MR-guided vacuum-assisted breast biopsy in the management of incidental enhancing lesions detected by breast MR imaging

Purpose

The objective of this study was to determine the clinical value and accuracy of magnetic resonance (MR)-guided vacuum-assisted breast biopsy (VAB).

Materials and methods

We retrospectively analysed 106 incidental breast lesions detected on MR imaging in 98 patients. Patients with nonpalpable suspicious lesions that were only MR visible were referred for MR-VAB performed with a 10-gauge needle. All patients with a VAB diagnosis of infiltrating carcinoma, carcinoma in situ or atypical epithelial hyperplasia were referred for surgery. Histopathology of the surgical specimen was considered the reference standard.

Results

MR-guided VAB was attempted in 29/106 lesions (27%); in 2/29 patients, the procedure could not be performed owing to failure to visualise the lesion. Lesions with clearly malignant features and borderline lesions (atypical ductal hyperplasias) were identified in 12 cases (44%) and benign entities in 15 (56%). Seven of 12 (58%) malignant lesions were <10 mm. Among the 27 successful MR-VAB procedures, VAB yielded one false-negative diagnosis (4%) and underestimation (4%). MR-guided VAB sensitivity and specificity were 92% and 100%, respectively, with a positive predictive value of 100% and a negative predictive value of 93%.

Conclusions

The results of this study indicate that MR-guided VAB offers good accuracy in characterising nonpalpable breast lesions visible on MR imaging alone. Small lesion size (<1 cm) did not prove to be a limitation for the success of the procedure.     

MR imaging-guided 10-gauge vacuum-assisted breast biopsy: histological characterisation

Purpose

The aim of this study was to evaluate a handheld vacuum-assisted device for magnetic resonance imaging (MRI)-guided breast biopsy.

Materials and methods

In 47 patients, a total of 47 suspicious breast lesions (mean maximum diameter 9 mm) seen with MRI (no suspicious changes on breast ultrasound or mammography) were sampled using a 10-gauge vacuum-assisted breast biopsy (VAB) device under MRI guidance. Histology of biopsy specimens was compared with final histology after surgery or with follow-up in benign lesions.

Results

Technical success was achieved in all biopsies. Histological results from VAB revealed malignancy in 15 lesions (32%), atypical ductal hyperplasia in four lesions (8%) and benign findings in 28 lesions (60%). One of four lesions with atypical ductal hyperplasia was upgraded to ductal carcinoma in situ after surgery. One of seven lesions showing ductal carcinoma was upgraded to invasive carcinoma after surgery. Two lesions diagnosed as infiltrating carcinoma by VAB were not validated at excisional biopsy due to complete removal of the lesion during the procedure. During the follow-up (mean 18 months) of histologically benign lesions, we observed no cases of breast cancer development. Because of morphological changes on follow-up MRI scans, two lesions underwent surgical excision, which confirmed their benign nature. Besides minor complications (massive bleeding, n=1) requiring no further therapeutic intervention, no complications occurred.

Conclusions

MRI-guided biopsy of breast lesions using a handheld vacuum-assisted device is a safe and effective method for the workup of suspicious lesions seen on breast MRI alone.     

Role of sonoelastography in characterising breast nodules. Preliminary experience with 120 lesions

Purpose

This study was performed to evaluate the diagnostic accuracy of sonoelastography in differentiating and characterising nodular breast lesions.

Materials and methods

A total of 120 nodular lesions diagnosed on mammography and/or ultrasonography in 110 women (mean age 51.27 years) were evaluated with sonoelastography and classified according to elasticity score (S1–S5). Needle biopsy was performed in 104/120 cases, whereas 16/120 were sent for follow-up. Sensitivity and specificity of sonoelastography were determined by taking biopsy findings as the gold standard.

Results

Biopsy yielded the following results: 66 benign, three equivocal and 35 malignant lesions. Sensitivity and specificity of sonoelastography were, respectively, 88.5% and 92.7%. All nodules with an elasticity score of 5 were malignant, and those with a score ≤3 were benign, with the exception of four cases of invasive carcinoma with atypical elasticity (two lobular and two ductal with liquefaction necrosis). Twenty-two lesions were scored 4: 17 were malignant, two equivocal (columnar cell hyperplasia and complex sclerosing lesion) and three benign (sclerotic fibroadenomas).

