Vacuum punch biopsy of the breast with a stereotaxic guide. A new procedure for percutaneous diagnostic biopsy based on 120 cases

PURPOSE: To test the capabilities of vacuum core biopsy (VCB) in the diagnosis of mammographically indeterminate lesions. MATERIALS AND METHODS: 120 patients (131 lesions) were examined using VCB with 14G or 11G vacuum core. RESULTS: VCB was mostly performed because of indeterminate microcalcifications (67 cases) or soft tissue densities/architectural distortion (64 cases). 112 benign changes, 14 DCIS and 5 invasive carcinomas were found. Excellent accuracy was achieved (presently 100%), since complete excision of small lesions/areas (< or = 1 cm) or partial excision of larger lesions was possible. No relevant hematomas or infections occurred. Patients tolerated the painless procedure very well. DISCUSSION: This report confirms our previous experiences. This method promises to replace diagnostic open biopsy of indeterminate or suspicious nonpalpable lesions.     

Academic associate program: integrating clinical emergency medicine research with undergraduate education

MATERIALS AND METHODS: The diagnostic accuracy of scintimammography with 99mTc-MDP was evaluated in 400 consecutive women with clinical or mammographic suspicion of breast cancer, candidate to surgery and/or excisional biopsy. Lateral views of both glands were acquired, in prone position, 5-10 min after the injection of 550-740 MBq of 99mTc-MDP. The scintigraphic results were compared to mammograms and classified using the histological findings as gold standard. RESULTS: Mammography was suggestive for cancer in 231 (57%), suspicious in 49 (12%) and indeterminate in 120 (31%) patients. Breast carcinoma was histologically proven in 330 women, benign breast diseases in 70. The tumor size ranged from 4 x 5 to 50 x 60 mm. 99mTc-MDP visualized as foci of increased uptake 305/330 cancers (92%). In particular, in women with indeterminate mammograms the SMM had a diagnostic accuracy of 84%, correctly characterizing 101/120 lesions. Twenty missed cancers had largest diameter < or = 10 mm, 5 < or = 15 mm. Lack of 99mTc-MDP uptake occurred in 64 out of 70 benign lesions. These lesions were classified as truly negative. Conversely, 3 fibroadenoma and 3 epithelial hyperplasia with moderate or severe atypia were falsely positive. The overall specificity was 91.5%; the accuracy was 92%, the positive and negative predictive values were respectively 98% and 72%. CONCLUSIONS: The results obtained in this study suggest that 99mTc-MDP scintimammography accurately detects breast carcinomas with largest diameter > 10 mm; it differentiates malignant from benign lesions, and it shows promising insights in characterizing breast abnormalities mammographically indeterminate.     

Likelihood of malignant disease for various categories of mammographically detected, nonpalpable breast lesions

To determine the likelihood of malignant disease for mammographically detected, nonpalpable breast lesions, we defined 11 morphologic categories and retrospectively reviewed the mammograms in 859 cases in which biopsy was performed after a wire localization procedure at our institution during 1989 and 1990. Within each category, the total number of lesions and the percentage of cases with a surgical pathologic diagnosis of malignant involvement were as follows: benign calcification, 25 (0% malignant); indeterminate calcification, 200 (22%); malignant calcification, 39 (92%); smooth mass, 84 (1%); irregular mass, 337 (40%); architectural distortion, 45 (47%); asymmetric breast tissue, 37 (3%, or 1 case of asymmetrically prominent ducts); smooth mass with calcification, 3 (0%); irregular mass with calcification, 68 (66%); architectural distortion with calcification, 14 (57%); and asymmetric breast tissue with calcification, 7 (29%). The overall rate of malignant involvement for the 859 cases was 34%. If follow-up examinations rather than biopsies had been done for the lesions categorized as benign calcification, smooth mass, smooth mass with calcification, and asymmetric breast tissue (excluding asymmetrically prominent ducts), the overall positive predictive value would have increased from 34 to 41%, and 148 biopsies would have been deferred (17% of all biopsies). If morphologic criteria are applied to the evaluation of mammographically detected, nonpalpable lesions, the rate of malignant disease at biopsy may reach 40%. This rate correlates with that in recent large series.     

