Sonographically guided directional vacuum-assisted breast biopsy using a handheld device.

OBJECTIVE: The goal of this study was to show that one can safely remove all sonographic evidence of masses in the breast less than or equal to 1.5 cm in greatest dimension using the 11-gauge handheld Mammotome, thereby reducing the possibility of a false-negative diagnosis and other shortcomings of the automated core biopsy device. SUBJECTS AND METHODS: Over a 12-week period (May 3--July 31, 2000), 124 sonographically guided breast biopsies were performed in 113 patients, using a new handheld directional vacuum-assisted biopsy device. All lesions that were less than or equal to 1.5 cm were biopsied using a handheld Mammotome; an attempt was made to continue the biopsy until no sonographic evidence of the lesion remained. RESULTS: Of these 124 lesions, 14 had infiltrating ductal carcinomas, four had infiltrating ductal carcinomas with associated ductal carcinoma in situ, one had infiltrating lobular carcinoma, one had ductal carcinoma in situ, three had atypical ductal hyperplasias, one had atypical lobular hyperplasia, and one had phyllodes tumor. Only one infiltrating ductal carcinoma was entirely removed histologically at Mammotome biopsy. There were no underestimates of disease. No cases of epithelial displacement were observed in any of the surgical excisions of malignancies. The remaining 99 lesions were benign. CONCLUSION: The handheld Mammotome diminishes the shortcomings of the automated core biopsy device. It reduces the possibility of false-negatives and underestimation of disease. It eliminates the need for multiple insertions and reduces the likelihood of epithelial displacement. As a result, we now use this device for all sonographically guided biopsies of breast masses smaller than 1.5 cm and recommend that others consider it for such use.     

Sonographic detection and sonographically guided biopsy of breast microcalcifications

OBJECTIVE: The purpose of this study was to evaluate the ability of sonography to depict and guide biopsies of mammographically suspicious microcalcifications and to reveal the mammographic features and histologic outcomes of lesions amenable to sonographically guided biopsy. SUBJECTS AND METHODS:. Suspicious clusters of microcalcifications without other mammographic abnormalities were evaluated on sonography before biopsy and divided into two groups: those with and those without microcalcifications seen on sonography. Sonographically detected lesions underwent sonographically guided biopsy; lesions not seen on sonography underwent mammographically guided biopsy. Imaging features and histologies were correlated, and the positive predictive value of sonography was determined. RESULTS: Of 111 lesions (105 patients), 26 lesions (23%) were identified and underwent sonographically guided biopsy; 85 lesions (77%) were not identified sonographically. The diameters of microcalcification clusters in the sonographically identified group were significantly larger (p = 0.0005) and contained larger numbers of microcalcification particles (p = 0.038) compared with clusters not identified sonographically. Sonographically identified lesions were seen as masses (77%) or dilated ducts (23%) with echogenic foci. Sonographically identified lesions were more likely to be malignant than those not seen on sonography (69% vs 21%, respectively; p < 0.00002). Of 38 malignant lesions, those visible on sonography were more likely to be invasive than those not seen on sonography (72% vs 28%, respectively; p = 0.018). In malignant lesions undergoing core biopsy and surgical excision, the extent of disease was underestimated less with sonographically guided biopsy (7%, 1/15) than with stereotactic biopsy (33%, 5/15). CONCLUSION: Suspicious microcalcifications are seen infrequently on sonography (23%) but, when detected, can be successfully biopsied with sonographic guidance and more frequently are malignant and represent invasive cancer than those seen on mammography alone.     

Sonographically guided directional vacuum-assisted breast biopsy: preliminary experience in Venezuela.

OBJECTIVE: The purpose of this study was to evaluate the use of sonographically guided directional vacuum-assisted biopsy in the histologic diagnosis of breast lesions. MATERIALS AND METHODS: Eighty-eight lesions in 83 women underwent sonographically guided 11-gauge directional vacuum-assisted breast biopsy during a 26-month period. Biopsies were performed using high-resolution sonography equipment with a 7.5-MHz transducer, obtaining a median of 17 specimens per lesion. Imaging studies, medical records, and histologic findings were reviewed. RESULTS: Median patient age was 48 years (range, 25-78 years). Median lesion size was 1.2 cm (range, 0.4-2.5 cm). Twenty-four (27.3%) of 88 lesions were palpable. The median time required to perform biopsy was 17 min (range, 10-40 min). Complete removal of the lesion seen at sonography occurred in 78 (88.6%) of 88 lesions and was significantly more frequent in lesions measuring 1.5 cm or less than in larger lesions (68/71 = 95.8% vs 10/17 = 58.8%,p < 0.0003). A surgical procedure was spared in 79 (95.2%) of 83 women. In 36 lesions with imaging and clinical follow-up after sonographically guided biopsy with benign findings (range, 4-24 months; median, 11.3 months), we found no evidence of cancer or scarring in the breast. CONCLUSION: In our small series, sonographically guided directional vacuum-assisted biopsy was a fast and accurate method for breast diagnosis. This technique resulted in complete removal of 95.8% of lesions shown at sonography measuring 1.5 cm or less and spared a surgical procedure in 95.2% of women. Further work is necessary to refine indications, evaluate cost-effectiveness, and assess long-term outcome.     

