Biomedical subjects

S H Heywang-Köbrunner

Publications and source records attributed to S H Heywang-Köbrunner.

At least 19 recordsLinked to original sources

PubMed2006

[Experiences of the Bavarian mammography screening program].

The Bavarian Mammography Screening Program started in April 2003. A detailed analysis of the consistency of diagnosis in the evaluation of vacuum-assisted stereotactic or core needle breast biopsies is presented. A total of 32 pathologists participated in a blinded evaluation of the biopsies. Each case was evaluated independently by two participating pathologists. A total of 1,357 cases were reviewed. The histopathological reports of the biopsies made by the two consulting pathologists were compared. The concordance rate of the first and second consulting pathologist was 93% for the B-classification. In general, the level of diagnostic agreement was very high for well defined, benign and malignant lesions. Some of the discrepancies resulted from the incorrect application of the B-classification. Discrepancies in the reports were also due to divergent interpretation of benign and "borderline" lesions. The protocol for the blinded evaluation of breast biopsies in two rounds assured a high level of quality. In conclusion, prerequisites for the success of a mammography screening program are interdisciplinary consensus conferences and audit rounds involving pathologists.

Biopsy, Needle↗

PubMed2005

MR-guided intervention in women with a family history of breast cancer.

OBJECTIVE: A study was undertaken to assess the clinical value of magnetic resonance (MR) imaging-guided interventions in women with a family history, but no personal history of breast cancer. METHODS AND PATIENTS: Retrospective review was performed on 63 consecutive women who had a family history, but no personal history of breast cancer. A total of 97 lesions were referred for an MR-guided intervention. Standardized MR examinations (1.0 T, T1-weighted 3D FLASH, 0.15 mmolGd-DTPA/kg body weight, prone position) were performed using a dedicated system which allows vacuum assisted breast biopsy or wire localization. RESULTS: Histologic findings in 87 procedures revealed 9 (10%) invasive carcinomas, 12 (14%) ductal carcinomas in situ, 2 atypical ductal hyperplasias (2.5%) and 2 atypical lobular hyperplasias (2.5%). Sixty-two (71%) benign histologic results are verified by an MR-guided intervention, retrospective correlation of imaging and histology and by subsequent follow-up. In ten lesions the indication dropped since the enhancing lesion was no longer visible. Absent enhancement was confirmed by short-term re-imaging of the noncompressed breast and by follow-up. CONCLUSION: Malignancy was found in 24%, high-risk lesions in 5% of successfully performed MR-guided biopsy procedures. A 57% of MR-detected malignancies were ductal carcinoma in situ. In 10% of the lesions the intervention was not performed, since no enhancing lesion could be reproduced at the date of anticipated intervention. Such problems may be avoided if the initial MRI is performed in the appropriate phase of the menstrual cycle and without hormonal replacement therapy.

Adult↗

PubMed2005

[Clip marker placement following MR-guided vacuum biopsy of the breast].

PURPOSE: The purpose of our study was to determine the placement accuracy, usefulness as a guide for wire localization, and long-term stability of tissue marker clips following MR-guided vacuum-assisted biopsy (VB) of breast lesions. METHODS: During a 2-year period, MR-guided VB with an 11-gauge device was performed in 79 lesions. In 26 lesions a marker clip was placed at the biopsy site. RESULTS: In 18 cases, the clip was shown to be closely adjacent to the lesion on post-interventional MR images. In seven cases in which minor bleeding occurred, the clip dislocated (< or =15 mm) in the direction of the needle pathway. In one case dislocation in the dorsal direction (< or =5 mm) was observed. In eight cases with a malignant or borderline histology according to the VB, the marker clips served as targets for mammographically guided wire localization. In all of those patients, histology results derived from open surgery confirmed those of VB. Eighteen patients with benign findings according to the VB were followed up 6 months later. Among these cases we found a significant displacement of the marker clip in one case (3 cm). The clip generally caused a round artifact (diameter of 9+/-2 mm). In two cases it was not possible to determine whether the lesion had been removed completely or was just behind the artifact caused by the clip. CONCLUSION: Based on our results, clip marker placement following MR-guided vacuum biopsy should be called into question due to the possibility of masking the lesion by a metallic artifact and because of possible dislocation.