CT-guided transthoracic needle biopsy: a comparison between automated biopsy gun and fine needle aspiration

AIMS: We retrospectively investigated the diagnostic accuracy and complication rate of transthoracic core biopsy using an automated biopsy gun and compared the findings with those of aspiration needle biopsy. PATIENTS AND METHODS: Seventy-three patients underwent 74 core biopsy procedures and 50 patients underwent 52 aspiration biopsy procedures. Of these, a final diagnosis was obtained in 107 lesions with surgery or clinical course. Fifteen patients in which a final diagnosis was not obtained were excluded from the study on diagnostic accuracy. Thus, in the study of diagnostic accuracy, 63 core biopsy procedures for 62 lesions are included. Core biopsy was performed with an 18 G cutting needle using an automated biopsy gun. Aspiration biopsy was performed with a 20 G aspiration needle. RESULTS: Core biopsy yielded sufficient material in 57/63 procedures (90.5%). A correct diagnosis was obtained in 36 procedures (85.7%) for malignant leisons and a specific benign diagnosis was obtained in 11 procedures (52.4%). Aspiration biopsy yielded a correct diagnosis in 26 procedures (81.3%) for malignant leisons and in seven (46.7%) for benign lesions. The overall correct diagnosis were 75.8% and 71.7% with core biopsy and aspiration biopsy, respectively. Core biopsy gave a higher predictive rate than that of aspiration biopsy for both benign and malignant lessons (P < 0.02). Pneumothorax occurred in 18/74 (24.3%) patients with core biopsy and in 18/45 (40.0%) patients with aspiration biopsy. Of these, three with core biopsy and two with aspiration biopsy needed tube drainage. The other complication was haemoptysis, which occurred in six patients following core biopsy and in three after aspiration biopsy. All nine cases subsided spontaneously. There were no fatal complications. CONCLUSIONS: Core biopsy with a biopsy gun increase the diagnostic accuracy with a higher histologic predictive rate and no obvious additional risk of complications.     

Are stereotaxic breast biopsies adequate?

BACKGROUND: Stereotaxic core breast biopsy (SCBB) has been proposed as a cost-effective and reliable method of evaluating mammographic lesions. This study evaluates an initial experience with SCBB and assesses the adequacy of the biopsy specimens obtained. METHODS: Two hundred forty-one SCBB were performed on 221 patients during 13 months by four radiologists. Mammograms were assigned a suspicion index on a scale of 1 to 5. One pathologist performed a blinded retrospective review of all SCBB specimens and assigned an adequacy score based on the quality and amount of the tissue present. RESULTS: The majority of SCBB were ordered by general surgeons (67%). A suspicion index score of 3 was assigned to 74% of lesion specimens. Twelve percent of specimens were malignant. Overall SCBB adequacy (score > or = 2) was 77%. Adequacy was present in 74% of benign biopsy specimens as compared with 100% of malignant specimens (p < 0.005). Only 62% of specimens reported as benign without specific features were adequate. There were no differences in adequacy between individual radiologists or during the study period. CONCLUSIONS: SCBB is largely used by surgeons to assess indeterminate mammographic lesions. One of four benign specimens was inadequate. Benign SCBB specimens must be interpreted with caution.     

