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Biomedical subjects

L Liberman

Publications and source records attributed to L Liberman.

At least 55 records · Page 3Linked to original sources
PubMed1997

Analysis of cancers not diagnosed at stereotactic core breast biopsy.

PURPOSE: To evaluate the mammographic and histopathologic features of carcinomas not diagnosed at stereotactic core biopsy. MATERIALS AND METHODS: A retrospective review revealed 144 surgically confirmed carcinomas preoperatively sampled with stereotactic core biopsy. Diagnosis at stereotactic core biopsy was carcinoma in 116 (81%) lesions, atypical hyperplasia in 21 (15%), and benign findings discordant with those from mammography in seven (5%). Mammographic and histopathologic findings in the latter 28 cases were reviewed. RESULTS: Prompt repeat biopsy was recommended in all 28 cases. The frequency with which a cancer yielded atypical hyperplasia at stereotactic core biopsy was higher for calcifications than masses (30% vs 5%, P < .0001), ductal carcinoma in situ (DCIS) than infiltrating carcinoma (33% vs 7%, P = .0002), and noncomedo than comedo DCIS (60% vs 9%, P = .0008). No significant difference was observed in the likelihood of benign core biopsy findings without atypia in malignant calcifications versus masses (7% vs 3%, P = .43), DCIS versus infiltrating carcinoma (7% vs 4%, P = .43), or noncomedo versus comedo DCIS (0% vs 9%, P = .49). CONCLUSION: The likelihood of not diagnosing carcinoma was highest for calcifications and for noncomedo DCIS. Discordance in mammographic and histopathologic findings or the presence of atypical hyperplasia may enable the radiologist to identify missed or underestimated carcinomas prospectively and avoid a delay in diagnosis.

Adult↗
PubMed1997

Mammographic findings after stereotactic 14-gauge vacuum biopsy.

PURPOSE: To evaluate mammographic findings after stereotactic 14-gauge vacuum biopsy. MATERIALS AND METHODS: Retrospective review was performed of results at stereotactic 14-gauge vacuum biopsy in 108 lesions in 100 women. The median number of specimens obtained per lesion was 12 (mean, 14; range, 1-50). In all cases, mammography was performed immediately after vacuum biopsy. Pre- and postbiopsy mammograms were reviewed. RESULTS: Postbiopsy mammograms depicted air at the biopsy site in 78 (72%) of 108 lesions and hematoma in 65 (60%) of 108 lesions. Of 55 lesions depicted as calcifications, postbiopsy mammograms depicted a decrease in the number of calcifications in 45 (82%), including nine cases in which all calcifications were removed. No residual lesion was identified on postbiopsy mammograms in 14 (13%) of 108 lesions; 11 (58%) of 19 mammographic lesions that measured 0.5 cm or less in maximal dimension were completely removed. Nineteen patients underwent a needle localization procedure, at a median 14 days (range, 6-51 days) after vacuum biopsy. In one patient a hematoma was depicted at mammography 10 days after biopsy; in the remaining 18 (95%) patients, mammograms obtained during needle localization depicted no hematoma or air. CONCLUSION: Air and hematoma were often present on mammograms immediately after stereotactic vacuum biopsy, but these changes resolved rapidly. Stereotactic vacuum biopsy provided wide sampling of calcifications and allowed complete removal of the mammographic lesion in some cases.

Adult↗
PubMed1997

Stereotactic core biopsy of calcifications highly suggestive of malignancy.