Adult↗

PubMed2003

Success of sentinel lymph node mapping after breast cancer ablation with focused microwave phased array thermotherapy.

BACKGROUND: Breast cancer tumor ablation as part of a multimodality approach in the treatment of breast cancer is the subject of recent interest. This study was conducted to determine if the ability to perform sentinel node biopsy was impaired after thermal-induced ablation of breast cancer. METHODS: We studied patients who had sentinel node biopsy after preoperative focused microwave phased array for breast cancer ablation. RESULTS: Twenty-one patients with T1-T2 breast cancer and clinically negative axilla underwent wide local excision and sentinel node biopsy guided by blue dye and sulfur colloid. Surgery was done an average of 17 days after microwave ablation. Fifteen of 22 patients (68%) had histologic evidence of tumor necrosis. Sentinel lymph node mapping was successful in 19 of 21 patients (91%). Axillary metastases were detected in 42% of cases. CONCLUSIONS: This study documents successful sentinel lymph node mapping for patients treated with antecedent local tumor ablation using focused microwave phased array ablation.

Axilla↗

PubMed2003

Interdisciplinary consensus on the use and technique of vacuum-assisted stereotactic breast biopsy.

PURPOSE: Quality assurance of stereotactic vacuum-assisted breast biopsy (VB). METHOD: A consensus was achieved based on the existing literature and the experience of VB users (Ethicon Endosurgery, Norderstedt). RESULTS: The imaging work-up must be completed according to existing standards before an indication for stereotactic VB is established. Indications include microcalcifications and small non-palpable masses; for the time being lesions very close to the skin and architectural distortions (radial scar) are considered less suitable. Acquisition of >20 cores (11 Gauge) should be routinely attempted (goals: as complete a removal of small lesions as possible, thereby increasing diagnostic confidence and reducing so-called 'underestimates'). The pre/post-fire and post-biopsy stereotactic images and a post-biopsy orthogonal mammogram must be documented. All cases with no or uncertain histopathological correlation require discussion in a regular interdisciplinary conference and a documented consensus concerning further work-up or therapy. Standardised documentation of the primary findings and follow-up mammography after approximately 6 months is requested. CONCLUSION: This consensus includes protocols for the establishment of an indication, performance indicators, interdisciplinary interpretation and therapeutic recommendation, documentation and follow-up. It does not replace official recommendations for percutaneous biopsy.

Biopsy, Needle↗

PubMed2002

Follow-up of breast lesions detected by MRI not biopsied due to absent enhancement of contrast medium.

Our objective was to follow-up patients in whom scheduled MR-guided vacuum biopsies for suspicious lesions were aborted due to absent enhancement of contrast medium. Thirty-seven of 291 scheduled MR-guided vacuum biopsies were aborted. Six cases were lost to follow-up. Two could be unequivocally identified and were nevertheless biopsied. In 25 of 29 patients absent enhancement was confirmed on subsequent studies without compression. Varying hormonal or inflammatory changes between initial MRI and MR-guided vacuum biopsy most probably explain the findings. Enhancement re-appeared on short-term follow-up <6 months without compression in 4 of the 29 patients. Too strong compression during MR-guided vacuum biopsy explains the absence of enhancement in these patients. Of note, on histology, three of these cases proved malignant. We conclude that short-term follow-up without compression is necessary and recommended for all lesions not visible during scheduled MR-guided vacuum biopsy.

Artifacts↗

PubMed2002

Multicenter study for the evaluation of a dedicated biopsy device for MR-guided vacuum biopsy of the breast.