Conclusions

The use of sonoelastography to complement mammography and ultrasonography could help in the differential diagnosis of nodular breast lesions, especially in Breast Imaging Reporting Data System (BI-RADS) 3 lesions with marked elasticity (S≤3). In these cases, the high concordance between elastography and cytology or histology in diagnosing benign lesions could reduce the number of needle biopsies and guide women at low radiological risk towards follow-up.     

Sonographically-Guided 14-Gauge Core Needle Biopsy for Papillary Lesions of the Breast

Objective

We wanted to assess the need for surgical excising papillary lesions of the breast that were diagnosed upon sonographically guided 14-gauge core needle biopsy.

Materials and Methods

Sixty-nine women (age range: 25-74 years, mean age: 51.7 years) with 69 papillary lesions (4.9%) were diagnosed and followed after performing sonographically guided 14-gauge core needle biopsies. Surgical excision was performed for 44 (64%) of 69 papillary lesions, and 25 lesions were followed with imaging studies (range: 6-46 months, mean: 17.9 months). The histologic findings upon core biopsy were compared with the surgical, imaging and follow-up findings.

Results

Core needle biopsies of 69 lesions yielded tissue that was classified as benign for 43 lesions, atypical for 18 lesions and malignant for eight lesions. Of the 43 lesions that yielded benign papilloma upon core needle biopsy, one had intraductal papillary carcinoma found upon surgery. An immediate surgical biopsy was recommended for this lesion because of the imaging-histologic discordance. No additional carcinoma was found during the imaging follow-up. Surgical excision was performed for 17 atypical papillary lesions, and this revealed intraductal (n = 6) or invasive (n = 2) papillary carcinoma in 8 (47%) lesions. Of the seven intraductal papillary carcinomas, surgery revealed invasive papillary carcinoma in one (14%).

Conclusion

Our results suggest that papillary lesions of the breast that are diagnosed as benign upon sonographically guided 14-gauge core needle biopsy can be followed when the results are concordant with the imaging findings.     

MRI-guided percutaneous coaxial cutting needle biopsy of small pulmonary nodules: feasibility

Objectives

To prospectively evaluate the feasibility, safety and accuracy of magnetic resonance imaging (MRI)-guided percutaneous coaxial cutting needle biopsy of small (≤2.0 cm in diameter) pulmonary nodules.

Methods

Ninety-six patients (56 men and 40 women) with 96 small lung nodules underwent MRI-guided percutaneous coaxial cutting needle biopsy. These lesions were divided into two groups according to maximum nodule diameters: 0.5–1.0 cm (n?=?25) and 1.1–2.0 cm (n?=?71). The diagnostic accuracy, sensitivity and specificity were calculated, and comparison of the two groups was performed using Fisher's exact test.

Results

All specimens obtained were sufficient for diagnosis. Histological examination of needle biopsy revealed 64 malignant, 30 benign and 2 indeterminate nodules. The final diagnoses from surgery or clinical follow-up were 67 malignant nodules and 29 benign nodules. The diagnostic performance of MRI-guided percutaneous coaxial cutting needle biopsy in diagnosing malignant tumours was as follows: accuracy, 97 %; sensitivity, 96 %; specificity, 100 %; positive predictive value, 100 %; and negative predictive value, 91 %. There was no significant difference between the two groups (P?>?0.05, Fisher's exact test). No serious complications occurred.

Conclusions

MRI-guided percutaneous coaxial cutting needle biopsy is a safe and accurate diagnostic technique in the evaluation of small lung nodules.

Key Points

? MRI-guided biopsy helps clinicians to assess patients with small lung nodules. ? Differentiation of malignant and benign nodules is possible with 97?% accuracy. ? MRI guidance enables accurate lung biopsy without ionising radiation. ? No serious complications occurred in MRI-guided lung biopsy.     