PURPOSE: To assess stereotactic core biopsy for evaluation of Breast Imaging Reporting and Data System (BI-RADS) category 5 calcifications (highly suggestive of malignancy). MATERIALS AND METHODS: Retrospective review of mammograms revealed 31 women (aged 34-86 years) with BI-RADS category 5 calcifications who underwent 14-gauge stereotactic core biopsy with an automated gun. Records were reviewed to determine the frequency with which stereotactic core biopsy obviated a surgical procedure. Cost savings were based on Medicare estimates of $472 for stereotactic core biopsy and $1,335 for surgical biopsy. RESULTS: Of 31 patients, stereotactic core biopsy revealed carcinoma in 19 (61%), atypical ductal hyperplasia (ADH) in eight (26%), and benign findings discordant with mammographic results in four (13%). Surgical biopsy was recommended for the 12 patients with ADH or benign but discordant core biopsy diagnoses. Of the 19 patients with carcinoma at stereotactic core biopsy, two chose to undergo a second biopsy surgically, two had small foci of ductal carcinoma in situ (DCIS) that would have been fully excised with surgical biopsy, one with DCIS at stereotactic core biopsy underwent axillary dissection after invasion was found at surgery, and one underwent excision but had tumor at lumpectomy margins. Thirteen (42%) of 31 patients were spared a surgical procedure, saving $100 per patient. CONCLUSION: Stereotactic core biopsy with an automated gun obviated a surgical procedure in 42% of patients with BI-RADS category 5 calcifications, resulting in modest cost savings in this group.

Adult↗
PubMed1997

Clip placement after stereotactic vacuum-assisted breast biopsy.

PURPOSE: To assess accuracy and usefulness of placement of a localizing clip after stereotactic, vacuum-assisted breast biopsy. MATERIALS AND METHODS: Retrospective review was performed of 57 lesions that underwent placement of a localizing clip after stereotactic vacuum-assisted biopsy with an 11-gauge (n = 42) or 14-gauge (n = 15) probe. The clip was placed when images obtained after stereotactic biopsy suggested that the lesion seen at mammography was removed. Coordinates of the clip on stereotactic images obtained after placement were compared with lesion coordinates determined before biopsy. Surgery was performed in 25 cases. Mammographic and histopathologic findings were reviewed. RESULTS: The distance from clip to lesion site was less than 1 cm in 40 (95%) of 42 lesions that underwent clip placement with the 11-gauge probe versus 11 (73%) of 15 lesions that underwent clip placement after 14-gauge biopsy (P < .04). The biopsy site was identified in the surgical specimen in 19 (100%) lesions with clips after 11-gauge biopsy and five (83%) of six lesions with clips after 14-gauge biopsy. No complications occurred. CONCLUSION: A localizing clip can be placed in proximity to the stereotactic biopsy site through an 11-gauge probe. Clip placement can enable accurate localization for surgical excision.

Adult↗
PubMed1997

MR imaging of the breast in patients with occult primary breast carcinoma.

PURPOSE: To evaluate the utility of contrast material-enhanced magnetic resonance (MR) imaging of the breast for localization of the site of primary breast carcinoma in patients with isolated ipsilateral axillary metastasis, without other focal findings at physical examination or mammography. MATERIALS AND METHODS: Twelve women with biopsy-proved metastatic adenocarcinoma to axillary lymph nodes and occult primary tumor underwent MR imaging at 1.5 T with a three-dimensional spoiled gradient-echo pulse sequence before and after administration of gadopentetate dimeglumine. Enhancing areas were correlated with histopathologic findings at mastectomy (n = 8) or breast-conserving treatment (n = 4). RESULTS: In nine (75%) of the 12 patients, enhancement was seen on MR images that represented the site of the primary tumor at surgery. Eight had focal masses, and one had an area of regional enhancement. Two patients had negative MR findings, and no tumor was found at mastectomy. One patient with regional enhancement on MR images had no corresponding tumor at surgery. CONCLUSION: Breast MR imaging enables identification of the site of primary tumor in most patients suspected of having occult primary breast cancer, and MR findings can influence surgical treatment.

Adenocarcinoma↗
PubMed1997

Mammographic features of local recurrence in women who have undergone breast-conserving therapy for ductal carcinoma in situ.

