Four hundred forty-seven needle biopsies of the lung were carried out on 348 patients in a nonhospital outpatient setting. There were no fatalities or serious complications. A reliable working diagnosis was obtained in 74% of patients (86% true positive for malignancy). Diagnostic thoracotomy was avoided in 31%, and the diagnostic interval was shortened in most. Impressive economic benefits resulted. Careful postbiopsy evaluation revealed pneumothorax in 41% of patients, with 10% requiring chest tube drainage, usually on an ambulatory basis. With management of the infrequent complications by the radiologist, outpatient needle biopsy of the lung can be safe, reliable, and highly cost effective.
Six cases of benign hemorrhagic renal cyst are presented. Although these masses resembled cysts on nephrotomography and arteriography, exclusion of malignant disease was difficult on cyst puncture and gross surgical inspection. The aspirated fluid contained degenerating hemorrhagic material in all cases, malignant cells in none, and fat in one. Contrast medium injected into the cyst showed the cavity to be irregular in three and smooth in three. A presumptive diagnosis is possible by a combination of tests. Diagnosis was confirmed by surgery in two patients and by autopsy in one. Nephrectomy can be avoided.
I read with interest the article by Kettritz et al.1 regarding the accuracy of stereotactic 11-gauge vacuum-assisted breast biopsy (VAB) for diagnosing breast cancer in nonpalpable breast lesions. Of the 2893 VAB procedures performed, 19 (0.7%) yielded findings that were not representative, whereas 2874 were performed successfully. Atypical ductal hyperplasia (ADH), which was diagnosed in 141 lesions, was upgraded to cancer in 32 of 135 lesions that underwent surgical excision. No follow-up information was available for lobular carcinoma in situ (LCIS), which was diagnosed in 18 cases. Benign histology was diagnosed in 2090 lesions, with cancer going undetected in 1 of 24 lesions that underwent surgical excision. The false-negative rate was defined as the percentage of lesions diagnosed as being benign on VAB that later proved to be malignant. This rate, which was calculated excluding nonrepresentative lesions and including benign lesions with (n = 1438) or without (n = 628) follow-up imaging data, was 0.05% (1 of 2090). Although the reported results are impressive, I believe that the analysis may overstate the accuracy of this technique. I prefer an alternative false-negative rate, defined as the percentage of pathologically confirmed malignant lesions that yielded benign stereotactic biopsy findings without findings of atypia or high-risk lesions.2 This approach requires delineation of atypical and high-risk lesions (including ADH and, variably, LCIS, atypical lobular hyperplasia, radial scar, papilloma, and/or benign phyllodes tumor), knowledge of the total number of cancers found in the study group at any time, and knowledge of how many of those cancers yielded benign (including discordant or nonrepresentative) findings on original biopsy. False-negative rates calculated in this manner have been reported for stereotactic 11-gauge VAB2, 3 and automated 14-gauge large-core needle biopsy.2, 4, 5 To calculate this alternative false-negative rate for the study conducted by Kettritz et al.,1 more data are needed. For the 19 nonrepresentative lesions and the 18 lesions diagnosed as LCIS, we must know how many of each were rebiopsied and how many cancers subsequently were identified. The total number of cancers among the 2893 lesions evaluated with VAB equals the number of cancers detected on rebiopsy of nonrepresentative lesions and rebiopsy of lesions diagnosed as LCIS plus the number of cancers detected on VAB (n = 625), rebiopsy of lesions diagnosed as ADH (n = 32), and rebiopsy of lesions found to be benign (n = 1). The total number of false-negative lesions equals the number of cancers found on rebiopsy of nonrepresentative lesions plus the one cancer detected on rebiopsy of a lesion that initially was found to be benign.
Mammographic Abnormalities Caused by Percutaneous Stereotactic Biopsy of Histologically Benign Lesions Evident on Follow-Up MammogramsRobert L. Lamm1 and Roger J. JackmanAudio Available | Share
Percutaneous removal of benign mammographic lesions: comparison of automated large-core and directional vacuum-assisted stereotactic biopsy techniques.R J Jackman, F A Marzoni, Jr and K W NowelsAudio Available | Share
PURPOSE: To describe our experience with stereotactic histologic biopsy in patients with breast implants. MATERIALS AND METHODS: Thirty-one (1.3%) of 2,399 consecutive lesions on which stereotactic histologic biopsy was performed were in breasts containing implants. Biopsy difficulties were evaluated for lesions in breasts with and breasts without implants. Biopsy was performed on lesions in patients with implants prone on a dedicated table, with automated large-core (n = 13) or directional vacuum-assisted (n = 18) devices. Follow-up was surgical (11 of 11 malignancies and two of three high-risk lesions) and mammographic (one of three high-risk lesions and 17 of 17 benign lesions). RESULTS: There were no implant ruptures, hematomas requiring drainage, infections requiring treatment, false-negative findings, or histologic underestimations. Difficulties with stereotactic histologic biopsy were more prevalent in breasts with implants and included positioning problems in 10 (50%) of 20 lesions in breasts with subglandular implants and zero (0%) of 10 with subpectoral implants, lesions seen on only one view in four (13%) of 31 lesions, specimen radiographs negative for calcifications in two (10%) of 20 lesions, prominent bleeding in two (6%) of 31 lesions, and suboptimally small tissue samples in three (10%) of 31 lesions. CONCLUSION: Stereotactic histologic biopsy is safe in breasts with implants. Compared with that in breasts without implants, biopsy is often technically more difficult and may eventually prove less accurate.
Stereotactic Histologic Biopsy with Patients Prone: Technical Feasibility in 98% of Mammographically Detected LesionsRoger J. Jackman1 and Francis A. Marzoni, Jr.2Audio Available | Share
