Roxanne Lorans

US-guided Renal Transplant Biopsy: Efficacy of a Cortical Tangential Approach

PURPOSE To describe the cortical tangential approach to ultrasonographically (US) guided renal transplant biopsy and evaluate its efficacy in obtaining sufficient cortical tissue. MATERIALS AND METHODS This HIPAA-compliant retrospective study was exempted from review by the institutional review board. Informed consent was not required. The number of core biopsy samples, glomeruli, and small arteries obtained during 294 consecutive US-guided renal transplant biopsies in 254 patients (134 men, 120 women; age range, 19-79 years; mean age, 52.2 years) in one department between June 1 and December 31, 2008, were recorded, along with any ensuing complications. Procedural success was assessed according to Banff 97 criteria. RESULTS There were 1.2 +/- 0.4 (standard deviation) biopsy core samples taken per case by 11 radiologists using the cortical tangential approach. In 290 cases, biopsy results showed 21.7 +/- 10.1 glomeruli and 5.0 +/- 2.8 small arteries. Two hundred seventy-six (95%) cases were adequate or minimal according to Banff 97 assessment criteria. Of the 14 inadequate cases (5%), six were lacking only one glomerulus to achieve minimal status. Only one biopsy core sample was taken in all 14 inadequate cases and in 233 successful cases (success rate, 85%). None of the 43 cases with two or more biopsy core samples taken were inadequate (success rate, 100%). Two patients (0.7%) had a hemorrhagic complication requiring transfusion, and another four patients (1.4%) experienced a minor self-limiting complication. CONCLUSION The cortical tangential approach can be used by a cohort of radiologists to achieve 95% or higher collective success in obtaining cortical tissue during renal transplant biopsy, with few complications. The success rate is higher, without increased complications, when more than one core specimen is taken.

Contrast-enhanced Digital Mammography: A Single-Institution Experience of the First 208 Cases.

Contrast‐enhanced digital mammography (CEDM) is the only imaging modality that provides both (a) a high‐resolution, low‐energy image comparable to that of digital mammography and (b) a contrast‐enhanced image similar to that of magnetic resonance imaging. We report the initial 208 CEDM examinations performed for various clinical indications and provide illustrative case examples. Given its success in recent studies and our experience of CEDM primarily as a diagnostic adjunct, CEDM can potentially improve breast cancer detection by combining the low‐cost conclusions of screening mammography with the high sensitivity of magnetic resonance imaging.

The Future of Contrast-Enhanced Mammography

OBJECTIVE The purpose of this article is to discuss facilitators of and barriers to future implementation of contrast-enhanced mammography (CEM) in the United States. CONCLUSION CEM provides low-energy 2D mammographic images analogous to digital mammography and contrast-enhanced recombined images that allow assessment of neovascularity similar to that offered by MRI. The utilization of CEM in the United States is currently low but could increase rapidly given the many potential indications for its clinical use.

Initial Experience of Tomosynthesis-Guided Vacuum-Assisted Biopsies of Tomosynthesis-Detected (2D Mammography and Ultrasound Occult) Architectural Distortions

OBJECTIVE As experience and aptitude in digital breast tomosynthesis (DBT) have increased, radiologists are seeing more areas of architectural distortion (AD) on DBT images compared with standard 2D mammograms. The purpose of this study is to report our experience using tomosynthesis-guided vacuum-assisted biopsies (VABs) for ADs that were occult at 2D mammography and ultrasound and to analyze the positive predictive value for malignancy. MATERIALS AND METHODS We performed a retrospective review of 34 DBT-detected ADs that were occult at mammography and ultrasound. RESULTS We found a positive predictive value of 26% (nine malignancies in 34 lesions). Eight of the malignancies were invasive and one was ductal carcinoma in situ. The invasive cancers were grade 1 (4/8; 50%), grade 2 (2/8; 25%), or grade 3 (1/8; 13%); information about one invasive cancer was not available. The mean size of the invasive cancers at pathologic examination was 7.5 mm (range, 6-30 mm). CONCLUSION Tomosynthesis-guided VAB is a feasible method to sample ADs that are occult at 2D mammography and ultrasound. Tomosynthesis-guided VAB is a minimally invasive method that detected a significant number of carcinomas, most of which were grade 1 cancers. Further studies are needed.

Can adding contrast-enhanced digital mammography (CEDM) as an adjunct to diagnostic mammography/US help decrease biopsy rates in women with suspicious (BIRADS 4) breast lesions?

6 Background: Traditional screening mammography (MG) enables early detection of breast cancer and therefore results in decreased mortality. Mammography, however, is an imperfect tool and limited by an overall sensitivity of 75-85%. Specificity is limited as well resulting in many false-positive examinations and unnecessary follow-up examinations. The recent development of contrast-enhanced digital mammography (CEDM) has made the usage of IV contrast enhancement with mammography a possibility. CEDM is an angiographic technique that uses digital subtraction, which removes the normal mammary gland on images in order to detect breast tumors and visualize their vascularity. The literature is promising with regard to CEDM as studies have found that CEDM achieves increased sensitivity without reductions in specificity in comparison to MG, US and/or MRI. METHODS In this multi-reader study we compared the diagnostic accuracy of CEDM as an adjunct to MG/US in patients with suspicious findings (BI-RADS 4). The study population included 31 patients who were imaged with CEDM prior to their scheduled US or stereotactic-guided biopsy. We compared the relative performance of MG/US alone versus MG/US/CEDM in determining the probability of malignancy. Histology served as the gold standard. RESULTS See table below. CONCLUSIONS The addition of CEDM to the workup of suspected lesions on MG and/or US preliminarily decreases the number of false-positive MG thereby with potential to reduce cost and unnecessary patient harm. [Table: see text].