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Biomedical subjects

A J Leibman

Publications and source records attributed to A J Leibman.

At least 19 recordsLinked to original sources
PubMed1999

Experience with breast biopsies using the Advanced Breast Biopsy Instrumentation system.

OBJECTIVE: A retrospective review of our experience with advanced breast biopsy instrumentation (ABBI) was undertaken to evaluate its efficacy for excisional breast biopsy of lesions detected on mammography. To our knowledge, experience with ABBI has not been previously reported in the radiology literature. MATERIALS AND METHODS: Biopsies using the ABBI system and an adapted dedicated table were performed in 53 patients who had 54 mammographically evident lesions. Samples were obtained with cannulas ranging in size between 5 and 20 mm. Indications for biopsy were calcifications (n = 22) and masses (n = 31). RESULTS: Forty-five specimens (44 patients) had benign results at pathology: 15 specimens were diagnosed as fibroadenoma, 15 as cystic breast disease, and four as reactive lymph nodes; the remaining 11 specimens had benign diagnoses of adenosis, fibrosis, and hyperplasia. The average specimen size was 4.8 cm in greatest longitudinal dimension. One patient had a nondiagnostic biopsy for calcifications later found to be dermal. Seven patients were diagnosed as having breast cancer; in six of these, the tumor involved the margins of the specimen. One patient had marked atypia that required reexcision for the diagnosis of intraductal carcinoma to be made. CONCLUSION: The ABBI procedure is a more invasive and less readily available procedure than core needle biopsy for sampling of benign breast lesions. In seven cases of malignancy diagnosed at breast biopsy, the ABBI technique completely excised only a single lesion. In our experience, the ABBI procedure offered no advantages over core needle biopsy for either benign or malignant lesions.

Biopsy, Needle↗
PubMed1997

Mammography of the postreconstruction breast.

Experience with mammographic examination of the reconstructed breast after mastectomy is limited. Typical mammographic changes associated with breast reconstruction are described. When these changes are identified on mammography, they can prevent patients from having unnecessary biopsies and can alleviate patient anxiety. A retrospective review of all mammograms performed in our breast center was made to identify typical as well as unusual findings on the postreconstruction mammogram. The findings were correlated with the type of reconstruction and the physical examination findings. Mammography after mastectomy and breast reconstruction was performed in patients with palpable abnormalities, a suspicion for implant failure, or for patient anxiety. In the postreconstruction patient with a palpable mass, features characteristic of fat necrosis were the most frequent abnormal findings on mammography. Unusually placed implants or focal implant ruptures may explain a mass discovered on breast physical examination. Imaging of the reconstructed breast after mastectomy yields typical mammographic findings. Fat necrosis can be identified on mammography and may explain a new palpable mass on physical examination. Mammography continues to be useful to identify a postoperative complication or implant failure and to differentiate it from tumor recurrence.

Adult↗
PubMed1994

Mammographic and sonographic findings after silicone injection.

The illicit use of silicone injection for cosmetic augmentation was performed in the 1960s. However, this method of augmentation was subsequently abandoned. Recently, a resurgence of this practice has occurred. We present reports of 2 patients who had non-medical-grade silicone injected into their breasts clandestinely. The clinical findings and imaging features are presented.

Adult↗
PubMed1994

Imaging of complications of augmentation mammaplasty.

The recent Food and Drug Administration hearings have brought new attention to breast implants and the importance of mammography in these patients to detect unsuspected breast pathology and complications of this surgical procedure. More patients are now being seen with implant failures in mammography departments. Very little attention has been paid to the mammographic findings and their significance until recently in the plastic surgery literature. A retrospective review was undertaken of all patients who had undergone prior augmentation mammaplasty and were imaged between 1989 and 1992. Patients with complications such as capsular contracture and implant rupture constitute the basis of our study. Mammography can be used to detect complications of augmentation mammaplasty such as calcific or fibrous capsular contracture. In calcific contracture, fine microcalcifications along the edge of the implant can be seen by mammography. Fibrous contracture is identified in mammography by a thick band of tissue surrounding the implant. Contour changes and slippage of the prosthesis also can be easily imaged mammographically. After implant rupture, free globules of silicone within the breast or silicone accumulated within axillary lymph nodes can be imaged by mammography. However, irregularities in the implant contour or encapsulated implant rupture may be occult in mammography and detected only by sonography or magnetic resonance imaging (MRI). Mammography is an excellent method for evaluating the integrity of a breast implant. However, because mammography cannot image the posterior portion of the implant, other modalities may be used in the evaluation of suspected complications of augmentation mammaplasty. Sonography is helpful in cases in which mammography fails to define a palpable mass suspected to represent a contour abnormality.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Imaging of breast cancer after augmentation mammoplasty.

