Percutaneous Ultrasound-Guided Core Needle Biopsy: Comparison of 16-Gauge versus 14-Gauge Needle and the Effect of Coaxial Guidance in 1065 Breast Biopsies - A Prospective Randomized Clinical Noninferiority Trial.

PURPOSE: Ultrasound-guided core needle biopsy (CNB) is considered the standard assessment to diagnose sonographically visible suspicious breast mass lesions. Based on nonrandomized trials, the current German guidelines recommend at least three cylinders with ≤ 14-gauge needle biopsy. However, no recommendation is made as to how many specimens are needed with a smaller needle size, such as 16-gauge, or if biopsy with coaxial guidance improves diagnostic accuracy and quality. Therefore, in a prospective monocentric unblinded randomized controlled clinical noninferiority trial, the diagnostic accuracy of 16-gauge versus 14-gauge core needle biopsy, with and without coaxial guidance, was evaluated. MATERIALS AND METHODS: 1065 breast biopsies were included in order to analyze the number of core samples necessary to obtain an appropriate rate of diagnostic quality adequate for histological evaluation, and to achieve high diagnostic accuracy and diagnostic yield. Histological results were verified by surgery or long-term follow-up of at least two years up to five years. RESULTS: In order to obtain an additive diagnostic accuracy of > 99 %, a minimum of two cylinders with 14-gauge biopsy were required. The diagnostic accuracy and the diagnostic quality of 14-gauge biopsy were not affected by the coaxial technique. When performing a 16-gauge biopsy, five cylinders were required to achieve an additive diagnostic accuracy of > 99 %. Without coaxial guidance, 16-gauge CNB required at least three samples, whereas five needle passes with coaxial-guided 16-gauge biopsy were needed. CONCLUSION: The diagnostic accuracy and quality of ultrasound-guided 16-gauge core needle biopsy were inferior to the 14-gauge needle size, regardless of the use of a coaxial technique.

HER2 status on persistent disseminated tumor cells after adjuvant therapy may differ from initial HER2 status on primary tumor.

BACKGROUND: Persistence of disseminated tumor cells (DTCs) is observed in 10 to 15% of breast cancer patients and is associated with poor prognosis. These patients might benefit from secondary adjuvant targeted therapy. The aim of this study was to assess HER2 status of persistent DTCs to determine whether the use of HER2-targeted agents might be a therapeutic option in patients with tumor cell persistence. PATIENTS AND METHODS: Bone marrow was obtained from 85 primary breast cancer patients intraoperatively and after completion of systemic treatment (median follow-up of 13 months; range: 6-30 months). Immunofluorescence double staining was used for identification of cytokeratin-positive, HER2-positive cells. RESULTS: A total of 31 out of 85 (36%) patients had DTCs preoperatively. Out of 85 (16%) patients, 14 were DTC positive after completion of surgery and adjuvant cytotoxic therapy. Five of these patients had HER2-positive DTCs, however, the corresponding tumor was HER2 positive in only one case. The remaining nine patients with HER2-negative DTCs had HER2-negative primary tumors. CONCLUSION: HER2-positive DTCs can be detected in patients with HER2-negative tumors, even after adjuvant therapy. Such patients may benefit from (secondary) HER2-targeted therapy in an adjuvant setting.

Speciation of dissolved copper within an active hydrothermal edifice on the Lucky Strike vent field (MAR, 37 degrees N).

The objective of this study was to determine the concentrations of different fractions of dissolved copper (after filtration at 0.45 microm) along the cold part of the hydrothermal fluid-seawater mixing zone on the Tour Eiffel edifice (MAR). Dissolved copper was analyzed by stripping chronopotentiometry (SCP) after chromatographic C(18) extraction. Levels of total dissolved copper (0.03 to 5.15 microM) are much higher than those reported for deep-sea oceanic waters but in accordance with data previously obtained in this area. Speciation measurements show that the hydrophobic organic fraction (C(18)Cu) is very low (2+/-1%). Dissolved copper is present mainly as inorganic and hydrophilic organic complexes (nonC(18)Cu). The distribution of copper along the pH gradient shows the same pattern for each fraction. Copper concentrations increase from pH 5.6 to 6.5 and then remain relatively constant at pH>6.5. Concentrations of oxygen and total sulphides demonstrate that the copper anomaly corresponds to the transition between suboxic and oxic waters. The increase of dissolved copper should correspond to the oxidative redissolution of copper sulphide particles formed in the vicinity of the fluid exit. The presence of such a secondary dissolved copper source, associated with the accumulation of metal sulphide particles, could play a significant role in the distribution of fauna in the different habitats available at vents.

