Percutaneous lymph node biopsy

Advances in imaging modalities for detecting lymphadenopathy, the ease, safety, and accuracy of the tools and techniques, and the addition of refined ancillary studies for cytologic analysis will continue to increase the acceptance and use of percutaneous lymph node biopsy (PLNB) by fine-needle aspiration (FNA), especially in lymphomas.     

Sonographic detection and fine-needle aspiration biopsy of nonpalpable recurrent or metastatic melanoma in subcutaneous tissues

Subcutaneous or lymph node metastases from melanoma may not be palpable because of their small size, their distance from the skin surface, or their location in an area of fibrosis due to previous surgery or irradiation. High-resolution sonography has been used to detect clinically occult foci of recurrent or metastatic melanoma, whereas real-time, ultrasound-guided, fine-needle aspiration biopsy provided cytologic confirmation. Following excision of cutaneous melanoma, sonographic follow-up of the areas of the surgical scar and lymphatic drainage is recommended whenever residual disease is suspected or when clinical evaluation is limited by postoperative or postradiation changes. Any nonpalpable hypoechoic mass detected in those areas should have a biopsy under real-time sonographic guidance.     

Sonographic appearances of superficial soft tissue lipomas.

High-resolution real-time sonography was used to evaluate 35 superficial soft tissue lipomas. Thirty were located in subcutaneous tissues and 5 in superficial muscles. The lipomas were assessed for location, shape and size, boundaries, echotexture, homogeneity, and sound through transmission. All were elongated, with their greatest diameter parallel to the skin. Twenty-three lipomas (66%) showed a homogenous echotexture. Twenty-one (60%) were well defined, and the remainder showed ill-defined margins blending into the surrounding tissues. Twenty-nine percent of the lipomas were hypoechoic, 22% were isoechoic, 29% were hyperechoic, and 20% showed a mixed pattern. An elongated isoechoic or echogenic mass in the subcutaneous tissues should suggest the diagnosis of lipoma.     

Percutaneous biopsies of the breast: State of the art

Percutaneous biopsy of nonpalpable breast lesions can be performed using mammographic or ultrasound guidance. Stereotaxy is the only technique applicable to microcalcifications and very small masses. With few exceptions, discrete masses greater than 0.7–0.8 cm can be visualized on high-frequency sonograms. Because of the continuous real-time monitoring of the needle placement and of the sampling procedure, sonography has proved to be highly accurate and safe in experineced hands. In addition to depending on the accuracy of the radiologist in hitting the target and the accuracy of the cytopathologic diagnosis, the success of fine-needle aspiration biopsy depends on successful tissue extraction. The lack of significance of insufficient specimens and the importance of properly recording such results in the calculation of accuracy values for fine-needle aspiration biopsy are emphasized. On the other hand, confidence in a negative cytologic result (i.e., adequate specimen without malignant cells) of a perfectly guided procedure is a prerequisite for the nonsurgical management of nonpalpable breast masses and thus for reducing the number of surgical biopsies.     

Ultrasound-guided needle biopsy of the breast and other interventional procedures.

The techniques of and indications for ultrasound-guided needle biopsy of nonpalpable breast lesions are described. High-frequency ultrasonography offers several distinct advantages over sterotaxy and is the technique of choice for guiding the drainage of cysts and fluid collections and the biopsy of any solid mass that can be identified on sonograms. Ultrasonography also can be used for localizing such lesions preoperatively.     

Soft-tissue sarcoma: MR imaging vs sonography for detection of local recurrence after surgery.

To determine the value of MR and sonography in detecting local recurrences of soft-tissue sarcomas after surgery, 26 MR and sonographic studies performed in 21 patients were reviewed retrospectively. Recurrences were confirmed histologically in 12 (46%) of 26 studies. The MR images and sonograms were obtained within 1 month of each other. The findings were classified as recurrence, no recurrence, or indeterminate. Sonography was instrumental in guiding fine-needle aspiration biopsy of impalpable lesions. In two cases, the findings on sonography were indeterminate. In both of these cases, the sonograms had been obtained soon after surgery (at 2 and 4 months). The sensitivity and specificity in the detection of local recurrences were 83% and 93%, respectively, for MR and 100% and 79%, respectively, for sonography. These differences were not statistically significant. We conclude that MR and sonography appear to be equally useful in the detection of local recurrences of soft-tissue sarcomas, sonography can be used for routine follow-up and in guiding needle biopsies, sonography may be more difficult to interpret than MR during the early postoperative period, and MR should be used if sonography is inconclusive.