Fine needle aspiration biopsy of the breast: importance of benign, nonspecific results.

RATIONALE AND OBJECTIVES: The authors attempted to determine the importance of benign but nonspecific findings from an adequate sample obtained with image-guided, fine-needle aspiration biopsy (FNAB) of the breast. MATERIALS AND METHODS: Four hundred thirty-seven image-guided FNAB specimens obtained over a 4-year period were reviewed. Pathologic results, mammograms, sonograms, and radiology reports were correlated for all cases described as benign but nonspecific on the basis of cytologic results. Lesion characterization, type of imaging, and targeting accuracy were assessed. Follow-up method (imaging and/or clinical follow-up, core biopsy, open biopsy) was determined. RESULTS: Of the 427 lesions, 99 (23%) were designated benign but nonspecific. In 75 of the cases, biopsy (core or open) had been performed or there had been at least 2 years of follow-up at the time of this study. Of these, 32 lesions were benign on the basis of follow-up, 27 (36%) were benign at secondary biopsy, seven (9%) were malignant at final biopsy, and nine (12%) were lost to follow-up. Five of the seven cancers occurred in the 1st year of the study; these lesions were sampled for biopsy based on their mammographic appearance. The lesions in an additional 24 patients were benign after at least 1 year of follow-up. CONCLUSIONS: Benign, nonspecific imaged-guided FNAB results are reliable if targeting is accurate and if the mammographic findings support a benign process.

Magnetic resonance imaging after arterial portography with manganese dipyridoxal diphosphate.

RATIONALE AND OBJECTIVES: The authors assess performing hepatic magnetic resonance imaging (MRI) after arterial portography with manganese dipyridoxal diphosphate (MnD-PDP), a hepatobiliary contrast agent, as an invasive but potentially highly sensitive means of focal lesion detection. METHODS: Eight pigs underwent superior mesenteric artery catheterization and injection of 10 mumol/kg MnDPDP. Magnetic resonance imaging at 1.5 T (SE-140/10) was performed before, then at 15 and 30 minutes after injection. Seven or more days later, the same MRI protocol was performed after intravenous injection of 10 mumol/kg MnDPDP. RESULTS: Fifteen minutes after intra-arterial injection, enhancement of the liver predominated (86 +/- 13%), followed by the renal cortex (44 +/- 14%), pancreas (26 +/- 9%), and spleen (14 +/- 9%). At 30 minutes, enhancement of renal cortex significantly increased (50 +/- 14%). There was no significant difference in enhancement of the liver, spleen, pancreas, or renal cortex when we compared intra-arterial and intravenous administration. CONCLUSION: After the injection of 10 mumol/kg MnDPDP into the superior mesenteric artery of pigs there is no significant difference in visceral organ enhancement compared to intravenous administration. The data suggests that the hepatocyte binding sites may be overwhelmed by this dose and/or injection rate of MnDPDP.