Wojciech Kibil

Vacuum-Assisted Core Biopsy in Diagnosis and Treatment of Intraductal Papillomas

BACKGROUNDnThe aim of this study was to assess the value of mammographically-guided and ultrasonographically-guided vacuum-assisted core biopsy (VACB) in the diagnosis and treatment of intraductal papillomas of breast and to answer the question of whether biopsy with the Mammotome (Mammotome; Cincinnati, OH) allows the avoidance of surgery in these patients.nnnPATIENTS AND METHODSnIn the period 2000 to 2010, a total of 1896 vacuum-assisted core biopsies were performed, of which 1183 were ultrasonographically guided and 713 were mammographically guided (stereotaxic).nnnRESULTSnIn 62 patients (3.2%) histopathologic examination confirmed intraductal papilloma, and in 12 patients (19.4%) atypical lesions were also found. Open surgical biopsy specimens revealed invasive cancer in 2 women these 12 women (false-negative rate, 16.7%; negative predictive value, 83.3%). Biopsy specimens from the remaining 50 patients (80.6%) revealed papilloma without atypia, and further clinical observation and imaging examinations did not show recurrence or malignant transformation of lesions. Hematoma developed in 3 (4.8%) patients as a complication of biopsy; surgical intervention was not required in any of the patients.nnnCONCLUSIONnVACB is a minimally invasive and efficient method for diagnosing intraductal papilloma of the breast. If histopathologic examination confirms a benign lesion and corresponds to the clinical presentation, surgery may be avoided. However in all cases, histopathologic diagnosis of papilloma with atypical hyperplasia or a suspected malignant lesion in imaging examinations, despite negative biopsy results, should always be an indication for surgical excision.

The use of magnetic resonance mammography in women at increased risk for developing breast cancer

Introduction The use of conventional imaging techniques, namely mammography (MMG) and ultrasound (US), for breast cancer (BC) detection in women at high risk for the disease does not bring optimal results in many cases. Aim The present study evaluated the effectiveness of magnetic resonance (MR) mammography (MRM) in cases where US and MMG failed to detect suspected breast lesions. Material and methods The study group consisted of 379 women who had had no breast pathologies detected by US and MMG. This group was then divided into 4 groups according to the relative risk of breast cancer development. All the women underwent MRM, and any breast pathology detected by MRM was then verified by open surgical biopsy (OSB). Results Based on the MRM findings, 37 women with breast pathologies were identified. All detected pathologies were then classified into one of the BIRADS (Breast Imaging Reporting and Data System) categories. Of these, 33 patients underwent open surgical biopsy. There were a total of 17 benign and 16 malignant breast pathologies that were not visualized by US and MMG. The types of malignancies found, in order of their frequency, were as follows: invasive ductal carcinoma (11 cases), ductal carcinoma in situ (2 cases), invasive lobular carcinoma (2 cases), and lobular carcinoma in situ (1 case). An analysis of MRM effectiveness in detecting BC showed 93.7% sensitivity and 64.71% specificity. Conclusions All women with a 20% or greater lifetime risk of developing BC should undergo annual MRM as a diagnostic adjunct to US and MMG.

Ultrasound-guided vacuum-assisted core biopsy in the diagnosis and treatment of focal lesions of the breast – own experience

INTRODUCTIONnVacuum-assisted core biopsy (VACB) guided by ultrasound is a minimally invasive method used in diagnosis and treatment of breast focal lesions. Vacuum-assisted core biopsy is an interesting minimally invasive alternative to open surgical biopsy.nnnAIMnTo assess the value of ultrasound-guided vacuum-assisted core biopsy in the diagnosis and treatment of breast focal lesions.nnnMATERIAL AND METHODSnIn the period 2009-2010, 397 ultrasound-guided vacuum-assisted core biopsies were performed. Mean age of the patients was 41.7 years (18-92 years), and size of the lesions ranged from 3 mm to 65 mm, mean size being 12 mm. All women with diagnosed atypical ductal hyperplasia or cancer were qualified for surgery. The patients with histopathologically benign lesions were under follow-up.nnnRESULTSnSamples sufficient for histopathological examination were obtained from 394 cases (99.2%). Of all 397 lesions, 293 (73.7%) were diagnosed as benign, there were 6 (1.6%) cases of atypical ductal hyperplasia and 98 (24.7%) malignant lesions. Three hundred and sixty-nine lesions were below 15 mm in diameter, of which 339 (91.9%) were totally removed during the VACB.nnnCONCLUSIONSnThe results obtained confirm high efficiency of ultrasound-guided VACB in the differential diagnosis of breast focal lesions, including impalpable ones. It is a safe method with a low complication rate. In the case of benign lesions with a diameter not exceeding 15 mm, it allows one to excise the whole lesion and is a very good alternative to an open surgical biopsy. Vacuum-assisted core biopsy should be a standard and the method of choice in diagnosing breast lesions.