Diffusion-weighted magnetic resonance imaging in focal breast lesions: analysis of 78 cases with pathological correlation

Purpose

This study assessed the usefulness of magnetic resonance diffusion-weighted imaging (DWI) in distinguishing between benign and malignant breast lesions.

Materials and methods

Gadolinium-enhanced magnetic resonance imaging (MRI) and DWI with determination of the apparent diffusion coefficient (ADC) were performed on 78 women, each with a focal breast lesion at least 7 mm in diameter, which was studied by cytology or histology.

Results

Final diagnoses were obtained by cytology in 29 cases and histology in 49 (11 percutaneous biopsies and 38 surgical specimens). There were 43 benign lesions (13 fibrocystic disease, eight fibroadenoma, seven adenosis, five normal breast tissue, four inflammatory lesions, three intramammary lymph nodes, two scleroelastosis and one fat necrosis) and 35 malignant lesions (30 invasive ductal carcinoma, two invasive lobular carcinoma, one ductal carcinoma in situ, one carcinomatous mastitis and one metastasis from neuroendocrine carcinoma). The mean ADC values were 1.677±0.151 for benign lesions and 1.298±0.129 for malignant lesions (p<0.001). With an ADC cutoff value of 1.48, DWI had 88.6% sensitivity [confidence interval (CI) 78.1%?C99.1%] and 95.3% specificity (CI 88.9%?C100%), with 31 true positives, four false negatives (three invasive ductal carcinoma and one carcinomatous mastitis), 41 true negatives and two false positives (one fat necrosis and one fibroadenoma). With the cutoff value set at 1.52, DWI sensitivity (35 true positive, no false negative) was 100% and specificity was 86% (CI 75.7%?C96.3%) due to 37 true negatives and six false positives (an additional two fibroadenoma and two fibrocystic disease compared with those recorded with the cutoff set at 1.48). The overall accuracy of DWI considering both cutoff values (72 correct evaluations out of 78 cases) was 92.3% (CI 86.4%?C98.2%).

Conclusions

DWI is a reliable tool for characterising focal breast lesions.     

Real-time virtual sonography (RVS)-guided vacuum-assisted breast biopsy for lesions initially detected with breast MRI

Purpose

To report on our initial experiences with a new method of real-time virtual sonography (RVS)-guided 11-gauge vacuum-assisted breast biopsy for lesions that were initially detected with breast MRI.

Materials and methods

RVS-guided 11-gauge vacuum-assisted biopsy is performed when a lesion with suspicious characteristics is initially detected with breast MRI and is occult on mammography, sonography, and physical examination. Live sonographic images were co-registered to the previously loaded second-look spine contrast-enhanced breast MRI volume data to correlate the sonography and MR images.

Results

Six lesions were examined in six consecutive patients scheduled to undergo RVS-guided 11-gauge vacuum-assisted biopsy. One patient was removed from the study because of non-visualization of the lesion in the second-look spine contrast-enhanced breast MRI. Five patients with non-mass enhancement lesions were biopsied. The lesions ranged in size from 9 to 13 mm (mean 11 mm). The average procedural time, including the sonography and MR image co-registration time, was 25 min. All biopsies resulted in tissue retrieval. One was fibroadenomatous nodules, and those of four were fibrocystic changes. There were no complications during or after the procedures.

Conclusion

RVS-guided 11-gauge vacuum-assisted breast biopsies provide a safe and effective method for the examination of suspicious lesions initially detected with MRI.     

CT-guided needle biopsy performed with modified coaxial technique in the diagnosis of malignant lymphomas

Purpose

The aim of was study was to evaluate the accuracy of computed tomography (CT)-guided core needle biopsy (CNB) performed by modified coaxial technique as an alternative tool to surgical biopsy in patients with suspected malignant lymphoma.

Materials and methods

Between May 2005 and December 2008, 67 CT-guided CNB of deep lesions were performed on 64 patients with suspected malignant lymphoma. In 19 out of 64 patients (29.7%), recurrent lymphoma was suspected. A modified coaxial technique was used in all cases, and multiple samples were obtained for histological and immunohistochemical studies.

