Cryoablation of benign breast tumors: evolution of technique and technology.

We report on improvements in cryoprobe design and techniques of cryoablation as a minimally invasive alternative to open surgery for the treatment of benign breast tumors. In the study, which was conducted in 12 centers, 124 lesions in 102 patients were monitored for a period of 12 months after cryoablation. Two different treatment techniques were used: Double HI FREEZE and Tailored Freeze. In patients treated with the Tailored Freeze technique significantly better results were recorded 12 months after the procedure: the median reduction in tumor volume was 91%, 73% of all tumors treated were nonpalpable, 84% of lesions less than 2.5 cm in maximum diameter were nonpalpable, and none of the 31 mammograms performed yielded abnormal findings. Patient satisfaction was good to excellent in 92% of the patients. The safety profile of this technique was excellent; all complications were minor. Evolution of cryoablation freezing techniques, coupled with improvements in cryoprobe design, has resulted in significant improvements in both safety and effectiveness.

Total cost comparison of 2 biopsy methods for nonpalpable breast lesions.

OBJECTIVE: To identify, quantify, and compare total facility costs for 2 breast biopsy methods: vacuum-assisted biopsy (VAB) and needle-wire-localized open surgical biopsy (OSB). STUDY DESIGN: A time-and-motion study was done to identify unit resources used in both procedures. Costs were imputed from published literature to value resources. A comparison of the total (fixed and variable) costs of the 2 procedures was done. PATIENTS AND METHOD: A convenience sample of 2 high-volume breast biopsy (both VAB and OSB) facilities was identified. A third facility (OSB only) and 8 other sites (VAB only) were used to capture variation. Staff interviews, patient medical records, and billing data were used to check observed data. One hundred and sixty-seven uncomplicated procedures (71 OSBs, 96 VABs) were observed. Available demographic and clinical data were analyzed to assess selection bias, and sensitivity analyses were done on the main assumptions. RESULTS: The total facility costs of the VAB procedure were lower than the costs of the OSB procedure. The overall cost advantage for using VAB ranges from $314 to $843 per procedure depending on the facility type. Variable cost comparison indicated little difference between the 2 procedures. The largest fixed cost difference was $763. CONCLUSIONS: Facilities must consider the cost of new technology, especially when the new technology is as effective as the present technology. The seemingly high cost of equipment might negatively influence a decision to adopt VAB, but when total facility costs were analyzed, the new technology was less costly.

The evolving practice pattern of the breast surgeon with disappearance of open biopsy for nonpalpable lesions.

BACKGROUND: Recent advances in technology have prompted growth in the surgeon's armamentarium for breast biopsy. For nonpalpable, mammographically detected lesions, the options include stereotactic needle/wire localization and open biopsy (SNL/OBx), stereotactic needle core biopsy (SNCB), and directional, vacuum-assisted biopsy (VAB; Mammotome). METHODS: A review of 372 patients with 424 breast lesions biopsied by the same surgeon between January 1993 and August 1997 was performed. RESULTS: SNCB and VAB procedures were less invasive and less morbid than SNL/OBx. Vacuum-assisted biopsy was superior to SNCB for sampling efficiency, with 74% of microcalcifications removed compared with 20% (P <0.0001). Additionally, underestimation of disease was seen with the SNCB technique, but not with VAB. Follow-up mammography found no false negative biopsies in any group. Over the 56 consecutive months, VAB progressively replaced SNL/OBx and SNCB as the procedure of choice. CONCLUSION: A breast surgeon can use VAB to replace open biopsy and core needle procedures for the initial biopsy of nonpalpable breast lesions.

Laparotomy for pelvic fracture.

To establish criteria for laparotomy, the records of 224 patients admitted with an acute pelvic fracture were reviewed. Forty-four patients underwent laparotomy; 2 had no intraabdominal injury. The mechanisms of injury was blunt trauma in 31 patients and gunshot wound in 13. All four patients who died had blunt trauma. Major or minor pelvic fracture classification did not predict intraabdominal visceral injury, except for bilateral pubic rami fractures, which were commonly associated with bladder rupture. The accuracy of the indications for laparotomy was calcualted and criteria were established. Signs of an acute abdominal disorder, the presence of a penetrating wound, abnormal findings on pyleography or cystography, persistent shock, evisceration, and diminished distal pulses, singly or in combination, had a 90 percent accuracy in indicating correctable traabdominal injury. Peritoneal lavage was less reliable, with a 57 percent accuracy. Additional criteria to be considered are enlarging palpable abdominal hematoma, fracture or dislocation with bony fragments protruding into the pelvis, signs of persistent bleeding, and rectal injury or a large perineal wound.