Patient follow-up after concordant histologically benign imaging-guided biopsy of MRI-detected lesions

OBJECTIVE: The purpose of this study was to review the reported experience and suggest follow-up after biopsy for MRI-detected lesions. CONCLUSION: Imaging-guided biopsy, using MRI or sonographic guidance, of MRI-detected lesions may result in false-negative results that are not appreciated at the time of the biopsy. A 6-month follow-up MRI is suggested as the most appropriate interval to identify lesions that were missed at biopsy without clinically significant delay in diagnosis of those lesions that are malignant.     

Scar formation after stereotactic vacuum-assisted core biopsy of benign breast lesions

AIM: To evaluate scar formation of impalpable breast lesions with benign histological outcome using stereotactic 11-gauge vacuum-assisted core biopsy (VACB). MATERIALS AND METHODS: Two hundred and ten lesions with benign histology for which follow-up mammograms were available, were assessed for scar formation at the biopsy site. All biopsies were performed using stereotactic VACB with 11-gauge needle. The incidence of post-biopsy scar formation and the number of specimens removed were determined. RESULTS: In 4.3% (9/210) of the lesions for which a biopsy was performed with 11-gauge directional vacuum-assisted technique, the follow-up mammogram revealed a scar formation. Of these, six were minimal scars, two were moderate scars and one was a marked scar. Minimal and moderate scars were diagnosed on imaging only. However, the case with marked scar formation required tissue diagnosis to rule out malignancy. CONCLUSION: Although uncommon, scar formation can be seen in the follow-up mammograms after percutaneous breast biopsies. It is important that the radiologist interpreting follow-up mammograms is aware of the features of this lesion and its relationship to the biopsy procedure.     

Follow-up of benign results of stereotactic core breast biopsy

RATIONALE AND OBJECTIVES: The purpose of this study was to obtain long-term follow-up data on women with benign histologic results of a breast stereotactic core needle biopsy (CNB). MATERIALS AND METHODS: Mammography charts of 300 consecutive women who underwent prone stereotactic CNB with digital radiography were reviewed. Women with frankly malignant or suspicious histologic findings (51 patients) or a technically unsuccessful stereotactic CNB (one patient) were excluded. The remaining 248 benign core biopsies in 229 women were included in the study. RESULTS: Follow-up mammograms were obtained for 152 lesions with benign histologic results following stereotactic CNB. The mean length of follow-up after stereotactic CNB was 34.6 months. Cancer was diagnosed in six women who underwent surgical biopsies 1/2 to 30 months after benign stereotactic CNB. An initial chart review demonstrated that no follow-up data were available for 64 lesions, and information was missing for an additional seven. CONCLUSION: SCNB remains a sampling procedure that can result in false-negative histologic results. Intrinsic procedural issues were identified that could minimize the potential for missing a malignancy. Goals for patient compliance with follow-up recommendations fell short of expectations.     

CT导引下骶骨病变穿刺活检

目的 探讨CT导引下对骶骨病变穿刺活检技术和应用价值.方法 在CT导引下对21例骶骨病变联合使用Ackermann骨钻针、切割式活检针和抽吸式活检针采集骨性标本和非骨性标本.结果穿刺成功率100%,除1例标本为含坏死组织和凝血块外,其余均获得病理结果,病理活检成功率95.2%.结论 CT导引下穿刺活检是对骶骨病变作出正确诊断的可靠方法,操作简便、安全,并发症少,为术前诊断提供重要的参考依据.正确合理使用操作方法可以提高穿刺的成功率和缩短穿刺时间.     

