Freehand 3T MR-guided vacuum-assisted breast biopsy (VAB): a five-year experience

2017 ◽  
Vol 59 (5) ◽  
pp. 540-545 ◽  
Author(s):  
Licia Gristina ◽  
Giuseppe Rescinito ◽  
Alessandro Garlaschi ◽  
Simona Tosto ◽  
Luca Cevasco ◽  
...  
Keyword(s):  
Breast Biopsy ◽  
Ductal Carcinoma ◽  
False Negative ◽  
Surgical Pathology ◽  
Benign Lesions ◽  
Imaging Results ◽  
Malignant Lesions ◽  
3T Mr

Background Magnetic resonance (MR) permits the detection of some malignant lesions that cannot be identified with mammography or ultrasonography. The characterization of these MR-only detectable lesions often requires a biopsy. Purpose To evaluate the technique, the feasibility and the accuracy of freehand 3T MR-guided VAB for the characterization of suspicious, MR-only detectable lesions and to compare VAB results with surgical pathology and follow-up imaging results. Material and Methods During 2010–2015, 118 women who were referred for MR-guided VAB were retrospectively reviewed. All BI-RADS MR 4 and 5 lesions and some BI-RADS MR 3 lesions (according to clinical context and patient anxiety) were scheduled to undergo biopsy. Results A total of 123 suspicious lesions were retrospectively selected. Technical failures occurred in only two cases (1.6%) due to the location of the lesions. Histopathological results revealed 59 benign lesions (48%), 27 high-risk lesions (22%), and 35 malignant lesions (28.4%). Surgical pathology results led to the reclassification of eight B3 lesions: one proved to be a ductal carcinoma in situ, while seven presented with invasive features. B3 underestimation also occurred in 29% of the cases. MR follow-up was achieved for all the benign lesions and no false-negative cases were observed. No complications, 3T-related artefacts, or difficulties were observed. Conclusion Freehand 3T MR-guided VAB was found to be a valid, safe, fast, and inexpensive alternative to surgical histology.

Advantages and Challenges of Using Breast Biopsy Markers

2021 ◽  
Author(s):  
Taghreed I Alshafeiy ◽  
Alison Matich ◽  
Carrie M Rochman ◽  
Jennifer A Harvey
Keyword(s):  
Breast Biopsy ◽  
Percutaneous Biopsy ◽  
Standard Of Care ◽  
Benign Lesions ◽  
Accurate Identification ◽  
Biopsy Tissue ◽  
Local Practices ◽  
Frequency Of Use ◽  
Lesion Localization

Abstract Percutaneous image-guided biopsy procedures are the standard of care for histologic assessment of suspicious breast lesions. Post-biopsy tissue markers (clips) optimize patient management by allowing for assessment on follow-up imaging and precise lesion localization. Markers are used to ensure accurate correlation between imaging modalities, guide preoperative localization for malignant and high-risk lesions, and facilitate accurate identification of benign lesions at follow-up. Local practices differ widely, and there are no data detailing the exact frequency of use of clips for different breast biopsies. There are many indications for biopsy marker deployment, and some difficulties may be encountered after placement. The placement of biopsy markers has many advantages and few disadvantages, such that deployment should be routinely used after percutaneous biopsy procedures with rare exception.

scholarly journals Prevalence of c-myc expression in breast lesions associated with microcalcifications detected by routine mammography

2009 ◽  
Vol 127 (2) ◽  
pp. 66-70 ◽  
Author(s):  
Renato Coimbra Mazzini ◽  
Simone Elias ◽  
Afonso Celso Pinto Nazário ◽  
Cláudio Kemp ◽  
Ângela Flávia Logullo
Keyword(s):  
Breast Imaging ◽  
Ductal Carcinoma ◽  
Percutaneous Biopsy ◽  
Screening Mammography ◽  
University Hospital ◽  
Premalignant Lesions ◽  
Breast Lesions ◽  
Benign Lesions ◽  
Cross Sectional ◽  
Malignant Lesions

