Needle aspiration and core biopsy of prostate cancer: comparative evaluation with biplanar transrectal US guidance

Biplanar, transrectal ultrasound (US) guidance of needles was used in the transperineal biopsy of possibly malignant prostatic lesions in 80 patients (83 biopsies). A 22-gauge cytologic needle was used to locate and fixate the lesion, and aspiration specimens for cytologic and histologic evaluation were obtained (with 22- and 14-gauge needles, respectively). Twenty-one 19-gauge needle core biopsies were also performed. Forty-nine patients (61%) had histologically prove adenocarcinoma. The rate of cancer diagnosis was 53% with cytologic evaluation and 54% with histologic evaluation (combined yield, 61%). This included 34% of cancers less than 1.0 cm in diameter and 56% of those 1.0-1.5 cm. Thirteen of 23 (57%) of these lesions were nonpalpable or equivocal on digital rectal examination. These results suggest that transrectal US guidance of thin-needle biopsies is useful in diagnosing early prostate cancer.     

Calcifications highly suggestive of malignancy: comparison of breast biopsy methods.

OBJECTIVE: The purpose of this study was to compare the usefulness of, and cost of diagnosing with, different breast biopsy methods for women with calcifications highly suggestive of malignancy. MATERIALS AND METHODS: One hundred thirty-nine women with calcifications highly suggestive of malignancy underwent diagnostic biopsy. Of these, 89 women had stereotactic biopsy with a 14-gauge automated needle (n = 25), 14-gauge vacuum-assisted probe (n = 17), or 11-gauge vacuum-assisted probe (n = 47); and 50 women had diagnostic surgical biopsy. Medical records were reviewed. Cost savings for stereotactic biopsy were calculated using Medicare data. RESULTS: The median number of operations was one for women who had stereotactic biopsy versus two for women who had diagnostic surgical biopsy. The likelihood of undergoing a single operation was significantly greater for women who had stereotactic rather than surgical biopsy, among all women (61/89 [68.5%] vs. 19/50 [38.0%], p < 0.001) and among women treated for breast cancer (55/77 [71.4%] vs. 6/37 [16.2%], p = 0.0000001). Stereotactic 11-gauge vacuum-assisted biopsy, as compared with 14-gauge automated core or 14-gauge vacuum-assisted biopsy, was significantly more likely to spare a surgical procedure (36/47 [76.6%] vs. 16/42 [38.1%], p = 0.0005). Stereotactic 11-gauge vacuum-assisted biopsy resulted in the greatest cost reduction, yielding savings of $315 per case compared with diagnostic surgical biopsy; for women with solitary lesions, stereotactic 11-gauge biopsy decreased the cost of diagnosis by 22.2% ($334/$1502). CONCLUSION: For women with calcifications highly suggestive of malignancy, the use of stereotactic rather than surgical biopsy decreases the number of operations. Stereotactic 11-gauge vacuum-assisted biopsy, as compared with 14-gauge automated core or 14-gauge vacuum-assisted biopsy, is significantly more likely to spare a surgical procedure and has the highest cost savings.     

US-guided transthoracic cutting biopsy for peripheral thoracic lesions less than 3 cm in diameter

PURPOSE: To evaluate the safety and accuracy of ultrasonography (US)-guided transthoracic cutting biopsy for diagnosing peripheral thoracic lesions (<3 cm). MATERIALS AND METHODS: Fifty consecutive patients with peripheral thoracic lesions less than 3 cm in diameter underwent US-guided percutaneous transthoracic cutting biopsy with a modified technique. Fifty lesions (43 parenchymal lung, two pleural, two chest wall, and three anterior mediastinal lesions) were sampled for biopsy. The final diagnosis was based on histopathologic analysis of surgical specimens (n = 18) or clinical follow-up (n = 32). RESULTS: The histology recovery rate was 98% (49 lesions), and the correct diagnosis was obtained in 48 lesions (96%). Twenty-four (48%) lesions were malignant, and 26 (52%) were benign. The diagnostic accuracy for malignant lesions was 92% (22 of 24 lesions). A specific benign diagnosis was made in 17 (65%) of the 26 benign lesions, and the negative predictive value for malignancy was 93% (26 of 28 lesions). Only two patients (4%) developed postbiopsy pneumothorax, and three (6%) developed postbiopsy hemoptysis. Biopsy helped prevent surgery or thoracoscopy in 32 patients (64%): 18 patients with benign disease and 14 with multiple metastases or inoperable cancer. CONCLUSION: US-guided transthoracic cutting biopsy appears to be a safe and effective method for diagnosing peripheral thoracic lesions less than 3 cm in diameter. The high diagnostic accuracy for benign lesions and metastatic lung cancer can help prevent surgery in many cases.     

