Underestimation of Ductal Carcinoma In situ on Sonographically Guided Core Needle Biopsy of the Breast

PURPOSE: The purpose of this study was to determine the underestimation rate of ductal carcinoma in situ (DCIS) on sonographically guided 14-gauge core needle biopsy of the breast and to investigate the factors associated with this underestimation. MATERIALS AND METHODS: We retrospectively reviewed 2990 consecutive lesions that underwent sonographically guided 14-gauge core needle biopsy between January 2005 and December 2008. Among them, 61 lesions were pathologically proven to be DCIS (2.04%). A total of 50 DCIS lesions (mean patient age: 50.7 years old, age range: 36-79 years old) that underwent surgical resection were included in this study. After surgery, the lesion proven to be invasive was defined as being in the underestimated group and the lesion proven to DCIS was defined as being in the correctly diagnosed group. We determined the underestimation rate of DCIS and we retrospectively reviewed and compared the clinical, pathologic and radiologic features of the two groups. RESULTS: The underestimation rate of DCIS was found to be 28% (14 of 50 lesions). The underestimation of DCIS was significantly frequent for a clinically palpable lesion (78.6% (11/14) vs. 30.5% (11/36), respectively, p = 0.002). The sonographically maximal diameter of a lesion was significantly larger in the underestimated group than that in the accurately diagnosed group (28.4 +/- 14.0 mm vs. 17.6 +/- 10.3 mm, respectively, p = 0.017) and underestimation was significantly frequent when the sonographic lesion size was > 20 mm (p = 0.012). There was no significant difference in terms of age, the lesion type, the Breast Imaging-Reporting and Data System (BI-RADS) category or the pathologic features between the two groups. CONCLUSION: The underestimation rate of DCIS was 28% for sonographically guided 14-gauge core needle biopsy of the breast. Clinical symptoms such as a palpable lesion and a sonographic lesion size > 20 mm were the factors related with the underestimation of DCIS.

The Value of Ultrasound-Guided Tattooing Localization of Nonpalpable Breast Lesions

OBJECTIVE: To investigate the value of ultrasound-guided tattooing localization (US-tattoo) using a charcoal suspension for breast lesions. MATERIALS AND METHODS: One hundred sixty-four nonpalpable breast lesions in 134 patients (mean age 47 years; range 30-74 years) were marked with a charcoal suspension under US guidance. The medical records associated with the US-tattoo, the pathology results and the follow-up US results were reviewed. RESULTS: The average size of the localized lesions was 1.0 cm. The procedure time was < 5 minutes (range, 2-10 minutes) per lesion. The US-tattoo was well tolerated in all cases. The only technical difficulty encountered was a needle tip blockage caused by a large charcoal particle (4.9%). The surgeon easily identified the tattoo with the exception one case. In addition, surgery could be safely delayed from one to 57 days after the making US-tattoo. The pathology result was benign in 108 cases, borderline in five, and malignant in 51. The excised specimen was < 4 cm in 76.6% (82/107) of the benign cases (mean; 2.7 cm). The pathologist could identify the mass around the tattoo and was able to make a specific diagnosis in 81.3% (87/107) of benign lesions. The only complication encountered was residual charcoal marking along the incision scar (3.6%). All follow-up US documented the removal of the lesions. CONCLUSION: An US-tattoo for nonpalpable breast lesions is a very simple and accurate method that can help surgeons design and schedule an open biopsy.

The Role of the Use of US-guided Vacuum-Assisted Breast Biopsy for the Total Removal of Sonographic Evidence in Low- and High-Risk Benign and Malignant Breast Lesions