CONTEXT AND OBJECTIVE: Genetic abnormalities in cell proliferation-regulating genes have been described in premalignant lesions. The aims here were to evaluate c-myc protein expression in non-palpable breast lesions associated with microcalcifications, detected by screening mammography, and to compare these results with histopathological, clinical and epidemiological variables. DESIGN AND SETTING: Analytical cross-sectional study, with retrospective data collection, in a university hospital in São Paulo. METHODS: Seventy-nine female patients who underwent routine mammography between 1998 and 2004 were studied. Lesions classified by the Breast Imaging Reporting and Data System (BI-RADS) as 4 or 5 underwent percutaneous biopsy using a large-core needle. Ninety-eight lesions were studied anatomopathologically. Paraffin blocks properly representing the lesions were selected for immunohistochemical analyses using the streptavidin-biotin-peroxidase technique with monoclonal mouse c-myc antibodies. RESULTS: Among the 98 lesions, 29 (29.6%) contained malignant neoplasia; 40 (40.8%) had a positive immunohistochemical reaction for c-myc. When the groups were divided between lesions without atypias versus atypical lesions plus malignant lesions, 31.03% of the 58 lesions without atypias were positive for c-myc and 55% of the 40 malignant and atypical lesions (P = 0.018). Comparing the atypical lesions with ductal carcinoma in situ versus the benign lesions without atypias, c-myc was present in 51.61% of the 31 atypical lesions and 31.03% of the benign lesions without atypias (P = 0.057). CONCLUSION: C-myc protein was more frequently expressed in atypical and malignant lesions than in benign lesions without atypias. C-myc expression correlated with the presence of atypias (P = 0.018).

scholarly journals Role of Acoustic Radiation Force Impulse Elastography in the Characterization of Focal Solid Hepatic Lesions

2018 ◽  
Vol 8 ◽  
pp. 5 ◽  
Author(s):  
Harshavardhan Nagolu ◽  
Sudhakar Kattoju ◽  
Chidambaranathan Natesan ◽  
Meera Krishnakumar ◽  
Sunil Kumar
Keyword(s):  
Acoustic Radiation ◽  
Radiation Force ◽  
Acoustic Radiation Force ◽  
Acoustic Radiation Force Impulse ◽  
Benign Lesions ◽  
Metastatic Lesions ◽  
Arfi Elastography ◽  
Malignant Lesions ◽  
2D Imaging

Objective: The purpose of the study is to investigate the usefulness of acoustic radiation force impulse (ARFI) elastography in the characterization of focal solid liver lesions as benign, malignant, or metastatic using ARFI two-dimensional (2D) imaging and ARFI quantification (shear wave velocities [SWVs]). Materials and Methods: Sixty lesions were included in this study. The lesions were classified into three groups: Group I included benign lesions (n = 25), Group II included malignant lesions (n = 27), and Group III included metastatic lesions (n = 8). ARFI elastography was performed in all these patients using a Siemens ACUSON S 2000™ ultrasound machine. Stiffness and size of the lesions were assessed on ARFI 2D images in correlation with B-mode ultrasound images. SWVs were obtained in these lesions for the quantification of stiffness. Results: In ARFI 2D images, malignant lesions were predominantly stiffer and larger, while benign lesions were softer and similar in size (P < 0.05). The mean SWVs in benign, malignant, and metastatic lesions were 1.30 ± 0.35 m/s, 2.93 ± 0.75 m/s, and 2.77 ± 0.90 m/s, respectively. The area under receiver operating characteristic curve of SWV for differentiating benign from malignant lesions was 0.877, suggesting fair accuracy (95% confidence interval: 0.777–0.976); with a cutoff value of 2 m/s, showing sensitivity: 92%; specificity: 96%; positive predictive value: 96%; negative predictive value: 93% (P < 0.05). Statistically significant difference exists in SWV of benign and malignant or metastatic lesions. Conclusion: ARFI elastography with 2D imaging and quantification might be useful in the characterization of benign and malignant liver lesions.

