Ultrasound-guided Aspiration Biopsy Research Articles

Prophylactic administration of antibiotics unnecessary following ultrasound‐guided biopsy and ablation therapy for liver tumors: Open‐labeled randomized prospective study

To determine the prophylactic effect of antibiotics administration in the prevention of infection following an ultrasound-guided percutaneous liver biopsy or treatment of liver tumors, we performed an open-labeled randomized prospective study of patients who received prophylactic antibiotics after undergoing those procedures. We studied 101 patients, with ultrasound-guided percutaneous aspiration biopsies of the liver performed in 48 to diagnose diffuse liver diseases or liver tumors, while percutaneous ethanol-injection therapy was performed in two patients with malignant liver tumors and percutaneous radiofrequency ablation was performed in 51 patients. An oral administration of levofloxacin at 400 mg/day was given to 50 of the enrolled patients from the morning of the treatment day for three days. Preventive antibiotics were not administered to the remaining 51 patients. Body temperature, peripheral blood leukocyte number, c-reactive protein, alanine aminotransferase, and lactic dehydrogenase were measured daily for three days after treatment. Most parameters changed following percutaneous treatments of liver tumors, though no significant differences were seen between the patients treated with antibiotics and those untreated. Most significantly, there was no difference in the frequency of post-procedure infection between the groups. Our results suggest that prophylactic administration of antibiotics following a percutaneous liver biopsy and treatment of liver tumors does not have a significant impact on the post-procedure results or incidence of infection.

Komplikationen der Endosonografie und endosonografischer Interventionen – Ergebnisse einer Umfrage an deutschen Zentren

Endoscopic ultrasonography is a widely used technique in Germany and not restricted to highly specialised centres. Complementary to the traditional radial scanners, longitudinally scanning echo endoscopes have gained considerable acceptation. Multicentre data on the complications of endoscopic ultrasound and endoscopic ultrasound-guided interventions at German centres do not exist. From 2004 to 2006 all German centres performing endoscopic ultrasonography were surveyed and asked to report on their complications. From 1991 to 2006 100 604 endosonographic procedures had been performed in 67 centres (85,084 diagnostic endosonographies without any intervention, 13,223 endoscopic ultrasound-guided finde-needle aspiration biopsies, 2297 endoscopic ultrasound-guided therapeutic interventions). 38 centres reported on 104 complications, of which 88 were considered to be severe (overall complication rate 0.1 %). Complications of diagnostic endoscopic ultrasound occurred at a rate of 0.034 %, almost all of them were duodenal and oesophageal perforations. There had been complications in 0.29 % of all endoscopic ultrasound-guided fine-needle aspiration biopsies and subsequent to 1.61 % of all endoscopic ultrasound-guided therapeutic interventions. The overall mortality of non-interventional and interventional endosonographic procedures was 0.01 %. Under the specific circumstances in Germany, endoscopic ultrasound, both conventional and interventional, was confirmed to be a safe diagnostic and therapeutic technique. In future, the prospective assessment of complications should become an essential part of quality management of endoscopic ultrasound.

Endosonografisch gestützte Biopsie: diagnostischer Ertrag, Fallstricke, Qualitätssicherung

Endoscopic ultrasound-guided biopsies have proven to be of significant value in the diagnostic evaluation of benign and malignant diseases, as well as in the staging of malignant tumours of the gastrointestinal tract and adjacent organs. The high prognostic and therapeutic relevance of the resulting cytopathological diagnoses necessitates a shared responsibility of endosonographer and cytopathologist. Quality control programs are required. The diagnostic yield of endoscopic ultrasound-guided biopsies depends on the location, size and characteristics of target tissues, and technical factors (i. e., type of needle used, biopsy technique, and material processing). Other weighing factors include training, expertise and interaction of the endosonographer with cytopathologists. On-site cytological evaluation, which has proven to be successful in optimising the diagnostic efficiency of endoscopic ultrasound-guided fine-needle aspiration biopsy, is notably practiced in Northern American and French academic institutions. It seems to be a sensible alternative to collect specimens for histological and immunohistochemical investigations in addition to the cytological smears in consideration of the economic and structural terms in the German health-care system. Endoscopic ultrasound-guided fine-needle aspiration succeeds in harvesting core biopsies in 3 out of 4 cases with 22-gauge needles. Therefore the use of 19-gauge needles for endoscopic ultrasound-guided aspiration or trucut biopsy may be necessary only in selected cases.