Changes in tumour biological markers during primary systemic chemotherapy (PST).

BACKGROUND: The influence of primary systemic therapy (PST) on the expression of relevant therapeutic markers is still under investigation. PATIENTS AND METHODS: Corresponding "baseline" biopsies and post-chemotherapy surgical specimens from 87 patients treated with neoadjuvant anthracycline- or taxane-based chemotherapy were analysed for the expression of the oestrogen receptor (ER), the progesterone receptor (PR), the B-cell lymphoma protein 2 (Bcl-2), the v-erb-b2 erythroblastic leukemia viral oncogene homolog 2 (Her2/neu), the tumour protein p53 and the proliferation-related Ki-67 antigen. RESULTS: The pathological response rate was 70%. Twenty-three tumours (26%) changed hormone receptor classification after chemotherapy (7, ER; 16 PR). A significant change was also observed for Her2/neu status. Eleven tumours which were positive prior to PST down-regulated Her2/neu after chemotherapy. The median Ki-67 index decreased from 30% before to 13% after treatment (p<0.01). Minor changes were observed in the expression of Bcl-2 and p53 (9%). Only the reduction of Ki-67 was associated with pathological response to PST. CONCLUSION: Her2/neu status as well as ER and PR status should be re-evaluated on post-chemotherapy surgical specimens since changes can be observed.

Cystosarcoma phyllodes of the breast: a rare diagnosis: case studies and review of literature.

Cystosarcoma phyllodes (CP), otherwise known as phyllodes tumour (PT) of the breast, is a very rare but locally aggressive fibroepithelial tumour in its malignant form, and accounts for 0.3-1% of all breast neoplasias. Using 4 cases reports with different histological classifications as examples (benign-borderline-malignant), we describe the (differential) diagnosis and treatment options of this tumour entity and give an additional review of the available literature.

Tubal transport of spermatozoa does not appear to be dependent on normal cilia function.

OBJECTIVE: To report the case of a woman with Kartagener's syndrome with complete immotility of ciliae and normal transport of spermatozoa. DESIGN: Case report. PATIENTS: A 31-year-old woman with Kartagener's syndrome. SETTING: Medical university-affiliated teaching hospital. INTERVENTION(S): Ultrasonography, hysterosalpingoscintigraphy using technetium-99m-labeled macroaggregates of human serum albumin, application of oxytocin. MAIN OUTCOME MEASURE(S): Dynamic anteroposterior scintigraphy using a gamma camera. RESULT(S): The transport of labeled macrospheres through the fallopian tube into the peritoneal cavity on the side of the leading follicle, compared to the contralateral oviduct where the labeled material may have accumulated within the fallopian tube, is similar to those reported in normal fertile women. CONCLUSION(S): Transport of spermatozoa is not dependent on normal ciliary function.

Development of a gel-simulation model and generation of standard tables for the complete extirpation of benign breast lesions with vacuum assisted biopsy under ultrasound guidance.

In combination with high-resolution ultrasound (US), vacuum-assisted biopsy (VB) techniques can be used for accurate diagnosis confirmation and therapeutic minimally invasive removal of benign breast lesions. We developed a gel-simulation model to imitate the removal of benign breast lesions (e.g., fibroadenoma) with VB from a turkey breast-phantom. Bilobular US-sensitive models in the form of a fibroadenoma were manufactured from flexible, cuttable synthetic material (longitudinal diameters of 4-20 mm). They were implanted in turkey meat and vacuum biopsied under 2-D and 3-D imaging with 11G and 8 G needles. The minimum number of cylinders removed per tumour volume, the maximum complete excision tumour size and the optimum needle gauge were determined. Lesions with a longitudinal diameter of up to 10 to 12 mm could be removed with the 11G needle, those up to 20 mm with the 8G needle. The values for the correct needle size, number of cylinders per tumour size to be removed produced with the gel turkey phantoms provide a reference for clinicians performing VB with total excision intent. VB is suitable for the removal of benign lesions with a diameter of up to 20 mm.