Maternal smoking during pregnancy and psychiatric adjustment in late adolescence

Large-core (14g) needle biopsy (CNB) of the breast is a new diagnostic modality increasingly being used to evaluate patients with mammographic abnormalities. Two hundred twenty-four CNBs were performed on 198 patients. Surgical follow-up was available in 64 cases (28.6%). Overall concordance rate was 93.8% (60 of 64 cases). Of the four discordant cases, two were diagnosed as atypical ductal hyperplasia (ADH) on CNB; on excision, these cases showed cribriform ductal carcinoma in situ (DCIS); two remaining cases, diagnosed on CNB as ADH versus DCIS, showed invasive carcinoma (DCIS with invasive component and infiltrating cribriform carcinoma, respectively) on excisional biopsy. Malignancy, primary (52) or metastatic (5), was identified in 57 cases (25.4%); 47 of these patients underwent surgical excision, and the diagnosis was confirmed in all of these cases. Of 51 cases with radiographic evidence of microcalcifications, 48 (94%) had microcalcifications in the CNB: 30 (62.5%) were benign, 11 (22.9%) were malignant, and 7 (14.6%) were diagnosed as ADH. In the remaining three cases (1.3%), only benign breast tissue without microcalcifications was seen, and the lesion was considered to have been missed. Biopsy specimens were obtained from 173 lesions because of the presence of a mass: 125 (72.3%) were benign, 45 (26%) were malignant, and 3 (1.7%) were diagnosed as ADH. Follow-up was available in 118 patients with benign lesions: all were mammographically stable or decreased at 6 or 12 months; no follow-up was available for the remaining patients. CNB of the breast is a highly sensitive (96.9%) and specific (100%) technique for management of patients with mammographic abnormalities. The histologic findings should be correlated with the mammographic appearance, and an attempt should be made to achieve a specific diagnosis in all lesions, particularly masses. The diagnosis of ADH should always prompt excisional biopsy because of a high frequency of false-negative results caused by sampling errors or underestimation.     

Mediastinal needle biopsy. A 15-year experience with 139 cases

BACKGROUND: Radiologically guided needle biopsy and cytologic evaluation provide a reliable method of diagnosis for planning definitive therapy of patients with mediastinal lesions. MATERIALS AND METHODS: In this retrospective study of one of the largest series from a single institution, 141 consecutive mediastinal needle biopsies from 139 patients were reviewed during a 15-year period. RESULTS: Adequate material was obtained with a diagnosis achieved in 128 cases (92%). Of these, 33 cases (26%) had benign diagnoses; the remaining 95 (74%) had malignant diagnoses, including 81 carcinomas, 3 sarcomas, 8 lymphoproliferative lesions, 2 malignant germ cell tumors, and 1 malignant thymoma. All benign cases were diagnostically confirmed, and 94 of 95 malignant cases were classified correctly. The only discrepancy that occurred involved a malignant lymphoma diagnosed as a malignant germ cell tumor. Of the 13 inadequate samples, the major category included a nodular sclerosis variant of Hodgkin's disease (4 cases), 1 case of thymoma, 1 case of tuberculous lymphadenitis, and 7 cases for which no follow-up data were available. CONCLUSION: Needle biopsy is reaffirmed as a reliable and sensitive diagnostic tool for mediastinal lesions, with an overall cytologic diagnostic accuracy of 99% with adequate material. Sclerotic lesions may pose a limitation to this technique and require generous sampling before a more invasive diagnostic procedure is undertaken.     

Meta-analysis of the efficacy of extradural clonidine to relieve postoperative pain: an impossible task

PURPOSE: The diagnostic accuracy and rate of complications of CT-guided core biopsies (CB) from suspected tumors of the chest were compared to the accuracy a complications of fine-needle aspiration biopsies (FNAB). METHODS: The accuracy in the diagnosis of a benign or malignant lesion of 79 FNAB (19.5 G self-aspirating cutting needle) and of 83 CB (18 G automated core biopsy) and the rates of pneumothorax, pleural drainage and hemoptysis were retrospectively evaluated. RESULTS: With FNAB, the sensitivity for malignant lesions was 62.1% and the accuracy 68.4%. With CB the sensitivity amounted to 85.9% and accuracy to 86.7%. The rate of pneumothorax was 25.3% following FNAB, with a drainage rate of 5.1% compared to 19.3% and 6.0%, respectively, following CB. The rate of pneumothorax and drainage increased with increasing path length through aerated lung. In advanced emphysema, the pneumothorax rate did not increase; however, in pneumothoraces, pleural drainage was mandatory in 20% of FNAB and in 100% of CB. Hemoptysis without any therapeutic consequences occurred in 3.8% following FNAB and in 6.0% following CB. CONCLUSIONS: With CB diagnostic accuracy can be clearly increased without an obvious increase in the complication rate. However, in patients with obvious emphysema, the pleural drainage rate of pneumothorax may be higher following CB.     

