Biomedical subjects

L Liberman

Publications and source records attributed to L Liberman.

At least 73 records · Page 4Linked to original sources

PubMed1995

Recurrent carcinoma after breast conservation: diagnosis with stereotaxic core biopsy.

PURPOSE: To evaluate the utility of stereotaxic core biopsy (SCB) in diagnosing recurrent carcinoma after breast-conserving therapy (BCT). MATERIALS AND METHODS: Of 316 patients evaluated with SCB, 17 (5%) had nonpalpable lesions in breasts previously treated with BCT. Surgical correlation was obtained in 14 patients. SCBs were performed with digital stereotaxic equipment, with patients prone. RESULTS: Carcinoma detected at SCB in 11 (79%) of 14 patients included infiltrating ductal carcinoma (IFDC) in five, ductal carcinoma in situ (DCIS) in five, and infiltrating lobular carcinoma (ILC) in one. Surgical histopathologic findings agreed with core biopsy findings in 10 of these patients. In one patient with two SCB-proved foci of IFDC, one IFDC was identified at mastectomy. In two (14%) patients, SCB revealed atypical ductal hyperplasia; however, DCIS was found at surgical biopsy. In one patient, the SCB finding of fat necrosis was confirmed at surgical biopsy. CONCLUSION: These data suggest that SCB may be useful in diagnosing recurrent carcinoma in the conservatively treated breast.

Biopsy↗

PubMed1995

Atypical ductal hyperplasia diagnosed at stereotaxic core biopsy of breast lesions: an indication for surgical biopsy.

OBJECTIVE: The purpose of this study was to evaluate the prevalence of carcinoma found at surgical biopsy of lesions identified as atypical ductal hyperplasia by stereotaxic core breast biopsy. SUBJECTS AND METHODS: Stereotaxic core biopsies of 264 mammographically evident lesions were done with the patients lying prone on a dedicated stereotaxic table, with an automated gun and a 14-gauge needle. Atypical ductal hyperplasia was identified in 25 (9%) of 264 lesions, including four (3%) of 159 masses and 21 (20%) of 105 lesions evident as calcifications. Surgical biopsy was recommended in all 25 of these cases and was performed in 21. Results of stereotaxic core biopsy and surgery in these 21 cases were reviewed and correlated. RESULTS: Of 21 cases identified as atypical ductal hyperplasia at stereotaxic core biopsy that were subsequently evaluated with surgical biopsy, histopathologic analysis of the surgical specimen yielded benign histologic findings without atypia in four (19%), atypical ductal hyperplasia in six (29%), and carcinoma in 11 (52%). Of the 11 carcinomas, histologic findings showed ductal carcinoma in situ in eight (73%) and invasive ductal carcinoma in three (27%). CONCLUSION: The finding of atypical ductal hyperplasia at stereotaxic core breast biopsy is an indication for surgical biopsy because of the high prevalence of ductal carcinoma in these lesions.

Biopsy, Needle↗

PubMed1995

Mammography immediately after stereotaxic breast biopsy: is it necessary?

