Automated stereotactic core needle biopsy of microcalcifications with correlation to surgical biopsy.

PURPOSE: To compare pathologic findings from stereotactic core and excisional biopsies in patients with microcalcifications in the breast. MATERIAL AND METHODS: Stereotactic core needle biopsies of 101 lesions with mammographic evidence of microcalcifications were performed with long-throw (2.2 cm) automated core biopsy devices fitted with 2.1-mm needles. The core specimens were placed on microscope slides and radiographed. The pathologic features of core and excisional specimens were compared. RESULTS: In 100 of the 101 breast lesions, a correct choice for an additional diagnostic procedure or definitive treatment could have been made upon histopathologic findings of the core needle biopsy. CONCLUSION: Stereotactic core needle biopsy is a reliable alternative to surgical biopsy of breast lesions with microcalcifications provided that specimen radiography has been performed to ensure that appropriate tissue has been obtained. Excisional biopsy may be avoided if microcalcifications are visible in radiographs of core biopsy specimen with benign histology.     

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。     

Displacement of microcalcifications during stereotactic 11-gauge directional vacuum-assisted biopsy with marking clip placement: case report

A 53-year-old woman with right breast microcalcifications of intermediate concern underwent stereotactic directional vacuum-assisted biopsy with marking clip placement. Postbiopsy mammograms showed displacement of a few of the targeted microcalcifications adjacent to misplaced marker clips. Mammography following stereotactic breast biopsy is important to document the location and number of residual calcifications and to determine the adequacy and location of clip placement.     

MR-guided stereotactic breast biopsy: technical aspects and preliminary results

AIM: To assess the feasibility and accuracy of cytologic and microhistologic breast biopsy using a MR imaging-guided stereotactic system with MR-compatible non-magnetic needles. MATERIALS AND METHODS: Between December 2001 and September 2002, cytologic and microhistologic sampling of 14 lesions (12 patients) was performed in our radiology department using a commercially available MR-guided stereotactic device. MR-compatible non-magnetic needles or mixed kit (non-magnetic coaxial needle + conventional ferromagnetic needle) were used. Of the 12 patients examined, 2 were undergoing MR examination because of genetic/familial risk, 4 during post-operative follow-up and the remaining 6 for contradictory mammographic and sonographic findings. Ten of the 14 lesions were visible on MR alone. The mean lesion diameter was 12 mm (range 5-30 mm). RESULTS: The procedure was relatively simple and feasible. The procedure took 45 minutes on average. The cytologic samples were adequate in 4/14 cases (29%). The diagnosis was absence of malignant cells in one case, ductal carcinoma in one case and suspected carcinoma in two cases. The cytologic diagnosis was confirmed by core biopsy, and by post-operative histology in the malignant lesions. The remaining 10/14 (71%) cytologic samples were inadequate for diagnosis. All the microhistologic samples (100%) were considered sufficient for diagnosis and yielded diagnosis of benignity in 9/14 (60%) lesions and malignancy in 5/14 (40%). Two patients with benign diagnosis underwent surgery, which confirmed the diagnosis. The remaining seven patients were evaluated by follow-up MRI; the first follow-up at 3 months showed no significant changes. Post-operative histology of the 5 lesions with malignant microhistologic diagnosis confirmed the nature of the lesions. CONCLUSIONS: MR-guided stereotactic biopsy is a simple, fast and safe procedure comparable to the interventional breast procedures performed under mammography and ultrasound guidance. The stereotactic device used ensures correct positioning of the needle into the lesion. The new dedicated non-magnetic needles and the mixed kit provide quantitatively and qualitatively adequate tissue for the histologic analysis. On the basis of our initial experience, we conclude that the procedure is feasible and accurate and can therefore be recommended for routine clinical use.     