The accuracy of breast ultrasound in the evaluation of clinically benign discrete, symptomatic breast lumps

INTRODUCTION: Recent reports have suggested that breast ultrasound (US) is of value in distinguishing malignant from benign processes. The aim of this study was to establish the accuracy of US in detecting invasive malignancy in clinically benign, discrete, symptomatic breast lumps. METHODS: The US appearances of 205 clinically benign breast masses were documented prospectively and prior to mammography by one radiologist (AJE). The US appearances were then correlated with the fine needle aspiration (FNA), core biopsy and surgical findings and compared with the mammographic findings. RESULTS: The US findings were normal 72 (35%), simple cyst 63 (31%), solid benign 51 (25%), solid indeterminate 15 (7%) and solid malignant four (2%). Ultrasound characterized 13 (93%) of the 14 patients found to have invasive carcinoma as indeterminate or malignant. No patients with normal or simple cyst US findings had invasive malignancy. Ultrasound had significantly better accuracy (97% vs 87%, P < 0.02) sensitivity (93% vs 57%, P < 0.05) and negative predictive value (99% vs 92%, P < 0.002) than mammography in the detection of invasive carcinoma when indeterminate and malignant imaging findings were taken as positive. CONCLUSION: US is a useful adjunct to FNA/core biopsy in confirming the nature of symptomatic, clinically benign breast masses and is superior to mammography in this clinical setting.     

The occurrence of late asthmatic response to exercise after allergen challenge

OBJECTIVES: To evaluate the correlation between the pathological findings of stereotactic core needle biopsy (SCNB) and the prebiopsy mammographic findings, as well as the pathological findings of lesions that were subsequently removed by surgical excision. DESIGN: A retrospective review of 97 consecutive patients who underwent 100 SCNBs of suspicious nonpalpable mammographic lesions. The criterion standard is surgical excisional biopsy with needle localization. Mammographic findings were graded according to the American College of Radiology Breast Imaging Reporting and Data System. The pathological findings of SCNB were categorized into 4 groups: benign and specific, benign and nonspecific, premalignant, and malignant. Surgical excision of the lesion was performed if the pathological finding on SCNB was nonconcordant with the prebiopsy mammogram and when premalignant or malignant lesions were found. The pathological findings of lesions that were subsequently removed by surgical excision were compared with those of SCNB. SETTING: Community-based private multispecialty ambulatory practice. PATIENTS: A population-based sample composed of 97 patients who had grade III, IV, or V lesions on routine screening mammograms. INTERVENTION: Stereotactic core needle biopsy of nonpalpable mammographic lesions. MAIN OUTCOME MEASURES: Percentage of patients whose SCNB results were concordant with the mammographic findings and the pathological findings on subsequent surgical excision. RESULTS: Concordance between SCNB and mammography occurred in 97% of biopsy specimens. Concordance between the pathological findings of SCNB and those of surgically excised lesions occurred in 92.5% of biopsy specimens. We had 1 false-negative result. We had no false-positive diagnosis of cancer with SCNB. CONCLUSION: On the basis of accumulating literature and our own initial experience, SCNB is a promising, safe, and cost-effective procedure.     

Stereotactic core biopsy of breast microcalcifications. Aid to diagnosis?]