The purpose of this multicenter study was to determine the accuracy and clinical value of a dedicated breast biopsy system which allows for MR-guided vacuum biopsy (VB) of contrast-enhancing lesions. In five European centers, MR-guided 11-gauge VB was performed on 341 lesions. In 7 cases VB was unsuccessful. This was immediately realized on postinterventional images or direct follow-up combined with histopathology-imaging correlation; thus, a false-negative diagnosis was avoided. Histology of 334 successful biopsies yielded 84 (25%) malignancies, 17 (5%) atypical ductal hyperplasias, and 233 (70%) benign entities. Verification of malignant or borderline lesions included reexcision of the biopsy cavity. Benign histologic biopsy results were verified by retrospective correlation with the pre- and postinterventional MRI and by subsequent follow-up. Our results indicate that MR-guided VB, in combination with the dedicated biopsy coil, offers the possibility to accurately diagnose even very small lesions that can only be visualized or localized by MRI.

Biopsy↗

PubMed2002

European quadricentric evaluation of a breast MR biopsy and localization device: technical improvements based on phase-I evaluation.

Our purpose was to report about technical success, problems and solutions, as experienced in a first multicentre study on MR-guided localisation or vacuum biopsy of breast lesions. The study was carried out at four European sites using a dedicated prototype breast biopsy device. Experiences with 49 scheduled localisation procedures and 188 vacuum biopsies are reported. Apart from 35 dropped indications, one localisation procedure and 9 vacuum biopsies were not possible (3 times space problems due to obesity, 2 times too strong compression, 3 times impaired access from medially, 2 times impaired access due to a metal bar). Problems due to too strong compression were recognised by repeat MR without compression. During the procedure problems leading to an uncertain result occurred in eight vacuum biopsies, two related to the procedure: one limited access, and one strong post-biopsy enhancement. Improvements after phase-I study concerned removal of the metal bar, development of an improved medial access, of a profile imitating the biopsy gun, optimisation of compression plates and improved software support. The partners agreed that the improvements answered all important technical problems.

Biopsy, Needle↗

PubMed2002

MR-guided interventional breast procedures considering vacuum biopsy in particular.

Histologic work-up of just MR-detected breast lesions has become essential with increasing use of contrast-enhanced MR imaging. In the present article an overview is given about the different MR-guided breast interventions, performed since 1990. Presently, for reasons of costs and image quality closed magnets are most widely used. The following approaches have been described: MR-guided freehand localization in supine position, stereotaxic localization in supine position and most frequently used localization in the prone position by means of a compression device that immobilises the breast to prevent tissue shift during intervention. Only limited experience exists with interventions on open magnets. MR-guided wire localization is a well-established procedure. Recently, percutaneous vacuum biopsy of enhancing breast lesions has become possible under MR guidance. The new system allows accurate and safe access to lesions in any location of the breast and direct check-up of representative excision by visualisation of the cavity. Thus reliable histologic evaluation of lesions smaller than 10 mm is possible with this approach.

Biopsy, Needle↗

PubMed2002

MR-Guided vacuum biopsy of 206 contrast-enhancing breast lesions.

PURPOSE: To determine the accuracy and clinical use of MR-guided vacuum biopsy (VB) of enhancing breast lesions. MATERIAL AND METHODS: 254 lesions were referred to MR-guided vacuum-assisted breast biopsy. In 43 (16 %) patients the indication was dropped because the lesions could not be identified at the time VB was scheduled. This was due to hormonal influences (n = 37), to too strong compression (n = 3) or to misinterpretation of the initial diagnostic MRI (n = 3). In 5 cases (2 %) VB was not performed due to obesity (n = 2); problems of access (n = 2) or a defect of the MR-unit (n = 1). VB was performed on altogether 206 lesions. In 4 cases (2 %) VB was unsuccessful. This was immediately realized on the post-interventional images. Thus a false negative diagnosis was avoided. Verification included excision of the cavity in cases with proven malignancy or atypical ductal hyperplasia (ADH) and (for benign lesions) retrospective correlation of VB-histology with pre-and postinterventional MRI and subsequent follow-up. RESULTS: 51/202 successful biopsies proved malignancy. In 7 cases ADH and in 144 cases a benign lesion was diagnosed. One DCIS was underestimated as ADH. All other benign or malignant diagnoses proved to be correct. CONCLUSION: MR-guided VB allows reliable histological work-up of contrast-enhancing small lesions which are not visible by any other modality.

