Image-guided core-needle biopsy in malignant lymphoma: experience with 100 patients that suggests the technique is reliable.

PURPOSE: In an initial evaluation of 1,500 computed tomography (CT)-guided core-needle biopsies performed at our institute during the period from 1989 to 1994, we encountered 100 patients with the diagnosis of lymphoma. Here, we review the clinical impact of 109 image-guided needle biopsies in these 100 patients with non-Hodgkin's lymphoma (NHL) and Hodgkin's disease (HD). PATIENTS AND METHODS: NHL was diagnosed in 71 patients, and 29 had HD. Among the NHL patients, 17 (24%) had proven lymphoma diagnosed before the biopsy was performed; in 54 (76%) core-needle biopsy was performed as the first diagnostic procedure. Of 29 HD patients, nine (31%) were already established cases of HD, and in 20 (69%) core-needle biopsy was the first diagnostic procedure attempted. Most of the biopsies were performed under CT control using a 20- or 18-gauge Turner biopsy needle. RESULTS: Eighty-six patients received therapy based on the results of the needle biopsy alone. Fourteen patients received therapy after undergoing surgical biopsy for a suspected diagnosis of lymphoma, which could not be established with certainty on the basis of an earlier core-needle biopsy alone. In 78% of the patients, the needle biopsy saved a further surgical procedure that may have been difficult to perform because of the primary location of the tumor. CONCLUSION: From our experience in this study, image-guided core-needle biopsies provide sufficient information for the diagnosis of and subsequent therapeutic decision to treat most cases of lymphoma.

Vascular changes in traumatic amenorrhea and hypomenorrhea.

Pelvic angiography was performed in 12 cases of amenorrhea and hypomenorrhea which developed following curettage of abortion and in the puerperium. Six cases of similar age and obstetric history with normal menstrual cycles served as control. Pelvic angiography revealed widespread vascular occlusion of myometrial arteries, in seven of the twelve cases. These findings account for the small amount of endometrium removed on diagnostic curettage in these cases as well as the greatly reduced menstrual loss. The poor obstetric history of the cases studied may well be due to this excessive vascular damage.

PIP: In 12 women with amenorrhea or hypomenorrhea which developed following curettage for abortion or in the puerperium, 10 had hypomenorrhea and 2 had amenorrhea; there were 6 control cases. Pelvic angiography was done during the proliferative phase of cycles prior to Day 10. The uterine vascular bed was studied by the Seldinger retrograde femoral technique using 2 methods. In each case, a total volume of 30 ml of 80% sodium iothalamate (Angio-Conray) was used. Over 50% of the cases of hypomenorrhea showed significantly reduced vascularity in the endometrium. The poor obstetric history of these patients, with frequent early spontaneous abortions, may be due to the extensive vascular damage to the endometrium with fibrosis. Also these changes may account for the small amount of endometrium removed at diagnostic curettage as well as the greatly reduced menstrual loss. Radiographic findings are illustrated.