Breast calcifications seen on mammography may be associated with benign conditions or malignancies. Accurate characterization of these calcifications is crucial to providing optimal care that may ...spare women unnecessary biopsies and appropriately allow interval mammography. The purpose of this study is to determine if consensus characterization of calcifications by two breast imaging experts using standardized criteria can establish that follow-up is a safe option.
For this retrospective study, our breast imaging database was reviewed and the cases imaged between the years 1999 and 2001 were used to identify patients with calcifications who were recommended for a six-month follow-up or biopsy. All cases had been prospectively assessed by at least two expert breast imagers using standardized features to assess the findings before a recommendation for follow-up or a biopsy was made. A retrospective chart review examining the radiology reports was done to determine the percentage of women from each of the two groups who developed malignancies.
Of 744 patients who had mammographically identified clusters of calcifications, 490 clusters (409 single and 81 multiple) were diagnosed as probably-benign, and a short-interval 6-month follow-up was recommended. Of these calcifications followed for three years, only two (0.5%) of the single clusters proved to be malignant, and malignancy was diagnosed at the 12-month follow-up examination. In both cases, the women were diagnosed with ductal carcinoma in situ (DCIS). Of 254 clusters recommended for biopsy, 242 (215 single and 27 multiple) underwent biopsy. A total of 70 cancers were diagnosed: 54 (77.1%) were DCIS and 16 (22.9%) were primary invasive mammary carcinoma (10 cases of invasive ductal carcinoma, 3 cases of invasive lobular carcinoma, 2 cases of invasive ductal carcinoma with DCIS, and one case of invasive mucinous carcinoma with DCIS). Twenty-nine percent of women who had a biopsy performed had calcifications associated with malignancy. In contrast, in the women whose calcifications were followed by mammography, only 0.5% went on to develop malignancies.
Consensus review of calcifications by two breast imagers using standardized criteria is a safe follow-up option.
To explore the potential improvement in image contrast for breast imaging with use of monoenergetic photons.
The x-ray energy available from the National Synchrotron Light Source is from 5 to over 50 ...keV. A specific energy is selected with a tunable crystal monochromator. The object is scanned with a narrow beam of 80.0 x 0.5 mm. Mammography phantoms were imaged with plate and film as the imaging detectors. Phantom images were obtained at 16-24 keV and compared with images obtained with a conventional mammographic unit.
Preliminary findings indicate improved image contrast of the monoenergetic images compared with that obtained from the conventional x-ray source, particularly at 18 keV and below.
Pilot results are encouraging, and the authors presently continue to explore monoenergetic photon imaging with improved instrumentation, scatter rejection, and use of tissue samples.
Laparoscopic cholecystectomy is emerging as a preferred surgical method in the treatment of cholecystitis. Decreased morbidity and mortality rates make this an attractive altenative to conventional ...cholecystectomy. Recently, specific complications including bile duct transection, biloma formation, and liver lacerations have been reported. We report here, however, an unusual case of intraoperative spillage of stones into the introperitoneal cavity. Subsequent erosion through the diophragm resulted in expectoration of stones, or cholelithoptysis.