Mondor’s disease in a patient after a mammotome biopsy

Mondors disease is a rare, benign condition characterised by thrombophlebitis affecting subcutaneous veins of the chest and/or abdomen without an accompanying inflammatory response. The disease has a multifactorial etiology and its course is benign. It is usually self-limiting or it is eliminated by local treatment. Mondors disease in the thoracoepigastric region may be a rare complication of mammotome biopsy. The case presentation describes a 32-year-old patient with Mondors disease in the thoracoepigastric region after an ultrasound-guided mammotome biopsy of a breast. In the histopathological examination the lesion was diagnosed as fibroadenoma. Regardless of the diseases etiology, it is recommended to carry out diagnostic examinations to exclude co-occurring breast cancer.

Mammotome Biopsy Under Ultrasound Conrol in the Diagnostics and Treatment of Nodular Breast Lesions - Own Experience

Mammotome biopsy is an effective, minimally invasive, novel technique used in the verification of breast lesions.The aim of the study was to assess the value of ultrasound-guided vacuum-assisted core needle biopsy (mammotome biopsy) in the diagnostics and treatment of nodular breast lesions, considering own data.Material and methods. Analysis comprised 1183 mammotome biopsies under ultrasound control performed in 1177 female patients during the period between 2000 and 2010, at the Regional Clinic for Early Diagnostics and Treatment of Breast Lesions, I Chair and Department of General Surgery, Jagiellonian University, Collegium Medicum.Results. The average patient age amounted to 41.7 years. The size of the investigated lesions ranged between 4 and 65 mm (mean - 12 mm). The histopathological examination result was as follows: fibrocystic lesions (n=285), adenofibroma (n=477), adenosis sclerosans (n=188), hyperplasia without atypy (n=58), phyllode tumor (n=2), papilloma (n=14), hamartoma (n=1), atypical hyperplasia (n=25), in situ ductal carcinoma (n=4), in situ lobular carcinoma (n=5), infiltrating ductal carcinoma (n=114), infiltrating lobular carcinoma (n=4), non-diagnostic result (n=6). The histopathological diagnosis was obtained in 99.5% of cases. Patients diagnosed with atypical hyperplasia or cancer were qualified for surgery, according to accepted standards. The presence of a hematoma was the most common complication after the biopsy, observed in 16.5% of patients.Conclusions. The obtained results confirmed the high value of ultrasound-guided biopsies in the diagnostics of nodular breast lesions. The method is safe, minimally invasive, with few complications, providing a good cosmetic effect. In case of benign lesions with a diameter of less than 15 mm the mammotome biopsy enables to completely excise the lesions, being an alternative to open surgical biopsies. The mammotome biopsy should become the method of choice considering the diagnostics of nodular breast lesions.

Clinical predictors of malignancy in patients diagnosed with atypical ductal hyperplasia on vacuum-assisted core needle biopsy

Introduction Atypical ductal hyperplasia (ADH) is a benign lesion, which due to the risk of coexisting cancer is classified as a lesion of uncertain malignant potential. Aim To identify clinical predictors of cancer underestimation in patients with ADH diagnosed after vacuum-assisted breast biopsy (VABB). Material and methods Between 2001 and 2016, a total of 3804 vacuum-assisted core needle biopsies were performed at the First Chair of General Surgery of the Jagiellonian University Medical College in Krakow, including 2907 ultrasound (US)-guided biopsies and 897 digital stereotactic procedures. Seventy-six women were diagnosed with ADH and 72 of them underwent subsequent surgical excision. Demographic factors, medical history, family history, clinical symptoms, type and size of lesion determined in imaging scans, size of biopsy needle, and presence of coexisting lesions in VABB specimens were analysed as potential predictors of malignancy underestimation. Results Underestimation of breast carcinoma occurred in 21 (29.2%) patients. The upgrade rate was significantly higher only in patients with a lesion visible both in mammography (MMG) and US examinations and combined BIRADS-5. Conclusions Vacuum-assisted core needle biopsy is a minimally invasive technique used in diagnosing ADH. As the risk of breast malignancy underestimation is relatively high, open surgical biopsy remains the recommended procedure, especially in patients with lesions detected both in mammography and US examination. As we could not identify the factors that preclude cancer underestimation, all the women diagnosed with ADH should be informed about the risk of cancer underestimation.