OBJECTIVE: The purpose of this study was to determine whether mammography immediately after stereotaxic core breast biopsy should be performed routinely to diagnose hematoma, to confirm the sampling site, and to establish a new baseline for future mammograms. MATERIALS AND METHODS: Stereotaxic core biopsies of 113 mammographically indeterminate or suspicious lesions were performed by use of a dedicated stereotaxic table with digital imaging, a 14-gauge needle, and an automated gun. The indication for biopsy was a mass with or without calcifications in 59 cases (52%) and calcifications without a mass in 54 cases (48%). The number of core biopsies per case ranged from one to 16 (mean = six). Craniocaudal and mediolateral oblique mammograms of the sampled breast were obtained immediately after the biopsies and were compared with prebiopsy mammograms. In cases with microcalcifications, the mammograms also were compared with specimen radiographs. RESULTS: Mammograms obtained immediately after the procedure showed changes related to the biopsy in 86 cases (76%). These findings included decreased lesion size in 11 (10%), air at the biopsy site in 47 (42%), and hematoma, manifested as poorly defined increased density at the biopsy site, in 58 (51%). One hematoma was clinically significant, but the remaining 57 were clinically occult. When core biopsies were performed for calcifications, the postprocedural mammograms showed a decrease in the number of calcifications in 26 (48%) of 54 cases, but specimen radiographs showed calcium in 50 (93%) of 54 cases. Four lesions (three masses and one cluster of microcalcifications) disappeared after biopsy. In three cases, hematomas obscured residual calcifications at the biopsy site. CONCLUSION: Mammography immediately after core biopsy is not necessary for the diagnosis of procedure-related hematoma and is inferior to specimen radiography for verifying that calcifications have been sampled. Postprocedural mammograms also may be suboptimal for the establishment of a new baseline because of the frequent finding of hematoma.

Adult↗

PubMed1995

Stereotaxic core biopsy of impalpable spiculated breast masses.

OBJECTIVE: The role of stereotaxic core biopsy in evaluating mammographically detected lesions that have a high probability of being malignant is still debated. This study was undertaken to assess the use of stereotaxic core biopsy in evaluating spiculated masses, by determining the frequency with which core biopsy reduced the number of surgical procedures performed in the management of these highly suspicious lesions. MATERIALS AND METHODS: Forty-three impalpable spiculated breast masses in 43 patients were sampled with stereotaxic core biopsy. All patients underwent surgery. Patient charts were reviewed to determine the histopathologic findings at stereotaxic core biopsy and at surgery, and the number and type of surgeries performed. RESULTS: Invasive carcinoma was identified at stereotaxic core biopsy in 40 (93%) of 43 patients. Therapeutic surgical procedures were lumpectomy in 28 patients (22 with axillary dissection) and mastectomy in 12. The presence of tumor at the lumpectomy margins led to subsequent mastectomy in one case. One lesion yielded atypical ductal hyperplasia at core biopsy; surgical biopsy revealed ductal carcinoma in situ. Surgical biopsy was recommended in two lesions yielding benign histologies at core biopsy and revealed invasive ductal carcinoma in one. Thirty-three (77%) of 43 patients had the number of surgical procedures reduced by stereotaxic core biopsy; these were patients with carcinoma diagnosed at core biopsy who underwent one-stage lumpectomy with axillary lymph node dissection or mastectomy. CONCLUSION: Stereotaxic core biopsy reduced the number of surgical procedures in most women with impalpable spiculated breast masses. These data suggest that stereotaxic core biopsy is a valuable diagnostic technique for assessing these lesions, which are likely to represent carcinoma.

Adult↗

PubMed1994

Radiography of microcalcifications in stereotaxic mammary core biopsy specimens.

PURPOSE: To describe the technique of specimen radiography in stereotaxically guided core biopsies and evaluate its role in detection and diagnosis of microcalcifications in breast tissue. MATERIALS AND METHODS: Specimens from 361 stereotaxic breast core biopsies of 72 nonpalpable lesions with mammographic evidence of microcalcifications were obtained from 65 patients. Specimens were placed in saline on microscope slides and radiographed. RESULTS: Microcalcifications were detected radiographically in 146 of 361 (40%) cores. If calcifications were present on specimen radiographs, histologic detection of these calcifications was made in 114 of 146 (78%) specimens, and diagnosis was made in 118 of 146 (81%). If calcifications were not present on specimen radiographs, histologic detection was obtained in 27 of 215 (13%) specimens and specific diagnosis in 81 of 215 (38%). CONCLUSION: Specimen radiography should be routinely performed in stereotaxic core biopsies of breast microcalcifications to ensure appropriate tissue has been obtained and to direct pathologic diagnosis of the tissue specimens.

