Arrival time parametric imaging: a new ultrasound technique for quantifying perfusion of kidney grafts.

PURPOSE: Evaluation of a new standardised ultrasound (US) technique for diagnosis of acute rejection of kidney grafts. MATERIALS AND METHODS: Twenty-two kidney recipients underwent US examination following administration of 1.6 ml US contrast medium (USCM, SonoVue) 6 days after kidney transplantation. The examinations were performed with the Aplio US system (Toshiba). The difference in time to the first increase in signal intensity between the renal artery and the renal cortex was determined. Subsequently, the temporal course of contrast enhancement in the area of the renal artery following the first peak was recorded over 10 sec and depicted in colour using a Windows-based software. The resulting colour-time-images were evaluated by three readers who rated the images on an analogue scale from 1 (normal) to 5 (abnormal). RESULTS: 12 of the 22 patients had an uneventful clinical course. US demonstrated rapid inflow of the USCM into the renal cortex. The calculated time difference was 1.0 +/- 0.4 sec. The score assigned to the parametric images was 1.7 +/- 0.8. 8 of the 22 patients underwent biopsy and showed histologically proven rejection. The time difference in the rejection group was twice as high as in the normal group (2.2 +/- 0.7 sec, p < 0.05). The scores were in the abnormal range (3.7 +/- 1.6, p < 0.05). Two patients with perirenal haematoma also had high scores, without rejection. CONCLUSIONS: Acute rejection and perirenal haematoma are associated with a delayed signal increase in the renal cortex. This information can be provided with a single image with standardised colour display of the temporal course of USCM inflow.

[Image quality and characterisation of sonographically detected breast lesions: comparison of tissue harmonic imaging alone and in combination with frequency compounding]. / Steigerung der Bildqualität bei der Dignitätsbeurteilung mammasonografischer Herde mittels Frequenz-Compounding.

PURPOSE: To determine the accuracy of frequency compounding (FC) in detection and characterisation of breast lesions by ultrasound (US) and to assess the image quality in direct comparison with tissue harmonic imaging (THI). MATERIALS AND METHODS: A total of 60 breast lesions were examined; these were malignant in 39 cases and benign in 21 as confirmed by histology of core biopsy specimens (Aplio 80, Toshiba, Otawara, Japan). A total of 120 freeze frames, 60 B-mode scans with THI and 60 scans with FC were assessed by three independent examiners, who determined the presence of pathology on a scale of 1 to 5 using established criteria (BI-RADS classification). Image quality of each technique was rated on a ranking scale of - 2 (FC clearly superior to THI), - 1 (FC slightly superior to THI), 0 (identical), + 1 (THI slightly superior to FC), to + 2 (THI clearly superior to FC). The different US techniques were compared in terms of image quality and diagnostic accuracy using Mann Whitney U test and ROC analysis. RESULTS: The results for image quality were as follows: - 0.56 +/- 0.71. In 56 % of the images FC was superior to THI, both techniques were identical in 37 % of cases, and in only 7 % THI was superior to FC. The following AUCs (Area under Curve, presence of pathology) were calculated: 0.945 and 0.969 for THI and FC, respectively (not significant). The two US techniques had comparable sensitivity (FC/THI 100/98 %) and specificity (FC/THI 76/74 %). CONCLUSION: Altogether, the diagnostic value of FC was comparable to that of THI with only slight differences. For ultrasound examinations of breast lesions, FC improves the image quality and conspicuity of pathology.

[Characterization of sonographically detected breast lesions using three-dimensional data sets]. / Dignitätsbeurteilung mammasonographischer Herde mittels dreidimensionaler Darstellung.

