The value of stereotactic vacuum assisted breast biopsy in the investigation of microcalcifications. A six-year experience with 853 patients.

PURPOSE: Vacuum Assisted Breast Biopsy (VABB) is a minimal invasive technique, in the diagnostic approach for non palpable lesions. The aim of this study was to evaluate the efficacy and accuracy of VABB in the investigation of breast microcalcifications, a significant mammographic sign of early breast cancer. The rate of histological underestimation and the false negative rate were assessed based on the follow up data and the histological examination of the surgical specimens. METHODS: From January 2005 to November 2011, 853 women with mammographically detected microcalcifications, classified as BI-RADS 3-5, were referred to our Breast Unit for evaluation. During this 6-year period, 825 vacuum-assisted breast biopsies were performed, while 28 women (3.3%) were not submitted to VABB due to superficial location of microcalcifications. RESULTS: VABB histology revealed 594 benign (69.6%), 66 high risk (7.7%) and 164 malignant (19.2%) lesions. Twenty- nine cases were classified as non diagnostic, as in one case (0.1%) the sample of the biopsy was maladjusted and not suitable to undergo histopathological examination due to mechanical alterations and in 28 (3.3%) cases microcalcifications were located in proximity to the skin and open surgical excision was performed. The overall documented underestimation rate was 4.6%, the false negative rate was 2.4%. The sensitivity of the method was 98.2%, specificity 100%, positive predictive value 100% and negative predictive value 97.6%. CONCLUSIONS: VABB is a safe and accurate method for the evaluation of suspicious microcalcifications and diagnosis of early breast cancer.

The use of oxygen in Fournier's gangrene.

Fournier's gangrene is an aggressive form of necrotizing fasciitis of the perineal, perianal or genital regions, usually caused by a polymicrobial infection that includes virulent organisms. Over the last decades, we have treated 9 patients suffering from Fournier's gangrene using systemic chemotherapy with broad-spectrum antibiotics, and with extensive, sometimes serial surgical debridement. Recently in one case, in addition to treatment, we used locally 100% oxygen in daily doses with promising results in healing wound. Herein, we report this case with a brief review of the literature concerning pathogenesis, risk factors, and treatment approaches.