垂体促甲状腺激素分泌瘤5例报告并文献复习

目的 探讨垂体促甲状腺激素(TSH)分泌瘤所致中枢性甲亢的临床特点.方法 对1992～2006年在解放军总医院确诊和治疗的5例垂体TSH分泌瘤患者的临床资料进行回顾性分析,并结合文献资料进行总结.5例患者中男性4例、女性1例,平均年龄39.8(26～51)岁,平均病程为5.84(0.6～16)年.结果 5例垂体TSH分泌瘤占解放军总医院同期诊断的垂体腺瘤的0.33%(5/1 500).所有患者均伴有甲状腺毒症,其中4例为首发症状,例为视物模糊,所有患者均没有视野缺损.确诊之前误诊为原发性甲亢接受抗甲状腺药物治疗者3例,治疗6～16年,其中1例曾2次行甲状腺手术治疗.5例患者均有甲状腺激素水平增高,同时不伴TSH抑制(3.94～54.7mU/L);3例患者行促甲状腺激素释放激素(TRH)兴奋TSH试验,例无反应、1例呈过强反应.鞍区MRI检查4例为大腺瘤(直径1.5～3.6cm),例为微腺瘤.4例大腺瘤患者均行经口鼻蝶入路垂体瘤切除术,术后病理均证实为垂体腺瘤,例术后联合垂体放射治疗.术后1～2周复查血清甲状腺激素和TSH水平正常,随访3～32个月甲状腺功能仍正常.结论 甲状腺毒症患者血清TSH水平不被抑制时应警惕垂体TSH分泌瘤的存在,鞍区影像学检查可以进一步明确诊断,垂体TSH分泌瘤经口鼻蝶入路垂体腺瘤切除术联合垂体放射治疗可获得良好疗效.     

人白血病相关蛋白16在垂体泌乳素腺瘤患者中的表达及其与雌激素受体α表达水平的相关性分析

目的 探讨人白血病相关蛋白16(LRP16)在垂体泌乳素腺瘤患者中的表达情况及其与雌激素受体α(ERα)表达水平的关系.方法 选取2009年10月-2014年9月于解放军总医院神经外科术中切除并经病理证实的31例成人垂体泌乳素腺瘤标本(观察组)和22例成人非垂体泌乳素腺瘤标本(对照组).免疫组织化学法检测两组标本的泌乳素(PRL)、LRP16和ERα表达水平.结果 垂体泌乳素腺瘤30岁以下患者以女性多见,30岁以上患者以男性多见,且男性垂体泌乳素腺瘤患者均为肥胖或超重;31例垂体泌乳素腺瘤中有26例(83.9%,26/31)LRP16为阳性表达,明显高于非垂体泌乳素腺瘤组(22.7%,5/22),有28例(90.3%,28/31)ERα为阳性表达,明显高于非垂体泌乳素腺瘤组(31.8%,7/22).垂体泌乳素腺瘤中LRP16与ERα的表达量和表达强度的变化趋势均同步,二者存在一定正相关关系.结论 高体重指数(BMI)可能是男性垂体泌乳素腺瘤发生发展和预后不良的高危因素;LRP16可能通过ERα参与了垂体泌乳素腺瘤的增殖与形成.     