PURPOSE: To determine the role of the use of a US-guided vacuum-assisted biopsy for the removal of sonographic evidence (excisional mammotome) for low- and high-risk benign and malignant breast lesions. MATERIALS AND METHODS: We retrospectively reviewed the pathological results of 678 excisional mammotomes (611 low- and 46 high-risk benign and 21 malignant lesions). We compared the pathological results of the excisional mammotomes and the corresponding subsequent surgery of 27 high-risk benign (7/46 cases) and malignant (20/21 cases) lesions. We also reviewed the follow-up US findings of low- (306/611 cases) and high-risk benign lesions (33/39 cases). RESULTS: Fifteen of 27 (55.6%) surgical cases revealed a residual lesion on the excisional mammotome. There was no case of upgrade pathology seen for a surgical specimen. Follow-up sonography of 306 low-risk benign lesions showed a negative finding for 231 (75.2%) cases, post-biopsy changes in 56 (17.8%) cases, and residual lesions in 19 (5.7%) cases. None of the lesion was palpable. Follow-up sonography of 33 high-risk benign lesions revealed a negative finding in 28 (85%) cases, a post-biopsy scar in 4 (12%) cases, and a local recurrence in 1 (3%) case; none of the cases showed a residual lesion. CONCLUSION: We suggest that an excisional mammotome can replace surgical excision for low-risk cases and may avoid the immediate surgery for high-risk benign lesions; however, surgery is crucial for a malignancy.

Sonohysterography-Guided Biopsy of Focal Endometrial Abnormalities: Technical Feasibility and Diagnostic Accuracy

PURPOSE: To assess the feasibility and diagnostic accuracy of a sononohysterography-guided biopsy in an evaluation of focal endometrial lesions. MATERIALS AND METHODS: Sixty-five consecutive patients with focal endometrial lesions detected on baseline sonohysterography were enrolled prospectively. The biopsy was performed under real-time sonohysterography guidance, using a 3.1 mm Pipelle endometrial sampler as the primary biopsy device. The feasibility was evaluated from the technical success rates and the number of "diagnostic" specimen for the histological diagnosis. The diagnostic accuracy was assessed by comparing the biopsy results with the final pathological diagnosis obtained by the surgical procedure. RESULTS: Sonohysterography-guided biopsy was performed successfully in 59(90.8%) out of 65 patients. The reasons for failure in 6 patients were a failure to pass through the cervix (n=3); failure to target a focal lesion (n=2); and inadequate uterine distension (n=1). The biopsy specimen was "diagnostic" in 49 (83.1%) out of 50 patients, and "non-diagnostic" in 10 patients with insufficient tissue (n=6) and indeterminate cellular features for a histological diagnosis (n=4). The cytology results of the sonohysterographically-guided biopsy correlated well with the pathological diagnosis in 35 (92.1%) out of 38 patients who underwent subsequent surgical procedures. CONCLUSION: Sonohysterography-guided biopsy is technically feasible and can be an accurate method for diagnosing focal endometrial lesions. It could be considered to be a reliable office triage as an alternative to hysteroscopic biopsy in patients with focal endometrial abnormalities.

Ultrasonography-guided Fine-needle Aspiration Biopsy for Thyroid Nodules: Effective Technique and a Peculiar Smear Method

PURPOSE: We wanted to evaluate the effective methods that are appropriate for an endemic area of thyroid disease and to compare the differences of cytologic diagnostic rates with and without using a peculiar smear technique. MATERIALS AND METHODS: We analyzed the incidence rate of insufficient results, complications and the total procedure times of 1,126 thyroid nodules in 776 patients who underwent US-FNAB (ultrasonography-guided fine-needle aspiration biopsy) from January to December 2005. We compared the diagnostic rate between the two groups; the groups' tests were performed with a peculiar smear technique (Group A, n = 313) or with a conventional smear technique (Group B, n = 250). RESULTS: According to the size of the thyroid nodule, the incidence rate of an insufficient result on US-FNAB and the mean total procedure time for 1126 thyroid nodules in 776 patients were measured as 16.9% (52/308) and 208 seconds for nodules under 0.5 cm, 9.8% (30/306) and 160 seconds for nodules between 0.5 cm-1.0 cm, and 6.0% (30/504) and 134 seconds for nodules over 1.0 cm. These 776 patients showed no significant complications, except for mild pain. In Group A, the incidence rate of an insufficient result was calculated as 15.1% (14/93) for the group with nodules under 0.5 cm, 5.3% (5/95) for the group with nodules between 0.5 cm-1.0 cm, 4.8% (6/125) for the group with nodules over 1.0 cm, and 8.0% (25/313) for the total A Group. In Group B, the incidence rate of an insufficient result was measured as 33.3% (15/45) for the group with nodules under 0.5 cm, 28.1% (25/89) for the group with nodules between 0.5 cm-1.0 cm, 21.4% (24/112) for the group with nodules over 1.0 cm, and 25.7% (63/245) for the total B group. There was a statistically significant correlation between the rate of an insufficient result and the peculiar smear technique or the size of the thyroid nodule. CONCLUSION: We consider that US-FNAB is very simple, safe and accurate diagnostic method for thyroid nodules, and US-FNAB with a peculiar smear technique is able to increase the diagnostic rate for thyroid nodules.

