Bibliothek

Notizen: The purpose of this study was to assess the accuracy of stereotactic vacuum-assisted biopsy (SVAB) for the diagnosis of high-risk lesions, which include papillary lesions and atypical lobular hyperplasia (ALH). Retrospective review was performed of 212 consecutive SVABs at our institution between May 1, 2000 and February 28, 2001. Biopsies were performed using an 8-gauge SVAB probe, with the patient prone on a dedicated stereotactic table. Eleven to 17 cores (mean 12.4) were harvested from each lesion. Radiography of core specimens was performed in cases in which the targeted lesion contained microcalcifications. Six of the lesions (2.8%) demonstrated intraductal papilloma, 1 (16.7%) of which had features suggestive of a radial scar, and 7 (3.3%) demonstrated ALH. Surgical excision was performed on 3 of the 6 (50%) papillomas and all 7 (100%) cases of ALH. Histopathologic analysis at surgical excision demonstrated benign breast tissue in 1 of the papillomas (33.3%), radial scar in 1 (33.3%), and atypical ductal hyperplasia (ADH) in 1 (33.3%). One papilloma not surgically excised underwent repeat mammography at 6 months and demonstrated no change. Of the surgically excised lesions with ALH, 4 (57.1%) retained the diagnosis of ALH, though one of these (25%) also demonstrated a coexisting radial scar. One lesion (14.3%) demonstrated ductal carcinoma in situ (DCIS), 1 (14.3%) demonstrated lobular carcinoma in situ (LCIS), and 1 (14.3%) demonstrated fibrocystic change. Lesions diagnosed as papillomas at SVAB did not demonstrate malignancy, but 2 (66.7%) were found to contain high-risk lesions that may impact surveillance or prophylactic therapy (i.e., tamoxifen). Because of the relatively small series reported, additional studies are necessary to further assess the accuracy of SVAB in the diagnosis of benign papillary lesions. ALH diagnosed with SVAB that underwent subsequent surgical excision demonstrated cancer in 1 of 7 lesions (14.3%). This rate of cancer underestimation is similar to that seen with ADH diagnosed with SVAB, which warrants surgical excision to rule out malignancy. Therefore we recommend that lesions demonstrating ALH at SVAB be considered for surgical excision to rule out malignancy.

Notizen: Abstract:   The increased interest in the use of neoadjuvant chemotherapy for patients with locally advanced or large tumors at initial presentation necessitates the recognition of sequelae of this therapy. This article describes the interval appearance of malignant, linear-branching, microcalcifications during neoadjuvant chemotherapy for locally advanced breast cancer. Mammographically the malignant microcalcifications appeared only in the region of the breast where the primary tumor was found. Pathologically only a subpopulation of malignant cells responded to the chemotherapy, demonstrating viability of the majority of the tumor, with cell death only in the subpopulation. With the increased use of neoadjuvant chemotherapy, it is important to recognize previously undescribed mammographic findings secondary to this therapeutic approach. 

Notizen: ▪ Abstract: Determination of needle length for needle localization of nonpalpable breast lesions prior to surgical excision biopsy may occasionally be problematic. A method for more accurate needle length determination is presented for use when uncertainty arises. This method was evaluated in 46 consecutive lesions targeted for excision biopsy following mammographically guided needle localization. ▪

Notizen: ▪Abstract: The purpose of this study was to compare the mammographic findings of patients with HIV infection and age-matched controls and to correlate these findings in patients with HIV infection to their CD4 counts. A case-control study of the mammograms of 67 HIV-infected women and 58 age-matched controls was performed and compared for any statistically significant differences in the number, size, density, and bilaterality of axillary lymph nodes. Similar analysis of intramammary nodules and calcifications was made. These findings were correlated with the patient’s CD4 counts. The presence of axillary nodes and bilaterality of the nodes was equivalent in both HIV-positive patients and controls. However, the nodes of HIV-infected women were statistically larger and denser. When the criteria of large (〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:1075122X:TBJ134:ges" location="ges.gif"/〉2 cm), absent, fatty hilum and increased density were used in this study, the presence of HIV infection was high. Benign-appearing nodules and calcifications were equally common in HIV and control patients. CD4 counts did not correlate with any of the axillary node or intramammary nodule features. In patients with large (〈inlineGraphic alt="geqslant R: gt-or-equal, slanted" extraInfo="nonStandardEntity" href="urn:x-wiley:1075122X:TBJ134:ges" location="ges.gif"/〉2 cm), dense axillary nodes without fatty hila, the diagnosis of HIV infection should be considered. ▪