Actinomycose pelvienne Expérience tunisienne : à propos de 5 cas

Actinomycosis is a rare suppurative disease due to Actinomyces species. These Gram-positive, non-acid fast anaerobic filamentous bacteria are normal inhabitants of the human body, tending to reside in the oropharynx and bowel but are occasionally found in the vagina. Pelvic actinomycosis is a rare bacterial disease in women. Clinical manifestations are various and non specific and may be acute or chronic. No consensus exists for treatment. We reviewed files and identified all five cases of pelvic actinomycosis managed at Obstetrics and Gynaecology department "A" at the Maternity Center of Tunis over an eight-year period (1998-2005). The women's average age was 39.2 years. One patient was menopausal and consulted for bleeding. The other four patients were younger and had all been using an intrauterine device (IUD) for contraception. They presented with acute clinical manifestations. Their main symptom was pelvic pain. Three women had fever, and two presented with urinary tract obstruction. All patients had surgery. A pelvic abscess was found in four cases. Laparoscopic management was possible in only one case. Laparotomy was necessary in the other four. Four women had adnexectomies, two with hysterectomy. Digestive complications occurred in three cases. Actinomycosis was diagnosed only after surgery, by the histological examination. This series confirms the difficulties encountered in the management of pelvic actinomycosis. We review the recent literature and describe the diagnostic and therapeutic procedures currently recommended. The relationship between pelvic actinomycosis and IUDs, the most common method of contraception in Tunisia, is clearly established. Clinical diagnosis of pelvic actinomycosis is difficult because the symptoms are non-specific. Laboratory tests can help by showing serious inflammation, however. Imaging findings are also non-specific and may suggest an abscess or an inflammatory or neoplastic process. Interventional radiology, specifically CT- or ultrasound-guided aspiration biopsy can facilitate diagnosis, which in any case requires a histological examination. Treatment of pelvic actinomycosis is not standardized and depends on clinical form. Medical treatment is based on long-term penicillin G. It is always necessary and may be used alone in cases of preoperative diagnosis. Surgery should be offered only in resistant cases and should always be followed by long-term antibiotic treatment. The prognosis of correctly treated pelvic actinomycosis is generally good.

Transesophageal Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA) and Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) Biopsy: a Combined Approach in the Evaluation of Mediastinal Lesions

It would be desirable to develop minimally invasive methods of tissue diagnosis from lymph nodes as well as solid lesions in the mediastinum. The aim of the present study was to test the combined method of transesophageal endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the evaluation of mediastinal lesions. EUS-FNA and EBUS-TBNA were compared in 33 patients, for the staging of lung cancer in patients with an established diagnosis of non-small-cell lung cancer (n = 20) or for diagnosis of a suspicious mediastinal lesion in patients with suspected lung cancer (n = 13). EBUS-TBNA and EUS-FNA were unsuccessful in one patient each. The diagnoses were verified in 28 of the remaining 31 patients either at thoracotomy (n = 9) or during the clinical follow-up (n = 19). A total of 119 lesions were sampled by EUS-FNA (n = 59) and EBUS-TBNA (n = 60). EUS-FNA and EBUS-TBNA demonstrated cancer in 26 and 28 lesions, respectively, and benign cytology in 30 and 28 lesions, respectively. Suspicious cells were found in three and four lesions by EUS-FNA and EBUS-TBNA, respectively. When the 60 EBUS-TBNA samples were compared with the 59 EUS-FNA samples, 11 additional cancer diagnoses and three samples with suspicious cells were obtained by EBUS-TBNA that had not been obtained by EUS-FNA. Conversely, EUS-FNA diagnosed 12 additional cancer diagnoses, one suspicious and one specific benign diagnosis (sarcoidosis) in addition to EBUS-TBNA. With a combined approach (EUS-FNA + EBUS-TBNA) in 28 of the 31 patients in whom a final diagnosis was obtained in the evaluation of mediastinal cancer, 20 patients were found to have mediastinal involvement, whereas no mediastinal metastases were found in eight patients. The accuracy of EUS-FNA and EBUS-TBNA, in combination, for the diagnosis of mediastinal cancer was 100 % (95 % CI, 83 - 100 %). EUS-FNA and EBUS-TBNA appear to be complementary methods. A combined approach with both EUS-FNA and EBUS-TBNA may be able to replace more invasive methods for evaluating lung cancer patients with suspected hilar or mediastinal metastases, as well as for evaluating unclear mediastinal or hilar lesions.