Stereotactic histologic biopsy with patients prone: technical feasibility in 98% of mammographically detected lesions

OBJECTIVE: The purpose of this retrospective study was to determine which mammographically detected lesions in need of imaging-guided biopsy could undergo prone, stereotactic biopsy. MATERIALS AND METHODS: From July 1991 through June 2001, 1687 consecutive patients (age range, 29-94 years; median age, 58 years) with 1894 lesions were referred by clinicians in a multispecialty clinic. The patients underwent stereotactic, prone, histologic biopsy of 1851 lesions (98%) and needle-localized breast biopsy of 43 lesions (2%). We performed stereotactic biopsies successively with 14-gauge automated large-core devices and 14- or 11-gauge vacuum-assisted devices. We evaluated lesions by patient, breast, lesion, and procedural variables to determine why stereotactic biopsy was not performed. RESULTS: Of 1851 lesions referred for stereotactic biopsy, biopsies were canceled in 42 lesions (2%) not considered suspicious enough to warrant biopsy. Of 1809 lesions in which stereotactic biopsy was considered to be warranted, stereotactic biopsy was canceled for technical reasons in 29 lesions (2%). Of 43 lesions referred for surgical biopsy, stereotactic biopsy was thought to be technically problematic in five (12%). Inability to accomplish a stereotactic biopsy in 34 (2%) of 1852 lesions needing a biopsy was due to proximity to the chest wall (n = 10, 29%), inadequate lesion visualization unrelated to lesion depth (n = 19, 56%), and patient factors (n = 5, 15%). CONCLUSION: Stereotactic biopsy had a technical success rate of 98% (1780/1809) and was used for histologic diagnosis in 96% (1780/1852) of mammographically detected lesions. Inadequate lesion visualization accounted for 85% (29/34) of stereotactic biopsy failures.     

Breast microcalcifications: retrieval failure at prone stereotactic core and vacuum breast biopsy--frequency, causes, and outcome

PURPOSE: To retrospectively determine the frequency and causes of failure to retrieve microcalcifications in nonpalpable lesions, as judged on a radiograph of the specimen, and to determine outcome in patients with those lesions. MATERIALS AND METHODS: Informed consent was obtained from each patient prior to biopsy. The institutional review board approved this HIPAA-compliant study and granted a waiver of informed consent. Retrospective review was performed of 1701 consecutive nonpalpable microcalcification lesions in 1511 women aged 29-92 years (median age, 54 years) who underwent percutaneous stereotactic biopsy on a prone biopsy table. Biopsy was successively performed with 14-gauge core, 14-gauge vacuum, and 11-gauge vacuum devices, with mild selection bias, and for each lesion, biopsy was performed with one device. Radiographs of the specimen were obtained to see whether microcalcifications were retrieved. Patient, mammographic, and biopsy variables were correlated with negative radiographs of the specimen. At repeat biopsy or mammographic follow-up, outcome was evaluated in patients with benign histologic results and negative radiographs of the specimen by using Fisher exact test P values. RESULTS: Radiographs of the specimen were negative in 16% (30 of 182) of lesions at 14-gauge core biopsy, in 4% (four of 96) of lesions at 14-gauge vacuum biopsy, and in 1% (19 of 1423) of lesions at 11-gauge vacuum biopsy (P < .001). Substantial bleeding was a significant factor (P < .001) in failure to retrieve microcalcifications at only 11-gauge vacuum biopsy. Histologic results in 53 lesions with negative radiographs of the specimen were malignant (n = 6), indicated atypical hyperplasia (n = 6), or were benign (n = 41). Follow-up in patients with 40 benign lesions was performed with repeat biopsy (n = 17, with malignancy in three lesions) or mammography (n = 23) for 15-128 months (median, 70 months); one patient with one lesion was lost to follow-up. CONCLUSION: Failure to retrieve microcalcifications was least common with 11-gauge directional vacuum-assisted biopsy and occurred in 1% (19 of 1423) of lesions. Cancer was missed in 8% (three of 40) of benign lesions in patients who were followed up.     

