Detection and classification of breast lesions using multiple information on contrast-enhanced mammography by a multiprocess deep-learning system: A multicenter study

Objective: Accurate detection and classification of breast lesions in early stage is crucial to timely formulate effective treatments for patients. We aim to develop a fully automatic system to detect and classify breast lesions using multiple contrast-enhanced mammography(CEM) images.Methods: In this study, a total of 1,903 females who underwent CEM examination from three hospitals were enrolled as the training set, internal testing set, pooled external testing set and prospective testing set. Here we developed a CEM-based multiprocess detection and classification system(MDCS) to perform the task of detection and classification of breast lesions. In this system, we introduced an innovative auxiliary feature fusion(AFF)algorithm that could intelligently incorporates multiple types of information from CEM images. The average freeresponse receiver operating characteristic score(AFROC-Score) was presented to validate system’s detection performance, and the performance of classification was evaluated by area under the receiver operating characteristic curve(AUC). Furthermore, we assessed the diagnostic value of MDCS through visual analysis of disputed cases,comparing its performance and efficiency with that of radiologists and exploring whether it could augment radiologists’ performance.Results: On the pooled external and prospective testing sets, MDCS always maintained a high standalone performance, with AFROC-Scores of 0.953 and 0.963 for detection task, and AUCs for classification were 0.909[95% confidence interval(95% CI): 0.822-0.996] and 0.912(95% CI: 0.840-0.985), respectively. It also achieved higher sensitivity than all senior radiologists and higher specificity than all junior radiologists on pooled external and prospective testing sets. Moreover, MDCS performed superior diagnostic efficiency with an average reading time of 5 seconds, compared to the radiologists’ average reading time of 3.2 min. The average performance of all radiologists was also improved to varying degrees with MDCS assistance.Conclusions: MDCS demonstrated excellent performance in the detection and classification of breast lesions,and greatly enhanced the overall performance of radiologists.

The Epidemiological, Clinical and Radiological (Echography, Mammography) Characteristics of Breast Pathologies at the Diagnostic Imaging Center (C.I.D) “Teriya” in Bamako

Breast pathology is varied, bringing together tumor and non-tumor lesions. Objective: To study the contribution of the ultrasound-mammography pair in the diagnosis of breast pathologies. Materials and Method: This was a retrospective descriptive study, carried out over a period of 3 years (from January 2018 to December 2020) at the Diagnostic Imaging Center (C.I.D) “TERIYA” in BAMAKO. It concerned all patients who came for a mammogram/ultrasound examination of the breast. All women admitted for mammogram or breast ultrasound who were diagnosed with a breast injury during the study period were included. Incomplete records and radiological checks were not included. The variables analyzed were age, sex, clinical data, and ultrasound and mammography aspects. The devices used are: a Voluson 730 PRO ultrasound machine and a G 600T type mammography machine. Results: At the end of our study, we collected 254 breast pathologies on a number of 382 women, i.e. a frequency of 66.49%. The average age of our patients was 41 years old. The dominant clinical data were mastodynia (41.88%) and mammary nodule (21.70%). On imaging (mammo-ultrasound) the lesions predominated on the left in 36% of cases, bilateral in 28% of cases and in the upper-outer quadrants in 31.5% of cases. Tumor pathologies represented 66.54% of which 45.27% were benign mainly composed of fibro-adenoma (20.88%) and cyst (18.50%), 11.8% of suspected cases and 9.45% of cancers. Non-tumor pathologies represented 33.46%, mainly mastitis (16.14%), galactophoric dilations (11.02%) and abscesses (5.51%). These pathologies were classified in 50.3% in ACR2, 17.75% in ACR3 and 4, and in 14.20% in ACR5. Lymphadenopathy was present in 73.21% of cases.