OBJECTIVE: This study was undertaken to evaluate the mammographic features of local recurrence in women who have undergone breast-conserving therapy for ductal carcinoma in situ (DCIS). MATERIALS AND METHODS: Retrospective review revealed 162 women with DCIS treated with breast-conserving therapy from 1978 to 1990 for whom follow-up data were available. Subsequent to therapy, 33 (20%) patients had a pathologically proven carcinoma in the treated breast. Mammograms at the time of local recurrence were available for 20 patients. We reviewed mammograms, clinical charts, and histopathologic findings in these 20 patients. For 14 of 20 patients, we also reviewed mammograms obtained at the time of the original DCIS. RESULTS: The median interval from diagnosis of the original DCIS to local recurrence was 26 months (range, 6-168 months). Recurrences were detected solely by mammography in 17 (85%) of 20 patients, by mammography and physical examination in two (10%), and solely by physical examination in one (5%). Eighteen (90%) local recurrence contained calcifications and eighteen (90%) involved the tumorectomy quadrant. When we compared available mammographic findings of the original DCIS and the local recurrence we found the mammographic pattern and calcification morphology to be the same in 11 (79%) of 14 DCIS and nine (82%) of 11 DCIS, respectively. Histopathologic analysis of recurrences found DCIS in 13 (65%) of 20 patients and DCIS and infiltrating carcinoma in the remaining seven (35%) patients. Of 13 pure DCIS recurrences, 12 (92%) were detected solely by mammography. CONCLUSION: In our study, local recurrence after breast-conserving therapy for DCIS invariably contained DCIS; 35% of recurrences also contained invasive carcinoma. The most common mammographic pattern of local recurrence was calcifications in the tumorectomy quadrant that were morphologically similar to the original DCIS. These findings suggest that many of these local recurrences reflect failure to eradicate the primary DCIS. Mammography achieved high sensitivity in revealing these lesions: 85% of local recurrences and 92% of recurrences that were pure DCIS were detected solely by mammography.

Breast Neoplasms↗
PubMed1997

Impact of core biopsy on the surgical management of impalpable breast cancer.

OBJECTIVE: The purpose of this study was to compare impalpable breast carcinomas revealed by core biopsy with those revealed by surgical biopsy with respect to the frequency of performing a single surgical procedure and finding tumor at the margins of the lumpectomy specimen. MATERIALS AND METHODS: Retrospective review found 197 solitary impalpable breast carcinomas revealed by core biopsy using a 14-gauge needle (n = 90) or surgical biopsy after needle localization (n = 107). Lumpectomy was the surgical treatment in 62 (69%) of the 90 cancers revealed by core biopsy and in 74 (69%) of the 107 cancers revealed by surgical biopsy. Records were reviewed to determine the number and type of surgeries performed on each patient and the histopathologic findings at surgery. Lumpectomy margins were considered positive if tumor was present at the inked margins of a lumpectomy performed as a separate procedure after the diagnostic biopsy. RESULTS: A single surgical procedure was performed 76 (84%) of the 90 patients who underwent core biopsy versus 31 (29%) of the 107 patients who underwent surgical biopsy. This difference was statistically significant (p < .00001). Tumor was present at the lumpectomy margins in five (8%) of the 62 cancers revealed by core biopsy versus four (5%) of the 74 cancers diagnosed by surgical biopsy. This difference was not statistically significant (p = .7). CONCLUSION: A single surgical procedure was performed significantly more often in patients in whom impalpable breast cancer was revealed by core biopsy. The likelihood of obtaining tumor-free margins at lumpectomy did not differ significantly for cancers revealed by either method. These data indicate that core biopsy provides the information necessary to plan surgical treatment and could decrease the number of surgical procedures required in patients with impalpable breast cancer.

Biopsy↗
PubMed1996

Pseudoangiomatous stromal hyperplasia: mammographic, sonographic, and clinical patterns.

PURPOSE: To analyze the mammographic, ultrasonographic (US), and clinical patterns of pseudoangiomatous stromal hyperplasia (PASH). MATERIALS AND METHODS: Preoperative mammographic and US images, clinical records, and histologic assessments were reviewed in seven cases of PASH as the sole component or dominant stromal component of a clinically or mammographically defined mass lesion. In five, a PASH tumor was diagnosed at image-guided 14-gauge core-needle biopsy; in two, it was diagnosed at surgical excisional biopsy. RESULTS: Four women were premenopausal, two were postmenopausal, and one 40-year-old patient had iatrogenic primary amenorrhea. Four of seven masses were palpable; three were discovered at mammography. Four masses enlarged over 6 months to 5 years. At mammography, all masses lacked calcifications; six were well defined, and one was spiculated. One was inapparent at US; the remaining six were well defined and hypoechoic. CONCLUSION: The diagnosis of this rare lesion with image-guided breast biopsy or surgical biopsy is consistent with a well-defined uncalcified mass at mammography and a solid hypoechoic mass at US, usually in a premenopausal woman.