Endoscopic ultrasound guided aspiration biopsy, neurolysis of coeliac plexus and punctures: Personal experience

Endoscopic ultrasonography, as relatively new diagnostic procedure, has made a significant progress in detection and presentation of small lesions of digestive tract, as well as in other organs. By introducing linear ultrasonography in clinical practice, the possibilities of this procedure became even more apparent, anabling even more precise diagnosis and various therapeutic procedures. With endoscopic ultrasound (EUS) guided aspiration biopsy it is possible to obtain samples in specific, well defined layer of gastrointestinal tract wall, and also from different parts of other organs and formations, which finaly enables establishing definite patohystologic diagnosis. First linear EUS procedure in this part of south-east Europe, was performed in University Clinical Center "Bezanijska Kosa" (N. Milinic, M. Petrovic) in 1999, and first EUS guided aspiration biopsy was performed on July 4th 2000 (N. Milinic--biopsy of pancreas). Using "Pentax" FG-36UX linear echo-endoscope, until now, 40 pancreas biopsies, 34 stomach biopsies, 9 biopsies of mediastinal lymph nodes, cysts and tumors, 22 biopsies of masses in retroperitoneal region, 7 biopsies of papilla Vateri, 4 biopsies of left suprarenal gland, 2 punctures of renal cysts, 14 biopsies of focal liver lesions, 2 punctures of liver cysts, and 5 neurolyses of coeliac plexus was performed. From 134 EUS guided biopsy samples, 114 was, according to pathologist, adequate for patohystologic evaluation, and in 96 cases obtained samples was essential for obtaining definite diagnosis. The major problem in this issue was a lack of well trained and expirienced cytologist, as also is the current problem in Western countires with more expirience and practice in this field. EUS guided aspiration biopsy, as the procedure itself, was successful in all cases. There were no major complications during the procedures, mainly because of using Colour-Doppler technique in defferentiating vascular from other structures. Results so far are showing that linear endoscopic ultrasonography is extremely precise diagnostic method, and should be used in establishing definite diagnosis in many well defined indications, and also is showing the consecutive need for specialy trained and expirienced citologists.

Criteria for the Diagnosis of Fibroepithelial Lesions of the Breast with Liquid-Based Cytology

To establish diagnostic criteria for diagnosing and differentiating fibroepithelial lesions of the breast on ThinPrep (Cytyc Corp., Boxborough, Massachusetts, U.S.A.).Eighty-four fibroepithelial lesions were sampled by ultrasound-guided aspiration biopsy. Based on smears and histologic correlates, there were 55 fibroadenomas, 26 papillary neoplasms and 3 phyllodes tumors. The ThinPrep slides for each sample were reviewed retrospectively and evaluated for specific morphologic and cytologic features.On ThinPrep slides, 95% of the fibroadenomas had a predominance of single myoepithelial nuclei, 89% had staghorn clusters, and 47% had myxoid stroma. Among the papillary neoplasms, 8% had a predominance of single columnar ductal cells, 31% had papillary groups, 23% had vessels, and 27% had collagenous spherulosis. The ThinPrep preparations of the phyllodes tumors showed that 67% had single myoepithelial nuclei, 33% had a predominance of single ductal cells, 67% had staghorn clusters, and 0% had myxoid stroma. A majority of the fibroadenomas and the papillary neoplasms showed mild to moderate ductal epithelial hyperplasia. A majority of the phyllodes tumors showed moderate ductal epithelial hyperplasia.Fibroepithelial lesions of the breast can be accurately differentiated using ThinPrep samples based on the evaluation of specific cytologic and morphologic features, including the presence of staghorn clusters, fibromyxoid stroma, vessels, collagenous spherulosis, papillary clusters and predominance of myoepithelial nuclei or columnar cells in the background. However, the degree of ductal epithelial hyperplasia does not aid in the diagnosis.