Compliance with Short-Interval Follow-up MRI after Benign Concordant MRI-guided Breast Biopsy

2020 ◽  
Author(s):  
Shruthi Ram ◽  
Helaina Regen-Tuero ◽  
Grayson L Baird ◽  
Ana P Lourenco
Keyword(s):  
Breast Biopsy ◽  
Short Interval ◽  
False Negative ◽  
False Negative Rate ◽  
Negative Rate ◽  
Guided Biopsy ◽  
Institutional Review ◽  
Biopsy Report ◽  
Mri Guided

Abstract Objective To evaluate compliance with short-interval follow-up MRI after benign concordant MRI-guided breast biopsy. Methods This institutional review board-approved retrospective study included all benign concordant MRI-guided biopsies performed between January 1, 2010, and May 1, 2018. The following was collected from the electronic medical record: patient and lesion characteristics, short-interval follow-up MRI recommendation, communication to referring physician, follow-up imaging, repeat biopsies, biopsy outcome, and patient insurance status. Compliance with recommendations was defined as follow-up MRI within 9 months of biopsy. Results Among 98 patients, there were 107 lesions with benign concordant MRI-guided biopsy results that met study criteria. After excluding 7 patients who underwent subsequent mastectomy, 50/91 (54.9%) patients were recommended short-interval follow-up MRI. Of these, 33/50 (66.0%) had a short-interval follow-up MRI. Direct communication of the short-interval follow-up recommendation was documented in the biopsy report for 4/50 (8%) patients. Subsequent MRI was available for 77/107 (72%) lesions at a median of 29 months following MRI-guided biopsy (range, 3–96 months). Subsequent mammography was available for 21/30 (70%) remaining lesions at a median of 47 months following MRI-guided biopsy (range, 23–88 months). There were two repeat biopsies, with one subsequent malignancy, resulting in a false-negative rate of 0.9% (1/107). Conclusions When short-interval follow-up MRI was recommended following benign concordant MRI-guided breast biopsy, compliance was 66.0%. Lack of communication of the recommendation may at least partially explain the low compliance. The low false-negative rate (0.9%) suggests routine short-interval follow-up MRI may be unnecessary following benign concordant MRI-guided biopsy.

99mTc sestamibi scintimammography

2004 ◽  
Vol 43 (01) ◽  
pp. 16-20
Author(s):  
E. Derebek ◽  
P. Balcı ◽  
M. A. Koçdor ◽  
B. Değgirmenci ◽  
T. Canda ◽  
...  
Keyword(s):  
False Negative ◽  
Malignant Lesion ◽  
Excisional Biopsy ◽  
Breast Lesions ◽  
Benign Lesions ◽  
Complementary Method ◽  
Diagnostic Role ◽  
Malignant Lesions ◽  
Palpable Breast ◽  
99Mtc Sestamibi

Summary Aim: Investigation of the diagnostic role of technetium-99m methoxyisobutylisonitrile (99mTc sestamibi) scintimammography in non-palpable, suspicious breast lesions described as microcalcification, mass and increased density using mammography. Patients, method: 35 women with non-palpable breast lesions were enrolled in the study. Anterior, left and right lateral, ipsilateral posterior oblique images were obtained 15 min after the injection of 740 MBq of 99mTc sestamibi. All scintigraphic images were evaluated visually and focal increased 99mTc sestamibi uptake was accepted as malignant lesion. Breast lesions were classified as microcalcification (13 women), mammographic mass (16 women) and increased density (6 women). Excisional biopsy was performed in all of them irrespective of the scintigraphic results. Results: The focally increased 99mTc sestamibi uptake was seen in 11 breast lesions with malignant lesions and in 4 breast lesions with benign lesions. The diffuse uptake of 99mTc sestamibi was seen in 18 breast lesions with benign lesions and 2 breast lesions with malignant lesions. There was no false positive result of 99mTc sestamibi in microcalcification group and there was no false negative result of the mammographic mass and increased density groups. Conclusion: Scintimammography might be a complementary method in decision making for the non-palpable, suspicious breast lesions that were evaluated as microcalcification, mass and increased density mammograpically.

Rare pulmonary tumors and carcinoma mimickers; experience from an interventional radiology unit with radiologic-pathologic correlation-A pictoral essay

2021 ◽  
Vol 17 ◽  
Author(s):  
Emre Ünal ◽  
Sevtap Arslan ◽  
Gulnar Aghayeva ◽  
Yasin Sarıkaya ◽  
Türkmen Çiftçi ◽  
...  
Keyword(s):  
False Negative ◽  
Clinical History ◽  
Ct Scans ◽  
Pulmonary Lesions ◽  
Pathologic Correlation ◽  
Pet Ct ◽  
Malignant Lesions ◽  
Slow Growing ◽  
Pulmonary Tumors