Adult↗
PubMed1996

Benign and malignant phyllodes tumors: mammographic and sonographic findings.

PURPOSE: To characterize imaging findings that suggest the benign or malignant histologic nature of phyllodes tumors. MATERIALS AND METHODS: Clinical and imaging findings were retrospectively reviewed in 46 women with 51 phyllodes tumors (32 benign, 19 malignant) identified at preoperative mammography. Thirty of these tumors were also evaluated with preoperative sonography. RESULTS: Mammography showed nonspiculated soft-tissue masses in 49 tumors. Four masses contained calcifications; three of these masses were benign. The tumors were 1-20 cm in diameter; tumors 3 cm or larger were statistically significantly more likely to be malignant (P < .004). Sonography showed solid, hypoechoic masses in 28 cases. At sonography, cystic areas were more often seen in malignant than in benign tumors, but the difference was not statistically significant. CONCLUSION: There is substantial overlap in the imaging characteristics of benign and malignant phyllodes tumors. A tumor diameter of 3 cm or greater appears to be associated with a higher likelihood of malignancy.

Adult↗
PubMed1996

Nondiagnostic stereotaxic core breast biopsy: results of rebiopsy.

PURPOSE: To determine the clinical implication of recommendation for repeat biopsy after large-core stereotaxic breast biopsy. MATERIALS AND METHODS: Repeat biopsy was recommended in 56 (18%; mean age, 51.0 years) of 314 consecutive women who underwent stereotaxic core biopsy. Biopsy was performed by using a dedicated prone stereotaxic table and digital imaging. When calcifications were present, specimen radiography was performed. Fifty of the 56 women underwent follow-up biopsy. RESULTS: Repeat biopsy was recommended because of ductal atypia in 30 patients, discordant imaging and histopathologic results in 15, diagnoses for which more tissue was required in 10, and radial scar in one. Twenty-two (39%) of the 56 had carcinoma. Carcinoma was detected in 15 women (50%) with ductal atypia and in seven women (47%) with discordant histopathologic and imaging findings. No other cancer was detected. CONCLUSION: Rebiopsy of those lesions for which results are nonconcordant or with a high incidence of coexistent malignancy is necessary for stereotaxic core biopsy to be optimally effective. Among the 56 patients, 39% had malignancy.

Biopsy, Needle↗
PubMed1996

Spiculated axillary adenopathy.

PURPOSE: To describe the mammographic and sonographic appearance of a pattern of spiculation of the contour of axillary lymph nodes. MATERIALS AND METHODS: Eleven cases of axillary nodes with spiculated contour were prospectively identified on routine mammograms. All cases were in women with breast cancer. Sonograms of axillary nodes were available in three cases. Medical records were reviewed, and histologic and nodal histopathologic findings and patient outcome were correlated. RESULTS: All women had primary, invasive breast carcinoma. Although disease was evident mammographically, four of nine women for whom the results of the physical examination were known did not have palpable adenopathy. Nodes were iso-to hyperdense (compared with breast parenchyma) on mammograms and were hypoechoic with irregular margins on sonograms. The spiculated pattern of the nodes correlated with extension of metastatic tumor in axillary nodes into perinodal fat. At a mean follow-up of 17 months, one patient was dead of disease, eight were alive with disease, and two were alive without disease. CONCLUSION: A pattern of spiculated axillary adenopathy in a patient with breast cancer appears to be consistent with extranodal extension of tumor into perinodal fat. This finding suggests a biologically aggressive tumor with a poor prognosis.

Adult↗
PubMed1996

Overdiagnosis of medullary carcinoma: a mammographic-pathologic correlative study.

