Clip migration after stereotactic vacuum-assisted breast biopsy with the patient in the decubitus position.

OBJECTIVE: To investigate the factors contributing to clip migration in stereotactic vacuum-assisted biopsy (VAB) of the breast using an upright unit with the patient in the decubitus position. METHODS: This retrospective study included 176 women with microcalcifications on mammograms undergoing stereotactic VAB with clip marking for analysis. The prebiopsy mammograms, stereotactic VAB images, immediate postbiopsy mammograms, and follow-up mammograms were reviewed. All VAB procedures were performed using an add-on upright unit with the patient in the decubitus position. The clip-to-lesion distance on the orthogonal view (craniocaudal view) on immediate postbiopsy mammography was estimated for each biopsy. Two cutoff points of clip-to-lesion distance of > 1 cm or > 2 cm were set for clip migration. The possible factors for clip migration based on clinical and imaging findings were then analyzed by Fisher's exact test. RESULTS: When the cutoff for clip migration was set at > 1 cm, thin breast (p = 0.013) and more superficial lesion (lesion closer to the skin along the line perpendicular to the posterior nipple line, p = 0.004) were associated with clip migration. When the cutoff was set at > 2 cm, thin breast (p = 0.019), high specimen number (p = 0.030), and posterior depth (p = 0.021) were associated with clip migration. CONCLUSIONS: Thin breasts, superficial lesion location, posterior lesion depth, and high specimen number were the factors associated with clip migration. KEY POINTS: • We reported clip migration after ST VAB using an upright unit with the patient in the decubitus position. • The occurrence of clinically significant clip migration (> 2 cm) in our study was 8.5%, which was within the range of the other reports with the patient undergoing ST VAB in the prone position. • Thin breasts, high specimen number, and more posterior depth were the factors associated with significant clip migration.

Efficacy of mammographic evaluation of breast cancer in women less than 40 years of age: experience from a single medical center in Taiwan.

BACKGROUND/PURPOSE: Mammography is the standard imaging modality for breast cancer diagnosis. However, the value of mammographic diagnosis in breast cancer patients aged less than 40 years old has not been well assessed. The goal of our study was to determine the diagnostic efficacy of mammography for the detection of breast cancer in women under 40 years of age in a single medical center in Taiwan. METHODS: Of 1766 women diagnosed with breast cancer in one medical center between 1999 and 2005, 227 (12.9%) who were younger than 40 years of age were enrolled, and 105 of these 227 patients had pre-biopsy mammograms available for analysis. The sensitivities for mammography at first (prospective) and second (retrospective) readings and for corresponding ultrasound were calculated. The distribution of different breast composition between the mammographic true-positive (TP) and false-negative (FN) lesions at the first and second readings was analyzed. RESULTS: Of the 105 patients, 104 presented with a palpable mass and the other one was asymptomatic. There were 109 pathologically proven breast cancers from the 105 patients; 92 of 109 cancerous lesions were detected at the first mammographic reading (sensitivity 84.4%), and the most common mammographic sign was microcalcifications (40.2%). The second reading detected seven additional cancers (99 of 109 lesions; sensitivity 90.8%). There was no significant difference between mammographic TP and FN lesions for the different breast composition on first and second readings. Ninety patients also had ultrasound available for correlation with 94 cancers diagnosed from them. The diagnostic sensitivity of ultrasound was 94.7% (89 of 94 lesions). CONCLUSION: Mammography has an acceptable sensitivity for the detection of breast cancer in women aged less than 40 years, regardless of different breast composition. Breast ultrasound can offer a higher sensitivity for such a population.

Septic Candida krusei thrombophlebitis of inferior vena cava with persistent fungemia successfully treated by new antifungal agents.

Treatment of Candida krusei fungemia can be problematic. We describe a 44-year-old critically ill, non-immunocompromised patient who had persistent Candida krusei fungemia complicated with septic thrombophlebitis of the inferior vena cava. Successful treatment was achieved by parenteral caspofungin followed by prolonged oral voriconazole. Persistent fungemia in the face of ongoing antifungal therapy and prompt removal of central line should alert physicians to the diagnosis of septic thrombophlebitis. Though combined therapy with amphotericin B and surgical intervention probably remains the treatment of choice, prolonged new antifungal agents, which have better efficacy, tolerability and bioavailability, may be a useful alternative where the central veins are relatively inaccessible or the patient is at high operative risk.