Simplifying Logistics and Avoiding the Unnecessary in Patients With Breast Cancer Undergoing Sentinel Node Biopsy. A Prospective Feasibility Trial of the Preoperative Injection of Super Paramagnetic Iron Oxide Nanoparticles.

PURPOSE: Sentinel node is routinely localized with the intraoperative use of a radioactive tracer, involving challenging logistics. Super paramagnetic iron oxide nanoparticle is a non-radioactive tracer with comparable performance that could allow for preoperative localization, would simplify the procedure, and possibly be of value in axillary mapping before neoadjuvant treatment. The current trial aimed to determine the a priori hypothesis that the injection of super paramagnetic iron oxide nanoparticles in the preoperative period for the localization of the sentinel node is feasible. METHODS: This is a prospective feasibility trial, conducted from 9 September 2014 to 22 October 2014 at Uppsala University Hospital. In all, 12 consecutive patients with primary breast cancer planned for resection of the primary and sentinel node biopsy were recruited. Super paramagnetic iron oxide nanoparticles were injected in the preoperative visit in the outpatient clinic. The radioactive tracer (99mTc) and the blue dye were injected perioperatively in standard fashion. A volunteer was injected with super paramagnetic iron oxide nanoparticles to follow the decline in the magnetic signal in the sentinel node over time. The primary outcome was successful sentinel node detection. RESULTS: Super paramagnetic iron oxide nanoparticles' detection after preoperative injection (3-15 days) was successful in all cases (100%). In the volunteer, axillary signal was presented for 4 weeks. No adverse effects were noted. Conclusion and relevance: Preoperative super paramagnetic iron oxide nanoparticles' injection is feasible and leads to successful detection of the sentinel node. That may lead to simplified logistics as well as the identification, sampling, and marking of the sentinel node in patients planned for neoadjuvant treatment.

Serial gadolinium-enhanced magnetic resonance imaging and assessment of facial nerve function in Bell's palsy.

Eleven patients with mild or moderate acute idiopathic peripheral facial palsy, so-called Bell's palsy, were serially examined by gadolinium-DTPA-enhanced MRI on mean days 11, 40, and 97 (third examination, n = 10) after the onset of palsy. Results of the clinical and neurophysiologic assessment of facial nerve function were compared with the gadolinium-enhanced MRI findings. Eight of the 11 patients demonstrated contrast enhancement of the facial nerve at the initial examination, but in 7 of them, the enhancement had disappeared by the time of the serial follow-up gadolinium-enhanced MRI scans. The disappearance of facial nerve enhancement was found to be related to clinical and neurophysiologic improvements in facial nerve function during recovery from Bell's palsy. The three patients whose scans were negative at the initial gadolinium-enhanced MRI examination had the same clinical severity of palsy, but initially they had milder neurophysiologic involvement than those who demonstrated enhancement; these three patients did not exhibit enhancement at serial follow-up scans. These findings indicate that the presence of enhancement at the initial MRI scan is not necessarily indicative of a poor prognosis for recovery.

Semiautomatic core biopsy. A modified biopsy technique in breast diseases.

PURPOSE: To evaluate a semiautomatic gun to retrieve diagnostic core specimens of lesions in the breast and the axillary region. MATERIAL AND METHODS: In a series of 180 consecutive core biopsies (2.1 mm), 145 (142 breasts and 3 axillae) were performed with a semiautomatic gun (18 stereotaxic and 127 US-guided) from lesions presenting mammographically as microcalcifications (n = 15) and opacities (n = 130). The gun did not work satisfactorily in 34 lesions, which were tumors with a very hard consistency. One additional patient was excluded because of technical failure. Biopsy diagnoses in the 145 patients were correlated to surgical histopathology, follow-up mammograms and/or clinical findings. RESULTS: Histologic examination of the specimens resulted in correct diagnoses in 89% (129/145) of the total material and in 87% (108/124) of cancers. In 107 cases, in which only 1 specimen was obtained, 83 of 89 cancers (87%) were detected. Length of specimens ranged from 3 mm (n = 2) to 17 mm (n = 31). Among patients with a 17-mm-long specimen, there was only 1 false-negative diagnosis. CONCLUSION: The semiautomatic gun provided diagnostic specimens in a majority of cases and could be used as an alternative to the automatic guns when size or location of the lesions necessitates a high precision. It was not suitable for use in very hard tumors.

