The role of freehand needle core biopsy in the diagnosis of isolated axillary lymphadenopathy.

Patients with isolated axillary lymphadenopathy are often referred to rapid-access breast clinics for diagnostic evaluation. In the absence of a discernable breast primary, tissue diagnosis has conventionally been pursued using open biopsy. We aimed to assess the value of freehand needle core biopsy (FNCB) as an alternative to this. A prospective audit was conducted over 6 years from 2002 to 2008. Twenty-eight procedures were performed, all carried out under local anaesthesia in the outpatient setting. The majority of cases (10) revealed metastatic breast cancer. Other diagnoses included metastatic ovarian cancer (2), metastatic melanoma (3), lymphoma (4), silicone granuloma (1) and chronic lymphocytic leukemia (1). Seven patients had inconclusive histology necessitating further open biopsy. This revealed primary lymphoma in 6 cases and benign histology in one. FNCB thus avoided the need for diagnostic excision biopsy in 75% (21/28) patients. However, it was found to be less useful in diagnosing de-novo lymphoma.

Serosal appendicitis: incidence, causes and clinical significance.

BACKGROUND: Serosal appendicitis is a histopathological diagnosis of an inflammatory reaction on the surface of the appendix caused by an extra appendiceal source of inflammation. OBJECTIVE AND METHODS: A retrospective review of a pathology database in a district general hospital identified patients with serosal appendicitis and a preoperative diagnosis of appendicitis. Two groups emerged: patients with serosal appendicitis secondary to a known cause of intra-abdominal inflammation and those in whom the cause remained unknown. The groups were compared with respect to postoperative complications, referral to outpatient clinics, admissions and procedures by case-note analysis. RESULTS: The incidence of serosal appendicitis was 0.01% (19/1379); 17 women; mean age 31.63 (10.49) years. Lanz incision was used in 16 patients, midline laparotomy in two and laparoscopy in one. A preoperative ultrasound scan was carried out in 5 of 19 patients. The cause of serosal appendicitis was confirmed in eight patients (intraoperatively or postoperatively) and remained unknown in 11 patients. The groups were comparable with respect to age, sex and mean follow-up. No significant difference was observed between them with respect to the above parameters. CONCLUSIONS: No further investigation is necessary in patients who undergo an appendicectomy but in whom the pathological diagnosis is serosal appendicitis. However, considering the patient demographics and the fact that patients with serosal appendicitis have probably undergone an unnecessary appendicectomy, the proportion of patients who underwent ultrasound scanning and diagnostic laparoscopy was small.