Adult↗

PubMed2002

[Do tissue marker clips after sonographically or stereotactically guided breast biopsy improve follow-up of small breast lesions and localisation of breast cancer after chemotherapy?].

PURPOSE: We wanted to determine if tissue marker clips after sonographically or stereotactically guided breast biopsy improve the follow-up of small breast lesions classified BI-RADS 4/5 and the localisation of breast cancer (TNM stage 2 or 3) after neoadjuvant chemotherapy. MATERIAL AND METHODS: Prospective analysis was performed of 108 breast lesions 1 cm or smaller mammographically classified as BI-RADS 4/5 and 14 breast lesions larger than 2 cm mammographically classified as BI-RADS 5. 33 of the 108 breast lesions 1 cm or smaller underwent sonographic core cut breast biopsy (group 1) and 75 stereotactic vacuum-assisted breast biopsy (group 2). All 14 lesions greater than 2 cm were stereotactically vacuum-assisted breast biopsied (group 3). The centre of the lesion was marked by a clip after the biopsy. Mammographies were performed in all patients of group 1 and 2 with a histologically benign finding (n = 31, n = 69, respectively) and in all patients of group 3 directly after clip placement and after 6 and 12 months. Clip localisation and possible divergence from the original position were verified by a grid. RESULTS: Two patients of group 1 and 6 patients of group 2 had breast conservative surgery (BET) because of the histological diagnosis of a ductal carcinoma in situ or invasive breast cancer. The tissue marker clips of the remaining 31 patients of group 1 and 69 patients of group 2 diverged with a mean value of 0.4 cm (standard deviation +/- 0.23 cm; range 0.1 cm to 0.9 cm) from their placement position after 6 months. After 12 months the marker clips deviated with a mean value of 0.4 cm (standard deviation +/- 0.21 cm; range 0.1 cm to 0.9 cm) in 94 patients and 0.8 cm (standard deviation +/- 0.25 cm; range 0.1 cm to 0.9 cm) in 6 patients from their original location. No tumour progression of the benign lesions in group 1 and 2 was diagnosed in follow-up mammograms. In all patients of group 3 the tissue marker clips were the only possibility to localize the tumour after neoadjuvant chemotherapy as all other diagnostic methods showed inconsistent results. CONCLUSION: Positioning a tissue marker clip in the tumour centre seems to be reasonable after interventional biopsy of breast lesions of 1.0 cm or smaller and before neoadjuvant chemotherapy.

Antineoplastic Agents↗

PubMed2001

[Plans of the German Roentgen Society and the Professional Association for Quality Assurance in Mammography].

A high level of quality is an unequivocal prerequisite for obtaining the highest possible accuracy in symptomatic patients and for reproducing the results concerning mortality reduction, which were obtained in large screening trials. Present deficiencies in Germany are due to legal regulations, which have not been updated and which are thus below European standard. Furthermore the quality assurance program has not proven sufficiently effective for mammography. In order to promote mammographic quality assurance, the German Roentgen Society proposes an accreditation program. The accreditation, which concerns A.) mammographic technique and positioning and B.) mammographic reporting is not obligatory, but will allow acquisition of special official certificates, which may support the patients to find doctors who perform and read mammograms with high quality and expertise. The accreditation shall be performed by personnel and/or institutions who are specifically trained surveyed.

Accreditation↗

PubMed2001

[New knowledge regarding tumor cell inactivation and histological evaluation after radiofrequency therapy. Single case observation and in vitro proof of a new hypothesis].

