Experience with Mammography in a Tumor Institution

Abstract

Soft-tissue roentgenography of the breast is not new. In the American literature, Leborgne (4) of Uruguay described the technic of examination and the rogentenographic appearance of various mammary tumors. Warren (5) of the United States in 1929 reported on 119 cases, 58 of which were malignant. Interpretative errors were made in but 8 cases, 4 being in the malignant group. He stated: “In many of the cases, there was no unanimity of opinion in the preoperative clinical diagnosis. Several opinions were often held as to the presence of malignant or benign tumors in each case. The opinion from the roentgenogram, on the other hand, was often very definite and, most frequently, correct.” Since Warren's publication an occasional enthusiastic proponent of this method of examination has appeared. However, as of the date of this study, no satisfactory statistical analysis of consecutive mammograms in patients with adequate follow-up has appeared in the American literature. Material One thousand consecutive x-ray examinations of the breast were performed at the M. D. Anderson Hospital and Tumor Institute in the period from May 1956 to May 1959. Adequate follow-up to date has been available on all except 2 patients. These were excluded from the series as both were examined in the terminal stage of malignant lymphoma, and neither biopsy nor autopsy was obtained. Six hundred and thirty-four patients were examined. For simplicity of presentation of results, each breast was considered a separate study. Frequently there was a lesion, benign or malignant, on each side, possibly with only 1 correctly diagnosed; or the patient may have had a previous mastectomy, leaving only one breast for study. Not all patients admitted to the Hospital's breast service were referred for mammography. During the three-year period 1,253 new patients with lesions subsequently proved by biopsy were seen at that clinic, and of these, 956 had malignant and 297 had benign lesions. Cases of a questionable or palpable nodule in the breast, an inverted nipple, or nipple discharge were referred for mammography. Occasionally breasts were normal to palpation even though there was undifferentiated carcinoma in the axillary nodes or osseous lesions resembling metastatic carcinoma of the breast. Breasts containing clinically obvious carcinoma or with a known diagnosis of carcinoma following recent biopsy were not studied. The opposite breast was examined when such a patient was referred for mammography, however. If the result of the previous biopsy was not stated on the request for roentgenography, both breasts were radiographed. Roentgenographic Technic Positioning of the patient is illustrated in Figures 1–3. One roentgenogram of the axilla is obtained and two of the breast, in 2 planes at right angles. These have resulted in good delineation of the quadrants, ease in positioning, and patient comfort with consequent cooperation.