A Study of Breast Parenchyma by Mammography in the Normal Woman and Those with Benign and Malignant Disease

Abstract

The breast parenchyma of 3,250 women was studied by mammography in an attempt to relate certain patterns to the normal breast, to benign disease, and to malignant disease. The analysis disclosed great similarities between the normal women and those with benign disease in respect to age and parity. This parallel appearance leads one to conclude there is a difference of only a slight degree between the woman with clinically apparent mammary dysplasia such as adenosis and fibrocystic disease and the “normal” and that the abnormalities are developmental, with their highest incidence in the late teens and early twenties. The roentgenographic appearance of the parenchyma in malignant tumor reveals a definite and significant relationship to visible ducts within the breast, usually bilateral, occasionally unilateral, and nearly always involving the remaining breast after prior mastectomy. More interesting and perhaps important is the “ductal hypertrophy and hyperplasia” and therefore “cancer risk” seen in women according to the degree of parity. Mammography is an excellent method of studying the gross anatomy of the breast. One can readily recognize alveolar and large duct structures and note their configuration, distribution, and prominence. More important, the histologic features of most breast diseases are reflected accurately on the mammogram. An analysis of the parenchyma in the normal and abnormal breast is, therefore, a valid study. Historically, Ingleby and Gershon-Cohen have written on comparative studies between the mammogram and the appearance of the breast in the laboratory, and it was to study the anatomy of malignant tumors that Salomon made the first mammograms. Method Mammograms were reviewed in the following categories with noted qualifications: a. Normal (2,000 women) (Figs. 3 and 4): The physical findings are negative, and there is no family history of breast cancer or personal history of breast disease; hormone therapy has never been administered. b. Mastectomy (200 women) (Fig. 7): One breast was removed some time prior to mammography. c. Benign (750 women) (Fig. 5): After mammography, a biopsy showed benign disease. d. Malignant (300 women) (Fig. 6): After mammography, a biopsy demonstrated carcinoma. All normal and abnormal parenchymal elements were noted, but the main emphasis was on assessment of the alveolar tissue and ducts; their presence or absence, amount, and distribution. This material was coded and later subjected to analysis by computer. Alveolar structures as seen on the x-ray film coincide with what the pathologist will identify as adenosis, sclerosing adenosis, and/or fibrocystic disease or micro-cystic disease. The mammogram depicts this as an area of increased density, and there is tremendous latitude as to degree and area of involvement. Ducts are anatomic tubular structures readily recognized in the subareolar area, but also elsewhere within the breast.

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