PURPOSE: The diagnostic value of 3D ultrasound (US) was evaluated in comparison to 2D US on the basis of a set of pre-defined criteria for breast lesions. The individual criteria were correlated with the histological findings and they were ranked according to their significance for lesion characterization in both 3D US and 2D US. MATERIALS AND METHODS: A total of 92 breast lesions were examined of which 61 were malignant and 31 were benign, as confirmed by histology of core biopsy specimens (Aplio 80, Toshiba, Otawara, Japan). The 2D and 3D data sets were stored digitally. The vascular tree was stored separately using 3D fusion. In addition, a power Doppler (PD) examination was performed. A total of 644 individual images were evaluated by two independent readers. The lesions were evaluated using established criteria (BI-RADS classification). For statistical evaluation, the individual US measurements were classified according to the following two groups: those suggesting malignant lesions and those suggestive of benign lesions. Pearsons's chi-square test was performed for both groups. The 2D and 3D techniques were compared directly using kappa (kappa) statistics. Odds ratios (OR) were determined for the purpose of weighting the individual criteria. The sensitivities and specificities of 2D and 3D US were calculated. RESULTS: The diagnostic value of 3D US was comparable to that of 2D US, with only slight differences observed for specific measurements. Analysis of 2D US data indicated that there was a strong correlation between malignant tumor growth and two specific 2D criteria: lesion margin and effect of the lesion on adjacent breast tissue (r (2) = 0.632, p < 0.001). Analysis of 3D images indicated that the significant measurements for tumor malignancy were shape and lesion margin in sagittal, transverse (r (2) = 0741, p < 0.001), and frontal views (r (2) = 0.592, p < 0.001) as well as retraction and lesion demarcation in the frontal views (r (2) = 0.649, p < 0.001). The comparison of 2D and 3D yielded primarily moderate (kappa = 0.412) to good (kappa = 0.789) agreement between the individual criteria. Crucial criteria for lesion characterization were the effect of the lesion on adjacent breast tissue (OR 47.8 [16.0-143.3]) in 2D US and the lesion margin (OR 36.4 [15.3-86.6]) and the 3 additional criteria of the frontal plane (OR 21.9-32.9) in 3D US. The two US techniques had comparable sensitivities (2D/3D 95-97 %/92-95 %) and specificities (2D/3D 54-58 %/61-67 %). The reconstructed 3D view of the vascular tree was subjectively considered to be helpful by both readers. A higher degree of vascularization was observed with 3D US. CONCLUSIONS: The diagnostic role of 3D ultrasound in the diagnostic evaluation of breast cancer is comparable to that of 2D US. Our findings illustrate the significance of the evaluation of frontal views in lesion characterization.

[Renal transplant: color duplex ultrasound and contrast-enhanced ultrasound in the evaluation of the early postoperative phase and surgical complications]. / Die Transplantatniere: Farbkodierte Duplex-Sonographie und kontrastmittelverstärkte Sonographie in der Beurteilung nephrologischer und chirurgischer Komplikationen.

Contrast ultrasound is a promising and straightforward method that is superior to established sonographic techniques such as conventional B-mode scanning which is used for volume measurement and hematoma demonstration. Color Doppler is important for the evaluation of rejection, the detection of perfusion defects, and complete vascularization in the diagnostic evaluation of kidney grafts. Moreover, contrast US has the potential for tumor characterization in transplanted kidneys. A single examination by contrast ultrasound can answer a variety of questions with respect to the early postoperative phase and chronic damage. New applications of contrast US will arise from the further technical development of ultrasound equipment. The rapid technical advances seen in recent years have been followed by the introduction of new software tools for the analysis of raw datasets or the improved visualization of microbubbles at very low energy. Initial studies show that efficient and early diagnosis of rejection is possible. Surgical complications like perfusion defects or hematoma can also be identified.

[A new method for standardized diagnosis following renal transplantation. Ultrasound with contrast enhancement]. / Eine neue Methode zur standardisierten Diagnostik nach Nierentransplantation. Die ultraschallkontrastmittelgestützte Sonografie.