Solid neuroendocrine breast carcinoma:mammographic and sonographic features in thirteen cases

This study aimed to determine and quantitate the mammographic and sonographic characteristics in 13 cases of solid neuroendocrine breast carcinoma(NEBC) and to analyze the association of radiological findings with the clinical and histopathologic findings.The clinical data and imaging findings of 13 female patients with histologically confirmed solid NEBC were reviewed.Imaging data were evaluated by two radiologists for a consensual diagnosis.All patients presented with one palpable mass;only 1 experienced occasional breast pain,and 5 complained of fluid discharge.In 7 patients,the masses were firm and mobile.Regional lymph node metastasis was noted in only 1 patient.For the 10 patients who underwent mammography,6 had a mass,1 had clustered small nodules with clustered punctuate microcalcifications,2 had asymmetric focal density,and 1 had solitary punctuate calcification.Most of the masses had irregular shape with indistinct or microlobulated margins.For the 9 patients who underwent ultrasonography(US),9 masses were depicted,all of which were hypoechoic,mostly with irregular shape and without acoustic phenomena.Different types of acoustic phenomena were also identified.One patient had developed distant metastases during follow-up.NEBC has a variety of presentations,but it is mostly observed on mammograms as a dense,irregular mass with indistinct or microlobulated margins.Sonographically,it typically presents as an irregular,heterogeneously hypoechoic mass with normal sound transmission.Histories of nipple discharge and calcification observed using imaging are not rare.

Clinical study of digital mammography,contrast-enhanced MRI as well as their combination in the diagnosis of breast cancer

Objective： To compare the effectiveness of digital mammography and MRI in the detection and diagnosis of breast cancer and to assess the value of these modalities as well as the combination of the two. Methods： Sixty-seven patients with surgery and pathology proved breast lesion （malignant, n = 32; benign, n = 46） underwent digital mammography and MRI, the pulse sequences included T1WI, T2WI, diffuse weighted imaging （DWI）, and dynamic contrast-enhanced MRI before surgery. Of the results of these two modalities, all lesions were classified into 5 groups according to BI-RADS classification, and the imaging findings were correlated to histopathology. The sensitivity and specificity of each modality as well as the combination of the two were calculated. Results： Of these 78 breasts lesions, The sensitivity was 78.13%% （25/32） for digital mammography and 93.75% （30/32） for MRI （P 〉 0.05）. The specificity was 73.91%% （34/46） and 89.13% （41/46） accordingly （P 〈 0.05）, both of them showed statistical difference. The sensitivity and specificity was 98.63% and 97.16% respectively as these two modalities were used in combination. Conclusion： Digital mammography in combination with MRI is helpful in the diagnosis of breast cancer, the sensitivity and specificity was enhanced when compared to that of single modality.

Comparison between Visualization of Microcalcifications by Digital Breast Tomosynthesis and Full-Field Digital Mammography

Objective: To date, few studies have compared the diagnostic performance and visibility of microcalcifications obtained using digital breast tomosynthesis (DBT) with those obtained from full-field digital mammography (FFDM). The visualization and characterization of microcalcifications with DBT remain controversial. The purpose of this study was to compare the visibility of microcalcifications and determine whether DBT exhibits a diagnostic advantage for visualizing microcalcifications over FFDM. Methods: We retrospectively reviewed 120 cases including DBT and FFDM imaging (60 histologically verified as breast cancers and 60 as benign microcalcifications or normal). DBT images with a wide scan-angle of 50° and FFDM images were obtained using a flat-panel system (MAMMOMAT Inspiration, Siemens). Images were independently reviewed by four board-certified radiologists and evaluated for the presence of microcalcifications, probability of malignancy (BI-RADS classification), and visibility. Results: In predicting the malignancy of detected microcalcifications, no significant difference was found between readers’ areas under the receiver operating characteristic curve for DBT and FFDM (p = 0.068). The visibility scores of detected microcalcifications were 3.74 ± 1.06 for DBT and 3.46 ± 0.93 for FFDM, respectively. The visibility of microcalcifications when using DBT was found to be significantly superior to that of FFDM (p < 0.05). Conclusion: Our results suggest that the image quality of DBT with a wide scan-angle is comparable or superior to that obtained with FFDM in terms of both visibility and assessment of microcalcifications.