重组人促甲状腺激素用于低中危分化型甲状腺癌患者的术后评估:Ⅰ期临床研究报告

目的:评价我国自主研发的重组人促甲状腺激素(rhTSH)在辅助分化型甲状腺癌(DTC)患者¹³¹I治疗前后动态评估中的作用。方法:该Ⅰ期研究采用剂量递增设计,纳入2019年5月至2020年11月就诊于北京协和医院及郑州大学附属肿瘤医院的24例DTC患者(男5例、女19例,中位年龄41岁),根据国产rhTSH(简称rhTSH)使用方法分为4个剂量组[0.9 mg×1 d(A组),0.9 mg×2 d(B组),1.8 mg×1 d(C组),1.8 mg×2 d(D组)],每组6例。每例患者接受2个阶段自身对照研究,依次为rhTSH阶段及停用甲状腺激素(THW)阶段。评估rhTSH的安全性、耐受性、患者生活质量[甲状腺功能减退症(简称甲减)症状体征积分、简式心境状态量表(POMS)]、药效学[促甲状腺激素(TSH)及甲状腺球蛋白(Tg)水平、诊断性全身显像(Dx-WBS)]及药代动力学(达峰时间、峰浓度)特征。采用配对t检验或Wilcoxon符号秩检验进行统计分析。结果:4个剂量组均未观察到剂量限制性毒性事件、严重不良事件或≥3级的不良事件。rhTSH阶段的生活质量相关评分明显优于THW阶段:甲减症状体征积分[-53.00(-53.00,-53.00)与-39.50(-47.00,-23.00)分;S=119.50,P<0.001];简式POMS评分[(91.92±12.06)与(99.67±19.13)分;t=0.95,P=0.025]。rhTSH末次给药后24 h血清TSH水平从基线的0.04(0.02,0.11)mU/L升至150.00(105.20,173.31)mU/L;随着rhTSH剂量增加,各组TSH呈增高趋势。在THW阶段,患者需经中位时间23 d的THW方达TSH≥30 mU/L水平,THW阶段TSH水平为73.51(57.22,106.22)mU/L;Tg在rhTSH给药后从基线[0.10(0.10,0.41)μg/L]逐渐升高,48 h达峰值[0.85(0.12,3.01)μg/L],THW阶段Tg水平为0.88(0.15,8.04)μg/L;2个阶段诊断性全身显像结果一致率为95.8%(23/24)。结论:在辅助DTC术后评估中,国产rhTSH对患者显示出较好的安全性,患者生活质量较好;其可有效升高患者TSH水平,并快速刺激Tg分泌及残余甲状腺摄碘。     

匙孔动态增强MRI对45例催乳激素分泌型垂体微腺瘤的诊断

目的:评价匙孔(keyhole)动态MRI对催乳激素(prolactin,PRL)分泌型垂体微腺瘤的诊断价值.材料和方法:回顾性分析45例经手术或临床证实的PRL分泌型垂体微腺瘤的动态增强MRI影像表现,由两位有经验的影像科医师阅片,不告知临床及实验室检查结果的情况下作诊断,垂体内见有粟粒、结节或片块状异常信号者作肯定微腺瘤诊断;垂体内信号不均匀者作可疑微腺瘤诊断;垂体内信号未见异常者不作微腺瘤诊断.结果:无临床及实验室检查参考时,可肯定垂体微腺瘤诊断者18例;可疑垂体微腺瘤诊断者26例;不作垂体微腺瘤诊断者1例.结合临床及实验室检查诊断正确率达97.8%.结论:keyhole动态MR对PRL分泌型垂体微腺瘤有较高的诊断价值,临床和实验室检查怀疑PRL分泌型垂体微腺瘤而MR平扫阴性的患者应常规作动态增强MR检查.     

分化型甲状腺癌术后随访中停用左旋甲状腺素2周的临床价值

目的观察分化型甲状腺癌(DTC)术后停用左旋甲状腺素(l-T_4)2周 TSH 水平变化及判断 DTC 残留、复发和转移甲状腺球蛋白(Tg)的界定值。方法甲状腺次全切或全切术后用(131)~I去除治疗,服用 l-T_4时,Tg相似文献   

亚低温对重型脑损伤患者垂体甲状腺激素的影响

目的　观察重型脑损伤患者在亚低温治疗过程中垂体甲状腺激素的变化。　方法98例重型脑损伤患者随机分为亚低温治疗组 (5 0例 )和对照组 (常规治疗 4 8例 )。采用双面夹心免疫法检测两组患者血清催乳素 (PRL)、促甲状腺激素 (TSH)、游离三碘甲状腺原氨酸 (FT3 )和游离甲状腺素 (FT4)在治疗前后的变化 ,比较临床疗效。　结果　治疗后亚低温治疗组的PRL、TSH、FT4分别为 (0 .2 5± 0 .0 2 )nmol/L、(0 .7± 0 .2 )mU/L、(15 .0± 5 .3)pmol/L ,明显低于对照组的PRL、TSH、FT4[(0 .4 6± 0 .0 4 )nmol/L、(1.1± 0 .3)mU/L、(2 1.2± 6 .4 )pmol/L],良好率 (6 2 % )高于对照组(35 % ) ,死亡率 (2 2 % )低于对照组 (4 2 % )。　结论　亚低温治疗能抑制伤后垂体甲状腺激素水平升高 ,提高疗效。     

