these findings consisted of a hard mass fixated to surrounding tissues. In 33 cases, an ill-defined thickening was discovered. The results of mammography showed a negative finding in 22 of the 137 cases. In 52 of the cases, a definite area of opaqueness was visible, but in 20 of these cases, it could not be seen in all mammographic views. Distortion of the tissue architecture was seen in 22 cases and a poorly defined opaqueness was seen in 10 cases. Secondary X-rays showed findings in 43 of the 139 cases, consisting mainly of skin or nipple retraction and skin thickening. These results indicate that ILC can be difficult to diagnose from X-rays. The radiologist should be careful to closely examine any abnormalities seen on a mammogram, even if they are slight. Also, any physical abnormalities discovered should not be overlooked because of a negative X-ray. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation

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