Adult↗

PubMed1994

Inflammatory breast carcinoma: mammographic findings.

PURPOSE: To identify and quantitate mammographic characteristics of inflammatory carcinoma (IC). MATERIALS AND METHODS: A retrospective analysis was made of the clinical and mammographic findings in 22 women (aged 31-66 years [mean, 51 years]) with IC, who were seen between 1980 and 1990 at the authors' institution. RESULTS: A palpable mass was present in 17 of the 22 women (77%); skin thickening, axillary adenopathy, nipple inversion, and erythema were common findings. At mammography, the findings in one woman with dense breasts were negative. A primary tumor, evident on the basis of a mass and/or malignant-type calcifications, was seen in all other cases. Skin thickening was present in 15 women, stromal coarsening in 11, diffusely increased breast density in nine, and axillary adenopathy in five. CONCLUSION: IC has a mammographic pattern of inflammatory changes: skin thickening and stromal coarsening and/or diffusely increased breast density, associated with evidence of a primary tumor mass and/or calcifications. In this series, inflammatory changes without an associated mass and/or malignant-type calcifications were not seen in women with IC.

Adenocarcinoma↗

PubMed1994

Imaging of pregnancy-associated breast cancer.

PURPOSE: To assess the use of mammography in diagnosis of pregnancy-associated breast cancer (PABC). MATERIALS AND METHODS: A retrospective review of medical records between 1973 and 1993 was performed in 85 women with breast cancer diagnosed during pregnancy or within 1 year after pregnancy. In 21 of these women, mammography was performed before biopsy; the mammographic findings in this study group, which had 23 cases of invasive carcinoma, were reviewed for signs of malignancy. Breast sonography was performed in six cases in five women; sonographic findings were also reviewed. RESULTS: Mammographic findings were present in 18 of 23 cases (78%), including mass (n = 13) (nine cases with calcification), suspicious calcifications (n = 4), and diffusely increased parenchymal density (n = 1). Breast sonography revealed focal solid mass in six of six cases. Axillary lymph node metastases occurred in 15 of 23 cases (65%). Although symptoms occurred before or during pregnancy in 12 cases (52%), PABC was diagnosed after pregnancy in 19 cases (83%). CONCLUSION: PABC is often advanced at diagnosis and associated with poor prognosis. Breast imaging studies usually demonstrate focal findings due to clinically evident PABC.

Adult↗

PubMed1994

Non-Hodgkin lymphoma of the breast: imaging characteristics and correlation with histopathologic findings.

PURPOSE: To determine the imaging characteristics of non-Hodgkin lymphoma (NHL) of the breast and correlate these findings with histopathologic subtype. MATERIALS AND METHODS: The authors retrospectively reviewed records in 32 cases of histologically proved NHL in 29 women. Mammography was performed before biopsy in all cases, and breast sonography was performed before biopsy in eight. RESULTS: Mammary NHL was primary in 21 of the 32 cases (66%) and secondary in 11 (34%). Mammography revealed a solitary, uncalcified mass in 22 cases (69%), multiple masses in three (9%), and diffuse increased opacity with skin thickening in three (9%). Four cases (13%) had normal findings. Seven of the eight sonograms revealed masses, which were solitary in five and multiple in two. Histologic examination showed diffuse NHL in 26 cases (81%) and follicular NHL in six (19%). No mammographic or sonographic features were identified that helped distinguish primary from secondary disease or follicular from diffuse NHL. CONCLUSION: Although the imaging characteristics may suggest the possibility of breast NHL, none of the findings are pathognomonic. The imaging pattern of mammary NHL is unrelated to its histopathologic subtype.

Adult↗

PubMed1994

Stereotaxic 14-gauge breast biopsy: how many core biopsy specimens are needed?