Early experience and midterm follow-up results with a new,rotational thrombectomy catheter

Purpose: To assess the efficacy and safety of the Rotarex rotational thrombectomy catheter in treating occlusions of the femoropopliteal arteries. Methods: The Rotarex catheter (Straub Medical, Switzerland) is a rotational thrombectomy device which is supposed to be able to remove fresh and partially organized clot material from an acutely or subacutely occluded vessel. Nineteen limbs of 18 patients (10 women, 8 men; mean age 72.9 ± 7.3 years) with acute or subacute (23 ± 16 days) occlusions of the middle or distal third of the superficial femoral artery or the popliteal artery were treated. The occlusions were 3–20 cm long. Results: Thrombectomy was technically successful in 15 of 19 vessels (79%). The primary procedural success including additional procedures such as angioplasty and/or stent-graft placement in 17 limbs was 94%. The mean ankle-brachial index improved from 0.36 ± 0.26 (before thrombectomy) to 0.81 ± 0.21 (2 days after the procedure) (p = 0.012). Clinical symptoms shifted to at least one Fontaine stage lower in 13 limbs. As complications we observed two perforations (arteries showing heavily calcified plaques), one arteriovenous fistula and three distal embolizations. One perforation, the fistula and one intimal tear after percutaneous transluminal angioplasty were treated with covered stents; the three distal embolizations were treated successfully with aspiration or Rotarex thrombectomy. In the other perforation the intervention was terminated. None of the complications needed surgical treatment. The complication rate was 31.5%. Follow-up studies showed three early (4–11 days) and six late (1–6 months) reocclusions. The cumulative primary patency rate was 68 ± 12% at 3 months, and 39 ± 13% at 6, 12 and 19 months; the secondary patency rate was 68 ± 12% at 3 months and 53 ± 13% at 6, 12 and 20 months. Conclusion: The Rotarex thrombectomy catheter is effective and quick in treating acute and subacute occlusions of the superficial femoral and popliteal arteries. It should not be used in arteries with heavily calcified plaques because of the risk of perforation. Limited long-term patency is mainly due to the complexity of the underlying lesion. Our results suggest that the Rotarex mechanical thrombectomy catheter is effective and might serve as an alternative treatment modality to intra-arterial lysis.     

Nonpalpable breast microcalcifications: frequency, management, and results of incisional biopsy.

In a series of 500 consecutive needle localizations, there were 165 biopsies for benign microcalcifications without a mass. An incisional biopsy was performed in 49 of these cases (30%). Follow-up mammograms were available for review in 39 of the cases. The average length of follow-up was 32 months. In no case did malignancy develop at the biopsy site. When an incisional biopsy is performed, careful follow-up mammography is an alternative to a repeated needle localization and biopsy in selected cases.     

Microfracture for chondral defects of the talus: maintenance of early results at midterm follow-up

We determined whether the early improvement in symptoms and function after microfracture in the management of articular cartilage defects of the talus is maintained at mid term follow-up. Factors influencing outcome and postoperative magnetic resonance imaging were also evaluated. We performed data collection prospectively using the Hannover Scoring System for the ankle (HSS) and a Visual Analog Scale (VAS) for pain and function preoperatively, at 1 ± 0.1 year (45 ankles), 2 ± 0.4 years (45 ankles), and at an average of 5.8 ± 2.0 years (39 ankles) postoperatively. MRI was used to assess cartilage repair tissue based on the following variables: degree of defect repair and filling of the defect, integration to border zone, surface of the repair tissue, structure of the repair tissue and subchondral bone alterations. Comparing the outcome scores of the last follow-up to the previous follow-up points, the HSS and the VAS (pain, function and satisfaction) showed no deterioration. Four ankles, however, underwent further surgery to address the chondral defect and were regarded as failures. A body mass index greater than 25 kg/m² and having severe post-traumatic cartilage damage appeared to be negative prognostic factors. Results for patients older than 50 years were not inferior to those in younger patients. Microfracture arthroplasty induces repair of localized articular cartilage defects of the talus maintaining the encouraging early results at mid term follow-up.     

Evaluation of the stereotactic 8G vacuum-assisted breast biopsy in the histologic evaluation of suspicious mammography findings (BI-RADS IV)