Optical mammography:Diffuse optical imaging of breast cancer

Existing imaging modalities for breast cancer screening,diagnosis and therapy monitoring,namely X-ray mammography and magnetic resonance imaging,have been proven to have limitations.Diffuse optical imaging is a set of non-invasive imaging modalities that use near-infrared light,which can be an alternative,if not replacement,to those existing modalities.This review covers the background knowledge,recent clinical outcome,and future outlook of this newly emerging medical imaging modality.

Correlativity study on mammographic features and c-erbB-2 of breast cancer

Objective: To investigate the correlativity between mammographic features and c-erbB-2 of breast cancer. Meth- ods: The mammographic features of 165 patients, including calcification, distinct, esion concentration, breast cysitic hyperplasia accompanied, were studied comparatively with c-erbB-2 gene stained with immunohistochemical technique. Results: Of 165 cases, calcification impression was 84 cases (50.91%), indistinct 80 cases (48.40%), lesions were concentrated of 87 case (52.73%), accompanied breast cysitic hyperplasia 85 cases (51.52%). Conclusion: Mammographic features of breast cancer could show the status of c-erbB-2, the positive chance is higher with calcification, indistinct, lesion concentration and accompa- nied breast cysitic hyperplasia.

Evaluation of Breast Masses Using Mammography and Sonography as First Line Investigations

Purpose: To study the specificity of mammography and ultrasonography separately and in combination for detection of breast masses (ultrasonography-mammography correlation);To study the investigations to evaluate various breast masses;To describe suitable indications, advantages and limitations of each technique compared with other available modalities;To study the mimics of breast masses;To have histopathology follow-up and retrospective evaluation with imaging findings to improve diagnostic skills in series of 166 patients complaining of breast mass. Material: The prospective clinical study was carried out in the department of Radiodiagnosis for a period of 2 year extending from December 2010 to December 2012 infemale patients complaining of breast mass. Well informed written consent was obtained from them. Histopathology follow up was obtained from either biopsy or post operative tissue. USG machine: Philips HD 11 XE USG of the breasts and axillary region done in supine position in presence of female attendant;Mammography machine: Allengers machine with Agfa special mammography cassettes. Cranio caudal and Medio-Lateral Oblique views are taken in the presence of female attendant. MRI: PHILIPS 1.5 T machine;CT: SIEMENS duel slice CT machine. Results: Ultrasonography and mammography was done in most of the cases were sufficient to diagnose the lesion in most of the cases especially in benign breast masses. MRI and CT scan was used in special cases to know the extent of the lesions, in mimics of breast masses, bony extensions, primary muscular and bony lesions. Total 166 patients complaining of breast mass in one or both breasts were examined and evaluated with USG and mammography. The lesions were confirmed on histopathology (FNAC/biopsy). Out of 30 diagnosed malignancies two lesions were missed on mammography and four lesions were missed on ultrasonography. One of them was missed on both. For malignancies specificity of mammography is 93.3% and that of ultrasonography is 86.67%. Combining both the modalities specificity is near 97%. Out of total 92 abnormal breasts 12 were missed on USG and 20 were missed on mammography. Combining both the modalities only 2 lesions were missed and were diagnosed on histopathology alone. Overall specificity for USG in breast masses is 86.9% and for mammography it is 78.6%. Combining both the modalities the specificity is 97.6%. The “p” value is obtained which is highly significant for combination of ultrasonography and mammography in comparison with any individual modality (p = 0.0059 & p = 0.0001 respectively). Conclusion: Our study confirms the higher combined sensitivity rate for ultrasonography and mammography for detection of breast masses including malignancies. USG is useful in cystic lesions, ectasias, infections, pregnancy-lactation, and dense breast evaluation and for image guidance, whereas mammography is useful in detecting microcalcifications, spiculated masses for early detection of malignancies and for stereotactic biopsies. To suggest single modality, ultrasonography is better in younger population and BIRAD 1, 2 & 3 lesions. Whereas, mammography is better in older population and BIRAD 4 & 5 lesions. However, sono-mammographic correlation is best in both.