We assessed the accuracy with which stereotactic core biopsy of breast microcalcifications helps to justify follow-up or indicate required surgical planning. Eighty-nine patients underwent stereotactic breast biopsy performed with large core needles. Histopathologic findings of microbiopsies were correlated with radiological findings, with follow up and with surgical findings. Agreement between radiological and histopathologic findings on biopsies was obtained in 86% for benign results. Even in the case of benign radiological findings, the histological results of microbiopsies required a surgical biopsy justified in 10% of cases. Radiologically suspicious or malignant microcalcifications were correlated with 35% benign and 65% malignant histologies on biopsies. The positive predictive value, negative predictive value and accuracy were respectively 93%, 86% and 95%. Invasive lesions were found on microbiopsies in 39% of excised malignant lesions. Multifocal lesions were proved on microbiopsies in 50% of all excised carcinomas. Microbiopsies help to disclose malignant lesions undetected on radiological analysis, and may obviate diagnostic surgical biopsy in many cases.     

Medical Treatment of ulcerative colitis: overview

Open surgical biopsy has long been the standard of care for the diagnosis of breast pathology. As more lesions are diagnosed by mammography, image-directed core biopsy has taken on increasing importance. This study consisted of a consecutive group of 540 patients who underwent breast biopsy for mammographically or sonographically detected lesions. The percentage of those undergoing image-directed biopsy and open biopsy were determined as well as the rate of positive biopsy for each method. Results showed that for patients with nonpalpable lesions, the proportion of image-directed core biopsies rose steadily during the study period, from 0 per cent in early 1993 to 70.1 per cent by early 1996. During this same period, positive biopsy rate rose from 23.9 to 31.0 per cent in the first 18 months of the study to a range of 45.2 to 48.3 per cent in the last 18 months. It was concluded that image-directed core biopsies have begun to impact the practice of breast surgery by replacing, to a great extent, the open surgical biopsy. This study also demonstrates an increased proportion of positive biopsies done by open surgical technique. It was suggested that many of the mammographically benign lesions are diagnosed by image-directed core biopsy, obviating the need for an open technique. An algorithm for managing nonpalpable breast lesions is presented.     

Core needle biopsy of synchronous ipsilateral breast lesions: impact on treatment

OBJECTIVE: The purpose of this study was to evaluate the role of core biopsy in the diagnosis of multiple synchronous ipsilateral breast lesions and to determine the impact of this information on patients' management. MATERIALS AND METHODS: Of 371 patients who underwent core-needle breast biopsy under stereotaxic (n = 278) or sonographic (n = 93) guidance, 20 (5%) underwent core biopsy of two mammographically separate lesions in the ipsilateral breast on the same date. Fourteen of these 20 patients subsequently underwent surgery. We retrospectively reviewed the medical, radiographic, and histopathologic records in these 14 patients and in 91 patients with single mammographic lesions diagnosed as carcinoma by means of core biopsy during the same period. RESULTS: In 11 patients, core biopsy revealed two sites of carcinoma. Core biopsy findings in these 11 patients were two areas of infiltrating ductal carcinoma (n = 5), one infiltrating ductal carcinoma and one infiltrating lobular carcinoma (n = 2), one infiltrating ductal carcinoma and one ductal carcinoma in situ (n = 1), and two foci of ductal carcinoma in situ (n = 3). All 11 patients with two core biopsy-proven foci of carcinoma underwent mastectomy. Patients were significantly more likely to be treated with mastectomy if core biopsy revealed two rather than one site of carcinoma (100% versus 38%, p < .001). CONCLUSION: Core-needle biopsy is useful in diagnosing multiple synchronous ipsilateral breast lesions. By showing whether carcinoma is present in one or more sites in the breast, core biopsy can provide information of critical importance in making treatment decisions.     

