ABSTRACT
OBJECTIVE: To determine the diagnostic accuracy of ultrasonographically (US) and stereotactically guided fine needle aspiration cytology (FNAC) for the diagnosis of non-palpable breast lesions. PATIENTS AND METHODS: From January 2002 to December 2004, 470 women with 478 mammographically detected non-palpable breast lesions had US or stereotactically guided FNAC of the breast lesion. Subsequent histological evaluation of the same lesion was performed at the Institute of Oncology Ljubljana, Slovenia. The correlation between the original cytological and histological diagnosis was assessed and the sensitivity, specificity, positive predictive value and negative predictive value were calculated. RESULTS: Among US-guided FNACs, 144 (53.5%) were histologically verified benign lesions and 125 (46.5%) were carcinomas. Cytological diagnoses were: true positive (TP) in 63 cases (50.4%), suspicious in 35 (28%), false negative (FN) in eight (6.4%), and in 19 (15.2%) cases, the material was inadequate for diagnosis. In the stereotactically guided FNAC group, there were 209 women with 209 lesions, with 95 (45%) histologically proven carcinomas and 114 (55%) benign lesions. Cytological diagnoses were TP in 49 (51.6%) cases, true suspicious in 21 (22.1%), FN in nine (9.5%), and in 16 (16.8%) cases, the material was not adequate for the diagnosis. CONCLUSION: The sensitivity of 88.7% and specificity of 98.6% for US-guided FNAC and 84.5% and 100% for stereotactically guided FNAC, respectively, suggest that clinicians can rely upon cytological diagnosis for planning further management of women with non-palpable breast lesions.
Subject(s)
Biopsy, Fine-Needle/standards , Breast Diseases , Cytological Techniques/standards , Stereotaxic Techniques , Ultrasonography, Mammary , Adult , Aged , Aged, 80 and over , Breast Diseases/diagnosis , Breast Diseases/pathology , Female , Humans , Middle Aged , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity , Statistics as TopicABSTRACT
Our aim was to find out the factors influencing the complete excision of nonpalpable carcinoma. During a 2-year period, 215 patients (median age 55 years) underwent biopsy after wire localization of 222 nonpalpable breast lesions. Mammographic, surgical and pathological factors were correlated with the outcome of surgery using contingence tables in SPSS statistical software. A total of 96 carcinomas were diagnosed: 38 in situ and 58 invasive carcinomas. Surgical margins were clear in 43, close in 20 and involved in 33 cases. Factors correlated with clear surgical margins are mammographically spicular lesion, cytologically proven carcinoma, excision of more than 50 g of tissue, carcinoma smaller than 10 mm, invasive carcinoma without in situ component, and unicentric ductal carcinoma in situ ( p<0.05). Complete excision of multifocal in situ carcinoma or invasive carcinoma with extensive in situ component, which are diagnosed on mammogram as suspicious microcalcifications, remains a puzzling surgical task.
Subject(s)
Biopsy/methods , Breast Neoplasms/pathology , Breast/pathology , Breast Neoplasms/diagnostic imaging , Carcinoma in Situ/diagnostic imaging , Carcinoma in Situ/pathology , Carcinoma, Ductal, Breast/diagnostic imaging , Carcinoma, Ductal, Breast/pathology , Female , Humans , Middle Aged , Palpation , RadiographyABSTRACT
An old female patient presented after a car accident with clinical and sonographic evidence of two lesions, located along the seat-belt line. Despite the recent history of trauma and the localization in the traumatized area, the discrepancy between the sonographic size of the smaller lesion and the findings on palpation, together with the lack of typical mammographic findings for fat necrosis rose the suspicion of malignancy. A fine needle aspiration biopsy was performed to confirm the nature of the smaller lesion.
Subject(s)
Breast Neoplasms/complications , Breast/injuries , Fat Necrosis/complications , Ultrasonography, Mammary , Accidents, Traffic , Aged , Breast Neoplasms/diagnostic imaging , Diagnosis, Differential , Fat Necrosis/diagnostic imaging , Fat Necrosis/etiology , Female , Humans , MammographyABSTRACT
The appearance of a sarcoma of bone is a well-recognized complication of Paget's disease. The most common type of such a sarcoma is osteosarcoma. Much less common are soft tissue lesions adjoining the pagetic bone that clinically and radiologically simulate sarcoma but histologically represent exaggerated periosteal bone formation as a manifestation of the basic pathologic process. We present a case of a bulky juxtacortical soft tissue mass in the thigh arising from a pagetic femur in a 62-year-old patient with polyostotic Paget's disease that was clinically and radiologically suspected to be a juxtacortical osteosarcoma. Microscopically, the lesion showed features of florid Paget's disease without any evidence of sarcomatous growth. It is important to be aware of this rare manifestation of Paget's disease to avoid unnecessary overtreatment.
