Emanuela Capalbo

Performance and role of the breast lesion excision system (BLES) in small clusters of suspicious microcalcifications

PURPOSE To assess the diagnostic performance of the BLES as a biopsy tool in patients with ≤ 1 cm clusters of BIRADS 4 microcalcifications, in order to possibly avoid surgical excision in selected patients. MATERIALS This is a retrospective study of 105 patients undergone to stereotactic breast biopsy with the BLES. It excises a single specimen containing the whole mammographic target, allowing better histological assessment due to preserved architecture. RESULTS Our case series consists of 41 carcinomas (39%) and 64 benign lesions (61%). Cancer involved the specimen margins in 20/41 cases (48.8%) or was close to them (≤ 1 mm) in 14 cases (34.1%); margins were disease-free in only 7 DCIS (17.1%). At subsequent excision of 39/41 malignant cases, underestimation occurred for 5/32 DCIS (15.6%), residual disease was found in 15/39 cancers (38.5%) and no cancer in 19/39 cases (48.7%). For DCIS cases, no residual disease occurred for 66.7% G1-G2 cases and for 35.3% G3 cases (P=0.1556) as well as in 83.3%, 40.0% and 43.8% cases respectively for negative, close and positive BLES margins (P=0.2576). CONCLUSIONS The BLES is a good option for removal of small clusters of breast microcalcifications, giving better histological interpretation, lower underestimation rates and possibly reducing the need of subsequent surgical excision in selected patients.

Bladder cancer diagnosis: the role of CT urography.

Aims and Background To evaluate the diagnostic performance of computed tomography urography (CTU), we first compared it with cystoscopy and subsequently analyzed which CTU phase of acquisition has the highest diagnostic accuracy in identifying bladder cancer. Methods In 2013, 177 patients underwent both cystoscopy and CTU. For all acquisition phases, we calculated sensitivity, specificity, diagnostic accuracy, and positive and negative predictive value (PPV and NPV, respectively). We also evaluated the Cohen K coefficient. Results Computed tomography urography sensitivity, specificity, diagnostic accuracy, PPV, and NPV were as follows: 96.3%, 86.4%, 92.8%, 92.9%, and 92.7%; concordance calculated with Cohen K was good: 0.8413. The arterial acquisition phase showed the highest diagnostic accuracy, identifying 93.4% of all lesions. Conclusions Computed tomography urography is an accurate examination for the diagnosis of bladder cancer, and the arterial acquisition phase provides the best diagnostic information.

Placement of port-a-cath through the right internal jugular vein under ultrasound guidance

PurposeThis study was undertaken to demonstrate the effectiveness of ultrasound (US)-guided placement of porta-cath (PC) through the right internal jugular vein (RIJV) by evaluating the onset of early and late complications.Materials and methodsFrom 30 June 2008 to 30 June 2011, we placed 695 port-a-caths in 694 patients with a mean age of 58 years. Exclusion criteria were active infection, bleeding disorders and life expectancy <6 months. The procedures were performed in the angiography suite under local anaesthesia. After US-guided puncture of the RIJV, the subcutaneous pocket was prepared, followed by tunnelling of the vein and closure of the surgical wound. In order to evaluate pneumothorax (PNX), all patients underwent chest X-ray a few hours after the end of the procedure unless there were clinical indications. We evaluated the technical success of the procedure and the rate of complications.ResultsTechnical success was achieved in all cases. The device was kept in place for an average of 168 days. There was one case of PNX (0.14%) as shown on chest X-ray and five cases of late complications (0.70%): one case of intracatheter thrombosis (0.14%), two cases of disconnection between the reservoir and catheter (0.28%) and two cases of PC infection (0.28%).ConclusionsThis procedure incurs very small number of complications compared with other positioning techniques using accesses such as the subclavian vein. Complications recorded in our study are comparable, in type and incidence, to those found by other authors, with the most frequent being device infection.RiassuntoObiettivoScopo del presente lavoro è stato dimostrare l’efficacia del posizionamento di port-a-cath (PC) attraverso la vena giugulare interna destra (VGID) sotto guida ecografica (US) valutando l’insorgenza di complicanze.Materiali e metodiDal 30 giugno 2008 al 30 giugno 2011 abbiamo posizionato 695 PC in 694 pazienti con età media di 58 anni. I criteri di esclusione sono: infezione in atto, coagulopatie e aspettativa di vita inferiore ai 6 mesi. Le procedure sono state eseguite in sala angiografica previa anestesia locale. Abbiamo effettuato la puntura sottoguida US delle VGID, poi è stata preparata la tasca sottocutanea e tunnelizzazione del tramite e chiusura della ferita chirurgica. Per valutare lo pneumotorace (PNX) abbiamo eseguito un radiogramma del torace dopo qualche ora dalla procedura salvo diversa indicazione clinica. Abbiamo valutato la riuscita della procedura e il tasso di complicanze.RisultatiLa riuscita tecnica dell’impianto è stata ottenuta nella totalità dei casi. Il dispositivo è stato mantenuto in sede per una media di 168 giorni/paziente. Abbiamo registrato uno PNX (0,14%) evidenziato all’Rx di controllo e 5 casi di complicanze tardive (0,70%): 1 caso di trombosi intra-catetere (0,14%), 2 casi di deconnessioni tra il reservoir ed il catetere (0,28%) e 2 casi di infezioni del port (0,28%).ConclusioniLe complicanze che abbiamo osservato sono paragonabili sia in termini di incidenza che di tipologia a quelle riscontrate da altri autori; infatti anche dal nostro studio emerge che l’infezione del dispositivo risulta essere la complicanza più frequente.