Ultrasound-Guided Fine-Needle Aspiration Biopsy of Multiple Thyroid Nodules

PURPOSE: To standardize the number of nodules which necessitates ultrasound-guided, fine-needle, aspiration biopsy in patients who have multiple thyroid nodules with the same sonographic characteristics as each other. MATERIALS and METHODS: From February, 2002 to March, 2004, among patients whose diagnosis was confirmed by ultrasound-guided, fine-needle, aspiration biopsy, 545 nodules of 203 patients were found in sonography with more than two thyroid nodules. Each thyroid gland nodule was classified on a score from 0 to 2 points on the basis of the following 5 characteristics: internal content, margin, echogenicity, shape and calcification in sonography. When the score of all characteristics was the same, by deciding on nodules with the same sonographic char-acteristics and with the score of at least one characteristic being different, we divided the nodules with different sonographic characteristics in a patient. By methods such as given in the preceding descriptions, patients with multiple thyroid nodules were separated into two groups: one in which all nodules had the same sonographic characteristics and another in which nodules have at least one different sonographic characteristic. Then, each pathologic result was searched for the same case and different case in each patient group. RESULTS: Among the 203 patients who were diagnosed with multiple thyroid nodules in ultrasonography, 79 patients (38.9%) had nodules with the same ultrasonographic characteristics and 124 patients (61.1%) had nodules with at least one different ultrasonographic characteristic. All 79 patients' nodules with the same ultrasono-graphic characteristics in each patient showed the same pathologic result in all cases (100.0%) and there was no case showing a different pathologic result. Otherwise, among the 124 patients' nodules with different ultrasono-graphic characteristics, each patient showed the same pathologic result in 111 (89.5%) and different pathologic result in 13 (10.5%). CONCLUSION: In patients who have multiple thyroid nodules, if a patient's nodules have the same sonographic characteristics, we can perform ultrasound-guided, fine-needle, aspiration biopsy about only one nodule and if a patient's nodules have different sonographic characteristics from each other, we must perform the biopsy for all nodules.

Percutaneous Biopsy for Small Lymphadenopathy Around the Abdominal Aorta and Inferior Vena Cava Using the Modified Coaxial Technique Under CT Guidance

PURPOSE: The author wanted to report the accuracy and safety of performing percutaneous biopsy of a small lymphadenopathy around the abdominal aorta and inferior vena cava (IVC) with using the modified coaxial technique (MCT) under CT guidance. MATERIALS AND METHODS: Thirty-six cases of CT-guided biopsy using MCT were performed in 35 patients (15 men and 20 women, aged 21-80 years, mean age: 56.5 years), who had small lymphadenopathy around the abdominal aorta and IVC. The maximum diameters of the target nodes were 11-20 mm in 21 cases, 21-30 mm in 14 cases and 31-40 mm in 1 case (mean diameter: 19.8 mm). The locations of the target lesions were the left or posterior side of the aorta (n=22), between the aorta and IVC (n=7), and the right or posterior side of the IVC (n=7). Using the modified coaxial technique, a guiding cannula was introduced precisely to the border of the target lesion. Fine needle aspiration biopsy was performed through the cannula and this was followed by multiple core biopsies (6-8 cores) using an automated biopsy gun. The pathologic results and complications were reviewed. The clinical course after biopsy and the histopathologic diagnosis were reviewed by following up the medical records. RESULTS: From examining the 36 biopsies, a definitive pathologic diagnosis was made in 33 cases (92%). The etiologies were as follows; 16 (44%) metastatic tumors, 11 (31%) lymphomas and 6 cases (17%) of tuberculosis with positive acid-fast bacilli (AFB). Two cases were reported as chronic granulomatous inflammation due to suspected tuberculosis, and they were treated with tuberculosis medication. One case was reported as chronic inflammation and so re-biopsy was performed; this resulted in the diagnosis of tuberculosis with positive AFB. Serious complications such as rupture of major vessels or bowel perforation did not occur. CONCLUSION: It is considered that performing percutaneous biopsy for small lymphadenopathy around the abdominal aorta and IVC with using the modified coaxial technique under CT guidance is an accurate and safe procedure.