PURPOSE: The purpose of this study was to evaluate the potential of the new 8G stereotactic vacuum-assisted breast biopsy (ST-driver, Mammotome; Ethicon Endosurgery) in the histologic evaluation of BI-RADS IV microcalcifications. MATERIALS AND METHODS: Fifty-eight patients with 61 mammographic BI-RADS IV microcalcifications underwent stereotactic vacuum-assisted breast biopsy (SVAB). The new 8G system was mounted on the ST driver, which was formerly used only with the hand-held version under sonographic guidance. The evaluation criteria for each biopsy were minimally invasive and operative histologies, the time needed for biopsy, the amount of bleeding, number of rotations and specimen, the degree of resection, and the complications. RESULTS: Fifty-eight of 61 biopsies were technically successful because > or = 50% were resected (29 x 100%, 8 x 90%, 5 x 80%, 6 x 70%, 3 x 50%, 3 x 0%). In 7 cases with representative biopsies of segmental suspicious microcalcifications, the degree of resection could not be exactly measured. All but 2 biopsies were performed without clinically relevant complications and after gaining enough specimens (? 12.6 specimen, 1.85 rotations). Those 2 patients showed evidence of severe bleeding into the breast tissue and operative revision had to be performed (3.5%). The size of intramammary hematoma was measurable in 27 biopsies and showed a range from 0.5 to 5 cm (? 2.7 cm). The average external bleeding was still low with 16 mL (5-80 mL). In 3 of 61 lesions, it was not possible to gain representative tissue as a result of displacement of the lesion after introducing or shooting the needle. The average time needed for all biopsies was 28.2 minutes for all but 5 very complicated biopsies, which took 16.1 minutes. The histologic findings with further operative workup were: 10 ductal carcinomas in situ (DCIS), 4 atypical ductal hyperplasias, 1 atypical lobular hyperplasias (ALH), 3 lobular carcinomas in situ (LCIS), and 6 invasive ductal carcinomas. In 7 of 12 of the initial DCIS histologies, the operative histology was also DCIS, whereas in 4 of 12, no residual malignant tumor was found. In 1 of 12 patients with an initial DCIS histology, operative histology revealed invasive ductal cancer (8.3%). The cases with lobular lesions (ALH, LCIS) did not show any evidence for residual tissue in the operative workup. Most frequent benign histologies were mastopathy (13), ductal hyperplasia (9), fibroadenoma (8), and sclerosing adenosis (5). The control examinations (maximum 1 year) did not show any signs for a false-negative biopsy. CONCLUSION: The 11-G SVAB has proven to be a perfect adjunct to the existing breast biopsy methods. The new 8G SVAB speeds up the method when used for the same size of lesions and enables the user to representatively biopsy lesions up to 3 cm in diameter. The method is still minimally invasive; however, the amount of hematomas as well as clinically relevant complications is increased.     

Papillary lesions of the breast: evaluation with stereotactic directional vacuum-assisted biopsy.

PURPOSE: To evaluate the use of stereotactic directional vacuum-assisted biopsy (SDVAB) in diagnosing and managing papillary lesions of the breast. MATERIALS AND METHODS: The authors retrospectively reviewed the mammographic and histopathologic findings of 26 cases in which papillary lesions were diagnosed at SDVAB. In all cases, subsequent surgical excision (n = 20) or long-term imaging follow-up (n = 6) was performed and correlated with findings at SDVAB. RESULTS: SDVAB of 26 lesions yielded tissue that was classified as benign in 12, atypical in six, and malignant in eight. Of the 12 lesions that were diagnosed as histologically benign at SDVAB, six were surgically excised. Of these six lesions, five yielded benign correlative results. The sixth lesion was thought to be discordant with the imaging findings, and was surgically excised and determined to be malignant. Of the six benign lesions that were not surgically sampled for biopsy, five decreased in size and one was not seen at radiographic follow-up. Of the six lesions diagnosed as atypical at SDVAB that were surgically excised, one was benign and five were atypical. None proved to be malignant. Of the eight lesions diagnosed as malignant at SDVAB, surgical excision demonstrated ductal carcinoma in situ in all eight; two also had foci of invasive carcinoma. CONCLUSION: Benign and malignant papillary lesions of the breast can be reliably diagnosed at SDVAB when the SDVAB results correlate with the imaging findings. However, the extent of malignant papillary disease may be underestimated at SDVAB; in our study, invasive carcinoma was later discovered in 25% of patients with this diagnosis.     