Results

A diagnosis of malignant lymphomas with specification of subtype according to the World Health Organization (WHO) classification was established in 41/67 cases. Other malignant neoplasms were found in 13/67, lymphoma without subtype specification was diagnosed in 7/67, whereas no conclusive diagnosis could be established in 6/67 cases. Overall diagnostic accuracy was 80.1%. In patients with a final diagnosis of malignant lymphoma, accuracy was 75.9%. No complications occurred.

Conclusions

Percutaneous CT-guided CNB is a safe, effective and reliable tool in the management of lymphomas in patients without superficial lymphadenopathy and can be considered an alternative approach to surgical sampling. The modified coaxial technique represents an effective tool that has a good diagnostic accuracy value with a low complication rate.     

Role of supersonic shear wave imaging quantitative elastography (SSI) in differentiating benign and malignant solid breast masses

Purpose

To evaluate sensitivity and specificity of supersonic shear wave imaging quantitative elastography (SSI) for distinguishing benign and malignant solid breast masses.

Materials and methods

100 patients with small solid breast masses, were included. The lesions were classified according to the BIRADS (Breast Imaging and Reporting Data System) by SSI. Measurement of the kilopascals (kPa) in different areas of the examined region of interest (ROI) was performed. Ultrasound-guided Tru-cut needle biopsy with an 18-gauge needle was done in all cases.

Results

From the malignant lesions (according to histopathological data), 15% were classified as BIRADS 4 and 85% as BIRADS 5 by SSI. Of the benign lesions, 98%, were classified as BIRADS 3% and 2% as BIRADS 4. According to the histological data, 100% of the lesions with a score of 5 (by SSI) were malignant and 100% of the lesions with a score of 3 were benign. 10% of the lesions with a score of 4 were benign and 90% were malignant. The mean elasticity values were significantly higher for malignant lesions than for benign lesions.

Conclusions

SSI has high sensitivity and specificity in the differentiation of benign and malignant solid breast masses.     

Sonographically Guided Core Biopsy of the Breast: Comparison of 14-Gauge Automated Gun and 11-Gauge Directional Vacuum-Assisted Biopsy Methods

Objective

To compare the outcomes of 14-gauge automated biopsy and 11-gauge vacuum-assisted biopsy for the sonographically guided core biopsies of breast lesions.

Materials and Methods

We retrospectively reviewed all sonographically guided core biopsies performed from January 2002 to February 2004. The sonographically guided core biopsies were performed with using a 14-gauge automated gun on 562 breast lesions or with using an 11-gauge vacuum-assisted device on 417 lesions. The histologic findings were compared with the surgical, imaging and follow-up findings. The histologic underestimation rate, the repeat biopsy rate and the false negative rates were compared between the two groups.

Results

A repeat biopsy was performed on 49 benign lesions because of the core biopsy results of the high-risk lesions (n = 24), the imaging-histologic discordance (n = 5), and the imaging findings showing disease progression (n = 20). The total underestimation rates, according to the biopsy device, were 55% (12/22) for the 14-gauge automated gun biopsies and 36% (8/22) for the 11-gauge vacuum-assisted device (p = 0.226). The atypical ductal hyperplasia (ADH) underestimation (i.e., atypical ductal hyperplasia at core biopsy and carcinoma at surgery) was 58% (7/12) for the 14-gauge automated gun biopsies and 20% (1/5) for the 11-gauge vacuum-assisted biopsies. The ductal carcinoma in situ (DCIS) underestimation rate (i.e., ductal carcinoma in situ upon core biopsy and invasive carcinoma found at surgery) was 50% (5/10) for the 14-gauge automated gun biopsies and 41% (7/17) for the 11-gauge vacuum-assisted biopsies. The repeat biopsy rates were 6% (33/562) for the 14-gauge automated gun biopsies and 3.5% (16/417) for the 11-gauge vacuum-assisted biopsies. Only 5 (0.5%) of the 979 core biopsies were believed to have missed the malignant lesions. The false-negative rate was 3% (4 of 128 cancers) for the 14-gauge automated gun biopsies and 1% (1 of 69 cancers) for the 11-gauge vacuum-assisted biopsies.

