Occasionally,
a cluster
eter)
calcifications
biopsy
of oven
fine
of very
is found
(less
by means
30 of these
than
0.3 mm
of magnification.
“clusters
of dust
particles,”
in diam-
References
After
1.
I have
Sicktes lesions:
yet
468. Homer MJ. cally benign
to find a malignancy. Dr Sicbdes
gestive lions
routinely
uses
of malignancy. that
dust.”
he
I wonder
followed
up
If so, perhaps
sidered
magnification
suggestive
if many
fit into
these
tiny
the
2.
in cases that are sugof the tiny calcifica-
category
I call
calcifications
“particles
need
not
be
of
Imaging features and management and probably benign breast lesions.
Am 1987; 25:939-951. Sickles EA, Ominsky SH,
3.
con-
Medical
of malignancy.
follow-up of probably benign cases. Radiology 1991; 179:463-
EA. Periodic mammographic results in 3,184 consecutive
practice: ogy 1990;
Sollitto
RA, Calvin
audit of a rapid-throughput methodology and results
of characteristiRadiol Clin North
HB, Monticciolo
DL.
mammography screening of 27,114 examinations. Radiol-
175:323-327.
References 1.
Sicktes
EA.
lesions: 468. 2.
3.
Hetvie low-up
results
Periodic mammographic in 3,184 consecutive
follow-up
of probably
cases. Radiology
MA, Pennes DR. Rebner M, Adler DD. Mammographic of low-suspicion lesions: compliance rate and diagnostic Radiology 1991; 175:155-158.
yield. WolfeJN, Buck KA, Salane M, Parekh breast: overview of 21,057 consecutive
Edward
benign
A. Sickles,
Department
1991; 179:463fot-
NJ. Xeroradiography of the cases. Radiology 1987; 165:
305-311.
U Aneurysm of the Aorta
Formation
responds:
to be seen
after
Repair
of Coarctation
Washington
University
mammograms
Dr Saylem’s if they are too
because
I do not ob-
tam additional
spot-compression magnification views of calcifications unless some calcific particles already have been identifled on conventional (nonmagnification) images. I do occasionally
encounter
in diameter)
calcifications,
clusters
of very
as does
magnification
are too small
to demonstrate
as pinpoints
views,
discrete
of white.
(less
tiny
Dr Sayler.
than
these
calcific
shapes,
usually
Therefore,
0.3 mm
However,
I do not
even
on
a biopsy
in this
situation.
Among
pe-
the
Pennsylvania
last
Avenue,
Northwest,
Washington,
DC
I read with
interest
the article
by Pinzon
et al (1) in the July
1991 issue of Radiology. They reported aneurysm formation in 30% of their patients after surgical repair of coarctation of the aorta.
Among
lated
to the
the
not
A widely synthetic
mechanisms
synthetic
(eg, scar,
accepted patch
they
patch
graft
infection,
theory
repair
discussed,
used
and
about
some
in the
repair,
aneurysm
is compliance
many
clusters
My report
of calcifications
that
of an 11.2% frequency
intermediate
among
those
others
choose
of probably
found
in the
Currently,
this
theory
certainly
is strongly
supported
cases
is
is composed
which
almost
entirely
of asymptomatic
Sayler) term
them
as “bow-level
or with
any other
“suspicious.”
These
suspicious”
wording lesions
lesions
that includes are much
better
native
of aneurysm formation is extremely no such complication was encountered
of 62 consecutive and
10 for
balloon
postsurgical
angioplasty aomtic
procedures
coamctations)
(3).
(as does
Dr
the pejorative called
References
“proba-
bly benign,” thereby giving proper emphasis to the overwhelming likelihood of a benign origin, and reducing the chance that either the patient or her surgeon will opt for
Pinzon the
2.
3.
women, less than 2% of cases eventually are managed by means of periodic mammographic surveillance (3). Finally, I want to reiterate an important recommendation made in my article: For those lesions that we choose to follow up as an alternative to biopsy, we should scrupulously avoid describing
(52 for
1.
literature,
higher than those cited by Dr Sayler, but considerably lower than the 20% frequency published by Homer (2). These differences may well relate to the patient population examined in a given mammography practice. For example, in my screening practice,
in one series
from
angioplasty balloons
to call normal.
benign
American
after
tion of mechanical forces in the aortic wall, postulated by Olsson et al (2). These investigators implicated the effect of diffement tensile strengths across the aomtic wall in conjunction with the use of a noncompliant foreign material.
are used, the prevalence rare; as a matter of fact,
in my study
oth-
or maldistribu-
cases and senvations.
that I included
me-
formation
mismatch,
the recent experiences with percutaneous balloon of coarctation of the aorta. When appropriate-sized
that directly address this issue. I do not share Dr Sayler’s belief
were while
thrombosis).
10 such cases I have encountered, three were ductal carcinoma in situ. Readers should note that my cancer yield of three of 10 Dr Saylem’s yield of zero of 30 cases are anecdotal obTo my knowledge, there are no published studies
20037
Editor:
appearing
recommend
George
Center
ems were
particles
riodic mammographic surveillance for these lesions because I cannot identify discrete round or oval particles (see intempretive criteria for probably benign calcifications, described on page 464 of my article [1] and illustrated in fig 1). Rather, I recperforming
2150
MD
of Medicine,
Medical
on regular
spot-compression
0. Cheng,
Department
The data in my article cannot be used to answer question of whether calcifications are significant
ommend
of California
From:
Dr Sickles
only
Box 0628, University
School of Medicine San Francisco, CA 94143-0628
Tsung
small
MD
of Radiology,
JL, Burrows
aorta
PE, Benson
in children:
LN, et at.
postoperative
Repair
morphology.
of coarctation Radiology
of
1991;
180:199-203. Otsson P, Sodertund 5, Dubiel WT, Ovenfors CO. Patch grafts or tubular grafts in the repair of coarctation of the aorta: a follow-up study. Scand J Thonac Cardiovasc Sung 1976; 10:139-143. Rao
PS.
Cardiovasc
Pseudoaneunysm
Diagn
following
balloon
angioplasty?
Cathet
1991; 23:150-151.
Notice
to the
Readers
“Anatomy Thin-Section
of the Major Fissure: Evaluation with CT.” Radiology 1991; 180:839-844
We were unable to maintain the quality in this article at the level of the original apologize for the occurrence.
Standard
and
of the printed figures submitted images. We
biopsy.
Volume
181
#{149} Number
3
Radiology
#{149} 905