The use of state-of-the-art mammography in the detection of nonpalpable breast carcinoma.

Between November 4, 1984, and September 1, 1988, a total of 16,439 patients were evaluated at the Comprehensive Breast Center at Mount Sinai Medical Center (MSMC) of Miami Beach with clinical examination, state-of-the-art mammography, and, when indicated, complimentary ultrasound mammography. As a result of this, 547 patients had open surgical biopsy, 207 carcinomas were detected in 207 patients, 183 carcinomas (80% of total malignancies) were clinically occult and detected only with breast imaging. Since 207 malignancies were found out of 547 areas examined, our rate was 1 carcinoma in every 2.6 biopsies. One hundred seventy-nine malignant lesions had preoperative needle localization and specimen radiography. Eighty-seven (47%) clinically occult carcinomas were identified because of microcalcifications by mammography alone. Two hundred twenty-six (98%) of the carcinomas were called malignant or suspicious for malignancy with only three (2.4%) false negatives. Twenty-two (10%) patients had axillary lymph-node metastasis. While recent large series report a 15 to 30 per cent rate of carcinoma for nonpalpable, mammographically detected breast biopsy specimens, it is our experience at MSMC with the use of physical exam and mammography, complemented by ultrasound when indicated, that rates of detection of carcinoma are more significantly improved than what the recent literature suggests; therefore, our approach to achieve this better detection will be discussed.