Biological characteristics of HCC by ultrasound-guided aspiration biopsy and its clinical application.

To probe the pathological biological characteristics of hepatocellular carcinoma (HCC) by the ultrasound-guided aspiration biopsy and assess the clinical application value of this method. The biopsy and DNA analysis by flow cytometry (FCM) were taken in 46 cases with HCC nodules, including 26 cases and 20 cases with nodules < or =3 cm and >3 cm in diameters respectively, and 12 cases with intrahepatic benign hyperplastic nodules. They were taken in 22 cases of 46 cases with HCC before and after the therapy. Fine-needles and automatic histological incised biopsy needles were used. The fresh biopsy tissue was produced into the single cell suspension, which was sent for DNA detection and ratio analysis of cell period. The ratio of each DNA period of cell proliferation of each group was calculated and compared with each other. The DNA aneuploid (AN) and apoptosis cell peak were observed and their percentages were calculated. The ratios of S and G(2)/M periods of DNA, which reflect cell hyperproliferation, in the group with HCC tumors >3 cm in diameter were markedly higher than those of the group with HCC nodules < or =3 cm in diameter and the group with the benign hyperplastic nodules (P<0.01 except A:B of S period, P<0.05). The ratios of the middle group were also apparently higher than those of the latter group (P<0.01). The ratio of DNA AN of 46 cases with HCC nodules was 34.8 % (16/46). None of the cases with the intrahepatic hyperplastic nodules appeared AN. The DNA AN appeared more apparently with the growth of the tumors. The AN ratio of the group with tumors >3 cm in diameter was 55 % (11/20), markedly higher than that of the group with tumors < or =3 cm in diameter which was 19.2 % (5/26) (P<0.01). The FCM DNA analysis of 22 specimens of hepatic carcinoma tissue before therapy showed that the aneuploid peaks appeared in 5 cases (22.7 %). The ratio of G(1) period rose after therapy while the S period and G(2)/M ratios fell (P<0.01). The aneuploid peak disappeared in the 5 cases after the therapy, while the apoptosis peaks in 12 cases (54.5 %) appeared. Addition to supply the information of the pathological morphology of the tumor, the ultrasound-guided fine-needle aspiration tissue could be sent for FCM DNA analysis to comprehend its pathological biological characteristics. This can not only provide the clinic the reliable information about the occurrence, development, diagnosis, curative effect and prognosis of tumors but also supply biological information for clinic to choose therapeutic schemes.

Diffusion Weighted MR Image of Intracranial Hemorrhage

Purpose: To determine changes in the signal intensity of intracerebral hemorrhagic lesions according to the time interval, between the onset of symptoms and MR imaging in the T1-weighted (T1W1), T2-weighted (T2W1) and diffusion-weighted modes. Materials and Methods: Thirty-four patients with hemorrhagic stroke who underwent DWI and conventional MRI were involved in this study. Hemorrhagic phase was determined according to the time interval between the onset of symptoms and MR scanning, and was as follows: acute (3 days or less): eight patients); early subacute (7 days or less): ten patients; late subacute (4 weeks or less): seven patients; early chronic (3 months or less) : four patients); and late chronic (more than 3 months): five patients. Using a 1.5T MR imager and the single-shot echo-planar imaging technique, T1-weighted, fast spin-echo T2-weighted, and diffusion-weighted were obtained. In all cases qualitative signal intensity (SI) at the center of a lesion was recorded, and the ratio between this and normal brain parenchyma was calculated. Results: SI at the center of a lesion was found to be iso or high/high/high (T1WI/T2WI/DWI) in five of eight acute-phase cases (interval of 24 hours or less) and low/low/low in the remaining three (interval of 72 hours or less). Other signal intensities were as follows: early subacute phase: high/low/low (all ten cases); late subacute phase: high/high/high (all seven cases); early chronic phase: high/high/high (all four cases); late chronic phase: low/high/low (all five cases). Mean SIRs were as follows: in the five acute-phase cases in which SI was iso or high: 1.420.78 / 2.580.84 / 1.350.08 (T1WI / T2WI / DWI); in the remaining three acute-phase cases: 0.94 0.18 / 0.630.16 / 0.270.10; in the early subacute phase, 1.350.01 / 0.970.21 / 0.860.22 in early subacute phase, 1.580.04 / 1.540.09 / 1.440.14; in the early chronic phase: 1.260.11 / 1.060.14 / 0.970.12; and in the late chronic phase: 0.652.23 / 1.510.12 / 0.230.18. Conclusion: The DWI findings of intracerebral hemorrhage reflect the findings of T2WI. When interpreting the DWI findings in patients with intracerebral hemorrhage, an understanding of the temporal evolution of this is very helpful . The no-show rate, patient distribution, chief complaint, type and number of additional radiologic examinations, patient compliance rate, biopsy result, rate of cancer detection, and staging of cancers were determined. The merits and demerits of the clinic were also assessed. Results: A total of 671 patients attended, with a no-show rate of 13.2%. Referrals from the Health Promation Centre accounted for 90.4% of patient visits. The most frequent complaint was a suspicious nodule at mammography. One additional radiologic examination was performed in 429 patients, two examinations in 70, and three or more examations in five. The most frequent type of examination was ultrasonography, followed by magnification compression view, mammography, and ultrasound-guided aspiration biopsy. An additional radiologic examination was recommended in 81.2% of patients and compliance rate was 96.7%. Primary breast cancer was diagnosed in 16 patients (2.1%), and was found to be stage 0 and 1 in 64.3% of these. No significant demerits were apparent. Conclusion: Radiologic examinations play a very important role in the detection of early-stage breast cancer, and the establishment of an early detection clinic lead by a radiologist is a very effective and recommendable approach to screening.',PY = '2002-00-00',RF = '5',BN = '