Revaluation of breast cytology with pathologist on-site of lesions with suspicious sonographic features

OBJECTIVE Evaluating correlation estimation between diagnostic ultrasound (U.S.) of breast lesions and fine needle aspiration cytology (FNAC), and the correlation between cytology and histology (I) of these lesions undergo surgery. MATERIALS AND METHODS In 2010 we performed 1589 ultrasound breast. We identified 210 suspicious lesions to be subjected to FNAC, which was performed with pathologist on site, and extemporaneous analysis of the sample to assess their appropriateness. We classified the lesions in 5 ultrasound (U) classes according to the criteria defined by Echographic BIRADS Lexicon. The results of cytology were classified in 5 classes (C) according to the guidelines of F.O.N.Ca.M. Then we evaluated the diagnostic correlation between U.S. and FNAC, and between FNAC and Histology. RESULTS The distribution of lesions in U classes was: 57U2, 55U3, 36U4 and 62U5. The diagnostic concordance between U and FNAC was 96.7%, with a sensitivity of 98%, specificity 93%, negative and positive predictive value respectively of 94.9% and 97.3%, and diagnostic accuracy of 96.6%. The 98 patients with C4-C5 lesions were subjected to surgery and the histology confirmed high-grade malignancy of lesions with a concordance of 99.7%. CONCLUSIONS Having achieved high diagnostic concordance between U and FNAC, and then between FNAC and histology, we may say that the FNAC, less invasive and traumatic for the patient than needle biopsy (CB), may be still a valid method when performed with pathologist on-site to assess the adequacy of the sample taken.

Mammographic findings after reshaping with autoprosthesis in women undergoing contralateral breast reconstruction and mastectomy.

Aims and background Breast reduction and mastopexy combined with inferior dermo-lipo-glandular flap (autoprosthesis) gives good breast shape, long-term projection, and upper pole fullness. We assess the impact on breast oncologic surveillance compared to other techniques. Methods A total of 105 patients who underwent mastectomy and reconstruction were divided into 3 groups of 35 patients each: groups 1 and 2 include patients with contralateral breast symmetrization performed with and without autoprosthesis technique, respectively. Group 3 is a control group without contralateral breast reshaping. On mammography, edema, skin thickening, architectural distortion, and calcifications were recorded, as well as further diagnostic examinations, biopsies, and surgical treatments required. Results Statistically significant differences (p<0.001) in the first follow-up mammography between groups 1 and 2 were stromal edema (6% vs 51%) and architectural distortion (74% vs 63%). The latest findings meant architectural distortion also have significant difference (p<0.001) in the last mammography (79% vs 66%). Microcalcification has statistically significant difference (p<0.001) in the latest postsurgical mammography, increased in group 1. Skin thickening had a similar course in either group. Mammography follow-up was not impaired in most cases notwithstanding the parenchyma distortion as compared with mammography after breast-conserving surgery. Four core biopsies were performed in both groups: 3 new breast cancers and 1 benign epithelial hyperplasia were found. Conclusions No difficulties were found impairing mammographic evaluation in patients treated with autoprosthesis as compared to other techniques.

Breast Foreign Body Extraction Using the Breast Lesion Excision System

The breast lesion excision system is a percutaneous image-guided device that uses radiofrequency energy to deliver intact gross specimens. We describe its use for removal of a breast foreign body. A 56year-old woman who carried the BRCA1 gene mutation could not undergo magnetic resonance imaging surveillance because a mammogram revealed a 0.5-cm radiopaque foreign body in the upper-outer quadrant of the left breast. The procedure was performed under local

Breast metastasis from cutaneous malignant melanoma mimicking a breast cancer

INTRODUCTION Breast metastases are very uncommon, either from solid tumors or malignant melanoma. CASE REPORT We present the case of a 42-year-old woman with a history of cutaneous melanoma of the shoulder excised 21 years ago. She presented with a palpable lump in the upper outer quadrant of the right breast. Ultrasound demonstrated a solid mass within a cystic lesion. A core biopsy was taken and first histology reported a poorly differentiated primary breast cancer suspected to be triple negative. MRI detected a satellite lesion in the same breast, a focus of suspected enhancement in the other breast, and the extramammary finding of an enhancing pulmonary lesion. Staging computed tomography detected widespread metastases to the lungs, brain, subcutaneous left shoulder, liver, pancreas, and hepatorenal recess. A core biopsy was taken from the left breast lesion and the previous slides were reviewed; histopathology and immunohistochemistry were in keeping with metastasis from melanoma. CONCLUSIONS The possibility of a metastatic lesion to the breast should be taken into account in any patient presenting with a breast lump and a previous history of melanoma. Breast involvement cannot be considered an isolated finding, as it might be the first manifestation of widespread disease.