Mammography combined with breast dynamic contrast-enhanced-magnetic resonance imaging for the diagnosis of early breast cancer

Objective The aim of this study was to investigate the application of mammography combined with breast dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) for the diagnosis of early breast cancer. Methods Mammography and DCE-MRI were performed for 120 patients with breast cancer(malignant, 102; benign; 18). Results The sensitivity of mammography for early diagnosis of breast cancer was 66.67%, specificity was 77.78%, and accuracy was 68.33%. The sensitivity of MRI for early diagnosis of breast cancer was 94.12%, specificity was 88.89%, and accuracy was 93.33%. However, the sensitivity of mammography combined with DCE-MRI volume imaging with enhanced water signal(VIEWS) scanning for early diagnosis of breast cancer was 97.06%, specificity was 94.44%, and accuracy was 96.67%. Conclusion Mammography combined with DCE-MRI increased the sensitivity, specificity, and accuracy of diagnosing early breast cancer.

THE MAMMOGRAPHIC CALCIFICATIONS IN BREAST CANCER

Objective: This study was performed to exam the relativeship between mammographic calcifications and breast cancer. Methods: All of the 184 patients with breast diseases underwent mammography before either an open biopsy or a mastectomy. The presence, morphology, and distribution of calcifications visualized on mammograms for breast cancer were compared with the controls who remained cancer free. Statistical comparisons were made by using the x 2 test. Results: Of the 184 patients with breast diaeases, 93 malignant and 91 benign lesions were histologically confirmed. Calcifications were visualized on mammograms in 60 (64%)of 93 breast cancers and 26(28%)of 91 non breast cancers. The estimated odds ratio (OR) of breast cancer was 4.5 in women with calcifications seen on mammo grams, compared with those having none ( P < 0.01). Of the 60 breast carcinomas having mammographic calcifi cations, 28 (47%) were infiltrating ductal carcinomas. There were only 8 (24%) cases with infiltrating ductal cancers in the group of without calcifications seen on the mammograms ( P <0.05). Conclusion: Our finding sug gests that mammographic calcification appears to be a risk factor for breast cancer. The granular and linear cast type calcification provide clues to the presence of breast cancer, especially when the carcinomas without associated masses were seen on mammograms.

COMPARISON OF INFRARED LIGHTSCANNING AND MAMMOGRAPHY IN BREAST CANCER DETECTION

Purpose: This study is in an attempt to assess the diagnostic accuracy of infrared lightscanning by comparing with that of mammograpby- Methods: A total of 104 patients had been examined by both mammography and infrared lightscanning before surgery.All Patients were divided into two groups: cancer and non cancer. The diagnostic accuracy of these two modalities were calculated. Results: Of 104 Patients, 43 had breast cancer and 61 had benign lesions, the sensitivity and specificity for mammography were 84% and 83%, 82% and 77% for infrared lightscanning. The predictive values of positivity for mammograpby and lightscanning were 80% and 70%, the negative Predictive value for these two modalities were both 87%. Conclusion: Infrared lightscanning,being of assistance to mammography, could enhance sensitivity and predictive values of positivity in detecting breast cancer, especially, in mammographically dense breast.

Initial Experience with Contrast Enhanced Digital Mammography (SenoBright)—In a Comprehensive Clinical Breast Center

Objective: The purpose of initiating contrast enhanced digital mammography in our center was to evaluate the complimentary benefit of this technology with screening digital mammography and real time ultrasound in equivocal cases and high risk patients with dense breast. The intended goal was to reduce the incidence of further diagnostic and invasive procedures. Methods: Patients thought to be candidates who had good renal function confirmed by serum Blood Urea Nitrogen (BUN) and Creatinine were offered the procedure, and 225 patients had the procedure during the period of March 2013 through November 2014. The contrast enhanced digital mammograms (SenoBright) are performed on the Senograph Essential Unit. A total of 8 images are obtained: 4 conventional digital mammograms and 4 contrast enhanced digital mammograms. The patients with a positive SenoBright study had a tissue diagnosis of the lesion obtained by either a stereotactic needle biopsy, ultrasound guided core biopsy, or ultrasound directed open excisional biopsy. Results: The 225 patients who had the procedure included high risk patients with dense breast (41), patients with abnormal mammograms (92), and patients with equivocal clinical, mammographic and real time ultrasound findings (92). 31 studies were interpreted as positive and 194 as negative. 33 biopsies were performed, with 31 patients having a positive study and 2 patients with a negative study. 22 cancers were detected. Conclusion: We found that the addition of dynamic contrast enhanced digital subtraction mammography (SenoBright) was helpful in distinguishing malignant from non-malignant lesions. It was also effective in demonstrating multifocal lesions and identifying non-palpable occult carcinomas in the dense breast. It proved to be a valuable complimentary adjunctive diagnostic modality for a comprehensive clinical breast center.