Imaging-guided percutaneous biopsy of focal splenic lesions: update on safety and effectiveness

OBJECTIVE: The purpose of this study is to determine the safety and effectiveness of percutaneous imaging-guided biopsy in the diagnosis of focal splenic lesions. MATERIALS AND METHODS: From May 1995 to November 1997, 20 imaging-guided biopsies of focal splenic lesions were performed in 18 patients, including seven patients with a prior diagnosis of extrasplenic malignancy (breast cancer, n = 3; lymphoma, n = 2; ovarian cancer, n = 1; and osteogenic sarcoma, n = 1), three immunosuppressed patients (cause of immunosuppression: AIDS, n = 1; liver transplantation, n = 1; and bone marrow transplantation, n = 1), two patients with anemia, one patient with a recent history of IV drug abuse, and five patients with incidentally discovered splenic lesions. Biopsies were performed with an 18-gauge (n = 1), a 20-gauge (n = 8), or a 22-gauge (n = 14) self-aspirating needle or an 18-gauge cutting needle (n = 1). Biopsies were considered successful if a specific diagnosis of benign or malignant disease was made. RESULTS: A specific diagnosis was made in 16 (88.9%) of 18 patients, and no complications occurred. Malignancy was diagnosed in six patients including three patients with lymphoma. Benign conditions were diagnosed in 10 patients: a cyst in two patients; hamartoma in one; lipogranuloma in one; infarct in one; and infection in four, including one case each of Candida albicans, Pneumocystis carinii, Mycobacterium tuberculosis, and mixed flora. The tenth benign diagnosis was a pseudotumor of the spleen related to a bulbous tail of the pancreas that was inseparable from the splenic hilum. Biopsy did not establish a diagnosis in one patient with lymphoma and in one patient with presumed splenic candidiasis. A mean of 1.5 needle passes was made per biopsy. CONCLUSION: Imaging-guided splenic biopsy is a safe technique that provides a specific diagnosis in most patients with focal splenic lesions.     

Add-on device for stereotactic core-needle breast biopsy: how many biopsy specimens are needed for a reliable diagnosis?

PURPOSE: To prospectively determine whether there is a minimum number of cores required for histopathologic diagnosis of mammographically detected nonpalpable breast lesions with an add-on 14-gauge stereotactic core-needle biopsy device. MATERIALS AND METHODS: The study was approved by the ethics committee of the hospital; informed consent was obtained. Biopsy was performed in 197 patients with 205 lesions (97 masses, 108 microcalcifications). The first sample (from the center) was collected in container A; second and third samples (2 mm from center), in container B; and additional samples, in container C. Malignancies, atypical ductal hyperplasia (ADH), and radial scars were excised. Benign lesions were followed up mammographically (mean, 24 months). Strict sensitivity and working sensitivity were calculated separately. Stereotactic biopsy with diagnosis of a nonmalignant lesion that, after surgery, proved to be malignant was considered false-negative when strict sensitivity was calculated. Stereotactic biopsy with diagnosis of ADH or radial scar was considered true-positive if the findings at surgery corresponded to the results at biopsy or indicated malignancy and was considered false-positive if the findings at surgery were benign when working sensitivity was calculated. Sensitivity, specificity, and overall accuracy of stereotactic biopsy were determined for masses and microcalcifications in all three containers by using surgical samples and findings at mammographic follow-up as reference. At chi2 analysis, P < .05 was considered to indicate significant difference. RESULTS: Strict sensitivity of the first sample was 77% (66 of 86) (90% [35 of 39] for masses, 66% [31 of 47] for microcalcifications). Results of the first sample were false-negative significantly more often in microcalcifications (n = 16) than in masses (n = 4) (P = .010). Combined results of containers A and B (ie, three samples) yielded higher strict sensitivity than those with first sample alone (95% [37 of 39] for masses [P = .196], 91% [43 of 47] for microcalcifications [P < .001]). With multiple samples, strict and working sensitivity were both 100% (39 of 39) for masses and 91% (43 of 47) and 98% (46 of 47), respectively, for microcalcifications. Four false-negative diagnoses (ADH, three cases; lesion with discordant mammographic and stereotactic biopsy findings, one case) were microcalcifications. CONCLUSION: More than three samples are needed (a minimum number was not determined) for a histologic diagnosis of a mass lesion by using an add-on stereotactic biopsy device.     