Conclusion

The outcomes of the sonographically guided core biopsies performed with the 11-gauge vacuum-assisted device were better than those outcomes of the biopsies performed with the 14-gauge automated gun in terms of underestimation, rebiopsy and the false negative rate, although these differences were not statistically significant.     

CT-guided transthoracic cutting needle biopsy of intrathoracic lesions: comparison between coaxial and single needle technique

Purpose

To evaluate the complication rates and diagnostic accuracy of two different CT-guided transthoracic cutting needle biopsy techniques: coaxial method and single needle method.

Methods

This study involved 198 consecutive subjects with 198 intrathoracic lesions. The first 98 consecutive subjects received a single needle cutting technique and the next 100 consecutive subjects received a coaxial technique. Both groups were compared in relation the diagnostic accuracy and complication rates.

Results

No significant difference was found between the two groups concerning patient characteristics, lesions and procedure variables. There was a borderline statistical difference in the incidence of pneumothorax at within 24-h post biopsy between patients in the single needle group (5%) and the coaxial group (13%) (P = 0.053). Little difference was found in the pneumothorax rate at immediately post biopsy between the two groups, which was 28% in the single needle group and 31% in the coaxial group. There was no significant difference in the hemoptysis rate between the two groups, which was 9.2% in the single needle group and 11% in the coaxial group. Both techniques yielded an overall diagnostic accuracy of 98% for malignant lesions with similar sensitivity (single needle: 96.9% vs. coaxial: 96.4%) and specificity (single needle: 100% vs. coaxial: 100%).

Conclusion

There is little difference in the pneumothorax rates and bleeding complications between patients who either received a single needle or a coaxial transthoracic cutting biopsy. Both techniques produce an overall diagnostic accuracy of 98% for malignant lesions.     

Atypical ductal hyperplasia and ductal carcinoma in situ as revealed by large-core needle breast biopsy: results of surgical excision

OBJECTIVE: This investigation compares the frequency of histologic underestimation of breast carcinoma that occurs when a large-core needle biopsy reveals atypical ductal hyperplasia or ductal carcinoma in situ with the automated 14-gauge needle, the 14-gauge directional vacuum-assisted biopsy device, and the 11-gauge directional vacuum-assisted biopsy device. SUBJECTS AND METHODS: Evaluation of 428 large-core needle biopsies yielding atypical ductal hyperplasia (139 lesions) or ductal carcinoma in situ (289 lesions) was performed. The results of subsequent surgical excision were retrospectively compared with the needle biopsy results. RESULTS: For lesions initially diagnosed as ductal carcinoma in situ, underestimation of invasive ductal carcinoma was significantly less frequent using the 11-gauge directional vacuum-assisted biopsy device when compared with the automated 14-gauge needle (10% versus 21%, p < 0.05) but was not significantly less frequent when compared with the 14-gauge directional vacuum-assisted device (10% versus 17%, p > 0.1). For lesions diagnosed initially as atypical ductal hyperplasia, underestimation of ductal carcinoma in situ and invasive ductal carcinoma was significantly less frequent using the 11-gauge directional vacuum-assisted biopsy device compared with the 14-gauge directional vacuum-assisted device (19% versus 39%, p = 0. 025) and with the automated 14-gauge needle (19% versus 44%, p = 0. 01). CONCLUSION: The frequency of histologic underestimation of breast carcinoma in lesions initially diagnosed as atypical ductal hyperplasia or ductal carcinoma in situ using large-core needle biopsy is substantially lower with the 11-gauge directional vacuum-assisted device than with the automated 14-gauge needle and with the 14-gauge directional vacuum-assisted device.     

Efficacy and cost-effectiveness of stereotactic vacuum-assisted core biopsy of nonpalpable breast lesions: analysis of 602 biopsies performed over 5 years

Purpose

The authors sought to evaluate the diagnostic accuracy and cost-effectiveness of vacuum-assisted core biopsy (VACB) in comparison with diagnostic surgical excision for characterisation of nonpalpable breast lesions classified as Breast Imaging Reporting and Data System (BI-RADS) categories R3 and R4.