Mammographic Findings Associated with Accelerated Partial Breast Irradiation Using Single Fraction Intraoperative Radiotherapy

Purpose: To evaluate the mammographic findings of women treated with accelerated partial breast irradiation (APBI) using single-fraction intraoperative radiotherapy (IORT). Materials/Methods: Women ≥ 40 years of age with unifocal invasive or intraductal carcinoma ≤ 2.5 cm on physical examination, mammography, and ultrasound were enrolled on an APBI trial using single fraction IORT. Post-treatment mammographic imaging was obtained at 6 months, 1 year, and then annually. Results: Between 12/02 and 6/04, 17 women underwent IORT at the time of lumpectomy (median age = 60 years;range = 40 - 83). The initial post-IORT mammogram showed increased density at the lumpectomy site in 11 patients (65%), while six patients (35%) had architectural distortion in the area of the irradiated tissue. Fifteen patients (88%) had numerous punctate, benign-appearing calcifications corresponding to the irradiated region. There was focal skin thickening near the incision in 13 patients (76%). At a median of 67 months, architectural distortion had stabilized and the benign-appearing calcifications remained stable in number and character. Eight patients (47%) had mammographic findings consistent with fat necrosis, ranging in size from 0.5 - 4 cm. Conclusions: After lumpectomy and IORT, mammographic changes include increased density and benign appearing calcifications in the irradiated region with focal skin thickening. These changes appear to stabilize over time and are consistent with post-treatment changes. These changes are important to identify in order to characterize benign changes from recurrent tumor.

Women’s Performance of Breast Cancer Screening (Breast Self-Examination, Clinical Breast Exam and Mammography)

Background: Breast cancer is the most common malignancy among women in Saudi Arabia. Despite the availability of early detection methods to diagnose breast cancer, a huge number of women are still unaware about these methods. This study was conducted to identify the attitude of women in Medina toward breast cancer screening methods, including breast self-examination (BSE), clinical breast examination (CBE) and mammography. Methods and Materials: A cross-sectional survey has been conducted on 124 women aged from 39 and older, who attended Taibah Medical Center for cancer screening either by doctor’s recommendation, family or friends advice, or by herself. Face to face questionnaire was used to collect data. All data were analyzed by statistical analysis system software. Results: The results showed only 35.5%, 27.4% and 37.8% of participants reported that they practiced BSE, CBE and annual mammography, respectively. Only 27.3% of women practiced BSE once per month, and 8.8% visited doctor annually for CBE. Both educational level (p = 0.004) and family history (p = 0.01) were significantly related to BSE. 57.7% of the participants who had positive family history practiced BSE, and 56.0% of the participants who practiced BSE were highly educated. Lacking awareness about BSE is the most important barrier in not practicing BSE, while not having a breast lump was the reason for not undergoing either clinical breast examination (38.7%) or periodic mammography (54.9%). Conclusion: This study emphasized the need for massive health education program to increase awareness, and improve the attitude of women toward breast cancer screening methods.

Intraductal papillary carcinoma of the breast: Analysis of mammography and MRI manifestations