Usefulness of CT Fluoroscopy-guided Percutaneous Needle Biopsy in the Presence of Pneumothorax During Biopsy

PURPOSE: When pneumothorax occurs during a percutaneous needle biopsy, the radiologist usually stops the biopsy. We evaluated the usefulness of computed tomographic (CT) fluoroscopy-guided percutaneous needle biopsy in the presence of pneumothorax during biopsy. MATERIALS AND METHODS: We performed 288 CT fluoroscopy guided percutaneous needle biopsies to diagnose the pulmonary nodules. Twenty two of these patients had pneumothorax that occurred during the biopsy without obtaining an adequate specimen. After pneumothoax occurred, we performed immediate CT fluoroscopy guided percutaneous needle biopsies using an 18-gauge cutting needle. We evaluated the success rate of the biopsies and also whether or not the pneumothorax progressed. We classified these patients into two groups according to whether the pneumothorax progressed (Group 2) or not (Group 1) by measuring the longest distance between the parietal pleura and the visceral pleura both in the early and late pneumothorax. Additionally, we analyzed the relationship between the progression of pneumothorax after biopsy and 1) the depth of the pulmonary nodule; 2) the number of biopsies; 3) the presence or absence of emphysema at the biopsy site; and 4) the size of the pulmonary nodule. RESULTS: Biopsy was successful in 19 of 22 nodules (86.3%). Of the 19 nodules, 12 (63.2%) were malignant and 7 (36.8%) were benign. Twelve patients (54.5%) were classified as group 1 and 10 patients (45.4%) as group 2. The distance between the lung lesion and pleura showed a statistically significant difference between these two groups: 1 cm in distance for group 1 (30%) and group 2 (70%), p 0.05). CONCLUSION: When early pneumothorax occurs during a biopsy, CT fluoroscopy guided percutaneous needle biopsy is an effective and safe procedure. Aggravation of pneumothorax after biopsy is affected by the depth of the pulmonary nodule.

Percutaneous CT-guided Biopsy for Lung Lesions 1 cm or Smaller: The Technique, Results and Complications

PURPOSE: The author wanted to assess the diagnostic accuracy and safety of percutaneous biopsy for lung lesions 1 cm or smaller; the biopsies were performed on the basis of the modified coaxial technique under CT guidance. MATERIALS AND METHODS: Thirty-five patients (22 men and 13 women) 23-76 years old (average age: 56.8 years) with lung lesions 1 cm or smaller underwent CT-guided percutaneous biopsy. Fifteen patients had underlying primary malignancies. After an 18 G guiding cannula was introduced to the border of the small lung lesion via the modified coaxial technique, fine-needle aspiration biopsy with 21 G needle and core tissue biopsies with 19.5 G or 20 G biopsy guns were performed through the lumen of the guiding cannula . The core tissue biopsies were finished after 6 macroscopic core tissue specimens were obtained. When the needle hit the eccentric portion of the small lung lesion, a 'fanning-out' technique with using the guiding cannula was applied to get multiple core tissue specimens from the small lung lesion. The diagnostic accuracy of this method was evaluated and the complications were reviewed. RESULTS: Both the cytopathologic and histopathologic specimens were obtained in all 35 cases. The fanning-out technique was necessary in 15 cases (43%) for obtaining six core tissue specimens from small lesions. The final diagnoses were 17 malignant lesions and 18 benign lesions. Sixteen lesions were true-positive, eighteen were true-negative, none was false-positive and one was false-negative. The overall diagnostic accuracy was 97%. The sensitivity for detecting malignancy and the specificity for benign lesion were 94% and 100%, respectively. The positive and negative predictive values were 100% and 95%, respectively. The diagnostic ability to characterize the specific cell type of the malignant lesion was 94% (16 of 17), that for the benign lesions was 83% (15 of 18), and overall diagnostic ability was 89% (31 of 35). Five patients (14%) developed a pneumopthorax, and one of them (3%) received a radiologic chest catheter to relieve moderate dyspnea. CONCLUSION: Percutaneous biopsy performed on the basis of the modified coaxial technique under CT guidance for lung lesions 1 cm or smaller is considered to be an accurate and safe procedure.