Cloning of the novel gene intelectin, which is expressed in intestinal paneth cells in mice

OBJECTIVE: The purpose of our study was to assess the accuracy of CT-guided biopsy of musculoskeletal neoplasms with respect to technique, anatomic site, and histology. MATERIALS AND METHODS: During a 3-year period (January 1992 to December 1994), 176 core needle biopsies and 45 fine-needle aspirations were performed under CT guidance on patients with musculoskeletal neoplasms. To assess the accuracy of these procedures, we compared the diagnosis at biopsy with the final diagnosis as determined at the time of definitive treatment of the lesion. All biopsy findings were categorized as a primary malignancy (excluding round cell lesions), round cell lesion, local recurrence, or metastatic carcinoma. In addition, each lesion was analyzed according to which biopsy technique was used, whether frozen tissue section or rapid cytologic evaluation was used, and at which anatomic site the mass was found. RESULTS: The accuracy for needle biopsy was 93% and that for fine-needle aspiration was 80%. The complication rate for both techniques was less than 1%. Accuracy rates for the four categories of primary malignancy, round cell lesion, local recurrence, and metastatic carcinoma were 87%, 75%, 94%, and 100%, respectively. The mismatch rates were similar in soft-tissue lesions (5/52) and bone lesions (16/169). Diminished accuracy was associated with round cell lesions (20%) and lesions located in the spine or the perivertebral region (20%). Nondiagnostic and insufficient specimens were found in 18 (8%) of the 221 patients. CONCLUSION. CT-guided biopsy of musculoskeletal malignancies is a safe and effective procedure if performed by a team of clinicians, pathologists, and radiologists who possess subspecialty expertise.     

Computed imaging-assisted stereotactic brain biopsy: a risk analysis of 225 consecutive cases

BACKGROUND: Treatment strategies for intracranial mass lesions are most effective when based upon histopathological diagnoses. Image-guided stereotaxy has provided the means to sample tissue from small or deeply seated intraparenchymal lesions with a relatively high degree of safety and accuracy. Although procedural complications are infrequent, devastating neurological sequelae may result from hemorrhage or direct trauma. This study was undertaken to identify factors that may confer an increased risk of morbidity from stereotactic brain biopsy. METHODS: Two hundred twenty-five consecutive computer-assisted stereotactic brain biopsy procedures were reviewed. Patient age averaged 47.4 years (range, 3-84 years); gender ratio was approximately 2:1 (male:female). Pre-existing medical conditions were identified in nearly half of the cohort. 61.3% of biopsied lesions were lobar; the remainder (38.7%) were "deep-seated" (thalamus, basal ganglia, pineal, hypothalamus, cerebellum, brainstem). Glial tumors accounted for the majority (44.4%) of biopsied lesions; metastases (12.9%) and lymphoma (11.6%) were also relatively common. Demographical, anatomical, surgical, and histological data were compiled and putative risk factors for morbidity identified. These variables were then subjected to univariate and logistic regression analyses to determine their significance as independent predictors of operative risk. RESULTS: Twelve patients suffered complications as a consequence of the biopsy procedure (eight from hemorrhage, four from direct trauma). Major morbidity (hemiparesis, aphasia, obtundation) occurred in eight patients (3.6%). Three patients (1.3%) suffered minor morbidity (transient, mild neurological deficits). One operative fatality occurred (0.4%). An increased risk of morbidity was associated with the preoperative use of antiplatelet agents, chronic corticosteroids, deep-seated lesions, malignant gliomas, and a greater number of biopsy attempts (p < 0.05). Factors not conferring increased morbidity included gender, age, pre-existing illness, extracranial malignancy, cardiac disease, hypertension, diabetes, HIV status, and instrument used to procure the specimen. CONCLUSIONS: Complications arising from stereotactic brain biopsy are infrequent but can be disastrous. Operative risk is a function of several independent variables, including lesion properties (location, histology), preoperative pharmacological therapy (corticosteroids, antiplatelet agents), and operative technique. This analysis suggests that the morbidity of stereotactic brain biopsy may be minimized by risk factor modification.     