Objective:To explore the diagnostic value of mammography and MRI in breast intraductal papillary carcinoma(IDPC)and compare the diagnostic value of the two methods.Methods:Collected 28 IDPC patients who underwent mammography and MRI from March 2011 to June 2019 and were confirmed by surgery and pathology.The imaging manifestations were analyzed and the accuracy of IDPC diagnosis was compared between the two methods.Results:Mammography of mammography:24 cases showed masses,3 cases showed asymmetric dense shadow with calcification,1 case showed large duct dilation in the areola area,and 6 cases showed short burrs on the edge of the tumor.MRI scan:28 cases of lesions had low signal intensity on T1WI and high signal on T2WI.19 cases showed cystic solid masses with small nodules on the cyst wall.25 cases showed obvious uneven enhancement lesions.The diagnostic accuracy of MRI was 89.3%.(25/28),the accuracy rate of mammography X-ray examination was 75.0%(21/28).There was no statistical difference in the diagnostic accuracy between the two methods,and it was not statistically significant(P=0.29).The combined use of the two inspection methods has a diagnostic accuracy rate of 96.4%.The combined two methods are more valuable than relying solely on mammography(P=0.03).Conclusion:IDPC is characterized by lobular or round masses.Large cysts with small nodules may be a special MRI manifestation of this cancer.Combining mammography and MRI can further improve the diagnosis of IDPC.

Mammographic features of breast cancer: Analysis of 118 cases

Objective: The aim of this retrospective study was to evaluate the mammographic imaging features (markers) on different types of breast cancer and improve early radiological diagnosis of breast cancer. Methods: Analyzed the mammographic images of 118 patients with breast cancer confirmed by surgery and pathology. Among 118 cases, 70 cases were infiltrating ductal carcinoma (59.3%), 17 cases were ductal carcinoma in situ (DCIS, 14.4%), 7 cases were mucinous carcinoma (5.9%), 5 cases were medullary carcinoma (4.2%), 1 case was tiny micro carcinoma (0.9%) and 18 cases were other types cancer (15.3%). Results: The mammographic appearance of 118 patients with different breast cancer included: tumor mass (n = 80, 68.8%), microcalcification (n = 57, 48.3%), which were subdivided into two groups (a) microcalcification only, 13 cases (13/118, 11%); (b) combined with other mammographic features: 31 cases with tumor mass (31/118, 26.3%); 7 cases with architecture distortion (7/118, 5.9%), 6 cases with focal asymmetric density (6/118, 5.1%). Six cases appeared as architecture distortion only, 41 cases with abnormal vessel signs (34.7%). Conclusion: The microcalcifications are the most frequently basal X-ray signs in DCIS. Architecture distortion and focal asymmetric density are special X-ray signs that were easily missed. The abnormal vessels are also important accompaniment signs of breast cancer. The use of coned compression technique is particularly important to improve the radiological diagnosis of breast cancer.

Combined use of fine needle aspiration cytology and full field digital mammography in preoperative assessment of breast masses

Objective: To evaluate the accuracy of these two methods and focus on the analysis and management of the false-negative cases. Methods: Results of full field digital mammography (FFDM) and fine needle aspiration cytology (FNAC) were obtained and analyzed from a consecutive of 102 women with palpable breast masses, results were correlated with the histopathological findings. Results: Of the 102 cases, malignancy was confirmed in 43 cases (42.16%) by final pathological examination, the sensitivity and specificity of cancer detection with FNA cytology was 90.7% (39/43) and 89.8% (53/59), re- spectively, the whole accuracy was 90.2% (92/102), with a positive predictive value of 86.7% (39/45) and a negative predictive value of 93.0% (53/57). FFDM gave a sensitivity of 88.4% (38/43), specificity of 83.1% (49/59), and whole accuracy 85.3% (87/102), the positive predictive value and negative predictive value was 79.2% (38/48) and 90.7% (49/54), respectively. All the FNAC-negative cancer cases were suggestive of malignancy by FFDM findings, however, the benign cases which present as equivocal finding by FNA cytology, could not be ruled out the presence of malignancy. Conclusion: FNAC and FFDM both are accurate, effective and economical diagnostic modalities, combined use of these two methods can reduced the misdiag- nosis rate of breast masses.

