Breast biopsy avoidance: the value of normal mammograms and normal sonograms in the setting of a palpable lump.

PURPOSE: To review the authors' experience with patients who presented with breast lumps and had normal mammograms and normal sonograms. MATERIALS AND METHODS: The findings from 600 lumps in 486 women with no focal ultrasonographic (US) mass or mammographic finding in the area of clinical concern were retrospectively studied. Evaluated parameters included the individual reporting the lump, qualitative descriptors for the physical finding, mammographic density, US characteristics in the area of concern, whether there was a change in imaging and/or physical examination results, and whether there were diagnostic biopsy findings at follow-up. The study group included 540 lumps in 435 women who had a minimum mammographic and clinical follow-up of 2 years, as well as 60 additional lumps in 51 patients who underwent biopsy. RESULTS: No patient in the nonbiopsy group developed carcinoma at the initial site of concern during a mean mammographic and clinical follow-up period of 43 months, and all biopsy specimens were benign (negative predictive value, 100%). CONCLUSION: Results of this retrospective study suggest that breast biopsy may be avoided in women with palpable abnormalities when both US and mammography depict normal tissue at the lump site.

Identification of the sentinel node in patients with breast cancer.

Sentinel node analysis represents a significant advance in the diagnosis and treatment of invasive breast cancer. The traditional crude method of full axillary dissection for assessing the status of the axillary nodes can now be discarded in favor of the much more elegant and modern approach of minimally invasive sentinel node analysis and its attendant elimination of the morbidity of traditional axillary node dissection. The many impediments to and pitfalls in the technique of sentinel node analysis, however, must be recognized and overcome for the procedure to be reliable and consistently successful. The use of ultrasound and a smaller particle size can help overcome many of these pitfalls. Because ultrasound identification of the axillary sentinel node in patients with invasive breast cancer is possible, it may allow for percutaneous excision of these nodes in the future (Fig. 8). Combining percutaneous excision and ablation of the primary breast carcinoma with percutaneous excision of the sentinel node allows for the nonsurgical treatment of small breast cancers in the future. The modern breast radiologist should be at the forefront of these advances.

Incidental treatment of nipple discharge caused by benign intraductal papilloma through diagnostic Mammotome biopsy.

OBJECTIVE: The purpose of this study was to evaluate imaging-guided vacuum-assisted mammotome biopsy as a minimally invasive method of obtaining a satisfactory diagnosis and eliminating the bothersome symptoms in patients presenting with nipple discharge. MATERIALS AND METHODS: Forty-nine women who presented with nipple discharge and who had final pathologic diagnoses of papillary lesions were retrospectively identified. Fifty-six lesions were biopsied in this group. The examinations included mammography, ductography, sonography, and, if possible, percutaneous biopsy. All lesions were centrally located and most were superficial. Of this study group, four patients with five lesions proceeded to sonographically guided automated core biopsy, and 38 patients with 44 intraductal lesions identified by sonography advanced to sonographically guided biopsy with an 11-gauge mammotome probe. One patient underwent stereotactic 11-gauge mammotome biopsy. Patients not advancing to sonographically guided biopsy were those with masses either in the nipple or nipple-areolar complex (five patients), one patient with no identifiable lesion at sonography, and one directly referred for open surgical biopsy. RESULTS: In all biopsied patients, satisfactory tissue for diagnosis was obtained. In patients biopsied with the mammotome probe, follow-up at a mean time of 13 months revealed resolution of the presenting problematic discharge in 97.2% of patients. Complications were mild and infrequent. Only one of 50 percutaneously biopsied lesions was not benign and required subsequent surgery. CONCLUSION: Papilloma excision with percutaneous biopsy allows safe and accurate tissue analysis and a high probability of terminating the symptomatic nipple discharge.

Radiologic findings of adult primary immunodeficiency disorders. Contribution of CT.

STUDY OBJECTIVE: We wished to review the chest radiographic and computed tomographic (CT) findings in adults with primary immunodeficiency disorders, and to evaluate the influence of CT on the treatment of these patients. DESIGN: Retrospective blinded review of radiographs, CT scans, and clinical data. SETTING: National referral center for immunodeficiency disorders. PATIENTS: Forty-six chest radiographs and 22 CT examinations of subjects with primary immunodeficiency disorders were independently scored. Nineteen of the subjects who had CT scans had B-cell deficiency, while 3 had T-cell deficiency. RESULTS: CT-detected bronchiectasis in 15 of 19 subjects with B-cell deficiency, compared with 7 cases detected on chest radiograph. Unsuspected upper lobe bronchiectasis was found on CT in 15 cases. Other CT findings in this group included small nodules in seven subjects, interstitial lines in four, air trapping in seven, ground glass or parenchymal consolidation in nine, evidence of small airways disease in nine, and mucus plugs in four. Two of the three subjects with T-cell disorders showed cavitation and two had unsuspected reactive mediastinal adenopathy. Clinical management appeared to be altered in five subjects with B-cell deficiency by CT findings of severe focal or diffuse bronchiectasis or small airways disease. Additionally, CT localized the bleeding site in three subjects with hemoptysis. CONCLUSIONS: CT is valuable for detection of bronchiectasis in subjects with B-cell immunodeficiency and may alter treatment of these patients.