Ultrasound (US) imaging is an important diagnostic tool following renal transplantation. Unfortunately, due to the heterogeneity of the recipients and their multimorbidity, imaging procedures in the early phase after kidney transplantation are difficult and of limited use. We performed a study to evaluate the use of a contrast enhancer for US examination as a standardized method in the follow-up of kidney transplant recipients.The study included 40 recipients: 32 were examined on the 5th to 7th day following transplantation and 8 patients at the time when clinically suspicious findings occurred (acute rejection, tumor, acute tubular necrosis). Following the intravenous application of the contrast medium, pictures were taken during the arterial and parenchymatous phase and compared with conventional B-mode and power Doppler pictures of the same visual plane. Three examiners assessed different parameters of the transplant organ (max. vascularized area, suspected hematomas, tumors, rejection, acute tubular necrosis). Findings were confirmed by histological results of a biopsy if rejection, tumor, or acute tubular necrosis were suspected. Application of ultrasound contrast medium significantly increased visualization of the vascularized kidney area. Also, US findings in the follow-up after acute rejection therapy corresponded with the clinical course; 19 hematomas could be detected with contrast medium compared to only 9 without. With contrast medium a perfusion deficit was detectable in three patients compared to one patient with power Doppler US. Also, US contrast medium helped to detect tumor vascularization in two patients in whom conventional sonography suspected no abnormality. Ultrasound contrast medium enhancement is a reproducible, reliable, and easy to apply method which is superior to conventional sonography in the follow-up after kidney transplantation. This method is also helpful to detect and control acute rejections and to better visualize hematomas, deficits of perfusion, and tumors.

[Endovenous treatment of primary varicose veins: an effective and safe therapeutic alternative to stripping?]. / Die endovasale Lasertherapie varikös veränderter Stammvenen: Eine effektive und komplikationsarme Alternative zum Venenstripping?

Endovenous laser therapy (EVLT) is a new, minimally invasive therapeutic option for treating primary varicose veins and provides an effective and safe alternative to conventional surgical management (stripping). Short-term and intermediate-term outcome is comparable to surgical stripping in terms of elimination of venous reflux (90 % - 98 %), resolution of visible varices (85 %), and improvement of subjective complaints such as sensations of heaviness and tension (96 %). Complications occur in 1 % - 3 % of cases, which is markedly below the rate of conventional surgical management (up to 30 %). The intermediate-term incidence of recurrent varicosis in a vein treated by EVLT depends on the laser fluence applied and is reported to range from 7 % - 9 % compared to 10 % - 20 % after surgical intervention. Based on a review of the current literature and our own experience, this survey article presents an overview of the indications and contraindications, the technique and pathophysiology of laser-induced venous occlusion, and the results and possible complications of EVLT.

Early postoperative ultrasound of kidney transplants: evaluation of contrast medium dynamics using time-intensity curves.

OBJECTIVE: To evaluate kidney recipients in the early posttransplant phase by semiquantitative analysis of the arterial arrival of ultrasound (US) contrast medium using time-intensity curves. PATIENTS AND METHODS: Twenty-two kidney recipients underwent US examination after intravenous bolus administration of 2.4 ml of US contrast medium (SonoVue, Bracco Altana) 5 to 7 days after transplantation. The examinations were performed with the Aplio US system (Toshiba) and a 3.5-MHz wideband transducer using contrast harmonic imaging at a low mechanical index of 0.1. Arterial arrival was documented digitally over 60 sec (image repetition rate: 10 images per sec) for subsequent evaluation of contrast medium kinetics in the main renal artery, interlobar artery, subcapsular area, and renal vein using the system's integrated time-intensity curve (TIC) software. The increase, decrease, and percentage enhancement factor were calculated from the curves. Four patients were excluded from analysis because of perirenal hematoma (n = 3) or a polar perfusion loss demonstrated by power Doppler (n = 1). RESULTS: Twelve of the remaining 18 patients assigned to the nonrejection group showed an uneventful clinical course. These had uniform TICs with an early and steep increase of similar magnitude in the main renal artery (11.7 +/- 4.5 intensity units/sec), interlobar artery (8.7 +/- 4.6 intensity units/sec), and subcapsular area (8.3 +/- 3.7 intensity units/sec) followed by a washout and subsequent plateau phase. Six patients showed histologically proven acute rejection on day 5 or 6 after transplantation (rejection group). This group had a delayed (time to peak in the subcapsular area: 32.9 +/- 8.3 sec in the rejection group versus 20.9 +/- 4.7 sec in the nonrejection group, p < 0.05) and smaller subcapsular percentage increase (41.2 +/- 21.9 % versus 114.4 +/- 59.8 %, p < 0.05). In the rejection group the subcapsular area (3.8 +/- 2.3 intensity units/sec) showed a less pronounced increase than the main renal artery (7.9 +/- 5.9 intensity units/sec) and interlobar artery (8.7 +/- 3.8 intensity units/sec). The RI in the rejection group was in the normal range at the time of contrast-enhanced US (day 5: 0.78 +/- 0.06) and increased to abnormal levels in the further course (day 7: 0.94 +/- 0.09). CONCLUSIONS: Quantitative determination of arterial arrival of an US contrast medium in the early phase after kidney transplantation is possible. This new US procedure might identify acute rejection earlier than conventional techniques.