CT导引下经皮肌肉骨骼病变穿刺活检

目的 探讨CT导引下经皮穿刺活检在肌肉骨骼病变诊断的价值，评估激光导引装置在肌肉骨骼病变CT穿刺活检中的作用。方法 165例CT引导下肌肉骨骼穿刺活检病例（其中36例使用Pinpoint激光引导系统），骨骼穿刺活检142例，软组织穿刺活检23例。149例有手术病理、切开活检病理或临床随访资料。结果 165例肌肉骨骼病变的穿刺活检总正确率为75．2％（124／165）。其中骨骼病变穿刺活检的正确率为73．2％（104／142），肌肉软组织病变穿刺活检的正确率为87．0％（20／23）。Pinpoint激光导引下CT穿刺活检的诊断正确率为80．6％（29／36）。使用骨钻针穿刺诊断正确率73．8％（96／130），使用抽吸针穿刺诊断正确率80．0％（28／35）。大病灶（直径〉3cm）穿刺活检诊断正确率80．6％（79／98），小病灶（直径≤3cm）穿刺活检诊断正确率67．2％（45／67），二者之间差异有统计学意义（P〈0．05）。结论 CT导引下经皮骨骼肌肉活检是一种安全、简便、有效的诊断和鉴别诊断方法。对大病灶的诊断正确率优于较小病灶，在小病灶中，使用Pinpoint激光导引装置有助于提高诊断正确率。     

高频乳腺X线片对乳腺良恶性病变钙化的分析

目的研究高频乳腺X线片对鉴别乳腺良、恶性病变钙化的意义。方法152例经临床和病理证实的女性乳腺良、恶性病变患者（87例良性病变和65例恶性病变）均经高频乳腺X线摄影。回顾性分析了所有患者的乳腺X线表现，并着重鉴别了乳腺良、恶性病变钙化的X线特征。结果在乳腺X线片上，大多数良性病变的钙化表现为散在分布的粗颗粒状、环状或斑片状灶，形态规则，密度较高，而恶性病变的钙化多呈簇状分布的细颗粒与导管型，诸如泥沙状、短棒状、针尖状灶，形态不规则，密度较低。结论乳腺病变钙化的X线表现随病变性质而不同，因此，高频乳腺X线片对鉴别乳腺良、恶性病变起重要作用。     

CT导向下肺中央型病变穿刺活检

目的：探讨CT导向下穿刺活检对肺中央型病变的可行性和安全性.方法：回顾性分析CT导向下穿刺活检的108例肺中央型病变患者的病例资抖,其中57例术前已行支气管镜检查但未取得明确结果.分析108例行穿刺活检的患者的活检阳性率和并发症发生率,并与随机抽取的同期108例肺周围型病变患者的结果进行甘比分析.结果：中央型病变组的活检阳性率（96.3%）与周围型组（98.2%）比较差异无显著性意义;总的并发症发生率中央型组（56.5%）明显高于周围型组（26.9%）,两组比较差异有显著性意义（P〈0.05）,但较严重并发症的发生率两组差异无显著性意义.57例支气管镜检查诊断不明确病例的活检阳性率为96.49%,并发症发生率63.16%.结论：对于肺中央型病变,只要严格掌握适应证,CT导向下穿刺活检是可行、安全和有效的,尤其适用于支气管镜检查无法明确诊断的病例.     

Accuracy of CT-guided chest biopsy for benign lesions

Purpose

To demonstrate that CT-guided chest biopsy can effectively prevent surgery for patients with benign tumors.

Patients and methods

We present a cohort of patients who underwent CT-guided biopsy for a chest lesion where diagnosis could not be achieved through other means. The gold standard was defined, based on availability, by surgery or imaging and clinical follow-up over a 2-year period.

Results

From a total of 114 biopsied lesions, 101 were malignant and 13 were benign. Sensitivity and specificity values for benign lesions were 92.1 and 92.3% respectively with PPV and NPV of 60 and 98.9%. Sensitivity and specificity values for malignant lesions were 86.1 and 100% respectively with PPV and NPV of 100 and 48%. No statistically significant correlation could be established between the groups with concordant and discordant results.

Conclusion

The diagnosis of specific benign lesion on CT-guided biopsy, all sizes and sites included, may effectively prevent unnecessary surgery.     

