Colour-duplex echography in atherosclerotic carotid artery disease.

The first and larger part of this article is devoted to a brief review of colour duplex echography of atherosclerotic lesions of the carotid artery: history, basic principles, technique, and diagnostic value. The authors, a vascular surgical team, witness from their own experience, with due attention to surgical practice. In the last part concerning duplex-based surgical decision, the results of a small scale trial conducted in 1996 in their department are presented: in 36 consecutive operated cases, the operative data and excised plaque were compared to the preoperative colour-duplex data regarding degree of stenosis, geometry of the lesion, and plaque composition. Results were expressed as perfect, fair, poor: stenosis (33, 2, 1), geometry (27, 5, 4), plaque (20, 10, 6). The surgical decision appeared perfectly justified in 35 cases (97%). It is concluded that colour-duplex echography is invaluable in the management of carotid artery atherosclerotic disease and that carotid artery surgery may generally be performed after a "duplex only" investigation. Every laboratory should make continuous efforts in monitoring and improving its own quality.

Incidence of invasive versus non-invasive carcinoma in comparing palpable and non-palpable solid breast lesions.

A retrospective study was done of all patients with a suspicious mammographic breast lesion surgically biopsied in our institution within the last 5 years. Incidence of invasive versus non-invasive carcinoma and stage at presentation (according to TNM classification system) of palpable and non-palpable lesions were compared. We found a significant difference of non-invasive carcinoma in non-palpable and palpable cancers: 42.2% versus 4.3% (p < 0.001). Patients with a non-palpable invasive carcinoma presenting at stage I (i.e. pT1 with no axillary metastasis) rated significantly higher compared to those with palpable lesions 51.8% versus 9.4% (p < 0.001). The true positive biopsy rate is 30%. As low as 10% has been considered reasonable. We have a total of 56% carcinomas detected on all biopsies: 30% for non-palpable lesions and 66.8% for palpable lesions. A more aggressive approach towards screening and biopsy of breast lesions might increase early detection of carcinoma and so improve survival.