Breast Cancer Early Detection Clinic lead in Department of Radiology: Early Experiences

Purpose: To describe the operation of our Breast Cancer Early Detection Clinic, lead by a radiologist. Materials and Methods: From its opening in July 2000, until September 2001, patients who attended the Breast Cancer Early Detection Clinic at the Department of Radiology were referred mainly from the Health Promotion Center. Additional radiologic examinations were performed immediately, and according to the results, patients were either referred at once to a surgical clinic or a follow-up schedule was arranged for them there. The no-show rate, patient distribution, chief complaint, type and number of additional radiologic examinations, patient compliance rate, biopsy result, rate of cancer detection, and staging of cancers were determined. The merits and demerits of the clinic were also assessed. Results: A total of 671 patients attended, with a no-show rate of 13.2%. Referrals from the Health Promation Centre accounted for 90.4% of patient visits. The most frequent complaint was a suspicious nodule at mammography. One additional radiologic examination was performed in 429 patients, two examinations in 70, and three or more examations in five. The most frequent type of examination was ultrasonography, followed by magnification compression view, mammography, and ultrasound-guided aspiration biopsy. An additional radiologic examination was recommended in 81.2% of patients and compliance rate was 96.7%. Primary breast cancer was diagnosed in 16 patients (2.1%), and was found to be stage 0 and 1 in 64.3% of these. No significant demerits were apparent. Conclusion: Radiologic examinations play a very important role in the detection of early-stage breast cancer, and the establishment of an early detection clinic lead by a radiologist is a very effective and recommendable approach to screening.

Ultrasound for diagnosis of infection in revision total hip arthroplasty

Eighty consecutive patients (85 hips; 43 women; median age, 74 years [range, 33-90 years]) underwent a revision total hip arthroplasty. Preoperatively and guided by ultrasound, biopsy specimens of the joint pseudocapsule were taken, and joint fluid was aspirated for culture. Capsule morphology was investigated with light microscopy. When septic loosening was defined as 2 intraoperative cultures yielding the same microorganism, the prevalence was 12%. Sensitivity of the capsule biopsy cultures was 67%; specificity, 68%; positive predictive value, 22%; and negative predictive value, 94%. Joint fluid was often sparse and always falsely sterile. One specimen from a hip with septic loosening showed histologic changes (≥3 foci, each with ≥3 plasma cells/high-power field) consistent with chronic infection. The remaining 8 septic loosenings eluded histologic detection, yielding 11% sensitivity. All aseptic loosenings were classified correctly (specificity 100%). Positive and negative predictive values were 100% and 89%. Ultrasound-guided aspiration and capsule biopsy with cultures and histology does not seem to be sufficiently accurate in the preoperative diagnosis of infected total hip arthroplasty.