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.

Usefulness of CT-Guided Automatic Needle Biopsy of Solitary Pulmonary Nodule Smaller than 15 mm

PURPOSE: To evaluate the usefulness of the CT-guided percutaneous lung biopsy for the solitary pulmonary nodules smaller than 15 mm in diameter. MATERIALS AND METHODS: Between April 2002 and May 2003, we evaluated twenty-five patients (11 men, 14 women, mean ages: 52.5 years) who had solitary pulmonary nodules, which we could not discriminate as being benign or malignant on the CT findings. All the subjects had CT-guided percutaenous cutting needle biopsy (PCNB) performed on them at our institution. A definitive diagnosis of benignity or malignancy was established to retrospectively analyze the patient's records. We evaluated the accuracy, sensitivity, specificity and complications of PCNB for the definitive diagnosis of benignity or malignancy. The sensitivity and specificity of PCNB were determined using the Chi-square test, and the correlations with pneumothorax and emphysema after biopsy were analyzed using Spearman's rank correlation coefficient. RESULTS: In two nodules of the twenty-five nodules, no definitive diagnosis could be established. Of the remaining twenty-three nodules, 7 (30.4%) were malignant and 16 (69.6%) were benign. Twenty (87%) of the twenty-three definitively diagnosed nodules were correctly diagnosed with PCNB. Of the twenty nodules, 6 (30%) were malignant and 14 (70%) were benign. The sensitivity and specificity of the malignant nodules were 85.7% (6/7) and 100% (16/16), respectively. The sensitivity and specificity of the benign nodules were 87.5% (14/16) and 85.7% (6/7), respectively. Post-biopsy complication occurred in nine patients (36%): Hemoptysis (n=4, 16%) and pneumothorax (n=5, 20%). However, there was not a statistical significance between pneumothorax and emphysema after biopsy (r=0.3, p=0.15). CONCLUSION: When CT-guided percutaneous lung biopsy of the solitary pulmonary nodules smaller than 15 mm in diameter was performed without an on-site cytopathologist, we know that PCNB can yield high diagnostic accuracy and very few complications.

Central Lung Tumors with Obstructive Pneumonitis:Ultrasonographic Findings and Usefulness of Ultrasound-guided Biopsy

PURPOSE: To determine the ultrasonographic findings and assess the usefulness of ultrasound (US)-guided biopsy of central lung tumors in patients with obstructive pneumonitis. MATERIALS AND METHODS: Fourteen patients with central lung tumors causing obstructive pneumonitis, as seen on chest radiographs and chest CT scans, were examined between January 1997 and January 2000. In no patient conclusive histologic diagnosis obtained by means of bronchoscopic biopsy or sputum cytology. Eleven patients were men and three were women, and their ages ranged from 45 to 83 (mean, 64) years. For all examinations, real-time, linear-array, convex US units with a 3.75- and a 5.0-MHz transducer were used. The images obtained were analyzed for evidence of consolidation or atelectasis in the lung, demonstrable tumors, and tumor size and echogenicity. For US-guided percutaneous transthoracic biopsy, 19.5G automatic biopsy devices, were employed. RESULTS: Lung consolidation due to a wedge-shaped, homogeneous, hypoechoic lesion was revealed by sonographic fluid bronchograms, air bronchograms, air alveolograms, and visualization of intraparenchymal pulmonary vessels, which showed appropriate motion with respiration. The tumor presumed to be causing obstruction was seen as a hypoechoic nodule near the hilum or as a well-defined hyperechoic mass inside the partially consolidated lung. Pleural effusion was observed in one case. The cytologic findings indicated the presence of squamous cell carcinoma (n=4), adenocarcinoma (n=4), small cell carcinoma (n=3), non-small cell carcinoma (n=2) and large cell carcinoma (n=1). The success rate was 100%, and there were no complications. CONCLUSION: In patients with central lung tumors causing obstructive pneumonitis, chest ultrasonography and US-guided biopsy are useful adjunctive diagnostic modalities and techniques.

