A ten-year, single-center experience: Concordance between breast core needle biopsy/vacuum-assisted biopsy and postoperative histopathology in B3 and B5a cases.

PURPOSE: To determine the concordance rate between core needle biopsy/vacuum-assisted biopsy (CNB/VAB) and postoperative histopathology in B3 (lesions of uncertain malignant potential) and B5a (in situ) lesions found on mammograms or ultrasound. MATERIAL AND METHODS: 2,029 consecutive biopsies performed over 10 years for patients who underwent mammograms or ultrasounds. For CNB 14G needle and for VAB 8G/10G needles were used. In all biopsies, we identified the age, BI-RADS®, histopathological biopsy results, B-category, nuclear grade for DCIS and postoperative histopathology results in B3 and B5a cases from the biopsy. RESULTS: The B-categories from CNB/VAB were as follows: B2 42.2 percent (n = 856), B3 4.5 percent (n = 91), B5a 5.7 percent (n = 115), and B5b 47.6 percent (n = 967). In the B3-category, 72/91 patients underwent surgical excision, with a concordance rate of 83.3 percent (n = 60/72) and a discordance rate of 16.7 percent (n = 12/72) to postoperative histopathology. From the discordant cases, 67.7 percent (n = 8/12) showed DCIS and 32.3 percent (n = 4/12) showed invasive breast cancer. The BIRADS of the discordant cases was 4b in 41.7 percent (n = 5/12) and 5 in 58.3 percent (n = 7/12). The PPVs for malignancy of B3 lesions were 0.21, with no statistical significance between subgroups. In the B5a-category, 101 of 115 patients underwent surgery in our hospital, with a concordance rate of 80.2 percent (n = 81/101) and a discordance rate of 19.8 percent (n = 20/101) to postoperative histopathology. From the discordant cases, 55 percent (n = 11/20) showed invasive breast carcinoma of no special type (NST). CONCLUSION: Our concordance rate for B3 (83.3 percent) and B5a (80.2 percent) lesions in the biopsies to postoperative histopathology is matching to previously published literature. Surgical excision is our recommendation for lesions biopsied with a B3 category in the histopathology and a BIRADS category of (4b, 4c and 5). The PPVs for malignancy of B3 lesions showed no statistical significance between subgroups. Also, the nuclear grade of DCIS was not statistically significant in terms of upgrade into invasive breast cancer.

Posttraumatic Aneurysm of a Patent Umbilical Vein: Diagnosis and Specific Treatment.

A patent umbilical vein is a rare condition in healthy volunteers, but can be detected in up to 11% of patients with liver cirrhosis as a consequence of portal hypertension. We report the case of a 52-year-old woman who was admitted to our department with acute abdominal pain after blunt trauma to her forehead and abdomen. She had a history of alcohol abuse with liver cirrhosis that had been classified as Child-Pugh stage C 5 years earlier. Signs of portosystemic shunting had been present at an earlier endoscopy, and esophageal varices were found. Clinical examination revealed typical signs of liver cirrhosis, and ultrasound examination showed an aneurysm of 6 cm of the umbilical vein, which had not been present at earlier examinations. After lowering portal hypertension by inserting a transjugular intrahepatic portosystemic shunt, an open surgical resection of the aneurysmal umbilical vein was performed without complications. The patient recovered well and was discharged from the hospital 10 days later. We hypothesize that the abdominal trauma prompted or aggravated umbilical vein aneurysm in this patient with liver cirrhosis and portal hypertension. Due to the risk of rupture, a surgery-based resection is a valuable treatment option.

Thoracic aortic stent graft: comparison of contrast-enhanced MR angiography and CT angiography in the follow-up: initial results.

The objective of this study was to compare contrast-enhanced magnetic resonance angiography (CE MRA) and multislice computed tomographic angiography (MS CTA) in the follow-up of thoracic stent-graft placement. The CE MRA and MS CTA were performed following nitinol stent-graft treatment due to thoracic aneurysm ( n=4), intramural bleeding ( n=2) and type-B aortic dissection ( n=5). Corresponding evaluation of arterial-phase imaging characteristics focused on the stent-graft morphology and leakage assessment. Stent-graft and aneurysm extensions were comparable between both techniques. Complete exclusion (aneurysm, n=4; dissection, n=2) was assessed with high confidence with CE MRA and MS CTA. Incomplete exclusion (intramural bleeding, n=2; dissection, n=3) was assigned to lower confidence scores on CE MRA compared with MS CTA. On CE MRA the stent-graft lumen demonstrated an inhomogeneous signal, the stent struts could not be assessed. The CE MRA can be used as alternative non-invasive imaging for follow-up of nitinol stent grafts. Arterial-phase leak assessment can be less evident in CE MRA compared with MS CTA studies; therefore, the use of late-phase imaging seems to be necessary. The diagnostic gap of stent-graft fracture evaluation using MRA may be filled with plain radiographs.

Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy.

Non-occlusive mesenteric ischemia (NOMI) compromises all forms of mesenteric ischemia with patent mesenteric arteries. It generally affects patients over 50 years of age suffering from myocardial infarction, congestive heart failure, aortic insufficiency, renal or hepatic disease and patients following cardiac surgery. Non-occlusive disease accounts for 20-30% of all cases of acute mesenteric ischemia with a mortality rate of the order of 50%. Acute abdominal pain may be the only early presenting symptom of mesenteric ischemia. Non-invasive imaging modalities, such as CT, MRI, and ultrasound, are able to evaluate the aorta and the origins of splanchnic arteries. Despite the technical evolution of those methods, selective angiography of mesenteric arteries is still the gold standard in diagnosing peripheral splanchnic vessel disease. In early non-occlusive mesenteric ischemia, as opposed to occlusive disease, there is no surgical therapy. It is known that mesenteric vasospasm persists even after correction of the precipitating event. Vasospasm frequently responds to direct intra-arterial vasodilator therapy, which is the only treatment that has been shown to be effective.

Perivascular inflammatory reaction to a Hemobahn stent-graft: diagnosis with 3D MR angiography.

PURPOSE: To present a rare perivascular inflammatory reaction to a commercially produced polytetrafluoroethylene-covered stent and demonstrate the utility of 3-dimensional (3D) magnetic resonance angiography (MRA) in the diagnosis of this phenomenon. CASE REPORT: Three weeks after percutaneous deployment of a Hemobahn stent-graft to treat a high-grade stenosis and aneurysm of the proximal left superficial femoral artery (SFA), a 70-year-old diabetic man developed fever, pain, and local swelling of the left thigh. Venous thrombosis was excluded by ultrasound imaging; a normal flow profile was seen in the left common and superficial femoral arteries. Blood analysis found elevated inflammatory markers. MRA revealed extensive soft-tissue edema and perivascular contrast enhancement around the left SFA, but the stent-graft was patent. The clinical symptoms resolved within 7 days after initiation of anti-inflammatory therapy. Follow-up MRA scans demonstrated significantly reduced inflammatory reaction over the next few months. CONCLUSIONS: Symptomatic perivascular inflammatory soft-tissue response to a stent-graft can be diagnosed with MR imaging studies.