Effectiveness of mesh hernioplasty in incarcerated inguinal hernias

Introduction The use of mesh is still controversial in patients undergoing emergency incarcerated hernia repair, mostly because of potential infectious complications. Aim The main aim of this study was to assess the efficacy of tension-free methods in treating incarcerated inguinal hernias (IIH), with and without intestine resection. The secondary aim was to establish an algorithm on how to proceed with incarcerated hernias. Material and methods A retrospective analysis of patients who underwent surgery due to an inguinal hernia at the First Department of General Surgery Jagiellonian University Medical College in Krakow, in the period 1999–2009. Operative methods included Lichtenstein, Robbins-Rutkow and Prolene Hernia System. The rate of postoperative complications was compared in patients who underwent elective and emergency surgery. Results The study group consisted of 567 patients (546 male) age 19–91 years. In this group 624 hernias were treated using the three tension-free techniques – 295 using the Lichtenstein method, 236 using PHS and 93 using the RR technique. Out of the 561 operations 89.9% were elective. No correlation (p > 0.05) was found between the type of surgery and such complications as postoperative pain duration and intensity, fever, micturation disorders, wound healing disorders, testicle hydrocoele, testicle atrophy, spermatic cord cyst, sexual dysfunction, wound dehiscence, wound suppuration, seroma, haematoma and hernia recurrence. Conclusions Mesh repairs can be safely performed while operating due to an IIH. The use of a synthetic implant, in emergency IIH repairs, does not increase the rate of local complications. Synchronous, partial resection of the small intestine, due to intestinal necrosis, is not a contraindication to use mesh.

mAmmotome biopsy in diAGnosinG And treAtment of intrAductAL pApiLLomA of the breAst

UNLABELLEDnIntraductal papilloma is a benign breast tumor which needs histopathological verification because of the risk of cancer coincidence.nnnTHE AIM OF THE STUDYnTo assess the value of the mammography-guided and ultrasound-guided vacuum-assisted core biopsy in the diagnosis and treatment of intraductal papillomas of breast and to answer the question if mammotome biopsy allows to avoid surgery in these patients.nnnMATERIAL AND METHODSnIn the period 2000-2011, a total of 2246 vacuum-assisted core biopsies were performed, of which 1495 were ultrasound-guided and 751 were mammography-guided (stereotaxic). In 76/2246 patients (3.4%), aged 19-88 years (mean age was 51,5) histopathological examination confirmed intraductal papilloma.nnnRESULTSnAtypical lesions were accompanying intraductal papilloma in 16/76 cases (21%). Open surgical biopsy performed in these group revealed invasive cancer in 3 women. In all 60 cases (79%) with benign papilloma in biopsy specimens, further clinical observation did not show recurrence or malignant transformation of lesions.nnnCONCLUSIONSnVacuum-assisted core biopsy is a minimally invasive and efficient method used for diagnosing intraductal papilloma of the breast. If histopathological examination confirms a benign character of the lesion, surgery may be avoided but regular follow-up is recommended. However, in all cases histopathological diagnosis of papilloma with atypical hyperplasia, should always be indication for surgical excision.

Anatomical aspect of nerve-preserving surgery for rectal cancer.

The outcome after resection for rectal cancers has improved following standardization of the surgical technique and the introduction of total mesorectal excision (TME) (1-4). In particular the TME technique has resulted in better local control and survival (5). The existence of nodal metastases has been the most important overall prognostic factor in determining long-term survival rates (6). Adequate lymphadenectomy measured by analysis of at least 15 lymph nodes, correlates with improved survival, independent of stage, patient demographics, and tumor characteristics (7). However, surgical resection of the rectum with TME performed for rectal cancer has been connected with a high risk of loss of sexual function due to autonomic nerve damage. It is a common complication and may occur after radical pelvic sur gery of all types: radical prostatectomy, radical cystoprostatectomy, anterior rectal resection and abdominoperineal rectal resection. The pathophysiology of sexual dysfunction after pelvic surgery is unique because it can be a result of vascular or neurogenic factors alone, or a combination of both. Age, sex, type of surgery, and presence of malignant disease have all been shown to be associated with an increased risk of postoperative sexual dysfunction (8). In 1982, Walsh and Donker demonstrated that impotence following radical prostatectomy often occurred secondary to injury to the branches of the pelvic plexus that innervates the cavernous bodies of the penis, and they proposed minor modifications in the surgical procedure to avoid this complication (9). Later, these modifications were widely implemented during surgical procedures involving radical prostatectomy (10) and cystoprostatectomy (11). The sphincter-saving procedures also diminished the risk of postoperative sexual dysfunctions in abdomino-perineal resection (APR). The impotence rates after APR reported in the literature vary from 15% to 92%, and sexual dysfunction rates after all rectal cancer surgeries range between 10% and 60% (12). Most surgeons are currently perform ing TME with preserva tion of the neurovascular bundles, a technique which has been shown to be effective in reducing postoperative sexual dysfunction rates. In 1997 Enker et al. reported that APR performed in accordance with the principles of TME and autonomic nerve preservation results in preserving both sexual and urinary functions (13). Their study showed that 57% of patients undergoing APR and 85% undergoing sphincter preserving operations maintained their urinary and sexual functions (14). With the increasing popu larity of laparoscopy some surgeons perform laparoscopic assisted TME. Quah reported that sexual dysfunction rates in men were higher after laparoscopic surgery than after open surgery, while the rates of sexual dysfunctions in women stayed the same for both techniques (15). However, owing to the paucity of reports