In a study, a radiofrequency (RF) treatment was performed on a patient with a small breast cancer after vacuum biopsy. As usual in cases with a malignant diagnosis, surgical excision and axillary dissection followed. Histopathology revealed some residual tumor in the margin of the cavity. It could not be distinguished from vital tumor on the hematotoxylin eosin (HE) stain. Based on the correlation of MRI and histopathology after subsequent surgical excision, we did, however, presume that the residual was contained within the zone of inactivation. Thus the hypothesis arose that, if too high temperatures can be avoided, it might be possible to inactivate tumor cells without significantly impairing histopathologic assessment. This hypothesis was supported by the following in vitro experiment performed on a fresh specimen: An RF treatment was performed using temperatures up to 70 degrees C only. Half of the specimen underwent HE-staining, the other half vitality testing. The results indicate that if a given temperature range is strictly observed it appears possible to inactivate tissue before tissue sampling, since histopathologic diagnosis will not be impaired. Further technologic improvements may eventually allow to develop a pre-treatment method which might permit to avoid potential hematogenous tumor spread during subsequent biopsy.

Biopsy↗

PubMed2001

[Spectral transillumination of the female breast].

PURPOSE: Evaluation of wavelength-associated characteristics by transilluminating normal and pathological breast tissue. METHOD: 80 in vivo and 52 in vitro measurements were carried out with a Mammaspectrograph (Siemens AG, ZFE München). 31 patients had a carcinoma and 59 patients a benign breast lesion. Measurements were performed with an increment of 10 nm, wavelengths between 550-1100 nm. RESULTS: Normal and pathological breast tissue could be characterised in the area of absorption maxima of fat, water and haemoglobin. Atrophic breast tissue has a remarkable transmission minimum at 930 nm. Tumors with a high number of cells and neovascularisation showed a strong absorption over the entire "diagnostic window" and a transmission minimum at 970 nm. Below 700 nm the high concentration of haemoglobin resulted in an increase of transmission. Less wavelength-associated characteristics were seen in tumors with mastopatically-transformed surrounding tissue. CONCLUSION: To differentiate breast tissue, transillumination has to be performed in the area of absorption maxima of fat, water and haemoglobin.

Adenocarcinoma, Mucinous↗

PubMed2001

CT-guided obturator nerve block for diagnosis and treatment of painful conditions of the hip.

Obturator nerve blocks (ONB) have been performed by anaesthesiologists mainly to eliminate the obturator reflex during transurethral resections. An effect on hip pain has also been described. However, being a time-consuming and operator-dependent procedure if performed manually, it has not been widely used for chronic hip pain. The purpose of this pilot study was to check whether CT guidance could improve reproducibility of the block (= immediate effect) and to test its potential value for treatment of chronic hip pain. Fifteen chronically ill patients with osteoarthritis underwent a single ONB. Sixteen millilitres of Lidocaine 1% mixed with 2 ml Iopramide was injected into the obturator canal. The patients were followed up to 9 months after the intervention. With a single injection pain relief was achieved for 1-8 weeks in 7 of 15 patients. Excellent pain relief for 3-11 months was achieved in another 4 patients. Reasons for a mid-term or even long-term effect based on a single injection of local anaesthetic are not exactly known. The CT-guided ONB is a fast, easy and safe procedure that may be useful for mid-term (weeks) and sometimes even long-term (months) treatment of hip pain.

Arthroplasty, Replacement, Hip↗

PubMed2001

International investigation of breast MRI: results of a multicentre study (11 sites) concerning diagnostic parameters for contrast-enhanced MRI based on 519 histopathologically correlated lesions.