Materials and methods

From January 2004 to December 2008, we conducted 602 stereotactic, 11-gauge, VACB procedures on 243 nonpalpable breast lesions categorised as BI-RADS R3, 346 categorised as BI-RADS R4 and 13 categorised as BI-RADS R5. We calculated the diagnostic accuracy and cost savings of VACB by subtracting the cost of the stereotactic biopsy from that of the diagnostic surgical procedure.

Results

A total of 56% of the lesions were benign and required no further assessment. Lesions of uncertain malignant potential (B3) (23.6%) were debated at multidisciplinary meetings, and diagnostic surgical biopsy was recommended for 83.1% of them. All malignant lesions (B4 and B5) underwent surgical excision. VACB had a sensitivity of 94.9%, specificity of 98.3% and diagnostic accuracy of 97.7%. The cost savings per VACB procedure were 464.00 euro; by obviating 335 surgical biopsies, the overall cost savings was 155,440.00 euro over 5 years.

Conclusions

VACB proved to have high diagnostic accuracy for characterising abnormalities at low to intermediate risk of malignancy and obviated surgical excision in about half of the cases, allowing for considerable cost savings.     

3-T breast magnetic resonance imaging in patients with suspicious microcalcifications on mammography

Objective

To investigate the diagnostic value of 3-Tesla (T) breast MRI in patients presenting with microcalcifications on mammography.

Methods

Between January 2006 and May 2009, 123 patients with mammographically detected BI-RADS 3–5 microcalcifications underwent 3-T breast MRI before undergoing breast biopsy. All MRIs of the histopathologically confirmed index lesions were reviewed by two breast radiologists. The detection rate of invasive carcinoma and ductal carcinoma in situ (DCIS) was evaluated, as well as the added diagnostic value of MRI over mammography and breast ultrasound.

Results

At pathology, 40/123 (33 %) lesions proved malignant; 28 (70 %) DCIS and 12 (30 %) invasive carcinoma. Both observers detected all invasive malignancies at MRI, as well as 79 % (observer 1) and 86 % (observer 2) of in situ lesions. MRI in addition to conventional imaging led to a significant increase in area under the receiver operating characteristic (ROC) curve from 0.67 (95 % CI 0.56–0.79) to 0.79 (95 % CI 0.70–0.88, observer 1) and to 0.80 (95 % CI 0.71–0.89, observer 2), respectively.

Conclusions

3-T breast MRI was shown to add significant value to conventional imaging in patients presenting with suspicious microcalcifications on mammography.

Key points

? 3-T MRI is increasingly used for breast imaging in clinical practice. ? On 3-T breast MRI up to 86 % of DCIS lesions are detected. ? 3-T MRI increases the diagnostic value in patients with mammographically detected microcalcifications.     

Underestimation rate of lobular intraepithelial neoplasia in vacuum-assisted breast biopsy

Objectives

To evaluate the underestimation rate and clinical relevance of lobular neoplasia in vacuum-assisted breast biopsy (VABB).

Methods

A total of 161 cases of LN were retrieved from 6,435 VABB. The histological diagnosis was ALH (atypical lobular hyperplasia) in 80 patients, LCIS (lobular carcinoma in situ) in 69 patients and PLCIS (pleomorphic lobular carcinoma in situ) in 12 patients. Seventy-six patients were operated on within 2 years after VABB and 85 were clinically and radiologically monitored. The mean follow-up was 5.2 years, and the prevalence of malignancy was evaluated in the group of 85 patients.

Results

The clinico-pathological characteristics significantly favouring surgery were larger lesions, occurrence of a residual lesion following VABB and histological LCIS and PLCIS subtypes. The VABB underestimation rate as compared to surgery was 7.1 % for ALH, 12 % for LCIS and 50 % for PLCIS. Overall, 11 of the 148 patients included in this survival analysis developed an ipsilateral tumour.

Conclusion

Although obtained retrospectively in a relatively small series of patients, our data suggest that only patients with a diagnosis of PLCIS in VABB should be treated with surgery, whereas patients with ALH and LCIS could be monitored by clinical and radiological examinations.