[Use of state-of-the-art ultrasound techniques in diagnosing sarcoidosis of the salivary glands (Heerfordt's syndrome)]. / Einsatz moderner Ultraschallverfahren in der Diagnostik der Speicheldrüsensarkoidose (Heerfordt-Syndrom).

AIM: The parotid gland is a rare site of sarcoidosis (6% of all cases). The role of state-of-the-art ultrasound techniques in the diagnostic assessment of parotid sarcoidosis (Heerfordt's syndrome) is presented. PATIENTS AND METHODS: Four patients (three male, one female; aged 31-42 years) with inconclusive parotid swelling associated with fever and uveitis were referred for diagnostic assessment by the ENT outpatient service over a 1 year period. High-resolution ultrasound (US) was performed using the SONOLINE Elegra system with a 7.5-MHz wide-band transducer and various, special US techniques (tissue harmonic imaging, photopic imaging, color-coded duplex US, and power Doppler). Diagnoses were confirmed in all cases by puncture and histology. RESULTS: Two patients with typical lung findings (stage I and II sarcoidosis) and two patients without known sarcoidosis showed an inhomogeneous nodular appearance of the clinically enlarged salivary glands at US. Duplex US demonstrated hypervascularization in three cases and moderate, inhomogeneous vascularization in one. In comparison to plain B-mode scanning, optimal visualization of the hypodense, nodular, structural changes was achieved using contrast-enhancing techniques. All patients underwent US-guided puncture for determining the etiology of parotitis. Histology demonstrated granulomatous epitheloid cell inflammation. CONCLUSION: An inhomogeneous nodular appearance of the parenchyma of enlarged parotid glands with areas of hypervascularization, which is optimally depicted by state-of-the-art US techniques, should suggest Heerfordt's syndrome as a possible differential diagnosis.

[Ultrasound at the bedside: does a portable ultrasound device save time?]. / Sonographie am Krankenbett: Zeitgewinn durch Nutzung eines tragbaren Ultraschallgerätes?

AIM: To prospectively determine whether the use of a portable ultrasound device results in a detectable reduction of the time required for acute ultrasound (US) assessment at the bedside. MATERIALS AND METHODS: A total of 125 patients underwent US at the bedside, among them 68 for abdominal assessment, 12 patients for chest or soft-tissue evaluation, and 45 patients with vascular disease. Five different US systems equipped with 3.5 MHz and 7.5 MHz wide-band transducers were compared in terms of overall examination time including transport, setting up and disassembling, switching on and off as well as initializing the device (but without writing of the report). The following ultrasound systems were used: the portable SonoSite 180 (SonoSite, Germany) as well as the mobile units Masters/Gateway 2000 (Diasonics, USA), Tosbee (Toshiba, Japan), PowerVision 7000 (Toshiba, Japan), and SONOLINE Elegra (Siemens AG, Germany). RESULTS: The portable ultrasound device significantly reduced the examination time per patient to a mean 16 +/- 4 min from 26 +/- 5 min for the mobile units (p < 0.05). This result was predominantly affected by the time required for switching on and initializing the device as well as the duration of positioning at the bedside and to a lesser extent by elevator waiting time. CONCLUSION: The overall time required for performing an ultrasound examination at the bedside can be considerably reduced if a portable device is used instead of a mobile system.