Relationship between Full-Field Digital Mammographic Features and Clinicopathologic Characteristics in 176 Cases with Breast Cancer

OBJECTIVE Different mammographic features are probably predictive of different prognosis. However, ambiguity still exists in understanding the relationship between them. In resent years, digital mammography has been available for clinical use which has led to a revolution in the resolving of images and an increase in early-stage breast cancer detection. Based on the above knowledge, this study was performed to evaluate the relationship between full-field digital mammographic features and clinicopathologic characteristics in breast cancer. METHODS Digital mammograms of 176 patients with pathologically proven breast cancer were reviewed. Also, clinical and pathologic records （histological types and axillary lymph nodes status） were retrospectively examined. RESULTS Most of the patients with a solitary microcalcification were young women under the age of 50（84.4%）, but the majority of the patients with microcalcifications complicated by a mass were elderly women. Microcalcifications detected by mammography occurred frequently in ductal carcinoma in situ （28.1%） and in early invasive carcinoma （15.6%）. Breast cancers with expression of microcalcifications combined with a spiculate mass had a high metastatic rate of axillary lymph nodes （69.4%）. A high metastatic rate of axillary lymph nodes was also found in the patients with solitary worm-like microcalcifications （57.1%）, solitary spiculate mass （53.7%） and solitary non-worm-like microcalcifications （44.4%）. Simple worm-like microcalcifications accompanied with metastasis of 4 to 9 axillary lymph nodes occurred in 42.9% of the（6/14） cases. The patients with microcalcifications combined by a spiculate mass and with metastasis of 4 to 9 axillary lymph nodes accounted for 27.8% （10/36） of the cases, and those with metastases of 10 and over accounted for 16.7% （6/36）. CONCLUSION Solitary microcalcifications occur frequently in young women and are usually associated with early breast cancer. There is a close relationship between worm-like microcalcifications, a spiculate mass and positive metastases of axillary lymph nodes, which are an index of poor prognosis.

Women’s Awareness of Mammographic Screening for Breast Cancer in Togo

Breast cancer represents a real public health problem due to its increasing frequency, its seriousness and its psycho-social implications. The aims of this study were to determine the level of awareness of women on the performance of mammography in the diagnosis and screening for breast cancer. This was a cross-sectional study over a period of 4 months (from October 1, 2016 to January 31, 2017) in Togo. It consisted in completing a questionnaire distributed to women above 30 years of age. The mean age of the women was 42 years. 88.8% of them had heard of breast cancer. There was a link between age, occupation, level of education and awareness of breast cancer. Only 20.8% of women had heard of mammography, with a link between awareness of mammography and age, occupation, and level of education. A link was noted between awareness of breast cancer and awareness of mammography. Information on mammographic breast cancer screening is inadequate in Togo.

Mammography during Breast Cancer Awareness Month Campaigns in Lomé(Togo): In Relation to 1074 Cases over a Period of 5 Years

Background: This study aimed to describe the results of mammography done during breast cancer awareness campaigns in Lomé. Methods: This was a retrospective multicenter study which focused on the analysis of mammographic examinations, with or without breast ultrasound, carried out in three (3) clinics in Lomé over a period of five (5) years during the breast cancer awareness month (Pink October) campaigns. We included in our study women of all ages who underwent a mammography during the study period. Additional ultrasound was performed as needed in some women to better characterize a lesion. The parameters studied were socio-demographic data, and aspects of breast lesions. We classified the lesions in order of severity according to the BI-RADS classification. Results: During the study we counted one thousand and seventy-four (1074) women who underwent mammography examinations, corresponding to an average of 214.8 women per year. The median age of the women was 46 years. The most represented age group was 40 - 49, constituting 30% of cases. Mammography was performed on all women and ultrasound was performed on 51.3% of women. Lesions suspicious for malignancy (BI-RADS IV) and lesions highly suggestive of malignancy (BI-RADS V) represented 3.5% and 1.9% of cases respectively, amounting to a prevalence of 5.4%. They occurred more frequently from the age of 30 years with a statistically significant difference (p = 0.02). These lesions could be identified on mammograms as masses with irregular shapes and spiculated margins representing 16.1% and 9.7% of masses respectively. On ultrasound, these were solid masses with irregular and ill-defined borders, representing 25.2% and 5.2% of solid masses respectively. Lesions suspicious for malignancy were most often found in the UOQ (upper outer quadrant) in 70% of cases. Conclusion: Mammography screening for breast cancer remains a necessity in our community, even if the rate of cancer detected remains low. It allows for early diagnosis of cancers, promoting better management.