Biomedical subjects
Publications and source records attributed to H E Reynolds.
Cholesterol granuloma of the breast is a rare condition that may be related to the common disorder mammary duct ectasia. Its importance is in its tendency to mimic carcinoma clinically and radiologically. The authors report a case in a 65-year-old asymptomatic woman.
To evaluate the current state of interventional mammography in the United States, surveys were sent to 1,000 randomly selected active members of the American College of Radiology (group 1) and the entire 1991 membership (n = 73) of the Society of Breast Imaging (group 2). Three hundred seventy-one (37%) group 1 and 49 (67%) group 2 responses were received. Some respondents did not answer all questions. Of group 1 respondents, 331 (93%) performed preoperative needle localization and 272 (73%) used a hook wire; 92 (25%), a J wire; and 55 (15%), a needle-dye technique. For group 2 respondents and these techniques, the results were 45 (94%), 32 (65%), eight (16%), and seven (14%), respectively. One hundred ninety-nine (62%) group 1 and 24 (55%) group 2 physicians administered local anesthetic during needle localization. Fifty-six (16%) group 1 and 25 (56%) group 2 physicians performed fine-needle aspiration cytology, as opposed to 11 (3%) and nine (20%) for core-needle biopsy, respectively. Cyst aspiration was performed by 245 (70%) group 1 and 40 (82%) group 2 respondents, galactography by 126 (36%) of group 1 and 30 (61%) of group 2, and pneumocystography by 57 (16%) of group 1 and 23 (48%) of group 2. For most procedures, informed consent was obtained by a minority of radiologists in both groups.
Eighty-nine consecutive patients undergoing needle localization at two facilities were alternately assigned to "local-anesthesia" (n = 46) and "no-local-anesthesia" (n = 43) groups. Those in the local-anesthesia group received 1-2 mL lidocaine hydrochloride 1% subcutaneously at the expected site of insertion of the localizing needle. All patients were asked to rate the level of pain they experienced from the procedure as a whole by using a 10-cm horizontal visual analog pain scale. Data about patient age, menopausal and menstrual status, average daily caffeine intake, and whether the patients considered mammography to be a painful procedure were collected. Patients who did not receive local anesthesia had a lower mean pain score (2.52) than those who did (3.27, P = .18). Premenopausal patients in the second half of their menstrual cycle at the time of the procedure had a significantly higher pain score than those in the first half (3.54 vs. 1.70, P = .05). Patients who considered mammography a painful procedure reported a higher level of pain than those who did not (3.79 vs 2.38, P = .012). There was no relationship between age, caffeine intake, or menopausal status and pain experienced.
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Radiographic density is considered an important feature in the evaluation of noncalcified breast masses, yet no studies assessing its value have been published. The radiographic densities of 91 biopsy-proved, nonfatty, noncalcified breast masses were evaluated by three mammographers. The density determinations made by each observer were compared with the histologic outcome for the 51 benign and 40 malignant lesions. With the kappa statistic, interobserver agreement was relatively poor (0.22 to 0.49), and intraobserver agreement for one expert mammographer was 0.50. When the majority opinion of the mammographers was used, sensitivity was 48%, specificity was 80%, and both positive and negative predictive values were 66%. As a solitary feature in lesion analysis, mammographic density is difficult to assess and is of limited value for the prediction of the benign or malignant nature of noncalcified breast masses.
Among mammography patients, a small but growing group of highly motivated women refer themselves directly for screening without the suggestion of their physicians. We surveyed 485 patients during a 3-month period to study how self-referred mammography patients differ from physician-referred patients. Self-referred patients were more likely than physician-referred patients to have a family income of more than $30,000 per year, to be college graduates, and to consider their health as good or excellent. A large percentage of self-referred patients performed other health-promoting practices, but were not significantly more likely to do these than were physician-referred patients. Women who referred themselves were more likely to have a friend with breast cancer and to believe that cancer could be cured. They expressed much less worry about radiation exposure and were more likely to consider $50.00 an appropriate charge for a screening mammogram. By far, the greatest motivator for self-referred patients was health promotion and disease prevention. Self-referred mammography patients tend to be wealthier, more education, and less concerned about the cost and radiation dose of mammography when compared with physician-referred mammography patients.