[Image quality and detection of pathology by ultrasound: comparison of B-mode ultrasound with photopic imaging and tissue harmonic imaging alone and in combination]. / Bildqualität und Detektion pathologischer Prozesse im Ultraschallbild: Vergleich von B-Bild-Sonographie mit photopischer Bildgebung und harmonischer Bildgebung einzeln und in Kombination.

PURPOSE: To determine the accuracy of photopic imaging (PI) in detecting pathology by ultrasound (US) and to assess the image quality in direct comparison with conventional B-mode ultrasound and tissue harmonic imaging (THI). MATERIAL AND METHODS: Fifty-two patients underwent US examination, among them 29 patients for abdominal assessment and 23 for otolaryngological assessment. A total of 208 freeze frames, 52 B-mode scans each with and without THI and 52 B-mode scans each with and without PI, were assessed by three readers, who determined the presence of pathology on a scale of 1 (definitely abnormal) to 5 (definitely normal). All 52 patients underwent US follow-up within six weeks. The results were confirmed by CT in 30 patients and by histology in five cases. Image quality and different color encodings of each technique were rated on a ranking scale of 1 (optimal) to 4 (poor). The different US techniques were compared in terms of image quality, diagnostic accuracy, and color encoding using McNemar's test and ROC analysis. RESULTS: The results for image quality were as follows: B-scan 3.9; THI 1.9; PI 2.8; and THI plus PI 1.5 (each p < 0.05). The following AUCs (Area under Curve, presence of pathology) were calculated: 0.925, 0.990, and 0.990 for B-mode US, THI, and PI, respectively (not significant), and 0.994 for THI plus PI (significant compared to B-mode scan). The different color encodings were rated as follows: reddish brown 1.6, gray 1.9, blue 3.1, and green 3.6 (each p < 0.05). CONCLUSION: For ultrasound examinations, PI in combination with THI improves the image quality and conspicuity of pathology.

Comparison of B-mode and conventional colour/power Doppler ultrasound, contrast-enhanced Doppler ultrasound and spiral CT in the diagnosis of focal lesions of the liver: Results of a multicentre study.

AIM: In patients with lesions of the liver we compared diagnoses based on different methods of ultrasound as well as spiral CT with the final diagnosis reached at the time of the patient's discharge from hospital. METHOD: From records of a prospective multicentre study including 90 liver lesions investigated with B-mode baseline and conventional colour/power Doppler ultrasound, contrast-enhanced colour/power Doppler ultrasound and spiral-CT, we evaluated only those where diagnoses for all modalities were available, and where the diagnosis at discharge comprising all clinical, laboratory and imaging data as well as histologic proof was at least "highly probable". RESULTS: 60 lesions met the inclusion criteria. 20 lesions were ultimately diagnosed as benign, and 40 as malignant. With respect to the diagnosis of malignancy, sensitivity was 92.5 % (37/40) with B-mode and unenhanced conventional colour/power Doppler US ultrasound, 97.5 % (39/40) with contrast-enhanced colour/ power Doppler ultrasound, and 100 % with CT; the corresponding specificities were 65 % (13/20), 85 % (17/20) and 80 % (16/20). 4 of 7 false positive, and 2 of 3 false negative results in the unenhanced technique were diagnosed correctly with contrast-enhanced Doppler ultrasound. CONCLUSION: Compared to conventional ultrasound, contrast-enhanced Doppler ultrasound improved the diagnostic accuracy in 10 % of the cases. Its accuracy in our study was equal to that of CT.