轻度甲状腺功能异常对血清半胱氨酸蛋白酶抑制蛋白C水平的影响

目的探讨轻度甲状腺功能异常对血清半胱氨酸蛋白酶抑制蛋白C(cystatin C,Cyst C)水平的影响。方法测定诊断为亚临床型甲状腺功能低下及亢进患者的血清Cyst C含量,同时检测两组患者TSH恢复正常时血清Cyst C水平的变化。结果研究对象包括26例亚临床型甲状腺功能低下患者及14例亚临床型甲状腺功能亢进患者。亚临床型甲状腺功能低下组在左旋甲状腺素治疗前后的TSH分别为7.8(4.3~26.7)mU/L和2.3(0.36~4.0)mU/L。同时血清Cyst C含量由(0.72±0.18)mg/L升高至(1.1±0.3)mg/L,差异具有统计学意义(P<0.01)。亚临床型甲状腺功能亢进组诊断时TSH均值为0.06(0.001~0.25)mU/L,当甲状腺功能恢复正常时为1.6(0.28~4.0)mU/L。同时Cyst C水平则由(1.08±0.31)mg/L下降至(0.91±0.30)mg/L,差异有统计学意义(P<0.05)。结论轻度甲状腺功能异常对血清Cyst C含量有显著影响,因此在用Cyst C反映肾功能变化的同时应考虑到是否有甲状腺功能异常对血清Cyst C水平产生的影响。     

CT引导下经皮乙酸注射联合肝动脉化疗栓塞治疗原发性肝癌

目的 研究经导管肝动脉化疗栓塞(TACE)联合经皮乙酸注射(PAI)治疗原发性肝癌的疗效.方法 选择52例肝癌患者,分为TACE联合PAI治疗组(26例)和单纯TACE组(26例),比较两组治疗效果.结果 联合组与单纯TACE组AFP下降率为78.3%和50.0%,肿瘤体积缩小有效率分别为65.4%(17/26)和38.5%(10/26),1、2年生存率分别为73.1%(19/26)、38.5%(10/20)和57.7%(15/26)、19.2%(5/26),差异有统计学意义(P＜0.05).结论 TACE联合PAI治疗原发性肝癌效果明显优于单纯TACE组.     

68Ga—DOTATATEPET／CT在垂体腺瘤中的应用价值

目的观察新型SSTR显像剂68Ga-DOTATATE在不同类型垂体腺瘤中的摄取情况,评估其对奥曲肽治疗生长激素腺瘤的疗效评价作用。方法选取34例（男15例,女19例）原发垂体腺瘤患者,其中22例为分泌型腺瘤（5例为促肾上腺皮质激素腺瘤,17例为生长激素腺瘤）,12例为无功能腺瘤。有13例生长激素腺瘤术前行奥曲肽治疗,分别于治疗前后行68Ga—DOTATATEPET／CT显像,其余患者术前行显像。结合MRI判断腺瘤位置并使用PET／CT自带软件勾画ROI,获得肿瘤SUVmax、肿瘤体积和密度指数（DI）。显像后2周内所有患者均行经鼻垂体腺瘤切除术,并行病理和常规免疫组织化学检查。采用Mann—Whitneyu检验分析数据。结果分泌型腺瘤的DI大于无功能腺瘤的PI（7．16±4．52与1．08±1．40;u=48．5,P〈0．05）,而前者的肿瘤体积小于后者[（2．92±1．60）cm2和（9．10±7．00）cm2;=43．0,P〈0．05],但两者的SUVmax。差异无统计学意义（M=130．0,P〉0．05）。促肾上腺皮质激素腺瘤与生长激素腺瘤的DI差异无统计学意义（u=18．0,P〉0．05）,且前者的肿瘤体积小于后者[（0．95±1．08）cm。和（3．49±3．01）cm2;M=16．5,P〈0．05]。奥曲肽治疗有效的8例生长激素腺瘤患者的DI高于治疗无效的5例腺瘤患者的DI（3．55±0．91与1．38±0．69;M=2．0,P〈0．05）。结论68Ga—DOTATATEPET／CT显像可以观察垂体腺瘤的体积变化,可用于垂体腺瘤疗效评估,且奥曲肽治疗前DI高者疗效优于DI低者。     

