ABSTRACT
PURPOSE: To evaluate the use of US-guided vacuum biopsy for diagnosis and treatment of probably benign breast masses. MATERIALS AND METHOD: Retrospective review of 382 US guided vacuum biopsies over a 44 months period (september 2001 to may 2005) with the 11-g handheld mammotome. A total of 308 benign tumors, 59 borderline lesions and 15 carcinomas were diagnosed. The average number of specimens is 13.1 (3-37). Surgical resection has been systematic for carcinomas and selective for papillomas. Surgical correlation (n:35) or mammographic follow-up (n:347) are presented. RESULTS: Complete removal occurred in 371/382 (97.1%) immediately after biopsy and 337/382 (88.2%) after one month: 138/142 (93.7%) for fibroadenomas and 52/53 (98.1%) papillomas less than 15 mm. Open surgical biopsy was carried out for 35 patients on the basis of incomplete removal (3 cases) or histologic findings (8 invasive carcinomas, 7 ductal carcinoma in situ, 3 atypical ductal hyperplasia, 1 fibrocystic changes with atypia and 11 papillomas). No lesion was under-diagnosed and the rate of avoided surgery was 94.5%. Of the 347 lesions that were not surgically biopsied (42 borderline lesions and 305 benign lesions), 337 were monitored at 1-43 months (average: 20 months, > or =24 months: 57 patients). Ten underwent additional biopsy but no missed cancer was detected. Patients tolerance was good or very good in 83%, and the complication rate was 1.3%. CONCLUSION: US-guided vacuum biopsy is an accurate and well tolerated technique. It is an alternative to surgery for masses less than 15 mm including fibroadenomas and papillomas or in patients with imaging-histologic discordance at core biopsy.
Subject(s)
Biopsy, Needle/methods , Breast Neoplasms/pathology , Ultrasonography, Interventional , Adolescent , Adult , Aged , Biopsy, Needle/instrumentation , Breast/pathology , Carcinoma/pathology , Carcinoma in Situ/pathology , Carcinoma, Ductal, Breast/pathology , Female , Fibroadenoma/pathology , Follow-Up Studies , Humans , Middle Aged , Papilloma/pathology , Retrospective Studies , VacuumABSTRACT
PURPOSE: To assess the reliability of vacuum-assisted biopsy in diagnosing and managing atypical ductal hyperplasia and ductal carcinoma in situ of the breast. MATERIALS AND METHOD: Retrospective review of 2130 stereotactic large-core biopsies in 1638 patients over a 40 month period (January 2000 to May 2003) using the mammotome 11-gauge and a dedicated Fischer table. A total of 135 cases of atypical ductal hyperplasia and 322 cases of ductal carcinoma in situ were diagnosed. The average number of cores was 18 (5-64). Surgical resection was systematic for carcinomas and selective for atypical ductal hyperplasia. Correlation with surgical findings (n:356) or mammographic follow-up (n:98) is presented. The influence of various factors on the risk of underestimation was analyzed. RESULTS: Resection revealed an underestimation of 10/37 (27%) for atypical ductal hyperplasia. It was lower (9%) when the radiological lesion had completely disappeared. Underestimation of ductal carcinoma in situ was 12/319 (3.8%). It was higher for masses, high-grade lesions or with micro-infiltration, or in the case where the peripheral edge was affected. Of the 98 atypical ductal hyperplasia that were not surgically biopsied, 81 were monitored at 9-42 months (average: 29 months). Sixteen underwent repeat biopsy: two infiltrating lobular carcinomas were detected in the same area. CONCLUSION: Underestimation of atypical ductal hyperplasia was high, justifying systematic surgical resection. Underestimation of ductal carcinoma in situ and its practical consequences are not significant with the extension of sentinel lymphadenectomy to the wide high-grade lesions or with micro-infiltration.
Subject(s)
Biopsy, Needle/standards , Breast Neoplasms/pathology , Carcinoma in Situ/pathology , Lymphangioma, Cystic/pathology , Adult , Aged , Aged, 80 and over , Biopsy, Needle/methods , Female , Humans , Middle Aged , Reproducibility of Results , Retrospective Studies , VacuumABSTRACT
The authors report a case of a voluminous extra-pleural hematoma in relation to a fracture of the body of the eleventh thoracic vertebra on a 74 year-old man after craniothoracic injury. Thoracic CT Scan showed a homogeneous posterior parietal mass of tissue density (40 HU) outlined by a fatty lining associated with a fracture of the eleventh thoracic vertebra. This allowed a modification in the diagnosis of a hemothorax established previously on conventional radiography. The authors insist on the gravity of this affection when the volume of the hematoma is important. But this is very rare (6 cases out of which 5 were autopsic findings). If present it requise an urgent surgical treatment without forgetting the fiability of CT Scan which relies on putting into evidence the pleural lining sign.