Comparison of diagnostic performance of unenhanced vs SonoVue - enhanced ultrasonography in focal liver lesions characterization. The experience of three Italian centers

PURPOSE: To evaluate the diagnostic performance of contrast-enhanced US with SonoVue (Bracco, Milan, Italy) compared to baseline US in focal hepatic lesions characterization. MATERIALS AND METHODS: A comprehensive number of four operators from 3 hospitals evaluated 57 consecutive patients with 60 focal hepatic lesions (28 hepatocellular carcinomas, 11 metastases, 13 hemangiomas, 1 hepatocellular adenoma and 7 focal nodular hyperplasias) by baseline gray-scale ultrasound (US) and color Doppler US. The same lesions were subsequently scanned by contrast-enhanced US after intravenous bolus administration of 2,4-4,8 ml of SonoVue by employing intermittent high or continuous low transmit power imaging. The diagnosis of lesions nature (benign or malignant) and histotype proposed by the on-site operator was finally compared to the definite diagnosis reached by reference procedures (multiphasic contrast-material enhanced helical-computed tomography or magnetic resonance in 24 lesions and fine needle US guided biopsy in 36 lesions). Diagnostic performance (sensitivity, specificity and overall accuracy expressed by the agreement with the reference procedures) of baseline and contrast enhanced US were compared. RESULTS: Differences in sensitivity (baseline vs contrast-enhanced US: 13/39 [33%] vs 32/39 [82%]), specificity (baseline vs contrast-enhanced US: 12/21 [57%] vs 16/21 [76%]) and overall accuracy (baseline vs contrast-enhanced US: 25/60 [41%] vs 47/60 [78%]) were significant (p<0.05; McNemar test). CONCLUSIONS: SonoVue-enhanced US determined a significant improvement in diagnostic performance in the characterization of focal liver lesions if compared to baseline US.     

ERCP、CT、B超对胰胆管下段疾病的诊断准确性

目的 比较ERCP、CT、B超对胰胆管下段疾病的诊断准确性。方法 100例临床表现为梗阻性黄疸，反复上腹痛、恶心呕吐的患均经ERCP、CT及B超检查本组患经手术病理或活检证实为良性病变(胆总管结石)57例，恶性肿瘤31例，其中胆总管癌11例，胰头癌13例，以及壶腹癌8例。上述3种方法术前的定性诊断准确率均与手术病理结果对照。结果 对胆总管结石的定性诊断准确率：ERCP为98％(n=56)，CT为72％(n=41)，B超为61％(n=35)；对恶性肿瘤的定性诊断准确率：ERCP为97％(n=31)，CT为78％(n=25)，B超为63％(n=20）。结论 ERCP对胰胆管下段良恶性病变的定性诊断准确率明显高于CT和B超，但因CT与B超均属无创性操作且对某些恶性肿瘤也有较高的定性诊断准确率，因此在影像诊断中应考虑3项技术优势互补。     

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.     

Touch-preparation cytologic examination of breast core biopsy specimens: Accuracy in predicting benign or malignant core histologic results

RATIONALE AND OBJECTIVES: The purpose of this study was to determine the accuracy of touch-preparation cytologic examination of breast core biopsy specimens in predicting benign or malignant core histologic results. MATERIALS AND METHODS: One hundred two core biopsies were performed on 88 women with stereotactic or ultrasonographic (US) guidance. Slides were prepared by smearing one core sample on each slide, spraying the slides with fixative, and staining them with the Papanicolaou technique. Slides were blindly reviewed by a cytopathologist. Cytologic results were categorized as positive for malignancy, not diagnostic for malignancy, or insufficient for diagnosis. Results were correlated with histologic results from all specimens obtained during the core biopsy. RESULTS: Imaging depicted the lesions sampled for biopsy as masses (n = 70), clustered calcifications (n = 29), focal asymmetries (n = 2), or architectural distortion (n = 1). Touch-preparation slides of 87 (85%) lesions contained sufficient material for diagnosis. Cytologic results correctly identified 12 of 16 (three of five intraductal and nine of 11 invasive) malignancies in 10 of 13 masses and two of three clusters of calcifications. Two false-positive results occurred, both with fibroadenomas. Overall, touch-preparation studies produced 69 true-negative and four false-negative results. Excluding slides with insufficient material, the sensitivity, specificity, and accuracy of touch-preparation results were 75%, 97%, and 93%, respectively. Including insufficient samples, accuracy was 79%. CONCLUSION: Although touch-preparation cytologic examination of breast core biopsy specimens is fairly accurate in prediction of benign or malignant core histologic results, its correlation with histologic results is not sufficient to justify routine use in immediate counseling and treatment planning.     

