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One hundred and twenty pathologically proven lesions were digitized by computer and recorded on film. Four measures of malignancy, calcification, spiculation, roughness, and area-to-perimeter ratio then were mathematically extracted from the digitized xeroradiograph lesions. Using three methods of classification, these were identified by the computer as malignant and benign. Two radiologists then classified the photographed lesions. Comparison of the computer classification and the radiologists' classification using operational characteristic curves showed the computer to perform as well as an expert radiologist.

Mammography does not replace a good physical examination, and it does not replace clinical indications for a breast biopsy. It may, however, supply important diagnostic information. In order to detect early lesions of the breast, an optimal approach would consist of a routine breast examination every 6 months and a mammography every year. A clinically suspect breast lesion should always be biopsied, regardless of the mammographic interpretation.

Summary Early sarcomatous changes in neurofibroma are difficult to recognize either clinically or microscopically. The surgeon must view any neurofibroma that he is requested to remove, save for purely cosmetic or diagnostic reasons, with a high index of suspicion. Recurrence following surgical removal is very high and inadequate removal may accelerate the course of the disease. Metastasis and sarcomatous alterations in other neurofibromas are associated with recurrence. A case of neurofibrosarcoma of the breast associated with a recurrent neurofibrosarcoma of the back is presented, and the significance of the breast lesion in differential diagnosis is discussed.

The diagnosis and treatment of breast cancer is assessed. Although considerable efforts have been made in the diagnosis and treatment of mammary carcinoma the rates of incidence and mortality have not been appreciably altered. Many reports on the surgical treatment of breast cancer lack significance because of small sample size and inadequate statistical validation. It has been estimated recently that 75% of the duration of breast cancer occurs in the preclinical prediagnosable phase. The preclinical interval in a breast lesion of average growth is about 8 years while that of the clinical phase is about 2 years. The available data do not support the notion of "early" diagnosis. Nonetheless classical radical mastectomy remains useful in curing the curable and ameliorating the incurable.

Summary A breast mass developed in a patient on estrogen therapy three years after having undergone radical prostatectomy for carcinoma of the prostate. The breast lesion was proved by acid phosphatase stains to be metastatic from the prostate. Fifteen cases of breast lesions developing in patients with carcinoma of the prostate have been reported. Breast metastases from prostatic carcinoma seem to indicate the terminal phase of this disease.

An accurate roentgen diagnosis of any breast lesion based on recognition of morbid anatomic change presumes familiarity with the normal anatomic roentgen appearances. In a recent report of the normal breast we 1 indicated some limitations of the roentgen examination in such borderline pathologic states as mazoplasia, cystiphorous desquamative epithelial hyperplasia, epitheliosis and adenosis. Since the roentgenologist can attain little more accuracy than the pathologist, if limited to a macroscopic examination in making conclusive diagnoses of breast lesions, claims made for the roentgen studies inferring accuracy akin to the pathologist's microscopic studies must be carefully analyzed. This is well exemplified in those cases of fibro-adenomas of the puberal period when clinically, roentgenographically and macroscopically a diagnosis of neoplasia is agreed on only to be controverted by the microscopic finding of simple hyperplasia. 2 While it is difficult to credit some of the recent enthusiastic reports on the roentgen examination of

One of the most satisfying experiences, for both surgeon and patient, is the withdrawal of a small amount of cloudy fluid from a discrete mass in the breast followed by the discovery that the lump which had terrified the patient has completely disappeared. Breast cyst aspiration is a safe, painless, inexpensive way to differentiate a benign breast lesion from a potentially malignant one. It shows immediately whether the lesion is really cystic and not dangerous or solid and possibly malignant. If a cancer should be growing inside the cyst, aspiration would reveal the presence of bloody cyst fluid. If a cancer should grow in the cyst wall rather than in the cyst lumen, withdrawal of the cyst fluid not only would fail to make the mass disappear, but it would make the nodularity of the cancer more apparent. In addition to these diagnostic advantages of breast cyst aspiration, there is