PURPOSE: To determine the optimum number of specimens to obtain at stereotaxic core breast biopsy. MATERIALS AND METHODS: Stereotaxic biopsies were performed in 145 mammographically evident lesions by using a dedicated table with patients in the prone position. Samples were obtained with an automated gun and a 14-gauge needle. Indications for biopsy were calcifications (n = 53) and masses (n = 92). Three to 11 (mean, 5.4) core biopsy specimens were obtained per lesion and were analyzed separately. RESULTS: Diagnostic material was obtained in the first specimen in 102 (70%) of the 145 lesions. Obtaining two, three, four, five, and six core specimens yielded a diagnosis in 117 (81%), 129 (89%), 132 (91%), 137 (94%), and 140 (97%) of the 145 lesions, respectively. Obtaining five specimens yielded a diagnosis in 46 (87%) of the 53 calcifications and 91 (99%) of the 92 masses. Obtaining six specimens resulted in a diagnosis in 49 (92%) lesions evident as calcifications but did not improve the yield on masses. CONCLUSION: Stereotaxic 14-gauge core biopsy achieved a 99% diagnostic yield with five specimens for masses. Additional specimens may be necessary to diagnose some calcified lesions.

Biopsy, Needle↗

PubMed1994

Mammary cystosarcoma with mature adipose stromal differentiation (lipophyllodes tumor) arising in a lipomatous hamartoma.

This report documents an uncommon variant of benign cystosarcoma phyllodes with mature adipose stromal differentiation, for which the term lipophyllodes tumor is proposed. Origin of this unusual tumor within a lipomatous hamartoma was confirmed by histologic and mammographic observations. The lesion developed in a 40-year-old woman 2 months post partum, and she remained well after treatment by biopsy. Lipophyllodes tumor, which features mature adipose tissue in much of the stromal component of a cystosarcoma, should not be mistaken for a malignant neoplasm. Complete excision is adequate therapy.

Adipose Tissue↗

PubMed1993

Microcalcifications on postoperative mammograms as an indicator of adequacy of tumor excision.

Mammograms, including microfocus spot magnification views, were obtained before reexcision of the tumor-ectomy site in 43 women with breast carcinoma. These studies were prospectively evaluated by radiologists experienced in breast imaging. All women had mammographically evident microcalcifications associated with their original tumors. In all, tumor was at or near the margin of resection or the status of margins was unknown, necessitating reexcision of the tumorectomy site. Of 29 women with residual microcalifications, 20 had residual tumor. The positive predictive value of residual microcalcifications was 0.69. The positive predictive value was greatest (0.90) in women with ductal carcinoma in situ, when more than five microcalifications were present. Residual microcalifications not due to carcinoma were secondary to sclerosing adenosis, fat necrosis, and foreign body granuloma. Of the 13 cases in which no residual calcifications were left after tumorectomy, residual tumor was found in four. The negative predictive value of the absence of calcifications for total excision of tumor was 0.64 for all tumor types and was 1.0 for the noncomedo subtype of ductal carcinoma in situ.

Adult↗

PubMed1993

Mammographic findings in men with breast cancer.

OBJECTIVE: Our objective was to identify the mammographic findings of breast cancer in men. MATERIALS AND METHODS: The mammograms of 23 men with proved breast cancer (mean age, 63 years; range, 44-86 years) were retrospectively reviewed. Medical histories included gynecomastia in five, prior cancer in three, and radiation exposure in two. The most common signs were a mass in 13 and bloody nipple discharge in eight. RESULTS: Carcinoma was evident mammographically as an uncalcified mass in 17 patients (74%) and as a mass with microcalcifications in two patients (9%). Three tumors were not evident on mammograms, including one that was obscured by gynecomastia. Tumors were largely subareolar (14/17, 82%), and all were ductal cancers, including six pure intraductal carcinomas. CONCLUSION: Mammograms of men with breast cancer usually show an uncalcified subareolar mass, which may mimic or be obscured by gynecomastia. If calcifications are present, they may not have a pattern usually associated with malignancy.