Key Points

? The treatment of ALH and LCIS in VABB is still debated ? Some authors favour radical treatment and others a more conservative approach ? Only patients with PLCIS in VABB should be treated by surgery     

Fibrotic lesions of the breast: radiological findings and core-neddle biopsy results

Objectives

To evaluate the incidence of breast lesions with a histopathological diagnosis of focal fibrosis based on imaging guided core biopsy, to review the radiologic findings and to assess the diagnostic reliability of 14 G core needle biopsy.

Materials and methods

723 patients, who had undergone 14 G core biopsy and/or surgical excisions, were retrospectively analyzed. Overall, 43 lesions were diagnosed as focal fibrosis. Physical examination, mammography, ultrasonography, and follow-up findings were all reviewed.

Results

Radiological evaluation revealed that 35 (81%) lesions were solid masses. Of 35 mass lesions, 24 (69%) were well circumscribed, the remaining 11 (31%) lesions were ill defined on mammograms or sonograms. None of the lesions had pathological microcalcifications. Three lesions were surgically excised because of radio-pathological discordance after core needle biopsy.

Conclusions

Focal fibrosis of the breast is a benign condition and reflects the ductal and lobular atrophy secondary to stromal proliferation. The radiological findings of this entity may vary and sometimes mimic those of malignant lesions. The incidence of focal fibrosis among our study population is 6% and a well-defined mass lesion is the most frequent finding. Core needle biopsy is a safe and reliable diagnostic procedure in the management of these cases.     

Ultraschallgezielte Stanzbiopsie der Mamma: Technik,Ergebnisse, Indikationen

Purpose. The purpose of this retrospective analysis was to assess the diagnostic accuracy and complication rate of sonographically guided core needle biopsy in palpable breast masses, mammographically detected nonpalpable lesions, and sonographically detected clinically and mammographically occult lesions. Patients and methods. Sonographically guided core needle biopsy was performed in 590 lesions in 572 patients, by using an automated biopsy gun with a 14-gauge large core needle and a coaxial system. Core needle biopsy results were compared with surgical biopsy in 265 cases. 325 lesions with benign histologic diagnoses were followed up for at least 18 months. Results. 234 carcinomas and 356 benign abnormalities were found in the 572 patients. Core needle biopsy reached a sensitivity of 98.7% at a specificity of 99.7%. Understimation rates for lesions initially diagnosed as DCIS and for lesions initially diagnosed as ADH were 3/10 and 6/14, respectively. Of three false-negative results, two were immediately recognized, and one was identfied at follow-up. Serious bleeding occured in one patient (0.2% complication rate). Conclusions. This report confirms that sonographically guided large core needle biopsy is a safe, reliable and cost-effective method for the assessment of both palpable and nonpalpable, mammographically and sonographically detected breast abnormalities.     

Is Ductal Carcinoma In Situ With “Possible Invasion” More Predictive of Invasive Carcinoma Than Pure Ductal Carcinoma In Situ?

Objectives

To compare the underestimation of ductal carcinoma in situ (DCIS) vs DCIS with “possible invasion” at breast biopsy and to determine if any factors related to clinical indication, imaging abnormality, biopsy, or DCIS-grade affected the likelihood of underestimation.

Methods

Of 3836 consecutive lesions that were biopsied by using a 14-gauge needle, 117 lesions revealed DCIS. Surgical pathology results of invasive carcinoma were compared with needle biopsy results of DCIS or DCIS with possible invasion. Clinical indication, imaging abnormality, biopsy guidance modality, sample number, and histologic grade were recorded. Yates corrected χ² and Fisher exact tests were used to determine differences between groups.

Results

A total of 101 lesions were DCIS and 16 were DCIS with possible invasion at biopsy. Thirty-six of 117 lesions (31%) revealed invasive carcinoma at resection pathology. Invasive carcinoma was present more often when DCIS with possible invasion was diagnosed compared with pure DCIS (7/16 [44%] vs 29/101 [29%], P = .36). No factor, including clinical indication, imaging abnormality, biopsy guidance method, sample number, or grade, was found to significantly affect the likelihood of underestimation for lesions diagnosed as DCIS vs DCIS with “possible invasion.” The likelihood of pure DCIS underestimation significantly increased when lesions were high grade compared with either intermediate or low grade (18/44 [41%] vs 9/44 [21%] vs 2/10 [20%], P = .03).

