positive predictive value for malignancy on surgical excision of breast lesions of uncertain malignant potential b3 diagnosed by stereotactic vacuum assisted needle core biopsy vancb a large multi institutional study in italy

Abstract Percutaneous core biopsy (CB) has been introduced to increase the ability of accurately diagnosing breast malignancies without the need of resorting to surgery. Compared to conventional automated 14 gauge needle core biopsy (NCB), vacuum-assisted needle core biopsy (VANCB) allows obtaining larger specimens and has recognized advantages particularly when the radiological pattern is represented by microcalcifications. Regardless of technical improvements, a small percentage of percutaneous CBs performed to detect breast lesions are still classified, according to European and UK guidelines, in the borderline B3 category, including a group of heterogeneous lesions with uncertain malignant potential. We aimed to assess the prevalence and positive predictive values (PPV) on surgical excision (SE) of B3 category (overall and by sub-categories) in a large series of non-palpable breast lesions assessed through VANCB, also comparison with published data on CB. Overall, 26,165 consecutive stereotactic VANCB were identified in 22 Italian centres: 3107 (11.9%) were classified as B3, of which 1644 (54.2%) proceeded to SE to establish a definitive histological diagnosis of breast pathology. Due to a high proportion of microcalcifications as main radiological pattern, the overall PPV was 21.2% (range 10.6%–27.3% for different B3 subtypes), somewhat lower than the average value (24.5%) from published studies (range 9.9%–35.1%). Our study, to date the largest series of B3 with definitive histological assessment on SE, suggests that B3 lesions should be referred for SE even if VANCB is more accurate than NCB in the diagnostic process of non-palpable, sonographically invisible breast lesions

Alpha-Particle Monitoring Systems Based on a BJT Detector on High-Resistivity Silicon

A battery-powered, wireless alpha-ray sensor has been designed and realized using a high-resistivity-silicon BJT as radiation detector. Thanks to its excellent signal-to-noise ratio and intrinsic amplification, real-time alpha particle detection is possible using simple readout electronics which records alpha particle arrival time and charge spectrum

A simple method to save on costs in pulmonary emphysema operations

The hazard of prolonged air leaks causing protracted postoperative hospital stay increases the already high costs of lung volume reduction operations for severe emphysema. To solve the problem, Cooper [1] proposed to reinforce the staple line with bovine pericardial strips. Subsequently, an inert material, such as expanded polytetrafluoroethylene (Gore-Tex; WL Gore & Associates, Inc, Flagstaff, AZ), was introduced, displaying the same advantages of bovine pericardium but apparently of more practical use [2]. Lung volume reduction operations can be performed either through sternotomy or videothoracoscopy. The use of videothoracoscopy is increasing as the reduced trauma seems particularly desirable in such compromised patients, although automatic staplers further increase costs. Each unilateral lung volume reduction procedure usually requires 8 to 12 loading units, and the number of cartridges doubles with bilateral procedures. Also because of our experience with more than 1,700 thoracoscopic procedures, we opted for videothoracoscopy within our department. It was immediately apparent that polytetrafluoroethylene sleeves specifically designed for automatic endoscopic staplers further increased the expenses, as each loading unit of polytetrafluoroethylene reinforcing sleeves costs about 66 US. Considering the number of reinforcing strips required (8 to 12 for unilateral lung volume reduction operation, 16 to 24 for bilateral lung volume reduction operation) the expense is relevant. Following the instructions of the manufacturer, the polytetrafluoroethylene sleeve (SEAMGUARD Staple Line Reinforcement Material; W.L.Gore & Associates) is positioned on a 45-mm Endopath stapler (Ethicon Endosurgery Inc, Cincinnati, OH), and after firing, the exceeding part of the sleeve is grasped distally to the jaws, removed and discarded. We developed our own technique to reuse these parts of the sleeve to reinforce three more staple lines. The two remaining parts of Seamguard are sectioned with straight scissors along the folding lines of the residual sheets of Gore-Tex, thus producing three wide and three narrowe strips (Fig 1). One of the larger strips is now laid on the cutting surface of the stapler\u2019s cartridge jaw and tied to it with two Vicryl 4-0 precut threads (Ethicon) (Fig 2). The narrower strip is fixed to the stapler\u2019s anvil in the same way. It is important to check that the two knotted threads are positioned within the limits of the cut line and the knots are kept externally with long edges. The Gore-Tex sheet exceeding the cutting zone of the stapler must be sectioned (see dotted line in Fig 2) to prevent the polytetrafluoroethylene lamina flaps from folding back while the stapler is applied onto the parenchyma. Sometimes the distal thread is pushed forward by the stapler blade without being sectioned. Grasping one of the two longer edges of the thread and sectioning it with endoscopic scissors overcomes the problem (Fig 3). The same steps are repeated until the entire parenchyma line is stapled, reusing every part of each new Seamguard sleeveOur hospital pays 66 for each set of Seamguard. At an average of 8 to 12 (for unilateral operation) and 16 to 24 units (for bilateral operations) is required, the expense can reach $528 to$792 or $1,056 to$1,584, respectively. With our technique the cost for reinforcing the staple lines is reduced to one fourth (ie, $132 to$198 [for unilateral procedures] to $264 to$396 [for bilateral procedures]). Because the cost of the stapler and its reloading units cannot be reduced, the marked reduction of expenses for reinforcing the staple line with Seamguard allows us to cope with the economic aspect of this operation. The slightly longer time required for fashioning and tying the stripes is overcome by its economic advantage; furthermore, the cutting and tying time decreases progressively as experience increases