Management of non malignant papillary lesions diagnosed on percutaneous biopsy

PURPOSE: To assess the reliability of percutaneous breast biopsies in diagnosing and managing non malignant papillary lesions and determine if subsequent excision must be systematic. MATERIALS AND METHODS. Retrospective review of 2233 breast biopsies over a 43 months period (September 2001 to March 2005): sonographically guided core biopsies (n = 836), ultrasound (n = 346) or stereotactic (n:1051) guided vacuum biopsies. 86 non malignant papillary tumors were diagnosed (core biopsy:28, US:38 and stereotactic guided vacuum biopsy:20). A larger sample was systematic after core biopsy: lumpectomy (n = 19) or vacuum biopsy (n = 9). Surgical excision followed vacuum biopsy (n = 18) in case of atypia or sampling excision. Alternatively, yearly follow-up was advised (n = 40). Correlation with surgical findings (n = 37) or mammographic follow-up (n = 49) is presented. The influence of various factors on the risk of underestimation was analysed. RESULTS: Surgical resection revealed an underestimation of 5/37 (13.5%): 4/19 with core- and 1/18 with vacuum-assisted biopsy corresponding to 4 low grade ductal carcinoma in situ and a microinvasive ductal carcinoma in situ. It was higher for core biopsies and related to age and size: higher when women<50 years and when radiological image>1 cm. The influence of the other factors was not significant. Of the 9 non operated papillomas after core biopsy, vacuum biopsy revealed an additional underestimation (low-grade ductal carcinoma in situ). Of the 49 papillary lesions that were not surgically biopsied, 40 were monitored at 2-42 months (average: 19 months). No carcinoma was detected during this follow-up. CONCLUSION: Percutaneous biopsy is an accurate technique in managing papillary tumors. A larger histologic specimen is necessary after core biopsy. Vacuum biopsy is an attractive alternative to surgery for smaller papillomas (<1 cm), but in spite of nonsignificant results we advise subsequent excision in case of multiple papillomas, atypia or residual tumor.     

Sonographically guided percutaneous biopsy of gastrointestinal tract lesions

OBJECTIVE. Our objective was to evaluate the role and safety of sonographically guided percutaneous biopsy in the diagnosis of digestive tract lesions when the lesions are not suitable to biopsy by endoscopy and safely reachable by sonography. MATERIALS AND METHODS. We performed 42 biopsies in 41 patients (age range, 14-81 years; mean age, 57.5 years). We performed biopsies with real-time sonographic guidance using graded compression, with a 3.5-5-MHz microconvex transducer. In 39 biopsies, core specimens were obtained with an 18-gauge automatic needle gun; fine-needle aspiration biopsy was obtained in 28 patients with a 22-gauge needle and in the other four patients with a 21-gauge needle. In the remaining three patients, a coaxial technique with 20- and 22-gauge needles for cytology was used. RESULTS. In 40 (95.2%) of 42 core biopsies performed, a specific diagnosis was obtained. A positive diagnosis was obtained in 16 (45.7%) of 35 fine-needle aspirations. The lesions were located from the pharynx to the sigmoid colon. Twenty-eight patients had malignant lesions, and 13 had benign lesions. Only one serious complication, bile peritonitis, was observed. CONCLUSION. Percutaneous biopsy with sonographic guidance can be used safely and efficiently to diagnose digestive tract lesions that can be visualized on sonography and are not accessible endoscopically.     

Follow-up of breast lesions diagnosed as benign with stereotactic core-needle biopsy: frequency of mammographic change and false-negative rate.

PURPOSE: To determine how often lesions diagnosed as benign with stereotactic core-needle biopsy (SCNB) change at follow-up mammography and to determine the optimal follow-up strategy and the delayed false-negative rate. MATERIALS AND METHODS: From July 1992 through December 1995, 355 of 540 cases (66%) in which SCNB yielded benign results were managed with follow-up mammography. Mammographic follow-up was available for 298 of these cases (84%). Follow-up mammography reports were reviewed. When a change was reported, pre- and postbiopsy mammograms, pathology reports, and results of subsequent mammographic follow-up were reviewed. RESULTS: Mammographic change occurred in 21 of 298 cases (7%) at intervals of 6-55 months (mean, 20 months). Change occurred after initial mammographic stability in 10 of 21 cases. Repeat biopsy was performed in 18 of 21 cases. Malignancy was diagnosed in two cases: one mass that changed at 6 months and one case of microcalcifications that changed at 24 months. This represented a delayed false-negative rate of 2% (two of 105 malignancies among 540 biopsies). CONCLUSION: A small percentage of cases diagnosed as benign with SCNB will change on follow-up mammograms, which may necessitate repeat biopsy. These results suggest that 6-month follow-up for cases that yield nonspecific benign results at SCNB and yearly screening mammography for cases with specific benign results is a reasonable management strategy.