Diagnosis of Heerfordt's syndrome by state-of-the-art ultrasound in combination with parotid biopsy: a case report.

The parotid gland is rarely affected by sarcoidosis (6% of all cases). If there is initial parotitis, and other major symptoms include fever, uveitis, or facial paralysis, the condition is referred to as Heerfordt's syndrome. The case presented here describes the diagnostic work-up and differentiation of swelling of the parotid gland by employing state-of-the-art ultrasound techniques in a 33-year-old patient with Heerfordt's syndrome. Color-coded duplex ultrasound demonstrated hypervascularization. Tissue harmonic and photopic imaging ultrasound additionally depicted hypoechoic, septated structural lesions of the glandular parenchyma with an optimized contrast. Since such structural changes are not a specific sonographic criterion for sarcoidosis, ultrasound-guided biopsy was performed for further clarification of the etiology of parotitis and for excluding lymphoma. In conclusion, state-of-the-art ultrasound with the option of obtaining a biopsy at low risk is a useful procedure for diagnosing unclear pathology of the parotid gland with rapid histological confirmation.

Successful stent-graft repair of a vertebrojugular arteriovenous fistula.

PURPOSE: To describe an apparently unreported endovascular means of treating a vertebral arteriovenous fistula (AVF) using a small-caliber stent-graft to permanently reconstruct the involved vessels. CASE REPORT: A 13-year-old girl presented with tinnitus caused by a high-flow AVF between the right extracranial vertebral artery and deep jugular vein arising from repeated internal jugular vein catheterization. A 4-mm-diameter balloon-expandable Jostent coronary stent-graft was placed in the vertebral artery via a percutaneous femoral access, with immediate and complete obliteration of the AVF and resolution of the tinnitus. Follow-up duplex ultrasonography at 15 months demonstrated patency and luminal integrity of the vertebral artery. CONCLUSIONS: Vertebrojugular AVFs are rare and usually treated with transcatheter embolization techniques, but percutaneous repair using a small-caliber stent-graft appears feasible. This minimally invasive treatment might become the method of choice for AVFs in other small-bore vessels.

Gadolinium-enhanced MR angiography of the breast: is breast cancer associated with ipsilateral higher vascularity?

The aim of this study was to assess a possible association between breast malignancy and ipsilateral higher vascularity on gadolinium-enhanced MR angiography. One hundred six patients were examined by dynamic gadolinium-enhanced 3D MR imaging. Magnetic resonance angiographic views were generated by image subtraction and maximum intensity projection. The study included 85 patients with unilateral malignant breast neoplasms and 21 with unilateral benign lesions. Three blinded readers independently reviewed the MR angiograms after masking the lesions and the corresponding contralateral sites. The readers were asked to determine whether vascularity was higher on the right side, higher on the left side, or equal on both sides. The results were analyzed by the Kappa statistic and Pearson's chi-square test. The blood vessels of the breasts were clearly seen in all cases. There was good agreement among the observers (kappa > 0.54) in assessing vascularity on both sides. Breasts harboring malignant neoplasms were found to have a higher vascularity than the contralateral breasts (p < 0.005). This sign of malignancy had a sensitivity of 76.5%, a specificity of 57%, and an accuracy of 72.6%. Blood vessels of the breast can be depicted by MR angiography. Unilateral malignant neoplasms are associated with a higher ipsilateral vascularity. In conjunction with other indications of malignancy on gadolinium-enhanced MR images, a higher ipsilateral vascularity may serve as an additional sign of malignancy.

[Three-dimensional breast biopsy and surgery]. / Dreidimensionale Mammabiopsie und Chirurgie.

