Laminagraphy of the Breast
Willard J. Howland, T. H. Johnson, Terry A. Reagan · Radiology · 1969
The extensive studies of Egan (2), Gershon-Cohen (4), and many others have adequately demonstrated the value of mammography in the early diagnosis of breast cancer. Widespread usage of the technic has shown, however, that many breasts cannot be adequately studied by this procedure because of extensive fibrosis or glandular hyperplasia. These patients are predominantly in the earlier age groups where the importance of diagnosis is obvious. Strax (6), in a study of 3,000 mammograms, found that over half the menopausal or premenopausal women have fibrous or glandular breasts. Wolfe (7) studied these problems extensively and states that tumor calcification is the only definite diagnostic sign in breasts with severe degrees of fibrosis. He also stated (8) that adenosis and cystic disease are seen more commonly in women with breast cancer. Friedman et al. (3) reported an overall diagnostic accuracy of only 68 per cent when mammograms of all age groups are included in the study and believed that mammography cannot be relied upon to exclude carcinoma in women under 55 years of age. Laminagraphy has proved helpful in the identification of calcification in lung masses and the fine detail study of many other areas of the body. Our aim was to study the possibility of an increased accuracy of mammographic diagnosis by laminagraphy of the breast. Materials And Methods In order to establish a laminagraphic method and study the technics which could be used, a breast phantom was constructed of lard, bacon, and bone meal. A variety of laminagraphic movements were used with this phantom, employing many technical changes. The phantom laminagrams were of excellent quality, but the technical factors were not adequate for the dense fibrotic breasts under investigation. Technic studies were then carried out with a mastectomy specimen implanted with calcium carbonate particles. An extremely large breast was selected, exhibiting marked fibrosis, in order to simulate the must difficult technical conditions. Primary evaluations included tube motions and the multiple categories of available radiographic films. Positioning of the patient proved a critical factor. With maintenance of a constant tube motion and phantom position, it was necessary to evaluate kilovoltage levels, collimation, magnification effects, and the tomographic section thickness. Results I. Laminagraphic Technics: Circular, elliptical, and linear tube motions were evaluated. The Siemens multiplanigraph unit was used for the initial studies. Satisfactory laminagrams could be obtained with any of the three motions with no significant difference in detail when the specimen was used alone. When the phantom specimen was placed against a simulated chest wall, the circular and elliptical motions produced considerable scattering from the chest wall with a decrease in film detail.