Haematomas after percutaneus vacuum-assisted breast biopsy.

PURPOSE: Clinically apparent haematomas are among most frequent complications after vacuum-assisted breast biopsy (VABB). We evaluated the prevalence and persistence of sonographically (US) detected haematomas and other tissue changes at the biopsy site after VABB. MATERIALS AND METHODS: We examined 48 women who underwent stereotactic 11G needle VABB; the majority of them had mammographically detected microcalcifications. US examination of the breast biopsy site was performed one week after the VABB in 48 patients, and in 45 patients once again three weeks after the VABB. In 13/45 patients US-guided fine needle aspiration biopsy (FNAB) of the changes visualised was performed 3 weeks after the biopsy. RESULTS: One week after the VABB, a haematoma at the biopsy site was detected in 45/48 (94 %) patients (mean length 16.3 mm, mean width 3.6 mm). Three weeks after the VABB, haematoma was detected in 25/45 patients (55 %) (mean length 9.3 mm, mean width 2.7 mm), and architectural distortion in 13/45 patients (29 %), in 7/45 patients (16 %), no changes were found. In 13 patients in whom FNAB (fine needle aspiration biopsy) was performed, haematoma was found in 6/13, fat necrosis in 3/13, reactive changes in 2/13, whereas 2/13 samples were unsatisfactory. CONCLUSION: The changes at the biopsy site can be seen by US in most of the patients one and three weeks after the VABB. These changes could potentially be used for US guidance and localisation of microcalcifications in patients requiring surgical biopsy.

Fine needle aspiration cytology: a survey of current European practice.

Fine needle aspiration cytology (FNAC) is practised widely throughout Europe. The majority of countries have dedicated cytopathologists as well as histopathologists practicing cytology. Despite this, FNAC is performed mostly by clinicians and radiologists except in the larger centres with dedicated staff with a special interest in cytopathology. The advent of One-Stop diagnostic services and image-guided procedures are prompting further development of FNAC clinics where cytopathologists take their own samples, issue reports in the same clinical session and take extra material for ancillary tests to complete the diagnosis. The volume of FNAC work varies accordingly; in dedicated centres FNAC represents up to 80% of the workload whilst, in the majority of countries, it represents one quarter or less. Hence, the rate of inadequate FNAC varies widely, depending on the local sampling policies and the organ, but does not exceed 25% in any of the countries. The most sampled organs are breast and thyroid, followed by lymph nodes. Most countries have dedicated training in cytopathology for pathology trainees, the duration varying between 6 months and 2 years of the total training time. This discussion, focusing on European practices, highlights the heterogeneity of FNAC activity but also its success in many centres where it is practiced to a high standard, particularly in breast, thyroid and lymph node pathology. The relatively high rate of inadequate material in some centres reflects local policies and calls for greater uniformity of FNAC practice, particularly specimen sampling. To achieve this, the future direction should concentrate on specialist training, to include performing as well as interpreting FNAC, as part of the curriculum. Current emphasis on web-based training may not provide first hand experience of the FNAC procedure and should be supplemented by attending FNAC clinics and developing the technique to its full potential.