Usefulness of Ultrasound-guided Autonomated Gun Biopsy and Fine Needle Aspiration in Thyroid Disease

PURPOSE: To compare ultrasound-guided automated gun biopsy (USG-AGB) with ultrasound-guided fine needle aspiration (USG-FNA) in thyroid disease. MATERIALS AND METHODS: The findings of 156 patients who underwent both USG-AGB and USG-FNA were reviewed. The histopathologic results were categorized as group I (non-tumorous disease), group II (benign tumor), or group III (malignant tumor) on the basis of the results of USG-AGB and surgery. The results of USGAGB and USG-FNA were compared, and the agreement rate between the two was obtained. Based on the histopathologic results of USG-AGB, the sensitivity and specificity of USG-FNA were obtained for each histopathologic group. The histopathologic results obtained at surgery (n=38) and the findings of USG-AGB and USG-FNA were correlated. RESULTS: The pathologic agreement rate between the two methods was very high (kappa=0.805, p<0.01). Based on the histopathologic results of USG-AGB, the sensitivity and specificity of USG-FNA were, respectively, 100%/97.9% for group I, 94.7%/91.7% for group II, and 87.5%/97.1% for group III. When the results of USG-AGB and USG-FNA were correlated with the surgical results obtained in the 38 patients, 21.7 % (5/23) and 27.3 (6/22) of patients found at USG-AGB and USG-FNA, respectively, to be group II, were found at surgery to be group III, while in 93.3 % (14/15) and 81.3 % (13/16) of group II, the respective USG-AGB and USG-FNA findings, and those abtained at surgery, coincided. CONCLUSION: Although the agreement rate between USG-AGB and USG-FNA is high, USG-AGB is a potentially valuable tool in the diagnosis of thyroid malignant tumor, which can be missed at USG-FNA.

Fluoroscopically Guided Biopsy of Intrathoracic Lesions: Diagnostic Accuracy of Combined Method Including Automated Gun Biopsy and Fine Needle Aspiration

PURPOSE: The purpose of this study was to evaluate the usefulness of combined automated gun biopsy (AGB) and fine needle aspiration (FNA) in the diagnosis of lung lesions. MATERIALS AND METHODS: Lung lesions in 102 patients were aspirated consecutively using a 21-gauge fine needle and biopsied with an 18-gauge automated gun at intervals of 3 -5 minutes. Final diagnosis was based on the findings of surgery or clinical follow-up. RESULTS: In 50 patients with malignant lesions, diagnostic accuracy was 80% with AGB and 76% with FNA, but using the combined modality, the figure was 94%. In 52 patients with benign lesions, diagnostic accuracy was 54% with AGB and 50% with FNA; using the combined modality, 69 percent accuracy was achieved. For all lesions, the diagnostic accuracy of the combined modality was thus significantly higher than that of a single method (p<.05). The complications which occurred were pneumothorax in six cases (5.9%), chest tubing in two (0.2%) and minor hemoptysis in nine (8.8%). CONCLUSION: In the diagnosis of lung lesions, the combined use of AGB and FNA is safe and can increase diag-nostic accuracy.