Ultrasound-guided aspiration biopsy of peripheral pulmonary nodules

Ultrasound-guided aspiration biopsy of peripheral pulmonary nodules

Lymphome primitif de la surrénale de phénotype B, diagnostiqué à la ponction—biopsie percutanée

The authors report a case of primary adrenal lymphoma in a 30-year old-female who complained of lumbar pain and was in poor general condition. Ultrasonography and CT scan revealed a heterogeneous mass with necrosis in the left adrenal gland. Non-Hodgkin's lymphoma of B-cell origin was determined by ultrasound-guided aspiration biopsy of the adrenal mass. Taking this case and the findings in the literature into consideration, the features of this disease have been reviewed and the problem of diagnosis, treatment and prognosis have been examined.

Diagnostic and interventional ultrasound for breast disease

The availability of reliable, portable computer-enhanced ultrasonography with high-frequency transducers has improved breast ultrasonography such that its role has increased dramatically. Diagnostic characteristics of breast lesions may be used to categorize these lesions according to their relative risk for malignancy. Furthermore, breast ultrasonography may be used to guide needle aspiration and biopsy of lesions so indicated by diagnostic evaluation. Results of ultrasound-guided aspiration and core biopsy accurately diagnose specific histopathology thereby avoiding unnecessary open biopsy for benign lesions and facilitating therapeutic planning for malignant lesions.

Ultrasound-guided aspiration biopsy for detection of nonpalpable axillary node metastases in breast cancer patients: new diagnostic method.

This study was designed to evaluate the accuracy of ultrasonography alone and in combination with fine-needle aspiration biopsy (FNAB) for detection of axillary metastases of nonpalpable lymph nodes in breast cancer patients. Ultrasonography was carried out in 150 axillas of 148 patients (mean age 57 years, range 30-80 years); and in 93 axillas lymph nodes were detected. Nodes were described according to their dimension and echo patterns and were compared with histopathologic results. FNAB was carried out in 81 axillas (122 nodes). The sensitivity of ultrasonography was highest (87%) when size (length >5 mm) was used as criterion for malignancy, but the specificity was rather low (56%). When nodes with a malignant pattern (echo-poor or inhomogeneous) were visualized, specificity was 95%. Ultrasound-guided FNAB had a sensitivity of 80% and a specificity of 100% and detected metastases in 63% of node-positive patients. It is concluded that FNAB is an easy, reliable, inexpensive method for identifying patients with positive nodes. In the case of negative findings, other diagnostic procedures to exclude lymph node metastases, such as sentinel node mapping, could be performed.

SPMP 8106 Ultrasound-guided aspiration biopsy in the diagnosis of subclinical regional metastases of the head and neck carcinoma

SPMP 8106 Ultrasound-guided aspiration biopsy in the diagnosis of subclinical regional metastases of the head and neck carcinoma

Ultrasound-guided biopsy of nonpalpable breast masses by surgeons.

Recently, ultrasound (US)-guided needle biopsy has been proposed as an acceptable alternative to open biopsy in women with nonpalpable breast masses. This study evaluated the accuracy of US-guided needle biopsy of nonpalpable breast masses performed by surgeons at the time of the initial clinical examination. Ultrasound-guided aspiration and/or core biopsy (US-GAB) was performed on 103 patients presenting with a nonpalpable, new, or increasing-size mass detected on mammography. Study patients included those whose US was classified as: fibroadenoma (FA) (n = 26), complex cyst (n = 32), indeterminate (complex cyst versus solid; N = 24), or suspect (n = 21). Of the 32 patients with diagnostic US of complex cyst, US-GAB confirmed 27 to be cysts. Twelve additional cysts were aspirated among the 24 indeterminate lesions. Sixteen FA were diagnosed on US-GAB; 11 of these underwent open biopsy and each was demonstrated to be a FA. Fibrocystic/benign-breast change (FBC) was diagnosed on 26 US-GAB; 15 of these underwent open biopsy, which demonstrated three FA and 12 FBC. Nine atypical lesions were diagnosed on US-GAB; six FBC, one papilloma, one FA, and one cancer were demonstrated on open biopsy. Seven cancers were diagnosed on US-GAB and all were confirmed on open biopsy. There were six insufficient specimens from US-GAB; four of these underwent open biopsy, which demonstrated two FA and two FBC. Ultrasound-guided aspiration and/or core biopsy performed by surgeons in conjunction with the initial clinical examination can accurately diagnose nonpalpable, mammographically detected breast masses.