Breast masses: removal of all US evidence during biopsy by using a handheld vacuum-assisted device--initial experience

PURPOSE: To assess the effects of removal of all ultrasonographic (US) evidence of breast lesions by using a vacuum-assisted biopsy (VAB) device. MATERIALS AND METHODS: Thirty-four women with breast masses underwent US-guided biopsy with an 11-gauge VAB device, with which removal of all evidence of the lesion was attempted. Histologic findings were compared with results of surgery and follow-up imaging. Patient tolerance and perceptions of the procedure and the ability of the procedure to eliminate a palpable finding were evaluated with questionnaires and findings at follow-up physical examination. RESULTS: The biopsy protocol was completed in all cases. Twenty-six benign lesions (76%) and eight malignancies (24%) were diagnosed. After VAB, 10 patients (29%) underwent surgery on the basis of histologic findings of invasive carcinoma (n = 7), ductal carcinoma in situ (n = 1), lobular neoplasia (n = 1), or atypical ductal hyperplasia (n = 1). VAB resulted in complete excision of four of 10 lesions: two of eight malignancies and two of two benign lesions. Among 21 patients with benign lesions who underwent 6-month follow-up imaging, eight (38%) had a definite residual mass. At 6-month follow-up examination, VAB was seen to have eliminated the palpable abnormality in seven (88%) of eight patients with initially palpable benign masses. Thirty-two patients (94%) described no or mild pain during biopsy, and 33 patients (97%) rated care as excellent. CONCLUSION: After removal of all US evidence of breast masses with a VAB device, there was a substantial probability that residual lesion that was not visualized during the procedure would later be found at surgery or follow-up imaging. A palpable mass (< or =1.2 cm in mean diameter) was eliminated in 88% of cases, and patient tolerance and perceptions of the procedure were favorable.     

US guidance for thoracic biopsy: a valuable alternative to CT

PURPOSE: To determine the role, accuracy, and selection criteria of ultrasonographic (US) guidance for biopsy for thoracic lesions. MATERIALS AND METHODS: Imaging-guided thoracic biopsies (n = 86) were performed in 84 consecutive patients. US guidance was used for lesions abutting the chest wall; computed tomographic (CT) guidance was used for all masses surrounded by aerated lung. Mass location and size, guidance modality, histologic results, procedure time, and complications were recorded. RESULTS: Thirty-four lesions (19 parenchymal, six pleural, six chest wall, three mediastinal) were amenable to US-guided biopsy. The mean mass diameter was 4.3 cm, the mean number of passes was 3.2, and the mean procedure time was 31.4 minutes. A histologic diagnosis was achieved in 31 (91%) patients, including all with small (< 2-cm) masses (n = 9). There was one case of pneumothorax. CT guidance was used in 52 (60%) of 86 cases. Lesions were parenchymal (n = 41), pleural (n = 1), and mediastinal and hilar (n = 10). The mean diameter was 2.9 cm, the mean number of passes was 2.3, and the mean procedure time was 45.2 minutes. A histologic diagnosis was achieved in 37 (71%) patients, including 18 of 27 with a small mass. Complications included pneumothorax (n = 21) and parenchymal hemorrhage (n = 2). CONCLUSION: US is an effective and safe alternative to CT for guidance at biopsy of masses abutting the chest wall. Real-time US visualization allows accurate needle placement, shorter procedure time, and performance in debilitated and less cooperative patients.     

Microcystic features at US: a nonspecific sign for microcystic adenomas of the pancreas.