Stereotactic vacuum-assisted breast biopsy: results, follow-up and correlation with radiological suspicion

PURPOSE: The purpose of this study was to assess the accuracy and clinical usefulness of stereotactic vacuum-assisted biopsy (VAB) for diagnosing suspicious, nonpalpable, only mammographically detectable breast lesions. MATERIALS AND METHODS: We retrospectively evaluated the results of percutaneous stereotactic VAB with 11-gauge needles performed over a period of 34 months on 228 nonpalpable suspicious breast lesions detectable on mammography only [Breast Imaging Reporting and Data System (BI-RADS) 3: 25.9%; BI-RADS 4: 67.1%; BI-RADS 5: 7%]. The imaging histological concordance was ascertained for each lesion. In cases of discordance, repeat biopsy or surgical excision were recommended; in cases of benign lesions, we urged a follow-up of at least 6 months and for borderline and malignant lesions a surgical excision. We also evaluated concordance between VAB results and subsequent examinations (surgical excision or followup). RESULTS: VAB demonstrated 123 (54%) benign lesions (with six cases of imaging-histological discordance), 26 (11.4%) borderline lesions and 79 (34.6%) malignant lesions. We obtained a suitable post-VAB mammographic or histological evaluation for 78 benign lesions, 17 borderline lesions and 76 malignant lesions, with one (1.3%) false negative (FN) case, two (11.8%) underestimations of borderline lesions, 14 (18.4%) underestimations of malignant lesions and no (0%) false positive cases. We did not observe any postbiopsy complications or scars. CONCLUSIONS: Percutaneous histological VAB with an 11-gauge needle proved to be, as reported in previous studies, a reliable method for diagnosing nonpalpable, mammographically detectable only breast lesions, with an underestimation rate lower than core biopsy and a FN rate similar to that of surgical biopsy, without any significant complications.     

Elective endovascular stent-graft repair of atherosclerotic thoracic aortic aneurysms: clinical results and midterm follow-up

OBJECTIVE: The purpose of this study was to evaluate the clinical and midterm results after endovascular treatment of atherosclerotic thoracic aortic aneurysms. MATERIALS AND METHODS: Twenty-eight consecutive patients who were 53-82 years old (mean age, 71.6 years) were treated with a commercially available endoprosthesis. Subclavian transposition or bypass surgery was performed before the procedure in eight patients. Size dynamics of the aneurysms were analyzed on the basis of diameter and thrombus volume measurements obtained on three-dimensional CT reconstructions before hospital discharge (n = 22) and at the 1-year (n = 22), 2-year (n = 12), and 3-year (n = 5) follow-ups. RESULTS: The technical success rate was 100%. There was no 30-day mortality. None of the patients had symptoms due to spinal cord ischemia. The survival rate at 1, 2, and 3 years was 96.1%, 90.9%, and 80.2%, respectively. During the perioperative period, patients presented with leukocytosis (37%), fever (36%), elevated C-reactive protein value (92%), pleural effusion (50%), and periaortic atelectasis (41%). Three early type I endoleaks sealed spontaneously. Three early type II endoleaks persisted over time, and one late type II endoleak was detected. In patients with type II endoleaks, thrombus volume of the aneurysms was constant (n = 2) or increased (n = 2). In patients without endoleaks, mean thrombus volume decreased (-53.2 +/- 56.8 mL, -40%) significantly (p = 0.001) during the first year. There was no significant interval decrease between the 1- and 2-year follow-ups (mean, -2.4 mL, p = 0.92) and between the 2- and 3-year follow-ups (mean, -0.4 mL, p = 0.68). CONCLUSION: Endovascular treatment of atherosclerotic thoracic aortic aneurysms may result in a substantial reduction of the aneurysm sac in patients without endoleaks.     

Accuracy of percutaneous core biopsy of isolated breast microcalcifications identified by mammography. Experience with a vacuum-assisted large-core biopsy device