PURPOSE: To evaluate the mammographic features of medullary carcinoma, to determine the frequency of pathologic overdiagnosis of this neoplasm, and to assess whether mammography can distinguish true from atypical medullary carcinomas, since this distinction has important prognostic implications. MATERIALS AND METHODS: Retrospective review revealed 25 patients with an initial pathologic diagnosis of medullary carcinoma. Histopathologic slides and mammograms were reviewed. RESULTS: After review of histopathologic slides, 14 (56%) lesions were classified as medullary carcinomas and 11 (44%) as atypical medullary carcinomas. At mammography, a circumscribed mass was present in four of the 14 (28%) medullary carcinomas and in one of the 11 (9%) atypical medullary carcinomas (P = .34), an indistinct mass was present in seven of the 14 (50%) medullary carcinomas and in five of the 11 (45%) atypical medullary carcinomas (P = .86), and an obscured mass was present in two of the 14 (14%) medullary carcinomas and in three of the 11 (27%) atypical medullary carcinomas (P = .62). Calcification, which was present in one of the 11 (9%) atypical medullary carcinomas, and s spiculated border, which was present in one of the 11 (9%) atypical medullary carcinomas, were not observed in medullary carcinomas (P = .44). CONCLUSION: At mammography, medullary carcinoma was usually an uncalcified mass with indistinct or circumscribed borders. Atypical medullary carcinoma may be misdiagnosed as medullary carcinoma. Mammography could not reliably help distinguish true medullary carcinomas from atypical medullary carcinomas.

Adult↗
PubMed1996

Core needle biopsy of synchronous ipsilateral breast lesions: impact on treatment.

OBJECTIVE: The purpose of this study was to evaluate the role of core biopsy in the diagnosis of multiple synchronous ipsilateral breast lesions and to determine the impact of this information on patients' management. MATERIALS AND METHODS: Of 371 patients who underwent core-needle breast biopsy under stereotaxic (n = 278) or sonographic (n = 93) guidance, 20 (5%) underwent core biopsy of two mammographically separate lesions in the ipsilateral breast on the same date. Fourteen of these 20 patients subsequently underwent surgery. We retrospectively reviewed the medical, radiographic, and histopathologic records in these 14 patients and in 91 patients with single mammographic lesions diagnosed as carcinoma by means of core biopsy during the same period. RESULTS: In 11 patients, core biopsy revealed two sites of carcinoma. Core biopsy findings in these 11 patients were two areas of infiltrating ductal carcinoma (n = 5), one infiltrating ductal carcinoma and one infiltrating lobular carcinoma (n = 2), one infiltrating ductal carcinoma and one ductal carcinoma in situ (n = 1), and two foci of ductal carcinoma in situ (n = 3). All 11 patients with two core biopsy-proven foci of carcinoma underwent mastectomy. Patients were significantly more likely to be treated with mastectomy if core biopsy revealed two rather than one site of carcinoma (100% versus 38%, p < .001). CONCLUSION: Core-needle biopsy is useful in diagnosing multiple synchronous ipsilateral breast lesions. By showing whether carcinoma is present in one or more sites in the breast, core biopsy can provide information of critical importance in making treatment decisions.

Adult↗
PubMed1995

Assessment of response to therapy of primary breast cancer by mammography and physical examination.

BACKGROUND: Accurate assessment of response to treatment is necessary to treat appropriately primary breast cancers that are not surgically removed. This retrospective study was undertaken to compare the effectiveness of physical examination (PE) and mammography to assess response of primary breast cancer to medical therapy in women who were ineligible for initial surgical treatment. METHODS: Thirteen women with 14 breast carcinomas were evaluated for interval changes. Except for 1 patient who had two follow-up studies, the other 12 each had a single follow-up study including PE and mammography; changes therefore were assessed in 15 instances. Response to treatment also was judged by mastectomy results in two instances, changes in metastatic disease by other imaging procedures in five, and changes in primary tumor by computed tomography in two breasts. RESULTS: In 11 of 15 assessments of posttherapy changes, PE and mammography results were similar concerning treatment response. Of four discordant follow-ups, the tumors were found to be stable by PE, whereas they were found to be increasing by mammography in two. In both of these cases, progression of disease outside the breast was identified by other imaging studies, consistent with the mammographic findings. In another case, disease appeared to regress by PE but was unchanged by mammography; disease extent in mastectomy specimens was consistent with that found mammographically and more extensive than that suggested by physical examination. In the fourth case, superficial healing of a fungating tumor was obvious by clinical examination but could not be appreciated by mammography. The detectability of changes was not related to type of treatment. CONCLUSIONS: Physical examination and mammography are both useful in the serial evaluation of breast cancers. Although usually complimentary, disease progression, when it occurs, may be detected by only one of these methods.

