Benign breast lesions: Ultrasound.

Benign breast diseases constitute a heterogeneous group of lesions arising in the mammary epithelium or in other mammary tissues, and they may also be linked to vascular, inflammatory or traumatic pathologies. Most lesions found in women consulting a physician are benign. Ultrasound (US) diagnostic criteria indicating a benign lesion are described as well as US findings in the most frequent benign breast lesions.

Fine-needle biopsy of hepatic hemangioma with sonographic guidance.

Thirty-three focal hepatic lesions later proven to be hemangiomas underwent sonographically guided fine-needle aspiration biopsy. Indications for cytologic assessment were an atypical sonographic pattern in 11 cases, the need to differentiate from liver metastases in 12 patients with a history of neoplasm, and other indications in 10. The aspirated material consisted of blood alone in 24 cases; in the other nine cases, endothelial cells and/or agglomerates of capillaries were demonstrated also, and this was considered to be diagnostic. In one case, intratumoral bleeding was demonstrated sonographically, but no treatment was needed. The possible angiomatous nature of an hepatic lesion should not be considered an absolute contraindication to biopsy, provided that a fine needle is used and the optimal route to the lesion is chosen.

Massive lymphorrhoea after fine needle biopsy of the cystic haemolymphangioma of the liver.

Trauma to a hepatic haemangioma from a fine needle biopsy has not yet been reported and the theoretical high risk with 22-23 g needles in patients with this lesion tends to be minimised. Through misdiagnosis biopsy was ordered in one case of cystic haemolymphangioma of the liver in a patient being checked by ultrasonography for possible metastases. Aspiration was complicated by a massive peritoneal lymphorrhoea, which regressed completely in 15 days. The mechanics of the event and its possible effect on the pre-existing liver failure, held to be the direct cause of death three months later, is a matter of hypothesis.

Ultrasonography versus laparoscopy in the diagnosis of hepatic tumors.

129 patients, with suspected primary or secondary benign or malignant liver neoplasm after clinical, biochemical and/or instrumental investigation underwent liver ultrasound and laparoscopy. Echographic findings were compared with laparoscopy when liver neoplasms were detected by the latter. When laparoscopy was negative, to evaluate the diagnostic accuracy of the two methods employed, the following variously associated parameters were analysed: clinical follow-up, liver biochemistry, computed tomography, liver selective arteriography and explorative laparotomy. In the 129 patients examined, echography showed 86.7% diagnostic accuracy and laparoscopy 89.4%. The association of the two methods led to a diagnosis of hepatic lesion in 98.4% with no further diagnostic investigations. The two procedures can be considered complementary to such an extent that, in case of suspected primary or secondary liver neoplasm, the association of ultrasound and laparoscopy represents a quick and ultimate diagnostic approach. Furthermore, the association of these two procedures seems the least expensive and the most feasible, even in not particularly well equipped units.

[Radiologic aspects of non-Hodgkin lymphomas of the kidney]. / Les aspects radiologiques des lymphomes non-Hodgkiniens du rein.

The authors review a series of 992 patients presenting with non-Hodgkins lymphoma and treated by the Milan Cancer Institute between 1968 and 1977. Intravenous urography was performed in 237 cases but only revealed 9 patients (3.8%) with non-Hodgkin lymphoma. Comparison of this low percentage with the 35% shown by necropsy examinations (9 mths) highlights the difficulty of detecting this condition by urography. The authors therefore recommend completion of the diagnosis by other radiological techniques (CT scan, renalarteriography (3 cases) and non-invasive examinations (ultrasound scanning, or Ga67 scintigraphy).

Combined modes of imaging for liver hemangioma in cancer patients.

Twenty-nine consecutive patients with single or multiple liver hemangioma were assessed with more than one mode of imaging. Static scanning with 99Tcm was done in 21, ultrasonography in 28, CT in 29 and angiography in 27. Fine-needle percutaneous biopsy was unwisely performed in 7 cases with a single but singular complication, severe peritoneal lymphorrhea. Four laparotomies and 2 laparoscopies completed the investigations. Fourteen patients had a history of primary cancer, and 3 of these had a secondary coexisting with the angioma. CT was characteristic; ultrasonography was sensitive and perhaps specific enough for small angiomas. The 2 combined plus angio-CT greatly reduce the need for hepatic angiography.

[Echography and percutaneous fine needle biopsy]. / Ecografia e biopsia percutanea con ago sottile.

Echography, even if it is a procedure widely used in numerous protocols, is not devoid of diagnostic inaccuracy. However, when fine needle percutaneous biopsy is associated to echography, the diagnostic accuracy raises to 88%. This combined procedure is easily carried out, it is inexpensive, without discomfort to the patient and devoid of major complications. When it is performed, other more invasive techniques, such as arteriography or laparotomy may be useless. Methods of application and case-reports are illustrated.

[Fine needle biopsy with ultrasound guidance: 263 cases (author's transl)]. / La biopsia con ago sottile su guida ecografica: 263 casi.

The combination between ecography and fine needle aspiration biopsy has greatly speeded up diagnostic procedures. Often this technique is better than other more invasive and expensive investigations, such as angiography and laparotomy, for its high diagnostic accuracy, the limited upsetting of the patient, the absence of serious complications and the simplicity to perform it. Here are some information on the technique, on the indications and on the complications of the procedure. The results of 263 cases of abdominal biopsy are presented.