乳腺可疑微钙化灶金属标记夹放置的筛选条件及近期移位的影响因素

目的 探讨乳腺微钙化灶活检过程中放置金属标记夹的筛选条件和影响标记夹移位的因素.方法 108例患者中的114处乳腺微钙化灶做了11 G真空辅助立体定位活检.活检后在每一处病灶都放置了标记央,采用Gel Mark Ultra(82处)或MicroMark Ⅱ标记央(32处).所有钙化簇按照直径和(或)分布被划分成直径<10、10～20、>20 mm的单簇和多簇钙化,并判断金属夹放置的筛选条件.在乳腺X线片上直接测量标记夹和活检部位的距离,按照<10、10～20、>20 mm分成3组.结果 直径<10 mm(25例)和直径10～20 mm之间的单簇钙化(20例)中分别有88.0%(22例)和70.0%(14例)的病灶在活检后显示钙化被取净,直径>20 mm的单簇钙化(17例)没有病灶能被取净.65.8%(75/114)的标记夹准确定位,39个标记夹发生移位,其中34个(87.2%)是沿针道移位,即"手风琴效应"移位.4例患者在活检部位发生大血肿,其中只有1例标记夹能准确定位.结论 直径<20 mm的单簇钙化及多簇钙化灶在活检后都需要放置标记夹,只有直径>20 mm的单簇钙化不需要放置.影响标记夹近期移位的主要因素是"手风琴效应"和血肿.     

侧卧式X线立体定位术在乳腺微钙化病灶中的临床研究

目的：探讨侧卧位术前X线导丝定位技术对乳腺微钙化病灶的应用价值。方法：选取120例乳腺微钙化病灶,随机分为侧卧式研究组及坐式对比组进行术前导丝立体定位,留置导丝引导外科手术进行切取活检。结果：两种不同定位方式中,针尖与病灶的距离、定位中不良反应及定位成功率方面有显著差异性（P＜0．01）;在切检成功率方面两者无显著差异性（P＞0．05）。结论：侧卧式X线立体定位导丝引导下切取活检是提高乳腺微钙化病灶诊断率的有效方法。     

Sonographically guided fine-needle aspiration biopsy of adrenal masses

Percutaneous fine-needle aspiration biopsy of solid adrenal masses was performed under real-time sonographic guidance in 18 patients. Cellular material was aspirated in all cases. Cytologic examinations were correct in 11 metastatic deposits, three primary adrenal adenocarcinomas, and one pheochromocytoma. One subsequently proven primary adenocarcinoma was not diagnosed. In two cases of adenoma, normal adrenal cells were aspirated. Percutaneous aspiration of adrenal masses is recommended when the precise nature of the lesions is clinically required. The simplicity and speed of fine-needle aspiration biopsy under sonographic control and its high diagnostic accuracy and safety suggest its use as a routine procedure in the management of patients with adrenal masses well depicted by sonography.     

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.     

Sonographically guided fine-needle biopsy of peripheral lung tumors

Sonographically guided transthoracic fine-needle biopsy of peripheral pulmonary masses was performed in seven patients. None of the masses was accessible to fiber bronchoscopy. Three tumors were apical, two paravertebral and two lateral. The puncture specimen allowed a histological diagnosis in all five cases of malignant disease. One of the other two patients was found to have tuberculosis and the last, radiation fibrosis. Pneumothorax did not occur in any of these cases.     

Mucinous breast carcinoma showing as a cluster of suspicious microcalcifications on mammography

We report a case of mucinous breast carcinoma whose mammographic features consisted of a suspicious cluster of microcalcifications as the unique sign of malignancy. The lesion was non-palpable and measured approximately 2 cm at the greatest diameter. The microcalcifications showed several morphologies: round, pleomorphic, and fine shapes were identified. The total number of microcalcifications was > 30 and the number per square centimeter varied from 10 to 20. The histological calcifications showed good correlation with the mammographic ones and were localized predominantly at the periphery of the tumor inside ducts with ductal carcinoma in situ or in the acellular mucin. Two types were observed: psammomatous and gross-irregular calcifications. To our knowledge, only one case with similar findings has been reported previously. Received 10 November 1997; Revision received 3 April 1998; Accepted 2 June 1998     

Sonographically guided core biopsy of the salivary gland masses: safety and efficacy

Over an 8-year period, we performed ultrasonography (US)-guided core biopsy of the salivary gland in 37 patients using an 1l-mm-throw 18-gauge automated biopsy system. The biopsy results were retrospectively compared with the findings of surgical pathology (n=18) or more than 6 months of clinical follow-up (n=19). The sensitivity, specificity, and accuracy of US-guided core biopsy for the diagnosis of malignancy were 75.0%, 96.6%, and 91.9%, respectively. No immediate or delayed complications occurred.