[Ultrasound-guided fine-needle aspiration of the breast]. / Stellenwert der Ultraschallgesteuerten Feinnadelpunktion der Mamma.

PURPOSE: Retrospective analysis of the results of all ultrasound (US)-guided fine needle aspirations (FNA) of the breast performed at our institution between 1988-2002. MATERIALS AND METHODS: The radiologic and pathologic information database was retrospectively searched for all referrals, in whom an US-guided FNA of the breast was performed as further diagnostic work-up of sonographically unclear or suspicious findings. Percutaneous tissue diagnosis was performed under US-guidance using a 20-Gauge-needle. Results were correlated with histology or sonographic and/or mammography follow-up examination, respectively. RESULTS: The total study population consisted of 324 patients (19-92 years). In 20 cases (6.2%), results of FNA were non-diagnostic, a cytologic diagnosis was established in the remaining 304 (93.8%) cases. Cytologically, malignancy was diagnosed in 60 cases; 2 of those were shown to be false positive by subsequent histologic work-up. In 33 of 244 surgery was performed. 9 cases were false negative. No complication was observed. The accuracy was 96.4% with a sensitivity of 86.6% and specificity of 99.2%. CONCLUSION: If a skilled cytopathologist is available, US-guided FNA is a highly accurate and minimal-invasive technique. False negative findings may occur, thus clinical and imaging findings should be taken into account for further therapeutic decision.

[Evaluation of bloody nipple discharge]. / Abklärung einer blutigen Mamillensekretion.

A 64-year old woman was referred for radiological evaluation of right sided bloody nipple discharge lasting for five months. Finally galactography supposed the diagnosis of an intraductal papilloma which was confirmed by surgery. Histopathologically an eight millimeter measuring intraductal papilloma with atypical ductal hyperplasia with signs of a carcinoma in situ was seen.

[Value of ultrasound in breast diagnostics]. / Stellenwert des Ultraschalls in der Mammadiagnostik.

Sonography permits the evaluation of uncertain palpabel lumps in the breast and is a supplement for clinical examination as well as for mammography in dense parenchymal tissues difficult to evaluate. Moreover, it serves for guided biopsies under permanent visual control.

[Diseases of the female breast: screening, mammography, ultrasound]. / Erkrankungen der weiblichen Brust: Screening, Mammographie, Ultraschall.

Now as before mammography represents the most important imaging technique when searching for breast cancer. In more than 90% of all cases this technique permits to identify a cancer, often a long time before any clinical findings. However, this method has its limits, especially in younger women with stimulated breast parenchyma or mastosis. In these cases sonography is the adequate supplementary examination technique. Ultrasound allows for more precise evaluation of nodular structures which by mammography alone are difficult to identify or not at all. Guided punctures and histological investigation of tissues offer higher degrees of diagnostic security. It is the aim of all screening programs to find smaller manifestations of a malignoma, if not their preinvasive stage, since prognosis is by far better than in tumors found by clinical manifestation only.

Ultrasonography of the retroperitoneum.

Ultrasonographic investigation of the kidneys and efferent urinary tract as well as juxtarenal organ regions has become an indispensable screening method in urology today. Various diseases of the kidneys can be detected rapidly and noninvasively. Some of these clinical pictures are discussed in detail. Above and beyond simple imaging, ultrasonography also allows special diagnostic interventions (biopsy) and therapeutic measures (i.e. nephrostomy).

[Interventional measures under sonographic control for diagnosis and therapy]. / Interventionelle Massnahmen unter sonographischer Kontrolle für Diagnostik und Therapie.

Surgery under sonographic monitoring and guidance has become widely and rapidly accepted for diagnosis and certain therapeutic measures. A conclusive diagnosis of tissue changes can be made today in most cases only via cytological examination, despite the manifold macromorphological diagnostic methods. Hence, this method is indispensable especially if there is an oncological problem. The rapidity of procedure and evaluation by rapid staining facilitate a quick decision for a particular therapy, so that surgery under sonographic guidance has become a popular method within a very short time. Intermittent palliative measures, such as nephrostomy, are preferred in therapy, but besides these drainage of the abscess has grown increasingly important since it is characterized by a high rate of healing and small risk. In addition, it is a procedure that is hardly invasive and can be tolerated even by severely ill patients. We must await the development of new technologies, for example magnetic resonance tomography, in this regard, by which non-invasive diagnosis may become even more refined and sophisticated. However, puncture will remain an indispensable aid for some time to come as far as daily clinical routine is concerned.

[Ultrasound diagnosis of adrenal gland diseases]. / Ultraschalldiagnostik bei Nebennierenerkrankungen.

Diseases of the adrenal glands are detectable by means of ultrasound under the condition of an enlargement of the organs. Due to the different advantages, sonography remains the first choice of imaging techniques, though computer tomography still ist superior and most useful for interdisciplinary discussion. Possibilities and limitations of the ultrasound evaluation of the adrenal glands are discussed.

[Ultrasound-guided incisional biopsy in generalized and focal diseases of the liver]. / Ultraschallgeleitete Schneidbiopsie bei generalisierten und fokalen Erkrankungen der Leber.

Sonographically guided liver biopsies under permanent visual control using fine needles are far less traumatic than previous biopsy techniques and carry a very low risk. They may be performed on an outpatient basis, especially when using the newly developed cutting-edge needle which allows to perform core biopsies of various parenchymal organs. Risks are discussed.

The hypersplenic spleen. A contractile reservoir of granulocytes and platelets.

Epinephrine-induced mobilization of noncirculating granulocytes and thrombocytes was evaluated in 13 subjects with marked variation in spleen size and correlated with the sonographically recorded contraction of the spleen. The effects of epinephrine on blood granulocyte and thrombocyte counts correlated highly with splenic contraction but not with spleen size. The findings provide further insight into mechanisms of hypersplenism, suggest that the big spleen of hypersplenism mimics the contractile reservoir function of the spleen of certain animals, and point out that the "marginal" granulocyte pool mobilized by epinephrine is not randomly distributed throughout the body.

[Indications for ultrasound-guided fine needle puncture under permanent view. 1. Diagnostic puncture]. / Indikationen zur ultraschallgezielten Feinnadelpunktion unter permanenter Sicht. 1. Diagnostische Punktionen.

Using fine-needle punctures under real-time control and permanent view it is possible to examine even very small lesions of parenchymal organs, especially of the abdomen, with high efficiency. Cytological proof can be obtained. This method can be performed without greater risk, if minimal factors of safety are observed.

[Indications for ultrasound-guided interventions under permanent view. 2. Therapeutic puncture]. / Indikationen für ultraschallgezielte Eingriffe unter permanenter Sicht. 2. Therapeutische Punktionen.

Using a centrally perforated linear-array transducer developed in our institute, ultrasonically guided interventions for diagnosis and therapy can be performed. Percutaneous nephrostomy, drainage of obstructed bile system or abscesses are easily carried out. A simple drainage system is presented; the technique of application is described.