CT-guided cutting-needle biopsies of selected chest lesions.

In an effort to improve on our diagnostic yield from percutaneous transthoracic biopsy, we used 14-gauge cutting needles in 56 selected patients. These biopsies were preceded by 18-, 20-, or 22-gauge aspirations in 42 patients, allowing a direct comparison of the efficacy of the needle types. Specific diagnoses were made by cutting-needle biopsy in 78% (25/32) of patients with nonlymphoproliferative malignancies, in 73% (8/11) with lymphoma or thymoma, and in 54% (7/13) of patients with benign diseases. In those in whom both aspiration and cutting needles were employed, a higher percentage of specific diagnoses was achieved by cutting-needle biopsy than by aspiration biopsy: 72% vs 64% in nonlymphoproliferative malignancies, 62% vs 12% in the lymphoproliferative group, and 55% vs 22% in benign disorders. Complications were encountered in 20% of all patients studied. This study shows that, for selected chest lesions, CT-guided cutting-needle biopsies can be performed safely and are useful, especially in the diagnosis of lymphoproliferative or benign disease.

Cutaneous involvement in chronic myelomonocytic leukemia.

BACKGROUND: Chronic myelomonocytic leukemia has been associated with various nonspecific cutaneous manifestations. Rarely has the leukemia been reported to directly affect the skin. METHODS: This case documents the progression of a patient who ultimately developed chronic myelomonocytic leukemia, by clinical examination, hematologic parameters, dermatopathology, and bone marrow pathology. RESULTS: The skin showed nonspecific cutaneous involvement, progressing to specific leukemic lesions parallel with increasing systemic and hematologic involvement. CONCLUSIONS: Chronic myelomonocytic leukemia can manifest with lesions of leukemia cutis. The possibility of nonspecific cutaneous involvement in the preleukemic phase exists.

Benign and malignant breast disease: magnetic resonance and radiofrequency pulse sequences.

Thirty patients with suspected abnormality of the breasts on mammography were evaluated with magnetic resonance imaging (MRI) in a blind fashion. Spin-echo (SE) 250/30 msec scans were used to screen the examined breast. At the location of the suspected abnormality, inversion recovery (IR) 1000/30/300, SE 1000/30, and SE 1000/120 scans were performed. On the basis of these magnetic resonance images and experience with 70 previously studied patients, abnormalities of the breasts were grouped into five patterns. Ten malignant lesions exceeded 1 cm in diameter and were all correctly diagnosed by mammography and MRI. Of the remaining 20 benign conditions, four were suspicious for malignancy on MRI compared to eight with mammography. The shape of the lesion and the change in its signal intensity with different MR radiofrequency pulse sequences allows differentiation between a benign and a malignant process. On the basis of this preliminary experience, it seems MRI may have an adjunctive role to screening mammography. SE 1000/120 scans show higher signal intensity from carcinoma than from normal duct tissue, fibrocystic disease, and fibroadenoma. In this respect, it may allow some tissue specification in the breast.