Adult↗

PubMed1993

Screening mammography: value in women 35-39 years old.

OBJECTIVE: The value of screening mammography for detecting early breast cancer in younger women is not widely recognized. We review the results of screening mammography and of breast biopsies performed on the basis of mammographic findings in women 35-39 years old to determine the detection rate for breast cancer and the stage of breast cancers detected at mammographic screening in this age group. MATERIALS AND METHODS: Computer-tabulated results of mammography in women 35-39 years old who participated in a mobile mammographic screening program during the 36-month period from January 1989 to December 1991 were retrospectively reviewed with a standardized data collection form. Pathology reports from biopsies recommended on the basis of screening mammograms or follow-up examinations (coned views/sonograms) also were reviewed. Data were compared with results of mammographic screenings and pathologic findings at biopsy in women 40-49 years old who participated in this screening program during the same period. RESULTS: A total of 5105 screening mammograms were obtained in women 35-39 years old. Of these, 4654 (91%) showed no abnormalities. Biopsy was recommended in 36 (< 1%). Eight biopsies showed carcinoma, intraductal in five and stage I infiltrating ductal in three. Mammograms showed calcifications in all cancers detected; two infiltrating cancers also had an associated mass. The number of breast cancers detected was 1.6 per 1000 screenings, comparable to our rate of 1.4 cancers per 1000 screenings in women 40-49 years old. Because the number of cancers detected was small, the 95% confidence interval for the ratio of detection rates was wide, ranging from 2.56:1 to 1:2.29. CONCLUSION: Early stage tumors in women 35-39 years old can be detected on mammograms. The breast cancer detection rate in women 35-39 years old was comparable to that for women in their forties in our population; however, our data do not exclude a more than twofold difference in detection rates between these two groups. These data should be considered in determining the value of mammographic screening in women 35-39 years old.

Adult↗

PubMed1993

Use of digital mammography in needle localization procedures.

OBJECTIVE: With digital technology, images can be displayed rapidly and manipulated. This study was undertaken to assess the duration and accuracy of needle localizations performed with digital vs film-screen technology. These two technologies also were compared with respect to radiation doses and ability to image a standard phantom. SUBJECTS AND METHODS: A prototype digital mammographic system with both a 512 x 512 matrix and a 1024 x 1024 matrix was evaluated by using the American College of Radiology mammography accreditation phantom, and these results were compared with testing done on commercially available, dedicated, analog mammography equipment. Duration, accuracy of needle placement, and number of exposures needed to perform localization were recorded for 157 consecutive needle localizations done with digital technology, and these results were compared with data collected from 103 needle localizations done with film-screen technology. Another 33 localizations attempted with digital imaging were aborted because of technical factors. Average glandular doses were calculated for those women who had a compressed breast thickness of 4-5 cm. RESULTS: The time to complete needle localization was reduced by almost 50%, from 20 to 11 min, when digital technology was used. Because of the small (5 x 5 cm) field of view of the digital system, an additional mammogram obtained at the onset of the procedure was found to be helpful in localization, but otherwise the number of images was the same regardless of imaging receptor. Mean glandular dose was reduced by about 50% with digital imaging from 0.219 to 0.120 cGy. In those 17% (33/190) of needle localizations that could not be completed with digital imaging, failure was due to a variety of factors. Despite improved detectability of fibrils, specks, and masses on digital images, digital systems did not show some fine calcifications or soft-tissue masses during needle localizations. Difficulty in imaging lesions near the chest wall or in the axilla and the small field of view also caused procedures attempted with digital imaging to be aborted and completed with film-screen systems. CONCLUSION: The time to complete needle localization was reduced by 50%, with a similar reduction in patients' radiation dose, when digital mammography was used. These findings should be applicable to stereotaxic procedures done with digital mammography. Factors limiting the use of digital mammography equipment included inability to image some fine calcifications and some masses, difficulty in imaging near the chest wall and in the axilla, and a small field of view.