PURPOSE: To evaluate the diagnostic accuracy of 11-G vacuum-assisted stereotactic core biopsy (VAB) of isolated clusters of microcalcifications identified by mammography. MATERIALS AND METHODS: Retrospective analysis of 364 consecutive procedures from February 1999 to June 2002. Final outcome was histological diagnosis at surgery or mammographic follow-up. Linkage with local cancer registry was available. Diagnostic accuracy and upgrading of atypical ductal hyperplasia (ADH) to carcinoma or of ductal carcinoma in situ (DCIS) to invasive carcinoma (INV) was evaluated. The positive predictive value (PPV) of radiological judgement (score 1 to 5) and of the cluster volume (only for unifocal lesions) for ADH or more severe lesions was also considered. RESULTS: A total of 364 consecutive VAB procedures were evaluated (average age 54.9, range 33-81). VAB report was negative, ADH, DCIS or INV in 192, 22, 126 or 24 cases, respectively. Of 188 cases with ADH or more severe reports at VAB or surgical biopsy 16 had an originally negative VAB report, yielding a sensitivity of 91.4%. Upgrading at surgical biopsy for cases with follow-up was 29.4% (5/17) for ADH (DCIS=2, INV=3) and 17.3% (20/115) for DCIS. Of 221 cases with known outcome and mammograms available for review PPV was 37.1%, 65.9%, 90.9%, and 89.4% for radiological suspicion degrees 2,3,4 and 5, respectively (chi squared for trend = 32.44, p<10(-6)) and was 70.0%, 72.4% and 89.4% for cluster volumes of 0-60, 61-500 and >500 mmc, respectively (chi squared for trend= 2.36, p=0.12) among 195 unifocal clusters. No microcalcifications were found at core radiography in 20 cases (VAB negative=18, ADH=1, INV=1) with DCIS or INV occurring in 4 or 1 case, respectively, at further surgery. CONCLUSIONS: Core biopsy avoids unnecessary surgery in many subjects with suspicious microcalcifications, although it implies a non negligible risk of false negative report. Surgical biopsy in VAB negative cases could be indicated according to other variables (e.g. the degree of radiological suspicion). VAB has relevant limits in grading breast lesions, as ADH or DCIS are associated to a considerable risk of upgrading at surgical biopsy. VAB reports other than INV need to be confirmed at surgery before an individual treatment strategy may be defined.     

Vacuum-assisted large-core breast biopsy: complications and their incidence.

OBJECTIVE: To assess both the rate and types of complications associated with vacuum-assisted large-core breast biopsy (VALCBB) at our institution. METHODS: Three hundred and four VALCBBs performed in 297 patients between Sept. 18, 1997, and Mar. 30, 1999, were evaluated. Complications associated with VALCBB were assessed at the time of the procedure and in the post-procedure period. Adverse outcomes included pain, bleeding or bruising, and hematoma. Complications were also classified in terms of minor, significant, and major severity. RESULTS: VALCBB yielded non-minor (i.e., significant and major) complication rates of 3.9% during the procedure and 3.6% in the post-procedure period, with only 2 complications (vasovagal-induced seizure and migraine) that required treatment. CONCLUSION: With proper technique and patient preparation, VALCBB is a very safe procedure with a low complication rate.     

Rheolytic hydrodynamic thrombectomy for percutaneous treatment of acutely occluded infra-aortic native arteries and bypass grafts: midterm follow-up results

RATIONALE AND OBJECTIVES: To evaluate the efficacy of a rheolytic thrombectomy catheter (RTC) for treatment of acutely occluded infra-aortic native arteries and bypass grafts and to determine midterm primary patency, death, and amputation-free survival rates. METHODS: From March 1995 to September 1997, 112 patients with occluded arteries or bypass grafts were primarily treated with RTC at two centers. Thrombus removal was evaluated by two angiographers. RESULTS: More than 75% of the thromboembolic material could be removed with RTC alone. Mean activation time of RTC was 280 +/- 163 seconds. Residual mural or organized thrombi (29%) required adjunctive fibrinolytic therapy or aspiration thrombectomy. Remaining stenoses were treated with percutaneous transluminal angioplasty and additional stent implantation. For acute reocclusions, surgical intervention was required. Technical success after the entire procedure was 88.4%. RTC-associated complications included distal embolization, dissection, vessel perforation, and technical failure of RTC. Mean follow-up time was 14.8 months +/- 11.5, rates of primary patency, secondary patency, death, and amputation-free survival were 60%, 84%, 16%, and 75% after 2 years, respectively. CONCLUSIONS: RTC is a rapid and efficient technique for mechanical thrombectomy of acutely thrombosed native leg arteries and bypass grafts. Midterm results are comparable to the results of alternative treatment modalities such as Fogarty balloon thromboembolectomy or local fibrinolysis.