Microcystic adenoma of the pancreas is a benign tumor with no malignant potential and may not require surgery if it is asymptomatic. In the past, a mass containing more than six small (<2-cm) cysts at ultrasonography (US) has been considered to be diagnostic for microcystic adenoma. However, a retrospective study of 36 patients with focal or diffuse pancreatic lesions containing over six small cysts demonstrated that this finding can occur in a wide variety of neoplastic and inflammatory lesions, most of which are malignant. These lesions included adenocarcinoma (n = 18), mucinous cystadenocarcinoma (n = 2), islet cell carcinoma (n = 1), lymphoma (n = 1), sarcoma (n = 1), metastases (n = 2), pancreatitis (n = 4), and adenoma (n = 7). Thus, a finding of multiple small cysts in a pancreatic mass is not specific for microcystic adenoma, and if diagnosis is based on US findings alone, many malignant tumors will be misdiagnosed as microcystic adenomas. Furthermore, computed tomography provides only limited assistance in this setting due to overlapping findings. Needle biopsy can be highly accurate in diagnosing both microcystic adenoma and other malignant lesions and should generally be performed for all lesions with the US features described earlier.     

Image-guided 25-gauge needle biopsy for thoracic lesions: diagnostic feasibility and safety

PURPOSE: To report our experience regarding the feasibility and safety of 25-gauge needles for biopsy of thoracic lesions. MATERIALS AND METHODS: Twenty-six patients with thoracic lesions, predominately pulmonary nodules, measuring 0.7-5.2 cm (mean, 1.6 cm) underwent biopsy with computed tomographic (n = 24), ultrasonographic (n = 1), or fluoroscopic (n = 1) guidance. Nineteen patients had severe chronic obstructive pulmonary disease (COPD), one had severe restrictive lung disease, and one had a coagulopathy; the other five patients had nonpulmonary primary tumors. Biopsy with an inner 25-gauge needle traversing an outer extrapleural coaxial cannula was performed in all patients. Cytologic quick staining was performed routinely to determine specimen adequacy and to establish a preliminary diagnosis. Complications, specimen adequacy, and need for larger specimens were evaluated. RESULTS: Adequate specimens (as determined by cytopathologists) were obtained in 24 (92%) of 26 patients, with a definitive diagnosis achieved in 23 (88%) patients during initial quick staining (17 malignant and six benign diagnoses). Two cases initially considered suspicious for malignancy were reclassified as benign (thymoma and histoplasmosis). At the request of cytopathologists, a larger needle was used to supplement the 25-gauge needle in six patients: In one patient, it provided further diagnostic information; in four, it did not; and in one, it confirmed non-Hodgkin lymphoma. Five patients developed a small pneumothorax (<10%) with use of the 25-gauge needle alone; one other patient, in whom larger needles were placed, received a radiologic chest catheter to evacuate the pneumothorax, thereby allowing the biopsy to continue. CONCLUSION: Image-guided 25-gauge needle biopsy is both feasible and safe.     

CT导引下穿刺活检对胰腺占位性病变的诊断价值

目的 探讨CT导引穿刺活检胰腺占位性病变的诊断价值.方法 回顾性分析CT导引细针穿刺胰腺占位性病变68例,其中胰头区病变49例、胰体12例和胰尾7例.病灶直径2～7 cm,<3cm 10例,3～7 cm 58例.术前均作CT平扫和增强扫描,均采用前路进针,使用20 G细针穿刺.活检标本送病理科作组织病理检查.结果 68例患者均安全地穿刺到病变内,活检成功率为100%.穿刺活检诊断率为恶件病变46例,良性17例,5例未见病变.5例中2例经临床和CT随访均无异常,另3例最终证实胰腺囊腺癌2例和胃癌转移1例.穿刺活检总正确率、灵敏度和特异度分别为96%、95%和100%.CT导引活检对恶性、良性病变的正确率为94%和100%(P>0.05).较大肿块病灶(≥3.0 cm 97%,<3 cm90%)和病变位于胰尾(胰尾100%,胰头96%,胰体92%)的正确率稍高,但经统计学检验正确率差异并无统计学意义(P>0.05),未发现严重的并发症.结论 CT导引经皮细针穿刺活检胰腺占位性病变是一种安全的有效的诊断和鉴别诊断的方法.     

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.     