Biopsy of nonpalpable cervical lymph nodes: Selection criteria for ultrasound-guided biopsy in patients with head and neck squamous cell carcinoma

This article is designed to find an appropriate policy to select nonpalpable cervical lymph nodes in head and neck squamous cell carcinoma patients for ultrasound-guided aspiration biopsy (USB). According to the literature, generally used selection criteria are width of nodes > 10 mm, length-to-width ratio > 2 and absent echo-rich hilum. In 562 nonpalpable nodes of 355 patients (mean age 60 y, range 20–92 y) with head and neck squamous cell carcinoma, a USB procedure was carried out. Nodes were classified according to dimensions and to echo pattern. Representative cytology was obtained in 489 nodes; 112 were classified as malignant. Of the 412 nodes with a width ≤ 10 mm, 79 were malignant. Width is the strongest predictor for malignancy and, if corrected for width, the length-to-width ratio is of no influence. Of the 142 nodes with an echo-poor centre, or an inhomogeneous pattern, 46% were malignant, compared to 13% of 342 nodes with an echo-rich centre. It is concluded that selection of lymph nodes of the neck of patients with squamous cell carcinoma of the head and neck should be based on width and echo pattern. We advise subjecting nodes with an echo-rich centre or homogeneous pattern and a width ≥4 mm to USB, and also subjecting nodes with an echo-poor centre or inhomogeneous pattern with a width ≥3 mm to USB.

AN OPERATED CASE OF MINUTE BREAST CANCER WHICH WAS DAIGNOSED BY ULTRASOUND-GUIDED ASPIRATION BIOPSY CYTOLOGY

A 40-year-old woman was seen at the hospital because of a tumor of the right breast in the middle of July, 1992. Physical examination revealed that she had a tumor of small bean sized, hard (solid), and well-movable, at the lateral side of the right breast. On mammography any sharp tumor shadow was not found and echomammographyshowed an 6×4mm sized, relatively smoothly outlined hypoechoic mass, which was considered as fibroadenoma. Simultaneously ultrasound-guided aspiration biopsy cytology was performed and it was confirmed that the tumor was ductal carcinoma. On August 11th, a partial mastectomy (less than 1/4) with axillary lymph node dissection was done under the consideration of T1aN0M0, stage I of UICC criteria, on the lateral side of CD boundary in the right breast. Postoperative radiotherapy (contact irradiation, 2 Gy×25, total dose 50 Gy) was performed against the residual breast.

Superior vena cava syndrome. Rapid histologic diagnosis by ultrasound-guided transthoracic needle aspiration biopsy.

We prospectively analyzed the diagnostic yield and safety of ultrasound (US)-guided transthoracic needle aspiration biopsy in the histologic diagnosis of 40 patients with superior vena cava (SVC) syndrome. During a 4-yr period, 40 patients with SVC obstruction were admitted to National Taiwan University Hospital. Of these patients 10 had histologic confirmation by sputum cytology (3 patients), fiberoptic bronchoscopy with biopsy (2 patients), or lymph node biopsy (5 patients) at admission. A total of 30 undiagnosed patients underwent real-time ultrasonographic (US) evaluation as well as color Doppler imaging. Patients with tumor detectable by US underwent US-guided transthoracic needle aspiration biopsy. Of the 30 patients who received US chest examination, 29 had widening of the upper mediastinal shadows in the chest radiographs. In 27 patients tumors were detected by chest US. After assessment of collateral vessels by color Doppler US, these 27 patients underwent US-guided transthoracic needle aspiration biopsies; histologic diagnoses were confirmed in 25. The diagnostic yield was 83.3%. The mean duration from admission to histologic diagnosis was 2.1 days. None of the patients developed complications. We conclude that chest US and color Doppler images are useful tools for evaluation of patients with SVC syndrome. US-guided transthoracic needle aspiration biopsy appears to be a safe, effective, and rapid approach for obtaining an accurate histologic diagnosis. Specific treatment can thus be initiated without delay.