Background: Although imaging findings along with patients’ clinical history may give clue for the etiology of a pulmonary lesion, the differentiation of benign pulmonary lesions from lung cancer could be challenging. Objective: The aim of this review article was to increase the awareness of the carcinoma mimicking lung lesions. Methods: This paper was designed to illustrate rare pulmonary tumors and carcinoma mimickers with emphasis on radiologic-pathologic correlation. Pitfalls encountered on CT images and also false positivity of PET-CT scans were also presented. Conclusion: Several benign pulmonary lesions may grow in size on follow-up and some may show pathologic FDG (18F-fluorodeoxyglucose) uptake, which makes them indistinguishable from lung carcinoma by imaging. In addition, some slow-growing malignant lesions, such as carcinoid, may be false-negative on PET/CT scans.

The Medicolegal Aspect of Error in Pathology: A Search of Jury Verdicts and Settlements

2007 ◽  
Vol 131 (4) ◽  
pp. 615-618
Author(s):  
Michael J. Kornstein ◽  
Sean P. Byrne
Keyword(s):  
Medical Errors ◽  
Medical Malpractice ◽  
Breast Biopsy ◽  
False Negative ◽  
Clinical Pathology ◽  
Surgical Pathology ◽  
Legal Cases ◽  
Jury Verdict ◽  
Fine Needle Aspirates ◽  
Jury Verdicts

Abstract Context.—Identifying medical errors is a topic of current attention. Among the various approaches is the study of medical malpractice cases. Objective.—To identify the most common medical errors involving the practice of pathology from a medicolegal perspective by analysis of published jury verdict and settlement reports. Design.—Search approximately 50 publications that gather jury verdict and settlement information using LexisNexis, an on-line searchable archive, for pathology-related cases. Results.—One hundred seventy-one legal cases were identified from 1988 through 2005. Nearly one-half involved surgical pathology; among the remainder, cytology cases slightly outnumbered those pertaining to clinical pathology. Among the surgical pathology cases and overall, based on this database, the most common reason for a medical malpractice lawsuit related to pathology was the alleged missed diagnosis of melanoma on a skin biopsy specimen. Less commonly, the surgical pathology cases involved breast biopsy specimens, gynecological specimens, lung, genitourinary system, technical or preanalytic errors (eg, mixed-up specimens), soft tissue, hematopathology, head and neck, gastrointestinal/hepatobiliary system, or thyroid. Among the 48 cases related to cytology, 37 involved false-negative Papanicolaou smears. Less common were cases related to fine-needle aspirates of the breast or thyroid or cytology specimens of the lung. Among the 36 cases involving clinical pathology, 32 related to the blood bank—usually transfusion-acquired human immunodeficiency virus infection. Conclusions.—These data are in agreement with other publications as to the most frequent causes of medical malpractice allegations related to pathology. As these issues are addressed, the number of errors should decrease. Studying the jury verdict and settlements data may provide additional insight into medical errors and patient safety.

The role of Sonoelastography in characterization of solid breast lesions

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Alaa Othama Hendawy Ghanem ◽  
Yasser Ibrahim Abd Elkhalek ◽  
Mohamed Gamal Aldin Abd Elmoteleb
Keyword(s):  
Family History ◽  
Ductal Carcinoma ◽  
Final Diagnosis ◽  
Breast Disease ◽  
Breast Lesions ◽  
Infiltrative Ductal Carcinoma ◽  
History Of ◽  
Malignant Lesions