Usefulness of Pe rcutaneous Multiple Core Tissue Biopsy of Small Lung and Pleural Lesion Using Modified Coaxial Technique Under CT Guidance

PURPOSE: To assess the usefulness of modified coaxial technique for percutaneous multiple core tissue biopsy of small lung and pleural lesion. MATERIALS AND METHODS: The author retrospectively reviewed 37 cases of small (

Usefulness of the Coaxial Technique in US-Guided Breast Core Biopsy

PURPOSE: To evaluate the usefulness of the coaxial technique in US-guided breast core biopsy. Materials andMethods : Using the coaxial technique, US-guided breast core biopsy was performed in 49 breast lesions (40patients). Under US-guidance the 17-gauge, 13 cm long introducer needle was positioned proximal to the lesion.Once the needle was in place, the central trocar was removed and was replaced with the core biopsy needle. We usedan 18-gauge, 16-cm-long core biopsy needle with a 17 mm specimen notch. Four to eight tissue specimens wereobtained from each lesion, and the quality and quantity of specimens, procedure time, and complications and theirrate were evaluated. RESULTS: For 48 of 49 lesions, specimens were adequate for histopathologic diagnosis, andthe findings were as follows : six cases of invasive ductal carcinoma, one of ductal carcinoma in situ, 29 offibrocystic disease, eight of fibroadenoma, two of chronic inflammation, and two of sclerosing lesion. In 12lesions agreement between the pathologic results of needle core biopsy and surgical results was 100%. Theprocedure time was about 15 minutes and no significant complications were noted. CONCLUSION: In breast corebiopsy, the coaxial technique is simple and time-saving, and compared with stan-dard breast core biopsy, may alsobe less traumatic and decrease the potential risk of seeding the biopsy tract with malignant cells.

Analysis of 62 Cases with Stereotaxic Breast Biopsy with a Prone Table System: Emphasis on Lesions with micro calcifications

PURPOSE: To evaluate the efficacy of stereotaxic breast core biopsy using a prone table system, and theeffects of operator experience, lesion characteristics and number of samples on biopsy results in cases involvingnonpalpable breast lesions. MATERIALS AND METHODS: We performed stereotaxic core biopsies of 62 nonpalpablemammographic lesions in 61 patients. Subsequent surgical excision was performed in 11 cases with micro calcifications and one case with a mass. We equally divided patients with micro calcifications into two groups(early and late periods) and analyzed the mammographic findings. Correlation of the pathologic results of corebiopsy with those of surgical excision were investigated. RESULTS: In two patients, stereotaxic biopsy wasimpossible due to poor visibility of micro calcifications and thinness of the compressed breast. In 59 patients,core biopsy was successfully performed and specimens were adequate for pathologic examination. The average numberof micro calcifications seen on specimen mammography in the two groups was 1.8 (range: 0~8) and 2.5 (range:0~4)respectively. In patients from whom less than five and five or more samples were taken, the average number of micro calcifications seen on specimen mammography was 1.5 (range: 0~6) and 2.6 (range: 0~8), respectively,throughout the whole period. The pathologic findings were fibrocystic change in 50 cases, fibroadenoma in four,ductal carcinoma in situ in four, invasive ductal carcinoma in one, and atypical ductal hyperplasia in one. Theagreement rate of pathologic results between core biopsy and surgical excision was 83% (10/12) for malignancy and75% for histology. In three cases with disagreement between core and surgical pathologic results, the samplingnumber was small (3~4 times) and in two of the three cases, micro calcifications were not visible on mammography. CONCLUSION: Operator experience and sampling numbers larger than five results in an increased number of micro calcifications in specimens and more reliable core biopsy.

