The Venous Diameter Ratio in the Radiographic Diagnosis of Breast Cancer

Increased vascularity is a secondary sign in the roentgen diagnosis of breast cancer. Although many radiologists remain dubious of its value, Egan(1, 2) believes that the finding has diagnostic significance in about 50 per cent of cases. Our interest in this particular aspect of mammography was stimulated by a comparative study of 1,000 consecutive cases in which both mammography and thermography were performed. Unilateral prominence of the superficial veins was observed to be a useful criterion in the thermographic diagnosis of cancer. For this reason, a review of this series of cases was initiated to determine whether a correlation existed between vessel size and the presence of abnormal thermographic signals. Although unilateral vessel prominence was sometimes obvious, no marked difference was apparent in most cases. Therefore, a simple method of measuring the comparative diameters of the superficial veins was devised. Although certain technical factors inherent in mammography tend to minimize the precision desirable in measurements of this type, the data obtained correlated well with thermographic findings and indicated that comparative venous diameters are an important parameter in the routine interpretation of mammograms. Methods and Material Measurements were made with a 7-power Bausch and Lomb aplanatic measuring magnifier (Fig. 1) equipped with a 20-mm metric scale in 0.1-mm divisions. The instrument magnifies both scale and object and is inexpensive and readily available. The mammograms of 185 proved cases were first examined to establish a baseline. No selective factors were used except for deletion of all patients with a previous mastectomy, which was necessary because the normal variation of vessel size is so great that measurements in the solitary breast are not significant. The series included 88 cancerous and 97 benign tumors of all types. Clinical, operative, and histopathological data were available for each. The diameter of the largest vein in the vicinity of a tumor was determined and compared with the diameter of the comparable vein in the opposite breast. In the absence of a mass, the largest comparable veins were selected and measured. Measurements were made in any one of the three basic projections which best demonstrated the veins, but like projections were used for each breast. The result for each comparison was expressed as a ratio2 and plotted against the number of cases. As may be seen in Figure 2, the ratio most common to the nonmalignant tumors was 1.1:1, whereas 1.4:1 or greater included the majority of cancers. For this reason, the 1.4:1 venous diameter ratio was chosen as an arbitrary dividing line for the analysis of a subsequent series of unknowns. All patients with a VDR of less than 1.4:1 were to be considered as having benign disease; those with 1.4:1 or greater, malignant.