Abstract Background Mammography and Sonography are the important sensitive imaging modalities available in detection of breast cancer. Sonoelastography is a relatively new imaging technique which acts as a complementary tool to improve the diagnostic ability of ultrasound for evaluating patients with breast masses. Objective To evaluate the role of sonoelastography characterization information on solid breast lesions over conventional sonography and mammography either benign or malignant lesions to reduce the number of benign biopsies performed. Methods A prospective study was carried at private centers, starting from august 2019 till december 2019. Results The study conducted on 40 patients with palpable breast lesions classified to BIRADS 3 and 4a according to conventional ultrasound and mammographic criteria. Their ages ranged from 18 to '75 years with a mean age 47.72 14.91, 22 cases (55%) had no family history of pervious breast disease, and 18 cases (45%) had family history of pervious breast disease. All patients were subjected to full history taking, clinical examination, conventional gray scale ultrasound, and mammography and ultrasound elastography. All patients underwent histopathological assessment to reach the final diagnosis. Among Studied cases , 28 lesions were sampled by fine needle biopsy (70%) and 12 lesions were sampled by true cut needle (30%) .the results revealed 27 breast lesions were benign (67.5%), 9 malignant lesions (22.5%) and 4 lesions shows atypia (10%) according to histopathological assessment. Among final diagnosis of breast lesions fibro adenoma was the most frequent benign breast lesion detected as 12 lesions from 27 benign breast lesions were fibroadenoma., Also infiltrative ductal carcinoma was the moste frequent among malignant breast lesions as 5 lesions from 9 malignant lesions were infiltrative ductal carcinoma. Conclusion Ultrasoundelastography has significant complementray role beside conventional mammogram and ultrasound in characterization of solid breast lesions.

scholarly journals Role of FNAC in diagnosis of parotid lesions

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Ahmed Youssef ◽  
Daren Cope ◽  
Sundus Alsedra ◽  
Mohamed Zahran ◽  
Abdel Rahman El Tahan
Keyword(s):  
Salivary Gland ◽  
False Negative ◽  
Benign Lesions ◽  
True Negative ◽  
Histopathological Correlation ◽  
John Hunter ◽  
Malignant Group ◽  
Malignant Lesions ◽  
Sensitivity Specificity

Abstract Background Salivary gland masses are considered challenging for diagnosis regarding its origin and whether benign or malignant. Unique features of FNAC as a safe and easy diagnostic procedure with little discomfort to the patient made it a favorable primary diagnostic tool. Information regarding the nature of parotid lesions whether being benign or malignant is the main objective of FNAC. We have done a restrospective study for FNAC for parotid masses performed in John Hunter hospital (Newcastle, NSW, Australia) along the peroid from 2014-2018. Histopathological correlation was done in 74 cases to test the accuracy of FNAC in diagnosis of parotid lesions. Results Of the total 74 FNAC done for parotid lesions in which a histopathological correlation was done, we get 46 (62.2%) benign lesions (37 neoplastic and 9 non-neoplastic) while 28 (37.8%) were malignant tumor. Pleomorphic adenoma was the most common in benign tumor side (45.7%) while SCC is the most common in malignant group (53.6%). Compatibility between FNAC and histological diagnosis was found in 74% (55/74), of which 78.3% in benign lesions (36/46) and in 68% of malignant lesions (19/28). FNA cytology was true positive in 21/74 cases (28.4%) and true negative in 41/74 (55.4%) cases. We have 5 (6.8%) false-negative and 7 (9.5%) false-positive results. As a result, we get sensitivity of 81%, specificity of 85%, and accuracy of 84%. Conclusion The role of FNAC in diagnosis of primary salivary gland pathology is considered with some debate about sensitivity/specificity; however, sometimes it should be repeated or correlated with clinical/histopathological confirmation.

scholarly journals The Use of Contrast-Enhanced Ultrasonography for the Characterization of Focal Liver Lesions

2017 ◽  
Vol 33 (6) ◽  
pp. 500-511
Author(s):  
Jennifer E. Bagley ◽  
Dennis E. Paul ◽  
Sutton Halferty ◽  
Dora DiGiacinto
Keyword(s):  
High Sensitivity ◽  
Diagnostic Process ◽  
Focal Liver Lesions ◽  
Liver Lesions ◽  
Benign Lesions ◽  
Underlying Liver Disease ◽  
Contrast Enhanced ◽  
Contrast Enhanced Ultrasonography ◽  
Malignant Lesions

Focal liver lesions often occur with or without an underlying liver disease. Contrast-enhanced ultrasonography can aid in characterizing liver lesions, potentially avoiding biopsy and computed tomography procedures. Contrast-enhanced ultrasonography has a high sensitivity and specificity for differentiating characteristics of liver lesions compared with noncontrast sonography. The different contrast characteristics aid in differentiating benign and malignant lesions. Malignant lesions tend to have washout of contrast in the venous phases, whereas benign lesions have hyperenhancement during the venous phases. Therefore, contrast-enhanced ultrasonography should be considered an essential component of the diagnostic process for diagnosing and following focal liver lesions.

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