CT-Guided Biopsy of Pulmonary Lesions: A Comparison of Diagnostic Accuracy and Complication Rate betweenAutomated Gun Biopsy and Fine Needle Aspiration Biopsy

PURPOSE: To compare the efficacy and safety of CT-guided automated gun biopsy with those of fine needleaspiration biopsy of pulmonary lesions. MATERIALS AND METHODS: Under CT guidance, we performed automated gunbiopsies in 115 cases of 109 patients and fine needle aspiration biopsies in 119 cases of 108 patients withpulmonary lesions. Between the two methods, we compared the diagnostic rate, diagnostic accuracy and frequency ofcomplications according to the depth and diameter of pulmonary lesions. RESULTS: The overall diagnostic rates ofautomated gun biopsy and fine needle aspiration biopsy were 76.5% (88/115) and 64.7% (77/119) respectively. Therewas a significant statistical difference (p=0.048), especially in the case of malignant lesions less than 3 cm(p=0.027) and more than 6 cm (p=0.008) in maximal diameter. The diagnostic accuracy of automated gun biopsy andfine needle aspiration biopsy showed significant statistical difference only in malignant lesions more than 6cm inmaximal diameter (p=0.008), and in the lesions located from 1 cm to less than 3cm from the pleura (p=0.030), asseen on CT. There was no significant statistical difference in the frequency of complications. CONCLUSION:Automated gun biopsy of pulmonary lesions under CT guidance is safe, with complications rate comparable to thoseof fine needle aspiration biopsy. A higher overall diagnostic rate can be achieved by automated gun biopsy than byfine needle aspiration biopsy. For the diagnosis of pulmonary lesions under CT guidance, automated gun biopsy istherefore a more useful procedure than fine needle aspiration biopsy.

Transjugular Liver Biopsy: The Efficacy of Quick-Core Biopsy Needle System

PURPOSE: To evaluate the efficacy of the Quick-Core biopsy needle system in performing transjugular liverbiopsy. MATERIALS AND METHODS: Between December 1995 and June 1997, eight patients underwent transjugular liverbiopsy involving use of the Quick-Core biopsy needle system; the conditions involved were coagulopathy (n=4),thrombocytopenia (n=3), and ascites (n=1). Via the right internal jugular vein, the right hepatic vein wasselectively catheterized with a 7-F transjugular guiding catheter, and a 14-guage stiffening cannula was theninserted through this catheter; to obtain core tissue, a Quick-Core needle was then advanced into the liverparenchyma through the catheter-cannula combination. Eighteen- and 19-guage needles were used in three and fivepatients, respectively; specimen size, adequacy of the biopsy specimen and histologic diagnosis were determined,and complications were recorded. RESULTS: Biopsy was successful in all patients. The mean length of the specimenwas 1.4 cm (1.0-1.8 cm), and all were adequate for pathologic examinations; specific diagnosis was determined inall patients. There were two malignant neoplasms, two cases of veno-occlusive disease, and one case each ofcirrhosis, fulminant hepatitis, Banti syndrome and Budd-Chiari syndrome. One patient complained of neck pain afterthe procedure, but no serious procedural complications were noted. CONCLUSION: Our preliminary study shows thatthe Quick-Core biopsy needle system is safe and provides adequate core tissues with high diagnostic yields.

Fluoroscopically Guided Automated Gun Biopsy of Chest Lesions: Diagnostic Accuracy and Complications

PURPOSE: To determine the diagnostic accuracy and frequency of complications of fluoroscopy-guidedtransthoracic needle biopsy, using an automated gun biopsy system. MATERIALS AND METHODS: We retrospectively reviewed 86 patients who underwent automated gun biopsy between October 1995 and October 1996. An 18-gauge cutting needle was used in all cases. All biopsies were performed under fluoroscopic guidance by one interventional radiologist. RESULTS: Tissue sufficient for histologic diagnosis was obtained in 73 of 86 biopsies(84.9%). Fifty-six lesions were malignent and 30 were benign. Sensitivity and diagnostic accuracy for malignant lesions were 87.5% and 87.5%, respectively while cell type specificity in malignant diagnosis was 91.7%(11/12). Sensitivity and diagnostic accuracy for benign lesions were 80.0% and 73.3%, respectively. Postbioptic pneumothorax occurred in three of 86 biopsies(3.5%), one of which required placement of a chest tube. CONCLUSION: Automated gun biopsy is a simple, safe method for the diagnosis of focal chest lesions. An automated biopsy device offers high diagnostic accuracy in cases involving malignant and benign lesions of the chest, and is particularly useful for determining malignant cell type and specific diagnosis of benign lesions.