Stereotactic, automated, large-core needle biopsy of nonpalpable breast lesions: false-negative and histologic underestimation rates after long-term follow-up.

PURPOSE: To determine the rate and causes of false-negative findings and histologic underestimates at stereotactic biopsy of nonpalpable breast lesions. MATERIALS AND METHODS: Stereotactic, 14-gauge, automated, large-core needle biopsy (LCNB) was performed in 483 consecutive nonpalpable breast lesions. Excision was advised for the 143 carcinomas, 25 atypical ductal hyperplasia (ADH) lesions, and five radial scars. Mammographic follow-up was advised for the benign lesions without a repeat biopsy. RESULTS: Of the 310 benign lesions, 259 underwent mammographic follow-up at 6-85 months (median, 55 months) without repeat biopsy, 48 underwent repeat biopsy and three were lost to follow-up. On the basis of the histologic diagnosis of carcinoma at surgical biopsy, diagnosis with LCNB was not correct (i.e., disease was underestimated at histologic examination) in 14 (58%) of 24 ADH lesions and two (40%) of five radial scars. Two (1.2%) of 161 lesions with a final diagnosis of carcinoma were benign at LCNB but malignant at repeat biopsy (i.e., false-negative findings at LCNB). Repeat biopsy was prompted by mammographic progression at 6 and 18 months after LCNB. CONCLUSION: The false-negative rate with LCNB was 1.2% in this study and 4.0% in the literature. The presence of carcinoma in ADH and radial scar lesions was often underestimated.

Percutaneous removal of benign mammographic lesions: comparison of automated large-core and directional vacuum-assisted stereotactic biopsy techniques.

OBJECTIVE: The purpose of our study was to evaluate how often histologically benign lesions were completely removed as shown by the initial mammogram after biopsy. We compared three percutaneous biopsy techniques. MATERIALS AND METHODS: Retrospective review was performed on 1206 consecutive impalpable breast lesions having percutaneous stereotactic biopsies done on a prone biopsy table using 14-gauge automated large-core needles (n = 721); 14-gauge directional vacuum-assisted probes (n = 192); and 11-gauge directional vacuum-assisted probes (n = 293). Lesions that were histologically benign and that did not have subsequent surgical excision had mammographic follow-up. The 667 initial mammograms after biopsy (advised to be done at 6 or 12 months and accomplished at 1-53 months [median, 7 months] after biopsy) were reviewed to see if the lesions were no longer apparent. RESULTS: The lesion was absent in 9% (40/422) of lesions for which 14-gauge large-core biopsy was used, 22% (21/95) of lesions for which 14-gauge vacuum-assisted biopsy was used, and 64% (96/150) of lesions for which 11-gauge vacuum-assisted biopsy was used (p < .0001). No mammographic pseudolesions were created by the biopsy. No clinically significant complications occurred. CONCLUSION: The lesion was more often completely removed with directional vacuum-assisted biopsy than with automated large-core biopsy and more often completely removed with 11-gauge probes than with 14-gauge probes.

Needle-localized breast biopsy: why do we fail?

PURPOSE: To determine what factors are associated with unsuccessful needle-localized breast biopsy (NLBB). MATERIALS AND METHODS: Findings in 280 consecutive nonpalpable breast lesions in 262 women (age range, 27-87 years; mean age, 55 years) who underwent nonstereotactic, mammographically guided, standardized NLBB were retrospectively analyzed according to mammographic lesion type, lesion size, number of lesions per breast, needle type, proximity of needle to lesion, radiologist, specimen size, surgeon, and histologic findings. RESULTS: Biopsy failed in seven (2.5%) of 280 lesions. Failures were related to lesion type, lesion size, number of lesions per breast, accuracy of needle placement, and volume of tissue removed. Removal of more than one tissue specimen converted failure to success in 14 (67%) of 21 initially missed lesions, all microcalcifications. CONCLUSION: Unsuccessful NLBB was more likely with two lesions per breast, small lesions, small specimens, and microcalcifications. Piercing such lesions with the localizing needle led to successful biopsy. Removal of more tissue was helpful with missed microcalcifications.

Stereotaxic large-core needle biopsy of 450 nonpalpable breast lesions with surgical correlation in lesions with cancer or atypical hyperplasia.