A multicentre study was undertaken to provide fundamentals for improved standardization and optimized interpretation guidelines of dynamic contrast-enhanced MRI. Only patients scheduled for biopsy of a clinical or imaging abnormality were included. They underwent standardized dynamic MRI on Siemens 1.0 (163 valid lesions > or = 5 mm) or 1.5 T (395 valid lesions > or = 5 mm) using 3D fast low-angle shot (FLASH; 87 s) before and five times after standardized bolus of 0.2 mmol Gd-DTPA/kg. One-Tesla and 1.5 T data were analysed separately using a discriminant analysis. Only histologically correlated lesions entered the statistical evaluation. Histopathology and imaging were correlated in retrospect and in open. The best results were achieved by combining up to five wash-in or wash-out parameters. Different weighting of false-negative vs false-positive calls allowed formulation of a statistically based interpretation scheme yielding optimized rules for the highest possible sensitivity (specificity 30%), for moderate (50%) or high (64-71%) specificity. The sensitivities obtained at the above specificity levels were better at 1.0 T (98, 97, or 96%) than at 1.5 T (96, 93, 86%). Using a widely available standardized MR technique definition of statistically founded interpretation rules is possible. Choice of an optimum interpretation rule may vary with the clinical question. Prospective testing remains necessary. Differences of 1.0 and 1.5 T are not statistically significant but may be due to pulse sequences.

Adult↗

PubMed2001

Stereotactic breast biopsies: analysis of needle deviation based on stereotactic views.

Stereotaxy is widely used for breast biopsy and needle localization of mammographically detected lesions. If a lesion shift occurs during stereotaxy, corrections (even though possible with vacuum biopsy) is difficult due to the difficult assessment of the exact 3D shift. In this study we investigated the correlation between lesion shift (in up to three dimensions) and its visualisation on the stereotactic images (0 degree, -15 degrees, +15 degrees). The study was performed on a Fischer prone table (Fischer Imaging Europe, Vejle, Denmark) using a 3.8-mm steel ball (as lesion) and a 20-G needle. The 17 major malpositions of the ball with respect to the needle were imitated and imaged. A simple rule is suggested as to how the deviation in all three dimensions can be detected from the scout and the two stereotactic views. The rule proved to be a valuable tool to correctly assess lesion shifts.

Biopsy, Needle↗

PubMed2000

In situ and minimally invasive breast cancer: morphologic and kinetic features on contrast-enhanced MR imaging.

PURPOSE: This retrospective study was undertaken to investigate the morphologic and dynamic features of in situ and minimally invasive breast cancer on contrast-enhanced (c.-e.) MR imaging and to examine possible associations to pathology features. MATERIAL AND METHODS: A total of 71 patients underwent MR imaging. T1-weighted FLASH-3D images were obtained before and after intravenous administration of Gd-DTPA. Histopathologic analysis of 78 lesions revealed ductal carcinoma in situ (DCIS) n = 50 and DCIS with microinvasion n = 28. MR features were correlated with histopathologic findings. RESULTS: Enhancement in DCIS was focal (73%), diffuse (10%) or ductal (17%). No enhancement occurred in two cases (4%). In 65% enhancement speed was classified as delayed. There was a tendency toward a more ill-defined (83 vs. 43%) enhancement pattern in high grade DCIS and a more ductal (29 vs. 12%) and faster (50 vs. 29%) enhancement in comedo type DCIS. However, significant differences in the enhancement behaviour could neither be demonstrated between high grade and non high grade DCIS nor between comedo and non comedo type DCIS. No significant differences were noted between pure and microinvasive DCIS. CONCLUSION: In this retrospective analysis the majority (96%) of DCIS lesions show contrast enhancement. However, in only about 50% of DCIS the criteria of a so-called 'typical' enhancement behaviour was fulfilled, that means strong, early, focal ill-circumscribed or ductal. Enhancement that follows a duct is often associated with malignancy, however this feature was only present in 17% of the cases. c.-e. MR imaging allowed the detection of 25 additional foci of DCIS. Therefore malignant in situ lesions can be present with atypical enhancement, and should be taken into consideration in high-risk patients in particular.

Adult↗