Calcifications highly suggestive of malignancy: comparison of breast biopsy methods.

OBJECTIVE: The purpose of this study was to compare the usefulness of, and cost of diagnosing with, different breast biopsy methods for women with calcifications highly suggestive of malignancy. MATERIALS AND METHODS: One hundred thirty-nine women with calcifications highly suggestive of malignancy underwent diagnostic biopsy. Of these, 89 women had stereotactic biopsy with a 14-gauge automated needle (n = 25), 14-gauge vacuum-assisted probe (n = 17), or 11-gauge vacuum-assisted probe (n = 47); and 50 women had diagnostic surgical biopsy. Medical records were reviewed. Cost savings for stereotactic biopsy were calculated using Medicare data. RESULTS: The median number of operations was one for women who had stereotactic biopsy versus two for women who had diagnostic surgical biopsy. The likelihood of undergoing a single operation was significantly greater for women who had stereotactic rather than surgical biopsy, among all women (61/89 [68.5%] vs. 19/50 [38.0%], p < 0.001) and among women treated for breast cancer (55/77 [71.4%] vs. 6/37 [16.2%], p = 0.0000001). Stereotactic 11-gauge vacuum-assisted biopsy, as compared with 14-gauge automated core or 14-gauge vacuum-assisted biopsy, was significantly more likely to spare a surgical procedure (36/47 [76.6%] vs. 16/42 [38.1%], p = 0.0005). Stereotactic 11-gauge vacuum-assisted biopsy resulted in the greatest cost reduction, yielding savings of $315 per case compared with diagnostic surgical biopsy; for women with solitary lesions, stereotactic 11-gauge biopsy decreased the cost of diagnosis by 22.2% ($334/$1502). CONCLUSION: For women with calcifications highly suggestive of malignancy, the use of stereotactic rather than surgical biopsy decreases the number of operations. Stereotactic 11-gauge vacuum-assisted biopsy, as compared with 14-gauge automated core or 14-gauge vacuum-assisted biopsy, is significantly more likely to spare a surgical procedure and has the highest cost savings.

Short air bubble in the gastric fundus during fasting: radiographic sign of gastroparesis after lung transplantation.

This study was undertaken to assess whether gastroparesis, as a chronic complication of lung transplantation, correlates with height of the gastric air bubble on chest radiographs of erect fasting subjects. Height of the gastric air bubble and presence or absence of a gastric air-fluid level were assessed on chest radiographic examinations (posteroanterior, lateral, upright position, during fasting, immediately after bronchoscopy, median 148 days after transplantation) obtained on 3 separate days for each of 19 recipients of lung transplantation. Seven of the subjects (five women, two men) had chronic upper gastrointestinal symptoms after transplantation and a confirmed diagnosis of gastroparesis. The gastroparesis was idiopathic in six of the subjects and associated with cytomegalovirus gastritis in one subject. The other 12 subjects, each without upper gastrointestinal symptoms, served as controls. Median height of the gastric air bubble was significantly less in the gastroparetic (2.8 cm; range, 1.0-4.6 cm) than in the control (4.7 cm; range, 1.0-12.4 cm) group (p<0.05). Height of the gastric air bubble was at most 4.6 cm among the seven gastroparetic subjects, whereas it exceeded 5.0 cm on at least one occasion in 8 (67%) of the 12 control subjects (p<0.005). The likelihood of a gastric air-fluid level was 86% for symptomatic subjects and 25% for the control group (p<0.01). When lung transplantation is complicated by chronic gastroparesis, postbronchoscopic chest radiographic examinations of fasting subjects are associated with a gastric air bubble limited to high in the fundus, usually including a fluid level.

The use of helical CT and CT angiography to predict vascular involvement from pancreatic cancer: correlation with findings at surgery.

OBJECTIVE: The purpose of this study was to test the accuracy of helical CT with and without CT angiography to predict vascular involvement from pancreatic cancer and correlate the resultant images with findings at surgery. SUBJECTS AND METHODS: Helical CT and CT angiography was done in 84 patients who had adenocarcinoma of the pancreas to refine an integrated CT angiography protocol. Of these patients 38 underwent radical pancreatoduodenectomy. Vessel integrity of the superior mesenteric artery, superior mesenteric vein, and portal vein was assessed prospectively on both axial CT scans and CT angiograms and correlated with findings at surgery and in particular with the ability of the surgeon to dissect the tumor from these vessels along the vascular planes. RESULTS: CT angiograms were obtained in 82 (98%) of 84 studies. Of the 38 patients who underwent radical pancreatoduodenectomy, resection was aborted in 11 (29%) because of vascular encasement, Compared with axial CT images, CT angiography was more accurate at revealing unresectable cases. In all but one of 11 patients with vessel encasement (narrowing of the lumen) revealed on CT angiography, the lesion was unresectable. Vessel encasement was shown in only two of these 11 patients on axial CT images (of these two patients, one underwent tumor resection). The negative predictive value of a resectable tumor was 96% for CT angiography and axial helical CT compared with 70% for axial helical CT images alone (p = .021). CONCLUSION: Helical CT with CT angiography of the pancreas provides useful information about local vascular involvement from pancreatic carcinoma. Compared with conventional axial helical CT, the addition of CT angiography improves radiologists' ability to predict the resectability of pancreatic tumors.