Experience with mammography in patients with augmentation mammoplasty has been limited by the younger age of the patients and the bias of the physicians that mammography may be ineffective in imaging the breast with a prosthesis. With recent advances in imaging of the augmented breast and the increase in popularity of augmentation mammoplasty, more of these patients are undergoing mammography. We reviewed the mammograms and clinical history of 25 women with breast implants and breast cancer. Seven (28%) of the 25 women were asymptomatic and referred for screening mammography. Mammography or sonography was positive in 22 (88%) of the 25 women. There was no nodal involvement in 11 of 18 patients with infiltrating duct carcinoma, 5 women with intraductal carcinoma, and 2 women with lobular carcinoma in situ. In this study, women with implants who developed breast cancer presented with nodal metastases in only 28% of cases. Modified position views should be performed in all patients, and sonography may be helpful in evaluating palpable masses even when mammography is normal. Breast cancer can be detected in the augmented breast by mammography even if clinically occult.

Adult↗
PubMed1993

Tubular carcinoma of the breast: mammographic appearance.

OBJECTIVE: Tubular carcinoma of the breast is an uncommon malignant growth that can have subtle mammographic findings. Tubular carcinoma is usually found incidentally during screening mammography. It can be differentiated from conventional breast cancers by its smallness and the lack of palpable findings on physical examination of the breast. The mammographic findings in patients with pure tubular carcinoma (90% tubular formation or greater on histologic examination) have not been reported in the recent radiologic literature. MATERIALS AND METHODS: We reviewed the mammographic and sonographic findings and clinical histories of 13 patients with biopsy-proved pure tubular carcinoma. Findings on physical examination of the breast were normal in nine patients. RESULTS: On mammograms, 11 of the 13 tubular carcinomas appeared as small (1.7-cm diameter or less) spiculated masses. The average tumor diameter measured on mammograms was 0.8 cm in patients with normal results of physical examination of the breasts and 1.2 cm in patients with a palpable mass. In two patients, mammography showed suspicious microcalcifications or normal findings. Sonography was performed in three patients and results were normal. CONCLUSION: Tubular carcinoma of the breast manifests mammographically as a small spiculated mass. Because of their smallness, tubular carcinomas can be differentiated from other forms of infiltrating ductal carcinoma on mammograms. Tubular carcinomas are most frequently found incidentally at screening mammography. With the growing emphasis on screening mammography, an increase in the detection of this form of breast cancer can be expected.

Adenocarcinoma↗
PubMed1992

Breast imaging and the augmented breast.

Women with augmented breast implants are presenting for mammograms in greater numbers over the past year due to recent publicity regarding the safety of silicone gel-filled implants. New issues are being raised in light of this recent increase, making it essential for patients and health care providers to understand the limitations of mammography and how to best minimize problems.

Adult↗
PubMed1992

Intraductal extension of silicone from a ruptured breast implant.

Silicone rupture is a known complication of closed capsulotomy. Imaging of silicone within breast tissue after rupture of an implant is not uncommon. Intraductal extension of silicone on mammography is a very rare finding. This case report described the imaging features of silicone within the breast tissue and ducts that necessitated subcutaneous mastectomy for definitive treatment.

Adult↗
PubMed1992

Mammography in women with axillary lymphadenopathy and normal breasts on physical examination: value in detecting occult breast carcinoma.