Fe analysis by the ferrozine method: Adaptation to FIA towards in situ analysis in hydrothermal environment.

The target of this study is the adaptation of the ferrozine method to flow injection analysis (FIA) to perform iron analysis in situ using an in situ chemical analyser in hydrothermal environments. The adaptation of the method to FIA was followed by its optimisation using an experimental design screening method. The goals of the optimisation steps were to decrease the detection limit and to increase the measuring range to cope with the constraints of in situ analysis. The method allows the determination of iron in the mixing zone of hydrothermal fluid, enriched in iron, and seawater. A single manifold gives the possibility to analyse either Fe(II) or SigmaFe [Fe(II)+Fe(III)] in situ, or SigmaFe in the lab on hydrothermal seawater samples. The measuring range of the method was increased to up to 2000muM, which is coherent with the study of the chemical environment of communities associated with deep-sea hydrothermal activity. Finally, the method was applied in situ using the chemical analyser Alchimist during the ATOS cruise on hydrothermal vent fields on the Mid Atlantic Ridge.

Desulfurobacterium crinifex sp. nov., a novel thermophilic, pinkish-streamer forming, chemolithoautotrophic bacterium isolated from a Juan de Fuca Ridge hydrothermal vent and amendment of the genus Desulfurobacterium.

A novel thermophilic, chemolithoautotrophic bacterium, designated as NE1206(T), was isolated from a Juan de Fuca Ridge hydrothermal vent sample (tubes of the annelid polychaete Paralvinella sulfincola attached to small pieces of hydrothermal chimney). The cells were rod-shaped (1.2-3.5 x 0.4-0.7 microm), occurring as single motile rods or forming macroscopic aggregates visible as pinkish to brownish streamers. The new isolate was anaerobic. It grew between 50 and 70 degrees C (optimum 60-65 degrees C; doubling time approximately 1 h 15 min at 60 degrees C), between pH 5.0 and 7.5 (optimum pH around 6.0-6.5) and at sea salts concentrations between 20 and 40 g l(-1 )(optimum 30 g l(-1)). Cells grew chemolithoautotrophically in an H(2)/CO(2) atmosphere (80/20, v/v; 200 kPa). Molecular hydrogen was the sole electron donor used by the strain. Nitrate and elemental sulfur served as electron acceptors, yielding ammonia and hydrogen sulfide, respectively (nitrate reduction supported higher growth rates than sulfur reduction). The G+C content of the genomic DNA was 36.7+/-0.8 mol%. Phylogenetic analyses of the 16S rRNA gene located the strain within the genus Desulfurobacterium. However, the novel isolate possesses physiological and biochemical characteristics that differ from the previously described species of this genus. We propose that the isolate represents a novel species, Desulfurobacterium crinifex sp. nov. The type strain is NE1206(T) (DSM 15218(T), CIP 107649(T)). An amendment of the genus Desulfurobacterium description is proposed, based on the phenotypic characteristics of the novel species.

Seven cases of fungemia with Saccharomyces boulardii in critically ill patients.

Saccharomyces boulardii (Sb) is a particular strain of Saccharomyces cerevisiae (Sc). This viable yeast is used in intensive care adult patients, delivered in packets of 500 mg, for preventing diarrhea associated with antibiotics or enteral feeding at a regimen of 1-2 g/day. Between June 1996 and October 1998, seven cases of fungemia with Sb occurred in a 12-bed intensive care unit (ICU). All the patients concerned were severely ill patients, mechanically ventilated, treated by broad spectrum antibiotics with central venous catheter and were pretreated with Sb, except for one patient. In this study, Sb was identified by specific mycologic methods and confirmed the genomic identity between isolates of blood culture and yeasts from the treatment packets, contrary to a few other reports concerning Saccharomyces species published in international literature. The hypothesis discussed for explaining these cases of Sb fungemia are: (1) an intestinal translocation of Sb administered at a high dosage in severely ill patients, (2) a contamination of the central venous catheter, especially in the patient not pretreated with Sb and (3) a massive colonization of critically ill patients by the yeast as has been reported for Candida species. We note that cases of fungemia with Sc and Sb have become more and more frequent in the international literature during the last 10 years and we do not recommend administering Sb treatment in critically ill patients.