Ultrasound-controlled stereotactic breast biopsy--description and initial clinical results of a new breast biopsy device

The aim of this prospective study was first to describe a new dedicated 3D-ultrasound guided stereotaxic breast biopsy unit and second its specificity, sensitivity, accuracy and positive predictive value (concerning malignant and benign lesions). Technical considerations are noted and discussed. SUBJECTS AND METHODS: 45 women (aged between 20 and 77 years; mean age: 49.73 years) with sonographically suspect breast lesions were assigned to the new biopsy device (Sonopsy, NeoVision Corporation, Seattle). All biopsies were performed by an experienced radiologists (G. Wolf) and the results compared to the surgical biopsies. RESULTS: Sensitivity and accuracy was 93.3%, specificity 100%, the positive predictive value (concerning malignant lesions) 95.4% and (concerning benign lesions) 97.8%. In 9/45 biopsies (20%) complications were noted (1 hematoma, 2 collapses, 5 vasovagale reactions). In 13/45 Cases (28.9%) the suspect lesions were more distinctively, respectively more clearly defined on the conventional/dedicated sonography unit. CONCLUSION: This dedicated unit combines all advantages of sonographic and stereotaxic guided core biopsies. Our results show that this technique is a promising new method for breast biopsy.     

What''s new in cosmetic surgery of the hand? Technical notes]

INTRODUCTION: Any breast lesion/abnormality detected at mammography must be characterized as (non)-neoplastic before surgery. Fine needle aspiration cytology (FNAC) permits a precise diagnosis in over 70% of cases but exhibits many inadequate, false negatives or questionable findings. This makes surgical biopsy mandatory in many cases. An alternative is offered by fine needle biopsy (FNB: 16-18 G needles) or by large core biopsy (LCB: 14 G needles), which procedures can reduce the number of questionable diagnoses with no major discomfort or side-effects for the patient. MATERIAL AND METHODS: January, 1996, to October, 1997, we performed 422 microhistologic biopsies on breast lesions at the Unità Integrata di Senologia, Azienda Ospedaliera Careggi, Florence, Italy. 383 of these lesions were nonpalpable. FNB was performed in 221 cases and LCB in 201. Most biopsies (65%) were carried out under US guidance and some others (25%) under stereotactic guidance. RESULTS: Microhistologic biopsy allowed accurate lesion characterization in most cases, even though LCB obviously performed much better. Samples were inadequate in 5.88% of cases with FNB and only in 2.98% of cases with LCB. The false negative rate was 1.92% for FNB and 0.99% for LCB. Surgical biopsy was needed for an unquestionable diagnosis only in 9.5% of FNB and 3.9% of LCB cases. CONCLUSIONS: Our results confirm the literature data on how LCB can be considered a valid alternative to surgical biopsy (and, to some extent, to FNAC); in particular, its advantages are: moderate invasiveness, little patient discomfort and high diagnostic accuracy. Moreover, the procedure is short (5-10 minutes) and costs much less than surgical biopsies (1/2 to 1/4).     

The Advanced Breast Biopsy Instrumentation (ABBI), a system for stereotactic excision of mammographically suspect nonpalpable findings in the breast

Advanced Breast Biopsy Instrumentation (ABBI) allows radiologically guided stereotactic excision of non-palpable radiodense lesions with high accuracy. Tissue cylinders of 5, 10, 15 or 20 mm diameter and of variable lengths can be removed very accurately under local anaesthesia and on an outpatient basis. Thirty-six patients with suspicious clusters of microcalcifications (n = 29) and with round lesions (n = 7) of the breast were qualified for ABBI. We were able to perform the excisional biopsy in a total of 34 patients. The breast of one woman was too small to safely fit into the system and in another woman the lesion could not be visualized by the system. In 2/34 cases (6%), the excision was imprecise due to slight dislocation of the breast parenchyma by the advancing cylinder knife. In one case (3%), ABBI missed the target within a dense mastopathic breast. In all cases the excisions were well tolerated. No wound complications occurred and the cosmetic result was excellent. Histology revealed 28 benign (82%) and 6 malignant (18%) lesions. Among the 27 small microcalcifications there were 3 invasive carcinomas, 3 ductal carcinomas in situ (DCIS), 1 lobular hyperplasia, 14 mastopathies, 1 fibroadenoma, 1 duct papilloma and 4 calcifications in scars. Four of the 7 round-shaped lesions were found to be fibroadenomas, 1 lobular hyperplasia, and 2 mastopathies. With the ABBI system, non-palpable breast lesions can be precisely localized and excised.     