检测粪便中SFRP2基因超甲基化对筛查结直肠癌的意义

 目的 探讨粪便中分泌型卷曲相关蛋白2(SFRP2)基因超甲基化作为筛查大肠癌的非侵袭性方法的可行性.方法 用甲基化荧光定量PCR(Methylight)技术分析大肠癌69例,腺瘤34例和增生性息肉26例瘤组织和粪便中SFRP2基因甲基化状态,30例健康者作为对照.同时,分析SFRP2基因甲基化与肿瘤临床病理特点之间的关系.结果 SFRP2基因在91.3%(63/69)的大肠癌组织、79.4%(27/34)的进展型腺瘤组织和53.8%(14/26)的增生性息肉组织中发生超甲基化,在同一患者所对应的粪便中有87.0%(60/69)、61.8%(21/34)和42.3%(11/26)发生超甲基化.在正常对照的结肠黏膜组织中没有检测到SFRP2基因甲基化,但在粪便中有2例发生了SFRP2基因超甲基化.此外,SFRP2超甲基化与肿瘤的临床特征包括性别、年龄、肿瘤分期、位置及病理分级等无显著相关性.结论 粪便中SFRP2基因超甲基化是大肠癌的一种新的分子标记物,对于非侵袭性检测大肠癌具有高度的潜力.     

肾上腺血肿4例暨文献复习

为分析肾上腺血肿的病因、临床特征、鉴别诊断及治疗 ,对解放军总医院 1993年 3月～ 2 0 0 1年 12月行肾上腺手术的病例资料进行回顾调查 ,并复习了相关文献。2 82例肾上腺手术病例中经病理诊断为肾上腺血肿 4例 ,2例因怀疑为肾上腺腺瘤而进行手术 ,另外 2例因同侧肾脏病变行切除术而于术中发现。复习有关肾上腺血肿的国内文献 7篇 ,至今共报道肾上腺血肿 4 6例 ,36例有明确的外伤史 ,误诊为肾上腺肿瘤行手术治疗的 12例 (2 6 1% ) ,作随访观察 34例 (73 9% )。医务人员对肾上腺血肿有足够的认识是确诊的关键 ,经肾上腺B超对可疑血肿追随检查 ,详问病史并行增强CT、MRI扫描有一定帮助 ,在排除恶性或高分泌功能肾上腺腺瘤的前提下 ,可随诊观察     

MRI诊断踝关节外侧韧带损伤的Meta分析

 目的 探讨MRI技术在诊断踝关节外侧韧带损伤的有效性。方法 应用Meta分析。检索3个中文数据库(中国期刊全文数据库、万方数据库、中文科技期刊数据库)和3个英文数据库(PubMed、EMbase、The Cochrane Library)进行相关研究。检索年限均为从建库至2018-11。总结了符合条件的研究,提取数据以计算磁共振成像(MRI)在诊断踝关节外侧韧带损伤时的灵敏度和特异度。结果 16项研究符合纳入,包括660例患者。MRI诊断急性距腓前韧带损伤的合并敏感度为0.93[95%CI(0.86,0.97)],合并特异度为0.55[95%CI(0.27,0.80)]。诊断慢性距腓前韧带损伤的合并敏感度为0.86[95%CI(0.77,0.91)],合并特异度为0.80[95%CI(0.67,0.89)]。诊断急性跟腓韧带损伤的合并敏感度为0.72[95%CI(0.58,0.82)],合并特异度为0.86[95%CI(0.68,0.95)]。诊断慢性跟腓韧带损伤的合并敏感度为0.57[95%CI(0.44,0.69)],合并特异度为0.92[95%CI(0.86,0.96)]。结论 MRI检查在诊断慢性距腓前韧带损伤时的诊断效能较高。诊断急性距腓前韧带损伤时,MRI检查可以有效筛选ATFL损伤患者。在诊断急慢性跟腓韧带损伤时,其阴性结果对排除跟腓韧带损伤有一定的参考价值。     