For the histological verification of suspicious non-palpable small breast tumors, the three-dimensional breast biopsy applied as cylindrical extirpation using the ABBI system is the optimal solution at present. Because of the possibility of performing mammography during the operation, errors of localization can be corrected and incorrect incisions avoided. Taking the three radiomorphologically leading symptoms into consideration--suspicious microcalcification, focal shadow and structural irregularity--it can be stated that the digital mammography of the ABBI system is more sensitive than the conventional one for detecting microcalcification, but focal shadow and structural irregularity are detected less well by digital technique. These structures should be preoperatively marked by using sonography. After the complete removal of suspicious microcalcification checked by digital mammography during the operation, residual tumor might be found in a second excision when histologically invasive or intraductal tumor terminations reach the excision margin (R1 resection). Thirteen invasive and 8 intraductal carcinomas were found in 80 cases of cylindrical extirpation using the ABBI system. In 7 procedures carried out to exclude an in-breast recurrence, 3 intraductal carcinomas and 1 invasive carcinoma were observed. In 8 of 12 invasive carcinomas and in 1 of 5 intraductal carcinomas, breast-conserving therapy was indicated. Two cases of invasive carcinoma fulfilled the criteria applied (minimal tumor-free margin > 2 mm, no extensive intraductal component) to use the ABBI cylinder as lumpectomy without a second excision to follow.

[The ABBI system as a possibility for evaluating non-palpable lesions]. / Das ABBI-System als Möglichkeit zur Abklärung nicht palpabler Läsionen.

For non-palpable lesions detected radiographically alone, lumpectomy after needle-localization is currently performed. Specimen radiography provides an indirect proof of complete excision of the mammographic abnormality. Up to now, intraoperative mammography of the operated breast has not been possible. Digital intraoperative mammography is now possible with the ABBI-system, which will be introduced in this article. In a pilot study, we have investigated, whether it is possible to excise small carcinomas with the ABBI stereotactic biopsy device (maximum diameter 20 mm) without compromising breast conserving therapy. In a prospective study, 69 patients were diagnosed or treated using the ABBI-system. In all 60 patients with a primary lesion, a cylindrical excision was performed. Of these, 11 invasive and 5 intraductal carcinomas were diagnosed. 7 of the invasive and 2 of the intraductal cancers were treated with breast conserving surgery. In 9 cases, an in-breast recurrence was suspected. In 7 of these a cylindrical excision was performed. One invasive and 3 intraductal carcinomas were found and mastectomy was performed in these four patients. In two patients with the suspicion of an in-breast recurrence, the ABBI-system was used to perform a core-needle biopsy. In one patient, the biopsy finding was positive and mastectomy was performed. Patients with lesions close to the chest wall are not suited for the ABBI-system. The postoperative course was uneventful in all cases, the cosmetic result after breast-conserving therapy was very good. The advantages of this new method consist in the reliable stereotactic localization of suspicious lesions and in the fast intraoperative imaging.

[Stereotactic tumor biopsy and tumor excision]. / Stereotaktische Tumorbiopsie und Tumorexstirpaton.

Stereotactic procedures are indicated in nonpalpable breast lesions that are suspicious in mammography. Using the ABBI system all established procedures (stereotactic needle biopsy, fine needle biopsy, core needle biopsy) can be performed. Also the resection of cylindrical tissue specimen with a maximum diameter of 20 mm can be carried out, controlled by digital mammography. For the exact diagnosis of lesions with a diameter up to 15 mm, cylindrical extirpation is recommended. In several cases this can be considered as definitive lumpectomy. Neither lesions localized close to the thoracic wall nor retromamillary lesions can be treated by using the ABBI system. While digital mammography is the method of choice for the detection of microcalcifications, the visualization of opacifications may be difficult. Overall the ABBI system was used in 40.7% of our patients with nonpalpable breast lesions.

[Minimal invasive surgery in clinically occult breast carcinoma]. / Minimal invasive Chirurgie beim klinisch okkulten Mammakarzinom.

The ABBI (Advanced Breast Biopsy Instrumentation) system is a new method of breast surgery of nonpalpable tumors which permits intraoperative mammography. In a pilot study it was shown that a small carcinoma can be removed by a mammographically and stereotactically controlled biopsy (20 mm maximum diameter). An indicated breast-conserving therapy can be carried out when using this method.