Applications of PET in lung cancer

An estimated 180,000 new cases of lung cancer will be diagnosed in the United States this year, and lung cancer accounts for approximately 25% of all cancer deaths. The overall 5-year survival rate is 14%, and this has not changed over the past several decades. Lung cancer diagnosis and treatment is a major health problem globally. Most lung cancers are detected initially on chest radiographs, but many benign lesions have radiologic characteristics similar to malignant lesions. Thus, additional studies are required for further evaluation. Computed tomography (CT) is most frequently used to provide additional anatomic and morphologic information about the lesion, but it is limited in distinguishing benign from malignant abnormalities in the lung, pleura, and mediastinum. Because of the indeterminate results from anatomic imaging, biopsy procedures including thoracoscopy and thoracotomy may be used even through one-half of the lesions removed are benign and do not need to be removed. FDG-PET imaging provides physiologic and metabolic information that characterizes lesions that are indeterminate by CT and that accurately stages the distribution of lung cancer. Exploiting the fundamental biochemical differences between cancer and normal tissues, FDG imaging takes advantage of the increased accumulation of FDG in transformed cells. FDG-PET is very sensitive (approximately 95%) for the detection of cancer in patients who have indeterminate lesions on CT. The specificity (approximately 85%) of PET imaging is slightly less than the sensitivity because some inflammatory processes such as active granulomatous infections accumulate FDG avidly. The high-negative predictive value of PET suggests that lesions considered negative on the study are benign, biopsy is not needed, and radiographic follow-up is recommended. Several studies have documented the increased accuracy of PET compared with CT in the evaluation of the hilar and mediastinal lymph node status in patients with lung cancer. If the mediastinum is normal on PET imaging and there is no other evidence of metastatic disease, the patient has a thoracotomy. If the mediastinum is abnormal on PET imaging, mediastinoscopy is performed with the PET images providing the lymph node stations to target. Whole-body PET studies detect metastatic disease that is unsuspected by conventional imaging and demonstrate some of the anatomic abnormalities detected by CT to be benign lesions. Management changes have been reported to occur in up to 41% of patients based on the results of the whole-body studies.     

Production of soluble single-chain T-cell receptor fragments in Escherichia coli trxB mutants

The aim of this work has been to determine whether the joint use of mammography and scintimammography is capable of reducing the number of biopsies required in patients with suspected breast cancer. We have performed scintimammography in 90 patients, 97 lesions, with breast cancer suspicion. In the mammography was evaluated the degree of malignancy suspicion and the size of the lesion. Only 41 of the biopsies revealed the presence of cancer. The sensitivity, specificity, PPV and NPV of scintimammography were 85%, 79%, 74% and 88%. According to the mammography findings 20 lesions (1 breast cancer) were included as low, 31 lesions (4 breast cancer) as indeterminate and 46 lesions (36 breast cancer) as high malignancy suspicion. 14 lesions (2 low, 2 indeterminate and 10 high suspicion) were smaller than 1 cm. The scintimammography was positive in all breast cancer of low and indeterminate suspicion of malignancy and in 30 of high probability. On the basis of this results we propose that a biopsy must be carried out to those lesions with a high suspicion of malignancy, and to lesions with low or indeterminate suspicion that are smaller than 1 cm or that present a positive scintimammography. Following this protocol, only 64 of the 97 biopsies would have been necessary, with a reduction of the 34% in the total number of biopsies and, more important, a 65% of reduction in the number of biopsies carried out in the groups of low and indeterminate suspicion of malignancy. At the same time we would indicate biopsy in all cases of breast cancer.