[Non-palpable breast lesions and core needle biopsy with Mammotome 11G: is surgery required in patients with atypical ductal hyperplasia?]. / Lésions mammaires impalpables et macrobiopsies stéréotaxiques avec le Mammotome 11 G: faut-il opérer après diagnostic d'hyperplasie canalaire atypique?

Atypical ductal hyperplasia (ADH) of the breast is a difficult histologic diagnosis. It is usually found, but not always, on clusters of microcalcifications. The subsequent risk of breast carcinoma is 4 to 5 times more important and the carcinoma can arise in the same breast or in the contralateral breast. Diagnosis can be establish on core needle biopsy with Mammotome 11G. The risk of under-estimation (ductal carcinoma in situ or invasive carcinoma) is about 20%. This risk is drastically decreased if the target (the calcifications) is completely removed by the Mammotome. This study includes 62 cases of ADH found on 633 calcifications biopsied by Mammotome 11G. In 31 cases, surgery was performed and ADH was confirmed in 25 cases (6 cases was under-estimated). In the other 31 cases, all calcifications were removed, there was no other risk factor and follow-up was suggested. Like after surgery, yearly bilateral mammography during about 20 years is recommended. In this last group, there was no false-negative result, median follow-up: 35,5 months (22-62).

[Malignancy in ACR 3 category mammographic lesions, masses and calcifications]. / Les opacités et les microcalcifications de la classification ACR 3 liées à un cancer.

At screening mammography, lesions must be assigned to BI-RADS classification. Category 3 is used for nonpalpable probably benign lesions. This category is defined either by a subset of lesions that are so likely to be benign that follow-up is a reasonable alternative to immediate biopsy, or by a less than 2% malignancy rate for American BI-RADS, or than 5% for French ANAES. The initial work-up to analyze the lesion must be complete, not only with four screening standard views but with magnification views and sonography if necessary. The risk of malignancy is very low and the pronostic factors are the same as in screening detected carcinomas.

[Stereotactic 11-gauge directional vacuum-assisted breast biopsy: experience with 249 patients]. / Macrobiopsies stéréotaxiques par système à aspiration 11-G: à propos de 249 patientes.

PURPOSE: To assess the value of percutaneous vacuum-assisted core biopsy to improve the diagnosis of non palpable mammographic abnormalities. MATERIALS AND METHODS: A total of 252 core biopsies using an 11G Mammotome((R))were performed in 249 patients. Stereotactic localization was performed in the prone position on a dedicated digital Fischer table. RESULTS: Fifty-one, or 25%, of 200 clusters of microcalcifications corresponded to carcinomas: 126 benign lesions, 23 atypical hyperplasia and LCIS, 31 DCIS, 15 invasive ductal carcinomas, and 4 false negative biopsies. In these 4 last cases, surgery was performed because radiographs of the core biopsy showed no microcalcifications; carcinoma was confirmed at histology of the surgical specimen. Using the BI-RADS system, 7 lesions were category 3, 175 lesions were category 4, and 18 lesions were category 5. From a total of 52 masses, 31 were benign lesions, 2 were borderline lesions, and 19 were invasive carcinomas. From these, 5 lesions were category 3, 31 were category 4, and 16 were category 5. Diagnostic surgical biopsy was avoided in 161 cases (63%), in 152 cases for benign lesions including 151 lesions classified as category 4 lesions and in 9 cases for multifocal or recurrent malignant lesions. CONCLUSION: When technical pitfalls are avoided and when presence of microcalcifications in the core biopsy sample is verified, vacuum assisted core biopsy with Mammotome((R)) 11G provides accurate diagnosis of non-palpable mammographic abnormalities.

Congenital muscular dystrophy: use of brain MR imaging findings to predict merosin deficiency.

PURPOSE: To evaluate the brain magnetic resonance (MR) imaging findings in patients with the "classic" form of congenital muscular dystrophy (patients with normal intelligence) in relation to the absence of merosin, a recently identified molecular component in the basement membrane of muscle fiber. MATERIALS AND METHODS: Brain MR images in 15 patients (13 children, two adults) were reviewed and correlated with the patient's merosin status. Merosin was evaluated by means of immunocytochemical study of specimens from muscle biopsy. RESULTS: Nine patients had merosin deficiency. All patients had diffuse white matter alterations similar to those seen in cases of leukodystrophy. Periventricular and subcortical white matter were involved. The corpus callosum and internal capsule were spared. Follow-up MR images were available in two patients; changes were nonprogressive. White matter signal intensity was normal in the six patients with normal uniform labeling against merosin. Ventricular dilatation and cortical atrophy were observed in both groups. CONCLUSION: Diffuse white matter changes resembling those seen with leukodystrophy may be a valuable criterion for diagnosis of merosin deficiency in patients with classic congenital muscular dystrophy.

[Ultrasonography and tomodensitometry staging of kidney tumors: anatomo-radiologic correlations in 46 patients]. / Bilan d'extension TDM et IRM des tumeurs du rein: corrrélations anatomo-radiologiques chez 46 patients.

OBJECTIVE: To comparatively evaluate CT scan and MRI in the preoperative staging of renal tumours. METHODS: 46 patients with a solid renal tumour were investigated preoperatively by CT scan (n = 43) and MRI (n = 46), the results of which were compared with pathological data. RESULTS: MRI assessed capsular effraction with a sensitivity of 95.6% and a specificity of 52.1%, versus 95.2 and 40%, respectively, for CT scan. Three cases of perirenal extension were detected by MRI. The sensitivity of MRI was higher than that of CT scan for the demonstration of adenopathy (71.4% versus 57.1%) with specificities of 92.3 and 88.8%, respectively. Fourteen cases were associated with tumour extension into the proximal renal vein, which extended into the distal segment of this vein in 12 cases, into the inferior vena cava in 6 cases and as far as the right atrium in 2 cases. The performance of MRI was always better than that of CT scan in relation to venous segments of surgical interest (respective sensitivities of 70% and 83.33% in the distal renal vein and 66.6% and 83.33% in the inferior vena cava: and respective specificities of 84.8% and 97% in the distal renal vein and 91.8% and 97.5% in the inferior vena cava), provided the results of T1-weighted spin echo sequences and FLASH gradient echo sequences were assessed conjointly. CONCLUSION: These results lead us to now prefer MRI to CT scan for the preoperative staging of renal cancer, in the presence of a contraindication to iodinated contrast agent injection, very large tumours, and whenever venous extension is suspected on ultrasonography.