Mammographic and pathological correlations in a breast screening programme

Mammography was performed as a screening procedure on 5000 self-selected women aged between 35 and 60 years. The biopsy rate, on areas regarded as suspicious of malignancy, was 2.58% with cancer being found on histology in 18.6% of biopsied cases. Aggregated microcalcification alone was the commonest indication for biopsy but was never associated with carcinoma when all the visible foci of calcification were rounded in form. However, benign disease sometimes occurred with irregular foci of calcification. Rounded mass lesions, mostly, but not entirely, well defined, provided the second commonest indication for biopsy but were benign in the vast majority of cases. Generally ill-defined masses were often malignant when associated with microcalcification and/or spiculation. Localised ductal dilatations, with or without microcalcification, were always benign in this series. Architectural distortion was uncommon but was associated with carcinoma in each of the two cases. Spiculation was a reliable, but not invariable, indicator of malignancy. The significance of these radiological and pathological correlations is discussed with regard to case management.