Critical analysis of the diagnostic imaging of focal hepatic lesions]

The aim of this paper is to evaluate the number and type of consecutive initial diagnoses of focal hepatic lesions obtained by abdominal US and CT. The diagnoses were coded according to the Index for Radiological Diagnoses (ACR). From January 1990 through April 1991, US and CT diagnosed focal hepatic lesion in 16.4% and 9.1% of cases, respectively. A lower number of focal hepatic lesions was diagnosed by CT, which however was more accurate as to the nature of the lesion itself. This is due to the fact that CT is often used to stage hepatic neoplasms already confirmed by US-guided fine-needle biopsy (FBN). The correlation between the initial diagnosis and actual clinical status demonstrates a high rate of occasional findings, especially with US. The rate of questionable diagnoses relative to primary or secondary malignancies was very high. This could be explained by caution in making a severe diagnosis, by awareness of the limits of macroscopic diagnostic techniques and by the immediate availability of US-guided FNB. In conclusion, the coding of consecutive initial diagnoses, by US and CT, could contribute to a practical evaluation of diagnostic imaging techniques, especially when correlated with the respective anamnestic and clinical data. Further studies are necessary to confirm this hypothesis.     

US-guided core-needle biopsy of the thyroid gland

PURPOSE: To evaluate safety, yield, and accuracy of ultrasonography (US)-guided core-needle biopsy of the thyroid gland. MATERIALS AND METHODS: Findings at 209 consecutive core-needle biopsies of lesions of the thyroid gland in 198 patients (median age, 48 years; age range, 14-80 years) were retrospectively reviewed. In 138 (66%), findings at previous fine-needle aspiration cytologic (FNAC) analysis were nondiagnostic on one to five occasions. Biopsy was performed as an outpatient procedure with direct US guidance by using nonadvancing 16-18-gauge core needles. Hospital records were reviewed 6 months to 5 years following biopsy to determine final diagnosis, delayed complications, and influence of biopsy findings on subsequent patient treatment. Final diagnoses were determined on the basis of findings at excisional histologic analysis, clinical course, or other laboratory values. The sensitivity, specificity, and accuracy of US-guided core-needle biopsy were calculated. RESULTS: One hundred ninety-nine (95%) specimens were adequate for histologic diagnosis. The sensitivity, specificity, and accuracy of core biopsy in differentiating neoplastic (malignant and benign) from nonneoplastic lesions of the thyroid gland were 96% (74 of 77), 89% (109 of 122), and 92% (183 of 199), respectively. The sensitivity, specificity, and accuracy of core-needle biopsy in the detection of malignant neoplasms were 61% (11 of 18), 100% (181 of 181), and 96% (192 of 199), respectively. After US-guided core-needle biopsy, 115 (58%) of 198 patients were treated conservatively, and no evidence of missed tumor manifested during the follow-up period. In the 83 patients who underwent surgical resection, biopsy was performed for therapeutic reasons in 76 (92%) and for diagnostic reasons in seven (8%). There were three cases of small postbiopsy hematomas and one of minor hemoptysis, but none required hospital admission. There were no major complications. CONCLUSION: US-guided core-needle biopsy of the thyroid gland is a safe outpatient procedure with a high diagnostic yield and accuracy, and frequently it obviates surgery in patients in whom findings at FNAC analysis are recurrently nondiagnostic.     

探讨双b值对比法在肝脏局灶性病变诊断中的作用

目的：探讨双b值对比法在肝脏局灶性病变诊断中的价值.方法：回顾性分析108例行肝脏MRI平扫及动态增强扫描患者的病例（肝癌44例.转移瘤4例,血管瘤40例,囊肿18例,局灶性结节增生2例）,分为良恶性两组（恶性组48例,A组;良性组60例,B组）.均行b值为500和800 s/mm2的DWI扫描,测量肝脏病变的信号强度值,计算相对信号比R500、R800（R=病灶信号/背景信号）,观察不同b值时病变的信号变化情况△R（△R=R800-R500）.采用X2检验分析采用△R值诊断良恶性病变与病理结果的一致性.结果：△R≥0.25有42例（PA组）,△R〈0.25（PB组）有66例,其中PA中有4个为良性病变（均为血管瘤）,PB中有10个为恶性病变（2个转移瘤,8个肝癌）,差异无统计学意义（X2=1.786,P〉0.05）.结论：双b值对比法在肝脏局灶性病变的定性诊断中具有可行性.