The psychological morbidity of military healthcare workers

OBJECTIVE: To measure the probable prevalence of psychological morbidity in military healthcare professionals using the General Health Questionnaire 28. RESULTS: 21 (35%) of military healthcare workers showed psychological ill health. Royal Air Force health staff had a significantly higher prevalence of ill health than both the Army [12 (63%) vs 6 (23%)] and the Royal Navy [12 (63%) vs 1 (8%)]. RAF non-commissioned staff were found to have a highly significant prevalence of ill health compared to the Army non-commissioned staff [7(70%) vs 1 (7%)], and Royal Navy non-commissioned staff [7 (70%) vs 0 (0%)]. CONCLUSION: The study shows significant differences in psychological ill health between Services at the RCDM. Comparison with civilian data showed that the overall prevalence of psychological morbidity was no higher than in NHS staff. The elevated level of ill health in the Royal Air Force staff warrants further investigation and possible intervention.     

生长激素瘤患者临床特征的回顾性分析

目的 分析生长激素瘤(GH瘤)患者的临床特征,并总结其诊治经验.方法 收集1990年1月-2016年12月在解放军总医院就诊的338例GH瘤患者的临床资料,回顾性分析其中病例资料较完整的252例患者的一般情况、病史资料、实验室及辅助检查结果 、治疗方式及结果 等,并对其中部分患者的疾病缓解情况进行随访.结果 我院GH瘤患者收治数量逐年增加,近3年收治患者例数占总收治患者例数56.2%;GH瘤患者男女比例约为1:1,就诊年龄呈正态分布,41~50岁发病人数最多;GH瘤患者最常见的临床体征为手、足增大(60.7%),其次为鼻翼增大(35.7%),最常见的临床症状为头痛(42.5%),其次为视力、视野改变(26.6%);GH瘤患者最常见的临床并发症为糖代谢异常(72.6%),呼吸睡眠暂停、甲状腺肿或结节、心功能异常及结肠息肉发生率均明显上升(69.5%、56.4%、57.0%及54.1%),上述并发症检查患者例数分别占本研究总患者例数的42.1%、23.4%、37.3%、47.6%和14.7%;GH 23.37±1.42μg/L,IGF-1804.28±273.93ng/ml;垂体GH瘤85.0%为大腺瘤;手术治疗仍为一线治疗方案,选择药物治疗患者较少;随访率38.0%(84/252),随访患者缓解率40.5%;术后早期GH水平判断手术长期缓解的阳性率与真实随访手术长期缓解的阳性率基本一致(χ2=3.368,P>0.05).结论 近年收治GH瘤患者数量不断增加,临床常见体征和症状分别为肢端肥大和头痛;对本病并发症的筛查尚不系统,存在大量遗漏,仍须加强患者治疗后随访,以改善患者生存质量;术后早期GH水平测定对手术预后有较高预测价值.     

MR differentiation of low-grade chondrosarcoma from enchondroma

PurposeTo evaluate magnetic resonance (MR) imaging for the discrimination between low-grade chondrosarcoma and enchondroma.Materials and methodsMR images of 34 patients who were confirmed with low-grade chondrosarcoma or enchondroma were retrospectively reviewed. After review of medical records, MR findings in 18 patients with low-grade chondrosarcoma and 16 patients with enchondroma were compared. MR images were retrospectively reviewed for the lesion location (central or eccentric; epiphysis, metaphysic, or diaphysis), margin, contour, mineralized matrix, endosteal scalloping, cortical expansion, cortical destruction, soft tissue mass formation, and periosteal reaction. Signal intensity, the patterns of contrast enhancement (unilocular or multilobular), soft tissue mass, and adjacent abnormal bone marrow and soft tissue signal were also reviewed. Statistical analysis was performed with chi-square test.ResultsThe patients with low-grade chondrosarcoma had a significantly higher incidence of MR findings (P< .05): predominantly intermediate signal on T1-weighted images [72% (13/18) in low-grade chondrosarcoma vs. 25% (4/16) in enchondroma], multilocular appearance on contrast-enhanced T1-weighted images [83% (15/18) vs. 44% (7/16)], cortical destruction [33% (6/18) vs. 0% (0/16)], a soft tissue mass [28% (5/18) vs. 0% (0/16)], adjacent bone marrow and soft tissue abnormal signal [22% (4/18) vs. 0% (0/16)], and an involvement of the epiphysis or flat bone [56% (10/18) vs. 19% (3/16)].ConclusionMR imaging shows helpful features for differentiating low-grade chondrosarcoma from enchondroma.     