Breast Neoplasms↗

PubMed1992

Angiosarcoma of the breast.

Review of medical records revealed 29 women with biopsy-proved mammary angiosarcoma evaluated at the authors' institution from 1966 to 1991. The women ranged in age from 20 to 70 years (mean, 42 years). All presented with a palpable mass. Five of 29 (17%) had overlying bluish skin discoloration. Mammographic findings, available in 21 cases, included solitary uncalcified mass in 11 (52%) patients, mass with calcifications in two (10%), mass with associated skin thickening in one (5%), and no findings in seven (33%). Ultrasound, performed in five cases, revealed a solitary solid mass in three patients, multiple solid masses in one, and no findings in one. In the only case in which it was performed, magnetic resonance imaging revealed a mass with low signal intensity on T1-weighted images but higher signal intensity on T2-weighted images. Patients with higher-grade lesions at pathologic evaluation were significantly (P less than .05) more likely to have abnormal mammograms and to develop recurrent disease.

Adult↗

PubMed1992

Mobile mammographic screening of self-referred women: results of 22,540 screenings.

In this mass screening mammography program, self-referred women are accepted for screening only if part of a sponsoring organization. Screening is performed with mobile equipment, often at the work site. Of the first 22,540 screenings, 61% (n = 13,784) were of women aged 35-49 years. Eighty-nine percent (n = 20,025) of the screenings were normal. Of 51 women in whom cancer was found, 38 (75%) were recommended for biopsy on the basis of their initial two-view mammogram. The prevalence of breast cancer generally increased with advancing age but was similar between women aged 35-39 years and those aged 40-49 years. Of the 28 women with complete histologic studies, 43% (n = 12) had pure intraductal cancer and another 43% had negative findings at axillary node dissection. Program costs dictated a $65 fee. Within the design of this program it has been possible to screen large numbers of self-referred women and detect early carcinomas. Program design, however, may make screening more expensive than in a fixed screening site accepting only physician-referred women.

Adult↗

PubMed1977

Chemotherapy of an experimental glioma with nitrosoureas.

Chemotherapy experiments were performed with 2 nitro-sourea drugs in an experimental mouse brain tumor model. Cell suspensions of a transplantable mouse ependymoblastoma were injected i.c. by means of a stereotactic frame. The drugs used were 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea and 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea and 1-(2-chloroethyl)-3-(trans-4-methylcyclohexyl)-1-nitrosourea and were given by either i.p. or by direct intraneoplastic (i.n.) injection on the fifth day after tumor cell implantation. Injections i.n. of drugs were made with the stereotactic frame. Both drugs were highly effective in increasing the median day of death and in yielding large numbers of long-term survivors. Effectiveness was evident after i.p. or i.n. injection. However, with certain dosage schedules such as every 2 hr for 5 injections daily on 2 consecutive days, i.n. injection was more effective and less toxic than i.p. injection. The reason why repeated i.n. injections produced less toxicity than repeated i.p. injections is not definitely known but may be due to local metabolism of the drugs in the tumors and surrounding brain to a less toxic form. This is the first laboratory report of direct i.n. injection of the nitrosoureas, and the authors consider these results encouraging.

Animals↗

PubMedDate not supplied

Effectiveness of prostaglandin E1 in relieving obstruction in coarctation of the aorta without opening the ductus arteriosus.

The two main theories regarding the pathogenesis of coarctation of the aorta are the Skodaic hypothesis of ductal tissue constricting the aorta at the level of the insertion of the ductus arteriosus and the flow theory of decreased ascending aortic blood flow in the fetus, which results in associated isthmic narrowing and a localized shelf. To document that ectopic ductal tissue constriction can cause coarctation of the aorta in the absence of a patent ductus arteriosus, we report three cases of infants presenting with critical coarctation who responded to prostaglandin E1 infusion without opening the ductus arteriosus.

Alprostadil↗