Ultrasound-guided large needle core biopsy of the axilla.

PURPOSE: To study the diagnostic yield and safety aspects of large needle core biopsy of pathologic lesions in the axillary region using a semi-automatic biopsy gun. MATERIAL AND METHODS: A series of 21 consecutive large needle core (14G, 2.1 mm) biopsies of the axilla was evaluated. The biopsies were performed under ultrasound guidance with one (n = 13) or two (n = 8) needle passes. The results were correlated to the clinical, mammographic, ultrasound and surgical histopathologic findings. RESULTS: In 18 patients, specimens large enough for diagnosis were retrieved. In two patients the specimens were insufficient and non-diagnostic. In one patient with a non-malignant yield the result was false-negative. No neural or vascular injury occurred. CONCLUSION: The procedure might be safely employed in the diagnosis of ultrasonographically demonstrable lesions of the axilla, whenever specimens larger than those obtainable with a fine needle are desired.

Behaviour of the 2.1-mm (14 G) automated biopsy needle in phantoms.

PURPOSE: To study the behaviour of the 2.1-mm (14 G) core biopsy needle in targets of different consistencies and to correlate the needle behaviour to lengths of the samples. MATERIAL AND METHODS: A series of butter blocks at temperatures of -5 degrees C, -2 degrees C, +1 degrees C, +4 degrees C, +7 degrees C, +10 degrees C, +13 degrees C, +16 degrees C and +19 degrees C simulating lesions of different hardness in human breast, were passed with needles (3 passes at each temperature). Inner needle behaviour was studied both with and without outer cannula effect. RESULTS: At +4 degrees C to +13 degrees C the needle had a curved course, deviated to the side of its tip. At +4 degrees C, the needle was most deviated (range 4, 8, 10 degrees ) and the samples were largest (8, 12, 12 mm). At -5 degrees C to +1 degrees C the needle was bent, the cannula was not triggered and no sample was obtained. At +16 degrees C and +19 degrees C the needle had a straight course and the length of the sample was decreasing. CONCLUSION: Behaviour of the inner needle as well as the cannula depends on the hardness of the target. Targets of intermediate hardness yield adequate samples when the inner needle takes a curved course deviated toward the tip and get restored by the cannula.

MR imaging of primary, secondary, and mixed forms of lymphedema.

PURPOSE: To describe the pathological features and assess the diagnostic information of different MR sequences in patients with primary, secondary, and mixed (phlebo-, lipophlebo-, or lipolymphedema) forms of lymphedema of the lower leg. MATERIAL AND METHODS: In 26 patients with clinical diagnoses of primary (n=10), pure secondary (n=4), mixed (n=9) and combined secondary and mixed forms of lymphedema (n=3), MR imaging was performed with coronal and axial T1 SE, T2 TSE, fat-suppressed (SPIR) T2 sequences and axial T1 SE after i.v. injection of Gd-DTPA. RESULTS: In 24 patients there was a honeycomb pattern in the subcutis with a signal intensity corresponding to fluid (n=11), fibrosis (n=3), or both (n=10). Five patients with primary lymphedema showed subfascial fluid accumulation. Dermal edema was noted in 23 patients. Fat or edema components in the muscles were mostly seen in patients with phlebolymphedema. The honeycomb pattern was best seen on coronal T1 images, and fluid accumulations on axial SPIR-T2 images. Fibrosis was only assessible from the T2 TSE sequence. Gd-DTPA did not improve the diagnostic information. CONCLUSION: For evaluation of lymphedema and its mixed forms, an axial T2-weighted SPIR sequence in conjunction with a coronal T1 SE sequence are sufficient.