OBJECTIVE: The purpose of this study was to determine the value of mammography in detecting occult carcinoma in patients with axillary adenopathy and normal breasts on physical examination. MATERIALS AND METHODS: We analyzed the results of mammography performed in 17 patients; all women had palpable axillary lymphadenopathy of unknown origin and all had normal breasts on physical examination. RESULTS: In 10 of the 17 patients, mammographic findings were abnormal. The mammographic finding of axillary adenopathy in seven patients was inconsequential because the nodes were evident on physical examination. Three patients had abnormal mammographic findings that were potentially significant, including one with a poorly defined mass suggestive of breast carcinoma, one with a subcutaneous nodule, and one with parenchymal breast edema. Two of 17 patients had an occult breast cancer. In only one of the patients was the cancer detected on mammography. The other patient had undergone prior left mastectomy and was thought to have metastases to the right axilla from the contralateral breast. Mammographic findings in this latter patient were normal. CONCLUSION: While occult breast carcinoma was relatively common in our series (two of 17 patients), the ability to detect the tumor with mammography was disappointing (one of two patients). This may be explained by the fact that one postmastectomy patient with occult carcinoma had metastatic disease to the contralateral axilla and a normal remaining breast, which was pathologically confirmed at mastectomy. Our experience suggests that mammography is valuable in patients with normal breasts on physical examination who have primary carcinoma involving ipsilateral axillary lymph nodes. The procedure should be included in the diagnostic evaluation of patients with axillary adenopathy in order to detect the unusual case of occult breast carcinoma.

Axilla↗
PubMed1990

Breast cancer: mammographic and sonographic findings after augmentation mammoplasty.

The authors retrospectively reviewed 11 cases of breast cancer in patients who had undergone augmentation mammoplasty. The mammogram or sonogram was abnormal in 10 patients, including six with an abnormal mammographic density or ultrasound study and four with calcifications. One patient had dense breasts and no suspicious findings at mammography. In four patients without palpable findings in the breast, the malignancy was initially detected by means of mammography. In five of six patients with a palpable breast mass, special mammographic views and sonography were helpful in evaluating the mass. Lymph nodes were not involved in six (60%) of the 10 patients with ductal carcinomas. The detection of breast cancer in the augmented breast by means of mammography is possible, even in patients without palpable findings. Modified-position views and sonography may be helpful in evaluating palpable masses. Patients with implants who develop cancer do not necessarily present at a more advanced stage.

Adult↗
PubMed1988

Transvaginal sonography: comparison with transabdominal sonography in the diagnosis of pelvic masses.

In a retrospective study, we compared transvaginal sonograms with transabdominal sonograms in 67 women referred for evaluation of palpable pelvic masses. The diagnoses included ovarian cyst (27), endometrioma (12), complex cyst (four), dermoid (three), infection (three), ovarian malignancy (two), and uterine fibroid (three). The final diagnosis was made surgically in 41 patients (61%) and by a combination of sonographic and clinical correlation in the remaining patients. More information about the internal architecture or anatomy of the mass was provided by the transvaginal images than by the transabdominal scans in 51 (76%) of the patients. Transabdominal sonography did not provide more diagnostic information in any of the patients examined. Transvaginal sonography was helpful in obese patients, in those with a large amount of bowel gas, and in those unable to achieve adequate bladder filling. Six simple cysts and four complex pelvic masses were identified solely on transvaginal sonograms. The results suggest that transvaginal sonography has considerable advantages over conventional transabdominal sonography in the evaluation of pelvic masses in women.

Adult↗
PubMed1983

Cerebral toxoplasmosis in a patient with acquired immunodeficiency syndrome.

Patients suffering from acquired immunodeficiency syndrome (AIDS) are being encountered more and more frequently. Because of their immunosuppressed state, they often present with opportunistic infections of the cerebrum. Herein, the case of a patient with AIDS who had cerebral toxoplasmosis is reported. Although the computed tomographic features are nonspecific for cerebral toxoplasmosis, they are interesting because of the considerable variation in type of enhancement and extent of lesions revealed by injection of contrast medium.

Acquired Immunodeficiency Syndrome↗