Indium-111 pentetreotide single-photon emission tomography in patients with TSH-secreting pituitary adenomas: Correlation with the effect of a single administration of octreotide on serum TSH levels

Few data are available on the visualization of somatostatin receptors in vivo in patients with thyrotropin (TSH)-secreting adenoma. We studied five patients with TSH-secreting adenomas using single-photon emission tomography (SPET) after administration of indium-111 pentetreotide. The intensity of¹¹¹In-pentetreotide uptake by the tumours was correlated with the degree of TSH suppression after a single administration of 100 g octreotide s.c. Five patients (three women and two men) aged 27–46 years were investigated. Except for one patient with acromegaly, all had pure TSH-secreting inmours. One patient was previously untreated, while two had received octreotide, one antithyroid drugs, and one radioiodine. In all patients SPET demonstrated increased uptake of¹¹¹In-pentetreotide by the pituitary adenoma. The target to non-target ratio (T/nT) of¹¹¹In-pentetreotide uptake was higher than 10 in three patients. Administration of 100 g octreotide s.c. caused a significant reduction in TSH levels from 4.8±1.4 mU/l to a nadir of 3.1±1.1 mU/l after 6 h (P<0.001 by ANOVA). Suppression of TSH secretion ranged from 30% to 60% of the baseline value. The T/nT ratio showed a trend toward a direct relationship with the degree of TSH inhibition after acute octreotide administration (r=0.67;P=NS). Our study showed that¹¹¹In-pentetreotide scan visualized somatostatin receptors in all five of the patients with TSH-secreting pituitary adenomas, confirming the frequent presence of somatostatin receptors in these rare tumours, even though the correlation with the TSH inhibition after a single administration of octreotide did not reach significance.     

有限内固定结合外固定支架治疗复杂胫骨平台骨折的疗效分析

目的探讨有限内固定结合外固定支架治疗复杂胫骨平台骨折的临床效果。方法选择2010年1月~2013年6月在新疆维吾尔自治区人民医院米东医院外科收治的复杂胫骨平台骨折患者92例(SchatzkerⅣ型41例,Ⅴ型25例,Ⅵ型26例),男性61例,女性31例;年龄31~77岁,平均54.2岁。所有患者均为开放性骨折(Gustilo分型:Ⅰ型38例,Ⅱ型26例,Ⅲ28例),按照随机数字表法分为观察组和对照组,各46例。观察组采用有限内固定结合外固定支架治疗,对照组采用单纯钢板内固定传统手术治疗。对比两组手术情况、术后骨折愈合情况以及关节炎发生率,并对伤膝关节功能进行评估。结果观察组手术时间、术中出血量、术后愈合时间以及微动移位分别为(183.09±26.47)min、(304.75±51.47)mL、(0.57±0.11)周、(0.14±0.03)mm,均显著低于对照组的(213.47±34.23)min、(361.37±56.83)mL、(0.74±0.15)周、(0.31±0.07)mm;观察组术后膝关节评定优良率以及术后愈合率分别为97.83%(45/46)和93.48%(43/46),均显著高于对照组82.61%(38/46)和78.26%(36/46),而术后关节炎发生率观察组2.17%(1/46)低于对照组13.04%(6/46),上述差异均有统计学意义(P0.05)。结论有限内固定结合外固定支架治疗复杂胫骨平台骨折对患者造成的创伤小,术后恢复快,并且愈合程度高、关节炎发生率低,适合临床推广应用。     