PURPOSE: To determine whether histologic findings of cancer or atypical hyperplasia at large-core needle biopsy (LCNB) of nonpalpable breast lesions match histologic findings at excision. MATERIALS AND METHODS: Stereotaxic LCNB was performed with an automated prone unit, biopsy gun, and 14-gauge cutting needles in 450 nonpalpable breast lesions. Lesions classified as carcinoma or atypical ductal hyperplasia (ADH) at histologic examination after LCNB were excised. A pathologist retrospectively compared core and excisional histologic findings. RESULTS: Histologic comparison was performed in 116 of 135 carcinomas after LCNB. Histologic findings were concordant in 99 carcinomas. Partial discordance in 17 carcinomas led to an additional surgical procedure in one case. Histologic comparison was performed in 16 of 19 ADHs diagnosed with LCNB. Histologic findings were concordant in five and discordant in 11 ADHs. CONCLUSION: LCNB findings of carcinoma are accurate and allow definitive therapeutic surgery, including mastectomy. LCNB findings of ADH are inaccurate, and excisional biopsy is necessary.

A 7 year experience with low anterior sigmoid resections using the EEA stapler.

The EEA stapler was used in 205 patients over a 7 year period with 19 complications (9 percent) and 1 death (0.5 percent). Meticulous attention to technique and familiarization with the EEA stapler are necessary to achieve such results. The use of mechanical and oral antibiotic bowel preparation, perioperative systemic antibiotics, povidone-iodine irrigation of the rectal ampulla, and meticulous surgical technique have combined to lower the complication rate of this procedure to a minimum. The EEA stapler has greatly improved the safety and ease of anterior sigmoid resections and now provides a frequent alternative to abdominoperineal resection in many patients with midrectal and even low rectal lesions.

Impact of adjuvant chemotherapy on cosmesis and complications in stages I and II carcinoma of the breast treated by biopsy and radiation therapy.

Cosmesis and complication rates were examined in patients with early stage carcinoma of the breast treated by biopsy and radiation therapy with and without adjuvant chemotherapy in an attempt to determine the effect of chemotherapy upon these parameters. Between April 1, 1975 and June 1, 1980, 51 patients were treated with radiation therapy and adjuvant chemotherapy (XRT + ACT) and 83 patients with radiotherapy alone (XRT). Chemotherapy usually consisted of cytoxan, methotrexate and 5-fluorouracil for 6 or 12 cycles. Minimum follow-up was 36 months. Cosmetic results deteriorated with time in both groups but to a greater extent in the XRT + ACT group. At 36 months, excellent cosmetic results were obtained in 73 of the 83 patients (88%) in the XRT group compared to 37 of 51 patients (73%) in the XRT + ACT group (p = less than .05). Comparison of the two treatment groups revealed that complication rates were significantly increased in the XRT + ACT group. Of the 51 patients in the XRT + ACT group, 21 patients (41%) suffered complications compared to 8 (10%) of the 83 patients in the XRT group (p = less than .001). This difference in complication rates resulted primarily from an increased incidence in the XRT + ACT group of wet desquamation in the electron beam portal used to treat the internal mammary lymph nodes and a trend towards a higher incidence of spontaneous nonpathologic rib fractures, myositis and arm edema. An increased incidence of nonbreast primary cancers was not seen. Our preliminary conclusions are that adjuvant chemotherapy has a negative impact upon cosmesis and complication rates in patients being treated with definitive radiotherapy. However, cosmetic results remain satisfactory and complication rates are maintained at an acceptable level. Continued close follow-up will be required before definitive conclusions can be reached as to the overall incidence and severity of the changes noted.

Outpatient adult inguinal hernia repair.

Repair of adult inguinal hernia has been done on an outpatient basis at our surgical facility for the past six years. In 616 consecutive repairs, complications have been remarkably few: one patient was electively admitted to hospital, two hernias have recurred and one patient needed to be catheterized. Patient acceptance has been enthusiastic.

Bacteremia following cleft palate repair--a prospective study.

A prospective study of temperature patterns and blood cultures following cleft palate repair suggests that bacteremia in these cases is common. Twenty-seven years without serious complications supports the authors' view that antibiotic therapy is not indicated.

Biopsy and definitive radiation therapy in stages I and II carcinoma of the female breast.

One hundred-twenty patients with Stages I and II carcinoma of the female breast were treated by biopsy followed by definitive radiation therapy without mastectomy. The breast received 4500-5000 cGy (rad) using a 6 MV linear accelerator followed by a supplement to the area of the primary tumor of 2000 cGy (rad) using electrons in 99 patients (83%) and interstitial implantation in 21 patients (17%). Local recurrence was not recorded in the 43 patients with Stage I disease, while three of 77 patients (4%) with Stage II disease suffered a local recurrence. The actuarial five-year relapse-free survival was 91% and 60% in Stages I and II respectively. Cosmetic results were considered excellent by both physician and patient in the majority of cases. Axillary dissection was the recommended method of staging the axilla but was noted to be more morbid than axillary sampling. Electrons may be as effective as interstitial implantation as a means of supplementation following external beam therapy if specific guidelines are followed.