Conclusion

For lesions biopsied by using a 14-gauge needle, there is a trend towards underestimation of the presence of invasive carcinoma when pathology reveals DCIS with possible invasion compared with pure DCIS. High-grade DCIS was significantly more likely to be underestimated.     

Utility of percutaneous joint aspiration and synovial biopsy in identifying culture-positive infected hip arthroplasty

Purpose

Percutaneous synovial biopsy has recently been reported to have a high diagnostic value in the preoperative identification of periprosthetic infection of the hip. We report our experience with this technique in the evaluation of patients undergoing revision hip arthroplasty, comparing results of preoperative synovial biopsy with joint aspiration in identifying an infected hip arthroplasty by bacteriological analysis.

Materials and methods

We retrospectively reviewed the results of the 110 most recent revision hip arthroplasties in which preoperative synovial biopsy and joint aspiration were both performed. Revision surgery for these patients occurred during the period from September 2005 to March 2012. Using this study group, results from preoperative cultures were compared with preoperative laboratory studies and the results of intraoperative cultures. Synovial aspiration was done using an 18- or 20-gauge spinal needle. Synovial biopsy was done coaxially following aspiration using a 22-gauge Chiba needle or 21-gauge Sure-Cut needle. Standard microbiological analysis was performed on preoperative synovial fluid aspirate and synovial biopsy. Intraoperative tissue biopsy bacteriological analysis results at surgical revision were accepted as the “gold standard” for the presence or absence of infection.

Results

Seventeen of 110 (15 %) of patients had intraoperative culture-positive periprosthetic infection. Of these 17 cases, there were ten cases where either the synovial fluid aspiration and/or the synovial biopsy were true positive (sensitivity of 59 %, specificity of 100 %, positive predictive value of 100 % and accuracy of 94 %). There were seven cases where aspiration and biopsy results were both falsely negative, but no false-positive results. Similar results were found for synovial fluid aspiration alone. The results of synovial biopsy alone resulted in the identification of seven infected joints with no false-positive result (sensitivity of 41 %, specificity of 100 %, positive predictive value of 100 %, and accuracy of 91 %).

Conclusions

Standard microbiological analyses performed on percutaneous synovial biopsy specimen during the preoperative evaluation of patients undergoing revision hip arthroplasty did not improve detection of culture-positive periprosthetic infection as compared to synovial fluid aspiration alone.     

Präoperative Markierung und Biopsie nicht palpabler Mammaläsionen mit einer Zieleinrichtung am Magnetom Open

Purpose. MRI-guided interventional maneuvers in the breast, when closed MRI scanners are employed are relatively complex and time consuming. The purpose of our investigations was to develop a special device for the localization and biopsy of breast lesions using an open low-field MRI Scanner (Magnetom Open, Siemens, Erlangen, Germany) permitting free access to the patient. Materials and Methods. Due to its particular material and construction characteristics, a newly developed device for localization and biopsy of breast lesions is appropriate to remain within the magnetic field during the examination without degrading image quality. We performed 125 tests in a phantom and 31 investigations in patients including 26 wire-localizations and 5 biopsies. Results. The interventional maneuvers in the phantom could be performed very precisely. In all 125 phantom studies, the needle (14G coaxial biopsy cannula, Bard) was positioned close to the simulated lesion. In 25 out of 26 patients the needle was positioned within a distance less than 5 mm from the lesion. When using the 14G coaxial biopsy cannula (Bard, Karlsruhe, Germany) the needle tip was found adjacent next to the lesion in all 12 cases (7 wire-localizations, 5 biopsies). Conclusions. Our results indicate that our device allows very precise preoperative localization of breast lesions within the Magnetom Open. Using MRI-compatible, large-core needles, biopsy under direct MRI control resulted in good results.