Adult↗
PubMed1995

Displacement of carcinomatous epithelium in surgical breast specimens following stereotaxic core biopsy.

A variety of needling procedures in the breast may lead to dislodgment and displacement of fragments of breast carcinoma into tissue outside the target lesion of the needling procedure. To assess how frequently displaced fragments of carcinoma are seen in surgical breast specimens following stereotaxic core needle biopsies, slides were reviewed from 43 consecutive cases of breast carcinoma in which surgical excision and/or mastectomy had been performed following an initial diagnostic stereotaxic 14-gauge core biopsy procedure. In 12 of 43 (28%) cases, displaced carcinomatous fragments were identified outside of the main tumor mass. These patients were subjected to other needling procedures that included local anesthetic injection at the time of core biopsy (43 cases), needle localization (22 of 43 cases), suture placement (18 of 43 cases), and fine-needle aspiration (1 of 43 cases). Attributing carcinomatous displacement solely to the core needle biopsy is complicated by these additional needling procedures. In 18 instances, local anesthetic injection by 25-gauge needle was the only needling procedure other than the core biopsy. In 7 of these 18 (39%) cases, fragments of displaced carcinoma were observed outside the main tumor mass. The authors have previously observed only one case in which a 25-gauge needle was associated with epithelial displacement, suggesting that the core biopsy was more likely to have been the cause of displaced epithelium in these cases. Long-term clinical follow-up will be necessary to determine the biologic and clinical significance of these findings.

Adult↗
PubMed1995

Stereotaxic core biopsy of breast carcinoma: accuracy at predicting invasion.

PURPOSE: To assess the accuracy with which stereotaxic core biopsy of breast carcinoma predicts the presence of invasion. MATERIALS AND METHODS: Stereotaxic core biopsy was performed in 63 breast carcinomas in 59 patients in the prone position. All patients subsequently underwent surgery. Histopathologic results of stereotaxic core biopsy and surgery were correlated. RESULTS: Results of stereotaxic core biopsy and surgery were concordant in 58 (92%) of the 63 cases, yielding invasive carcinoma in 46 cases and ductal carcinoma in situ (DCIS) in 12 cases. Results were discordant in five cases (8%), including three cases for which stereotaxic core biopsy results indicated DCIS but surgery yielded invasive ductal carcinoma. The positive predictive value of stereotaxic core biopsy for the presence of invasion was 98% (47 of 48 cases) and the negative predictive value was 80% (12 of 15 cases). CONCLUSION: Stereotaxic core biopsy of breast carcinoma can help confirm invasion with high accuracy but cannot reliably indicate the absence of tumor invasion when only DCIS is found.

Biopsy, Needle↗
PubMed1995

Impact of stereotaxic core breast biopsy on cost of diagnosis.

PURPOSE: To determine the frequency with which stereotaxic core biopsy of the breast obviated diagnostic surgical biopsy and to estimate the savings in cost of diagnosis with this procedure. MATERIALS AND METHODS: Stereotaxic core biopsy of 182 nonpalpable, mammographically evident lesions was performed, and data from clinical follow-up were obtained. Savings in cost were assessed by using national Medicare reimbursement data and a relative value system based on national physician reviews (Relative Values for Physicians [RVP]). RESULTS: Stereotaxic core biopsy replaced a surgical procedure in 140 of 182 patients. The mean adjusted direct savings in cost per stereotaxic core biopsy were $893 (Medicare) or $1,491 (RVP). Use of stereotaxic core biopsy decreased the cost of diagnosis by 52% (RVP) or 55% (Medicare). CONCLUSION: Stereotaxic core biopsy obviated surgical biopsy for most nonpalpable lesions sampled, resulting in a greater than 50% reduction in biopsy costs. If these results were generalizable to the national level, annual savings would approach $200 million.

Biopsy, Needle↗