Numerical Simulation of Efficiency-Droop Mechanisms in InGaN/GaN Blue Light-Emitting Diodes

We will report on a systematic analysis of above aspects carried out by means of numerical device simulations. The aims of this analysis are (i) to improve understanding of droop mechanisms, (ii) to provide guidelines for LED optimization. Specific results will address 1) the suitability of pure droop mechanisms and/or the combination of 2 or more mechanisms to explain the droop, 2) the effects of above technological changes on IQE vs current curve

Technique of thoracoscopic retrieval of the lung

Extraction of a resected specimen after a thoracic minimally invasive operation presents different problems depending on the amount of parenchyma removed. After a major pulmonary resection (lobectomy or pneumonectomy), the size of the specimen always requires a minimal thoracotomy incision of at least 5-6 cm. In the case of neoplasms it is mandatory to adopt precautions in order to protect the wound edges from possible tumoral seeding during the extraction. The authors, based on their personal experience of 545 video-thoracoscopic procedures, discuss the problems of retrieving the specimens after video-endoscopic resections and describe techniques and precautions which must be taken to extract the resected tissue safely

Major vascular injuries in laparoscopic surgery

Background: Major vascular injuries (MVI) still occur in laparoscopic surgery. Methods: We report our institution's experience of two MVI (aortic lesions) in a series of 3545 laparoscopies (July 1991\u2013December 2000). We compared this experience with other series reporting MVI from Medline, Embase, Current Contents, and Best Evidence. Results: There were no deaths, but we had 23 postoperative and eight intraoperative bleedings, including two hepatic vessel lesions during dissection and six vascular lesions (four minor vessels and two aortic) related to trocar insertion. Prevention and treatment options are also discussed. Conclusions: The incidence of MVI reported in the literature is 0.05%, but the true incidence is difficult to estimate because results are not always comparable and there is a possibility of underreporting. The mortality rates (8\u201317%) are high. No technique or instrumentation is completely safe; therefore, a high level of alertness must be maintained at all times and precautions must be adopted to avoid major complications

Infiltrating Epitheliosis of the Breast: Fine Needle Aspiration Cytology

Epitheliosis (or usual duct hyperplasia) is a proliferation of epithelial and myoepithelial cells located within enlarged acini and small ducts, which is characterized by irregular and peripheral fenestration. Infiltrating epitheliosis (IE) is a specific lesion, characterized by classical epitheliosis flowing out into the adjacent stroma. The stroma is desmoplastic and shows keloid appearance with irregular elastosis. IE can mimic malignancy both on radiological and histological grounds. The aim of the present study is to describe the fine needle aspiration cytological features of 6 consecutive cases of IE, with histological correlation. IE cases presenting as screen detected lesions and preoperatively diagnosed on fine needle aspiration cytology (FNAC) were reviewed. All patients had radiologically breast lesions suspicious for malignancy that underwent FNAC followed by surgical resection. The FNAC smears presented some features that could lead to a misdiagnosis of malignancy, such as bloody background, high cellularity, and stromal fragments containing epithelial cells. Nevertheless, malignancy was excluded, due to the absence of atypia and the presence of myoepithelial cells in the cell clusters. IE presents a special FNAC pattern that can be misinterpreted as malignancy. Therefore, knowledge is necessary to avoid patient overtreatment