Discogenic lumbar pain: association with MR imaging and CT discography

OBJECTIVE: To correlate MR and CT discography findings with pain response at provocative discography in patients with discogenic back pain. MATERIALS AND METHODS: Forty-seven patients aged 25-54 years who underwent MR imaging and subsequent CT discography (97 discs) were included in this study. MR images were retrospectively evaluated regarding disc degeneration, endplate abnormalities, facet joint osteoarthritis, and high intensity zone. During discography concordant pain was regarded as positive, whereas discordant pain and no pain were regarded as negative. MR and CT discographic findings were analyzed on the base of concordant pain using the Chi-square test. RESULTS:: Concordant pain was significantly common in the following (P < 0.05): grade 4 or 5 disc degeneration [88% (30/34) in concordant pain versus 48% (30/63) in discordant pain and no pain], high intensity zone [56% (19/34) versus 30% (19/63)], combination of above two findings [53% (18/34) versus 25% (16/63)], fissured and ruptured disc at discogram [94% (32/34) versus 57% (36/63)], and contrast beyond inner annulus at CT discogram [97% (33/34) versus 57% (36/63)]. CONCLUSION: Typical MR findings with concordant pain at discography include grade 4 or 5 disc degeneration and presence of a high intensity zone. Typical CT discography findings with concordant pain were fissured/ruptured discs and contrast extending into/beyond the outer annulus on CT.     

Stereotactic vacuum-assisted breast biopsy in 268 nonpalpable lesions

PURPOSE: We evaluated the reliability of stereotactic vacuum-assisted breast biopsies (VAB) from our personal experience. MATERIALS AND METHODS: Between January 2003 and December 2005, 268 patients underwent VAB with an 11-gauge probe at our institution. Inclusion criteria were nonpalpable lesions, undetectable by ultrasound and suspected at mammography (microcalcifications, circumscribed mass, architectural distortion), for which cytology and/or core biopsy could not provide a definite diagnosis. Lesion mammographic patterns were microcalcifications in 186 cases (77.5%), mostly localised clusters (130/186: 70%); circumscribed mass with or without microcalcifications in 36 cases (15%) and architectural distortion with or without microcalcifications in 18 cases (7.5%). On the basis of the Breast Imaging Reporting and Data System (BI-RADS) classification, 16 cases (7%) were graded as highly suspicious for malignancy (BI-RADS 5), 81 (34%) as suspicious for malignancy (BI-RADS 4b), 97 (40%) as indeterminate (BI-RADS 4a) and 46 (19%) as probably benign (BI-RADS 3). Lesion size was 20 mm in only 38 cases (16%), 30 of which appeared as microcalcifications. RESULTS: In 28/268 lesions (10.5%) the biopsy could not be performed (nonidentification of the lesion; inaccessibility due to location or breast size). In 12/240 (5%) biopsies, the sample was not representative. Pathology revealed 100/240 (42%) malignant or borderline lesions and 140/240 (58%) benign lesions. Among the malignant lesions, 16/100 (16%) were invasive carcinoma [infiltrating ductal carcinoma (IDC) or infiltrating lobular carcinoma (ILC)], 13/100 (13%) were microinvasive (T1mic), 35/100 (35%) were ductal carcinoma in situ (DCIS), 9/100 (9%) were lobular carcinoma in situ (CLIS). Among the borderline lesions, 27/100 (27%) were atypical epithelial hyperplasia [atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH)]. In 9/100 surgically treated lesions (9%), there was discordance between the microhistological findings of VAB and the pathological results of the surgical procedure: 8/9 were underestimated by VAB (four ADH vs. DCIS, three DCIS vs. IDC, one ADH vs. IDC), and 1/9 was overestimated (T1mic vs. DCIS). Complications following VAB occurred in 9/240 patients (3.7%). CONCLUSIONS: In our experience, VAB showed fair reliability in the diagnosis of nonpalpable breast lesions despite a portion of failed (10.5%), nonsignificant (5%) procedures and underestimated lesions (9%).