Tubular carcinoma of the breast: sensitivity of diagnostic techniques and correlation with histopathology.

OBJECTIVE: Our objective was to assess our experience in diagnosing pure tubular carcinoma of the breast and to correlate the radiologic and histopathologic features. MATERIALS AND METHODS: A retrospective review of 932 consecutive cases of proven breast cancer diagnosed between 1990 and 1997 revealed 78 cases (8.4%) of tubular carcinoma in 69 patients. Clinical, imaging, cytologic, and histologic findings were analyzed. RESULTS: Mammography revealed tubular carcinoma in 68 (87%) of the 78 cases. Sonography showed tubular carcinoma in all 38 cases in which it was used; nine of these lesions were mammographically occult. These nine lesions were slightly, but not significantly (p < .05), smaller than the 29 lesions that had also been detected on mammography. Large core needle biopsy was performed in 22 patients (sensitivity, 91%). At biopsy, diagnoses were malignant (n = 16 [73%]), suspicious (n = 4 [18%]), atypia (n = 1 [4.5%]), and benign (n = 1 [4.5%]). Fine-needle aspiration biopsy was used to evaluate 36 cases of tubular carcinoma (sensitivity, 50%); cytologic diagnoses were malignant (n = 15 [42%]), suspicious (n = 3 [8%]), atypia (n = 10 [28%]), and benign (n = 8 [22%]). Only 15 (19%) of the 78 tubular carcinomas were palpable. Other tumors were detected within the excised tissue in 47 of the patients (68%); of these other types of lesions, ductal carcinoma in situ was found most often. CONCLUSION: Most cases of tubular carcinoma can be revealed by mammography; for mammographically occult tubular carcinoma, sonography can be performed. The rate of accuracy for determining the presence of tubular carcinoma is higher with large core needle biopsy than with fine-needle aspiration biopsy. Finally, when tubular carcinoma is diagnosed, other histologic types of carcinoma often occur in the same breast.

Localization of breast lesions identified on one mammographic view: the skin-pinch technique.

Mammographic abnormalities may occasionally be seen on only one view. With a simple method, preoperative needle localization of such clinically occult lesions can be performed. The technique involves use of the relative mobility of the skin and subcutaneous tissue of the breast compared with that of the more fixed parenchymal cone. Geometric ratios and changes in tube angulation are unnecessary with this approach.

Drug-resistant tuberculosis in an urban population including patients at risk for human immunodeficiency virus infection.

In the past 5 yr, an increased incidence of tuberculosis has been noted in the United States. Simultaneously, the population infected with human immunodeficiency virus-type I (HIV-I) and the number of cases of acquired immunodeficiency syndrome (AIDS) have increased. Selected areas of the United States have also reported increases in the frequency of drug-resistant isolates of Mycobacterium tuberculosis. Because our institution serves a population in which tuberculosis, AIDS, and drug resistant isolates of M. tuberculosis are frequently encountered, we sought to better define interrelationships among these factors by retrospectively reviewing the demographic, clinical, bacteriologic, and radiologic data for all adult patients in whom M. tuberculosis was isolated from a culture of respiratory-tract secretions during a 1-year period (June 1, 1988 to May 31, 1989). Two hundred forty-six patients were thus identified; 66.5% were U.S. born blacks, and 62.6% were 17 to 40 yr of age. Risk factors for HIV infection were present in 106 patients. The overall resistance rate (one or more drugs) = 30.9%, with primary resistance = 22.6% (35 of 155) and secondary resistance = 49.2% (29 of 59). In addition, 12 resistant isolates were found in 32 patients whose prior treatment status was indeterminate. Of the resistant isolates, 56.6% (43 of 76) were multiply resistant. Isoniazid resistance was noted in 90.7% (69 of 76) and rifampin resistance was noted in 50% (38 of 76) of the resistant isolates. No significant differences in the overall frequency of resistance were noted in patients at risk for HIV infection compared with those without these risks.(ABSTRACT TRUNCATED AT 250 WORDS)

Steatocystoma multiplex: appearance at mammography.

The authors present mammographic findings in a patient with steatocystoma multiplex. Numerous oil cysts were seen in both breasts at mammography. The mammographic appearance is characteristic of, if not pathognomonic for, steatocystoma multiplex.

Autourethrography.

"Autourethrography," a technique of retrograde urethrography in which the patient injects the contrast material, was used on 22 patients. The results of the study were compared with the results of nonemergency retrograde urethrography performed on 22 patients during an earlier 1-year period. The following observations of the autourethrography group were made. Patient tolerance was enhanced, with less discomfort and anxiety. There was no extravasation of contrast material outside the urethra, compared with extravasation in three of 22 patients (14%) in the control group for whom conventional techniques were used. Retrograde opacification of the posterior urethra was achieved in 20 of 22 patients (91%) in the autourethrography group, compared with 13 of 22 patients (59%) in the control group. Radiation exposure to the examining radiologist was eliminated. Autourethrography is a technique that has important benefits for both the radiologist and the patient.